HomeMy WebLinkAbout0357 AMES WAY - Health r
Ames Way
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UPC 12534
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No. GOO �/0 U Fee /00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zlppltratton for Mtgogal 6p6temc Cottgtructton Vermtt
Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No.39-6 uJ,¢lsl Owner's Name,Address,and Tel.No. 411
Assessor's Map/Parcel
Installe 's Name,Address,and Tel.No. WVWOM
mo A9esi ner' ame, ddress and 1.N�� / o,• B/ . egg_
Type of Building: _
Dwelling No.of Bedrooms Lot Size d�sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) _`?30 gpd Design flow provided �T l/ U O gpd
Plan Date Number of sheets Revision Date
Title _
Size of Septic Tank Type of S.A.S. S S e P S 11�.1 6
i.
Description of Soil
rrL e LA
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the'system in operation until a Certificate of
Compliance has been issued by this Board of U9q.11th.
Signed Date D
Application Approved by .S, Date !/ 6
Application Disapproved b A. Date
for the following reasons
Permit No. 2 0 0 q l d p Date Issued S y 0
4.
41
No. 2oa�1 J�0 8
Fee
t THE COMMONWEALTH OF MASSACHUSETTS Entered irrconiput I:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
f
01pplication for Disspogal 6p5tem Cowaruction Permit
Application for a Permit to Construct( ) Repair(,14upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No.3 J Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
/ d4
/ qfG
Installer's Name,Address,and Tel.No. o l '� —Desi ner's ame Address and
/�� �31� ,%`ego r's.N
i
D
Type of Building: _
a
Dwelling q g No.of Bedrooms Lot Size �d✓ s . ft. Garbage Grinder
( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) —gpd Design flow provided �7` // O D gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. /� &:Z �J�
Z
Description of Soil
•,4
LA
Nature of Repairs or Alterations(Answer when applicable)
1•'
Date last inspected: '
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of H alth. ,1
Signed /Y/ Date /
Application Approved by �.S, Date 111,r // 6
Application Disapproved b Date
for the following reasons
Permit No. 2 D O Gl — l b b Date Issued S �/ O
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( )
Abandoned( )by ����7 Z
at �j JT �¢G has been constructed in accordance
with the provisions of Title 5 and the tspoZal System Construction Permit No. -6 OR 05 dated S- q" O `�
Installer DesignerfL—
#bedrooms Approved design flow Q gpd
The issuance of this permit shall]not be construed as a guarantee that the system wi.1'function!as designedl
Date Inspector ./ G� �-✓ e�'TL �\
No. o ci Fee /0 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
Mgpogal *pgtem Con -truction Permit
Permission is hereby granted to Construct ) Re ai �U Upgrade Abandon
P ) Pg ) )
System located at
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Constructio must be completed within three years of the date of this p rmit.
Date S �/ 2 0D Approved by
I
Town of Barnstable
WE'°'�.� Regulatory Services
Thomas F. Geller, Director
• BABNBTABLL
NAS& 1e� Public Health Division
pTFa ''' Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 503-362-4644 Fax: 303-790-6304
Installer & Designer Certification Form
Date: J S0 Sewage Permit#"C Assessor's Map\Parcel f 10 O_a7
Designer: I '� "' Installer: ,
Address: �b BN_ -b b I :address: gz� AA1 11-11—A-G
f 0 2-53�-
On mil/ t � bl 1 j6Mvas issued a permit to install a
date (insW-Lo,
taller)
septic system at Amt� based on a design drawn by
(address)
dated DS
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box andior septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or anv vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by desiErner to follow.
.. ������• OF MAss9�ti .
o D R E M
c �
staller's Signature) N 1140
• RfGI EEO
1 SANI T00
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTA E 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.
I
Q: Health/Septic/Designer Certification Form 3-Z6-04:!doc
i
•
APPLICANT: �/` 1 r�,V� V"t P/✓
ADDRESS: 35� 1"me< Oow GPJT JI
DESIGN FLOW: 330 gpd
REVIEWED BY: TD, DATE: Ell/ql
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)] X
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]- if not, a variance is required [310 CMR 15.412(4)] x
Location of impervious surfaces (driveways,parking areas etc.)
[310 CMR 15.220(4)(d)] X
Location all buildings existing and proposed 310 CMR
15.220(4)(c)] n
Location and dimensions of system components and reserve areas
[310 CMR 15.220(4)(e)] X
System Calculations [310 CMR 15.220(4)(f)]
daily flow X
septic tank capacity (required andprovided) ly
soil absorption system (required andprovided) X,
whether system designed for garbage grindei A
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 X each test) [310 CMR 15.220(4)(h)]
Names of soil evaluator and BOH representative [310 CMR X
15.220(4)(h) and (i)]
Location and date of percolation tests (performed at proper
elevation?) [310 CMR 15.220(4)(i)] X
Percolation test results match loading rate? [310 CMR 15.242] ,
Certification statement by Soil Evaluator 310 CMR 15.220(4) A
Observed and Adjusted groundwater(method for adjustment
given or indicated) [310 CMR 15.103(3) and 310 CMR X
15.220(4)(n)]
[15.220(4)(k)]
cation of every water supply,public and private, [310 CMR
X
Address 359 l MgS ln/Gi ��l`�►'Vt 66� /U4
`� � Sheet ] of 7
within 400 feet of the proposed system location in the case
of surface water supplies and grgyel packed public water supply x
within 250 feet of the proposed system location in the case
within 150 feet of the proposed system location in the case X
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)] x
Water lines`and 6thef--Aibsurface utilities located [310 CMR
15.220(4)(m) (if water line cross see 310 CMR 15.211(1) 1 )
Profile of system showing invert elevations of all system
components and the bottom of the SAS [310 CMR15.220(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)] X
Test Holes adequate to confirm adequate groundwater separation?
1310 CMR 15.103(3)] )(
Benchmark within 50-75' of system [310 CMR 15.220(4)( )] ,X
Materials specifications noted? [various sections of 310 CMR
15.000] X
System components not> 36" deep(unless Local Upgrade
Approval or LUA.requested){310 CMR 15.405(l(b) x
Address 35 W (,PiLI ly V)4 Sheet 2 of 7
Size OK? '[310 CMR 15.223(1)] J('
Inlet tee located ten inches below flow line 310 CMR 15.227(6)] X
Outlet tee 14" or 14"+ 5" per foot for increase ft depth [310 CMR
15.227(6)] X
Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)]
Note regarding instatlation on stable compacted base [310 CMR
15.228(1)] X
Separation between inlet and outlet tees (no less than liquid
depth) 310 CMR 15.227(2) X
Inlet/Outlet elevations at least 12" above high groundwater
(except as described 310 CMR 15.227(5)) or permitted for
upgrades under LUA [310 CMR 15.405(1)(k)] X
Minimum cover 9" (Tanks buried more than 9" must have risers
on all openings and on the d-box) [3 10 CMR 15.2228(1) and 310 X
CMR 15.232(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 systems<1000gpd,
two fors stems>1000 gpd 310 CMR 15.228(2)
All at-grade covers secured to unauthorized access? [310 CMR
15.228(2)] X
> 10 ft from building foundation [310 CMR 15.211(1)] x
'Buoyancy calculation Required/Done 310 CMR 15.221(8)]
H-20 Where a ro riate? [310 CMR 15.226(3)]
Setbacks from resources [310 CMR 15.211
Required when other than single-family dwelling or flow>1000
d [310 CMR 15.223(l)(b)] x
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)]
Address 3%/7 Sheet 3 of 7
_ r
Located at least ten feet from any Vwater line? [310 CMR
15.222(2)] X
Disposal piping at least 18"below water line (when water and
sewer cross, see 310 CMR 15.211(1)[1])
Cleanouts required/provided ? [310 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)] x
Proper pitch on all runs? (.005 within gravity-distributed trencki
and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] }�
Siphon problem/(leachfield below um chamber)Endca s or vent manifolds ecified?
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 15.252(2)(h)]
Materials specified (310 CMR 15.251(5) specifies various pipe—
types allowed)
}
Stable compacted base [310 CMR 15.22](2) and 310 CMR
15.232(2)(a)] X
Splash plate or baffle tee required on inlet/provided?(when
pressure sewer 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)( ]
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 20" MUST BE
TO GRADE [310 CMR 15.231(5)]
Service components accessible (not too deep,with piping,
disconnects accessible)
Alarm floats - alarm on circuit separate from Pumps specified?
Exceeds two units must have two pumps operating
eratin in lead-lag
b
mode. [310 CMR 15.231(6) and (8)]
Stable Compacted Base [310 CMR 15.221(2)] M..
Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)]
Address J VV ��/-
l�'P.l� Ik Sheet 4 of 7
i
Calculations correct?
4 feet of naturally occurring material demonstrated?[310 CMR
15.240(1)]
.Required separation togroundwater? 310 CMR 15.212)_] )C
Aggregate specified as double washed [310 CMR 15.247(2)] X
System Venting required/provided? (system under driveway or
>36" deep) [310 CMR 15.241] X
Inspection ports specified and within 3"final grade? [310 CMR
15.240(13)] , x
Breakout requirements met?(No violation of breakout elevation
within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and x
Guidance Document]
Chambers and Gal. in trench configuration supplied with inlet
every 20 ft. [310 CMR 15.253(6)] Al
Each structure with one inspection manhole (if>2000 gpd must
be tograde) 310 CMR 15.253(2)] x
Aggregate I' m inimum-4' maximum. [310 CMR 15.253(1)(b)]
2' sidewall credit maximum [310 CMR 15.253(1)(a)] X
In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)]
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)]
Situated along contours [310 CMR 15.251(2)]
Breakout OK? [310 CMR 15.21](1)[4] and Guidance Document]
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)(g)]
Separation between-beds 10' minimum. [310 CMR 15.252(2)(f)]
Bottom area used in calculations only (310 CMR 15.252(2)(i)]
Address VV (0#4401� /144 Sheet 5 of 7
l
I
Pressure Dosed System ? Provided pump and piping
calculations as re uired,[310 CMR 15.220(4)(r)] X
Pressure dosing required on all systems>2000gpd or alternative
systems undef-.medial approval [310 CMR 15.254(2) and I/A x Remedial Use Approvals]
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)] x
Construction in fill - Did the plan specify that the fill shall meet
the specification of 310 CMR 15.255(3)? x
Impervious barrier and/or retainingwall ? [Guidance Document] x
Impervious barrier installation must be supervised by
designer [310 CMR 15.255(2)(b)]
Retaining wall must be designed by Registered Professional
Engineer [310 CMR 15.255(2)(a)] x
Side slope not exceed 3:1 ? r310 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)] X
�r:0 n�_t
k Check DEP Approval letters for credits and design conditions
If used with pressure dosing do not allow pressure discharge
to scour soil interface
Was DEP Approval Letter provided and/or have you
reviewed the letter for conditions? X
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 copy y 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 property line [310 CMR 15.412(4)]
New construction or increased flow proposed - [Refer to 310
CMR 15.414]
Address .�-y�� ��#W y>`/,Q
'�'''-`'S ��� ` .4A4 Sheet 6 of 7
Is the system in a Designated Nitrogen Sensitive Area(Zone II 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 C1bIR 15.290] ?(.
Address
J�� �S W7'u' Sheet 7 of 7
• I ��Sr
Town of Barnstable P# 1
Department of Regulatory Services
Date
erAB� Public-Health Division
use s$ 200 Main Stree4 Hyannis MA 02601
.
F
Date Scheduled J 'Time I'ee Pit.
,Foil Suitability Assessment for Sewage isposal
Performed By
/� Qi{�I�✓ Witnessed Dy: �"
i
LOCATION& GENERAL INFORMATION I
Lo-ation Address'. 357 A rules wk Owner'sNamc KR9 �
(.r�PLVlwr-, , wit I
Address
Assessor's Map/Parcel: "��d/as? l Engineer's Name��oJR
NEW CON S1RU�i ION REPAQt �" • i Telephone# 5 D
S Surface Stones
Land Use Q• (� �a Slopes(96) -
5"UDWetJ�ft . Drinking Water Well ft
Distances from: ripen Water Body ft Possible Area',Z-
> /2] ft
Drainage Way �� ft Property Line l _ ft Other
SKETCH:(street name,dimensiod6f lot.exact locations of tgsh holes&perc tests locate wetlands in prozitnity to holes)
/ EXISTING ` I�
I
r } DWELLING �`� to
!o
i
Q TOP OF FNDNEL 48.36
I I
I
ENCLOSED I
PORCH 1 t \ t
1
no found, o
j " I \ \ \ i
1 \
SHED N B\
_—.._.._.—.._..f...—�.._..___..t 30.00 tt a�
Depth to Bedrock
Parent material(gedlogic) I1—
Depth to Groundwater. Standing Water in Rolle::'
A . I Weeping from Pit Pace
Estimated Seasonali1jigh Groundwater Aj'A i
Dt TION FOR SEASONAL HIGH wATE�r TALE
' I. � in.
Method Used: in. Depth to$0111nOttlt st
Depth Observed standingiin obs.hole: 1 ln, croundwuter AdjustMent ft.
Depth tofwceping from side of obs.hole , _ q factor,..,._. Adj.tlrvundwaterl evel.,,...,
Index Well# Reading Date Index Well level — �'
I
PERCOLATION TEST . Ddte_.__.__.
Observation I TWO at 9" --
hole# '
`l e� Time at 6" - •-�----
Depth of Perc _ -
1001 Time:(9"-6") -
Slart Pre-soak Time.6
End Pre-soak
Rate Mi.Jlnch
ite Passed _
Site Failed; Additional Testing Needed(YIN)
Site Suitability Asseissmcut: S
200 9— • Original:"Public Health Division
Observation Hole Data To B e Completed on Back------
/D S ***If ercola ion test is to be conducted within 100' of wetland,;you must first notify the
If p n;viciinn at least one(1)we&prior to beginning-
DEEP OBSERVATION HOLE LOG Hole#
Soil Texture Soil Color Soil Other
De th from Soil Horizon S (structure,Stones,Boulders.
P Mottling g
•n (USDA) ( )
.Surface(t ) onsistenc R'o Gravel
Loft n) 0 4 N
�rt— �'t � (�'T!Yb. : Aid l•U .t��b gay •
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(inJ (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
D"-� 1� Sa•� 4 � q •
7/
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Muosell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel
1 �
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon it Texture Soil Color Soil Other
Surface(in.) (U A) (Munsell) Mottling (Structure,Stones,Boulders.
on ist n Crawl)
to
Flood Insurance Rate May:
Above 500 year flood boundary- No Yes
x
Within 500 year boundary No Yes,.
Within 100 year flood boundary No X 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 naturally occurring pervious material? >
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the require in' ,expertise and experience described in 3.10 CMR 15.017.
Signature I Date db
Q:ISEPTIOPERCFORM.DOC
TOWN OF BARNSTABLE
LOCATION J SEWAGE# D
VILLAGE ' /I���� ��/ ASSE SOR'S MAP&PA_RCEL D oZ�
INSTALLER'S NAME&PHONE NO. jy�/
SEPTIC TANK CAPACITY�� /Q®�
LEACHING FACILITY:(type) f�,� J �C�p� (size)
NO. OF BEDROOMS
OWNER
PERMIT DATE: O G ® 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 Llaching Facility(if any wetlands exist
within 300 feet of leaching facility). <. feet
FURNISHED BY
F®CCA/
"4
--4-7�F.J-,
� Y
�1I
_ 43
X;i
TOWN OF BARNSTABLE
LOCATION 357 Ames vl y SEWAGE#
VILLAGE RA LE ASSESSOR'S MAP&PARCEL
IPFRT £ NAME&PHONE NO.� Me Qf r SOS 3r-2-2I22-
�NsPE�'raRS
SEPTIC TANK CAPACITY. 4000 (attv-n P•G. Serk-re 4
LEACHING FACILITY:(type) L-EftC11 PIT- I (size) (ad x ro �V•�
NO.OF BEDROOMS . 1__1
54A2)OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility } I s Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Zed Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of Icaphing facility) 300 Feet
FURNISHED BY
O � 110,
M
Postal
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rrl Only;
r�-
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Certified Fee
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PS Form 3800,August 2006(Reverse)PSN 7530-02-000-6047
Town of Barnstable Barnstable
' a Regulatory Services Department 1 edea 1
�n�tvsrns►.�,
''SS. �` Public Health Division
i639• ,�� m
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 70062150000210418573
4/14/2009
Susan Stulsky
357 Ames Way
Centerville, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 357 Ames Way Centerville,MA was last inspected on
February 14, 2009,by Darren M. Meyer, 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 an overloaded or
clogged SAS.
• 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 THE BOARD OF HEALTH
Thomas McKean, R.S., CHO
Agent of the Board of Health
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14, 2009
required for Y
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:
When filling out A. General Information
forms the I 53
computer,
r,use 1. Inspector:
only the tab key
to move your Darren M. Meyer
cursor-do not Name of Inspector
use the return
key. n/a
Company Name
P.O. Box 981
Company Address
East Sandwich MA 02537
City/Town State Zip Code
508-362-2922 SI 3920
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
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.
Lq 31 D q
357 Ames Way#2-Cville-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15
11-AH Cvf;
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a. 357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14 2009
required for Y
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:
❑ 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
357 Ames Way#2-Cville-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�v 357 Ames Way
Property Address
Susan Stulsky
Owner Owners Name
information is y Centerville MA 02632 February 14 2009
required for ,
every page. City/Town 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 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.
357 Ames Way#2-Ulle-TITLE V INSP•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
357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14, 2009
required for y
every page. City/Town 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 '/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.
357 Ames Way#2-Cville-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w. 357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14, 2009
required for Y
every page. City(rown 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
I
❑ ❑ 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.
357 Ames Way#2-Cville-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is
required for Centerville MA 02632 February14, 2009
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner)provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
357 Ames Way#2-Cville-TITLE V INSP-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
357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14, 2009
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
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2007: 123 gpd
9 ( Y 9 (gpd)): 2008 98 gpd
Sump pump? ❑ Yes ® No
Last date of occupancy: CurrentDate
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):
357 Ames Way#2-Cville-TITLE V INSP-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15
Commonwealth of Massachusetts
up
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February required for Y 14, 2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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)
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
system installed in 06/07/79 per as-built
Were sewage odors detected when arriving at the site? ❑ Yes ® No
357 Ames Way#2-Cville-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
i
Commonwealth of Massachusetts
u--4t Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�, 357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14, 2009
required for Y
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 36 inchesfeet
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.):
No issues, no signs of leakage
Septic Tank(locate on site plan):
Depth below grade: 12 inchesfeet
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:
typical 1,000 gallon tank 8.5'x4.82'
Sludge depth:
4"
Distance from top of sludge to bottom of outlet tee or baffle 32
Scum thickness
0"
Distance from top of scum to top of outlet tee or baffle
10"
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? tapes/rods
357 Ames Way#2-Ulle-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14, 2009
required for y
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
System is hydraulically failed, leachate seeping out of inlet and outlet covers. Tank appears to be in
good condition and suitable for re-use. Installer to verify actual suitabli for re-use at time of install.
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):
357 Ames Way#2-CAlle-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
i
Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
357 Ames Way
Property Address
Susan Stulsky
Owner Owners Name
information is Centerville MA 02632 February 14, 2009
required for rY
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 n/a
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 was full. To be replaced upon system upgrade
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
357 Ames Way k2-Cville-TITLE V INSP-08/06 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
�.. 357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14, 2009
required for Y
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: 1 -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 full. System is hydraulically failed. No breakout is ocurring at this time.
357 Ames Way#2-Cville-TITLE V INSP-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
g. 357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14 2009
required for Y
every page. City/Town 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.):
357 Ames Way#2-Cville-TITLE V INSP•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�.d 357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14, 2009
required for y
every page. City/Town 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. O-J
VJ
41
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1 . �
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':ICJ
357 Ames Way-Cville-TITLE V INSP-08/06
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15
A Y
Commonwealth of Massachusetts
-- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
357 Ames Way
Property Address
Susan Stulsky
Owner Owner's Name
information is Centerville MA 02632 February 14, 2009
required for Y
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: > 15'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:
Hand auger shows no groundwater observed to 146", using Barnstable topographic and water
contour maps, groundwater is approximately 15' below grade.
357 Ames Way#2-Ulle-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
.0 C T ION SEWAGE PERMIT NO.
Y°IL LAG E
a
INS�TAER`S NAM=&/ ARESS
c�
BUILD R 0
DATE PERMIT ISSUED - ��- 72
DATE COMPLIANCE ISSUED
i
s j
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��J ��
� ti� �,
,�
LEGEND
PROPOSED CONTOURES yR"
WA
GRADE.
PROPOSED SPOT GRADE
D C'E OF EXISTING CONTOUR
PAVEMENT
/ 47 + 96.52 EXISTING SPOT GRADE
46 W— EXISTING WATER SERVICE -
-, 45\ TEST PIT
_ I OO /
�//48`\ \\ \�� \\ _ .e•!`44
Lli j , v LOT
Q� AREA 15406 Sf\+— \ j/� r3 •x.'
/ LOCUS MAP N.T.S.
GENERAL NOTES:
(n e0 RD OFGHEALTTHTO TAND THE DESIGN ENGINEER.APPROVEDMUST BE BY THE LOCAL
2. ALL AND
MATERIALS CONFORM TO THE REQUIREMENTS
HESTAENVRON ENVIRONMENTAL CODE. TITLE V, AND ANYAPPLICA
LOCAL RULES AND REGULATIONS.
j 48 3. HE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
S� c TO INSPECTION AND APPROVAL BY HE BOARD OF HEALTH AND THE
LI/�/XI S T/ ^ 1 DESIGN ENGINEER.
ING
011 D ' v E l I N`' \\ I 4 FROM THOSE SHOWNOHEREONDSHALLNBECR PORTED TO TTHEEDESGN
0 / o N G \ ENGINEER BEFORE CONSTRUCTION CONTINUES.
\ 1 TOR 5. ALL ELEVATIONS BASED- ON ASSUMED DATUM.
rn I // / E oP OF F 1 f 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
/ 48• CAL BOARD
6DN I I O HEALTH ORTHE COACPROPER INSPECTIONS DURING COOR OWNER TO NOTIFY THENSTRUCTION. OF
EN / N 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
i CLOSED / S. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
O�� PORCH / / ' TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
I _J � / L / (no / I 9. IT SHALL BE HE RESPONSIBILITY OF HE CONTRACTOR TO VERIFY
found i I / HE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION.
10. EXISTING LEACH PIT TO BE PUMPED AND REMOVED FILL WITH CLEAN MED. SAND
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
\ \ AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
13. NO ADDITIONAL PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING lPo \\ I 14. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPECIFIED OTHERWISE)
15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
FOR THE USE OF A GARBAGE GRINDER
Qi_ _ _ / \ Q4A \\ \� 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
17. PROPERTY IS LOCATED WITHIN ZONE II OR NITROGEN SENSITIVE AREA.
�'— TH—1 / k7b� \\ 4 3
47 - _ ___ TH-2 / \ \
OF gsS9 30
'00 ft
_\ 44
"....-MEYER - ___
C No. 1140 APPROX. LOCATION OF •s ___J
" EXIST. LEACH PIT i
PROPOSED SEPTIC SYSTEM UPGRADE PLAN
NITAR\a (5EE NOTE I O) BENCH MARK ' 357 AMES WAY,( CENTERVILLE, MA
MAP: 170 Prepared for: Mike Dedecco
PAINT SPOT—CORNER LOT. 227 Engineering by: Surveying by: SCALE DRAWN JOB. NO.
SURVEY REFERENCE: OF CONCRETE SLAB DEED BOOK. #8883 DARRENM.MEYER,R.S. Eco-Tech Eaviroam"W 1"=20' DMM
PLAN OF LAND BY GEORGE LOW & CO. ELEVATION = 46. 94 PO BOX981
DEED PAGE.' #163 FAST SANDMCH,MA 02537 (508) 364-0894 DATE: CHECKED SHEET NO.
DATED: MARCH 3, 1978 BARNSTABLE CIS DATUM 508•W-n22 05/01/09 DMM 1 of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE' PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:44.06
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
T.O.F. EL.=48.36 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER Z� OF
F.G. EL.=4OUTLET
T ET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. DAR M.
/- F.G. EL.=46.05t F.G. EL: 46.50f F.G: EL: 47.0(MAX.) M�
" No. 1140
L - 10"t 9• MIN COVER/ L e 34' L = 8'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) .
C/51
O Sal.`8 (MIN.) 36• MAX COVER O $a19j (MIN.) O S-1X (MIN.) NITAR
4"SCH40 PVC 4'SCH40 PVC 4"SCH40 PVC
10' 6 11.3" TQ_ l
INV.=44.53 4B'u0UlD 14 INVERT G 1 P
INV.=44.28
LEVIEL GAS BAFFLE J PROPOSED INV.=43.77 4 ROWS OF 4 UNITS AT 6.25'/UNIT - 25'/RbW
SOIL ABSORPTION SYSTEM (PROFILE)
INV.=43.94 INV.= 43.67 1
EXISTING 1.000 GALLON SEPTIC TANK
RESTORE VEGETATIVE COVER
EXISTING SEWER OUTLET
BACKFILL WITH CLEAN PERC SAND 75"
TO TOP OF CHAMBERS
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING :.:;..
zzzzz
PIPE INVERTS PRIOR TO CONSTRUCTION
2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=44.
GRADE ON A MECHANICALL COMPACTED SIX INV. ELEV.= 43.6677
INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 42.73 EXISTING SUITABLE
310 CMR 15.221(2) 2.83 MATERIAL
3) REPLACE EXISTING 1.000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH 4 x 2.83' 11.32 r� 76"
TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W.
IF FAILED, DAMAGED, OR UNDERSIZED. (7.18' PROVIDED) USE 4 ROWS OF 4-HIGH CAPACITY PROFILE
4) INSTALL INLET & OUTLET TEES AS REQUIRED ADJ. GROUNDWATER EL.=35.55 z ADS BIODIFFUSER UNITS-NO STONE
SEPTIC SYSTEM PROFILE TYPICAL SECTION
16
N.T.S. .2
Kra 11�
SOIL LOG P i -
DESIGN CRITERIA #: 12553
NUMBER OF BEDROOMS: 2 BEDROOM ACTUAL/3 BR DESIGN (PROP IS IN ZONE II) DATE: MAY 1, 2009 �34"----�
SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. SECTION END CAP
WITNESS: DAVE STANTON, BARNS. BOH
DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 330 G.P.D. Elev. �TP- � De th Elev. TP-2 Depth 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT
-
DESIGN FLOW: 330 G.P.D. 46.50 A LOAMY SAND 0" 46.25 A LOAMY SAND 0" "
toYR 4 t toYR a/1 8-
MODEL 16 HICAP
GARBAGE,GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 45.83 8" 45.58
B B LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT II
PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY LOAMY SAND LOAMY SAND EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
330 = 445.94 S.F. 10YR 5/8 IOYR 5/8 DIFFER SUGHTLY FROM ACTUAL PRODUCT APPEARANCE.
LEACHING AREA REQUIRED:
( ) 43.67 V73 34" 43.58 32" SIDE WALL HEIGHT 11.2" a.
.74 C VA C OVERALL HEIGHT 16"VA
"
DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) VA OVERALL WIDTH 34"
re PRIMARY S.A.S. MED. SAND MED.SAND 13.6 CF 4640 TRUEMAN BLVD
PERC 0 42.50 HILLIARD, OHIO 43026
USE 4 ROWS OF 4 - 16" ADS BIODIFFUSER H-20 UNITS-NO STONE 2.5Y 7/4 2.5Y 7/4 CAPACITY (101.7 GAL) AONmm oRmNAGE sY3TEMS, INc.
f BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) 33.50 156" 33.25 156• PROPOSED SEPTIC SYSTEM/SITE PLAN
(BIODIFFUSERS) 16 UNITS x 6.25 LF x 4.70 SF/LF = 470 SF PERC RATE <2 MIN/IN. (*Cl" HORIZON)
DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 347.80 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED AT 156• EL 33.25 357 AMES WAY, CENTERVILLE, MA
INDEX WELL- SOW-252 ZONE: 0
LEVEL: 46.8 ADJUSTMENT: 2.3 ft. Prepared for: Mike Dedecco
ADJUSTED HIGH GROUNDWATER AT EL 35.55 Engineering by: Surveying by: SCALE DRAWN JOB. NO.
DARRENM.MEYER,R.S. Boo-Tech Abvit»nmenW NTS D.M.M.
• I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 POBOX9ef (508) 364-0894
to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MAO1537 DATE CHECKED SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October. 1999. 5O8,M229Y2 05/01/09 D.M.M. 2 Of 2
i