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HomeMy WebLinkAbout0316 BUCKSKIN PATH - Health 316 Buckskin Path - r•, Centerville'- _ {::`1 . A= 191 — 126 I llllado �aEcvcc�°� 1111 UPC 12543 No.53LOR '°st,coNS°� HASTINGS, MN No �0 Fee d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4pfication for disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(4°6pgrade( )"Abandon( ) [:]Complete System Individual Components Location Address or Lot No.3/6/i'��4-r�°� fAE' Owner's Name,Address,and Tel.No.T/t/—Z.Ff— /V7FY Assessor's Map/Parcel/ l/ Installer's Name,Address,and Tel.No 7r5 �`f''�y Designer's Name,Address,and Tel.No. er— /foul�Co-fiGf��C a,� C' 8cveY8-- S'c�=�-�t f �'C/Cr.-�. J'��i�✓G ®"- a«"e Type of Building: Dwelling No.of Bedrooms Lot Size e- 37 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 6� gpd 4 Design flow provided gpd Plan Date /©C�/ Number of sheets ';17 Revision Date Title Size of Septic Tank /S'ov. Type of S.A.S. Description of Soil _�Q�� ry ��--�he— /4 " Nature of Repairs or Alterations(Answer when applicable) �'-c�- l//d�Q G�l .��T��r, � -tea'• �/3 � i��Xr � S ocJ �� �G�a�lf9ld'S /�/i�! .171�`/.�C� �•'�' (G "'Jl' �.�.0�°�' „� O Date last inspected: Agreement: 4 , 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 Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.c / Cay Date Issued d� ----Inc- t f ;y-'No. /~O[ (P Fee w" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yesr � PUBLIC HEALTH DIVISION - TOWNN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Misposal 6pstem Construction Permit ' r Application for a Permit to Construct( ) Repair(f�UpgradAbandon( ) ❑Complete System RIndividual Components Location Address or Lot No. -:7( Owner's Name,Address,and Tel.No.9e9=?�rr- P Assessor's Map/Parcel/F/l/.Z.i- t" Installer's Name,Address,and Tel.No:_94t�7-Y>�' � sL Designer's Name,Address,and Tel.No. � ,I�•�/.i�}'dr{/�,'/C"O C'O+-'ice Sr_r.•./� S'�se�rCr"f ✓.rf'!/�"c2'w''/4... .�'.r.*>',nc�G +�`✓r�o't1 3s7�_...C2-�se�-� �� ,/i�f' �'y.rw..,nt./n"C; �r.i' ..�i� .:��: ,��'. rJ�'6 v�€ir_r f^�+• Type of Building: ' r Dwelling No.of Bedrooms 4/ Lot Size . 3?' sq.8. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 414/U gpd Design flow provided el�171::� gpd Plan Date /1/1/ Number of sheets ; Revision Date Title Size of Septic Tank /3 u© �.,�.r/� lc�c>t� Type of S.A.S. cs,+�- �.-, ,— Description of Soil Nature of Repairs or Alterations(Answer when applicable) �, 4.. .ter. r�ir�v i ,y?sue /' / _ xCw s •/,� r 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 y Application Approved by ; Date /� 3 Application Disapproved by Date for the following reasons Permit No.c^� tl r L L' Date Issued --•--- ------------ --- _---- -------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( �)f Upgraded( ) Abandoned( )by at �/�' /�.;--�s�.r74 _i�r��`�- _. has been.constructed m �dated accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No f '-1^� - Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(�/)/ Upgrade( ) Abandon( ) System located at /G /s��,cG�s�, ,w y!�:,4/ �r,,tFvrr,�l/L and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must becompleted within three years of the date of this permit. Date Approved by Town of Barnstable "E .� Inspectionall Services Public Health Division t�uvsrnai.e. % . Thomas McKean,Director .0 ATfo '�° 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 `- Installer& Designer Certification Form Date: 2 z/ Sewage Permit#2o2/- o z,5 Assessor's Map\parcel t r C86�'G CG q Designer: �,A.� �O �, �AVI Sf' Installer: Address: (o Address: W2� ' On Z/ was issued a permit to install a (date) (installer) septic system at�3(le 0U(J1_5b_t d &_9 based on a design drawn by (address) . JJ dated /©/!2/ (designer) V/ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed 'mnnsranee with the to rms of the IAA approval letters (if applicable) DAVI D yGN o D. FLAHERTY,JR. No. 1211 DeXignature) o �G/STER� SgNITWO (Designer's S gnatur (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoaldeptAIHEALTMSEWER connecASEPTICOesigner Certification Form Rev 8-14-13.DOC r No. of(� 0 O Fee O o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpfitation for disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(V/ Upgrade( ) Abandon( ) '❑Complete System ❑Individual Components Location Addres or Lot No. 3 its. Owner's Name,Addr ss,and Tel.No. Assessor's Map/Parcel 4 _ Z (v 3kLo �s� t 0A. 2 I taller's Napte Addres$,and Tel.No. 42 f Yv a 8 Desi ner's ame,Address and^Tel.No. 3 17 Type of Building: Dwelling No.of Bedrooms y Lot Size 1 is , 3 19rsq.ft. Garbage Grinder( ) Other Type of Building A Q S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) e(140 gpd Design flow provided q&I , g, gpd Plan Date 3 _ Q — IL) Number of sheets Revision Date Title Size of Septic Tank t SD"O Type of S.A.S. to Arc Description of Soil Nature of Repairs or Alterations(Answer when applicable) 310-0e A c. u'F L�14 f Q�c hvt 1 Date last inspected: 'Z-vzx 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 Signed Date Application Approved by [\Vr�­ I�l� "Z� Date �j Q Application Disapproved by Date for the following reasons Permit No. Date Issued ��j� ,.�� ,L'•`� _ �,r__ '""'" `;� � ,i '�" `+.v ,--;a.:+.-a+G L � .r.� c:-�'S'+i "'!t"N�w..d.#.....'s ,wt..+w� 'a'`-^,..r+�. - •�c. .. Stir .✓ r No. L�l `�• t: Fee l o ± 40 Entered in computer: - JHE COMMONWEALTH OF MASSACHUSETTS P Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plication for Misposal 6pstem Construction i3ermit Application for a Permit to Construct( ) Repair(l� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components ,k Location Ad /sdres or Lot No. 3 t 1. 3�"` `s Owner's Name,Addr ss,and Tel.No. L-r-�yr ue dt! lJ o� 2 N, _-�,t ('U Assessor's Map/Parcel i-L (. 3 1 La PA k C FN 11,GI U4 06 2`'" u In taller's N� e,Addres and Tel.No. 02 �✓v' Deli er's ame,Address,'and Tel.No, c�.p.ew.0 ��n l^p►"rSA-S ,� -^S.neu.vv� & !` C'ron�,.rr' l/ y Type of Building: Dwelling No.of Bedrooms � Lot Size t� . 3 9�' sq.ft. Garbage Grinder( ) Other Type of Building At S No.of Persons Showers( ) Cafeteria( ) � Other Fixtures Design Flow(min.required) �1 UO gpd Design flow provided gpd Plan Date 3 Number of sheets Revision Date •i Title Size of Septic Tank S U y Type of S.A.S. A rL 3 Co 1 Description of Soil 0 - (p r (n - ((o b - / 30 C Nature of Repairs or Alterations(Answer when applicable) Ya 4 } 4 q c , Date last inspected:" Z�ev i o 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 ofke-ahk. 1 Signed Date Application Approved byG Date (O Application Disapproved by Date for the following reasons Permit No' 0 l V " D Date Issued -3 30 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by ('119-1 W t O1C r`,I(A y,N f at 3 I to 3" (A'_ c llc� , YOJ1 has been constructed in accordance with the provisions of"Title 5 and the for Disposal System Construction Permit No. dated Installer ` 019.0 uu Designer J C ro_j, r�tiV #bedrooms y Approved design flow y f' gpd The issuance o thi permit shall not be construed as a guarantee that the system wil cti;n.'as design d. Date _ t( .R �� J Inspector ✓�f� Cr --------- -------------------------------------------------------------------------- -- -------------------------- No. 01 0d 10 -- OK / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Vermit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at 3 lR C\c S��v`., e-, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be/coompleted within three years of the date of this permit. Date '/ v Approved by f Town of Barnstable _..-� Regulatory Services cl, Thomas I+.Geller,Director ` Public Health Division MAN. Thomas McKean,.Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 506.79C--•6..);A Date: ��'Z'(C) -- Sewage Permit# d t5 Assessor's Map/Parcel installer &Designer Certification Form Designer: �_ E 11ir.1 E� c i�fiI"v'i C - Installer: Cn(��w�c.1e.. Fnl er pets : Address: 111'3 4 c ccur,��c� '- : �W ---_..--- Address: _tq 0Zr,,3S. Cam, ems.;<<< V Ia On 3 3J Z�t� C �l e « ✓ r,-, was issued a permit to install a (date) (1 lstal)er septic system at -e 31 f''�c ��1-1 p I fit^ . r_._.based on a design drawn by `(address) 5C - t:n�jio exoe)� , Tq)r-. •__.-.. -- datedHoran_l`�l_ _V:'!_G_._... - (designer) _. - _V I certify that the septic system referenced above was installed substantially accordant; it) r 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. certify that the Septic system ret'erenced above was installed with major changes (i.c. - greater than 10' lateral relocation of the SAS or any vertical relocation of any Componcnt of the septic system) but in accordance with State& Local Regulations, Pliu1 revision or certified as-built by designer to follow. Stripout (if required) - • is)ected and the soils were round satisfactory. tnOF t JOHN i.. CHURCRC?i!t;;.. w,l 4,6( . o esigner s Signature P ASE PTURN 'ro NSTABI.E PUBLIC. IEAI. DIVISION. CERT1Fj (,A•iE F COMPLIANCE WILL NOT BE 15.SJJED UNTIL T THIS FORM AND AS• ILT• :CART) A BY THT IIARNSTABLE i'T,?1 LIC NFALT11.DIVISION. THANK Y1. q:\nfticu Iu41S14 dcsigllerceitilicnuan:' nn dnc .. —_ - .-..� ... -� .�.-..-. c�• T� -»�irc-.� -i�r i. .. oc• Gfa fATfi7-7Gi—�IJH TOWN OF BARNSTABLE 1� AiICW ,. .31(o 3; ctc s 6 r SEWAGE# Zoko VILLAGE A2^V/ ASSESSOR'S MAP&PARCEL lq I r 1 Z INSTALLER'S NAME&PHONE NO. 01�jecol SEPTIC TANK CAPACITY /.FO b LEACHING FACILITY: (type) J(o 11,,e 3&/(B (size) V VO NO.OF BEDROOMS eI OWNER PERMIT DATE: 3" 3o 7_'0 ►0 COMPLIANCE DATE: q Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility y It 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) 1 • - Feet FURNISHED BY ✓ 1"� ��(��l L`L 02 i Ri 4�y,f /t2 3g.s' A y3>S C� fly yo 0 �3 SS S 34 yz,v Q� gz. Town of Barnstable P# 1,, J 7�' Department of Regulatory Services Public Health Division Date 3 a2110 A 039. 200 Main Street,Hyannis MA 02601 Date Scheduled 3 '2 P Time Fee Pd. T Soil Suitability Assessment for Sewage isposal Performed By: Mc-rt��L �i rYl�tJiC! �.1.7 C>S:( Witnessed By: �i �✓_ LOCATION& GENERAL INFORMATO�N Location Address Owner's Name �l b (3 uGlcg lC.i r ,Pµ � Address 3&, (3-U,"4((-"k P� jt v Assessor's Map/Parcel: ` �D Engineer's Name C4,72 )i r�'Lt-C lP-iar � t�lec�f�15 NEW CONSTRUCTION REPAIR Telephone# SU LfZ� La) �t'-273-0377 Land Use 610tortgV 3U1_A1_fl Slopes(4'a) t 3 16 Surface Stones MtA Distances from: Open Water Body 150 ft Possible Wet Area >iSt5 ft Drinking Water Well 156 ft Drainage Way >1 C) ft Property Line >t ft Other 'y�� ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) SEE AT1ACr-tGi0 ?t i_wNS Parent material(geologic) OU IOA$'K Depth to Bedrock 1 + ko Depth to Groundwater. Standing Water in Hole: 5150 gS5 Weeping from Pit Face >136% �J 5 Estimated Seasonal High Groundwater i 3a" b5S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: _L i(C" Depth Observed standing in obs.hole: >13c` in, Depth to soil mottles: Depth to weeping from side of obs.hole: 7 7 in. Groundwater Adjustment At ja ft. Index Well# Reading Date: Index Well level a^ Adi,factor Adj.CJroutidwater Level PERCOLATION TEST Date 142161'° Thne `?S3J)M Observation Hole# Time at 9" Depth of Perc Time at G" Start Pre-soak Ttme @ �j:53 Time(9"-6") n1'4. End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) 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:\S EPTIC�PERCFORM.DOC i DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% ravel U-Q, q t+ +vn 5040 iv�t2 3h 10`riz % itb -It2 Fir+E �Awv z57 t, Ile-f5d- coaps'- tiAme 2.{j t0-15 o G4�vCt y17E. eoe DEEP OBSERVATION HOLE LOG Hole# °Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.% ray Ita ►m" C-1 11m VIME -S w0 .5-1 N n Of i5ILT Ilf-- Sao" C-3 ��I� G � tc_l-61'U ar-L; age, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel K DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency m Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No 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 pervious material? _ Certification I certify that on ©ck 27� l`1� (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 training,expertis and exp a ce described in 310 CMR 15.017. f Signature Date 3-21-16 Q:\SEPTiC1PERCFORM.DOC THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..... oF....... .s . ----------- Appliratiun for Disposal Works Tonstrnr#iun Prratit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at::6w y-) -•------•--------------••-------........--------• Locati - dress -.-•-•-_-_--•--------.•••--•.•--•--••-----or Lot No. ...... t1.. ..................................... ................•--•-•-••-..._....----- -- Owner •-- _-------•••.•-••..••--•---•-----Address Installer Address Pq 1� Type of Building Size Lot............................Sq. feet Dwelling k�lo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length------------_-- Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.........................................................................- Date........................................ a ,4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit:.................... Depth to ground water........................ 0 Description of Soil........'S .. ......... x c., ••-•--•-•--•----•--••--••-•--•----•-•....•--••••-•-----------•---•----•--•----•----••._........-•--•---••-•----••--••-------------------••••-•-•--•-----•--•-••-•••-•-••-•..........-----•......-••---•. W ............................................................................. -----•--•-•---------------------------------- ................................................ - ------------ V Nature of Repairs or Alterations—Answer when applicable.......zn_�..__ "1 d��_______________�_l� P� G.............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued b the ...5r ar health. J r Date Application Ap oved B . •.-----------•--•----•----------------------- - Date Application Disapproved r e following reasons--------------------------------------------------------•-----------------------•------------------•••-•---...... ---------•-•--•-----••---•-•----------------•------------•--•------------------------------•--••-----------•....__._._...-•------•••----•--••--•--------------•---••••••-------•----•-•-•---•-••-------. Date PermitNo.......................................................- Issued....................................................... Date ---------------- J t THE COMMONWEALTH OF MASSACHUSETTS ti BOARD OF HEALTH Appliratiun for Disposal Works Tonstrurtiun 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Locati - ddress or Lot No. 42e-,..................................... .........._....................................................................................... � �„ n���•� Owner ,.�.. G v Address +,'•.a�`/..... C.�J�!Y1�&,W.. ...•� fi%... 11 - --•--•---- ....--•----------•----------------------------•••••••-------------•......---•-----•-----••---.•... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ......................:..... No. of persons............................ Showers ( ) — Cafeteria ( ) 0 Other fixtures .......................I Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length...........---- Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...............1....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.............-............ 4 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ a ----•------------------•--.... --------•--------------------------.---------------------- ......--.-•-•- D Description of Soil........ r _ y --•------------------------------------------•---------------------------...-------••-•---------------------------...... U Nature of Repairs or Alterations—Answer when applicable__....!`__./ :-_�!JC��..............P.t�� A��Ga............... ..... .----•-•----------------------------------------------------------------------•••••------•.......-- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 1 5 of the State Sanitary Code—"The undersigned further agrees not to place the,system in operation until a Certificate of Compliance has bee issued b the�oard f healthSign . , r ` : . Da Application Ap oved B}�Y: . . ......... following -----•---•--.....Date Application Disapprove or a ollowin reasons---------------------------------•-•--------------------•---•-----------.-- ....................•-----•----..........----------••----•------••-----......------------....------....----•--•---.............-•--------------•-------------------------------------------------------. Date PermitNo......................................................... Issued-............:.......................................... i Date THE COMMONWEALTH OF MASSACHUSETTS » BOARD OF HEALTH ............ � :..OF......,0.,�.r� ......r� f� ...................... (Irdifirab-of Tuntoliaurr _ THISIJS TO CERTIFY,-That the Individual Sewage Disposal System constructed ( ) or Repaired /,�/ f f'�nstallerr s e'r -'"` ;. has been installed in accordance with the provisions of TITLE r Of he State Sanitary Cod s d r' d in the application for Disposal Works Construction Permit iv'o. ._ ._ _----------. dated/� '___ __ _______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.- DATE........................................................ , ..��. Inspector v^= THE COMMONWEALTH OF MASSACHUSETTS BOARD- OF HEALTH �✓ .�.1-.......OF..... k -.. 1.... ..... .=r....................... -- No....... ............ FEE... Disposal Murky Tunsir ion rrutit Permission is hereby granted...._i% ��-- d�t ' '................ H'' =------ ''f.................................... to Construct ( ) or�Repair (,.•,,.� n Ind vidua Sewage Disposal System at No.... • .. �a<r __y� f,:' r %%9? :i:.------.•.. -/ 't ram✓f''� �� St r et ' as shown on the appli tion for Disposal Works Construction 'f&o..................... Dated.......................................... - --------- -------- Board of Health DATE-- •---•------------------•-----•----•-----•-------------•-•---- FORM 1255 A. M. SULKIN, INC., BOSTON LOCAT ON SEWAGE PERMIT NO. VILLAGE jj,, 74 INSTALLER'S NAME i ADDRESS 'Adt " R U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� ,l �. ° �q, � � � i � ��. ' ` `, 1� i �� � � ♦ ' � �� � ® L/��' C�. � !" - _ _ � 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection r 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name tQ P.O.Box 763 Company Address Centerville Ma. 02632 �mm City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system of 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 ® Fails ❑ Needs Further Evaluation by the Local Approving Authority a 8 3/4/2010 n .� Inspector's Signature Date The system inspector shall submit a co of this inspection report to the A provin Authority Board Y P PY P P PP 9 Y(:::�, of Health or DEP)within 30 days of completing this inspection.'If the system is,a share ste, r has a design flow of 10,000 gpd or greater,the inspector and the system own it shall sgwit the report to the appropriate regional office of the DEP. The original should be sen,, to the sAtem Pner 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. t.�4 It t5ins•09/08 Title 5 Official Inspection Form:Su surface Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town 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: 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 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 J' Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 l f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 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 ❑ ® 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 Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection 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. ❑ ® 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- 1 0,000g pd. ® ❑ 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town 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? El ® 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: 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: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection 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: 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): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ .Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC orangeburg pipe ® other(explain): Distance from private water supply well or suction line. 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. 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) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 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.): 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town 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.): 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 I Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 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.): 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 � every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Sandy soil.Pit shows signs of hydraulic failure.Pit was empty at time of inspection.Stain line observed up to invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 Depth—top of liquid to inlet invert 1' Depth of solids layer 8" offDepth of scum layer Dimensions of cesspool 6'x8' Materials of construction Concrete block Indication of groundwater inflow ❑ Yes ® No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Sandy soil.Cesspools show signs of hydraulic failure.Stain line in both cesspool were up to inverts. 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.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom MapIF Abutters Map SizeONE Zoom Out ,� !� �� In CrD ti M 0 J .... 0 N 0 s� 20 Feet Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER (`—,rinhf 9MR,_901n Tr...n of Romefohlo KAA All r;nh+c roconl http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=191126&mapparback= 3/4/2010 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town 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: Bottom of LP 31' 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: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 _ I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 316 Buckskin Path Property Address Henrey Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/4/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 1 TOWN OF BARNSTABLE LOCATION 31(e ��cic s(R�r. 7A SEWAGE## Zo+o - 0$ 5 VILLAGE finAl-vi lU ASSESSOR'S MAP&PARCEL_ 114 1 1 Z(„ INSTALLER'S NAME&PHONE NO. _`g0�cr!a/P �n� SiZA yG�78 SEPTIC TANK CAPACITY /,(0 LEACHING FACILITY:(type) k, zj je Z/& (size) V t/D NO.OF BEDROOMS y OWNER HPn�t� PERMIT DATE: 3- 3o - 2Q t o COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility itl 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) 11 Feet FURNISHED BY 6� a i Rf 4Y•S AT 3P.s R3 y3.s �1 Ay te.Ir R� -7S,0 81 3(e.0 U 4t o 33 SS3 04 yt,o 13s" sz. http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=191126&seq=1 3/22/17,8:54 PM Page 1 of 2 I 1.) Assessor's Map 1A I Parcel JZ6 2. Bk.zSoq-f= Pg. zag SAP E"I 1 3. Plan Book z"'. Page ib 4. This property is in the Saltwater S Estuary Protection Area I 5.) This property is in Flabd Zone X � . Firm Map 25001 C0561 J 7/16/14ra m Tf5M FL �c Qom, � �� �""'"' -�._..�, -,..,,-,�.d k `�.`�°`•".�.``� � � � � � �,l` � -Z(i ce � �� ,� CENTERVILLE, MA Q:) -C �, � SITE LOCUS 2-Z 7 NOT To SCALE IR00 SEE A10-IF TF 44 o pe y �s O C. '`�' .�„„ �� �� „� �° `"►....- ""'.ram' �Q N�a� ',.. a r `\ �Q SAS Amp _2 � NOTE: ��� � IS 5- LOCATION OF UTILITIES IS APPROXIMATE AND ALL - UNDERGROUND AND OVERHEAD UTILITIES MUST BE r� DETERMINED IN THE FIELD PRIOR TO COMMENCEMENT tw of q OF ANY WORK, THIS INCLUDES, BUT NOT LIMITED TO, ;� y REQUESTS TO DIGSAFE, ANY PRIVATE UTILITY COMPANIES AND THE LOCAL WATER DEPARTMENT. <I? F c� Proposed Site and Septic Plan �F ° 1 3% 'BU('KSV,-1?4 CAI Centerville, MA TeR SgNITARIP Prepared by: Prepared for: All Cope Septic and Survey GRAPHIC SCALE A44-rHaN%f' 0^-( 618 Route 28 20 0 10 20 40 so 31 (O f51.c f5Kjt4 f2A1-14 West Yarmouth, MA 02673 (508) 771-4200 olicapeseptic@gmoil.com ( IN FEET ) l 2��, Sheet i of 2 Br. MA Check: SM Duvq. � 1 inch = 20 ft RAISE- MIN. 20" DIAMETER COVER CONSTRUCTION NOTES EL= 55,2} TO WITHIN, 6" OF FINISH GRADE flr�Po5r`D 1,) ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE', TITLE 5 (310,CMR t5.(x)O): a � RAISE MIN. �„����� /� _5�•� �, STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION. PPGRADE. AND L EXPANSION OF ON—SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR TIME TRANSPORT =TOWTHIN 6" OF FINISH GRADE RAISE MIN, 20"ptAME7IIi COYER AND DISPOSAL OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. `�u d TO VATHm g"aF FINISH GRADE 2-) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS POTENTIAL FOR 7 VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 ,LOADOG. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE AdAOSPHM y 3.) TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS AND D—BOX SHALL BE INSTALLED ON A STABLE MECHANICALLY—COMPACTED BASE ON SIX INCHES OF CRUSHED STONE,4_) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK. THE DISTRIBUTION BOX, AND f — sz"o t_ GEOTEXTILE THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN 6" OF FINAL GRADE. LEACHING Cj�.� 1 So MCP FABRIC FIELDS, TRENCHES, AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES SHALL 1 HAVE AT LEAST ONE(1)INFECTION PORT CONSISTING OF PERFORATED 4" PVC PIPE PLACED Existing St,2 VERTICALLY TO THE BOTTOMIN OF THE SOIL ABSORPTION SYSTEM WITH A CAP. TIED WITH MAGNETIC ` MARKING TAPE, ACCESSIBLE TO WITHIN 3" OF FINAL GRADE, ° (`q �ro a 1 �� Sn.D o 5.) PIPING SHALL CONSIST OF 4" SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A GAS BAFFLE .0 MINIMUM'CONTINUOUS GRADE OF NOT LESS THAN 2%FROM THE BUILDING TO THE SEPTIC TANK, 5a� Z' AND NOT LESS THAN IS OTHERWISE, GAS SAFFFI.E ! 50, 3/4" to ••• - - N i�11 1-1/2 STONE 6.) DISTRIBUTION LINES FOR THE SOL ABSORPTION SYSTEM SHALL BE 4" DIAMETER SCHEDULE 40 --20 (Double wash) PVC (OR EQUIVALENT') LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE CAPPED + g- . •.T 1,500 GALLON DB-3 H A7 END OR As NOTED. SEPTIC TANK T C7D0 GALLON D—BOX �N12�E($ ( ) 500 GALLON PRECAST "TO 7,) LINES FROM THE DISTRIBUTION BOX TO 13E LEVEL FOR THE FIRST TWO (2) FEET BEFORE (EXISTING) SEPTIC TANS( 1 ,I CONCRETE LEACH CHAMBERS WITH 4' OF PITCHINGON TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED.To C Assut# EVEN D1sTRIsunDN_ STONE ON ENDS AND 4" ON SIDES I3) GROUT O R USED AT ALL IG POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES _{/ j('---_— l O t ---�N F IN ORDER TO PROVIDE A WATERTIGHT SEAL l9�li *I '�_ �l LEACH CHAMBERS 5� I 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE {END VIEW) DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. 10.) IN ACCORDANCE WITH 310 CMR 15.221. ALL SYSTEM COMPONENTS SHALL BE MARKED NTH FLOW PROFILE MAGNETIC MARKING TAPE. S p� 11.) THERE ARE NO KNOWN WELLS OR WETLANDS WITHIN 150, OF THE PROPOSED SOIL ABSORPTION SYSTEM, �'�— f-Loo K Z d PLOD e-- NOT TO SCALE EL=kZg7Bottom Test Hole 12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL RECEIPT OF THE CERTIFICATE OF COMPLIANCE, THE PERIMETER SHALL DE STAKED AND FLAGGED TO PREVENT Be a USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM, 13EPTF' 0f' 13-) THE DESIGNER HALL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS IIJ� F fd D Z CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE ENGINEER, t 14.) THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE �Bv4 SYSTEM DESIGN CALCULATIONS BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE LATH THE TERMS OF THE PERMIT ' !t SE1yAGE DESIC�V FLOW: EXISTING BEDROOM DWELLING ® 110 GPD/BEDROOM O GIRD AND THE APPROVED PLANS, 48 HOURS ADVANCE NOTICE IS REQUESTED. �s iF 4 YdI 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR (MINIMUM DESIGN REQUIRED 1$ (�GPD} U IGL' SEWAGE DESIGN FLOW PROVDED: RR r (r� DETERMINING THE LOCATION W of ALL UNDERGROUND iINp AND OVERHEAD UTILITIES PRIOR TO � 1 t��})500 GALLON CHAMBERS Zp COMMFJNCEIuEN7 OF ANY WORK, THIS INCLUDES. BUT IS NOT LIMITED TO, REQUESTS TO DIGSAFE, i 3 I WITH 4' STONE ON THE ENDS AND 4 STURt ON THE SIDES ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. Vt = [{335 x 12.83) + 2(33,a+ 12.83) (2) z .74 =L{g� GPD PROVIDED WITH CONTRACTOR SHALL OR TO THAT ALL WAS F N Y ARE CONNECTED BY WATER TESTING 01y„ 45 CPD PROVIDED >t1'CO GPD REQUIRED WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. � - " ----�--, 17.) CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY �Pl�irRA) SEPTIC TANK CAPACITY REQUIRED: GPD x 200 =SSE® (MINIMUM)SEPTIC SYSTEM COMPONENTS. 41 Ye? 4,tot ) 16.) TEST HOLES COMPLETED PER STATE ENVIRONMENTAL CODE, TITLE 5. SOILS CAN BE i `NCHi E0' t) SEPTIC TANK CAPACITY PROVIDED: 1,500 GALLON SEPTIC TANK (EXISTING) VARIABLE AND TEST HOLE DATA IS NO GUARANTEE OF SOIL CONDITIONS IN OTHER AREAS, ff ���'� L41 kCr(GKE D A GARBAGE DISPOSAL IS NOT PERMITTED WITH THIS DESIGN FLOW w SOILS DIFFER FROM CHOSE SHOWN IN THE SOLE LOGS, DESIGN ENGINEER IS TO INSPECT THE S�CQI�tf> f�-P�lt� '�8}Ct�P(��>e}yeP •o AtyJ Cz�¢ig' dRAdF� °SOILS PRIOR TO PROCEEDING WITH 1NSTALLATIQN OF ANY SEPTIC COMPONENTS, � 19.) EXISTING SEPTIC COMPONENTS BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND , , sae CllIO"LAtAI Pf AIFUrL `( ABANDONED IN PLACE OR REMOVED AS REQUIRED, AREA TO BE COMPACTED TO MINIMIZE SETTLING. I P Proposed Sewage Disposal System TEST HOLE LOGS 3 � `� . 134� c0r—iN ?Ar4 Centerville, MA Test Hole t (EL�S3;�f) Test line 2 {EL=S,�,s},.t ' Depth Elev, Layer Son Class SOLI Color Depth Elev. Layer Soil Class F il 'Color I Prepared for: A LoA-1 5 YR31I V B FF 1 C W L VA'( 6'I,'160 1, 5z LDS" sw ToYKSIS .(i+$�Ilnf� gZ•`f'l g er Sv IvYR ' 16 ' NOD v5.51 4�� wtep .�r�1� Ilo.-00D� �FS.°F rneD-rt-t C 6 ��.�t�AbCE ( C, �,yY _N( cap � '�.113 3 (o ; Too`- gt.2 �`f,�1 CZ SA fatitsA LDo (t2. �t�."t� c�- fin( aE Y� (ra g t'17 -ti3p t2acE5tlrsl Z�gY La�(t?. .p•4. �t9 '(3 ®'I Colt s tIZ Brc7 rf1, °€ ' C S la I S r) G .t (a is rs T7e ZN Prepared b •� A OF e4 N x C"R e��E (LEc)Ill�Co�l N`°�s Ea R -1 t 516fe)'A y. OATS OF TESTING: 1"LI,g1'$.CXtO sp` CpMtF�Uerb�cJ''F'�, Prep . SOIL EVALUATOR: Mke- AIEL PIFNIM�T,y�L— oho DVI et rfeA-f& All Cape Septic and Survey WITNESS: DAVE STANTON BARNSTABLE HrALTH AGENT t� 1"A-/Z r,wc- -r® Tl46 S`5 'P f - l 618 Route 28 PERCOLATION RATE: LESS THAN < 2 MIN/INCH (Cl LAYER) West Yarmouth, MA 02673 NO GROUNDWATER ENCOUNTERED 1 O l t47� UP)II-5 A�' �Po vvrrm A ✓��^ (508) 771-4200 NO MOTTLING ENCOUNTERED /STE 7" t� SgNITAR PN � /t I `f�� I I II VaP"�A�C5 ������i��� Qllcopeseptic maii,Go►•n R\ Dote: t `1I7.42-{ Sheet 2 of 2 Project No. AC— - 1 iY A301p B'-13/4' 14'-0 V4' I s INENS — WSTER BATH n M � S m I NEVI TILE ROORING i '- TW7441 A V _ q T L D&-5ND I A301 `.. DBI.STUD - -- - � 3 P KET I S' 6--- TW]442 MASTER BEDROOM 4 1B6 Q NEW WOO ROORIN6 _ ; I MASTER-am II o 1__________ ATTIC ALCE51 Z U m I 'ems LL NOT IN CONTRACT) o ' HEAITLATOR CALIBER 604236IFT FIREPLACE /"•�Q A /GO KITCHEN 0 0 ro 44 LNINb'AREA I ID F i CATHEDRAL LEILINS I ;---._______ IV1 WPiINS pN m W I X 4 MAHOGANY 5/CO 4 V2' 4.'-W B I C P-0 4'I''-0 V4 P3G I h cl .....__._ r*; L OSET _ L `; �- PO o �I CONFIRM CURB FEI6K AT I o — q> BASE OF MALL LNIN6 ROOM KITL BREAKFAST AREA 6ARA6E AIID NEWETAODITION N4 u in I 1668 gSIT 1-CAR RE17.S (PIT CO1L%aETE SLAB CLOSET ------------------------- lALD RDOH i (PITCHED TO DRAIN) RTD. I' / I PRQVIISE 6/B'TYPs X SfM ri' ___________________ ® \TT�+AT NE DOOR II ,LNE PEA ^ NE T M6�2E O�IMOWALN TO G' TTEifI RY WIRM_ ARff 7 Mp SP�E5,TYPICAL ENTRY -- ^ LU NOTE. N --db+ OF �� SLOPE)-L TQR I I 4 t+ FLLSfi WI1H LMV-LKiBA ME1ER; � 1 TO PRE NEA POCNBD 5L WITNI I tl NEW [OR OAB AT-FERI TER II FAMILY ROOM DININS ROOM -- J EMRTYSTOOP !fin i K NEPI fANLRETE APRON i K ENTRY Q ---- P� o FXI59NFZDFLK 211- 6� EL 0 GC 00 E%ISTIN6 DRIVEWAY AND WAAY PAIR TO REMAIN ® LL LKW CL ® �I E. z U) &L w FIRST FLOOR PLAN (� U Bwc.v4•.r'o• ' A11 R g gP' =� O d x ., o �D a € ------------------------ --------------------------------------------------------------- ' z Z BATH ❑ l BEDROOM] y LAN � BBB��������rJy O a K LLCS \.� C Q�$ R L� „ s RZ HALL F O Q ' -------------------------------- O o DN LLOS MASTER BEDROOM .^ BEDROOM B - M i _________________________________________________________ EXISTINb DELK r LLJ u W a Z LL, in - w ® U r POYdIER LU LMNb ROOM KITLNFN BREAKFPST AREA gyp/ n�� IA�+ff 1l a L in\e tn sU 0 EX ISTING 5EGOND FLOOR FLAN D EL ____________________ M 0. FAMILY ROOM - DININ6 RWM I ENTRY .. N tn Z c�S Q F. TN6 c_n a .. VVp 0 rv'rJ'' W EXISTIN6FIR5T FLOOR FLAN EX101 R E------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------- I-------- - --------------------- ------- ----------- ------------------- ------------- Fill, Cl NBV BASEMEN up ---------- q PROVIDE ACZE55 CRAM5PATNTO ABOD • cr -------------------- -7---------------------------------------------- -------------------- ---- -----------f--------------------H------------------- NEPI CRAYLSPALE :-------------- ------------------------------------------------------------------------------------------------------- - ----- Ed 0 -- ----------+1---------------- ------------❑ - Ul REMOVE EASTM DOOR AV 0,7 0�7D�5_��. r _� Z BAN KALL WN5TRLW ON AS REOP TO FRWIDE NEIN 5'-0*MIK . _,�o Y FINIS OMDr,INTO PLAY %LvM in LIN. CILOS FLAY R1011 AND Rl'll� EXISTING F ATI04 HALL Z EXISTING BASEMENT AV 5LAJ3 A5 REQUIRED TO FROVVE NEW 6ARASE I uj 0 EXPANSION-REFER TO S-FLAIG ISH EXKMS SLAB EXISTING SLAB �M�16RADE NALL MIN FIN0 LU DN LU En LU -------------------------------- I aos IE I MASTER BEDROOM : ii—j- 11 M I I I Al ------------- Lopy L-------------------------------------------——-------- ------------------ ---------------- --- Faw 9-4-4 '24'-4" SECOND FLOOR PLAN -BASEMENT FLOOR PLAN Z 0 LU LL LU in Z < 0 u uj A102 TOP OF FOUNDATION = 55.2'± INISH GRADE OVER D-BOX= 5 4.55± PROPOSED VENT WITH CHARCOAL GENERAL NOTES PROVIDE EXTENSION RISER 4 SCHEDULE 1 PVC FILTER TO ABOVE GRADE FINISHED GRADE OVER BIODIFFUSERS = 53.8' - 54.5' @ MIN. SLOPE 1% SLOPE 2% MIN. 1. WITH COVER OVER INLET& FINISH GRADE OVER TANK EL.= REMOVABLE WATER-TIGHT COVER OVER @ UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE , OUTLET TO WITHIN 6"OF F.G. 54.2'± RISER TO WITHIN 6"OF FINISHED GRADE INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FOUNDATION = 54.4 �' BOX TO WITHIN 3"OF F.G. CODE AND ANY APPLICABLE LOCAL RULES. 5" DIA. OUTLET(S) (ONE PER TRENCH) 20"MIN.ACCESS 9"MIN. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.)_ YP.) 36"MAX. 1 f DESIGN ENGINEER. PROP.4"SCH. 40 9" MIN. I PVC SEWER PIPE PROP.4"SCH.40 36"MAX. 46"MAX. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PIPE SEE NOTE 21. TOP OF SAS/B.O. = 50.68' SYSTEM UNLESS OTHERWISE NOTED. MIN.SLOPE@ 1% 6" 3" 2" DROP MIN. 3„ 9" _ 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - 3"DROP MAX. MIN.sLOPE@,% L - 28± PROVIDE WATERTIGHT JOINTS (TYP.) ELEVATION =50.68' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" / 4"PVC IN FROM 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF *� - 51 .25' SEPTIC TANK 4" PVC OUT TO 1.33' THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. I O LEACHING FACILITY (TYP ) n7Y; 6"TYP '-EXIST. F' ' 51 .50' I/�y 0.90, TIV 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. " ✓ 12" 6" 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 48" OUTLET TEE 50,67'� MIN. 50.50' 50.25' 49.35 (LAID FLAT) 2.875'(34.5")--I----5.75'� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK' 6"CRUSHED STONE (TYP.) I FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY 5.0 NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 24.7'TO FOUNDATION COMPACTED BASE (TYP.) 4'MIN. 11.50' AND DESIGN ENGINEER. 6" CRUSHED STONE V�_ 5 OUTLET DISTRIBUTION BOX 40.0'(TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON AN APPROXIMATE M.S.L. DATUM OF 55.00' OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE ESTABLISHED ON A NAIL SET IN TREE AS SHOWN ON PLAN. COMPACTED BASE (3M M M BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 42.97' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10' 6" WIDTH 5' 8" DEPTH 5' 8" (Dimensions per Wiggin CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE Precast Corp., POcasset,MA) 16 - APB' 36HC (#3616BD BIODIFFUSERS H-20 TO THE DESIGN ENGINEER. 'CONTRACTOR I VERIFY THIS ELEVATION& DISTRIBUTION BOX DETAIL ` 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. REPORT TO ENGINEER IF DIFFERENT NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING �; - , �r• TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM * ' • • , ,' • • +o APPROPRIATE AUTHORITY. PERC NO. 12878 O • ** # , �,* � , O „ INSPECTOR: David W.Stanton, 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 ' • 4March 201013. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. i + • • + • DATE: " �� • • " � . " * • . TEST PIT#: 1 ; 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE .• ` ■ ' ` ' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. / ELEV TOP= 53.90' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, r . ,10, + + • * �+ r ELEV WATER= <43.07' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ' • . • " , 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN UJI • ,� , , •• • PERC RATE = 3 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. s ` +� ' ` LOCUS 16 -34 n R" r �. • . '♦ + DEPTH OF PERC= " „ 16. PROPOSED PROJECT IS LOCATED WITHIN: 1' Y r ` „' • • • * + + TEXTURAL CLASS: 1 ASSESSOR'S MAP 191 PARCEL 126 o ,� + uj co * , . 1 * • _ OWNER OF RECORD: HENRY W. COLE a f�. + ' * • i 0" 53.90' ADDRESS: 316 BUCKSKIN PATH I � • "+ .,•„ : ± ' Loamy Sand A CENTERVILLE, MA 02632 • * * •_ " 10Yr 3/1 53.40' FEMA FLOOD ZONE C �4_ MAP 191 �' ., • s r '� B6 „ Loamy 10Yr 5/8 d ' COMMUNITY PANEL# 250001 0015 D • 52.57' LOT 127 '� • • • . * " 16 17. DEED REFERENCE: BOOK 20726, PAGE 136 Q ZONE 11 r : ; ,� Perc h 4 / Sao EXISTING LEACHING PITS (2) ( : • * + + , * . 34" 51.07' 18. PLAN REFERENCE: PLAN BOOK 244, PAGE 67 AND SINGLE CESSPOOL TO BE • + , O 8S F PUMPED, FILLED WITH CLEAN , + 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. . , �� . • COARSE SAND AND ABANDONED Med. - Fine Sand C-1 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. TKIS PLA;J IS TO BE USED ONLY v ono 00 • 1, �, '• " -- • , 2.5Y 6/6 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY O� I try ^oo ' �S\�S PROPOSED 1,500 I�1 „ , ' ' . 4 + r8 ' . i FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. • - r , • JV GALLON SEPTIC TANK + + + + * ` •' + • ,• 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE 45.57' �s `-PROPOSED ,�,,, / "•, • �,. ' #` R ' 100" Very Fine Sand APPROVAL IS REQUESTED FROM 310 CMR 15.221(7): DISTRIBUTION BOX Y' • '' ' - - ' C-2 2.5Y 6/6 1). A 0.82'WAIVER(3.00'-3.82') FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. #316 PROP. TOTAL 16 ARC 36HC BIODIFFUSERS (H-20) 112" Traces of Silt 44.57' Coarse Sand EXISTING \BH (8 BIODIFFUSERS EACH TRENCH) 2.5Y 6/6 4 LOCUS PLAN 4-BEDROOM tiN C-3 10-15% Gravel; v DWELLING I w TOF = 55.2'+ 2��, x54.4' I SCALE: 1"= 1000' 130" Some Cobbles 43.07' No Mottling, Standing or Weeping Observed __ .. ---- - wqY � DECK � (i O __ -- ------ _ o DESIGN DATA TEST PIT DATA LEGEND s � � PERC NO. 12878 50xO EXISTING SPOT GRADE GARAGE o MAP 191 INSPECTOR: David W.Stanton, R.S. TP 1 LOT 227 NUMBER OF BEDROOMS (DESIGN) 4 EVALUATOR: Michael Pimentel, E.I.T. - - 50 - EXISTING CONTOUR ~53.9' DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 1999 PROPOSED CONTOUR TOTAL DESIGN FLOW 440 GAUDAY TP 2 DATE: March 26,2010 �5 .8' GAUDAY DESIGN FLOW X 200 % 880 TEST PIT#: 2 EXISTING OVERHEAD WIRES = 77/ Benchmark UHF EXISTING GAS LINE S \ Nail Set in Tree USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV TOP= - 53.80' Elev. =55.00' W W- EXISTING WATER LINE SWING-TIES ti���N� x53.5' x53 6' \ Approx. M.S.L. ELEV WATER- <42.9T TEST PIT LOCATION SCALE: V=20' MAP 191 �� LP PERC RATE _ DESCRIPTION HC1 HC2 LOT 125 INSTALL 16 ARC 36HC (#3616BD) BIODIFFUSERS (H-20) Cp EXISTING CESSPOOL MAP 191 DEPTH OF PERC= SEPTIC COVER IN (1) 42.7' 39.2' x53.7' LOT 126 SYSTEM CAPACITY TEXTURAL CLASS: 1 LP EXISTING LEACHING PIT D INSPECTION PORT (TYP OF 2 16,399 S.F. ± - SEPTIC COVER OUT(2) 48.7 PROPOSED ) (TOTAL L.F. OF BIOS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD - - N O o� MAP 191 0 PROPOSED 1,500 GALLON SEPTIC TANK BIODIFFUSER CORNER(3) 40.0' 57.8' �935 oo' (80.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 461.8 GAL. LEACHING DAY LOT 226 0" Loamy Sand 53.80' " BIODIFFUSER CORNER(4) 64.6' 41.9' PROPOSED 4''PVC VENT PIPE, EXACT / A 10Yr 3/1 PROPOSED 4 SOLID SCHEDULE 40 PVC PIPE LOCATION TO BE DETERMINED BY OWNER J TOTALS: 6" Loamy Sand 53.30' BIODIFFUSER CORNER(5) 72.0' 53.4' TOTAL NUMBER OF BIODIFFUSERS: 16 B p PROPOSED DISTRIBUTION BOX „ 10Yr 5/8 BIODIFFUSER CORNER(6) 51.0' 66.6' - TOTAL NUMBER OF COUPLINGS: 0 16 52.47 TOTAL LEACHING AREA: 624.0 PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) TOTAL LEACHING CAPACITY: 461.8 REV. DATE BY APP'D. DESCRIPTION C_1 Med. - Fine Sand PROPOSED SEPTIC SYSTEM UPGRADE 2.5Y 6/6 PREPARED FOR: HC-2 #316 NOTE: CAPEWIDE ENTERPRISES EXISTING EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE 100" 45.4T 4-BEDROOM ', Very Fine Sand DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER C-2 2.5Y 6/6 LOCATED AT DWELLING (4) "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO Traces of Silt TOF = 55.2'± ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST 112" 44.47' 316 BUCKSKIN PATH (2) NOTES: MODIFIED FEBRUARY 18, 2010). TRANSMITTAL NUMBER=W000052. Coarse Sand C-3 2.5Y 6/6 CENTERVILLE, MA (5) 10-15% Gravel; 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH Some Cobbles SCALE: 1 INCH = 20 FT. DATE: MARCH 29, 2010 130" 42 9T (1) SEPTIC SYSTEM COMPONENT. No Mottling, Standing or Weeping Observed 2� 'c �N o u 0 10 20 40 80 FEET CHI CHn-L Fw PREPARED BY: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE RESERVED FOR BOARD OF HEALTH USE U civi JC ENGINEERING, INC. HC-1 PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA ° 4 07 ' 2854 CRANBERRY HIGHWAY SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF (3) SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 (6) 3). ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE ZONE WATERSHED. - -- --------- ----- - SCALE: 1"=20' Drawn By: BSM Designed By:MCP ! Checked By:JLC JOB No. 1786