HomeMy WebLinkAbout0009 ANSEL HOWLAND ROAD - Health (2) 9 Ansel Howland Road, Centerville
j
IN
No12534
.2-1531.OR roanco
MASTINGO,YN
_
AsBuilt Page 1 of 1
TOWN OF BARNSTABLE
LOCATION J'nW r tlO cl 1 SEWAGE#
VII,LAGE ro _ASSESSOR'S MAP&PARCEL 7a o2f
INSTALLER'S NAME&PHONE NO. C.c Enfcnaltq
SEPTIC TANK CAPACITY /gyp
LEACHING FACILITY:(type)4 A&C 2F, ' ,. k-dQ (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: COMPL CE DATE: a
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .00-le OFOJFYW4 Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) AIA Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) /✓/� Feet
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FURNISHED BY e0cr g 1,.L<
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http://issgl2/intranet/propdata/prebuilt.aspx?mappar=172216&seq=1 6/5/2012
No. ! ( I Fee U U
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftphration for VzAsal Apstem Construction 3permit
Application for a Permit to Construct( ) Repair` Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. r 5 e► WewlAt^ca fV) Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel i 7 a 21 do C�V�I
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Cc�FPewic�c trht.✓P.<5cs 6,:), s-r �1.�s1 .t �ir Z��►- b3�'�
Type of Building:
Dwelling No.of Bedrooms Lot Sizeoc�o�' sq.ft. Garbage Grinder( )
Other Type of Building S Ly,� wJ l r No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 3 gpd Design flow provided 3 SJ• 2-A=1 gpd
Plan Date 3 O —2.o k L Number of sheets I Revision Date
Title
Size of Septic Tank i 00o r`Z 1• h Type of S.A.S. ( � S X 2 5-
Description of Soil
Plriv�
Nature of Repairs or Alterations(Answer when applicable) C V"L "Ib fLQ.
Date last inspected: ZJ l 2
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.
Si C Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. .7—tl/ —4iM- 1r=�— Date Issued
a �� � - o ►�
NO. Fee
COMMONWEALTH OF MASSACHUSETTS Entered in computer: r/r
PUBLIC HEALTH DIVISION --TOWN OF BARNSTABLE, MASSACHUSETTS Yes
r Zipprication for ;,ispbsAY`*pstrm (Construction 3perrnit
Application for a Permit to Construct( ) Repair'( Upgrade( ) Abandon( ) ❑Complete System Jk Individual Components
Location Address or Lot No. 9 A n g e 1 (4 Ala rca fV� Owner's Name,Address,and Tel.No.
Gr�v�,w,�e r--.
Assessor's Map/Parcel 17 of a f\o C,V t
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1
l/sq� ,, It 6h�c.✓�"ycz 1 i 3 CuMr.. �� S+' /10 '!u .� t t�A'�L
Type of Building: fi
Dwelling No.of Bedrooms Lot Size ( S 000- sq.ft. Garbage Grinder( )
Other Type of Building ,r-•L r No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required): gpd Design flow provided 3 S;. Zv gpd
Plan Date a LI-3 O -?O t L Number of sheets ( Revision Date
Title
Size of Septic Tank I DOO `Z•, Type of S.A.S. 1 I• S X 2-'3- r.e 0 v F (Z v) Afc $6 iFj cy
Description of Soil
� P i✓-vv7
Nature of Repairs or Alterations(Answer when applicable) Ck _�, ,/7fi<- \-'wt To
1-D 5
Date last inspected: 1^L
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 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.
i Sign(-(L A Date
Application Approved by ( '. 17 ( ~~ Date
Application Disapproved by 6r Date
for the following reasons
a
Permit No. Z u/ /E q Date Issued r- 3-?a/2
. ' 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
at 'i f9yne( t-6 k v-4 !-e,--J a4,1 ^�(( has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. a i7 1.2 -AJQ/A ed �-_� �/!2
Installer el Cc,_ c__ Designer "S(_oh,
#bedrooms 3 Approved design flow ?-3 D gpd
The issuance of this permit shall not
/bdcon trued as a guarantee that the system will function a des wed:
Date V/ V/' L_ Inspector I ` _
No. 2 0 / 2 — / Fee /a 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction Vermit
Permission is hereby granted to Construct( ) Repair(yO Upgrade( ) t Abandon( )
System located at Av-1',-2,(
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date S-3 - ( a Approved by I
t
r
. 7
I
Town of Barnstable
,,i• Regulatory Services
Thomas F. Geiler,Director
Asia. Public Health
Division-Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: 5'1y-1I Sewage Permit#7,411- 11 'Assessor's Map/Parcel
Installer&Designer Certification Form
Designer: SC En VAee-<(n% , T'nc,. Installer: ! G+aee 'id.4 L 46r f��
Address: 28511 Crone HiahweV Address: 153 Cv��va� Si
T v
East WOMInorn Nft 025268 ►✓Y10 v 2t-t5
On 3 Lo i 2. C-� �2L,nle) e.c- was issued a permit to install a
(date) (installer)
septic system at 9 AOS CA t4owl0vr8i Ran cA based on a design drawn by
(address)
sc Enye)eer60,� T'nG. dated Aectl 30, ZaiZ
/ (designer)
V I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
l 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. Stripout(if required)was inspected and the soils
were found satisfactory.
��rn op
� JOH
' ILL
1
(Ins ler s Signatu ) WL y
41,9
_/Aesigner's ignatur (A Slifnp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC ALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAof ice IonnMdesignercertitleation rorm.doc
TOWN /OF BARNSTABLE
LOCATION 9 /� �s l 14OW SEWAGE# dL�Id,
'VILLAGE Co,.n'lt/+Vf ASSESSOR'S MAP&PPARCEL 1` a.1A1,6
INSTALLER'S NAME&PHONE NO. C�ioP.ta�jf,��, �V��T�t jSs&~SS � � aww
SEPTIC TANK CAPACITY /000
LEACHING FACILITY:(type)Q0 A&C :y6 W,, Ff-020 (size) d/-r5 X
NO.OF BEDROOMS
OWNER L
PERMIT DATE: COMP LIA CE DATE: d
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -�e ObJ&W ( Feet
Private Water Supply Well and Leaching Facility(If any wells exist on at Pita
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) 1_ - /✓A Feet
FURNISHED BY LLC—
40
Town of Barnstable P#
Department of Regulatory Services l
a r,MWINUBM : Public Health Division Date l I J
u a1� 200 Main Street,Hyannis MA 02601
Date Scheduled Time , Fee Pd.
Soil Suitability Assessment.for Sewage Disposal
Performed By: �rcJ 1 I. aer7U�� 1T LS E Witnessed By: ,J ��
LOCATION&GENERAL INFORMATION
Location Address `l P aSe 1 i} k or,1 0 120,qA. Owner's Name (� j- i'1 Ca'y
62vLT Vrl-�0-IL Address S �
Assessor's Map/Parcel: � SG Evt/ ineer's Name + 5cvle,rtr1S
NEW CONSTRUCTION REPAIR Telephone# S 6 L 11 g�?7 5p 8-2 73-03 7 7
Land Use J`f S 1d_e, '�' Slopes(�) ® Surface Stones
Distances from: Open Water Body >1 6 0 ft Possible Wet Area (00 ft Drinking Water Well ft
Drainage Way ' 100 ft Property Line rV ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands i'n proximity to holes)
• Sew a4.,��� �� -
Parent material(geologic) oGsY1 Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: ,`t 6 0 a.. Weeping from Pit Fpee AI U n f
Estimated Seasonal High Groundwater '.+� ll ✓��
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: "
Depth Observed standing in obs.hole: _ _in, Depth to soil mottles: in.
Depth to weeping from side of obs.hole: In, Groundwater Adjustment f[.
Index Well# Reading Date: Index Well level , Adj.factor- Adj.Groundwater level,.
..-PERCOLATION TEST r bale "a is 'rin,e J6 4 H
Observation "
Hole# Time at 4"
Depth of Perc �.fo�s T Time at 6" `
Start Pre-soak Time @ '�' a Time(V-610)
End Pre-soak 1�"0 2
Rate MinJlnch `�1►)�N lq
Site Suitability Assessment:•Site Passed Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTICIPERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# 4 _
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.'Boulders.
Consistent2y,%Oraven
0—��. AI£ 3b
la-K S(� I OYA6/6
36-60 LS a.S- ..5A, 9r�v� e�
(od-44 Ga P1�G SahoP � S`iPS"I�
9y-�ao. G3 r Lv�t�, gsYy! rr<
lao—lab �� 1�S zry.G13
DEEP OBSERVATION HOLE LOG _. Holy Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
r" on is en % ravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.%a
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No. Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? e
If not,what is the depth of naturally occurring pervious material? .
Certification
I certify that on 7Lalk,3 (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 required traini g,expertise and e perieQnc�e described in 310 CMR 15.017.
. �1NW Date d y l
Signature ��--�
Q:\.SEFTICkPERCFORM.DOC
t
V
�\ CONINIONAVEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF E?:VIRONMENTAL AFF.4I 1
DEPARTMENT OF 1�'IR01�1E\TAL PR
E O ? 2
ONE 1�1,TER STREET. BOSTON. %1.A 0310b 6l 9:-. 1
c REC I E®
OCT
W'ILLIA%'F 11'ELD 8 1997 T c0lim
Governc T D H�t HDEPlj 'retan
ARGEO PAUL CELLL'CCI DAP" STRUFLE
Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO %ommissione
PART A L
Q CERTIFICATION
Property Address: 1 5�-� �� L Q-N�Z�'��� Address of Owner: �,Af5 Sk-,v litstz
Date of Inspection: L l C ,(oZ,(If different)
Name of Inspector: 1 —), "�ro
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: 414-,,C E/t r�"/'�.a ^-cP.�-�-��
Mailing Address: Rep AcnA
Telephone Number: r�G42 !6=jt;- /Lf Zed
CERTIFICATIOti STATEMENT
I cenii that I have personalh inspected the sewage disposa! system at this address and tha' the information reported below ,s true, accurate
and complete as of the time of inspectoo-.. The inspection %as performed based on my training and experience to the proper function and
maintenance of on-site sewage disposa systems. The system:
Passes
_ Conationai;% Passes
,�eecz Furthe- Ev lua n he local Approving Authortr\
F-
Inspector's Signature: Date: f )
� v
The Svste r Inspecto• shay' submr a cope of this inspect,on reocin to the Approving Authorih within thirt%, (30, days of completing this
inspect,or.. If the system is a shared vstem o- has a design flow of 10,000 god or greater, the inspector and the system owner shall submit
the repo^ to the appropriate regional ofiice of the Department o' Environmental Protectioe. The orig:na! snould be sent to the system owner
and copes sent to the buyer, if applicable, and the approving authorirn
INSPECTION SUMMARY: Check A, B, C, or D:
A] SYSTEM PASSES:
1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
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.
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 exfiltratton, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health. .
(zev;,sed 04/25/97) Page 1 of 10
DE_D"trie Wend Wios VN"_ htie_/nvww rnsonet state ma uWCec
- r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI01 ORM
PART A
CERTIFICATION (continued)
Property Address: �.
Owner:
Date of Inspection:
.1 t
61 SYSTEM CONDITIONALLY PASSES tcontin.j-d
_ Selvage backup or breakout or high static water level obsery in the distribu+ion box is due to broken or obstructed
pipets) or due to a broken,-settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times year due to broken or o ructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s; are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD O HEALTH:
Conditions exist which require further evaluation by he Board of Health in order to determine if the system is failing to protect the
public health, saiet`-and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALT DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH ND SAFETY AND THE ENVIRONMENT:
Cesspool or priv-, is within 50 feet of surface water
_ Cesspool or prn, is �%ithin 50 ieet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD O HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MAN ER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and s it absorption system (SAS and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply
The swern has a septic tank and oil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and oil 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 ttrar. 100 feet but 50 feet or more from a
private water supply well, uniess a well water analysis for coliform bacteria and voiatile organic compounds indicates that
the well is free from pollution fr-m that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used o determine distance (approximation not valid).
3) OTHER
1
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(revised 04;25/9'7) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO\ FORM
PART A
CERTIFICATION, (continued)
Propert-. Address:
Owner:
Date of Inspection:
DJ SYSTEM FAILS:
You must indicate either "Yes" or "No' as to each of the following
-
I have determined that the system violates one or more of the following failure c terra as defined in 310 CMR 15.303 The basis
for this determination is identified below. The Board of Health should be cons aed to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an verloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the grou or surface waters due to an overloaded or clogged SAS or
cesspool.
Sta:tc Mould level in the distnbition boa above outlet vert due to an overloaded or clogged S45 or cesspoo..
Lieuid depth it cesspool is less than 6" below rove or available volume is less than 1/2 day floe.
Recurred pumping more than 4 times in the las year NOT dvz. to clogged or obstructed pipes .
cumber o'.times pumped _
An, pon;on o'the So!; Absorption Svstem, esspool or privy is below the high groundwater eievatio-
Am port.on of a cesspool or privy is wit in 100 feet of a surface water supply or tributary to a surface %ate• supply.
An) por-ion of a cesspoo' or pri,.) is w thir a Zone I of a public well.
Am pe-�ic- of a cesspoo! or pnw is within 50 feet of a private water supply wel!
Am porl,or o-*a cesspool or privy s less than 100 feet but greater than 50 feet from a private water supply well with no
acceotabie Ovate, qualir, analvsis. If the well has been analyzed to be acceptable, anach cope of well water analysis for
col,iorm bacer;a yola:jle organs compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate erne, "Yes' or "No" as to eac of the following.
The iohow:rg cite•,a app�\, to ;arge sy tems in addition to the criteria above:
The system serves a facilm with a d sign flow of 10,000 gpd or greater (Large System: and the system is a significant threat to
public heath and safety and the emtronment because one or more of the following conditions exist:
'Yes No
the system is within 4 feet of a surface drinking water supply
the system is within 2>70 feet of a tributary to a surface drinking water supply
the system is locat in a nitrogen sensitive area (Interim Wellhead Protection Area • IWPA) or a mapped Zone 11 of a
public water suppl well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and16.00. Please consult the local regional office of the Department for further information.
(reviaad 04/25/91) Page 3 of 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Properth Address:
Owner: YDJ
Date of Inspection: C��
Check if the following have been done: You must indicate either."Yes" or "No" as to each of the following.
Yes No
_ Pumping information was provided by the owner, occupant, or Board of Health.
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 pan of this mspec►ion
_ As bull, plans have been obtained and examined. Note if they are not available with N/A.
_ The facdm. or d%%eliing .%as inspected for signs o`sewage back-up.
_ The sstern does not rece,ve non-sanitary or industrial waste flow.
_ The site %%as inspected for signs of breakout.
_ All s\sterrr components. excluding the So-1 Adsorption System, have been located on the site.
The septic tank manholes ,%ere uncovered. opened. and the interior of the septic tank was inspected for condition of
baffies or tees, materia; o' cons:ruction, dimensions,depth of liquid, depth of sludge, depth of scum.
The size and loca:,on of the Sol! Absorption Svstem on the site has been determined based on
The facdiv, o%%ne• ;ano occupants. r difteren: from owneri were provided with information on the proper maintenance of
Sub-Surface Disposal Svstem.
6"1k Existing miormation. Ex. Plan at B.O.H.
Determined in trig field u+ an, of the failure criteria related to Part C is at issue, approximation of distance is
unacce:)tabie [15.302.31:b`J
(revised 04/25/57i page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR..M
PART C
SYSTEM INFORMATION
Property Address: 9 kW--Z1\ �J
Owner: C--� P dl-
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flov. „affaeg o.d.bedroorr. for S.A.S
Number of becrooms 07 —
Number o-current residents 1
Garbage g,. der (yes or no:,
Laundry co-•^ected to system (yes or no'
Seasonal use Ives or no-._t�d
Water meter readings, if available (last two i2° year usage tgpd): �[
Sump Pump Ives or not ,
Las date o;occupancy
CONIMERCIAL'INDUSTRIAL•
Type of establtshmen:
Design fio%% gahonsda%
Grease trap present Ives or no_
Industria! \taste Holding Tani: present -ves or no_
Non-san,tan v aste d,scnargec to the T!t,e 5 system ivies or no_
\%ater meter read:n : if v it i
g-
a a ab e
Las:Fate o: o ,.panc,
OTHER: .Detcribe
Last care of occuoanc.
GENERAL INFORMATION
PUMPING RECORDS and source of ,nforma:ior
4,4 9 -� �0
System pumpec as par, or inspection: Ives or no.-W
If yes, volume pumped gallons
Reason for pumping
TYPE OF SYSTEM
_ Sevic tank'd;snbution bo>.soil abscrption system
Single cesspool
Overflow cesspool
Prn�•
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: 'v
Sewage odors detected when arriving at the site. ayes or not qJt�
(revised 04/25/97) Page 5 of 10
SLBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTESi INFORMATION (continued)
Propertyy ddress: wzlowk
Owner:
Date of nspection:
BUILDING SEWER:
(Locate on site plan)
Depth below grade.
Material of construction. _cast iron _40 PVC _other (explain)
Distance from private water supply well or suction li-<
Diameter
Comments: (condition of)oints, venting, evidence of leakage, etc.)
SEPTIC TANK;—'Ifs
(locate on site plan
Depth below grade
�21
Material of construct o. � _mea _F�berglas _Polyethvlene _othenexpla�n
If tank is meta,', lis: ate _ 1_ age cor.i;rmec b\ Cen;fica;e of Compiiance _(1es"No _
Dimensions
Sludge depth T
Distance from top o: siudee to bortorn of ou!ie: tee o, ba-;;e �
Scum thickness�9 n
Distance from top of scum to top of outle: tee or bade
Distance from bottom o scur-. to bo-o�- o�outlet tee c• bane
Now dimensions "ere determined , s�f_StJiLu2�
Comments
trecommendanon for pumping. condition o, inlet an outlet tees or baffles, depth of liquid level in relation to outlet_invert, structural
inlegr t�;, e.iden a of akaee. e:c.i ! ��> c i
Ql
GREASE TRAP:
(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.;
(revived 01!25.'91) Page 6 o1 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
g�L ; SYSTEM INFORMATION (continued)
Properh dress ( P'l( b�v 'zJ
Owner:
Date of Inspection:
qb5 lot�
TIGHT OR HOLDING TAN'K:�lank 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:
Capaciry gallons
Design floes gahors'da.
Alarm level A;arm in „ork!ng order _ Yes. _ No
Date of precious purrmping
Comments
)condition of inlet tee. condition o• a!a,rn and float switches, etc.)
DISTRIBUTION BOX:�QS
dcica;e on size p a-..
De,t^ o' Iicuid le e' aoo•.e ouile: rme"
Comments ll
e if leve! and .is eaua' evidence of solids carryover, idence of leakage into or out of box, etc.)
rr *
PUMP CHAMBER Jb
(locate on site plan.
Pumps in working order. (Yes or No,
Alarms in working order (lees or No
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
As12s-/971
A
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
ii ,�11 SYSTEM INFORMATION (continued)
Property ddress: elf' 1dLe)L t0V;4Q t)
Owner:
Date of Inspection: 6�
SOIL ABSORPTION SYSTEM (SAS):_U_G(
(locate on site.plan, if possible; exca,. ion not required, but may be approximated by non-intrusive methods]
If not determined to be present, explain:
Type:
leaching pits, number. idX�
leaching chambers, number:_
leaching galleries, number.
leaching trenches. number.length:
leaching fieids, number, o,mensions
over.'!oµ• cesspool, number
Alternative systern
Name of Tecnroiog�
Comments.
mote condition of sod. s+gns of hydraulic failure, level of ponding. condition ot`ege do , etc.,
YL6
CESSPOOLS:
(locate on site plan
Number and configura'�on
Depth-top of liquid to inlet Inver,
Depth of solids lave,
Depth of scum layer
Dimensions of cesspoo!
Materials of construction
Indication of groundAate-
inflow tcesspool must De pumpeC as par, Of rnspection�
Comments.
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:vo
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments
(note condition of soil, signs or hydraulic failure, level of ponding, condition of vegetation, etc.)
(rev1aad 04/25/97) -Page to of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property ddress:
Owner: "
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (locate where public water supply comes into house)
q
LC-
A
Al
�2
C 3 - 5` b3- 3. `
(ravis•f 04'25!5-) - Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propertm Address: �•� , G ''`a� .
Owner:
Date of Inspection:
Y � I
f •
Depth to Groundwater j iy Fee;
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained irom Design Plans on record
Observation of Site (Abutting property, obsertiation hole, basement sump etc.)
Determine it from local conditions
Check %+ith Iota' Board o• '1e2•:r
Check FE.NAA nlaos
Check pumping records
Check local eacatators irstalle•s
use I-SC,S Da:a
r•
Describe in Moir 0� %%010s r0%% \o_ es:ab;-6�ed the Groundwater Elevation. (Must be completed
(rev-sod 04.125'9'. Pag• 10 of 10
r
No.vgg��
.'.a, .. �--
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® gwlo
HEAL}
.....OF..........
App iration for Elhiposal Works Tomitrurtion Frrnti#
Application is hereby made for a Permit to C nstruct ( ) or Repair ( ) an Individual Sewage Disposal
systt: .. . ............... -- -'---''--' --.......-•••••---� •--------------• ..... .•'•--"-'---..........---
a.-
cation-Addre.js,e o No.
......... ...... ..................................... ......................... - ..........................
Owner Address
.......... ......... ...T......... - --------------------- -•-----•---•-•----••---•-•-
Installer Address
Type of Building Size Lot.................... .....Sq. feet
U Dwelling—No. of Bedrooms............` ............................Expansion Attic ( Garbage Grinder (
Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other �xturess -----•------------------•--.....-•--•--•--------... ...
W Design Flow............ .... .�a._................gallons per person per day. Total daily flow........ �>........_.............gallons.
14 Septic Tank—Liquid capacity.jl d..gallons Length................ Width................ Diameter----.----------- Depth................
Disposal Trench—No. ................... Width.............------- Total Length.................... Total leaching area....................sq. ft:
Seepage Pit No.-._&'-_)(&Diameter.................... Depth below inlet--.................. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit---.--.............. Depth to ground water........................
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--.................--..
.................-...........................................................................................................................................
0 Description of Soil........................................................................................................................................................................
x
U •••••---•-•--•---••----•-----•••-•---•---------'-•--•-•------•--------••.................•-•.._............-----------•----•----•---•-----•--•-•-----•-------••------------•--------••-.........-••-•-•.
W ••---•-•••••----------------•...••-••-•••--••-•----••---•-----•---•----•--•-••••••••-------------•-•--------•••-------------------•---•-------------•-•--•------•-•-••--•-......•-•-•------------•..----
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
--•--------------------------•---•--------------------•---..........----•---.....--•--...----•-•-••-----...--------------------------------------------•------------•-------------------..........--••-- '
Agreement:
The undersigned agrees to install the aforedescribed Individual Se age Disposal System in accordance with
the provisions of ii:L 5 of the State Sanitary Code—The undersign further agrees not to place the sys em in
operation until a Certificate of Compliance has been ^ s d byel�oard, f healt _ /
Signe .. Z3 �
e
Application Approved B --
..—.--
Date
Application Disapprove for he following reasons:
..............•-•---•------------...------.......--••--.......----•-•--•-•-•----------._.......•-----•-••-----------••--•---••-•----•-••----•--•---••-•-------------•-----•-----.... --•--...--•---
Date
PermitNo......................................................... Issued........................................................
Date
THE.COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.. ................................OF........................----............-----._.........---...............................
Appliration for Uiopoottl Workii Tonotritrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................_....----...................................................................... -----•------.....---------..-...---•--------------•--•--------------•--------------------------•--
Location-Address or Lot No.
.... -........................
......_... ............... ...........................................
Owner Address
W •............................"......-'-'-"-............_ .......-"--------.........•--•••----'...............'-•'•-..................•......... .......
Installer Address
dType of Building Size Lot............................S... feet
U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
.,
4 Other—Type e of Building No. of persons............................ Showers — Cafeteria
a YP g P ( ) ( )
a Other fixtures ---------- ----•__•----.---•-.-
d ---- ----------------•--------•--------------------------------- -------------'------------
W Design Flow............................................gallons per person per day. Total daily flow..__..............._..._.............._.....gallons.
WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0-4
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a' -••-'----••------•--•••••••--••-------....•••••--••-•-•----------•--•---•---•......................•.........................................................
0 Description of Soil........................................................................................................................................................................
x
U Nature of Repairs or Alterations Answer when applicable................................................................................................
----------------------------------------•-•-----•----------•-••••--•-•--•-------_..................-•-••--•---••••---•----------••-••-•--•-••-•--•-••-•----•••--•----'••-•••--•----------.........-'----
Agreement:
The undersigned agrees ta�install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of IT . �
p 5 of the State pSmitary 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.
Signe .--............................................................................... . ''-'-.--•• •-• .............
{. D ee
Application Approved B _ `.. ..�=4`'..:&_°:_..._.._.•---------------------------•-----••----•---------------- .�,�" .. .' ..........
Date
Application Disapprove for he following reasons------------------------•------------------------------'----•-'------------=-----..__............••-•--•--••-•--
..-••-------.....••--•-••---••••••----'•-----•••----•-•------------•----------------'----------•-------"I-•------------••-•-•••---•---------•----••••-•----•-•-•••-----••-••--•---•--•-......•-•........
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARF HE T
........................OF.... . - . ...... ...............................
{ Tyrrtifirtttr of Tompliatta
T J"I CE TIFYt That the Individual Sewage Disposal System constructed or Repaired ( )
by -- _... ......................."....._
r � sInsta r f'
has been installed in accordance with the provisions of TITLE j of The State Sanitary Co . as d cribed in the
application for Disposal Works Construction Permit No. �--`
' "'+� dated-: ! r
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE
SYSTEM WILL FUNCT ON ATISFACTORY.
DATE......'-".............. � .................................. Inspector. .! .
THE COMMONWEALTH OF MASSACHUSETTS
BOAR P.,OF �E ��T.�f............................OF... _...._............................... FE
No _.........
to ga q.
rk,5 Tonotr ion rrmit
Permission is hereby granted-.4--<.... : t -------•-_-•-•• -----•--........................................................
to Constr c� or Repair r,`)�an Ind' Irival' ewage ; spo
at No..
S reet �,r
as shown on the application for Disposal Works Construction Permit N C '" '„ ...... Dated.//��- .,Z.>� ..�........
...............•-------------.....•-••--•...-----•. 1�---•-••...........---........"'.•....
/j ?'J.......
mot, -_, Board ealth
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
-:i
110 (S;'A1zanG.E bQ1 t.JC+ R. ;...
beat��� Fww z I to x 3 t 3�o G•PD s�6N,E��, ,� .0 a . . ,-- - : ; � ' ... . . ..
.��-•+�s-tc �30i too ;: • �5�.Pv. _ '��NG- !tea
i
�r ooc mod_. •� . 7¢198 ._.��`�� �: �. • -
PtT u�.E l •� �.
15--,UZWALL AV-
Ic7p st= ,c Z.S • Fir
w y]S �.PL7. S - •'i: 1 AP�iQ
,.
.. . ... . ... _ ..
TOTAL -0G-SI60 -425
Tr>T-A t- vat Q-( FLOW < 33D&Pn.
G�J1GDLdTIOLJ t"10 Zht1W,otz LLAS.
71
A.
rjAX-f Eh
Au
h .
Tar t-wo 4441--c%cl
1
yACtiCc�•-. �ti'4� �����/I� �? 1JVC�
V.
!Z$✓i3 L 4'Pi'� DtS'Y . tW
10
PIT
CE�'TIFIEt7 P LC) r PL.
L oCATI C)"
G; ENT P-VI Lr
� � . u n �at.t�- � i S n - 1 '� .: ap': 1?•A.T t� � 311o/f3Z
V.MF ctZEwGE
Ti-(Al- T µ r-- ��*T)olJ S&Aow►.1
1•lEl`I oI4 COAA 'L' W t'C't-� Tti:;: SivE.Lt►-�r� t�t�T'.Z.'� f .
Aw r-> SCTe-,ACIC VCQc ICC-AAE� •1TS OF TNt: ;
-row u of ��11P-4-97 AtIt> is Oor G � NT EKV I Ll.G:: N �GI t.•0-5—
L,oGATF-tom• W i Tti- I Q T w r= t✓LOoty
• D4TEz
MAS�r�
5U2V�YoQ`-
TI- l's Ca t-A►-t IS UOT L'A►SCr> 016-I A�J OSTERV1l.� o
Iwst-e�.v�c_w; �,v4�/t_�{ '�'t1L- . UFt:, r�. Stt�wu� ��,��t <_n.�-.�-r• AL AN E• 6MA'-!_
L Ltir• n.r.. tJe.r--O 'ru nerccMtNt� L-n"r - I-tFJ�`.s
�A fju
lb_ CATION SEWAGE PERMIT NO.
ee-
V1LACE "4- D-(o
6 ��� � A Z)iJo� • ,r�����
I N S T A LLER'S NAME i ADDRESS
UILDE R ON .
OWNER
9 r(s
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED xzc
1
o6
O
T.O.F. EL.= 57.3'± FINISH GRADE OVER D-BOX= 56,2'± 4"SCHEDULE 40 PVC MIN. SLOPE 1
FINISHED GRADE OVER BIODIFFUSERS= 56,0' - 56.5' GENERAL NOTES
PROVIDE H.D.P.E. RISER��� SLOPE @ 2% MIN.INSPECTION PORT WITH
w/COVER TO WITHIN 6" REMOVABLE WATER-TIGHT COVER OVER 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
ACCESS BOX TO WITHIN 3"OF
FINISH GRADE OF F.G. (TYP OF 2) RISER TO WITHIN 6"OF FINISHED GRADE � F.G. (ONE PER OUTER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
@ FND. EL.= 56.8�± F.G. OVER TANK EL. = 56,2'± 5" DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES.
--- --- - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
20"MIN.ACCESS 1 I DESIGN ENGINEER.
COVER(TYP.OF 3) PROPOSED 4" 9"MIN. 9"MIN.
-EXISTING 4" 36"MAX. 36"MAX. TOP OF SAS/B.O. = 53,52' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
SEWER PIPE PVC SEWER PIPE SYSTEM UNLESS OTHERWISE NOTED.
` 1� I" 3"DROP MAX PROVIDE WATERTIGHT j 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
-- 6 3 2" DROP MIN 3 9 L = 52± JOINTS (TYP.) ELEVATION =53.52' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
MIN.SLOPE @ 1%
1� 4" PVC IN FROM 1.08' 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF
1 10'
14" 753.8 ± SEPTIC TANK 4"PVC OUT TO (TYP.) 13 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
• LEACHING FACILITY 0.59 7.13 (TYP) o
5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM.
CONTRACTOR CONTRACTOR SHALL 12" 6" , 53.03' 52.44' laid flat 2.875'(34.5")� 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
SHALL VERIFY SIZE 48" VERIFY CONDITION OF 53.27 MIN. 53.1 O ( (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
GAS BAFFLE 6"
AND CONDITION OF EXISTING TEES 5.0'CRUSHED STONE (TYP.) MIN. 11.5' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
5'
EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY COMPACTED BASE
25.0' AND DESIGN ENGINEER.
5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 57.65' ESTABLISHED
TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 45.53' BIODIFFUSERS (END VIEW) ON TOP OF A CONCRETE BOUND w/DRILL HOLE AS SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
SEPTIC TANK PROFILE ARC 36 (#3613BD1 BIODIFFUSFRS TO THE DESIGN ENGINEER.
*CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR DISTRIBUTION BOX DETAIL \ /TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT NOT TO SCALE _ NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
- STRUCTURES SHALL BE MADE WATERTIGHT.
` r TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
' c5i PERC NO. 13616 REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
INSPECTOR: Donald Desmarais, R.S. APPROPRIATE AUTHORITY.
---- -"-'^ ,• ��, EVALUATOR: Bradley Bertolo, E.I.T. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
° • LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
• • •c C.S.E. APPROVAL DATE: July 2003 THEY SHALL WITHSTAND H-20 LOADING.
• 6 `'o �;� � DATE: .April 24, 2012
13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
• ranberry • ` • . � TEST PIT#: 1
+ + ' ELEV TOP= 56.20' 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
• + . + .' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
I M + • + `� . , , ELEV WATER= <45.53' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
►• � �" - • ; ' • + FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
CO
�/'/� • O ! ' PERC RATE _ <2 min./inch
icy)
LOCU 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
; DEPTH OF PERC= 36"- SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
Benchmark O "' s . ' * 16. PROPOSED PROJECT IS LOCATED WITHIN:
Top of CB/DH \CEO ���ly ��AI . � � • `� � � TEXTURAL CLASS: 1
\ A �O .V • • , ASSESSOR'S MAP 172 PARCEL 216
Y Elev. =57.65 C
ca Approx. M.S.L c4�9�Fti, / I I"O
J S \\ ' + +' . . , „* • " OWNER OF RECORD: LAWRENCE F. McCARTHY
�� �E Sandy Loam 56.20' ADDRESS: 9 ANSEL HOWLAND ROAD
PROPOSED INSPECTION PORT WITH > > .T1- . . +► •R + 10 Yr 3/2
8° �'� • . • • 12" 55.20' CENTERVILLE, MA 02632
ACCESS BOX TO GRADE (TYP OF 2) TP 1 98, F / EXIS 1 . LEACHING PIT TO + a
BE PUMPED & FILLED 4 + , , . + . • + Sandy Loam FEMA FLOOD ZONE C
56x2' \, ��
WITH CLEAN SAND ;� # +• ,•� r� • '* . B 10 Yr 5/6 COMMUNITY PANEL# 250001 0015C
PROPOSED TOTAL 20 ARC 36 (#3613BD) �\ \ • *• + • ZON 2 * • • 36" 53.20'
BIODIFFUSERS IN A FIELD CONFIGURATION \ , '+ E • • 17. DEED REFERENCE: BOOK 11160, PAGE 280
PROPOSED DISTRIBUTION BOX / \ • ' # ' • • " Loamy Sand
: : ,*w+ ` C1 2.5Y 5/6 18 PLAN PLAN BOOK 343, PAGES 84-86
�` \ • I (10% Gravel)
PLAN BOOK 306, PAGES 17-24
EXISTING DISTRIBUTION ��,�� 6x2�TP2 LP 1 \\ * , /, + • �
BOX TO BE ABANDONED I\
�QSo CB/DH `� �� • * �` � • ,. + 60" 51.20' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
MAP 172 l�: 1% ••�• C2 Med. Coarse
5Y 5/6 20.-SHRUB AREA-
20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
PARCEL 17 Qi� '� -_ S ; �`\� ` Q J �� • • 00 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
QO �, "l « • ' _' 'CA 94 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
TREE (TYP) cn `•° � Silt Loam 48.37
C) C3 2.5Y 4/4 J
EXIST. GAL. SEPTIC LOCUS PLAN 120" (Firm) 46.20'
TANK TOO B BE UTILIZED IN / ! ��ono � \ 'Q ��' '�
THIS DESIGN �CF C4 Med. Sand
\ SCALE: 1"= 1000' 2.5Y 6/3
MAP 172 /� `./ O \\\ BUSH (TYP) / CB/DH Al128" 45.53'
J
/ A•9� �'� � No Mottling, Standing or Weeping Observed
PARCEL 18 �
#9 FO
EXISTING �R,� �56 � , DESIGN DATA TEST PIT DATA LEGEND
00� h 2-BEDROOM F� `�� i i PERC NO. 13616
SPRINKLER HEAD �� DWELLING
i
INSPECTOR: Donald Desmarais, R.S. 50xO EXISTING SPOT GRADE
(TYP OF 8) � TOF = 57.3'± �' / (NUMBER OF BEDROOMS (DESIGN) 3 (MIN. PER TITLE 5) EVALUATOR: Bradley Bertolo, E.I.T. - - 50 - - EXISTING CONTOUR
� ^' ��o• � �
QQ C.S.E. APPROVAL DATE: July 2003
10, r�"'�
7); I ./ O DESIGN FLOW 110 GAUDAY/BEDROOM DATE: April 24, 2012 PROPOSED CONTOUR
I Jry�Q, TOTAL DESIGN FLOW 330 GAL/DAYTEST PIT#: 2 GAS EXISTING GAS LINE
Z SWING-TIES SCALE: 1"=20' DESIGN FLOW X 200 % = 660 GAUDAY
ELEV TOP= 56.50, E/T/C EXISTING UNDERGROUND UTILITIES
� USE EXISTING 1,000 GALLON SEPTIC TANK
DESCRIPTION HC-1 HC-2 CB/DH ELEV WATER- <45.53 _
1 W W EXISTING WATER LINE
BIODIFFUSER CORNER(1) 24.4' 16.3' 45.5' PERC RATE _
SOS MAP 172 / F.�/C" �� BIODIFFUSER CORNER(2) 27.2' 26.2' 41.3' i DEPTH OF PERC = TEST PIT LOCATION
999�7c9 PARCEL 216 1 5�/ �_ ti /', P BIODIFFUSER CORNER(3) 50.9' 42.7' 1$.1' INSTALL 20 - ARC 36 (#3613BD) BIODIFFUSERS TEXTURAL CLASS: 1
D1 / Ir EXISTING 1,000 GALLON SEPTIC TANK
15,000 S.F. t � �
�� \ , Q1 BIODIFFUSER CORNER(4) 49.4' 37.5' 26.3'
MAP 172 SYSTEM CAPACITY PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE
1
(TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" 56.20'
PARCEL 217 \� �k" CB/DH (10.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY A/E Sandy Loam ❑ PROPOSED DISTRIBUTION BOX
P12„ 10 Yr 3/2 55.20'
Q Sandy Loam ® PROPOSED ARC 36 (#3613BD) BIODIFFUSER
/ ,' OQ TOTALS: B 10 Yr 5/6
Tip OOP (3 �� TOTAL NUMBER OF BIODIFFUSERS: 20 36" 53.20'
Q' �0 TOTAL NUMBER OF COUPLINGS: 0
O
TOTAL LEACHING AREA: 480.0
4) TOTAL LEACHING CAPACITY: 355.2 C1 Loamy Sand REV. DATE BY APP'D. DESCRIPTION
2.5Y 5/6 --
(10% Gravel) PROPOSED SEPTIC SYSTEM UPGRADE
(2 O NOTE: 60" 51.20'
alb• PREPARED FOR:
EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE C2 Med. Coarse Sand CAPEWIDE ENTERPRISES
s DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER 2.5Y 5/6
1) "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR 94" 48.37'
a, SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3, 2003 (LAST MODIFIED Silt Loamlot
LOCATED AT
C 4? MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. C3 2.5Y 4/4 9 ANSEL HOWLAND ROAD
HC-1 I HC-2 120" (Firm) 46.20'
CENTERVILLE, MA 02632
� NOTES: ,;,,,, C4 Med. Sand
2.5Y 6/3 SCALE: 1 INCH = 20 FT. DATE: APRIL 30, 2012
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC ��� �, 128 45.53 0 10 20 40 80 FEET
�� q�Q No Mottling, Standing or Weeping Observed ;ri cF I�J'A --
' SYSTEM COMPONENT. o e- \ S ,yG, ( g, 9 P 9 ��_
� LOCATION F THE PROPOSED � JOHN L. <<<P PREPARED BY: _
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOC O O RESERVED FOR BOARD OF HEALTH USE
#9 I CH CHILLJR. JC ENGINEERING, INC.
LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. \ �;
REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH EXISTING \ N .I 180 ; 2854 CRANBERRY HIGHWAY
TEST PIT DATA. 2-BEDROOM
DWELLING ;, TF. EAST WAREHAM, MA 02538
TOF = 57.3'± °f'
3.) PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION OVERLAY DISTRICT AND SITE PLAN . . .r 508.273.0377
ESTUARINE WATERSHEDS.
- ! ------
SCALE: 1" =20' Drawn By: MCP/BM Designed By:MCP ' Checked By:JLC I JOB No.2192