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HomeMy WebLinkAbout0023 BAIRD WAY - Health 23 BAIRD WAY Centerville A = 171 — 089 5ME D No.2-153LOR UPC 12M unaud.aan • Me"in USA I�ttlpNll�lm{K1W SFI OFMSRMWAM Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address To �i ✓) aN ner o�ner's Name �� O� 6 �� 4spec information is ✓l l/0 Arequired for every State Zip Code Date o page. 5y Tow n Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Mng out forms A. General Information filling out forms U �1� on the computer, J use only the tab 1. Inspector: key to move you 1 1 cursor-do not use the return Name of Inspector key. ,� C7 Company NameTo /oC U�7 Company Address S J� :�0-1 State Zip Code City/Tow n C U 10 _[� L �-6D — License Nu u rtuber Telephone Nu er B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in,the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 IOC 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further valuation by the Local Approving Authority I.- 7111, Inspector' Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 and or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l5 ns•.313 Title 5 of ficia im pecden Form:SvbSLtfaco SeWago Disposal System•Pagel of 17 1 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C2 3 dam, Property Address /C/ G o✓l �, ON ner CW ner's Name information is required for every /l ��HV�� i /� � oa6 . �/ _ page. City/Town State Zip Code Da e f Insp r�ction B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) 7stPasses: ve not found an information which indicates that an of the failure criteria described Y Y in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Healt h. 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. ❑ Y ❑ N ❑ ND (Explain below): t5ns•W3 TitleK0 ndat InspecticnForrrm Subsurface SowageDisposd System-Page 2of 17 Commonwealth of Massachusetts Title 5 official Inspection Form A _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address / Ow ner CW ner's Name information is Le 4✓t/1 l � oL required for every State Zip Code Date of spec' n 5t T page. own B. Certification (cost) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 mannerwhich will protect public health, safety and the environment: E7 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 Till 5 Of ticial ire pec Lion Form Subsurf ace Sewage Disposai System•pigo 3 of 17 5ns•V13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address //_�: do✓� ON ner ON ner's Name I �// ,/ information is L4 t��t_/ Ile / D� b � �7 required f or every /2 page. City/Town State Zip Code Date of], pectin B. Certification (cont.) 2. System will fail unlessthe Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections; Yes No ❑ Cg//" Backup of sewage into facility or system component due to overloaded or / clogged SAS or cesspool ❑ L—�/ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Ov/ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ns.y13 TiUe 5 0(f cial Ins pec fion F am:Subsurrace Sewage Disposal System-Page Of 17 Commonwealth of Massachusetts M_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ?a 0� S ��rr Property Address 0w ner Oro ner's Name l information is .��� e AZ vd 6 ZZ required f or every page, itylTown State Zip Code Dateo In ection B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: . ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ �/ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ L�' Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ l Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000g pd. ❑ 2 The system fgjL5. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15,304. The system owner should contact the appropriate regional office of the Department. t5iR5 3113 Title 50tficial impecbon F am Subst,rfaee Sewage Disposal System•Page 5or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Cw ner Cw ner's Name Ce.14,e,-Vi information is �required for every /l d page. City/Town State Zip Code Date of I specti C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No �❑ -Pumpinq 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? IJ ❑ Was the site inspected for signs of break out? Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: l� Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)J D. System Information Residential Flow Conditions: 3 Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 3 .3v 15 ns•3/13 T i tl o 5 Official Iris pec ti on Form Su bairf ace Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts w - r Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �? a 3 dei I r C� C'14 Property Address / C C'o✓IA /C/ Ow nrn Owner's tJarne vt �Ct�(//6 ' / information is if / Da required for every � page. City lTo`Nn State Zip Code Date of 14pectiofi D. System Information Description: / /��(� U � l l✓I ,/-2 C C&t f Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection D Yes No information in this report.) Laundry system inspected? ❑ .Yes No Seasonal use? ❑ Yes a"M0 Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CM R 15,203); Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: tyre,3I13 Title 5 Ch ficied Ins pm Uon F on n SuCsurf ace Sewage 01 sposal System•Pape 7 of 17 Commonwealth of Massachusetts L. Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address 1 / ✓ �i �iovlq / ON ner CW ner's Name information is O Gp ��� required f or every ����//// Stale Zip Code Date of I spectio page. Gty/Town D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: ri Type of 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): 15ins 3113 Title 5Offiaa)Inspection Fcxm Subsurface Sewage Disposal System.Page 8of 17 Commonwealth of Massachusetts AN Title 5 Official Inspection Form z Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address 4C4 ci /C:"/ Ow ner Cv ner's Name /� information is / �/��6 ) required for every (/P� ✓!�G D< page. Cityrrown State Zip Code Date of Apectioll D. System Information (cont.) Approximate age of all components, date installed (if known) and source of' for ation: a / / �,�Gt, o � ► n �, L._._ �G''��,/ , �-ems.-r.—oZ� Were sewage odors detected when arriving at the site? ❑ Yes a_-tVo Building Sewer (locate on site plan): — l/ Depth below grade: fee-t Material of construction�40 ❑ cast iron PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet �( Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ElYes ❑ No Dimensions: 4— Sludge depth: t5ns-3113 Title SOfficial UupectionForm:Subsurface Sewage Disposal System•Page got 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal Syste Form -/Not for Voluntary Assessments Property Address /V/C,C4V1e'i /Cj C7� Ow ner ON ner's Name information is required for every page C4y/rown State Zip Code Date df In ection D. System Information (cont) Septic Tank (cont.) � Distance from top of sludge to bottom of outlet tee or baffle Scum thickness ii Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): It ram) t ✓1 2c;/ Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15iru 3113 Title 5Of6cia'Iris pection Form Subsurface Sewage Disposal System-Page 10of 17 Commonwealth of Massachusetts essimm. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ON ner Ow ner's Name ) n Information is CeV,' (r e required for every page. City rFown State Zip Code Date of I spectio D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No (Sins•N13 TWe501ficial lmWtionPorm.Subsurface Sewage Disposal System.Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Addres P rtY s G O v►ca ner Ood ner's Name information information is 6 e required for every State Zip Code Date of I pection page. GtylTown D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): _ '�— (4e V1 Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): d .ec- Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.); " If pumps or alarms are not in worKing order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins Y13 Title 501ficiy lnspeclion Form;suusLeace sewage Disposal Syslom•Page 12 d 17 Commonwealth of Massachusetts -. . Title 5 Official Inspection ct ion Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address (� 0✓7a pro ner Cw ner's Name I^ _ information is e�mil/VI G�6JL required forevery State Zip Code Date of spect' n page. City/Town D. System Information (cont.) sb'l' Type /��GS�tc C�•w number. ❑ leaching pits ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): G v+ C�'✓o ✓t „y 3-- Lle"✓1 G!�C ./ V �;( ✓� ©� C4, 4 4/ C / G, N Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet Invert �— Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Title50fficial ins pectionForm suosLrtace Sewage Disposal system•Pape 13 of 17 t5ins•Yl3 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal Syste Form - Not for Voluntary Assessments cot-3 �G 1 r� a Property Address G dHa Ow ner OW ner's Name / information is �` c' required for every page. City(Tow n State Zip Code Date Inspe ion D. System Information (cont.) 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.): t51ns•3113 Title 5Offcial inspectionForm Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address I G CJ✓I�r Ow ner Cw ner's Name / "�information is Cell �< lle required for every State Zip Code Date of In ectio page. CityfTown D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to Llas wo permanent reference landmarks or benchmarks. Locate all wells within 10.0 feet. Locate r public water supply enters the building, Check one of the boxes below: TOWN OIL BA.RNSTABLE LOCATION. �( SE WAGE# Z o i 2- 2_2p VILLAGE Cen !✓ryi lLp_ _ASSESSOR'S MAP&PARCEL(7I INSTALLER'S NAME&PHONE N0. ;aeEi��eprl,es iLG, 5� k7T ybT, SEPTIC TANK CAPACITY /OOQ G�Ilon LEACHING FACILITY:(typo)aCi A,eG36/l — _ (size) X NO.OFBEDROOMS 3 w OWNER — PERMIT DATE: ' th Z'.I t COMPLIANCE DATE: Separmioo Distance Bctween c: No yao Maximum Adjusted Groundwater Table to the Bottom of Leaching facility z='1C0urr4ra( a beet Private Water Supply Well and Leaching Facility(If any wells exist on rd;" site or withiri 200 feet of leaching racility) /'✓r�_ _Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY C. A x 3 u ►3-4=air' ^ t � c C-4 40 50 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address / G Co✓i 01 /C/ pvv ner Cw ner's Name information is required for every �"ti 7��✓✓�/` �_ i/� page. City/Town State Zip Code Date oOnspectiofi D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /v/rl Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked local Board of Health - I / explain'. // //// ( � 0S / �57- /7t�4, ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5im-3113 Title60tncial IrupecVmForm SUOSLffaCe Sewage Disposal System,Page 16of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address / 1/4 CoA Ow ner ON ner's Name / �7 information is Q 14✓ v� 6J� �� required for every page City rfown State Zip Code Date f Inspe ion E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked ER"'Inspection Summary D (System Failure Criteria Applicable to All Systems) completed Le Sy tem Information— Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins 3113 Title50fAcial InspecGcr)Form subsLeace sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION 2,q i3 ct,i r d I/E a SEWAGE# 2 a ►2— 2_2p 'VILLAGE Ce,ln-erVI III ASSESSOR'S MAP&PARCEL 171 L919 INSTALLER'S NAME&PHONE NO. Gr{aeXAA Je En -rises UCG., 5'09-t477—?8TT SEPTIC TANK CAPACITY /000 G c 1 gv% LEACHING FACILITY:(type)dD MC36flC A q-d0 (size) � JF E', 8 NO.OF BEDROOMS 3 OWNER �Cel�►tr+ V ��ii /�'/C./�;c�.G PERMIT DATE: 1 2-01-2- COMPLIANCE DATE: /� I Separation Distance Between le: NO y aeo Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 61Covrr4eo-ad Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) /l/ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) I Jv Feet FURNISHED BY "add (,(_ �- p1 A-1= a3.S' U A-3,= 8-3=41,1' e i�ec 5 3 4a �p s I No. 4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es 01pplitation for ]Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Y Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S (Nk1 M VJA4 T Owner's Name,Address,and Tel.No. Mt VURr Assessor's Map/Parcel i'1 CQ/I�� kAj CaulnULOILLEr Installer's Name,Address,and Tel.No. $02-47'1 — $T7 Designer's Name,Address,and Tel.No. SOf5>,)73_.6?—7 C 406Wrp6r twtteJ'Wej L(-G a c. iRJGrtweu-tp(r -zjX_ 153 QW/Aedc- Sr -21?S Rsa-;� 9, Type of Building: Dwelling No.of Bedrooms Lot Size S}�2o f t sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) a2® gpd Design flow provided 6-L_, gpd Plan Date _JQV-j 11 i A OI DL Number of sheets Revision Date Title__� 3 DA16 WAH "5 Size of Septic Tank I,or-)® Gak Type of S.A.S. Description of Soil C 6AA519 j( i(,(� �C7 ��� euw Nature of Repairs or Alterations(Answer when applicable) �5� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si ed Date `�— °'•O®( Application Approved b a..>�' Date ; f 11/ 7® Application Disapproved Date for the following reasons Permit No.2_O (Z Date Issued ---------- --- __------- __- — _—_——_-__-- — — — - No. Fee THE COMMONWEALTH O-OWSACHUSETTS Entered in computer: 4' PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS 01ppl.cation for Misposal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair(�) Upgrade( ), Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. W14N Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1-1 gq ce/rle t l a3Qa A k� Installer's Name,Address,and Tel.No. 50$'f{T7 -6 a j 7 Designer's Name,Address,and Tel.No. IS CvucAct�►2C'.t � .?85 l'tcrt� �� Type of Building: q Dwelling No.of Bedrooms Lot Size ,,)Tt�o( sq.ft. Garbage Grinder t` Other Type of Building An 0A No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min:required) v;2 A 0 gpd Design flow provided `$•� gpd Plan Date _4uLy 11, 01 OIL Number of sheets Revision Date Title 23 BAILb try Gb'�Jtxyt�lLt. Size of Septic Tank t a wo C'ok Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer`when applicable) CT//�tJ I* � - y+`«' A4- D� !J p " QK � a Aw�A! k 70 Pt��tt vc�c.0 lty FIEzD ' FtCr Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 17— 11 r.30 12.1 Application Approved b _v�' Date �// Zo 17 Application Disapproved Date 11� y for the following reasons Permit No.20 t 2- z'L Date Issued l (� t Zv r Z - - - -- - -------- -------- --------- ------------------------------ _------------- --- --- . .. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) III Abandoned( )by CA06(jo c; g&zj&Q pjecsfE7S 4j 4I at o1?j 15AI W& }./I LA_Cs7 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7012-ZZU dated Installer e Ae&?,e (QC4 (=uTe0/kgjS3 L. C. Designer�G #bedrooms Approved design flow ffiasigned. Z.,�. gpd The issuance of this permit sha I not be c st�r'ued as a guarantee that the:sy em will fimcti Date � / !�`� Inspector - No. 7 o 12- zZ v Fee 74/W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( ) System located at a 'rew r L k and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her-du to comply with Title 5 and the following local provisions or special conditions. Provided:C ns ction must be completed within three years of the date of this permit. Date 0 /Z-- Approved by i I iuJ r. wI/VVi 7/13/2012 02:45 5082730367 Town of Barnstable of , Regulatory Services Thomas F. Geiler,Director O,a;u�L Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 ' Office:: 508-862-4644 Fax: 508-790-6304 Datc: 7 1 ah a Sewage Permit#20 Assessor's Map/Parcel I Jos9 r Installer&Designer Certification Form Designer: SG E0gneecCog. Tor, Installer: Gaeewide- C-,Otf-fe ise-S, 1- LC-Address: Z h5Y Ccpn�Xjcyylitkhu,-/ Address: VS-3 'f- fasA wo�ehAnn t-(Pr e z%3$ �'1 Ya On / / Co I G "` v' ZS was issued a permit to install a (date) II (installer) septic system at o?3 BairA Ufa Cenfl-rvillt based on a design drawn by (address) �G Co'Ameer(Aot , T+nG, dated �w�� 1 �1 aDlo1 (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. Stripout (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 I 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 req ' nspected and the soils were found satisfactory. �,,,�S,4OF s4.� JdHlti L. �^ JR. aller's Sign, re) No 41607 ,IM . .s esigner s Signatur (Affix esi e s mp Here) PLEASE RETURN O BA STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL HOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, q 1o�lict Ii+im:W�r.,igncrceililicmitm lunn.dou Town°�of Barnstable P# Department of Regulatory'Services Public Health Division Date r fo a�� 200 Main Street,Hyannis MA 02601 Date Scheduled 21 h Tune /0 Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: t�OP.1 P(YYI 7�)t�11 rr T i�656 Witnessed By: LOCATION&GENERAL INFORMATION Location Address Owner's Name ©13 13A(R6 WA4 QC1 L 4 t.(,Cr Address �BAI RD laUA� d6W1Q21 tL Assessor's Map/Parcel 11 ( laq Engineer's Name C 67WI i✓ &AGVkt9&5 NEW CONSTRUCTION REPAIR Telephone# j� Land Use: 51(,cIle "ii d(,61►'0 )Slopes % 1-2• — P ( Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line :7 10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands�n proximity to holes) she tak4��� �l�v� • 9 Uj ICU l i Parent material(geologic) DAY 1 Depth to Bedrock Depth to Groundwater. Standing Water in Hole: y l 2 to& 05,; Weeping from Pit Face Estimated Seasonal High Groundwater 7 1.2(o`by S DETERAHNATION FOR SEASONAL HIGH WATER TABLE Method Used: Dfrw• 0�osefuaflasl 711(0 Depth Observed standing in obs.hole: In. Depth to soil mottles: In. Depth to weeping from side of obs.hole: ",;in, Groundwater Adjustment ti. Index Well# Reading Date: -- Index Well level Adj.factor, ,— Adj.Groundwater Leval PERCOLATION TEST bate l 9 1Z Tlme /o A-(7 Observation Hole# Time at 9" G 4 ' Depth of Perc 3 D.-y 8 Time at 6" Start Pre-soak Time @ /D:o 1 Pf Time(9"-6") r End Pre-soak )o•,oD8 An Rate Min:/Inch 42, I Site Suitability Assessment: Site Passed YesSite Failed: — Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC 1 DEEP.OBSERVATION HOLE LOG Hole# I k 2. Depth from Soil Horizon Soil Texture Soil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling . (Structure,Stones;Boulders. rnnsixtenry.9b'Gravell 0 3 _ pill .. 3 -8 Joe LS 6 r 314 -36 6 LS l0irsl1 — — 36 C, M-G S 2.5`f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:j ' (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon 'Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stottes;Boulders. Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No— Yes _'✓___ Within 500 year boundary No V/ Yes ' Within 100 year flood boundary No.✓ Yes _ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? t;5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on /o ��99 (date)I have passed the soil evaluatonexamination approved by the Department of.Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and a erience described in�10 CMR 15.017. Signature Date :MPTIMERCPORM.DOC Q l ® CAT / SEWAGE PERMIT NO. a �r - I VILLAGE J f INSTA LLER'S NAME i ADDRESS 2 UILDER OR OWNER O*k) -0'1 L ,\1yZ-L M f-PS Cron,S M i LLS DATE PERMIT ISSUED ou DATE COMPLIANCE ISSUED L_ �, ` `71 60 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tozv Application is hereby m�de for a Permit to Construct or Repair an Individual Sewage Disposal System at: cation-Address ------------------------------------ Installer Address of Building 7- Size Lot..Z,6�_c2­0/....Sq. feet 1:4 Septic Tank—Liquid capacity./00.0.gallons Length... Width... Diameter---41.'.�."' Depth..S..T._"'. 1.4 Test Pit No. l_,!L2----minutes per inch Depth of Test Pit----Z,2--------- Depth to ground water...121-a/VZ_ ____________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'IT1 7 5 of the State Sanitary Code—The und igne further agrees not to place the system in operation until a Certificate of Compliance has been s 16d by t o rd iealth. Date - Application Disapproved for the following reasons:...................................................................................--_-------'--- --------------------------'-----''-------'-'---------'--------'------------'------'-----'---------- Date | Date Fing.... ................... No... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF..... ............f................7................................. Appliration for Dh4pogal Workti Towitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ............. A ...... .......................................... .................... ----------- V6;............................. "I r ation-Address or t o. .. ...................................... ress_/ er Ir s ....Ad 't';j_L.4 .4. .. .................................... st. ­41-111-cko _"-------*....­ .__�- . _,". d. in Her Address 7 of Building Size ....Sq. feet Dwelling—No. of Bedrooms..........;,,S.............................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures .......... ............................................................................................................................................ Design Flow........... .........................gallons per person per day. Total daily flow.............3�. t:l...................gallons. Septic Tank—Liquid*capacity.,.Mag.gallons Length. Width.-.'/'- Diameter..4__'46_". Depth,.' V---------- .... Disposal Trench—No- -----------_------ Width.................... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No......../----------- Diameter...... ........... Depth below inlet.-. '�?.... Total leaching area..../__97Z__sq. ft. Z Other Distribution box (1,,-) Dosing tank /*1'4'1'11 Percolation Test Results Performed by----- ------------------------------------------------------ Date...... ............ Test Pit No. ----minutes per inch Depth of Test Pit....Z�......... Depth to ground Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------_-------------- ............................................................................................................................................................. 0 Description of Soil............. - , 4 1:;, �........................................................................................... ---------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 TIT LEE 5 of the State Sanitary Code— The und7signedfurther agrees not to place the system in operation until a Certificate of Compliance has been s d by t o 'rd fiealth. Signed..... ... ....... _V'l . ............... ...... ------- ------- Application Approved By....... ... . .................................. Q Aelv? . ------------- Date Application Disapproved for the following reasons:............................................ ................................................................... .......................................................................................................................... ........................................................................ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......TO(-&-oe, .............OF.......40:� T, 104:.......................... Trrfifiratr of TI-Impliaurr THIS IS TO C R IFY,ZTh the I '�e)yag Disposal System constructed (V<or Repaired by-------------------------- . . ..... ...... .................................................................................... In 11 at.................. .. ....A;? ....7----t. ........ ........----- .. ....:n.................................................................................. has been installed in accordance wit.1i t e provi ons of TITLE 5 of The State Sanitary Code.as described in the application for Disposal Works Construction Permit ............. dated------------------ �?...... THE ISSUANCE OF THIS-.CERTIFICATE SHALL NOT BE CONSTRUE1) AS A GUARANTEE THAT THE SYSTEM WILL -.FUNCTION SATiSFACTORY. X DATE...... ................. Inspector.....t�):' -------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ..............OF.... ..................................... FEE. .............. Pautit ......... h y granted-..... .............................................. J61 Permission is y Z$9 to Construct 4T or Repair lndivi�ual Sem�aje Disposal S atNo............. ar�............................................................................................ /110 e Street as shown on the application for Disposal Works Construction Pkrmit No.....---- Board of DATE........ .................... ---------------- FORM 1255 HOBBS WARREN. INC., PUBLISHERS r y r 6 `: -r I •�� 40.3'.PRO I � r y r b N. Nit J �rN r�sY3 ,t \ ' n t( C /£}✓ i.- v1p A' 41 �5 u/LD/nrG -S;ETOACAC- ;eE as -F20w7- P20X�:'o5ED . , : . . ,y BE-D✓20oiv15 � �, SEPTIC 5YS7-E�1. CONST2UG'T/4N 5HA[.L G OnJF02M.; TO M�q SS ��S/ F '. GAL /L7� YFLOA ENV/,eONM4v74Ca T/TG c; s 77v ^! xaEQui .y,EA Z_7",y. TZ�GUl-A-TiONS TOP OF Fou,N!�<t T/ON*>..._.� .. .-' - -- " �.,-: .:,_.., r. . ..a.rw.r.-, ...r-.<..-•--a•--•- ..-i.,.,:+r ,-.,:...max...-,-._..., - -_-..,._ . .,�:k� .. ,. . _ 3,:. OF .4 S`/•O/VE ` D 11''IPER PE✓IOUs Co VET 2 h , MANHOLE Ca'i/E&? TO' X TEiJD TO 7"e� �2E`✓Eti/T /.�/C-5- W_ / Ts•-//n/ /' OF. F/n/i5'/-/�D GIz.4 Dom- • F ,b� _ �20i •! JNF/L T2AT/i1I6 S, o.✓�rz,5 COVAE 2%GpwE .1 30X �Z/"�t/rDG OVE V Q C45T//20.�/ _�r _ „M/N �.' P/T 4` p/TGf/ F� Ow LinNE /j/ .__ti_ ELF ( G? >rt N, pl TCy' C 4 /O"MIN t ^2- p/T Y �faDT /4" /St• /FooT : Mrni r�ircfi �- �} 17 /-¢ -/ 1A Y N/A 5 H E C7 d /A/J/�r 6 . ' STO NE GA L L'0Ni z) /A /A/VEE7 /N✓E.2T €LEV• 420O /0 SE!1T/G 45CO7TOMf O r 01 ��. �tNATG/ZT/G'HT /yVVE.eT _ ! PiT#` w. /N V E 0T A/0. GA e5AGE G ' IVDE,�?. / .• Cam( SIT pL ,�iN �@ +. �SEPT/C TAN.(G 4D/ST, /TZBU7/O.7N 80X = -3 _ - . �. •. :�R,�I�r O.GJ.7'G:.ETS�'A1/VD LEe4G.�✓I.VG T::'/T RA : E OF ,2,E_IA-0 A--C.E-Z7 G0, fCTZETE ONG'RETE ST,2EAA57;V 3000 Psi M/n/. 20000 To•ems LoLA E�> ,t /L, ( ..T, J4.f ji �- O tl 2 S` 6 TE M tJn/L.E 5 S N- Z O l A e 4ris. rsh IDE S/6,A1 L.O;A LD/n/G /S. USe_D. L CE rl Fy' ENE F� r A )OA/ S�ior�cw/v 7 F'L�1�1 /S PR 610. 01S I'f0 ON Tf-1E GPO CiND f • ` w, �. AS pViv AA/D / T OES / � 1�ti9�Ly' GL'/T?� 4 tow.JR.. �ti T.L�E 3LP Ck�- EQU; OF T 4E TOGVti OF .iy}., 7 18 'JA t U CA 7 ' AIEAL7�-/ a045A/T DATE lfrf,0, 7 /��D 4 pP�O✓,4 L F • T.O.F. EL.= 57.7'± FINISH GRADE OVER D-BOX= 56.2'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS = 56.2' - 56.6' GENERAL NOTES PROVIDE EXTENSION RISER SLOPE @ 2% MIN. INSPECTION PORT WITH WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 3"OF 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 F.G. (ONE PER OUTER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL, 56.9± F.G. OVER TANK EL. = 56.5 ± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. --EXISTING 4" _ PROPOSED 4" 36"MIN.AX. 36"MIN. AX. TOP OF SAS/B.O. = 53,83' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE � SEWCH. R PVC " SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE 6- 3" 3" DROP MAX 3„ g„ L - 3$'i 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - 2" DROP MIN MIN.SLOPE�1� PROVIDE WATERTIGHT ELEVATION = 53.83' FOR A DISTANCE OF 16 AROUND THE PERIMETER OF THE SAS. UNLESS A _ 4" PVC IN FROM JOINTS (TYP.) 1.33' nJ(TYP) 16„ 40 MIL GEOMEMBRANE LINER IS PACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 10" 14" �*54.1`± SEPTIC TANK 4" PVC OUT TO 0 90, (NP.) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE • LEACHING FACILITY 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL ' 12" 6" ' 53.40' �-- 52.50' laid flat 2.875'(34.5")-�I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 53.67 MIN. 53.50 ( ) (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 6"CRUSHED STONE (TYp.) 5'MIN. AND CONDITION OF EXISTING TEES GAS BAFFLE 5.0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE ASM OVER MECHANICALLY REQ'D 5.75' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 50.0' (TYP) AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 57.00' TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 45.80' BIODIFFUSERS (END VIEW) ESTABLISHED ON A NAIL SET IN A 16"OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIH-USERS (PROFILE) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION (BY INFILTRATOR SYSTEMS, INC.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES C,ON1t<ACTORTO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-ZO) TO THE DESIGN ENGINEER. NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE ►° / +(,� s " +0M • TEST PIT DATA 11- NO DETERMINATION HAS BEEN D REGULATIONS.O S. OWNER/APPLICANT CANTE AS TO COMPLIANCE I TH DEEDED OR ZONING IS TO OBTAIN SUCH DETERMINATION O FR OM OM ► `` • * r, �* „ *+ � ✓ PERC NO. 13685 APPROPRIATE AUTHORITY. ,+ . • a' INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS * EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. C.S.E. APPROVAL DATE: Oct. 1999 1l .w • * * ' %� 0 DATE: July 9, 2012 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE �M . • � ELEV TOP = 56.30' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ccQ R1 ' •« sw REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, U.P.#2\O • �' s� ` ' : ELEV WATER= <45.80' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). �� /' r! ,•` � / 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE _ <2 min./inch F # SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. LO�1 1 c ' DEPTH OF PERC= 30"-48" t v • , 16. PROPOSED PROJECT IS LOCATED WITHIN: �� O� ���, �'9 1� • 1 �/ TEXTURAL CLASS: 1 ASSESSOR'S MAP 171 PARCEL 89 CO N / / �F.o /�, I rrY OWNER OF RECORD: BARRY M. McKEE S ", y/� "9T '9y l �� J/ r'�' 0" a � ADDRESS: 23 BAIRD WAY \ 56.30 � , SO° �c` (� 1 N � r � " Fill CENTERVILLE, MA 02632 N �% �` \'� ��9� _ # + A/E3 Loamy Sand 56.05 m / T�<� J ZONE 2 , r 10Yr 3/2 8" 55.63' a MAP 171 ro / '� 1 l _ r • * ( FEMA FLOOD ZONE C PARCEL 88 g�� ,�01� o����� .� I \ \ - �� Ty a r + r r �r B Loamy 1oYr 5/6 Sand COMMUNITY PANEL# 250001 0015 C 00 30" 53.80' 17. DEED REFERENCE: BOOK 9328, PAGE 253 � Perc !��, 48" 52.30' 18. PLAN REFERENCE: P.B. 252, PG. 32 �s � Z Z3 ! 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. �+ F #23 cP 'k� �- - • • ! 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 56x3 S EXISTING O f/ ` ♦ FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY EXIST. 1,000 GAL. SEPTIC TANK _ � 2-BEDROOM ��y �0 O� :' + if -. Medium -Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. TO BE UTILIZED IN THIS DESIGN °l TO r 0��� g° 1��� y'�� r - * . • ( ISh o C 2.5Y 6/6 TOF = 57.7_ I �, - �. _ _ . _ (5/°gravel) TREE �= 56x LOCUS PLAN os 56x8' DECK �P� - MAP 171 SCALE: 1"= 1000' MAP 171 000 P`� /`� PARCEL 101 126" 45.80' ` 56x " No Mottling, Standing or Weeping Observed PARCEL 89 15,201 S.F.± 56z5' TP 1 DESIGN DATA TEST PIT DATA � 56x3' PROPOSED INSPECTION PORT PERC NO. 13685 LEGEND 56x6' WITH ACCESS BOX (TYP OF 2) MAP 171 - INSPECTOR. Donald Desmarais, R.S. 500' EXISTING SPOT GRADE �' � PARCEL 90 `SSA° TP 2 EVALUATOR: Michael Pimentel, E.I.T.NUMBER OF BEDROOMS (DESIGN) 3 (MIN PER TITLE 5) - - 50 - -- EXISTING CONTOUR 55x9' C.S.E. APPROVAL DATE: Oct. 1999 sty, 56x3 Benchmark DESIGN FLOW 110 GAUDAY/BEDROOM ?9�,�0� �, Nail in 16"Oak DATE. July 9, 2012 50 PROPOSED CONTOUR Elev. =57.00' TOTAL DESIGN FLOW 330 GAUDAY 56x2' Approx. M.S.L. DESIGN FLOW X 200 % 660 GAL/DAY TEST PIT#: 2 TELE -- EXISTING UNDERGROUND TELEPHONE = - EXIST. LEACHING PIT TO BE ELEV TOP= 56.30' PUMPED, FILLED w/ CLEAN 56x2_ PROPOSED TOTAL 20 ARC 36HC USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER <4 ' ❑/H/W EXISTING OVERHEAD UTILITIES SAND & ABANDONED-� (#3616BD) BIODIFFUSERS (H-20) = IN A FIELD CONFIGURATION PERC RATE = W W- EXISTING WATER LINE � - SWING-TIES SCALE: 1"=20' DEPTH OF PERC = � TEST PIT LOCATION DESCRIPTION HC-1 HC-2 HC-3 INSTALL 20 - ARC 36HC (#3616BD) H-20 BIODIFFUSERS PROPOSED TEXTURAL CLASS: 1 O -O EXISTING 1,000 GALLON SEPTIC TANK DISTRIBUTION BOX-' BIODIFFUSER CORNER(1) 50.0' 41.6' 64.1' BIODIFFUSER CORNER(2) 54.7' 44.7' 66.1' SYSTEM CAPACITY PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" 56.30' MAP 171 BIODIFFUSER CORNER(3) -- 29.1' 28.4' (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY 3„ Fill 56.05' ❑ PROPOSED DISTRIBUTION BOX PARCEL 102 BIODIFFUSER CORNER(4) -- 24.2' 23.2' A/E Loamy 8 10Yr 3/2 d TOTALS: " 55.63' PROPOSED ARC 36HC(#3616BD) H-20 BIODIFFUSER TOTAL NUMBER OF BIODIFFUSERS: 20 B Loamy Sand TOTAL NUMBER OF COUPLINGS: 0 10Yr 5/6 ' TOTAL LEACHING AREA: 480.0 30N 53.80 #23 TOTAL LEACHING CAPACITY: 355.2 REV. DATE BY APP'D. DESCRIPTION EXISTING o 2-BEDROOM �P PROPOSED SEPTIC SYSTEM UPGRADE � 0� DWELLING 1< NOTE: TOF = 57.7'± PREPARED FOR: EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE HC-1 HC-2 HC-3 DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER Medium -Coarse Sand CAPEWIDE ENTERPRISES c� "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR C 2.5Y 6/6 SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3, 2003 (LAST MODIFIED (5%gravel) r, MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. LOCATED AT DECK o 23 BAIRD WAY j SPECIAL NOTES: '" (4 CENTERVILLE, MA 02632 j 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF ---- ..___ SCALE: 1 INCH = 20 FT. DATE: JULY 11, 2012 EACH SEPTIC SYSTEM COMPONENT. o (3 126" 45.80' 0 10 20 40 80 FEET o g. 9 Weeping 12.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE No Mottling, Standing or Wee in Observed f - - PREPARED BY: PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT RESERVED FOR BOARD OF HEALTH USE _' JOHN L. „�* JC ENGINEERING INC. DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF f CHURC,rllLL JR. 2854 CRANBERRY HIGHWAY HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. (1 - �\ N 41^ ' EAST WAREHAM MA 02538 � 3. PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION (� 508.273.0377 SITE PLAN OVERLAY DISTRICT AND THE ESTUARINE ZONE WATERSHEDS. " _ SHED s Drawn By: MCP Designed By:MCP checked By:JLc JOB No.2265 SCALE: 1 =20'