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HomeMy WebLinkAbout0173 BAY LANE - Health 173 Bay Lane- _=` Centerville P A = 186 010 u - k f No. 42101/3 ®RA 4 .. 1 0% Up I tOVlN OF BARN aTABLE 9 LI: 15 UJ - •un nu�ere Proposetl Atltlilbn � � �S� _ I � S Ffindy Room ATnC a p 1 O�etle ®® _ Front Elevation Attic Floor Plan ro n Renco I ug 6rnle:7f9.1'�0' Piopoaetl AtltlPbn II II II _ II 11 II II II 11 333 W,L 7< II II kW"etlM CLIENT tl II II II I I EASi1NG GARAGE I I II II DATE_________. II --------- II -------- I I 11 I I II I I 1 I II I I II I I 1 i t I I I I SCALE 1 1 1 I I -------- -------- ________ WAVW 6I - - _ Rear Elevation CHECK BY AD - 1 / z� Prop sOAddltbn e—.»...... :ti.... �.,. .,... di� C4 ■p �adb�5 8 • F e - j s Left side Elevation Roof framing 6 5 vuw exaarc, - New Adddbn 8 Albmlbna I Abbreviated Eave(ootion) New DomuN ApomW na —} cx.x. 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Ford Company Name: James M. Ford Map: 186 Mailing Address: P.O. Box 49 Parcel: 010 OWervdk,MA 02655-M9 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Need Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: April 26, 2003 The system inspector shallla 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 173 Bay Lane Centerville, AM Owner: Linda Clark Date of Inspection: April 23, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 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: 2 • Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 173 Bay Lane Centerville, MA Owner: Linda Clark Date of Inspection: April 23, 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(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "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: i 3 Page 4 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 173 Bay Lane Centerville, MA Owner: Linda Clark Date of Inspection: April 23, 2003 D. System Failure Criteria applicable to all systems: You must indicate either`des"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ 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 ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ✓ 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. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: 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 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 answered n in Section E the system is considered a significant threat or answered If you have ans ed es to an question Y `Y Y q Y Z� "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 173 Bay Lane Centerville, MA Owner: Linda Clark Date of Inspection: April 23, 2003 Check if the following have been done: You most indicate`yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on.the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 173 Bay Lane Centerville, MA Owner: Linda Clark Date of Inspection: April 23, 2063 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): S Number of bedrooms(actual): S DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): n/a Number of current residents: 0 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): Yes Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): 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: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: Qallons--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 Other(describe): Approximate age of all components,date installed(if known)and source of information: Apr. 14/92-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Bay Lane Centerville, MA Owner: Linda Clark Date of Inspection: April 23, 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: 16" Material of construction: ✓ concrete _metal _fiberglass ___polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (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.): 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: 173 Bay Lane Centerville, MA Owner: Linda Clark Date of Inspection: April 23, 2003 TIGHT or HOLDING TANK: None (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.): The D-box was level and clean. No solids were present. There were no signs of failure or backup from the leach field. PUMP CHAMBER: None (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.): 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: 173 Bay Lane Centerville, MA Owner: Linda Clark Date of Inspection: April 23, 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: ✓ leaching galleries,number: 8-4'x 4'galleys-per design plan leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The leach field was located There were no signs of failure. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Bay Lane Centerville, AM Owner: Linda Clark Date of Inspection: April 23, 2003 Map: 186 Parcel:010. 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. A g a. �3 Q o - T1 a 3L.(66 y 3 Y� 35.6 y3(0 So 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: 173 Bay Lane Centerville, MA Owner: Linda Clark Date of Inspection: April 23, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 +/- 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: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnvtable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 15'+1 to Around water at this site The system was within 300'ofa tidal bay, There is no high ground water adjustment for this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE LOCATION SEWAGE ' e ' VILLAGE �' ASSESSOR'S MAP LOT v p INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY �'f 0 LEACHING FACILITY:(type) °r` �'/ / /� (size) NO. OF BEDROOMS PRIVATE WELL OR PURLICWATER , • �L-p BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: � VARIANCE GRANTED: Yes No o I A(3 �n �� niece' . TOWN OF BARNSTABLE � L(,-'-CATION /73 SEWAGE # r9/" lSo�- VILLAGE Chi+ 6ry ASSESSOR'S MAP & LOT I PLO =010 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I50D LEACHING FACILITY: (type) yX y, (size) NO.OF BEDROOMS s BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by::n S/,, d l' •t A B . .2 ❑3 100 Q / 31.(0 3Fs lol y 3(a so A No.....21::.ZS ! . Fnic.......�1l�...©.� . . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration fir Uiopviial Work.5 Toutitrnrtion famit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: 173 Bay__Lane,,,,,Centery_j_]1_e_,___MA_______________•,,,___,-„• _Map 186__.Lot. 10 . ............ ............................................................... Linda Clark Location-Address Same or Lot No. Addres .. ..................................... Installer Address Type of Building Size Lot__32,67 0±------_-_Sq. feet Dwelling—No. of Bedrooms..................._..._._..___..__.__......Expansion Attic ( ) Garbage Grinder (X ) Other—Type of Building No. of persons............................ Showers — Cafeteria Oa Other'fixtures ----------------------------------- W Design Flow..........110___________________________gallons per �� ��r day. Total daily flow_______...$ ...__...._._.._._........__gallons. WSeptic T —Liquid capacity_1500 g�lons Le h.10'-6"_ Width.5 -8��... Diameter________________ Depth...`_'.-$.��._ x Disposal�—No.•---I.--...----.. idth t otal Length------3�_._:.--.. Total leaching area-------/g---•----sq. ft. = �szS r Seepage Pit No._.....---.-.-____-- Diameter.................... �epth below inlet...:..:.___...__._. Total leaching area..::__._...___.sq. ft. Z Other Distribution box (X ) Dosing tank ( ) *Percolation Test Results Performed by-__.Baxter_-&__Nye_,___Inc_______________ a ............... Date........J.11.26.,184............. ,� Test Pit No. 1__2.----_______minutes per inch Depth of Test Pit------9.5 Depth to ground water.........9..5......... 4.1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---__-_____--___-._____- P4 ----------------------------•----•-------------------------•------------------------......------•---......................................................... 0 Description of Soil....Med i um, sandy gr avel___________________ U *.__Reference_Plan by Baxter & Nye for W. Archi_bald___datedAugust._1984r_�ui_ �d.................... x January 9, 1990 on abutt�n9___l_ot.__�Map 186 Parcel 28) ----------•- -- V Nature of Repairs or Alterations—Answer when applicable___R e p l d c e e x 1_S-t-i n_g-_c e s sp o 01_._w U t h_....................... Title V system. -------------------------------------------------------------------------------------------------•----.........-----------------------------•--------------------------------.......................---- Agreement: The undersigned agrees to install the aforedescribed Individual S age Disposal System in accordance with the provisions of TITLE 5 of the State Environm nValT--e dersiglaed further agrees not to place the system in operation until a Certificate of Compl nnc issue t o d health. Signed ------- -- --- ----- Date ApplicationApproved By ----------- emu ---- �---------------------------------------------------------------- ------- -- r (J �Date - Application Disapproved for the following reasons: ----- ------------------------------- -- -----.....---------- -----------------------................................. ..............................................D....a..'.. ..............No. ............, .-....�.6.. Issued --------------------- Date / ` ✓`' ~ 'r R�w �"�• � �� � gar t0 � A- -No...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for. Disposal Works Toustrnrtion Prrutit Application'is hereby made for a Permit to Construct ( X) or,l Repair ( )" an Individual Sewage Disposal System at: .� 173 'Bav Iriil?e._.CPrtter,till.e., l ••--..-...... Man 186 tole 10 Location-Address or Lot No. Linda Clark Same Address Owne Installer Address Type of Building Size Lot---U.& 0±--------Sq. feet �� Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( X) p.l Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q .. , Other fixtures/.---------------------------•--• -----------------.•••••-••-•-•-------•••-•----•---------••---••-••=-•-••••----•-••••......•..........--.......... W Design Flow...........1.10_.:< ....................gallons per pe i� Pe't day. Total daily flow__:�_....__82.5_________.__._.._.________gallons. WSeptic Tank-Liquid ca.pacity..15QQ..gallons Length..)Q'_- `� Width..5.f-X"_. Diameter................ Depth....5' x Disposal T�rens'lf�—No._.__4._.___.___. Width_�_.��.�._._�_�____ Total Length......36......... Total leaching area.....?7a-------sq. ft. Seepage Pit No..... ________. Diameter 4.,WA.6Dep�i below inlet.. ..... Total leaching area.. .....sq. ft. Z Other Distribution box (X ) Dosing tank ( ). a *Percolation Test Results Performed b .... ..NuP..._lad_t........................... Date.........1.1- 26484 Test Pit No. I...2...........minutes per inch Depth of Test Pit....... R ....... Depth to ground water_-_-__.__9 9...__... GPI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..--.____--____--_____- --------------------------------------------------------------------------------•-•---------.....--........------................--••--......••--.......•-•-- O Description of Soil Nadi-lam: S1r1dv_-araue-----------------------------------------------------------------------------------------------------=------------- v *.-ftference.._Planfbv_1axter_-&__Nn..for-- Arcbi-b l_d-. dtPd•--Alact�� t---19R4_-r �� ari'------------------ W January_ 9, 1990 on jbuttina- lot-_-(MdA--- -------------------------- U Nature of Repairs or Alterations—Answer when applicable....Ranhc p-e i-st i u--('e s pool.-tUkt b.................... TitleV s.ystem.•-••••••-•••••--•-••••••-•-••-•-•-•---....-•--•••---.. - ....... .......................la .• Agreement: ' --- I The undersigned,agrees to install the aforedescribed Individual S iZage Disposal System in accordance with -- the provisions of TILE 5 of the State Environmental C6d'e The undersigned further agrees not to place the system in operation until'*'-'Certificate of Compl�nc/eJha�s bee i�ssu/e�d`y the board of health. !,•Signed l / .> A/ 1'.-- d ........ ...........:.....1.;te-- ------------- . �..... ..............................—'--..........-....... Dare Application Approved By ............... .. . -.. : �.. Application Disapproved for the ollowing reasons- .................................................... ------------------------------------------------- ------------------- -------------------------- -- -- -- ------------------------------------------- ..........................................................................................................--------- ........................................ Permit No. ............ yam ....... Issued ........ Date..... �"- ----' Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C rrtifirate of Cfamylittne THIS IS TO CERTIFY, That,the Individual Sewage Disposal System constructed ( ) or Repaired ( X ) ' ........_. �,....-.. ...................................._ . t/ Installer at .173 Bad. Lane, Centervi.11e.. MA .... .. . . .....A.............. .....----......-- -- ---...-------------.............------------. ------......................................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... � .b....... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... ..... •�.............-�.. ..."-/ ---------------------.......... Inspector ....------........... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE N0.....9/- 1.�'� FEE.....7Lda z:..... nr �un # nr#ualnrrrmi� Permission is hereby grantted_lt�. - _ / / ,h:,t ----------------------------------------------------•. to Construct ( ) or Repair (X ) an Individual Sewage Disposal System atNo...... 1.1P....MA.................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No...../� Dated.......................................... ......................•..•_... ......-.,....------...-----------------------•-----•-----------...._ Board of Health DATE.................. � nj L;-- q FORM 3650IR HOBBS 6 WARREN.INC..PUBLISHERS j ' QSsr Z 2 Nor f i k 1 r N 1I+om AS uLt dc.ZMAQ forc4E5Z = 37 do N . 'N `R4Pg / °i W 6'TLAN 1.634C y . 7A7A E Gex 1,pD12 ^� SY.u6ZE Fdhl/LY OWELLIn(� -t/13FO2c+�.c•! 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' I First Floor Plan - - `� t SCw1e FIRST FLOOR PLAN I NCYLSIONS: 4 NORTHSIDE 7DESIGN SCALE: PREPARED FOR: •„ As NOTED u.a _ RESIDENCE OF: �^^•ra^pp410• '"" DATE:Mr & Mrs CARRINGTON CLARK Jr. � I <i I � - r , , I a' L - --------- ----�- -y---- I ------------------- ---' , �-- i *_.. . � H I �r/x.aauNn �•� I _._ EXISTING 8T7ED OMS & BATH BALCONY * �� 10) ----- a --— r - 1 rL r-------- BALCONY OPEN TO BELOW }i - -ME7J WNME11_. ._ �Xy_ A ,• ___.—._.— ___ BA � LcoNY _ `J - ° ' 1lrt. �� FU.�U.r,+-Fr � I=' � I � r� I " __.... .. __. ... _....__. .;/'� \ � �� � � \� -1 J , ♦ m. •. .I-,n -- i Secorid Floor Plan f�. SCALE ,�•—�'—� _ SECOND FLOOR. PLAN tilt 7DESIGN RTHSIDE REV7410Nl: SCALE: = AS NOTED PREPARED FOR: _ RESIDENCE OF: HATE: Mr & Mrs CARRINGTON CLARK Jr. ._tea MANHOLE COVER BROUGHT TO FINISH GRADE 5 21" N0� M/N. 2X SLOPE OVER Revisions: SOIL TEST PIT DATA 10'-6" !o I I 1)DIS7RIBU71O I BOX TO WITHSTAND H-10 FINISH GRADE LEACHING FACILITY DATE noN 1d-0 120 MIN 4 LOADING UNLESS UNDER PAVEMENT, DRIVES OR TRAVELED WAYS WHEREBY H-20 LOADING ' 12" M/N. 4' 2rLA YER OF °, INDICATES INDICATES OBSERVED V: 12 , �� o � , SHALL APPLY. 2. �,ssPEASTONE PERC GROUNDWATER N " 15 2 ROVIDE MET TEE AS SHOWN WHERE • CENTERNLLE TEST 1 0 ESLOPE OF INLET PIPE EXCEEDS 0.08 FT/FT ps Noit cR IN A PUMPED SYSTEM. END SEC710/ 314 -1 l/? ° 4 !NL£T -� aTP N0. TP N0. - PRECAST, STEEL - „ 5 8� 14• 5'-g 3)i1RST T1N0 FEAT PIPE Olrr OF THE WASHED I ( CUDDER GRD. EL GRD. EL REINFORCED 5-2 f 5-d' DISTRIBUTION BOX m eE wo LEVEL 8, I 3.3 BAY SEPTIC TANK - 4-6 PLAN VIEW ROTUN��M�ACTu� ,8 I I STONE GW. EL GW. EL INLET 4-00 MIN. ,• �, °,, 0 I I TEE LIQUID DEPTH TEE f Q�a •• 2" _ 8�_� -LOCUS 0 ' 8' MIN. 3/4' TO 1-1/2-STONE �: 2 rrREMOVEABLE COVER ° 2 L_ _J � 36 1 SEE 1 ; ` • ` t •e' , 1 ,, ' , • t ;� 5' DIA. OUTLETS) 5' DIA. INLET LE CENTER p q 2.5 PROVIDE CROSS SECT70N F 2 2 24" DIA. MANHOLE COVER • �` BOTTOM ON LEVEL STABLE B14Sl; ; 1 P 4" �- WATERTIGHT I � I 8 N. T.S. REFERENCED •� so• 3 3 PLAN VIEW 4' INLt - -' ,JOINTS (TYP) M�� 4 PLAN CROSS SECTION VIEW 15 4- OUTLET 16 12 , F._77n °G � � References- 4 NOTES l g 7 c� 5 BY 5 1) SEPTIC TANK TO WITHSTAND H-10 LOADING 3) INLET AND OUTLET TEES TO BE CAST IRON, 1� A��`Ss COVERS TO BEPROVIDED AT EACH NLE BAXTER UNLESS UNDER PAVEMENT, DRIVES, OR TRAVELED SCHEDULE 40 PVC OR CAST-IN-PLACE CONCRETE. : BOTTOM ON : IF--- 4'--I 6 'T • ° • "• L� STABLE • "• ' � 8' PLAN OF LAND /N CENTERVILLE, MASS AND 6 WAYS, WHERE BY H-20 LOADING SHALL APPLY. TEES TO BE CENTERED UNDER MANHOLE COVER. 2 ----� AS SURVEYED FOR ROSE D/R/CO BY NYE INC 2) ALL PIPE CONNECTIONS AND CONCRETE CON- CROSS SECTION VIEW e' MIN. 3/4- TO SEARSE & LAW SURVEYORS DATED 8 STRUCTION TO BE WATERTIGHT. -1/2' ST ONE LEACHING GALLEY DETAIL ASSESSOR'S MAP 186 PARCEL 10 JUN 1Z 1963. 8 SEPTIC TANK DETAIL No. OF GALLONS: 1500 DISTRIBUTION B 0 X DETAIL - NOT TO SCALE L 0 C U S MAP PLAN OF LAND /N CENTERVILLE, MASS 9 9 NOT TO SCALE NOT TO SCALE SCALE: 1"=2083' TO BE CONVEYED BY FREDERICK P. do 10 10 JANE R. NICKERSON BY BEARSE do 1 11 PIER ZONE RD-1 DESIGN ANALYSIS KE O 8, 955. 12 12 SETBACK REQUIREMENTS ENGINEERS DATED DESIGN FLOW: TOPOGRAPH/C PLAN OF LAND IN CENTERVILLE, FRONT 30' 5 BEDROOMS X 110 G•P.D./21EDROOM = - MA. FOR MLLIAM ARCHIBALD BY BAXTER AND NYE.,INC. DATED AUG., 1984 REVISED DATE: DATE: SIDE 10' 550- G P.D. I/"O TESTBY: TESTBY: REAR 10, o N/� SAMUEL R. N/CKERSON TRUST MIN. LOT AREA-43,560 S.F. SEPTIC TANK REQUIREMENTS: Project Title: --117fLG9BBA��_ i�RINDER WITNESSED BY: WITNESSED BY- :i?0 G.P.D. X 20OX = 1100 CAL. _ - -I 2 SEP Tl C -I USE A 1500 GAL. TANK / I 3 - - - _ _ - - - -- - - PERC RATE: PERC RATE: 100 YEAR FLOOD ZONE EL. ll.O' N.G.V.D. MIN./INCH MIN./INCH PERMI T / s e Io 11 f 4 �^f' 9 12 TP N0. TP N0. _� �� FENCE LINE 13 _ PLAN GRD. EL GRD. EL `_ � / -� �: -� LEACHING FACILITY REQUIREMENTS: `� _� N 47�8 58 E 550 GP.D. x 1.5 = 825 G P.D. GW. EL GW. EL I / f ' �__ 188.53' _ WITH GARBAGE GRINDER ON p , �//" ��� c TL o 0 0 ORYWELLS SHALL BE PRONDED TRY a-4�x 8� GALIFYS W/2 STONE 0 ` 14 { / o FOR ROOF DRAINS. \ STONE WALL pro / / 15 S(D�WALL AREA: (36 +3d+R *8� 33' = 290 SF. BA Y �j PLANTINGS PROPOSED (a Na WALK � 1 PLANTINGS 2 \ ( ( \ Q7-M AREA: 36 x8 = 288S.F.23 �00 LANE\ \ 1 � PROPOSED 3 1 0 0 / SPA ,..••,.•. ....,,y o \\ 4 4 5 ~ ti ADD171dV ••= • + • • . _ _ (CEN TER VILLE) 5 ` / ZZI 1 /9 6 6 CONC. l = LEACHING FACILITY PROVIDED L4 WIN EXISANG 4 /�EX/snNG BARNSTABLE, 7 7 � DECK CONC. AREA �. R SEED + . CONCRETE WALK : 0 8 8 STEPS 8.3' DECK PROPOSED ' INV a 16.0' D_� I W M2L_. 290 S.F. X 2.5 GAL/SF, = 725 G.P. MAO• EL=13.81 CONG PA71O :••ATCH EXISTING LIMIT / PROPOSED 4' Z 9 .:<.• ER- BOTTOM: 288 S F. X1.0 GAL-I F. =288 G.P.D. 9 w(/� / 17 P.KG OUTLET EIVS I to ►' Q TOTAL 1013 10 1 p / IN - ° W I, A a / 1 _r_ � /O/3 1 / qu 2 STORY a PREPARED FOIE / / PROPOSED WWD FRAME TO PROPOSED 1,500 GAL. a NOTES 12 12 m / 't? T.O.F. EL-1 SEPTIC TANK I h g O EXISTING SEP77C SYSTEM IS TO BE ABANDONED. THE DATE: DATE: / N / \� �,: - -Wd TR UNE� O y� � EXISTING 4 r EXACT LOCO 710N AND COMPONENTS OF THE SYSTEM ..' TTO I Q IS UNKNOWN. THERE ARE TWt7 EXISTING 4" P.V.0 LINDA CLARK TESTBY: TESTBY: �`�' 1 P.V.G OUTLET �••. COIVG PORCH/ POOL TO BE ABANDON - m OVERHEAD OUTLETS AS SHOWN. B077-I EXISTING OUTLETS A� 1a // ABANDONEDANDTO BE PLUGGED WATER TIGHT. IT 3 / I I �i - WIRES /S THE CONTRACTOR'S RESPONSIBILITY TO LOCATE WITNESSED BY: WITNESSED BY: p V E 7 THE EAIS77NG SYSTEM AND PUMP AND BACKFILL 1• COMPONENTS WITH MEDIUM COARSE SAND. G - O PERC RATE: PERC RATE: I I \ PROPOSED � 16 LIGHT 1 CONCRETE r ' 1'i ADD/TIOW POLEI N 1 PROPERTY ONES SHOWN HERON WEJRE COMP/LED MIN /INCH MIN.,4NCH l ' DECK _ / _= GARAGE BITUMINOUS 15 0 $ / FROM PLANS RECORDED AT THE BARNSTABLE COUNTY I I '� D /PAVE ENT I REGISTRY OF DEEDS /N PLAN BOOK 125 PAGE 93 EL.=15.5 PRaP0.SE0 •I :,� SLAB EL r ^ LEGE7VD PLAN BOOK 178 PAGE 131 AND DO NOT REPRESENT � CONG DECK J '''='=i£• =17.31 � _ ,� PROPOSED 2 i1 CONC• WALL�0.9 H AN ACTUAL SURVEY ON THE GROUND. A.M. Wilson PLANTINGS LAWN ADDITION 4 I EXISTING CONTOURS -l7 -- Associates 1 ` I AREA 0 \ PROPOSED CONTOUR J - ELEVATIONS ARE BASED ON MEAN LOW WATER I W $ ,g 1 Inc. INVERT ELEVATIONS \ / V GROUT AND SEALS TO BE USED AT ALL POINTS / n STONE FENCE LAWN 17 ( WHERE PIPES ENTER OR LEAVE ALL CONCRETE l STRUCTU„ES IN ORDER TO PROVIDE A WATERTIGHT 0 1 2 � I I � PLANTER AREA � SECTION 4" INVERT AT BUILDING 16.0 1 3/` / 8�60' a STONE SEAL 911 Man Street OdwvfeAA 02655 s FENCE /�/ �- PLANTING / FRECAST CONCRETE SEPTIC TANK, DISTRIBUTION BOX, 508--428-1450 iS 51 b3'30" W \ �2g�.. " AREA w OF " - I6 S 61�I'• 29.36" A •,tr • AND LEACHING FACILITY TO WITHSTAND H-10 LOADIN U�+LESS UNDER PAVEMENT DRIVES, OR TRAVELLED Drawing 4 INVERT AT SEPTIC TANK (IN) 15.46 30• N, S 5652.310 ;� �.� g Tltle: W %AYS t+IERE H-20 LOADING SHALL APPLY. 4" INVERT AT SEPTIC TANK (OUT) 1529 R.R. TIE 862s' F ALL + N SHIPLAP NEOPRENE 17 SEALED WITH GASKETS OR ASPHALT 4" INVERT AT DIST. BOX (IN) NTS IN SEPTIC TANK SHALL BE 15.21 N/I= CYNTH/A REMOLDS CEMENT TO PROVIDE A WATERTIGHT SEAL PROPOSED / � saM s>�,�.', ALL PIPES IN THE SYSTEM SHALL BE SCHEDULE 40 HOUSE 4" INVERT AT DIST BOX (OUT) 15.04 OR E0UAL ADDITION ' I I UNLESS OTHERWISE NOTED ALL CONSTRUCTION INVERTS AT LEACHING FACILITY: PLAN VIEW 1 =20 AND METHODS AND MATERIALS SHALL CONFORM TO TITLE 5 OF THE STATE ENVIRONMENTAL CODE 4" INVERT AT BEGINNING OF TOP OF FOUNDA TION SEP TlC AND ANY APPLICABLE LOCAL REGULATIONS. LEACHING FACILITY 147 OUNDA ' MANHOLE AND COVER BROUGHT FINISH GRADE lee .9 TO FINISHED GRADE WASHED CRUSHED STONES SHALL BE FREE OF ALL F S YS TEM 7 4" INVERT AT END OF 4 P.V.C. '"`� FIRST TWO FEET TO MIN- 290 SLOPE OVER LEACHINGDIRT, DUST, AND FINES. REPAIR LEACHING FACILITY _ NA 0 .02 FT (TYP.) BE LAID LEVEL HEAVEY EQUIPMENT SHALL NOT BE ALLOWED TO �A} - OPERATE OVER THE LIMITS OF THE SEWAGE DISPOSA 9 J.. I'll 180 15.46 1529 /5.2/ l5.04 v SYSTEM DURING THE COURSE OF CONSTRUCTION. �, GALLEYS O ' 14. 70 NO FIELD MODIFICATIONS TO THE SEWAGE DISPOSAL ��,,• n OOTOM 11. 4 SEPTIC TANK _ +�� SYSTEM SHALL BE MADE WITHOUT PRIOR WRITTEN OF LEACHING FACILITY - -------- - -- i1.4 BOTTOM OF LEACHING APPROVAL OF THE ENGINEER AND THE LOCAL TO BE INSTALLED ON A BC►►RD OF HEALTH. Scale: 1"= AS NOTED �---LEVEL do STABLE BASE. THI `-SYSTEM SHALL BE INSPECTED AS REQUIRED 0 FEET, OBSERVED GROUND WATER ADJUSTED HIGH BY -,ECTION 2.10 OF TITLE 5. ELEVATION 4.70____ GROUNDWATER = 7.4' A CERTIFICATE OF COMPLIANCE AS REQUIRED BY Date: DEC. 13 1990 Dwg No: ADJUSTED HIGH GROUND WATER 74 SYSTEM PROFILE SECTION 2.8 OF TITLE 5 MUST BE OBTAINED BY THE Design: C•P.J CONTRACTOR UPON COMPLETION OF THE ABOVE WORK NOT TO SCALE - IF AN "ASBUILT PLAN" IS REQUIRED DUE TO CONTRA Check: TOR DEVIATING FROM THESE PLANS, WORK FOR SUCH Drawn: J.V.B. PLANS SHALL BE COMPENSATED BY THE CONTRACTOR Job No: 2.0502.0 Sheet 1 of 1