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HomeMy WebLinkAbout0044 AUDUBON CIRCLE - Health 44 Audubon Circle Centerville P A = 1s91 179 l/// ��. mead® 3 UPC 12534 No.2-1 OWR BASTleot YN No. 20 I ' 3� Fee (�' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es 2ppfitation for Misposal Opstem Construttion i3ertnit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L4 q A-1jo 1.,n C4 Owner's Name,Address,and Tel.No. . Assessor's Map/Parcel (� i'] �� 'A n n A 13 o&1 .4 t f� T✓u5 , Installer's Name,Address,and Tel.No.ems ; �•�, Designer's Name,Address,and Tel.No. 60 Type of Building: Dwelling No.of Bedrooms —3 Lot Size f`o 21) sq.ft. Garbage Grinder( ) r Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 395110 gpd Plan Date S 1� '`2�l 1 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) �SL; �V*Vvk T j rpm,. 6 Date last inspected: -2,0 l Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal Si ned Date -J t 110 t 1 Application Approved by Date /� ZO to Application Disapproved br Date for the following reasons Permit No.�� /� Date Issued 5� I d ' No. 2a i I � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es i ftplication for Disposal *pstem Construction Vermit Application for a Permit to Construct( ) Repair*�), Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L4�rjy-jo%,^ ;d r-0!. Owner's Name,Address,and Tel.No. , A n m A 1J0✓J Pz)ib F-pa-�t�`� Thus Assessor's Map/Parcel ((i I I 11)9 Installer's Name,Address,and Tel.No.Caeeu),a, . Designer's Name,Address,and Tel.No. I�3 C�� r C�� Sr t�Z_ 1 .c_ t'�, z�,Y C✓ �,� l wy Type of Building: 77 Dwelling No.of Bedrooms J Lot Size 1(o, 2 0 sq.ft. Garbage Grinder( ) Other Type of Building ;`%t t,,110 -(io-ro-i t-1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 0 gpd Design flow providedF' L U gpd Plan Date S 17 201 1 Number of sheets `Re ision Date t Title Size of Septic Tank 7�qD r~x, Type of S.A.S. ' Description"of$ml-4"N _,,i;i-L. 1 ` Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal . _ Signed i— Date Jr O 1 2t> 1 r Application Approved by Date /0 2.0 Application Disapproved by DDate for the following reasons Per" it�,At /�9 Date Issued .5 ' tom! • ,j �._..' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitatr of Compliance THIS IS TO CERTIFY,that the On-site Sewa e Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by L41r?.t,J. +� 1(�✓.l S �� L�,L at �y' L. fC.\-e C2M,tt,*\t- has'been constructed in accordance with the pro isions of Title 5 and t e for Disposal System Construction Permit NoZ420- /V7 dated I Installer t 'Z�A-ff Designer 7T . L- 'eyi dL&-ti - #bedrooms Approved design flow and The issuance of this permit shall not be/con/sttrued as a guarantee that the system will°fun`ctiorLas d igned. Date �fl !t Inspector --------- ---------------------- ------------------------------------------------------------------------- -----20 - No. i t _ (3 1 Fee*too. DJ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Disposal *pstem Construction �Prmit Permission is hereby granted to Construct( ) Repair(y[) Upgrade( ) Abandon( ) System located at �L+ r�W�oi► l�dc�� C{ � �.�ll and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 7 �O� << Approved by / 05/20/2011 00:32 5082730387 90174 P. 003/003 'own of Barnstable Regulatory Services Thomas F.Geller,Director Public Health Division r 63g6 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508.862-4644 Fax: 508-790.6304 Date: 5f2o`1 Sewage Permit# Assessor's Map/Parcel la( 01 Installer&Designer Certification Form Designer: 'SC Enn►Oaect0 h , _r,nc. installer: Gafe_w►de. 1~,1lerfctseJ- Address: 165N Gcoobec,X W4% wa ! Address: '7(_3 d Cask Wuafglno,n Nfl 026BO �--Q/''1Y/��.```� VWA On �La�-�`t CAft"J4 '4)f) was issued apermit to install a (date) (installer) septic system at y flUAab04 Gisele- based on a design drawn by (address) dated (designer) [ 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. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State.& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. E,,�TH OR �LW aller's Si azure) { 4si A npHere)esig PLEASE RETURN TO BARNSTABLE PUBLIC ALTH DIVISION. CERTIFICATE OF COMPLIANCE 'WILT., NOT BE ISSUED UNTIL ROTA "I MS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARN'STABLE PUBLIC HEALTH DIVISION. THANK YOU. q:�oltice tocrosldesignerceaiPca�ion farm.goe TOWN OF BARNSTABLE LOCATION SEWAGE# ?-TV VILLAGE ( E,6,4 ,yj 1/= ASSESSOR'S MAP*LOT/4/ !T Q INSTALLER'S NAME&PHONE NO. 4 y7-D3 594 ✓oJYt'�i �,c/�ibrry s SEPTIC TANK CAPACITY rBDD LEACHING FACILITY: (type) (size) .3S k q NO.OF BEDROOMS :::....BUILDER OR OWNER qw, c/0!lHSO,q PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site 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 1 i �dDalfo� C�r�l� I r I i I ........ i �3pcic Town of Barnstable P# Department of Regulatory Services . H.A.—: Public Health Division Date p .e q. 200 Main Street,Hyannis MA 02601 Date Scheduled _ 5*1W _ Time Fee Pd. Soil Suitability�Assessment for Sew,agre Disposal 4Performed By: uf C161tA Witnessed By: LOCATION&GENERAL INFORMATION e^ ./� .: Location Address ++r] Owner's Name }{Ytdt�1 3Qf1 "l 1 Ru o'�8 [�1G i'1C-t o r'c.1t cm>w v Address 44 A Va 0 6®I, Assessor's Map/Parccl: 1 I"�q Engineer's Name Cf4(?zw J e t 5C.ElY)5 GGe"Y15,ThC NEW CONSTRUCTION REPAIR Telephone# � l 7 �� r G6 a 27 77 J`f� 7 7 Land Use Alu V anC Slopes(%) 2-5 Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well — ft Drainage Way ' ft Property Line 7 6 ft Other — ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) Parent material(geologic) Z'V �b� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: 7 I Z0 b5$ Weeping from Pit Face Estimated Seasonal High Groundwater :.. .. DETERMINATION FOR SEASONAL.HIGH WATER=TABLE Method Used: DIreCA bk0 ti VGA _ Depth Observed standing in obs.hole: 7)Z 0 .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 Adj.Groundwater Level= ............ ......._...... _..__. _... .............. ._..__... ...... _..._..._ _..___. ..........__... .._.............._. . ......... ........-.................. PERCOLATION TEST Date. 1 i) Time /C /! Observation Hole# Time at 9" .. ' n p U t� Depth of Pere >0- 7 b Time at 6" Start Pre-soak Time Q •/ A Time(9"-6") End Pre-soak Rate Min./Inch L Z • 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* w Barnstable Conservation Division at least one(1)week prior to beginning. .Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Ivfunsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) o-Z 2-b aIf, _ L 5 -i0 it 3/1 b=30 3 Ls 1© Ilr� 3t?-120 9cove.l DEEP,OBSERVATION HOLE LOG Hole#_` 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven 'D -2- - - — - Lillie. 2-b Rl� LS fD Y.r 311 LS 1.6_Yr 3t-120 G 11-GS 2.5 Y ('/16 5°/�SGave 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. Consistency,%Gravel) Flood Insurance Rate Mao: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed forthe soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? Certification I certify that on 10-21-91 (date)Ihave passed the soil evaluator examinalion approved by the Department of Environmental Protectnn and that the above analysis was performed by me consistent with the required training expertise a d expee described in 310 CMR 15.017. Signature Date Jr'5-11 Q:\SEPTIC\PERCFORM.DOC T6WN OF BARNSTABLE LOCATION l q �t/m SEWAGE# nVILLAGE een"t Aj y ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ICO& kfi 0 FY rf LEACHING FACILITY:(type) (Zv) 4-VC. ace! (v (size) I Y.t Y 2 Q NO.OF BEDROOMS 3 OWNER j4nt,� Oc,,t-u2 PERMIT DATE: '' 10 — 20 ( COMPLIANCE DATE: J — Z.A Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility We ! 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, t ffy y�y �s ys, I . 3, Zz,r N 43 frtq, v A) 7Q► 0 COMMONWEALTH OF MASSACHUSETTS �J EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION PAP PARCEL I`7 LOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 44 Audobon Circle Centerdle Owner's Name: David Johnson Owner's Address: 44 Audobon Circle Centerville C00PCD ly Date of Inspection: August 6 ,2003 Name of Inspector:(please print)Timothy E.Cash Company Name: Cash's Trucking Inc. RECEIVED Mailing Address: PO Box 7 armouthpor- , Tdephone Number.. 508-362-3221 AUG 0 7 2003 CERTIFICATION STATEMENT TOWN of BAREPT HEALTH DEPT.. I certify that[have personally inspected the sewage disposal system at this address and a information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and c%perience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved systesu inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: XX Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: August 6,2003 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments i, "This rrp®rt only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address low the system will perform in the future under the same or different conditions of vise. Tie 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Audobon Circle Centercille Owner: David Johnson Date of Inspection:August 6, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: This system is in good working order,I have found nothing to indicate that this system meets any of the faihre afteria gout forth bye the state. or local government. B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or enfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Audobon Circle Centercille Owner: David Johnson Date of Inspection:August 6.2003 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 pubic 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 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. Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:44 Audobon Circle Centercille Owner: 0avid Johnson Date of Inspection:AuDust 6, 2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for ail 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 /S day flow _ X Required pumping more than 4 times in the last year NOMdue to clogged or obstructed pipe(s).Number of times pumped - 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 i 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 forma h(Q_(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 hibutary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-I WPA)or a mapped Zone U 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 44 Audobon Circle Centercille Owner:David Johnson Date of Inspection: August S.2003 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 art of this g Y Y p 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 inspected for signs of 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 of the failure criteria related to Part C is at issue approximation of distance is unacceptable)13 10 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 44 Audohon Circle Centercille Owner: David Johnson Date of Inspection: August 6.2003 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:0 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no):i Water meter readings,if available(last 2 years usage(gpd)): 2001-34,000 2002-38,000 Sump Pump(yes or no):_ Last date of occupancy: 8/03 C OMMERC IAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd Basis of design flow(seats/persons/sgfietc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Owner of property Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval y Odlter(describe): Approximate age of all components,date installed(if known)and source of information: Installed in 5198 Were sewge Wors detected when arriving at the site(yes or no):_ Title 5 Inspection Form 6115/2000 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: 44 Audobon Circle Centercille Owner:David Johnson Date of Inspection: _August 6,2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: 10" Material of construction: xx concrete metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):T(attach a copy of certificate) Dimensions: 1000 aal. Sludge depth: 11.5' Distance fmm top of sludge to bottom of outlet tee or baffle:2.5 Scum ftckness: 0 Distance from top of scum to top of outlet tee or baffle: 0 Distance from bottom of scum to bottom of outlet tee or baffle: 0 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.): The tank over all is in Good shape and shows no signs of anv leakage. GREASE TRH (locate on site plan) Depth below grade: Material of construction:_concrete metal fiberglass_polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:44 Audobon Circle Centercille Owner: David Johnson Date of Inspection: August 6.2003 TIGHT or HOLDING TANK (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:—concrete metal fiberglass__polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: even 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.): Box is level and shows no sign of any leakage, or carrie over. PUMP CHAMBER (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Audobon Circle Centercille Owner: David Johnson Date of Inspection: August 6,2003 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ _leaching chambers,number. xx leaching galleries,number: 4 _leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: _innovativelat'temative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): 4 Maximizers in a trench 35'X9'shows no sign of any failure , no ponding ,vegitation good , no breakout or hydraulic failure. CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate 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: (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.): Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Audobon Circle Centercille Owner: David Johnson Date of Inspection: August 6.2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. o'� qq' SO7-1 sr / l Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Audobon Circle Centercille Owner. David Johnson Date of Inspection:guoust 6.2003 WE 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: _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) xx Accessed USGS database-explain: Cape Cod Comm. You must describe how you established the high ground water elevation: NOTE Next cage for figures. I augered down 12'no water encountered . Usinq well miw29 with a reading of 7.6 and a aiustment of 1.9 in zone B we come to the calculations on the next page. Title 5 Inspection Form 6/15/2000 11 Permit Number: _-_ D<,te: 8/6/03 Completed 1,y: Timothy E. Cash HIGH GROUNDANATER LEVEL COMPUTATION Site Location: 44 Audobon Circle ,Centerville t_Ol No. o N„Ur: David Johnson Add,ess: 44 Audobon Circle ,Centerville Contractor Cash's trucking Inc. nddress: PO Box 7 ,Yarmouthport .......------- ------.._........... ---------.._.._._..------ Now,: No watetr encountered F:9easut-:t.lepth to Suter la'.,IU to nearest 1i10 It. ............... I;)ate 8/6/03 12.0 ............................................................... nu On!h/daY(yaat S rEP 2 Using Waler-Leaaa Range Zone and Index Well Map locate rile anci drlcrminc: - - m1w29 Appropriate index well................................................... B -, Cal l'!ah r lever ,antie zone ..................................................... ---... STEP 3 Usinq monthly :Ultort "Current Watc!r Rt;sourccs Conditions" 1 t etermine r..nrrcnt depth to 7/03 7.6 water Irwel for index vrell ........................... ni(it i ear STEP 4 Using Table of k^larf--level AdirrsUnenls for intlr,x well (5 f t-P 2A),cur,enl depth I 10 water IUvcl fill irulex n•cll (STEP 3), and vvatet lUvrl zone (i f Ei'2131 dUlernunU i;alcrlr.vel adjusrrnenl 1.9 .......................................................................................... STEP 5 Estimate depth to Imp water by sublcac:tirg the vvater- level adjt.,stmenl (STEP 4) f-of"measwed depth to%^"21er level at site (S-1 1=1-1 1) ............................... 10__.-1 r..:............................. __ No. ^ 14 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migpont *V mem Construction i3ermit Application for a Permit to Construct( air( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. yy A9&14Pg8o r1 ii,C 1,! Owner's Na e,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. JoS,joLI o�c (3t?NrpS ZE AV , W �.1 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil irni� Nature of Repairs orAlteratiop s(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 Certifi- cate of Compliance has-been issued by this Board of Health. Signed Date ,r-2 7—4/2 Application Approved by Date 2�7�gSr Application Disapproved for thViolloYing reasons Permit No. _ Date Issued 9' - 33 yam) — No. ��"..:=. Fee �G r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: w Yes i PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for ;W6po.5ar *pgtem (fon5truction V.ermit Application for a Permit to Construct( air( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components i Location Address or Lot No. Owner's Nar9e,Address and Tel.No. `i',O- 9 2 ,6 Assessor's Map/Parcel c�4�71r Installer's Name,Address,and Tel.No. 477- �'� Designer's Name,Address and Tel.No. 46t."04 V. �14Nr05/ Y l CA#IM 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank e Type of S.A.S. Description of Soil Nature of Repairs or Alteratiops(Answer when applicable) _45 r.#l/ S/ ' Srati� 141-v✓h'A z " 1044 Srao-G 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 Certifi- g Cate of Compliance has been issu d by this card o H`eaatth. ` Signed 7./.e I Date Z 7-'412 Application Approved by 11Z1 Date as 2.7. �Ss' Application Disapproved fort following reasons Permit No. - .3 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 ✓os=!04 (J� /3ar•�5 ,$ at c/ O 9"o C ,r'4 ova has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated JS'2 7-fA Installer Jo y Ae. Designer os-C J. 6,4A.P10S The issuance of this permit shall not be construed as a guarantee that the system wilL function as designed. Date _ ! � Inspector NO. Ll S 79 Feed THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5pogal *pgtem Congtruction hermit Permission is hereby granted to Construct(//f Repair( )Upgrade( )Abandon( ) System located at rl moo gaff C_I�6/4, r,o-i-V,iiE 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 permit. Date: 5 'Z 7 Approved by f I�OtTIGC: TI>I�s rmrls T �e used- V tlite tten�iw Cif l il�c� 4 t ♦ t 1 - Zc+,# } CERTYFtCA' Ol i.OF SKETCHAND APPLICA'ION FOR A n. 5 ;d►1' S ' J `I j FltiV)i'iT (�VI�'I�t7U r ` DISPOSAL j 4 AN AL $ r 5 tk "I, -.Jos�pl �� . .Fsrwo hereby certtfY that the oppiicitttin fot disposal v�otks ,concerhltt the aY" ;,constritctRAI permit sighed by me dated pFoperiy tee at �DrabD s�trr�i / P n r„ s E .�.- �f�llowing citterte' a4-41 xa, , g' ` . ere ate no wetlAnds located within I0 0 fee:rbt of(lte�,ropd�ed leaching facility i titre at no prli�at6 iiaeli9 WIthifi; feel d(ihe'ioposed+sepiic yster t r p ,x r: a a R • �' re o increase ih f1tl�v and/or change in Use peoposeid Z a ;L 'I here ate no vatienceagttested br needed Ar. a b " ¢�, ��a • x lfthe proposed it' cuing tseilrty till be Ideated Wfihid 250 feet ofarty�Wetlands;the bottom of the ed t w r. p .' =Y - 'proposed leachin faciitt ,�4til 1> t be ioczited less than fourteen.t l4)feet above the maximum ad�t,st y t Lt Pa �'r ,groundwater tabie.elevati d � ' t' .F`� a s>;J � ...= c4: �� =" 'Pleasta complett�t�t�l�bhwi�idg " a Og''�aP R`�'a. A)Top oft�rouH�$levation(aceotditrg tti the Engineering Division 0.1 Sa map) a ,„ ,,' �;°.f E' $t 13 G 1 o- '`l F3 �,+sv V":` , t ''r a { ry ✓9d t t: ay,M➢s' r '+ e" d)ObsirWed ft}F�'oltttdwafer Table hievatiott(iceording to Health Division well trap),3 { FtY � }�� i1 "•4ri �y��4 �p,."iz°.�*���.t?' t b.?a`F !•R�?Y��ix3 tiF . - { �'�'S'v+ �as V.r�e�� s �r k- a •.1. ,� �`.a s+f.:eF�`1 ; t��.. t{� F'9 a 7 - -- - !. afr ,�m r ' F �. .R".4a v :. k`„�'° Yn { r `4•�, 14 fj DATE' /..,.. Si .,: ivl,7 h a Fla:}„ a :.1 r TL r.. 7- t o -"` •... r 't'Eiut 11�iSTALL;I:R I1Rl THE TbWi�l OF BE SEl'TCYS._ 13AIt�iSTABLE NUlvl R s j ,Fs.' },. �.^z (Attach a sketch plan of the�rPopdeed a�st8rtt�AitaaIf the licetss d tr:staller posesses a cetfifled plot plans ; ` this plan iahould be aubintttedlk` *' ��ft` — : , 5 -". j Alt, ,�E ,. is �r'0 M•.J�y94 'F'� Ivy;a :4 Ft r �,s;t okt f a-. 5 :N a {r• s' YS Y � A health Milei:cart • _ v s b 0 o r Is r >: S ` S x � 4 O � � �y 1 ra TOWN OF BARNSTABLE f LOCATION SEWAGE # ,3'S� t VILLAGE ASSESSOR'S MAP&LOT191 / NAME&PHONE NO.(-'^A S 7_1_c.,ieJg Zw- (S0qbGR_:y,2_t ,..SEPTIC TANK CAPACITY LEACHING FACILITY: (type) MAXL97IS S (size) A<` 9' N:O.OF BEDROOMS BUILDER OR OWNER L AVI )c 6-V96to PERMITDATE: Thij A? MY COMPLIANCE DATE: 99ia-U a4 Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 aw Ilse tb i i �uRck . of Wousv Jb° TOWN OF BARNSTABLE a e� � SEWAGE # LOCATION .��( s/D D�3o�t Cer <= VI,LAGE CBti? /�Vi 1/z ASSESSOR'S MAP & LOTS 4/ !7 Q INSTALLER'S NAME&PHONE NO. 4 y7-D3-9? JDSdpti 'o'-za A-&-s. SEPTIC TANK CAPACITY l'd d 0 L EACHING FACILITY: (type) wl rS (size) 3S^ SC cf NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: S -27"yf COMPLIANCE DATE: S 2 Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 �� �uDol�o� C«cl.� ��.�, �_ ��' ry n .'/ � S �`, so 3� .. 1,��� � �...Pp„ 1_O_C=Q— _ _ ' S. o .IJ,C;-E_RE.R.MIT 1J_0. T 1-Ns- �-=Al_ — R�- ►J=L-LNI=E�A=D-D=RE-S�S� -�_ 6-U I=L-D=E--R=5--1J O ATE—C.OKAP1.=1.Q /� I. ,., .... �� ... ...:.:, ^�.. .� .. _ .. .. ., _. 'pew/�� .. ..,. . .. __�... .. � .:. .. .. No.•••-�_ .. FR....117................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® HEALTH ....oF....... .. . ... �4,-.. s Applirntinn -for 43iti osal larks Cnnnitrnrtinn Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � .06" O� or Lot No O er /il _ ddr -------------------------- -•-------• wit/ ------------------------------------------- Installer Address Type of Building Size Lot. .A7J.-Z7'6..Sq. feet U Dwelling—No. of Bedrooms..._...... _____________ _ _ _____.Expansion Attic ( ) Garbage Grinder ( ) U-+ aOther—Type of Building ___________________________ No. of persons--------------.......-...... Showers ( ) — Cafeteria ( ) Q' Other fixtures ...................................................... w Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacit &V gallons Length................ Width.__--_-.__.. Diameter.....----------- Depth._--____------ x Disposal Trench— _ �____. Widt ------- ----------- Total Length-------------------- Total leaching area-_--._-_--_.-__-_sq. ft. Seepage Pit No ___ __ .._ i eter. .._..._.. .__ -�- Depth below inlet___ ______ _______ Total acl 'ng area_._____.._.___._sq. ft. z Other Distribution box ( ) Dosing tank ( ) ��- � +-^- �d � 7 4/ aPercolation Test Results Performed by-------- -----------------•-••'---••-••----------•---------•-•............ Date..........----- ----------------------.. .a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...-_.-.--_--_._-..----. fiq Test Pit No. 2................minutes per inch Deptb of Test Pit.--__-----_-_.--.__- Depth to ground water...---_---.-_--_._.---- rt-------f ;------ - I---- E Descri ti n of Soil.---- ter.____®�-�?-------4.f1 ! �o---" __. Lcfl=:' -___P�. --. V .._...... ---o�------------�` d►6e� ........ ------ �' �`a ---- ---- 11- w ------------------------------------- ------------------------------------•-...................... - -= W --------------- -------------------------- U Nature 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 Article XI of the State Sanitary Code— The undersigl d further agrees not to e the system in operation until a Certificate of Compliance has been issued by th&-boardj6f health. Sie - - ------- ------ -------------------•--------- /ate.. Application Approved By. te Application Disapproved for the following reasons:._.-..-. --•--------- --•------•-----------------•----•-•------------------------- -..------------------------- .. --...--•-•---•-•••-•------------•-----------------------------•-•-------------------•---------------•---•..-•-------•- ................................. ............................................... Due Permit No......................... �.� Issued. ' //`_7.te T ej No..... Fsg.... .............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD , HEALTH _....... - ....OF.--...- ................. .. ........................... Appliratiun -for Diipusttl Works Totuitrnrtion Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: cation dr ss o -- d - t/•• � / + � ------------------------------- ................................... ..{f..'-/. • ............................... . O er W �7+c^ fir"" - p Installer Address d Type of Building Size Lot _ _Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ------------------------- - No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------•.-----•-•--.----- - W Design Flow--------------------------------- ________gallons per person per day. Total daily flow.._.._._.........._.........................gallons. WSeptic Tank—Liquid capacitL_gallons Length................ Width................ Diameter__............__ Depth_--..__-_-..---. x Disposal Trench— Wid ------- _______ Total Length.-__-________--__-- Total leaching area....................sq. ft. Seepage Pit No.. t � _ Depth below inlet.---- --- Totjii1 ach'ng`area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) got 'tile. le (/ aPercolation Test Results Performed by-------------- ........................................................ Date---------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-....................... �14 Test Pit No. 2................minutes per inch dDep,, of Test Pit.._...__.....___.._. Depth to ground water_..--._.-_-____-__-_----0 t1 1� ..------. e f f... ------- Descripti n of Soil-----'""-----� -_6------�% o.s.. .... � � �• W --• - -------------------•-----------•--------- VNature 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 Article XI of the State Sanitary Code—The undersigi d further agrees not to e the system in operation until a Certificate of Compliance has been iswped by tC.a rd f health. Sie -- . ---------••... ............ .............................. Date Application Approved By...... .,. -------------- Application Disa roved or tl PP f ze following reasons: ......._ 'C >'-� ` ,�. ---•---•-•-•-----------•----•----------••----------------------------------------------- -•_ .... = D Permit No. - _... Issued_...: , =/.. at THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ....OF......A0. OwLrrtifiratr of 10.11omplianre �< T IS S CERT _Y That the Itulividual Sewage Disposal System constructed <r Repaired ( ) by----- ----- -- ---- - Installer has een installed in accordance with the provisions of Article XI of The State Sanitary CZdedescr'bed i the application for Disposal Works Construction Permit No....... --j------------------ dated..� _.:: .. . _......THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GM EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspec"tor.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS .ty�. BOARD Z.4 HEALTH .. X.+1.......OF........... �k. ..44:2 . '.............. No.... ...... FEE--- Dirivolitt r T1n trnrtilaat Permit • Permission 's eby granted'._..---- � -- - - �------ ------ -------...................................-.......................... to Const t ) or Re • ( ) n idual Se e�Disposal Sy atNo -- - --- . ....... ------- --- ----------------------•---- Street / as shown on the application for Disposal Works Construction r o Dated_:_( _..+ ''�._-.... ,_.. Ith DATE --/----r -----L------ ------=---------------•------ �v- j" - •-• Boar .J.. . .....:.........•----•----..... FORM 1255 HOBBS & WARREN. I .. PUBLISHERS T.O.F. EL.= 62.4 ± INISH GRADE OVER D-BOX= 59.3'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS= 58.4' - 59,3' GENERAL NOTES fPROVIDE EXTENSION RISER SLOPE @ 2% MIN. WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX PER WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 61 .5'± F.G. OVER TANK EL. = 61 .4'± 5" DIA. OUTLET(S) 3"OF F.G. (ONE PER ROW) CODE AND ANY APPLICABLE LOCAL RULES. 1 } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. -EXISTING 4" PROPOSED 4" 9" MIN. 9"MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE 36"MAX. 36"MAX. TOP OF SAS/B.O. = 56.33' -- s SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3"DROP MAX 3" 9„ L - 46'f PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2 DROP MIN 7r,,, JOINTS (TYP.) ELEVATION = 56.33' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A " 10" 4" PVC IN FROM 1.33' r107 " 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14" SEPTIC TANK 4" PVC OUT TO 0.90' (TYP.) ) 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE O LEACHING FACILITY SPECIFIED DROP BETWEEN 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL ' 12" 6" , 55.90' �- 55.00' laid flat 2.875'(34.5")_I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF 56.50 MIN. 56.33 (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE 5.0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY (TYP.) R MIN. 14.375' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE REQ'D 20.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 63.00'ESTABLISHED - TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= < 49.30' BIODIFFUSERS END VIEW ON A NAIL SET IN A 14"OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET EXISTING 1 ,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS PROFILE 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW (BY ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616 B D) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. _ 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING "t° • „ 9 " �Y #i ,, , t �` TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PERC NO. 13267�,, r "� • « , APPROPRIATE AUTHORITY. INSPECTOR: Donald Desmarais 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS ' + !'t4i�� �" � • ' LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE , EVALUATOR: Michael Pimentel, E.I.T. THEY SHALL WITHSTAND H-20 LOADING. ` C.S.E. APPROVAL DATE: Oct. 1999 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF AL L DIRT, DUST AND FINES. TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE '�" '"""w , ,"3+ . • "``' r MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ;; ` r,r ,� • ELEV TOP= 59.30' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, w ,'ram • 4 r • • • • ELEV WATER- <49.30' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). J r '+ LOCUS' ~\ ` PERC RATE 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN Of " . „ ' . ++, , " _ < 2 min./inch 0 ,r • � • , , `6� , � � SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. o Z �f`J, , a ; ; + , + " DEPTH OF PERC = 30"-48" 16. PROPOSED PROJECT IS LOCATED WITHIN: IM MAP 191 a {f • •-� • ,•'• I TEXTURAL CLASS: 1 ASSESSOR'S MAP 191 PARCEL 179 PARCEL 178 �- ' • • m < • 0.1 • . ). OWNER OF RECORD: THE ANNA BONADIO FAMILY TRUST Cl) N I: �� • " r • J ml m °' • ' •• •~ ' i " + 40 • 0" 59.30' ADDRESS: 47 AUDUBON CIRCLE Benchmark a N W r ' ' +t Litter CENTERVILLE, MA 02632 m I EXISTING LEACHING PIT TO BE PUMPED, FILLED Nail in 14"Oak W �1 • • *, , 2" 59.13' O I WITH CLEAN COARSE SAND &ABANDONED Elev. =63.00' MAP 191 z !�( ` ; w .* t • `, : A/E Loamy Sand v Approx. M.S.L. PARCEL 174 f� . " • - 6,. 10Yr 3/1 58 80' FEMA FLOOD ZONE C D U.P.#131012 EXISTING 1,500 GALLON SEPTIC " N • i r < � // • � COMMUNITY PANEL# 250001 0015 C TANK TO BE UTILIZED IN THIS DESIGN •+" • , . • = "� ' ' ; B Loamy Sand 17. DEED REFERENCE: DEED BOOK 22279, PAGE 224 Z� n S87°13'09"W of N�4o -' a'-- #� . __ a :_f , • ,• 10Yr 5/8 151.08' 4228T . . , . M r �, , • s 18. PLAN REFERENCES: 1.) PLAN BOOK 364, PAGE 40(1982 AUDUBON CIRCLE LAYOUT) I o 6j 18- « • • •• • ' t ; 30" 56.80' 2.) PLAN BOOK 272, PAGE 58 � /Yi �' � EXIST.VENT PIPE • • + �r8 @ 01 r_ • Perc TREE��NE (TO BE ABANDONED) _ • + • r• • • • $ � •� •Y 48" F 55.30' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 57x? r/ •• • • ' ; �a 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY _ , JI►/ ` 4 .• + 1 " • • , FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY C w-�� O�y� p O "'��' p°� _ y��l , * • • •« • • • • . . C Medium-Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 0 IV ^^ II F �G = ._ �`62 EXIST. 59x3' / 57xT r o #44 DECK LOCUS PLAN c0 EXISTING m ROPOSED INSPECTION PORT SCALE: 1"= 1000' 3-BEDROOM 0^ TP2 WITH ACCESS BOX(TYP OF 5) 120" 49.30' 4? � DWELLING 59x3'q m MAP 191 TOF - 62.4'± \ No Mottling, Weeping or Standing Observed o fs 1 PROP. TOTAL 20 ARC 36HC(#3616BD) I PARCEL 179 BIODIFFUSERS (H-20) IN A FIELD CONFIGURATION DESIGN DATA TEST PIT DATA LEGEND 16,215 S.F.t � ) \ h PERC NO. 13267 50xO EXISTING SPOT GRADE ROPOSED DISTRIBUTION BOX INSPECTOR: Donald Desmarais \ GARAGE NUMBER OF BEDROOMS (DESIGN) 3 / EVALUATOR: Michael Pimentel, E.I.T. - 50 EXISTING CONTOUR C.S.E. APPROVAL DATE: Oct. 1999� / = DESIGN FLOW 110 GAUDAY/BEDROOM -� 50 PROPOSED CONTOUR DATE: May 2, 2011 TOTAL DESIGN FLOW 330 GAUDAY EXISTING OVERHEAD UTILITIES / TEST PIT#: 2 £ O an / MAP 191 DESIGN FLOW X 200 % = 660 GAUDAY , EXISTING TELEPHONE LINE _ =USE EXISTING 1 500 GALLON SEPTIC TANK 00 y ELEV TOP 59.30��g �� / � / PARCEL 180 I Rc 1. ELEV WATER= <49.30 -� Q1 EXISTING WATER LINE SO / / PERC RATE _ \6 8�I G EXISTING GAS LINE DEPTH OF PERC = INSTALL 20 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TEXTURAL CLASS: 1 TEST PIT LOCATION SWING-TIES SCALE: 1"=20' SYSTEM CAPACITY O O 0 EXISTING 1,500 GALLON SEPTIC TANK I DESCRIPTION HCA HC-2 (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD 0" 59.30' (100.0')(4.8 SF/LF)(0.74 GAL/SQ.FT.)= 355.2 GAL. LEACHING/DAY Litter PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE BIODIFFUSER CORNER(1) 58.4' 30.2' 2" 59.13' Loamy Sand A/E Cl PROPOSED DISTRIBUTION BOX BIODIFFUSER CORNER(2) 44.4' 28.9' TOTALS: 6" 10Yr 3/1 58.80' BIODIFFUSER CORNER(3) 53.6' 48.7' TOTAL NUMBER OF BIODIFFUSERS: 20 Q PROPOSED ARC 36HC(#3616BD) BIODIFFUSER(H-20) TOTAL NUMBER OF COUPLINGS: 0 B Loamy Sand BIODIFFUSER CORNER(4) 65.6' 49.5' TOTAL LEACHING AREA: 480.0 10Yr 5/8 - - - TOTAL LEACHING CAPACITY: 355.2 (3 30° 56.80' REV. DATE BY APP'D. DESCRIPTION PROPOSED SEPTIC SYSTEM UPGRADE HC-1 �44 NOTE: PREPARED FOR: EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE �� do 4) DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER CAPEWIDE ENTERPRISES "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED C Medium-Coarse Sand EXIST. DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED 2.5Y 6/6 #44 DECK (2) JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. (5%gravel) LOCATED AT EXISTING 3-BEDROOM 44 AUDUBON CIRCLE DWELLING (1 CENTERVILLE, MA 02632 NOTES: TOF = 62.4'± SCALE: 1 INCH = 20 FT. DATE: MAY 5, 2011 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC �s'rT 120" 49.30' SYSTEM COMPONENT. HC 2 g, p g g 0 10 zo ao so FEET No Mottlin Weeping or Standing Observed r� w- �'F PREPARED BY: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED RESERVED FOR BOARD OF HEALTH USE avl CN. JC ENGINEERING, INC. LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH GARAGE a, 2854 CRANBERRY HIGHWAY >>s TEST PIT DATA. EAST WAREHAM9 MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHED. SITE PLAN 508.273.0377 SCALE: 1" =20' FDrawnBy: MCP Designed By:MCP Checked By: JLC JOB No. 1984