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0022 BEECH LEAF ISLAND ROAD - Health
r. 22 Beech Leaf Island Road Centerville A = 187 - 077 S M E LO] No.2.153LOR UPC 125U onmdAan • Umb In UGA 1�*—Mb� arurDnsnnaouaue SFI O M,OAMMUSMS i TOWN OF BARNSTABLE LOCATION =G4 L/t:'1ffjC 4HG( ejXWAGE# ,�),O ,. VILLAGE ASSESSOR'S MAP&PARCEL I� - �� INSTALLER'S NAME&PHONE NO. $jQ 20-%7:%,? / ✓OJ eee ,Ve 9,&PA ,9.r SEPTIC TANK CAPACITY 1T00 �lS LEACHING FACILITY:(type) -/Pytd e2 r 4"R�qC_OYC (size) NO.OF BEDROOMS 3 / OWNER M#/Z/fr H,4-1^Olj f?'/",e hgr4 PERMIT DATE: - `/- / COMPLIANCE DATE: 3"29 �3 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 fir, .��• , � 43: 2 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPlieatiou for Disposal 6pstem Coustrurtiou i3ermit Application for a Permit to Construct(� Repair Y,410pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.gl. EieG y L Ac q,4;YZ#4oY Owner's Name,Address,and Tel.No. Assessor's Map/Parcel/87 C�Y11F.r'vr!!P ��rryb�fh CK►sEy In taller's Name,Address,and Tel.No.S'Og-y?D-9`11 g Desi ner's Name Address,and Tel.No.,SD g-,?4 2-2 92-Z Type of Building: Dwelling No.of Bedrooms Lot Size `�, sq.ft. Garbage Grinder( ) Other Type of Building No:of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �`) gpd Design flow provided 3 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) _TV ritz /,S'00 lsA�Sr'.a?iG D- Sax 3 /?ou/ oX to -09d1 WRC Hif h`-20 "01/rs rvrrL, Me .fib n iAl Jer/scti Raw 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 3�f r �� Application Approved by Date Application Disapproved by Date for the following reasons q n Permit No. �� _ ( Date Issued 7—Cl � _. ,- _ •� - 4 - -_._ - - _ � _ .. -err.. allo. '�. "+ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for B18 7911 *pstem Construction permit Application for a Permit to Construct� Repair(lXQpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.Z z F/�C N L G!�{F L /✓ah Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /$7 _ 7 Installer's Name,Address,and Tel.No.$-oG-y26)- 9 73Z Designer's Name,Address,and Tel.No.So 2 3G.2- 2 q.�2 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 2 Design•Flow(min.required) -> gpd Design flow provided 3 3 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil k Nature of Repairs or Alterations(Answer when applicable) 1�'IsTi��� /S'00 G.Q� .S/�1iG l2- 13ox 3 /20� �,C 6 -l9US 14A'C HC ff-20 uAld—j' 6.,v/r4 1110 Srb zl. of 044& =ems Date last inspected: mod. 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 systeE n operation until a Certificate of Compliance has been issued by this Board of Health. Signed }� Date 3_ I r l� Application Approved by ' Date Application Disapproved by Date for the following reasons Permit No. aC�( 2J V 7 ( Date Issued `3! + /3 ,,.--°�-�— l _ d THE COMMONWEALTH OF MASSACHUSETTS t BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(4-)- Repaired(G} Upgraded( ) Abandoned( )by D�� O-e 73i41iy'US i at 12 -/=leiZ_)Lraa, been constructed inaccordance with the provisions of Title 5 and the for Disposal System Construction Permit No.-1o1-T-6'p 1 dated Installer,-/ps Gp11 yi Designer l J�. f Sort S rit// #bedrooms 3 Approved desi nn�flow 3 gpd The issuance of this permit all noZ construed as a guarantee that the systt will functt n designed. Date _3 Inspector ---- No. o;2 O 13 6 Fee 16 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction 3pPrmit Permission is hereby granted to Construct Repair( Upgrade( ) Abandon( /) System located at 21 (�'i�/=��'! Li=s4� rSLadl�i2osglil 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. j n Provided:Construction must be completed within three years of the date of this permit. Date 3 Approved by i i 04/02/2-1013 06:15PH 17744139468 ME'.,'ER 4-0 SONS PAGE 01/01 Town of Barnstable Regulatery Services Thomas F. Gefler, Director tTubhc Health Division Thomas ?VkKean,Director NO Main Street,.Ryau65,INIA 02601 Mi51—1jer De— Date: qL1 L13 sewace PermiO (P-0/3-0-7(sse . ti 7 A1�7 .. Installer- Addrem BC Address: Or WLIS issueL' a pet ut to install a septic System at Bmc-IL �A/ based or., a design drawn off. dated /3 (de6igner) -A- 1 certlfy- that Cle 5cpt1,,. system zeferenced above was irlsealled 3U1'),M)Mtk111Y a-CLOTcing tc =he design, whisk xna-v ImcIlude m-nor approved chan-2es such as lzte.ml re;K. Claton.ofl't distribution box ando- h., see tank. 1 ceftifv 1l12t the SePdc S�sLerll Tefereilced above wa-.3 izsralled with Major chLinges (i-e. gmater than ?Q' latemi reiecation of the SAS or anvv�rucal relocation of arty -cornponent of t, :1e sept2c system) but in accordance with State & Local Re-viations. 711ani.rclVision rjr certified as-bullt by designer to,follow. OF ARR Y TW (Designer's Signatuce (Affix Designer's Stamp Here) PLEASE RJETURN 1, PN'STA3LE LU—I 'M .. PUBLIC. kJFA1,TH Dj),'151,0N. CERTIFICATE. OF' U����YAL�INQT BE—15SUED UNTIL—1301R_LMIS FOP--\,I AN'D AS-BUILT rARL) AR(I :LIVED BY THr,BARNSTABLE PV 51,IC. HE,,kLT)i 15�-PIVI. 10N. THANK YOU. Q: Ce7�ificauoi Form 3-Z6-0&c Fnatuce To- p I Town of Bdi!MStable. P# off . Department of Regulatory Services gtE, : Public Health Divisio n Date & KAS 200 Main Street Hyannis MA 02601 ,bsy. tee$ Date Scheduled �`� Time / Fee Pd. i Soil Suitability Assessment for ,Se a asposal Performed By �'✓_ Witnessed By: i LOCATION & G//ENERAL INFORMATION _ � Location Address . �� P-A�/ lelW ISlr� OW1er's Name MQ y E+�iN C,s / id V l l le MA' Address f Assessor's Map/P4rcel- / e ` J®7 Engineer's Name (�4;rft#1\ NEW CONSIRUtON REPAIR Telephone# fd� 6 0 -3311 Land Use �LPr is tr it t[� �✓ Slopes(%) S J�o Surface Stones (-e v j Distances from: Open Water Body > (Q f[ Possible Wee Area >1 CL� ft Drinking Water Well a ft i 0-0 ft ? ft Other ft Drainage Way ft Property Line SKETCH:(Street name,dimensiods'of lot,exact locations of test holes&perc tests,locate wetlands in proxitnity to boles) I I . I PLA,� . D 24.w."3 j t i , i 1 i 1 i 1 , Parent material(ge(ilogic) - 4 " '°" a,5'"1 Depth t4 Bedrock .1. Depth to Groundwater. Standing Water in Hole:' i We. from Pit Face__. Estimated Seasonal Righ Groundwater D#,TERMINATION FOR SEASONAL HIGH WATER TALE Method Used: 1. la. Depth Qb�erved standing in obs.hole: in. Depth to sell Adjust !t. Depth toiweeping from side of obs.hole: in. ©roundwater Ad)ustment Index Well# Reading Date: Index Well level. Adj. A�•GraundwaterieVe1.,,e PERCOLATION TEST . Date_ Time . Observation Time at h" Hole# _ Pt i Depth of Pere Time at b" Time(9"-601) Start Pre-soak Time.@ End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed__XL — Site Failed;` Additional Testing Needed(YM) Original:,Public r'ealth Division Observation Hole Data To Be Completed on Back— ***If percolafiibn test is to be cond*.icted within 100' of wetland,you must first notify the Barnstable C44servation Division at least one (1) week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. Consistent %Gravel 11`g 41t CIV 61 C� Me-it &v � DEEP OBSERVATION HOLE LOG Hole# -K Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. Consistent %Gravel) 0`1— sat t q —gar t� r DEEP OBSERVATION HOLE LOG Hole# N 14, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel i I I i DEEP OBSERVATION HOLE LOG Hole# N Depth from Soil Horizon Soil Texture Soil Color $o'tl Other Surface in. USDA Munsell Mottling Structure.Stones,Boulders. Consistency, Gravel) 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? If not, what is the depth of naturally occurring pe ious material? Certificationon I certify that on O � ) (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required t,,` 'ni ,expertise and experience described in 3,10 CMR 15.017. Signature v Date 3 Q:\SEPTICIPERCFORM.DOC down cape engineering, irlSIEVE SOILS ANALYSIS 22 BEACH LEAF ISLAND RD CENTERVILLE, MA DATE OF REPORTA/25/13 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 22 BEACH LEAF ISLAND RD CENTERVILLE, MA LOCATION: DARREN MEYER TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 184.0 SIZE :WEIGHT RETAINED % RETAINED % PASSED (sum ) -------------:.......................................................--------------------:....................................- 1" 0.0 0.0%I 100.0% --------------F......................................................;---------------------F------------- 3/4" 0.0€ 0.0% 100.0% lyi�----------:......................................................:--------------------=------------------- " 0.0 0.0%` 100.0% --------------.......................................................---------------------F------------------- 0.0:: 0.0%::0.0 i 0.0% 100.0% --------------:.......................................................--------------------------------------- 0:0. -------------- - 0-- ...................100;0% #10 43.4 23.6%' 76.4% -------------......................................................:---------------------;..................................... #20 93.1 50.6% 49.4% --------------!.......................................................---------------------..................................... #40 155.6 84.6% 15.4% --------------..................................................2. ----------------------..................................... #50 168.2 91.4% 8I..6% #80 176.7€ 96.0% 4.0% -------------:.......................................................-----------------------------------....................... #100 178.3 96.9% 3.1% --------------i......................................................r---_------------------------------------ #200 180.4's 98.0% 2.0% PAN:SAMPLE: 182.E 100.0%' 0.0% --►------------------ 184.0€- --------------------- ----------------- i t- NOTE:TEST ON PASSING #4 ONLY, 52.3% RETAINED ON#4 RESULTS: j SOIL CLASSIFIED AS AASHTO A-1-b (GRAVEL AND SAND)(UNCOMPACTED) >98%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MINAN. MATERIAL NONCOMPACTED SOIL DESCRIPTION: SAND & GRAVEL J � Y r T S , n w Barnstable Town of Barnstable ��a� y v 411 OFNE Regulatory Services Department j; I; n,RE Public ;1 �i Health Division ,to; NA'S 0 �p >639• a� Main Street, Hyannis MA 02601 o Mpy, 200 Thomas F.Geiler,Director Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL# 7006 0810 0000 3524 7472 November 19, 2012 Marie Harold &Mary Beth Casey, TRS 22 Beech Leaf Island Road Centerville, MA 02632 The septic system located at 22 Beech Leaf Island Road, Centerville,MA was last inspected on 11/01/2012 by Frank Nunes III, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline'period will.result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH �MOeari, R.S. CH Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\22 Beech Leaf Rd Nov2012.doc 1 ' Commonwealth of Massachusetts Title 5`'Official Inspection Form Subsurface Sewagebisposal°System Form-Not for Voluntary Assessments M , 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town. State Zip Code 508.272.6433 Telephone Number -8. Certification rU -, I certify that I have personally inspected the sewage disposal system at this address and that the1-4 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�maintenapce of on site sewage disposal systems. I am a DEP approved system inspector pursuantto,Sect~ion:15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes t `-Yizi❑ Conditionally Passes �® Fails r-~ ❑ Needs Further Evaluation by the Local Approving Authority f.:; fi IA Ul 11/1/12 Inspecto s 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 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. ****This report only describes conditions at;the4ime;.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. ?Fit , 22 Beech Leaf Island Rd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments a 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 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: Evidence of backup at septic tank, d-box, and leach pit including high stain lines and charged soils 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: n/a ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 22 Beech Leaf Island Rd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 22 Beech Leaf Island Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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: n/a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"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 a. or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less • than '/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. 22 Beech Leaf Island Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 22 Beech Leaf Island Rd Property Address English Owners Name Barnstable MA 02632 11/1/12 CitylTown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 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- 10,000gpd. ❑ ® 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. 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. 22 Beech Leaf Island Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must 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: ❑ ® 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)] 4 4 22 Beech Leaf Island Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): n/a 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 0 No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Oct. 2012 Date Commercial/industrial Flow Conditions: Type of Establishment: n/a Design flow(based on 310 CMR 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: Last date of occupancy/use: Date Other(describe): n/a 22 Beech Leaf Island Rd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GM 22 Beech Leaf Island Rd ' Property Address English Owner's Name Barnstable MA 02632 11/1/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No pump history given Was system pumped as part of the inspection? ❑ Yes ❑ 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) 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): Approximate age of all components, date installed (if known)and source of information: 1985 per age of home Were sewage odors detected when arriving at the site? ❑ Yes ® No 22 Beech Leaf Island Rd-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 20"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Riser at outlet cover If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000g 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle >21, Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured 22 Beech Leaf Island Rd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Cityrrown State Zip Code Date of Inspection 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.): Septic tank exhibits conditions of backup including high staining above outlet invert and stained soils Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a Dimensions: Scum thickness t 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a 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): n/a 22 Beech Leaf Island Rd-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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.): n/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level w/the bottom of the pipe Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-Box w/high stain line 2"above top of outlet pipe Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 22 Beech Leaf Island Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 ' M Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G M , 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: o ❑ 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.): Leach Pit has effluent level just above last row of weep holes at this time, staining above this, and stained soils, it is directly under a cherry tree 5' below grade with riser to T of grade 22 Beech Leaf Island Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 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.): n/a 22 Beech Leaf Island Rd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanetif reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public watef;supply enters the building. Q 1 Q� 22 Beech Leaf Island Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM , 22 Beech Leaf Island Rd Property Address English Owner's Name Barnstable MA 02632 11/1/12 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water, ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: undetermined/system failed 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above 22 Beech Leaf Island Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 No. /G G . Fes$ ............. THE COMMONWEALTH. OF MASSACHUSETTS 0, I�� BOAR® OF HEALTH .."."._".............OF............... . ..... . . Appliration for Ditipooal Works Tnntrnrtiun lirrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: / L ,�v �'!.............�a �3 Location-Address -. o � r�t No. r ---.1'�.--•------•-•------•-•----•---•------------------•---- ....�/l �i4in� ��.............f ..�! �...---- owner < Address .......................... L---...........-----.....---•--.........--•-••................•............. Installer Address Type of Building Size Lou_ j f:3....Sq. feet U Dwelling—No. of Bedrooms........ ..................... .Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building Art................... No. of persons........................---- Showers ( ) — Cafeteria ( ) Pa Other fixtures -----------------------------------••-•••-...••......-- W Design Flow.................... ...............gallons per person per day. Total daily flow............................:3.. .0....gallons. WSeptic Tank—Liquid'capacity�q� .gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq.ft. Seepage Pit No-----------/.___.... Diameter......./.Z __.._. ..... Depth below inlet..... ..._. Total leaching area.....- 5._.sq. ft. Z Other Distribution box ( Dosin tank ( ) Percolation Test Results Performed by.-" y .�`Chi'ZA..f�t��..........•.......•................. Date........................................ Test Pit No. 1--_--_-?r�....minutes per inch Depth of Test Pit______&...... Depth to ground water.....iFL7........... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil.................................................................... ................................... ---------- ....-------------------------- •-----•-•--------- 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 i Ti 112 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the board of health. Signed_:�� .................................................................. .........................._.... ........� Date Application Approved BY 1. .� -•- Date Application Disapproved for the following reasons------------- ---•---••-••---•-•......---••--•--••---•-------•_.............................................. ....-•---•-------------------•••••---•.......--••-......_.......-•••••••--•-•---•.........•--•---•••---•----•-------------------•------------------------------......••-••-......---••----•••----------- Date PermitNo........................................ ............... Issued........................................................ Date i No---- ._-U. FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I .0 '....................OF.... I'll/ I` 1 ._..... Apphration for Uiipooal Works Tomitrur#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ,�.c-fl.......� .«moo. '. Location-Address or Lot No. A'k..................................................... .... .4,,9_-...... ltr......r.-7 ........... ll'' Owner /e Address 1;r --•-r4.� .-- --••..............................•-..............•.••--•- ......................... Installer Address UType of Building Size Lot..;5M !`XS_Z_._Sq. feet , Dwelling—No. of Bedrooms.........a................................Expansion Attic ( ) Garage Grinder ( ) Other—Type e of Building p� yp g _,fc-.r___________________ No. of persons___..____._._____._.._______ Showers ( ) = Cafeteria ( ) P 1 Other fixtures ---------------------------•••-• . W Design Flow..................... .............gallons per person per day. Total daily flow............................. 30...gallons. 9 Septic Tank—Liquid'capacity.' -_%•gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No.....................Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No------------{...... Diameter........ Depth below inlet........g__�_.... Total leaching area...... __sq. ft. Z Other Distribution box ( to�4 Dosing tank ( ) _ aPercolation Test Results Performed -1...1l7[c__................................. Date........ _...�.....� .......... a Test Pit No. 1............ 4--_._mmutes per inch Depth of Test Pit------- �'�.�.__ Depth to ground water........ '_�.__..,_.. (i Test Pit No. 2:...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil =- ----•-••••..._•-•-- Ur ...•• s—s�..t r^ r.� !` it 5 p— n 1 'y'`�..... � ,s�f ................................... hw.l ----------•------------------•-----•---•-•-•-----•-------------•------------------•----•-----------•-------------------------------•--••-------•---•-•------••----•-----••-•-•------•---------------•--- V1 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 TTTF....� 5 of the State.Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed._ r 3 Gy �7si `a Date... ,41[ lication Approved B -••-••..........__�- ......... � ............• ...� h• Application Disapproved or Date PP --- PPPP f the following reasons:---•--------- --•------------------•------•----•-••--•-•-••--•--------•-------•----•---•-•--•-•------....----._ ...........................•-------..........----•-•--•--.....---..............---------------------........-•----•----...------.....--------------------------------•---------•.................•---•-. Date PermitNo......................................................... Issued-....................................................... Date yr: THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ......... .... '`Cl.�:...........OF........e �. '.r '!51 /. /l.- ,� �'�" Tntif iratt of TontpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ), by �_�_( '�!7`....................••----. -•--- ------------•----------------••-•-•------....---..............--••-----------•--•----•--•---. .. nstaller at............................. ..........=4:i. .------. -- --- -- ---- 1��'-----------�---=J _------ ----------------------- �, oi has been installed in accordance with the provisions of TI`i'LE The State Sanitary Code as described in the application for Disposal Works Construction Permit No.........47... dated--------- —-__-_- ........ THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CO STRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. ............................... ........ . ............. ...D...IL-----4... ....... THE COMMONWEALTH OF MASSACHUSETTS - '� BOARD OF EALTH ....... . F ✓t�s. ,, ..... FEE......11........... �i��os�a� ork� �on�#rinn Trani# Permission is hereby granted...-............... -•-------------•--•---------------..__...._....-•----...._._..--- ---------...............---•-•--- to Construct ( ) or Repair ( ) an Individual Sewage -isposal Sy em - ---.......--•at Street ��// as shown on the application for Disposal Works Construction Permit No._At�:`I... 7Dated............... l`-?e-_ -------•------ --------- - Board of Health.. DATE............. .............................. FORM 1255 ,HOBBS & WARREN, INC.. PUBLISHERS ti AT N H-�✓sue # f� SEWAGE PERMIT. N0. ,VILLAGE� N S V*'-f lAAf Ah *o aac (%kERViCE A D D R E S S 150 Walnut StreetWcat Marnstable,.Mass.o;2 6 ° dok 1 & . KRIM 156,Walnut Str@@4 Mijarry1 d U 1 L D E R OR OWNER ns... . e� @@� As5Uf 4. Civ DA T E P E R M I T ISSUED D A T E COMPLIANCE ISSUED - 1 � _ 95 .. . r l G S 1•:t•d C>4.TA + ��.R f SCrs'TtG '' �3oX 15Ea�b�LS l ! ,TA4.1tL.,• r 1 f ° , � � � q s � vt S RoSALJ p tT V=E BoTTON. ARMt.A►,�&!' . . . it '1t3i�o • 1�. - • -! I •r ��'' ; =j�} .1- A�_1rCsk �pl . T 1 • l PE�,o�dTIGn.1= RATS.. t� tW 2 Maw oe��.._ ` '_. r ; ti . . :.. i j' ` W7}IHMf10r '• 1 - -ALAIT .•* ; #4 A ,:+ .., $AXT/L�Ry '` ,ran' JililtS q1' i ° t 'k i r .F19.,�.� $.., l . . i: I J.'�?..19, 119 ` t•�Q Q-t. • fi �� �°G-=/G .._. _ .... .. M , , //!��/� `.,v/A,,,, 1, 4 `� Y �r ' '• •. - 777ZL ..-.- - .. - �] V ��` TAtJtG (p j A WASULiDJ r, 1 ( , + . F t E zD Vt..oT ` p1_A4-J P ICO 1=1 LE l.rx,A.T101.1 C T�I�:�..�*► :5 3 �vAT N 1Jo SG m 5 G A t,� I '. .. I_ �'`_� to" 1 CILCrI F:'f TµAT r"f-- t f .4't. 14(;a St-tow U r-1�e.E.oN • foMP�-Y� taitrat Tta'�. rtvELt��. (3 AWV �Gk�TBfI►GK. Q�v�¢�M6►r,.iT� O Tye Tbw� OF j3AR#�4'r&ML's xwr-> t S• .r G G. ' . -D ` � _ . t ' L�c- - 1 f ATF3� Wf111 i�.! ' T DATA• ID�I�"•�! DAXTeR. t, L1416;;� t&-W--'1s: . ' .. . .tsT� cZc-.Cb Ltuwt> CAeVEyotc TONS PL LA IS Uarr $dSED oU AU t04TWPAE!►17 OtT Vtt.L6. tit�.5+�:.; SUev�! TOG oFF:s T; -S"ooLb UOT $6 USeA ApPLIGAt.IT 4 <1L t To •DMTe¢�,tluE. t..oT uuE1:. La/�•A 0 ' i �• N , ► � � I ���,r of t ' � . ; Ty tr G Ae i i � •u ? F ,u b T o F �2o ' r S { ,` ✓; T 60S� CENTERVILLE c6/oH 7;3, � � GENERAL NOTES: ' 15 E .. PARCEL •,. 59•48 i 187 EL L I 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 20302. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS \JER f + OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPUCA13LE ROAD CB/DH ♦ LOCAL RULES AND REGULATIONS. �vMQS 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ' ♦ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE Z N V104 e DESIGN ENGINEER. 0v P�Cv 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 000P ♦ 8.80 I ENGINEER BEFORE CONSTRUCTION CONTINUES. �GJ ♦ 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. A � ♦ 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF PARCEL ID: + THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF LOCUS: 187/064 100 ♦ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 22 BEECH U .7. PROPERTY IS SERVICED BY TOWN WATER. LEAF ISLAND J CO mV105 ,II, 1 8,ALL ARC DISTURBED DURING CONSTRUCTION SHALL BE RESTORED ROAD V, ♦ TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. PORCN PARCEL I D: % 8.20 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY ♦ i ♦ THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING ♦ iiiiii CONSTRUCTION. LOCUS MAP 16.80 187/077 � i • -�i i ♦ � 10. EXISTING CESSPOOLS TO BE PUMPED, CRUSHED AND REMOVED. AREA=.6 ACRES ; REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5 SPECS.IL LOCUS INFORMATION - ♦ q 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION ♦ ,i i i 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PLAN REF: 41594 A SH.3 i, TITLE REF: CTF 178826 V106 AND. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY # PROP. 1 ,500 GAL ; 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING PARCEL ID: MAP 187 PAR. 77 ,!y 7.40 ZONING: RD-1' SEPTIC TANK �• ,,�A 14. ALL PIPE TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) FLOOD ZONE: "B" 16.50 .� 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW COMMUNITY PANEL: 250001-0016-D DATED:07/02/92 i, i DECK O`% 4 FOR THE USE OF A GARBAGE GRINDER ♦ ' �„ ;,,,, ��O 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING SEPTIC SYSTEM 117. PROPERTY IS WITHIN A GROUNDWATER PROTECTION DISTRICT 3 �♦ �' "�;, �,,�G� 18. REMOVE ALL UNSUITABLE SOILS. 5 FT. AROUND LEACHING TO EL. 8.50 REPAIR PLAN ,cV ♦ I , �� OR TOP OF "C" LAYER & REPLACE W/CLEAN MEDIUM SAND PER TIT. 5 LOCATED AT: �v1o7pL22 BEECH LEAF ISLAND RD. #22 _ �`.7.00 ' TBM: TOP STEP PARCEL ID: CEN TER VI LLE, MA. ELEV=18.5'(GIS) � ��'�� %� 187/082 PREPARED FOR ,, ousr. ,.000G SEPTIC TANK ��\ '` f M A R I E HER 0 L D &i V108 ',(6;. ,I1, A MARYBETH CASEY TRS. o --L---- ! I \ \ I \ �� 1 4q FEBRUARY 26, 2013 % WALK-- 4 0 li I 5 _ - - — L � �,- �N E `� �.� ', \W -' Z/,y \ I � \,'� � � � �� ` M. ✓+ C9 , EXIST. LP; %F + o. 1`140 Alla7H C + . +'� ri Co \l `�NITAR�P� Zb�t 61 SCALE: 1'=20'103 5 MEYER & SONS INC. I �— - 0 'LEGEND B� �Li P.O. BOX 981 PROPOSED CONTOUR PROPOSED SPOT GRADE EAST SANDWICH, MA. 02537 R=36 _ — — 508 362— 2922 1 03 _ EXISTING CONTOUR ( 1 L 153.68 �' V O R f.O.P, � "�--__ ' ail �,1 i + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE V202 CBAS'® _-�---- ----�\ 19 TEST PIT " I SHEET 1 OF 2 J#1503 NOTE: TO PREVENT BREAKOUT, THE PROPOSED " NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:13.00 !FOR A DISTANCE OF 15' AROUND THE . (PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. OF MgsS INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER t4" OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. I NENc� DARRE G fF.G. EL.=17.0± F.G. EL.=16.50f F.G. EL: 16.50t F G. EL: 16.0(MAX.) �YE N f i N o. 1`140 9.45" 9" MIN COVER/ RED/S1E�E� L = 25't I 36" MAX COVER L = 1(' L = 10'((AX)) tp•37 INSTALL TWO INSPECTION PORTS (MIN.) " SANITAR�P� j„ )�j 0 S=1% (MIN.) EL. = 15.08 ® S=1% MIN.) ® S=1% MIN. 4"SCH40 il PVC - 4"SCH40 PVC 4"SCH40 PVC 1 4• 6. 0• .1 \INV. W =14.00 .48" LIQUID - INV.= 13.75 INV.= 13.00 LEVEL - COUPLER DETAIL jGAS BAFFLE J PROPOSED DD-BOX INV.=13.47 3 ROWS OF 6 UNITS 0 5'/UNIT + 1 COUPLERS ® 1.16'/UNIT = 31.16'/ROW INV.=13.65 DB o SOIL ABSORPTION SYSTEM (PROFILE) PROPOSED 1,500 GALLON SEPTIC TANK EXISTING SEWER OUTLET RESTORE VEGETATIVE COVER INV.=1 4.20 BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS 60" NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT=TOP ELEV.=13.00 PIPE INVERTS PRIOR TO CONSTRUCTION 2) TANK AND D-BOX SHALL BE SET LEVEL AND BOTTOM ELEV.= 11.67 EXISTING SUITABLE TRUE TO GRADE ON A MECHANICALLY COMPACTED 2.88' MATERIAL SIX INCH CRUSHED STONE BASE, AS SPECIFIED 5' MIN. ABOVE BOTTOM OF 2 T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 3 x 2.88' = 8.64' IN 310 CMR 15.221(2) (7.42' PROVIDED) USE 3 ROWS OF 6-ADS ARC 36HC 3) INSTALL INLET & OUTLET TEES W/ ADJ. GROUNDWATER EL.=4.25 _ (H20) UNITS - NO STONE W/ 1 COUPLERS GAS BAFFLE AS REQUIRED IN EACH ROW SEPTIC SYSTEM PROFILE TYPICAL SECTION O J6" N.T.S. N.T.S. SOIL LOG P#:13839 O DESIGN CRITERIA DATE: JANUARY 15, 2013 • SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE 1614 SECTION 10.75" NUMBER OF BEDROOMS: 3 BEDROOM DESIGN # INVERr WITNESS: DAVID STANTON, BARNSTABLE BOH HEIGHT END CAP SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. Elev. TP- 1 Depth Elev. TP-2 Depth ADS - ARC 36HC CHAMBER (H20 LOAD) GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 15.50 0" 15.50 0" FILL FILL MODEL ARC 36HC SEPTIC TANK: 330 gpd x 200% = 660 gpd USE NEW 1,500 GALLON SEPTIC TANK 11.50 48' 11.50 48" A LOAMY SAND A LOAMY SAND LENGTH 63" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT 11.00 IOYR 4/1 54" 1 11.00 10YR 4/1 54" EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY B B DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. LOAMY SAND LOAMY SAND SIDE WALL HEIGHT 10.75" DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) 8.50C tOYR 5/8 84" 8.50C tOYR 5/8 84" OVERALL HEIGHT 16" OVERALL WIDTH 34.5" 4640 TRUEMAN BLVD PRIMARY S.A.S. SIEVE 07.50 MEDIUM-COARSE MEDIUM-COARSE 10.7 CIF • HILLIARD, OHIO 43026 USE 3 ROWS OF 6 - ADS ARCHC 3616 H2O UNITS-NO STONE SAND + SAND CAPACITY AND EXTENDED 1.16' W/ COUPLER IN EACH ROW 2.5Y 6/4 I 2.5Y 6/4 80.0 GAL ADVANCED DRAINAGE SYSTEMS, INC. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) PROPOSED SEPTIC SYSTEM/SITE PLAN (CHAMBERS: 6/ROW)18 UNITS x 5.0 LF x 4.80 SF/LF = 432.00 SF 4.25 135" 4.25 1 1 135" 22 BEECH LEAF ISLAND ROAD, CENTERVILLE, MA (COUPLER: 1/ROW) 3 UNITS x 1.16 LF x 4.80 SF/LF = 16.70 SF TOTAL AREA = 448.70 SF PERC RATE <2 MIN/IN. ("Cl' HORIZON) Prepared for: Casey DESIGN FLOW PROVIDED: 0.74GPD/SF(448.70SF) = 332.03 GPD > 330 GPD req'd N07GROUNDWATER OBSERVED Engineering b : Surveying by: SC DRAWN DATE: 9 9 Y Y ALE Meyer&Sons, Inc. MacDougall Survey NTS D.M.M. 02/26/13 I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pO BOX 98f (508) 419-1086 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 02537 REV. DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. 508-362-2922 D.M.M. 2 Of 2