HomeMy WebLinkAbout0034 ANSEL HOWLAND ROAD - Health ,•An-sel"Howtan-d=Road—
Centerville P
A = 172 227
a .
l
0))\,.r,
NO. 152 1/3' ORA
.n
• k
TOWN OF BARNSTTABLE
LOCATION e 4111J10d kcf. SEWAGE# Q l/-D32
VILLAGE ASSESSOR'S MAP&PARCEL /72 -2,Z 7
INSTALLER'S NAME&PHONE NO.,f OY- 11, 2J'f 7- 3
SEPTIC TANK CAPACITY /too
LEACHING FACILITY:(type) eA wotJ,-I^S (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BYr2,/,�0�
PO Ire-if 10 Ct<s I
r 6
46
5N,
sa
_ r
TOWN OF BARNSTABLE
LQCATION 3 y Ads el #pW l!4`1Gt" K' f,SEWAGE#
VILLAGE {�'VI111: ASSESSOR'S MAP&PARCEL /�7/z 22 7
INSTALLER'S NAME&PHONE NO.SOB°'y2�'97.�� ✓DS z;/�G! l9!'�"(�S
SEPTIC TANK CAPACITY /D00 LEACHING FACILITY.(type) SOO eA yAiJgr5 (size)
NO.OF BEDROOMS g
OWNER 440,111SreI r4
PERMIT DATE: 2-/y—// COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY �l-1,�,f4�j giG4`C�/
nve-k
pay
r 6
sa
7 t
No. ® �I ' op- Fee (ffl=
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Xh5potar *paem Comaruction 3permit
Application for a Permit to Construct(i. Reptaiir( grade( ) Abandon( ) El Complete System Individual Components
Location Address or Lot No.Jy #4ye—L r7JCUL4a1 9 Owner's Name,Address,and Tel.No.
C�'�r,;/'rii//F Wl4r/s re lO 614 0;1/
Assessor's Map/Parcel 17z— 2 2
28a Installer's Name,Address,and Tel.N .J off— 7
Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or
Alterations(Answer when applicable) S?��VZww 0—d o X
_NL�f
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date 2
Application Disapproved by: Date
for the following reasons
Permit No. Z0 L' 7 ;Z Date Issued
—————— —————— -——————---———---——————————————————
No. Poll - 03 Z Fee Uv
f
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
t PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Mi.5po!9ar *pgte,m Con5tructtori Vertutt
Application for a Permit to Construct(6)"Repair(6,-115pgrade( ) Abandon O ❑;Complete System Individual Components
Location_Address or Lot No.3 7 #4 f e 4� 17 v6'Vg '4'4'7 X4 Owner's Name,Address,and Tel.No.
C (// t ~fvl' ,ke to 6,411111
Assessor's Map/Parcel
r-
Installer's Name,Address,and Tel N .�p�'•' Designer's Name,Address and Tel.No.3 0,8-y���55 I 3 'I
�'Iil,�/^ ' air ? /'/r f 2 aS S �:� �� f'� •�vy .3'1"�.�.���
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
c
Other Type of Building _ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
j
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
j Nature of Repairs orAlterations(Answer when applicable) /i=Ga - o � - .<_a,2 '{
Date last inspected:
Agreement:The undersigned agrees to ensure the construction and maintenance of the aforeidescribed on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
- Signed i/ Date
Application Approved by � � Date
i
Application Disapproved by: Date
for the lollowing reasons,
Permit No. 2 0((— o a� Date Issued 2 --/t/.
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( 6,-T Repaired (,—) Upgraded ( )
Abandoned( )by / y'
at ,. /�{ (z/ _ �� �� �/����has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 0 11-0 ?2 dated ?"/Y-
Installer 1j�g/ �,� ��� �,C Designer
#bedrooms Approved design flow U / gpd
The issuance of this permit shall not be co strued as a guarantee that the system Will function as designed. _
Date ' 1� � Inspector
t No. 2� �t(� � � � - -Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
; I
Wgpogar *pgtem Congtrurtton Permit
Permission is hereby granted to Construct ( 4_�-- Repair (G-) -Upgrade/( ) Abandon ( )
System located at .,,S'L/ hi4 e-1 wl,4",
7--e e V //i;
.i
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: Construction must be completed within three years of the date of this-P rmt .
Date �= i//� Approved by � � 1 ,
P
02/17/2011 08:04 50e4775313 ENGINEERING WORKS PAGE 01
Town of Bar»table
Regulatory Services
Thomm F.Geller,Director
Public Health Division
Thomas McKean,Director
zoo Mtn Slit, HydnniI6 MA 02601
Office: 509-9624644 Fax: 508-790-6304
Date: 2)1 t` Sewage Permit# 00 -o`°2 Assessor's Map/Psrrel
Installer ` er Certificathm Form
Designer: f 4e,,--F, '1 � ?- Ia alter:
Address: �nt Z✓Krce, WM its I A C. Address: �� Cwwve^A�
\ K, �' ss ��1f244 V'orstov.S N►o Its MA oZGyr
On i ,--Sv was issued a permit to install a
e) ( )
septic system at 3 J Anse i H O .►� q r�d� l� based one a design drawn by
( s)
dated 2. -7 t
f ( esi )
�. 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.
I certify that the septic ssyystan referenced above was installed with major changes (i.e.
greater than Z 0' 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 inspected and the soils
were found satisfactory. H OF
# T.,
�fJ MP tENTCE.
(lKstaller's Signature) NCM
�Q ors , a
(Designer's Signature) (Affix tamp Here)
PLEASE TUB STABLE PMjC HEALM DIVISI N. CLEMTE
OF CONWLIANCE NUT BE I D UNTIL THIS AS-
B ARE IVED BY ST UB C D iUN.
gAaffim£im%damVwceMfjc=on fb m.dw
Town of Barnstable P# 1347
Department of Regulatory Services
MWISTARM It Public Health Division Date Z6
200 Main Street,Hyannis MA 02601
Date Scheduled a 3 ( Time d �7 Fee Pd.
Soil Suitability Assessment for Sewage Pisposal
Performed By: _ � 1-e+� G ��r�'-CQ L Witnessed By: till tiV:
LOCATION & GENERAL INFORMATION
Location Address 3 4-A r /Z l Owner's Name !�, G��,, ccc,V-/J1
C�✓t —k/t/f Address -3-qA q-.se I 4-4(rw I q'w-1
Assessor's Map/Parcel: 1-7 2 —Z-Z - Engineer's Name / M6a
/ �,�,,L-e✓7tie e.�,wl-ee.��,
NEW CONSTRUCTION REPAIR " Telephone# �C U ff— 73-7—LI-7(A. F
Land Use {[�e5'�c.�vv i u� Slopes(g'o) [—2 Surface Stones �
Distances from: Open Water Body ft Possible Wet Areal 1. ft Drinking Water Well L d ft
Drainage Way -7(3 ft Property Line Z� ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
' 0
CIA
d
AN SF-L HG VJ .P
Parent material(geologic) w*w 1J�" Depth to Bedrock dJzn"
Depth to Groundwater. Standing Water in Hole: iJ/ Weeping from Pit Face AJ / 1—
Estimated Seasonal High Groundwater
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 ft.
Index Well# Reading Date: Index Well level�— Adj,factor,,,,,,,,.,P Adj.Groundwater l evel,,,,o, - -
} PERCOLATION TEST bate Thne, ,
Observation
Hole# Time at 9"
Depth of Pero Time at 6"
Start Pre-soak Time @ ' ~ Time(9"-6")
L.. Z'" 41r.1�1,
End Pre-soak
Rate Min./Inch,
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
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:\SEPTIC\PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# I
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consiste vcll
10 IYKyI2.
DEEP OBSERVATION HOLE LOG Hole# z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
A L a U�dC 2
36 �iZ�v C (`1—C sca►.v� 2,5 6/u tQ � 5 ��
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
os' tn Graygil
Flood Insurance Rate Man:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No P(� Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervio 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
(date)I have passed th
( e soil evaluator examination approved by the
I certify that on
-Department of Envir nmental Protection and that the above analysis was performed by me consistent with
the required tr ' ing,expertise and experience described in-310 CMR 15.017.
`�-- Date 0
Signature ,
Q:\SRVnC�PERCFORM.DOC
r
COMMONWEALTH OF MASSACHUSETTS R iEIVED
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR'
DEPARTMENT OF ENVIRONMENTAL PROTECT ON JUN 0 4 2003
x d TOWN CF BgRNST
HEALTH DEP7AB�E
A o
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
r PART A
CERTIFICATION
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632 Lpk a'l
Owner's Name: JORDAN C/Q REALTY EXECUTIVES
Owner's Address: 1597 RT.28 CENTERVILLE
Date of Inspection: 5/6/03
Name of Inspector: (please print) JOHN GRACI,INC. _
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 ,r
Telephone Number: 508-564-6813 FAX 508-564-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
_ Conditional P sses
_ Needs Furt r valuation by the Local Approving Authority
Fails
Inspector's Signature: Date: 5/6/03
The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspecti n. If the system is a shared system or has a design flow of 10,000 gpd or greater,the
inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be
sent to the system owner and copies sent to the buyer, if applicable,and the approving authority.
Notes and Comments
SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
****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.
Titles 5 IncnPrtinn Fnrm 6/1 Snnnn I
Page 2 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X 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:
SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
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.
n/a 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: n/a
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of
Health):
_ broken pipe(s)are replaced
_ obstruction is removed
_ distribution box is leveled or replaced
ND explain: n/a
n/a 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: n/a
Page 3 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
C. Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water
supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water
supply well". Method used to determine distance n/a
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and
volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy
of the analysis must be attached to this form.
3. Other:
n/a
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped NOT IN THE LAST YEAR..
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with
no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP
certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.]
NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in
310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E. Large 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.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat
under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
4
Page 5 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection ?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site signs inspected for of break out ?
P
X _ Were all system components,excluding the SAS,located on site '?
X _ 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?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X _ Existing information.For example, a plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable) [310 CMR 15.302(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM-O NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 1
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
�
Water meter readings, if available(last 2 years usage(gpd)): � 3,
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: NOT IN THE LAST YEAR.
Was system pumped as part of the inspection(yes or no): NO
If yes, volume pumped: n/agallons--How was quantity pumped determined?n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_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): n/a
Approximate age of all components,date installed(if known)and source of information:
1982-PERMIT82-352
Were sewage odors detected when arriving at the site(yes or no): NO
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 12"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: L 8' 6" H 5' 7"W 4' 10""
Sludge depth: 0"
Distance from top of sludge to bottom of outlet tee or baffle: 34"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or bafflel it
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL SEPTIC TANK COMPONENTS ARE STRCTURALLY SOUND AND FUNCTIONING
PROPERLY.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP: _(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert, evidence of leakage,etc.):
n/a
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
D-BOX IS STRUCTURALLY SOUND.
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
R
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 1
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.):
LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF
FAILURE.THE PIT HAS NOT BEEN MORE THAN 1/2 FULL. AT THE TIME OF INSPECTION IT WAS 1/2
FULL.BOTTOM IS AT 8'
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
n/a
A
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
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.
Vi
u
og
AA 1)a
AB 1b
ACV4
A� .
3v
3�y
to
Page I I of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34 ANSEL HOWLAND RD CENTERVILLE 02632
Owner: JORDAN C/O REALTY EXECUTIVES
Date of Inspection: 5/6/03
SITE EXAM
_Slope
_Surface water
_Check cellar
_Shallow wells
Estimated depth to ground water 12+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
GROUNDWATER WAS DETERMINED BY HAND AUGER-NO WATER AT 12'
11
LOCATION 14 SEWAGE PERMIT NO.
01 07 ./sC ow ✓
VILLAGE
+ 20�
I N S T A LLER'S NAME i ADDRESS
ROBERT B. OUR CO., INC.
GREAT WESTERN ROAD
�IORiH �AIIWIGII;-#A��--$?6�5
BUILDER OR OWNER
DATE PERMIT ISSUED 9_.2 S�
DATE COMPLIANCE ISSUED ��/0
r �A �r
-;�,
3 ` ��
��'-
t�.; , .
u+�,.
\�,
CID
f
TX
' ' " N
tr i
� t
i �$rvV
_ --�
5e _
6 _ t tAb
_77 IF
s
o.
No.._.' a L Fizim
THE COMMONWEALTH OF MASSACHUSETTS
_BO A R® �I-I
ApplirFatiun for UiupusFal Works Tuntrurtiun ramit
L Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
3 System a��t77: •.A� - .... !---��"
........�:.L.._....._....z: .. - ..... . . .. _.
ocation-Add t N
�4 4. �71.[..... V ner Address
W --••----------------------• +
� Installer Address ,,�
Q Type of Building Size Lot... feet
U Dwelling—No. of Bedrooms____. _________________________________Expansion Attic ( ) Garbage Grinder ( )
per., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other-fixtures ----------------•-------•-----
W Design Flow...... .....2r.5.................gallons per person per day. Total daily flow........ ..................gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •---•-------------------------- -------------------------•---------------........•--•--•--------------------.--.-------•--••---------------.-----------------
0 Description of Soil.......................................:
x
W -----•-----•-----------------------•------•-•------------•----••-•------•-------•------•----••-•--•------•---------------------•---••------•-----•------••--------••-----•--••-••-.....------------•----
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
------------------------------------------------------------------------------------•--............-----------•----------------------------------------•-•-----•-•-----•---••----••--...._..-•--••------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TT:2, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu b i the boa of health.
Signed........... ...... --- ---.. ...--- ---.......-----------....--•--
Date
Application Approved By........ ------------------------------------------
Date
Application Disapproved for the following reasons---------......................................................................................................
....-•-------------•-••-------------------------------•----------•••--••.....----------------••--....--•--•---------------------------•------•-----•••--------------------•------•--••---•-----......•--
Date
PermitNo.......................................................... Issued_.......................................................
Date
p 1'10
No..tl-5�1_35,L Fx$ .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....O F..........................................................................................
Appliration* for Uhiponttl Works Tontrnr�tion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( )..an Individual Sewage Disposal
System at:
................__......_...................................................................... ..............................-................................s..................................
Location-Address or Lot No.
......................_'---...................................................................... ..........--......................................................................................
Owner Address
W
Installer Address
Type of Building Size Lot.............................'' Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
a Other fixtures ---------------------------•-••• .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter____-______-___- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
a -------------------
-.......
•----------
ODescription of Soil........................................................................................................................................................................
x
W •-------------------------------- --------------••-------------------------------------•--••-••----------------------------------•------•-----•---•---------•-----•----•-•--•------------------•--------
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
-•---------------------------------------------------------•---------------......•----••............•-•---------------------------•--------•-----•-•--------------------••--•--•-------...---•-••---•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT s Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed.........................9------------••...----•------•-------_......... -----------------
Date
Application Approved BY---- '
Date
Application Disapproved for the following reasons---------------------------------------------------------------•-----------------------------------------------•-
---------------------••----------......----••-------------•----•----------------------------------.....-...------------------•--------------------------------------------.......................
Date
PermitNo......................................................... Issued....................................................7"
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Trrtifiratr of Tontplittnrr
THIS IS 0 CE� IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by Install .„� P ✓
ff (.
at ""� s- --------------------------V -------•------......
has been installed in accordance with the provisions of TI ` of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.v_r._"J.rZ .......... dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. pA
DATE.......---_-•-- Cj//Q/�................. Inspector....-• ..........................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
N
2:. '-� . ..........................................OF..................................................................................... J
......................... FEE........................
Ditipinal Works nntrttrtion "unfit
Permissions hereby granted---""..✓ j........ ---------------------------------------•-•-----------........................
to ConstrU , Y E3epair ( an Indiyidual-S w ge a po Syst. ,
at No
Street
as shown on the application for Disposal Works Construction Permit Noo--jy--------.._ Dated..........................................
��✓ f
DATE• L ..........
Board of Health
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
t.io Garzr3a��- ��cc*v.7U�1Z
I-ad I L..�4 F LAW - 11 O s. G G P•U. ,\ aS��— /./�. IJD �i - '
KEPI"IC T�1�lK'=J3`�OJ tr7G % • �C! u.FD. /� � ti
USA- t 00C-.) 64.L-.
1715F?�SAL. PiT - uSE. I000 Gam-. 1�
,-,UzWALL AeaA : ISO S.P.
ISo SF 'c 2.S , S-7S G.P.V.
�-� yam'. � ► .c ti So C�.PD. � ' - � _ ,
TOTAL 'vESIGKI m .i2S G•RD. ' - - -
I-voND,
G�fLGOLQYlO�.1 C7_AT<r S �����•l I-MIQ' 02 LEM, 2` s to
ID
per'-
�yw� P`jN OF Af `�� U,'`` P/T
y RPGfiAa'#UF;, or ALAN
B6lX rEA L: •� �� s +
M). '2A049 (E' JO 41 H '00
No.
i O/$TC6@i Q F 2�
Ti�sT P-��l-� �•� epo ; Tor rya �I
r.r •. // �.. .'//� r.
.T.► Jccrni :��
LcA ,� Pie I o00 5,8 '
+ 4�p/PA � Iw. G,aL.
S Jg501 V -$ox 5'1.� S�rlc I o A'.
INV. l 7-AN14
� 100O I''N'
I
GQA�t GaL . Z.
w LAN ••�
IIII Pi T ,
(a� W 1 r1-1 •i
I i WASHED
STon1E=
I I
EEQi'tFiED PLC)7 PL40-J
! P20E-rLE: LbGATIo� T1/l(�.<5
k� ►..I 5 C.A L —
WATBYL
1
GV►zT14=`r TEAT T1-1� u��I�TIo►J 5tloru►.1 -. pl--A.1-1 RL-F`��►•1GE
t-�E.r'l_�IJ GcaN\PL�(S W ITI•-! Tt-!c: �jIDE t_1►-�� � Z�
Aua `�C�-1':nCtG '~'c4v1�E�GuTS r7F TNT
•�o w►� G�= '��12-I��A.?-+.L� l��T;��i u,� �,� r 6-�-�c.,�,JCS
F3/4 XT'C-.
t2CGIS r'C_RC•D "Wo �U2V�`fo►:�.
"T-I-115 h t_A►-t I d�oT �ASEO
Ua4 pry
Sl4c'ww IA.Pr�L_1 [_t�.ti►T" I
r6 ter-mil i_ r'/blI►�t_ 1_U'C l-II�l�•.� -�LIJ �� �✓'Yt 'e
v N p cV
M 6 Z
Qo p OQO CD -)z Oz Q N Z _
!n J Li W Z Z O Q Q Z C O m I w 0
O y�°�6 J Z Q F CD T CD (n z Uj W } g C Q 0 to -
J Q WU Op Zw Qw a0 L?� m z ^ g •-
y,° A Q ° O Wa Of LLiJO m0 0(n W W m(nv
LIJ
y�e c = � J O
° o >m i
w�w f I
Q0 � ��
w z=N (n �L� _IQ- QQo � W U) V)V) _
z� cYi �
°c1 cC) ~ !Yz JQ ZO WOmH p wF �O zL � (J) a � Lj > �H m ~
(n Y Q Y= of = C) w a0 O0 �0� Q_i [r W QQ oa Ud
N O m Ljj=0 C-) U� F-Q Of _U O m Q Q d -)�U Of � ♦LLB w U
0 F-Z m 0 D F- �U(n �- Q W O W Y \,/
d Qa F W Q as ooz > O Ja F 0- QU � Z
JG UO >� O wp F 0 L, 0 aLLJ a J0 Z(n W(n gQ w
o �cA Oz CrW ~> ma za(n wC) U)) a Q Ow >o z m � Z_ w N \
a2 �o ..I az �-i 1-p oa0 JT0 a w (� U J �J �O m J U w II w \
�O F' Q O~ Opp U Z F m z W S F (n w F- W Q 0 m v QJ t- N
Z L��- z w F- C co y- F z O w S S a W Q 3 V o
4 Cam 0 [, a Q 0Q� F- z� F-a U
mw z J= z z OFm wp Faaf W0 JOU 00 � w w °
V Z 00wp QF- aJ� aOp Uz 0 0 Z Q_ w z m w
•,� A V)Z Z D S 0 SU-)a 0
0 d O �� Jo �} p=z w o a0r 0 (n (n z a (n O (D
z /A4 m� JO(n m UlO 0 �Oz O BOO �a a w N
do O/ ZDW QJZ J 0 (n ~ F- U) Q Jc) a0(n L-W U C O
Gb�°ti u=i�� �> �z� Q oaC > z oz(D CO LU F- Q o Z (� Q (n Q Q
Zw F Oz Zww m = UQz Fnp C F -
w �� Jw� }, za� Zo (/1ZN p F- aa> ZZ Of 0z Lj LJ 0 M
a �� �a w(n o 0 0 Z W V) a U Z
w > 0 QZCD Ja 0SZ p OZ O Liz z a W
O w LLJ Z W O W Q Q O O w a LLI �.a (nLLI J O F-Z z 0 .> a
'M M N F- �Q Q-a o0 WHO Q W0W O J 00< CrQ OWw (nFn m Z 0- 0 N
O O S �z 0 a Z 0 w m z a s l� _}- �` LZ U Wp 0 C) Ld U w
H w OF- wZ 0Qa a Sao a w w p 0 0
z O ►- Y Z F J Q _ w (nS0 (n z0a wmS SO L)m Z F V) O L
�C) W 3 Q (nw z�(n OOz Oww p WC)a J oz Uz~ ~zo �Q)=- am m =
C9 U o F 2 0 J mS QQw 0Uz o(nm F zip a w ��mm m�v w0m� 00 Z O �o
F F- F a C) Z w Q0 f�jr �aW zOLLJ W u0-jz ` Cr) Q L'i JUG aQw a� ~ W J
X LLI
X X W w C W C=)0 �=-t U)LLJ z0 C)F-Z W 0O� a W QOwLLJ U <-i~- LLJ=Q V) a Q c n
W W W F- m W Z J Q J~U W (/) }0 CD J W W Q F- W J a W (1)w Z W�'a w (n Z /'O/•� 7 p L M
�.J �.1..1 Jo JWO SOW Zaz J S=W Q = J('a DSO SZW a co Z S (n LL L p In
(' Q m Q O J t-F-0 Q L�w Q F-F-_ F- Q Q 0 F- �-a Q_ F- _ O Q �+
c (D
O N r7 d' to (D r-� 00 (r O N M A/ L-
•C I�
O O LL 0 C•� t'n�
CD (D
co
x a w W '::
1
*� r.TTS
CIO
J O Z q)
•�
= �
Q m U Z�i'I•{
V �O 0�O CJ '>
Q Z WWYO
O f�
o W O W O Z m W / l
U ry co
t (7b --�I
of
CD
S 60-2337 E o i
--- ---75 7i � (u / r
fence 155.7 ' C6 1
(D o + r
. ........ ..
r
M
of I +
(U C) N
CD,-, (U N O'
/ r r
T-i:. :PRO A.S.;::.: to (n I a
o .:` O ON (U \\ / opt x13
-00
r
+ N '
o CD + N
uj
r- ao o pro i w
z D Z L— ►7 / a�
CD \\ WOO O X m �- `+ '? rn
Q + LO /
v p
LQ
Y I a
C I \� U 2 1
Uu W I J O
��l o to
N
01i � N302!b'� T
0 - _ ' m (bM�il INO Oil t'd I ��
_ iO
N
CD
CD / O / '
X I, (U r CD �J
O / 0 (>, +
�6 0 o • r
�� ��� +2............ � . � z(U
' CD
mc:
81,lS OS N i (--)m
CP
o-
*n o o �
�� f o
y6
J
O•
:Y
i
NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH
{ GRADE SHALL NOT BE < EL: 99.5 FOR A
DISTANCE OF 15' AROUND THE THE S.A.S.
SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S. (3) 5" DIA.OUTLETS
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL RISER & COVER OVER EACH CHAMBER AND
OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE SET TO 3' OF F.G. TO ,SERVE AS INSPECTION PORTS 16"
T.O.F. 15.5 r. — �2
EXISTING F.G. EL: 102.3(MAX.) —�
F.G. EL.=102.7t -F.G. EL: 102.3t ti
W
F y 12„
L - 32' L = 12'(MAX.) 15.5" y
: ® S=,% (MIN.) S=1% (MIN.) 6"
4"SCH40 PVC 4'SCH40 PVC 2' LAYER OF 1/8" TO 1/2"
.. :.
DOUBLE WASHED STONE
6 •�4, .
1o"I aB $ as (OR APPROVED FILTER FABRIC) •�
.� 14" 6" 0000666 „
EXISTING 48" LIQUID INV.=100.45f aaaaaaa --3/a" TO 1-1/2" DOUBLE 2
4' 5.2' 4' WASHED STONE H—10 LOADING
LEVEL INV.=99.67 INV.=99.50
GAS BAFFLE PROPOSED D-BOX EFFECTIVE WIDTH = 13.2' D—BOX
EXISTING SEPTIC TANK INV.=99.00 N.T.S.
2-500 GALLON LEACHING CHAMBERS
SURROUNDED WITH STONE AS SHOWN
H-10 RATED
TOP CONC. ELEV.=100.3
BREAKOUT ELEV.=99.5
NOTES: 1 D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=99.00 seas
eases eases
GRADE ON A MECHANICALLY COMPACTED SIX ease eases ®®®® ® ®
INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=97.00 4' 2 X 8.5'=17.0' 4' ®®®®®® ® ® ®®
310 CMR 15.221(2). F- 33"
4' OF NATURALLY OCCURRING
2) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL EFFECTIVE LENGTH = 25.0' w ®
3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE & 5'(MIN.) TO G.W. N Z ®f®
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION -
4) MAXIMUM COVER OVER SEPTIC TANK, D-BOX & S.A.S. BOTTOM OF TP, EL=91.4 4
SHALL BE 36". j „
SEPTIC SYSTEM PROFILE 102
N.T.S.
BACK OF HOUSE 4" KNOCKOUT
20" DIA. COVER
DECK SOIL LOG 4" KNOCKOUT / 4" KNOCKOUT 62"
DESIGN CRITERIA DATE: FEBRUARY 3, 2011 (REF. P#13,187) 0
SOIL EVALUATOR: PETER McENTEE PE
NUMBER OF BEDROOMS: 3 BEDROOMS WITNESS:' DAVID STANTON R.S.
I HEALTH AGENT 4" KNOCKOUT
SOIL TEXTURAL CLASS: CLASS I ELEy. TP- 1 DEPTH ELEy. TP-2 DEPTH
DESIGN PERCOLATION RATE: <2 MIN/IN !�
p 'LA 102.5 A I 0" 102.1 A 0"
DAILY FLOW: 330 G.P.D.
DESIGN FLOW: 330 G.P.D. 4j SANDY LOAM SANDY LOAM
`� 1015 1OYR 4/2 12" 101.4 10YR 4/2 8„ 500 GALLON CAPACITY, H-10 LOADING
.
GARBAGE GRINDER: NO J rp g g
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY p o SANDY LOAM SANDY LOAM CHAMBERS
I C 10YR 5/8 10YR 5/8
LEACHING AREA REQUIRED: (330) = 445.9 S.F. p• ^' 99.0 42" 99.1 36"
74 ^ C C N.T.S.
USE 2-500 GALLON LEACHING CHAMBERS IN SERIES ��- (M-C SAND M-C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN
� -O '
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 7 2.5Y 6/4 2.5Y 6/4
,D% GRAVEL 10% GRAVEL 34 ANSEL HOWLAND ROAD, CENTERVILLE, MA
SIDEWALL AREA: 2(13.2' + 25.0') X 2 = 152.8 S.F. NI
BOTTOM AREA: 13.2' x 25.0' = 330.0 S.F. v!� Prepared for: Maristela Cavill, 34 Ansel Howland Rd, Centerville, MA 02632
TOTAL AREA:..............................................................482.8 S.F. i SCALE DRAWN JOB. N0.
Engineering by: 108-11
N 92.0 (� 12s" s1.4 ,2s" Engineering Works Inc. NTS P.T.M.
PERC IRATE <2 MIN/IN. ("C" HORIZON) CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74(482.8) = 357.3 G.P.D. 12 West Crossfield Road, Forestdale, MA 02644 DATE
S.A.S. LAYOUT NO GROUNDWATER ENCOUNTERED (508) 477-5313 2/7/11 P.T.M. 2 of 2
13.2'-