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HomeMy WebLinkAbout0023 ANTICO LANE - Health 23 Antico Lane Centerville P A = 172 003001 S//// UPC 12534 ' No.2-153LOR � HASTINGS, MN No. f,i`lJ� 1 —�( Fee / ) THE COMMONWEALTH"CIF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS' 4pliLation for 33ispo$af-6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.13 0� Owner's Name,Address�nd Tel.No. Assessor's Map/Parcel � A 2 C���� Installer's Name,Address - Tel No i/�1� ,��1� Designer's Rime,Addr ss�Tel. {�V i !�I t !Type of Building: 6wj%14t", �(� Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ea Design Flow(min.required), Wo gpd Design flow provided gpd Plan Date" 10,V, �/� Number of sheets I Revision Date Title Size of Septic Tank Type of S.A.S. "✓G['. �;/�,1(Gv>, f 5 3`x j t Description of Soil uhm D Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B a o ealt n 4Signed Date f 1 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. _ • -� �y'� Date Issued _ _ 1 TOWN OF BARNSTABLE pp�� LOCATION Z3 J"�AA-Lu Lr-^R- SEWAGE# 77=-V;; VILLAGE�/t4t1y'k% ASSESSOR'SyMAP&PARCEL 77 7 kcsloo INSTALLER'S NAME&PHONE NO. 6-F W EA*Vk5PS XA,- SEPTIC TANK CAPACITY D.$UU Sc. Q�✓� LEACHING FACILITY:(type) if �/V%60"5 (size) NO.OF BEDROOMS , OWNER p f • �'-� PERMIT DATE: 0() Z Z� COMPLIANCE DATE: D a 0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility s Feet Private Water Supply Well and Leaching Facility(If any wells exist on J 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 6'P kk F n In.S e S 'Z✓t 0 � 3s S� No. Q00 "— y Fee THE COMMONWEALTH"AF MASSACHUSETTS Entered in computer: Yew - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ri 4plication for Bisposah.. pstem (Construction Permit Application for a Permit to Construct( ) Repair(kf"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �C Ownex's Dame,Qddres�,and Tel.No. Assessor'sMap/Parcel M" 112 p ,�, � 5 Install 's N Address and el.No. -Ij -X�-o3� Designer's me,Address,and Tel. �.� b �� �,�S f ►vC C is71 '� S ��� W P N1S Iv1F �2l�LcU (j 1 (Tel. D2&&D Type of Building: Dwelling No.of Bedrooms Lot Size III V 1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures - Design Flow(min.required) �,V gpd Design flow provided 53--'� gpd ,- Plan Date I 0' !N 1�6Number of sheets Revision Date Title Size of Septic Tank 1 O Type of S.A.S. Z- 5 190 /:2.5 3'K Description of Soil Nature of Repairs or Alterations(Answer when applicable) r Date last'inspected: Agreement: f 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 Bo d o ealth. �7 �j �.� Signed ��~- Date /-'tJ Application Approved by Date /() -a ' Application Disapproved by Date for the following reasons Permit No,,, , Date,Issuedt) 7� Cif - r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V/) Upgraded( ) Abandoned( )by at has been constructed in accordance n with the pro,,/visions of Title 5 and the for Disposal System Construction Permit No. 1 y�dated l C�. a'I_ J Installer 94t'1 L f n�C(4,5 ��" Ff��►t Designer jL,GrI #bedrooms 3r�15�' Approved design flow �j 1 gpd The issuance of this permit shall of be construed as a guarantee that the system will function ass esigned. � a 2_ P Date t ' — (J Inspector ("-� i !! - I ------------------``�----------------------------------------------------------------------------------------------------- � /---------------- No. V�V " 3` a . Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal Opstem Construction permit Permission is hereby granted to Construct( ) + Repair( `�) Upgrade( ) Abandon( ) System located at ,-3 A n Ih c L{� 4/: 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. 11 Date �D 17 I � Approved byi �iV Town of Barnstable WE Inspectional Services sate, Public Health Division PIAs039. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 11 IZ-7 1107-C,Sewage Permit# 206-3`4 Z Assessor's Map\Parcel I-7 Z C13 f UU 1 Designer: &FrA F-.,4ef,, tSPs t,,.c Installer: G PA En4R1,2✓-.5e5 (vL Address: /5 a'�, Address: 13- Diu—a--cl{ S pe-+41 'Dcn-nss (\1\-- OR0/l, s 11AA- v Z On Z b &' A F11k,- ,',SAS was issued a permit to install a (date) /� (installer septic system at Z3 i(\A,-LG La�e \based on a design drawn by (address) G� C✓tY��l�s�S �o-t C dated Z G rJ Z C (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in c 1' ce with the to rms of the IAA approval letters (if applicable) �yAH OF 4� KEITH li. FERNANDES (Installer's Signature) WiL � z No.48725 (Designer's Signature) (Affix Desl e p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoMdeptAHEALTIASEWER connecASEPTICOesigner Certification Form Rev 8.14-13.DOC -\ COMMONW IVI EALTH OF ASBACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICI_AL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISPOSAL SYSTEM FORM " PART A CERTIFICATION Property Address: .. Owner's Name: " Owner's Address: q ' Date of Inspection: Name of Inspector: (please print) Company Name:a,_L l40wi Mailing Address: )QC-- Telephone Number:,�i� C -u =- CERTIFICATION STATEMENT Pr 1 certify that I have personally inspected the sewage disposal system at this address and that the lormation�repo ted 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 system-.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: /Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: 1 Date: 4 4,16 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system own;r 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 ****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. Title,5 Inspection Form 6/15/2000 page 1 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DTSPOSAL SYSTEM INSPECTIONFORIM PART A CERTIFICATION(continued) Property Address: C234n 94l' c� .Owner: �� Date of Inspection: 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 with310 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 Z. 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 surface water supply or tributary td 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 supplywell**. Method used to determine distance **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: 3 Page 5 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �3 Aakcn, t-,-anfD Owner: T hrJyraY , 0_1> Date of Inspection:d�Tajo Check if the following have been done.You must indicate"yes"or"no"as to each of the followins: Yes No Pumping,information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks. Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A') Was the facility or dwelling inspected for signs of sewage back up ? ` _ Was the site inspected for signs of break out? Were all system components, excluding the SAS, located on site f _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees. material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location.of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ Existing information. For example, a plan at the-Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 7 of I OFFICI AL INSPECTION FORA-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEW<4GE DISPOSAL SYSTEM INSPECTION FORK PART C SYSTEM.I NFORVI_gTION (continued) . Property Address: Owner: -e,,>,n n:c ('�CwNo p , Date of Inspection: r BUII;DING SEWER(locate on site plan) Depth below wade: Materials of construction:_cast iron _40 PVC - other(explain): Distance from private water suoDly well or suction line: Comments (on condition of pints; venting, evidence of leakage, etc.): SEPTIC TANK: ��°" (]ocate on site plan) Depth below Crade: 070 Material of-construction: `concrtte_rn e al_fberglass polyethylene other(explain) if tank is metal list age:_ is ate con,=,ned by a Certificate of Compliance (yes or no):_(at?ach:a copy of certificate) / r Dimensions: Sludge depth: y� ;a Distance from top of sludge to bottom of outlet tee or baffle: �. Scum thickness: g__ Distance from top of scum to too of outlet tee or baffle: Distance from bottom.of scum to bottom of outlet t=e or baffle: How were dimensions determined Comments (on pumr)ing recommendation, inlet and outlet to o baffle condition, structural integrity, liquid levels as related to outlet,nve,L, eyldence of leakage, etc.): r/ -Zn1,Ir —4 C.a °AD e A // tt avG q GREASE TRAP: ;�,i�alocare on site.pian) . Depth below grade:_ Material of construction:_concrete_metal_fiberglass polyethylene_other (explain):. — Dimensions: Scum thickness: Distance from top of scum to top o-outlet tee or baffle: Distance from bosom ofscum to boom of outlet tee or baffle: Date of last aumpinE: Comments (on pumping recom--nerdations; inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of!e'u1ia2e, etc.): f Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �23 14U'Cv:Ln� ,a Owner: a 1�C�da^�cC Cc.�W>�r Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):7- (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: p leaching galleries, number: leaching trenches, number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,' etc�,�.I '<Hi�ro ,�` Ga �r"y'�i/���F���1L'!' ,„'" ,: � 7 ��' r �✓� �� C'</1r?��--- CESSPOOLS:1 /' (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth'—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of.groundwater inflow(yes or no): . Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: fur.✓ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic.failure, level of ponding, condition of vegetation, etc.): .9 Page 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: AA' Owner 4r�r /x✓—S r Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells 9 Estimated depth to ground water I feet Please indicate(check) all methods used to determine the high ground water elevation: Obtained from.system design plans on record-If checked,date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with.local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: y 11 Permit Number: Date: Yn Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lot No. Owner: � � l� i Address: c� Contractor:Aortply i' rz � Address: q Notes: r STEP 1 Measure depth to water table to nearest 1/10 ft. ...................................... ............................ .Date �9 month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map 1ocate site.and determine. '- O Appropriate index well ,................. .................. '� OWater level:range zone :: STEP 3 Using'monthly'repor.4 Current Water.Resources Conditions determine current depth to -water.level for_index well ._...._:.. ............... "�� month/year STEP 4 Using•Table=of Waterdevel-Adjustments 'for index well_,(STEP::2A),current depth to water:level Jor:index,-well•(STEP 3), and water level zone.(STEP 213) determine-water-level:adjustment ..................:....................................................................... STEP 5 Estimate depth to high water by subtracting:the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ............................................................................... � Figure 13.—.Reproducible computation form. 15 i a. ' Q1 t't• s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION b F z w r W A a d A C � v �'H yve t TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACEkE SEWAGE DISPOSAL SYSTEM FORM RECEIVED °cDr,P .t < <s PART A 0 . CERTIFICATION JUN 2 7 2002 Property Address: 23 ANTICO LANE CENTERVILLE,MA 02632 a � � P Y TOWN OF BARNSTABLE Owner's Name: THOMPSON" HEALTH DEPT. Owner's Address: 23 ANTICOLANE CENTERVILLE,MA 02632 9 Date of Inspection: 6/14/02 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS,IY(C Mailing Address: P:O. BOX'.2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 k, 1• 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 Sectiona I'5.340 of Title 5(310 CMR 15.000). The system: K�,a X Passes _ Conditi` nally ,es _ Needs Furth aluation by the Local Approving Authority Fails. Inspector's Signature: G�' Date: 6/14/02 The system inspector shall submit a opy 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 sh Il.submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent Mahe buyer, if applicable,and the approving authority. Notes and Comments a . , THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****This report only describes=coudilions at the time of inspectiou and under the conditions of use A Ihal lioie. `fhls inspection does not address how the system will perform in the future under the same or different conditions of use. ;S ,} .. Title 5 lmnPrtinn Firm A11 S61-)h6,,. ;,,1• � Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 23 ANTIC.O,LANE CENTERVILLE,MA 02632 Owner: THOMPSON Date of Inspection: 6/14/02 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: THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL 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 o,Ois available. ND explain: n/a r 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'u`neven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstructioh'is removed _'`distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more<ha►i 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)ire replaced _obstruction is r"emoved ND explain: n/a t1 � , `Page 3 of I I i OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) o- Property Address: 23 ANTICO LANE CENTERVILLE, MA 02632 Owner: THOMPSON Date of Inspection: 6/14/02 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 kS 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 I 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 iised 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 nitrog"' equal fo or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be'attached to.this form. if1 3. Other: t n/a P x h ty , 1, Page 4 of 11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 ANTICO LANE CENTERVILLE,MA 02632 Owner: THOMPSON Date of Inspection: 6/14/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each.of the following for alLinspections: 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 ''/ 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 LAST YEAR. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspoot 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 tha.ttfacility 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.[ (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 systeni•fails.'The system owner should contact the Board of Health to determine what will be necessary to correct the failure. `C"A L 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 hassfailed.The owner or operator of any large system considered a significant threat under Section E or faileduildee Section'D'shall upgrade the system in accordance with 310 CMlt 15.304. l lie system owner should contact the appropriate'regional office of the Department. :f Page 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE_SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 23 ANTICO LANE CENTERVILLE,MA 02632 Owner: THOMPSON Date of inspection: 6/14/02 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 ofthe system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwe'll n'g inspected for signs of sewage back up ? X _ Was the site inspected for signs:pf break out'? 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 ofthe failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5• Ali y L f Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,SYSTEM INFORMATION Property Address: 23 ANTICO LANE CENTERVILLE,MA 02632 Owner: THOMPSON Date of Inspection: 6/14/02 i.,. . 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: 2 Does residence have a garbage grind'ef,(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)): fthr a C) _ 7 '(700 Sump pump(yes or no): NO D 1 _ L1 1(000 Last date of occupancy: n/a L COMMERCIAL/INDUSTRIAL Type of establishment: n/a r 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 I1V'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,'soif Asorptioh 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) r ` _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: 1998 PERMIT 98-381 Were sewage odors detected when arriving at the site(yes or no): NO J I 'Page 7 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE. SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 ANTICO LANE CENTERVILLE, MA 02632 Owner: THOMPSON Date of Inspection: 6/14/02 BUILDING SEWER(locate on site plan) Depth below grade:30" 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 u)Qtl.►' ` SEPTIC TANK: X(locate on site plan) Depth below grade:24" Material of construction:_concrete :metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age'confirned by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" H;5_' 6".W 5' 8'."' Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to botf'om of outlet tee or baffle: n/a How were dimensions determined: MEASUERD 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 COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Q Depth below grade: n/a Material of construction: concrete metal fiberglass_polyethylene_other(explain): n/a _ S 4 _ _ 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 relate to outlet invert,evidence of leakage,etc.): n/a :1t . 7 p, Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 ANTICO LANE CENTERVILLE,MA 02632 Owner: THOMPSO N Date of Inspection: 6/14/02 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.): VIDEO INSPECTED D-BOX-APPEARS.STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. 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 i 1 e � " R Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 ANTICO LANE CENTERVILLE, MA 02632 Owner: THOMPSON Date of Inspection: 6/14/02 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: 0 500 GALLON CHAMBERS leaching chambers, number: 2 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 i innovative/alternative system { ro; Type/name of technology: n/a , I Comments(note condition of soil;signg pf hydraulic failure, level of ponding,dare p soil,condition of vegetation,etc.): THE LEACH FIELD IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE BOTTOM IS AT 5'- SYSTEM SHOWS NO SIGNS OF FAILURE. 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 Q Page 10 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 ANT1CO LANE CENTERVILLE,MA 02632 Owner: THOMPSON Date of Inspection: 6/14/02 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. L � � 4A �A �g 6C x •, in Page I I of I I 0 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 ANTI Cd,LANE,CENTERVILLE,MA 02632 Owner: THOMPSON i Date of Inspection: 6/14/02 SITE EXAM _Slope J . _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 e'stablished'the high ground water elevation: GROUNDWATER DETERMINED BY AUGER-NO WATER AT 12' wil y+. Fi tic F 11 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �I Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpplication for ]k9potal *pgtem Con.5truction VCrmtt #a3 Application for a Permit to Construct()<)Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. UT� �•"-r 1 e-O 1-/+�� � Owner's Name,Address and Tel.No. bZYd-Z22_ Assessor's Map/Parcel ?2 �C�V w tGU�C—� L6T3-1 ,fix 63'5 e5w S•3 W _ Wt Installer's Name,Address,and Tel.No. Des* ner's Name,Address and Tel.No. 1P 'JULI.,\VFticW \VQC, Type of Building: G t,v s me S u� Dwelling No.of Bedrooms ) Lot Size%I7�) sq.ft. Garbage Grinder( � Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 515D gallons per day. Calculated daily flow 33 gallons. Plan Date kX 'ZZ i Number of sheets Z Revision Date 146►.S E Title S 1 r PL_,on) Q WCr C- J JIE;PTtG 5--(5►'Ew1, J nT \ A e k-r l co \/j©©Q S Size of Septic Tank 1 SZ`� '(�.�w►mot Type of S.A.S. %1_x25 Lc-Ac-,,k,yon ck_, P P 5 Description of Soil b 2" V6(V i N1 GGPL.ES 2"-L b r' 74 1 t`- 3 2 �� f "Q \Q A,M--& �Ztu QQO tQ�—E-P_� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to re the construc 'o nd maintenanc of the afore described on-site sewage disposal system in accordance with the provi ' ns of Title o ronmental Co and not to place the system in operation until a Certifi- cate of Compliance has b n issued this Board o ealth. Sig ed Date — Application Approved by Date Application Disapproved or the following reasonO Permit No. Date Issued DO `No. 6 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS %Wlication for Miopozaf 6p5tem Conotruction Permit Application for a Permit to Construct()()Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. l,o-T � &&A r t r-O L A of E Owner's Name,Address and Tel.No. Assessor'sMap/Parcel 1-T'L IzewlU ti=tGuec—o Lc>T-l'1 e,Scm. &3�5 0�ZZ7 3-Z. 3-3 /4-1,4­t ViiA�Li=N v1� Installer's Name,Address,and Tel.No. Des' ner's Name,Address and Tel.No. �� '�E�tZ�Vt+c.Iv�4u �JULL\utatw :E�YtUG vvG Type of Building: G WsrMZ S,>e, y Dwelling No.of Bedrooms 3 Lot Size �I)� sq.ft. Garbage Grinder(4 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33 gallons. Plan Date M Number of sheets 2- Revision Date l•�o►� E Title S t T_G P,,IAl Y ,01?C6E0 SciP-n C 645 i-Cwl )_c�,T \ -r I CC \AJ OOD j Size of Septic Tank 15CO Type of S.A.S. \Z-Az s Lt!:AL\.k(v06 yL �.k EEO�.ES Z"-1 la " tic 1(" - 3,2 � 32 - 1Z4 " G Description of Soil l�-2 �i r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ire the constr c'o nd maintenanc of the afore described on-site sewage disposal system Tn I'I in accordance with the provis'ts of Title o ronmental Co nd not to place the system in operation until a Certifi- cate of Compliance t as b n issued _ this Board o ealth. / p Sig ed 2�`s�- Date U. 2-� Application Approved by Date Application Disapproved or the following reaso ' Permit No. Date Issued , 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 -Vq C0 l_Avv CCEK e—'-1 1 has-bejen constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. at Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 1 1 r c- G! Inspector ` \ _ 4 CJ 0 R --------------------------------------- JFee � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi0pogaf 6potem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) - System located at A.N-r1 C-n 1-eX N.a 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. r © C Provided:Construction ust b1co pl t d within three years of the date of emit. j Date: A roved b r ® f PP y TOWN OF BARNSTABLE � dr LOCATION _N. �.r-r� LA--)f(�rh—'5 `�� SEWAGE'#" VILLAGE 0,64aC m� kOL ASSESSOR'S MAP( & LOT INSTALLER'S NAME&PHONE NO. -Zc�`5 SEPTIC TANK CAPACITY t qk� LEACHING FACIL=::(type) - Z C r"5 (size) ., NO.OF BEDROOMS BUILDER OR-OWNER CC L^ LVIA�S PERMIT DATE: — ' -Q --COMPLIANCE DATE: 11 1 Jam" elf 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 c5c) Z9 - - -- -- -- ------ ---- ----------- ----- - - - - - -- - TOWN OF BARNSTABLE wu � LOCATION �rr-r� c� �,c� 3 SEWAGE f f �-` VILLAGE Q ASSESSOR'S MAP & LOT —' INSTALLER'S NAME&PHONE NO. .: �c•;�, ��J -con SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Z (size) NO.OF BEDROOMS BUILDER OR OWNER n I m> PERMIT DATE: 04' - _COMPLIANCE DATE: i I 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 I � =7W Z Zg ,� RVAIC- 1 L r ANTI00 LAND - 2 SEPTIC as, —S I TANK \ P-DOX � 10 !2'*I C r ® LEACH .FIL.LD \ TH Z I a tT RU►�s C D 3 ,RM�H�OUSE PPG� AREA ,2-79 SF OF lo' WSUV ANE AS'6 M LN'r NO.29733 _ PLAN VIEW-LOT-1 CmL y Scale:I = 40 O,1 TH - I EL, 11 4 ��� TH-2 EL, 68.0 'PINE NEEDLES PINE NC-L=DLr=S 2,, O ORGANIC MAT. lip O ORGAWC MAT, \/R4. DRKGRA\/ LOAN! VRY, DRK, GRAM LOAM L4 A` rINL` SAID 5„ A FINE SAND yEL, BRN. LOAM YELL, BRM. LOAM a2„ B FINE SAND 27�� B FINE SAND. PERK TEST 1 PGRK TEST LT, YEL, 13Rn1 LT, YEL- BRN, 122 C V. FINL= SANG 12Z� C VRy, FINL SAND u PERC.oL.ATION TEST PELRCOLATION TEST CLASS I MATERIAL DePTI-1 - �18" CLASS t MATERIAL LESS THAN 2. MIN. 11�ICH DEPTH ��o'� L-E S5 T H A KI 2/V11 N/ I Al C H No WATER EN COLA NTED NO WAT1=R FINCOUNTEO DATGI 05/I4 J 96 No, ' P-514- ENGINEER! SULLIVAN ENGINEERING INC WITNCSS: 3',DUNt\IIt\IG/T OFB,, D- OF H. 1. Plan Reference, Cluster Subdivision No. 755 SITE PLAN "ANTICO WOODS Endorsed Feb 10, 1997 PROPOSED SEPTIC SYSTEM Book 531 Page 83 AT 2. Map 172 Reconfigured Lots 3-1, 3-2, 3-3, 4-1, 4-2&5-3 LOT No. ,ANTICO WOODS 3. Set Backs Front=20' Rear/Side=10' CENTERVILLE , MA ,4. The proposed foundation shown hereon complies with FOR the Town of Barnstable Zoning Set backs and is not within OLD CENTRE REALTY a flood plain „ , SCALE: I =40 DATE: MAY 26, 1998 SULLIVAN ENGINEERING INC. SHEET I of 2 OSTERVILLE, MA r ff NOTES _DESIGN DATA L Water Supply ForThis Lat is Municipal Water. Single Family-3 Bedroom With no Garbage Grinder 2 Location of Utilities Shown on This Plan Am Approx. Daily Flow=1 I O x 3=330 GPD At Least 72 Hours Prior to Any Excavation ForThis Septic Tank:3�0 GPD x 200%z 660 GPD Project The ContractorShall Make The Required Use 1500 Gallon Septic TanE • Notif ication to Dig Safe(1-800-322-4844) G AREA 3 The Contractor is Required 10 Secure Appropriate LEACHING GPDCHI CHIN N = SF Required Permits From Town Agencies For Construction Defined byThis Plan. Sidewall =2(1625,)2=148 S.F. 4 d Install Risers as Require to,Whhin 12'of ; 448oS.F.Total Provided 300 S►F. Finished Grade. LEACHING CHAMBER DESIGN 5.All Structures Buried Fomr Feet or More or Subject• At I Pipes to be Schedule 40.Use to Vehicular Traffic to be H-20 Loading. 2 -500 Gal.Leaching Chambers In a 6'Septic System to be Installed in Accordance With 12'x 25- Washed Stone Field as 310 CMR 15.00 Latest Revision And The Town of Shown. Barnstable Board of Health Regulations. Z All Piping tobe Sch.40 PVC ' FG.71.0 FG.68.0 Qt 68. 65.0 67.4 672 Top El.66.0. Bot.E1.63.0 66.0 , Bedding as Per Title 5 50 101 I ' 10.5� 10� I2 Bottom of Test Hole E 1.58,oNo.Water DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTtW Not to Scale Finish Grade Filter io Fabric —'Compacted FI(I NJ- Poo Stone to Leaching 3/4"-1 1/2Double a Chamber Washed r 4!-Id vi OF PETER SUUlVM NO.29733 y CROSS SECTION OF CHAMBER clvlt. '•:NOT TO SCALE `• �D LC>T. f �N'1l(A 'a rr Cl~14TEC,rlLLG S1 8 SHEET 2 of 2 a l'/ GENERAL NOTES:' ` DEEP OBSERVATION HOLE LOGS SYSTEM DESIGN CALCULATIONS: NO SCALE DESIGN FLOW: „ DEEP OBSERVATION HOLE 1 EL = 105f DEEP OBSERVA110N HOLE 2 EL = 101t EXISTING 3 BEDROOM DWELLING AT 110 GAL. PER DAY PER BEDROOM = 330 GPD 1. CONTRACTOR SHALL NOTIFY "DIG-SAFE AS REQUIRED PRIOR TO THE START OF ANY SOIL SOIL 330 GPD X 200% = 660 GALLONS USE NEW 1500 GALLON TANK (TITLE 5 MIN.) EXCAVATION WORK. CONTRACTOR IS RESPONSIBLE FOR PROTECTING UTILITIES WITHIN THE DEPTH FROM SOIL DEPTH FROM SOIL A 25' L. X 12.83' W. X 2' D. LEACHING CHAMBER (H-10) CAN LEACH: WORK AREA DURING CONSTRUCTION. SURFACE HORIZON TEXTURE SURFACE HORIZON TEXTURE Vt = [(25 X 12.83) + (25 X 2)2 + (12.83 X 2)2] X 0.74 GPD/SF = 349 GPD 0" - 2" 0 ORGANIC 0" - 1" 0 ORGANIC NOTE: A GARBAGE DISPOSAL IS NOT PERMITTED WITH THIS DESIGN. za Antico 2. THIS PLAN IS FOR SEWAGE DISPOSAL SYSTEM DESIGN PURPOSES ONLY. THIS PLAN IS NOT c.n:.,vw.,MA ozeaz FOR USE TO DETERMINE PROPERTY LINES. " A LOAM FINE SAND 1" - 5„ A LOAM FINE SAND INSTALL:2" - 4 TWO (2) - 500 GALLON LEACH CHAMBERS (H-10) WITH 4' OF STONE AROUND 3. CONTRACTOR SHALL DETERMINE THE LOCATION OF EXISTING UNDERGROUND UTILITIES PRIOR TO 4„ - 22" B LOAM FINE SAND 5" - 27" B LOAM FINE SAND ONE (1) 3 OUTLET DISTRIBUTION BOX - EXCAVATION � 4. ALL CONSTRUCTION SHALL CONFORM TO THE STATE SANITARY REGULATIONS (310 CMR 15.00) 22 - 122" C V. FINE SAND 27" - 122" C V. FINE SAND AND ALL OTHER APPLICABLE LOCAL, STATE, AND FEDERAL CODES AND REGULATIONS. 5/14/98 5. CONTRACTOR TO VERIFY EXISTING CONDITIONS, I JCLUDING ELEVATIONS OF EXISTING BUILDING DATE OF TESTING: >� SEWER, AND REPORT AND DISCREPANCIES TO THE DESIGN ENGINEER PRIOR TO THE SETTING PERCOLATION RATE: LESS THAN 2 MIN/INCH (PERC © 48" IN TP#1 & 66" IN Ti WITNESSED BY: SULLIVAN ENGINEERING INC OF ANY SEWAGE DISPOSAL SYSTEM COMPONENTS. PLAN BOOK 531 PAGE 83 J. DUINNING, AGENT, BARNSTABLE HEALTH DEPARTMENT DEED BOOK 31612 PAGE 246 • NO GROUNDWATER ENCOUNTERED i SEWAGE DISPOSAL SYSTEM NOTES: USE A LOADING RATE OF 0.74 GPD/SF FOR SIZING OF SOIL ABSORPTION SYSTEM. ASSESSORS' ID 172/003/001, 1. H-20 RATED COMPONENTS SHALL BE REQUIRED IN ANY AREAS SUBJECT TO VEHICULAR LEGEND LOADING AND AS REQUIRED ON THE PLAN. ° 32 EXISTING CONTOUR 2. THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS PLAN VIEW x12.34 EXISTING SPOT GRADE CONSTRUCTED AS SHOWN. ANY CHANGES OR DEVIATIONS FROM THIS PLAN MUST BE APPROVED IN WRITING. SCALE. 1 _ 20 GO �e� -•-w- WATER SERVICE LINE Q° TP TEST HOLE / BORING LOCATION 3. ALL GRAVITY SEWER PIPE SHALL BE 4" DIA. SCH 40 PVC UNLESS OTHERWISE NOTED. THE Q` oboe �, ST SEPTIC TANK MINIMUM SLOPE OF 4" DIA. SCH 40 PVC SHALL BE 0.01 FT/FT. DB DISTRIBUTION BOX 4. SOIL ABSORP11ON SYSTEMS MUST BE VENTED WHEN DISTRIBUTION LINES EXCEED 50 FEET IN SAS SOIL ABSORPTION SYSTEM LENGTH, WHEN LOCATED IN AREAS SUBJECT TO VEHICULAR LOADING, AND WHEN PRESSURE Existing Sewer line �� -x-x- FENCE DOSED. , OO �I! ' �,, A GAS LI N E 5. FINISHED GRADE SHALL BE A MAXIMUM OF 36 AND A MINIMUM OF 9" OVER THE TOP OF ALL . SYSTEM COMPONENTS. .7 .,; r IIII'IIhIPI ' Zc . Existing Septic Tank - - �\ TP 2 " (See Note #6) 6. EXISTING SEPTIC TANK SHALL BE PUMPED AND CLEANED. TEES AND/OR GAS BAFFLES SHALL BE ADDED AS NEEDED AND COVERS RAISED TO WITHIN 6" OF GRADE. 7. ALL SEP11C COMPONENTS SHALL BE INSTALLED WATERTIGHT. Existing Leaching Chambers B. COMPONENTS TO BE PROVIDE WITH WATERTIGHT ACCESS COVERS RAISED TO WITHIN 6" OF t (See Note #10) I BENCHMARK , J FLOOR PLAN GRADE WHERE REQUIRED n CL/CL CATCH BASIN RIM EL= - 9. PRIOR TO FINAL INSPECTION BY THE ENGINEER AND THE BOARD OF HEALTH ALL SYSTEM 100.5t COMPONENTS MUST BE INSTALLED INCLUDING ALL ACCESS COVERS WITH RISERS./ (ASSUMED) - NOT TO SCALE 10. EXISTING D-BOX AND LEACH CHAMBERS SHALL BE REMOVED. ANY CONTAMINATED SOIL WITHIN 5' OF THE PROPOSED SOIL ABSORPTION SYSTEM SHALL BE REMOVED AND REPLACED WITH KITCHEN �O � �' Gh�� s O CLEAN SAND. AREA TO BE COMPACTED TO MINIMIZE SETTLING. �+ O o° , • ,,. ' I I I � LIVING 11. CONTRACTOR SHALL VERIFY INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY SEPTIC �✓ I; I j "' `�� �` O IP cV SYSTEM COMPONENTS. s 12. EXISTING SOIL TESTING INFORMATION AND WATER LINE INFORMATION PER PLAN BY SULLIVAN i[tl III fie` 1 I I'I DINING ENGINEERING, INC DATED 5/26/1998 ON FILE AT THE BARNSTABLE BOARD OF HEALTH. t 1 k� 13. EXISTING FLOOR PLANS PROVIDED BY HOMEOWNER. SAS DETAIL fe moo°` I ¢ B 'S o'� O ' o° !i SCALE: 1" = 10' C3' INSPECTION PORT I � ,• I�EII� I I 'ter STONE ; BATH BED BUILD UP COVER BED 00 00 HiMIwR �. IIII I I LOT #1 AREA = 11,279 SQ. FT. KEiTM E '` BED FEVgNA S Gt1dIL � No.48725 25' � 5/tIpJ ` SCHEMATIC FLOW PROFILE: NOT TO SCALE RAISE (1) COVER To WITHIN s" OF GFM ENTERPRISES, INC. RAISE COVER FINISH GRADE R TO WITHIN 6" OF 20 40 60 FINISH GRADE ,'J PO BOX 1439 FINISH GRADE=101t FINISH GRADE=101.Ot SOUTH DENNIS, MA 02660 d, l PHONE: 508-694-5600 SCALE 1"=20' vvvvw.gfinexcavating.com LINES) EXITING D'BOX SHALL HAVE ' ' 35" Proposed +'� 4 4"0 SCH 40 SPEED LEVELERS AND SHALL REMAIN 1 (9" Min - 36" Max) _ PVC PIPE LEVEL FOR 2'-0" BEFORE PITCHING ,� (1) 4'SCH. 40 PVC CLIENT: DROP:2* min. DOWN TO LEACHING FACILITY INSPECTION PORT .. . . �--..._..__ 3' Max. " RnsE18oPwiT�Hl s'oFR�noE GERARD BRITT 4 DIA SCH 40 PVC PIPE 98.Ot 23 ANTICO LANE ' 10. PIPE SHALL BE PERFORATED 4 t4" WTHIN FIELD CENTERVILLE, MA 02632 21. a 2" LAYER OF 1 8" - 1 2"_ STONE OR FILTER FABRIC ..,': 97.43 DROP / / ( ) * 97.26 �TT,p,L �I`nitil"Ir,lrGIIYII�WN l ,N�I°" „ SITE: 97.6t yal,+Fh 2 EFFECTIVE : " Ial: : i !,, 3/4 - 1-1/2 STONE DOUBLE WASHED STONE BRITT RESIDENCE �- '.GASSBAFFLE *INLET INVERT ELEVATION II...U...s:t 7 lil 4 �1I DEPTH iuiuPI:sC ,, 23 ANTICO LANE 0 EXISTING D-BOX ALL III ,. CENTERVILLE, MA 02632 TITLE: COMPACTED BASE EXISTING 1,500 GALLON DB-3 W/ 6" LAYER OF 95.10 USE (2) SHOREY PRECAST (OR EQUAL) SEPTIC SYSTEM REPAIR PLAN SEP11C TANK D-BOX CRUSHED STONE ALL 500 GALLON LEACH CHAMBERS WITH 4' OF STONE AROUND SCALE: DATE: DRAWN: CHECKED: (END VIEW) I"= 20' 10/20/2020 KEF KEF Existing 17'f I„ 15't LONGEST RUN ( LEACHING CHAMBER EL=88t TEST HOLE CONDUCTED BY GFM ENTERPRISES INC PROJECT NO: DRAWING NO: REVISION: ON 10/19/2020 NATN NO GROUNDWATER ENCOUNTERED 9001 9001-SDS.dw N/A i 25.0 x 12.83 x 2.0' g I \ ,10.1.10.193\Users\Admin\OneDrive GFM Excavating\GFM Cloud\aa Engineering\Projects\9001 23 Antico Lane Barn stable\CAD\Plans\9001 SDS.dwg