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0779 BUMPS RIVER ROAD - Health
779 BUMPS RIVER RD Centerville A— 167 — 024 MEE:AD] KEEPING YOU ORGANIZED No. 12534 2-153LOR OORESTRY " MIN.RECYCLED Coro aNITLATIVE CONTENT10% wwwi%g1reinoro POST-CONSUMER MADE W USA GET ORGANIZED AT SMEAD,COM No. 9-0 (7 - 3 �� y Fee �'o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPfitatlon for Vsposal *pBtrm Construction 3pennit Application for a Permit to Construct( ) Repair k Upgrade( ) Abandon( ) ❑Complete System Egfndividual Components Location Address or Lot No. 9 S p,ltIER�ZJ� Owner's Name,Address,and Tel.No. MARY LRIe_S-iTj Assessor's Map/Parcel to 7 2- �i![[aC 1k PJU&X Oki) (I l V1 Installer's Name,Address,aW Tell.No. Designer's Name,Address,and Tel.No. 502-X 13 d-037] Type of Building: Dwelling No.of Bedrooms Lot Size 3;to- sq.ft. Garbage Grinder( ) Other Type of Building ( tD&_QZcA;I No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) all gpd Design flow provided _ �o`L gpd Plan Date 10-a.- f -7 Number of sheets 1 Revision Date Title `1 Zq� P� 01 0E4 Size of Septic Tank b 04> — _ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 74-2v-- To mer-x.) n-80,c U.; IT14 4 FEE 8F * ex4E syAAQcaXA>ceJG. 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 Healt Signed Date 10 X—.10 L-1 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 2 7- 31-1 Date Issued /0 7, v 100 No. !i' 0 (7 3LIf - . :.. Fee ! THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer: Yes f PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS apphLation for ]Disposal 0pBtpm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandorry( ) ❑Complete System Individual Components Location Address or Lot No. O IbUt%tpS + Owner's Name,Address,and Tel.No. Assessor's Map/Parcel (.0-7 1;L4 d"Vlf-L6 T79 `rkX-0 juice An 0 +Vt(..G-Cr, Installer's Name,Address,and Tel.No. " Designer's Name,Address,and Tel.No. ✓r'0%'~X1 - ?>d 3G t>;,�t i4.t> -rNc Type of Building: ••�� � Dwelling No.of Bedrooms s Lot Size � g_ sq.ft. Garbage Grinder( ) Other Type of Building R(E51 D6MTf W No."of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ��499.4 gpd Plan Date 1�,-, ...„Zp ( " Number of sheets Revision Date Title �'7�1 ,t/I'�t'A jk)l f1 nA <EWT&_li1L» Size of Septic Tank ()pQ C,AJI A) Type of S.A.S. Off! TOO C?a4�•C7sJ ��'��S 1 Description of Soil C;DIZ47/tl92i 5AoUb _30 Nature of Repairs or Alterations(Answer whenapp�li able)-')sf' EX/+9T t]j 6 1.606 644J-60 _CPj 4C„ ''�"A�.►tom 'n-11 1U1"1�t j D-13 V M0 (A) 50-0 * C�®N �.�....e�le 06, Gt�rt �'. - f,,,C,►t•t� ._� c 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 X Application Approved by .� Q Date /o v Application Disapproved by Date for the following reasons Permit No. 2 0 1 7- 3 L/ Date Issued /a THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate Of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired('X) Upgraded( ) Abandoned( )by CA?E w o aN� �.Q4 , - at n o&W)S Q•(!� f�4� t„ '(/f ftCffis been constructed in accordance. . with the provisions of Title 5 and the for Disposal System Construction Permit No. / ,:rt! 9dted 10 - 7 InstallerlAECA-; � Tt=_3Q /�'iSi�'� Designer #bedrooms Approved design flow ,[ gpd The issuance of this permit shall not be cons-trued as a guarantee that the sy e m will fun1 "as Zlesi ed. Date Inspector ------------------------------------------------------- No. F /7 -- 3 t, 61 Fee / 1)U - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBar *pstem Construction permit Permission is hereby granted to Construct( ) Repair(N Upgrade( ) Abandon( ) System located at 1 �'q(jN?s l((16k � clisu—myn/lI_L. 5 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 in Jet be c mpleted within three years of the date of this permit. /r 12 Date / r.Z / Approved byrC V A IV/ I3/YVIr Is:sU �0162r;tU3I61' #5707 P. 001/001 Town of Barnstable Regulatory Services Richard V. Scali, Interim Director �M Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: !d'13�!7 Sewage Permit# 20 t1 A Assessor's Map\Parcel ,�7/�y Designer: TG Ertltnee.cin , Inc-. Installer: Gage-Wi& 6nVerPrfseS Address; Address: 15'5 4omvylexciol S�reei East wow eiAaf ► , t4A 0255 o2(,,y9 On Ifs Ca dwide. &OV4We se.S was issued a permit to install a (date) (installer) septic system at 7-7 9 6emes Qitg,r based on a design drawn by (address) C- rngineerin s 'TOG . dated OcVar Z, 2,017 (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. 1 certify that Fhe system referenced above was constructed ' e with the terms of the RA approval letters (if applicable) ,�*- e 414sfgcy JOHN L a CHURCHILL JR, w st is S' C1 MO 1801 1$ (Affix Des' mp Here)eslgner's Sig re) YASE RE TO BARNSTABLE PUBLIC HEALT N. CERTIFICATE F COMPLTANCE, WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, Q:1Scpiic0esigner Certification Form Rev 8.14-13.doc � I I ,I • I Town of Barnstable P# 15Y. Department of Regulatory Services , I F Public Health Division P MARS. Date yl r�1a79 �� 200 Main Street,Hyannis MA 02601 �.•. > ' , l lo ' Data Scheduled �7 o Time Fee Pd._ 7, Soil Suitability S Di Asses►�ment or e g.f sposal _5 Performed-By: Nt�cllctQl I�tr�en del �� =15 1�►'� Witnessed By: LOCATION&.GENERAL INTORMA.TION Location Address Owner's Name RlU& �� !`IO 9dvt i t�. <'I' .Address 77q 15cv6L4:�< P_4PW,• I">-6 Assessor's Map/Parcel: C,-7 /O;IL( Engineer's Name C_ eV 1V J �P t1&OU65.6 5oS-113-0377 NEW CONSTRUCTION (( REPAIR Tele hono# 02 �1Z—1 , Land Use- t r 10.I Slopes(96) C� 5urfhco Stones V!//� I Distances from: Open Water Body >15 Qft Possible Wet-Area 2)�L5 Q fi DrinkingWatar clt Drnthaga Way >f!Q tt Property Llna ii ft Other I ft • SIM'TCHe(Street name,dimensions of lot,exact locations of het halos&pare testa,locate wetlands•('n proximity to holes) ' I' P 10n I. • i ' I Parent material(geologic) �('` � ' 1 C`t A ��6• �r r Depth to Bedrock_ S 3GDepth to Groundwater. Standing Water In Hole: �• Estimated Seasonal High Groundwater >/')6 a /3 6S I DETERMINATION FOR SSE ASONAL'HIGI1 WATER TABLE Method Used: _Dicect- 0mP,rydi0N De th Observed standing in obs.hole: >02 __„Ia, Depth to soll mottles; �)a` In . Delith to weeping from side of obs.hole: > / In, Groundwater Aluusttnent 1 A/ 4A 1 , Index Well f Ronding Dato:- Index Woll Imvol._ _,•.,r_ AdJ,.thetbr, Adj.a un'dwater•1.aVa1,,_ PERCOLATION TEST Dole-1 tmg jkoo ar Observation Hole# Time at 9" Depth of Pero I Time at 6" Start Pro-soak Time @ •o S Gti ___,_, 'Limo(9"•6") i F End Pro-sack 11;10 a", i Rate Mtn./Inch '• i ' Site Suitability Assessment Sitd Passed V Sltp Failed: Additional Testing Neadad(Y/N) !I V I Original: Public Health Division Observation Hole Data To Be Completed on Back I ***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. i Q:\SEPTIWBRCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# �a Depth from Sol Horizon Boll Texture Sdil Color Soil• Other Surface(In.) (USDA) Powell) Mottling (Structure,Stoners;Boulders. V re(etency.%'Qrsvo1l V u N' char �GG to /r 31, " 1q-30" L Sind 10 r 5/4 Coop see_ a.�Y. 6/` 6 — !0�/S% Gravel DEEP OBSERVATION HOLL LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surfaco(lo.) s. a (USDA) (Muneell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth frond Soil Horizon Soil Texture Soli Color Soil Other Surface(in.) (USDA) (Muneell) Mottling (Structure,Stones,Boulders., DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color moll Other Surface(in.) (U$DA) (Muneell) Motiling (Structure,Stones;Boulders, Flood Insurance Rate Map: / Above 500 year Mood boundary No— Yes Within 500 yea boundary No �!1 Yes,;.,.. Within 100 year flood boundary No.✓ Yes pepth of Naturally Occurring Pervious Mit erlal Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? e If not,what is the depth of naturally occurring pervious material? ... :. Cer'ti�n I certify that on I0" 7 (data)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,expertise a xperlence described In 4 10 CMR 15.017. Signature ZDatb QcxSBPTI0PBRCPORM.DOC TOWN OF BARNSTABLE LOCATION '72 ( (Id,[P ,IVr+2 RD SEWAGE# f 34� VILLAGE C��-r�r��(e.t� ASSESSOR'S MAP&PARCEL v2. INSTALLER'S NAME&PHONE NO.CARELO W SEPTIC TANK CAPACITY 11000 GA&44UJ LEACHING.FACILITY:(type) AL GkMAJWAS(size) 1:1. `X a-5 NO.OF BEDROOMS . OWNER MAYN PERMIT DATE: f 6 — 1 eL—AO G I COMPLIANCE DATE: ( ® -6 3 —;LO Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility IV®1U E Ok s, Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within A 300 feet of leaching facility) A Feet FURNISHED BY l hi,A" f%w[06 EwTx `�� k 2 9-3 a 25,9` b a e � r-4 Li`1 c.�s 5 ® Lill a t�T Town of Barnstable Barn Regulatory Services Department A&An `Ca j BARNSTABLE, MASS.39 Public Health Division Cb i639, `0 m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 3936 September 29, 2017 ERIC S ON, MARY A TR 779 BUMPS RIVER RD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 779 Bumps River Road, Centerville, MA was inspected on 09/08/2017 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level, <12" below inlet (per Town Code 360-9.1). You are ordered to repair or replace the septic system within two (2)years 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 THE BOARD OF HEALTH as McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\779 Bumps River Road Centerville.doc WA ♦ Town. of Barnstable Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-8624644 Richard ScA Director FAX 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO'REPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An`Y"marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA. ❑Discharge or ponding of effluent to the surface of the ground . ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. :. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(11 YEAR DEADLINE CRITERIA. ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). ' •. TWO 2 YEAR DEADLINE CRITERIA . q m esspoo ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) -beaching pit or cesspool with high liquid level,<12"below inlet (per Town Code Y §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. 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. Please see completeness checklist at the end of the form. Important:When A. General Information filling forms the computer, ����0`°�y�N DF o use only the tab 1. Inspector: :��A\ key to move your '�U- JA M E S G cursor-do not James D.Sears = m use the return Name of Inspector s key. Capewide Enterprises � Company Name �i, ! ••'p'< O 153 Commercial Street i�j��5�INSp�����\`� Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally.inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 9-12-17 pector'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 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 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 VV ��, Commonwealth of Massachusetts = W Title 5 Official InspectionForm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. 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: Failed system. The system is a 1000 Gal. Tank D Box and two overflow's. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. Cityrrown 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ 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 is less than 6" below invert or available volume is less than %day flow EA CIWIVO t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. Cityrrown 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- 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 11 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.doc•rev.6/16 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 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 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? ❑ ® 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): NA Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1000 Gal. Tank D Box and two over flow's. Number of current residents: 0 � Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2015-5,000Gal's g ( y g (gpd)) 2016-3,000GaI s Detail Sump pump? ❑ Yes ® No Last date of occupancy: NA 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. Cityrrown 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: NA 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.doc•rev.6/16 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 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank- D Box and pit 1978 permit# 184. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 8" 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: 1000 Gal. Precast H-10 Sludge depth: 3" t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. Cityrrown 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 27" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 8" below grade. Inlet tee, outlet baffle. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 779 Bumps River Road Property Address Richard Ericson Owner Owners Name information is required for every Centerville MA 02632 9-8-17 page. 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm,present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 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 0 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 is 16"x21"-22" below grade w/one line out. Box wall's are gone. Box show's signs of being over full and solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 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 GSM , 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 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: 1 ❑ 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.): Leaching is a old block'pool and 1000 Gal. pit. Both have been full to covers. Pit wall's are covered w/scum and solid's. Need to replace. 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official -Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. Cityrrown 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.): 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont:) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A -0 =3Y' B-1 -: 17 ` s e - ,V=� y, [R,5 31 e - =a9-3 io 1 o � s t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N0 Estimated depth to high ground water: 12'-6" 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: Auger T.H. 11'-T no G.W.. Bottom of pit at 8'-8" below grade. Bottom of pit at 3-4 above T.H.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1 • F Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 779 Bumps River Road Property Address Richard Ericson Owner Owner's Name information is required for every Centerville MA 02632 9-8-17 page. Cityrrown 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 115ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 7 No......... elp� ... F�s.... . .:. ��........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....... ............` own........OF.B.arna.t3,ble: ......... - ..-..--............................... ApplirFa#ion for Bispao al Works Toutitxnrtinn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 77.9.Bumps...Rver Road -•----------------------••--•-•-------------------------------_-------..._._..........--------- .................... - Location-Address or Lot No. Carl Ericson Centerville-. Mass-,--------------•-•_------------------.- - _......................•------•---------._...----•-------•---•--•----•--•- Own r Address W Joseph P. Macomber & Son Inc Centerville a --••.......................... ..... -------- Installer Address QType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons_______________________•-_-. Showers — Cafeteria Q+ Other fixtures -------------------------------•-- - W Design Flow.............._........_....................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*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........................................ Test Pit No. 1................minutes 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........................ �i -•-------------------------•-----------•--•--------------------------------.._..._......._-•••--......................................................... & GrvelO Description of Soil--- d_ .. --••------------------------•--•--------------------------------------------x U ...........................................................•................................................................................... ............................•................•........... W ,, VNature of Repairs or Alterations—Answer when applicable!-1JQJ___0�11on---- nk_8c__1_-1�J�J�J___ �11OT1 pit• (overflow) -----------------•------------------------_------------•----•------------------------••-•--•----•-•--------•----•---•----------•---•-----•----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITi:LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b i sued by the b and f ealth. Si ned___ = 41 - ` Date Application Approved BY - ....... ( A44.112 .....................-........... ---1 1�1� 7 ----- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- ---------------------------•----------•---------•---..._..--•-••---------•----....------•-------------•---------•-------------------------••-------------------------------- Date PermitNo....................................................... - Issued-....................-.................................. Date P By .:............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ............ ...TQwx.......oF..$9,xn.B e e...... Appliration for M�pati al Works Tumitratrtion famit t Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ........... = _y .............................. .................................................................................................. Location•Address or Lot No. Carl Ericson ................................................ .,w Centervil_cs__Mss........................................ ...... ._...._...- r W Joseph P & son Inc Centervi""Lle Address ----•---------------------•----------•----------•-----------......----------....._...•••••-•-•••-- ••----..._.._._._.__._...•----•--•-----•-•-•--•-----------•-----------=-----------•--.....__------ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms................................._..........Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type e of Building _______________ No. of ersons_._._____.____.___...__.____ Showers — Cafeteria W yP. g ------------- P ( ) ( ) Pa 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...;:r'.............. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test.Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit____________________ Depth to ground water_______--___________---. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------•--__-_---__--•------..._...._.._...------- _--------------- ••••------------------------- ----------------------- 0 Description of`Soil S _nc3 ------Gr`--------------------•••••--------------•----•---------------------------------------------------------------------------------------- xF U Nature of Repairs or Alterations—Answer when applicable.._ ............................................"_._�:__.1'�.:-_---° i1. l 1 » lon t�.n. w a,a on pit (overf�oyr) 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 been issued by the board of health. � � Date Application Approved By.___ - Date yA Application Disapproved for the following reasons:------_--- ______>.............._..................................................................... .................... ................... Date Permit No...........................=---••••-----•••-••--•------__ Issued--------- =` Date !n _ THE COMMONWEALTH OF MASSACHUSETTS s BOARD OF. HEALTH .............................Z,;�.Wn.0F....B :rnG ................................................ �rrtifiratr of otp iaaatre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) by � T'a Pamb ..� _S T nstaller at.-77°__Fjrnpq__Rver Road, __Centervil�e Ericson ------------------•-•--..•-----------------------------------•-•-- has been installed in accordance with the provisions of TI"' .F 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ ___ dated--- -__.__ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. //�� DATE..----•----•----•........j�__...-,1 ........ -� ............. Irispector..._....(2. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Torn.. of B3urnsltable= N �. .�/.. r`" FEE...........:..::.'-..... Disposal .: a �t it ion Trott JoS 6'61 Macomber__ &--_Son_--Inc . Permission is hereby granted = --- ............... •---._..---._..._.._._.._...-•-------------------...--_..... to Construct ( ) or Repaid(:. -an Individual Sewage Disposal System at No.. _779...3-urOiver Roads C,enterville -----------------------------Ericson.............. Street - r as shown on the application for Disposal Works,Construction Permit No ___ ____________ Dated___ .......... �/_ �,/ ---- DATE.....T �'`t 4 '•-----------------------------•---------...... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS �.� AT ION, S WAGE PER IT NO. VILLAGE Celvj CI&I, "lle I NSTALLER'S NAME & ADDRESS iT B U It D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��- t T.O.F. EL.= 22.6�t FINISH GRADE OVER D-BOX = 20.4'f FINISH GRADE OVER CHAMBERS = 19.5' - 20.5' GENERAL NOTES PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4„TO 1-1/2„ DOUBLE WASHED REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE WITH COVER OVER INLET& RISER TO WITHIN 6" OF FINISHED GRADE 1. UNLESS OTHERWISE NOTED ALL SYSTEM COMPONENTS AND CONSTRUCTION OUTLET TO WITHIN 6"OF F.G. 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE , F.G. OVER TANK EL. = 22.0't 5" DIA. OUTLET(S) MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) N OF G TO XTI DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 22.0 t _ _ STONE OR GEOTEXTILE FILTER FABRIC } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE I , PLACE RISERS ON ALL DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 9�� MIN. 9„ MIN TOP OF SAS= 17.83 CHAMBERS WITH „ SCH. 40 PVC 36 MAX. r- 17 00' 36" MAX. INLET PIPES TO 6"OF 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PI Pi BREAKOUT EL- 17.50 SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE I FINISHED GRADE 6" 3„ 3„ DROP MAX 3., 9„ L-58'f 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2 DROP MIN MIN.SLOPE(a31! PROVIDE WATERTIGHT o ELEVATION = 17.50' FOR A DISTANCE OF 1V AROUND THE PERIMETER OF THE SAS. UNLESS A ' -_ �-JOINTS (TYP.) o 0 4 PVC IN FROM �w 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF j 13" 14„ � 1 g g, SEPTIC TANK 10 4" PVC OUT TO 0 0 Q 0 0 0 0 0 0 0 0 Q o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE ( LEACHING FACILITY oo o SLOPE ALL LID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN ' oo o o 5 SO U INLET AND OUTLET ! CONTRACTOR CONTRACTOR SHALL �� , 12 6 , 2' oo °° 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 17.37 MIN. 17.20 0 00 � 0 ao 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE °° o00 0o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY oo °° o o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 4.0' 8 5' (TYP) I 4.0' 4 0, 14 0, AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX ! 4.83 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 20.00, Z5 L`- --- ---- -- - TO BE INSTALLED ON A LEVEL STABLE 25.0' (TYP.) ESTABLISHED ON A NAIL IN A PINE TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 10.00' PIPES TO BE LAID LEVEL. .00 12.83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK 2 - 500 GALLON CHAMBERZ., 5' MIN. CHAMBL.. , END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES "CONTRAS Y EXISTI:vU TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK& ' LH I C I �'" D I ST R I I I T I n R 1 D n X DETAIL C HAI V t R C7 p n'�TA I LS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. j NOTIFY 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 ,/ TEST P I T DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM SWING-TIES ` r ( ". 11 r ` APPROPRIATE AUTHORITY. .� _ C +� r PERC NO. 15485 ,c` A' r 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED DESCRIPTION HC-1 HC-2 ' -y {, � �M__ INSPECTOR: Donald Desmarais 1� 125 y ' UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR CORNER OF STONE (1) 17.2' 38.3' �gM EVALUATOR: Michael Pimentel, E.I.T. TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. ` '0 � fz c� -�-�' ;j C.S.E. APPROVAL DATE: Oct. 1999 CORNER OF STONE (2) 27.T 51.1' I '�` t Se 13, DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. . _ . - lll,t DATE: September 28, 2017 O i -V�? � ; •••' \? �`�`� 1 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE CORNER OF STONE 3 44.9' 58.3' r' r �' {'\ . _ `� �r •ens r-, MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. orthCORNER OF STONE (4) 39.2' 47.5' ' ' If � ELEV TOP = 20.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY 1 ! r !.• ..�' � ; „ %- _ FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ELEV WATER - <9.50' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN � ,,. _i `► _ �\ ; ,_.r -�'� PERC RATE _ < 2 MIN/IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. �' • LOCUS �, t DEPTH OF PERC =TEXTURAL CLASS: 30"-48" 16. PROPOSED PROJECT IS LOCATED WITHIN: ; _. { ,s Ai co r n •• ASSESSOR'S MAP 167 LOT 24 T �, I ' �! . I `• 1 OWNER OF RECORD: MARY A. ERICSON TR Z \ d ��( •. i / MARY A. ERICSON REV LIVING TRUST Bogs ' ' -'? ��� • 0" 20.00 779 BUMPS RIVER RD rr �, - -• U �. ADDRESS: EXISTING 1,000 GALLON i `�" � r ` ' !' ,` Y CENTERVILLE MA 02632 s� •IOv SEPTIC TANK TO BE UTILIZED y A Sand Loam P LP EDGE OF PAVEMENT Ar ^ '; i 10Yr 3/1 aaAA r FIN THIS DESIGN _ _ ���,�� � ��' � �� 18.50' 60 -- �- - J- -- • t v' \ I 18 FEMA FLOOD ZONE X _.� l - L ` Loamy Sand COMMUNITY PANEL# 25001 CO563J Bay B 10Yr 5/6 17. DEED REFERENCE: L.C.C. #180177 C_jBOX TO BE ABANDONED W \\ C f y p- 01.25 \ \ 1 5i�.„-_. a�_ " '' _. . �-R 30" 17.50 18. PLAN REFERENCE: L.C. PLAN#21611-A 16.00 EXISTING CESSPOOL TO BE PUMPED, �\ \ ?6 ` \ 0a '3' 38, 1 ,fl l' a0 �"� "''�~ *`' i 4F; 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. FILLED WITH CLEAN SAND AND FRUIT SAPLING \ 3�4'45' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY ?` • '� " r© fir:' ` FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY ABANDONED 'TYP OF 2 � - 11+ l ) BUSH \ \ ` i r• tt �. • \\ �. O \ .y - ;• __. �.� ' \ - • FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 9" PINE \ i ?�' \. ' // • ! F �Q 1 ' • Med.-Coarse Sand 26� • i C 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A 2.5Y 6/6 BUSH ,� t'�' °,If l \ �... r 10-15% Gravel DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A PROPOSED /� i CIDa` REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. INSPECTION "� � � '' CP 7 HOLLY \ I LOCUS PLAN i 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL PORT-\ L&drI REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. PROPOSED 2-500 p TP 2 \ 14 HOLLY 5 (TREE GALLON LEACHING „ _SCALE: 1000 23. IN ACCORDANCE WITH 310 CMR 16.401 -16.405, THE FOLLOWING LOCAL UPGRADE 20x5 CHAMBERS c vSTOOP 126" 9.50' APPROVALS ARE REQUESTED FROM 310 CMR 15.211: (2) ��^ . 4' HOLLY I (1.) A 2.8'WAIVER (20.0'- 172) FOR THE SETBACK FROM THE SAS TO THE HOUSE. ?? j No Mottling, Standing or Weeping Observed 2oxo .� BUSH L DESIGN DATA TEST PIT DATA LEGEND Benchmark �\�� �o O 172, #779 (5)-5 HOLLYS PERC NO. 15485 Nail in Pine HC-1 I EXISTING Elev.= 20.00' �'� � �, [ I INSPECTOR: Donald Desmarais 0 (1) 2-BEDROOM BUSH TYP NUMBER OF BEDROOMS 2 5Qx0' EXISTING SPOT GRADE Approx. M.S.L. ( (3 MIN. DESIGN PER TITLE 5) 3 ram DWELLING I DESIGN FLOW 110 EVALUATOR: Michael Pimentel, E.I.T. -- -- 50 -- - EXISTING CONTOUR ( ) TOF =22.6't GAL/DAY/BEDROOM 7" PINE �1��� \ 1� 00.� // TOTAL DESIGN FLOW 220 GAUDAY C.S.E. APPROVAL DATE: Oct. 1999 50 PROPOSED CONTOUR 4 P O DATE: September28, 2017 G o���E O �p�� L -' DESIGN FLOW x 200 % _ 440 GAUDAY TEST PIT#: 2 50 PROPOSED SPOT GRADE - HC-2 USE EXISTING 1,000 GALLON SEPTIC TANK CP EXISTING CESSPOOL l \ ) ELEV TOP = 20.50 \ \ PROPOSED ELEV WATER = < 10.00' GAS EXISTING GAS LINE �� DISTRIBUTION BOX I=PERC RATE _ -- /T%�- EXISTING UNDERGROUND UTILITIES r oti , '� _20_ _ i INSTALL 2 - 500 GAL. CHAMBERS w/ AGGREGATE WATER, DEPTH OF PERC = W W EXISTING WATER LINE METER ;/ SIDEWALL CAPACITY TEXTURAL CLASS: 1 TEST PIT LOCATION / PIT I (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAL/DAY MAP 167 (25.0'+ 12.83') (2 ) ( 2' ) ( 0.74 GPD/S.F.) = 112.0 GAUDAY -- EXISTING 1,000 GALLON SEPTIC TANK � LOT 24 011 20.50' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE .- "� .-_. i I �"`ry�j 35 LOT 2 S.F. BOTTOM CAPACITY P P (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAL/DAY A Sandy 10Yr 3/1 Loam D PROPOSED DISTRIBUTION BOX (25.0 x 12.83) (0.74 GPD/S.F.) = 237.4 GAUDAY 18� 19.00' B Loamy Sand t 1 PROPOSED 500 GALLON LEACHING CHAMBER TOTALS: 1OYr 5/6 TOTAL NUMBER OF CHAMBERS 2 30" 18.00, TOTAL LEACHING AREA 472.2 SQ.FT. REV. DATE BY APP'D. DESCRIPTION TOTAL LEACHING CAPACITY 349.4 GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE y ?atHOFp_ PREPARED FOR: 0 C Med.-Coarse Sand I°?c HILL,R.�m CAPEWIDE ENTERPRISES 2.5Y 6/6 CWL 10-15% Gravel 'q1807 LOCATED AT 779 BUMPS RIVER RD NOTES: CENTERVILLE, MA 02632 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF 126" 10.00' SCALE: 1 INCH = 20 FT. DATE: OCTOBER 2, 2017 0 10 20 40 80 FEET EACH SEPTIC SYSTEM COMPONENT. No Mottling, Standing or Weeping Observed 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF PREPARED BY: THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST RESERVED FOR BOARD OF HEALTH USE JC ENGINEERING, INC. PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL 2854 CRANBERRY HIGHWAY BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. SITE PLAN 508.273.0377 SCALE: 1" = 20' Drawn By: DT Designed By:SJI Checked By: MCP JOB No.3951