HomeMy WebLinkAbout1160 BUMPS RIVER ROAD - Health 1160 Bumps River Rd. , Centerville
- A= 188-139
No. 42101/3 ORA
ca
ESSELTE
10%
(*
O O O O
__
'emu-aa".riadlY 1�9' _:.-. ..r.-.w ,...:.,�..a.� .a.:_....a .. .. - _ -
No. Fee$50 .00
n
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
0[pphratiou for Migogal *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 1 1 6 0 Bumps River Rd Owner's Name,Address and Tel.No. 7 7 5—41 5 3
Assessor'sMap/Parcel Centerville, MA Mr & Mrs Minotti
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Lim E Robinson Sr Sept Sry
PO Box 1089, Centerville, MA 0263
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S: %'
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Septic repair, replace broken
D-Box. f c� -/,.?] Z /-,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 Cod d not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Bo f H th...-
Signed Date -7
41
Application Approved by Date
Application Disapproved for the following reasons
Permit No. rjy Date Issued
010.
! � Fee$50,00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
2pplication for Digaal *pgtem Congtruction Permit
Application for a Permit to Construct( Q Repair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 1160 Bumps River Rd Owner's Name,Address and Tel.No. 7 7 5—41 5 3
Assessor'sMap/Parcel- Centerville; MA Mr & Mrs Minotti
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Sr Sept Sry
i
PO Box 1089, Centerville, MA 0263
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
I
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date j
Title
Size of Septic Tank Type of S.A.S. '
Description of Soil sand
i
i
Nature of Repairs or Alterations(Answer when applicable) Septic repair, -replace broken
D-Box.
i
D 1
i
Date last inspected:
i
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 Certifi-
cate of Compliance has been issued by this Bo f H th.&_ p ;
i{ Signed Date
Application Approved by Date i
�It
Application Disapproved for the following reasons
{
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS .-
Minotti
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(r x)Upgraded( )
Abandoned(11)6 U r
at Bumps River Rd Centerville has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Wm E Robinson Sr Spt Sry Designer K
The issuance of this permit shall not be construed as a guarantee that the system ill function as designed.
Date 4, — 17 — 7 Inspector
--------------------------------
' No. 2 � Fee$5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Minotti lwiizpogal *p$tem Congtruction Permit
Permission is hereby granted'to Construct( )Repair(X)U grade( )Abandon( )
System located at 1160 Bumps River Ra
Centerville, MA
Installer Wm E Robinson Sr Spt Sry
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to r
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date: Approved by
i
i
i
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
I ,0 3.
3�L�
�-Tye
D.y. 9 Or 10
/` TOWN OF BARNSTABLE
i�LOCATION Z (/� t �. Z�U „\ SEWAGE#
�) ASSESSORS MAP & LOTJ 8- 131
VVILLAGE ��// �� ' i
INSTALLER'S NAME&PHONE NO. f�1h-f ,KQ�)k►✓r-nn cSP �2IU(C�
SEPTIC TANK CAPACITY �C
LEACHING FACILITY: (type) (S (size) �(� ox
NO.OF BEDROOMS
BUILDER OR OWNER � ��"/`�"
PERMIT DATE: (0— COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and-.reaching Facility(If any wetlands exist.
within 300 feet of leaching facility) Feet
Furnished by
' r
3�
j .
V
CERTIFIED SEPTIC SYSTEM REPORT
y � E
LOCATION 1
� 9
9] 14
1160 BUMPS RIVER RD . �+
CENTERVILLE, MA
MAP 188 PARCEL 139 LOT 2
PREPARED FOR
Owner
MR. & MRS . MINOTTI
1160 BUMPS RIVER RD .
CENTERVILLE, MA 02632
PURPOSE 7� 3
NEW ADDITION
PREPARED BY
HILLIARD HILLER
P .O . BOX 250
CENTERVILLE, MA 02632
508-778-1472
f
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
r DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON. NIA 02108 617-292-5500
r
WILLIANI F.WELD TRUDY COXE
Governo: Set:retary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address: %/6e:P sf/�/e..0 /�O� G��itity/LGEAddress of Owner:
Date of Inspection: .51.3---I97 (If different)
Name of Inspector: f/. /i/LG.cF✓Z
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name:
Mailing Address: ,ao )c ;?So
Telephone Number: sow- 77S—IY7;-
CERTIFICATION STATEMENT
I cerltfy 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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
_ Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, C, or D:
A] SYSTEM PASSE v
I have t found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any f lure criteria not evaluated are indicated below.
COCA MENTS:
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.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.
L✓ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised $s% O/97) Page 1 of 10
DEP r World Wide Web: http:lnvww.magnet.state.ma.us/dep
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: //Gv
Owner:
Date of Inspection:
B] SYSTEM CONDITIONALLY PASSES (continued)
�. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
✓ obstruction is removed
✓ distribution box is levelled or replaced
The system required pumpin more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval f the Board of Health):
broken pe(s) are replaced
obstruct on is removed
C] FURTHER EVALUATION IS REQUIRE BY THE BOARD OF HEALTH:
Conditions exist which require urther evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the a vironment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
I WHICH WILL PROTECT T E PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or pri is within 50 feet of a surface water
Cesspool or pri is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UN ESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUN IONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system as a septic tank and soil absorption system (SAS)and the SAS is within 100 feet to a surface water supply or
tributary t a surface water supply.
The syste has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The syst has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The syst m has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private ater supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the w I is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less t an 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
(revised 04/25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner: "i/"1 y�,voTjl
Date of Inspection:
D) SYSTEM FAILS:
You must indicate either "Yes" or"No" as to each of the follo ing:
I have determined that the system violates one or bre of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Bo d of Health should be contacted to determine what will be necessary to correct
the failure. _
Yes No
Backup of sewage into facility or syste component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to t 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 th 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 ti es in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped _.
M _ Any portion of the Soil Absorpt' n System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or p ivy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or rivy is within a Zone I of a public well.
Any portion of a cesspool o privy is within 50 feet of a private water supply well.
Any portion of a cesspool r privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality a alysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as o each of the following:
The following criteria apply to I rge systems in addition to the criteria above:
The system serves a facility wit a design flow of 10,000 gpd or greater-(Large System) and the system is a significant threat to
public health and safety and t e environment because one or more of the following conditions exist:
Yes No
the system is withi 400 feet of a surface drinking water supply
the system is wit in 200 feet of a tributary to a surface drinking water supply
the system is I ted in a nitrogen sensitive area(Interim Wellhead Protection Area•IWPA) or a mapped Zorie'll of a
public water su ply well)
The owner or operator of any su system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 nd 6.00. Please consult the local regional office of the Department for further information.
(revimed`04/25/97) Page 3 of 10
z
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 112�
Owner: A/,,/ "09
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
_ Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into.the system recently or
as part of this inspection.
_ As built plans have been obtained and examined. Note if they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
J _ All system components,49cluding the Soil Absorption System, have been located on the site.
�. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
/ Sub-Surface Disposal System.
v _ Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) (15.302(3)(b))
(revised 04? 5;/91) page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: //� ,6ria�� /l/�iC /�D G�.�i%E.Ze; 'K
Owner:
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow: g.p.d./bedroom for S.A.S.
Number of bedrooms:_33
Number of current residents:
Garbage grinder (yes or no):�
Laundry connected to system (yes or no): Y
Seasonal use (yes or no): !-/
Water meter readings, if available (last two (2) year usage (gpd):
Sump Pump (yes or no):-Al—
Last date of occupancy: f X3,eeiT L Y
COMMERCIAUINDUSTRIA .
Type of establishment:
Design flow: eallon day
Grease trap present: (yes r no)_
Industrial Waste Holdin Tank present: (yes or no)�
Non=sanitary waste dis arged to the Title i system: (yes or no)_
Water meter readings, if available:
Last date of occupa cy:
OTHER: (Descri )
Last date of occ ancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
7wL S✓vG� /S�i P67F /—� .C'„�Gdeo r9T G1��✓
System pumped as part of inspection: (yes or no) /V
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
1/ 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)
VA Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: _C
Sewage odors detected when arriving at the site: (yes or no)
(revised 04/35/97) Pago 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection: s/ �7
BUILDING SEWER:
(Locate on site plan)
Depth below grade
Material of constr ion: _cast iron _40 PVC _other (explain)
Distance f4(coprdvi
ate water supply well or suction line
Diameter
Commenttion of joints, venting, evidence of leakage, etc.)
14
SEPTIC TANK: (l--,'
(locate on site plan)
Depth below grade: plc
Material of construction: `concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions:
Sludge depth: A::;, t
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 baffler_
How dimensions were determined: e!111 --�4Z
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) &E9 TSACi: ftelo ��0. r,�c •�,cvo i'P/�GG (
/9
At/n �.andG,F'Tii/ y i9,P.y/���%� �.�/ 1 h'1 `d" t •�C �i.��' Ti1AC �/.�,� 4dS
Th'/' 4ii?oyG C�/�Y
GREASE TRAP:
(locate on site plan)
i Depth below grade:
Material of constructi n: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Scum thickness:
Distance from top f scum to top of outlet tee or baffle:
Distance from bo m of scum to bottom of outlet tee or baffle:
Date o/last pump ng:
Comments:
(recommendatio for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evide a of leakage, etc.)
(revised 04/25/97) page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: %/(a � ,CA Owner:
Date of Inspection:
TIGHT OR HOLDING TA7oncete
(Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _metal _Fiberglass _Polyethylene—other(explain)
Dimensions:
Capacity: jinlett
allons
Design flowgallons/day
Alarm level: Alarm in working order _ Yes; _ No
Date of prev :
Comments:
(condition ondition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: — o—
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) G�9S .f3?tea
T1t�;
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order (Yes or No)
Alarms in working orde (Yes or No)
Comments:
(note condition of pu chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
w
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: /�i/
Date of In coon:
SOIL ABSORPTION SYSTEM (SAS): v
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
fio d/=
CESSPOOLS: _
(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 (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of draulic 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 f hydraulic failure, level of ponding, condition of vegetation, etc.)
(reviled 04/25/97) Page a of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: *71-1 �y/,l/o�/
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
J
t
r
sa — -
6„ ,
Q
�l
' �o
- -------------- --- _
(ravi■od 04/]5797) — Page 9 of 10 - "`__
y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: 17/
Date of Inspection: 5/ �5
Depth to Groundwater,i�?-Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
se USGS Data
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
Q/P.Pv5Ti9/�G� �s/S 5/X�GtiS T/�'� SiTi�' f!T lz�G�'vQ77�.c� 37 TiY�
O�Sc'.zG'/.O Gvi?1.E2 T//�G.E ,�.r✓� 1957;z t�'Qi9tc/ivc
5�'vc�.d T�F_ G�-91C2
1i3L/c /3lc'G�cd /v T/tip �iT
1-/y10
ys'
32
(revised 04/25/97) Page 10 of 10
TOWN OF BARNSTABLE
LOCATION ef/W4 X-4 SEWAGE # x - k Y
VILLAG ASSESSOR'S MAP & LOT
U45TA -NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size) CX C
NO.OF BEDROOMS 3
Bi�ffiHER-OR OWNER �� �iiyoTi i
PERMTTDATE: 9-/3-75 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /y 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 leachin�fac* ) Feet
Furnished by 2 � '��
i
,e
3
f~ .� rJ-
L'O CAT ION SEWAGE PERMIT NO.
R d� 7'-y J
VILLAGE
INSTA LLER'S N ME i ADDRESS
S UILDERom+ OR OWNER
or
DA T E PERMIT ISSUED
DATE COMPLIANCE ISSUED
I w
s
�'
�3 y` �
��
,/r
1
No.._14?..... F zs... ............
37 _THE COMMONWEALTH OF MASSACHUSETTS
IA se I�0 c�1 BOAR® OF !-{ A T
_-•-------- -- ....OF... y _ _-- -----------•---••••---_----
Appli.rFation for Bhgpoii al Works Tomitrnrtiun r�'rrmit
Application is hereby made for a Permit to Construct or� ( a Individual Sewage Disposal
System at: �-_- / V Ctf $
.........�� � - 'g ................- .............. ...__,Okzoez�T:Avev.pll2:__
Location ..
----- --
,p Li -Address or Lo No.
n- a- r .. ,/ . `_,r� c ._... G._. ........................
O ez Address
V..r.. - -e ...... ..: .5'i �l / `� il. ..R1ur.=S...............................................................
Installer Address
d Type of Building Size Lot._ f_QS� ...Sq. feet
Dwelling—No. of Bedroo V ms-___.___.__ _ Expansion Attic ( ) Garbage Grinder ( )
44 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
04
Other fixtures -------------------------------- /�o��
W Design Flow.........._11__....................gallons per-perserr per day. Total daily flow..................3 _______gallons.
WSeptic Tank—Liquid capacity/ gallons Length...s3__.... Width__lf.__._._.___ Diameter................ Depth.... r
x Disposal Trench—No_____________________ Width______.._....____._ Total Length_.____._._..____.__ Total leaching area....................Sq. ft.
Seepage Pit No.../------------ Diameter._, .t.5... Depth below inlet................. Total leaching area-39d....sq. f .
Z Other Distribution box ( Dosing tank
'~ Percolation Test Results Performed by------- _____________ Date... ..�..�...............
Test Pit No. 1.. �_mmutes per inch Depth of Test Pith _r_ Depth to group water__�LLS
fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
-� ---•----• -•---••------••-•--•----•-----•-••-•-•--•---•••-•••-•----•-._..---•-•-• ••--••---...............................................................
O Description of Soil K '.-...---jt4-
U -•-••--•-------------------------L3�? �_ Y----`---------��- ricer
W
--------••-------
U Nature of Repairs or Alterations-Answer when applicable--_--___--..•__________________________________________________________________________________
---------•-----------------------------------------------------------------------------------•------------------------------------------_..--..........................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of-T T
p S 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.
Signe -- - ....... --•--•.................•••-•-----•---••-...---------••-•-•-•-•-----
Date
Application Approved BY �- L�fi,(!1-L -....-------•--------- (�v�,�'.._7.��.
v Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------------- -----------------
...............•----••-•--•-•-•-•••-••------•----••••--------•••-•-----------•---•----•---•-•--••--•-•_..._
------------------
Date
PermitNo......................................................... Issued.......................................................
Date
4 .. ..^.. .....:'.'.......
No.
`$ THE COMMONWEALTH OF -MASSACHUSETTS
BOAR® OF H A . T
""' O F.. +
A117p rltratioat for Uhgvoii al Works Towitrurttnn Vamit
Application is hereby made for a Permit to Constructv(, Yr 4( kj$ Individual Sewage Disposal
System at:
•. ff tt��
I Location-Address or Lot No.
Owner Address
a == .......-- =' ........
Instal ler Address "
_- q S
Q Type of Building __.- Size Lot_�--J...'��fy::-=_..._Sq. feet
U Dwelling—No. of Bedrooms........ ..............................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons_............................. Showers ( ) — Cafeteria ( )
Q' Other fixtures .......................... _
------------------------------------- --------
W Design Flow-......... %..' .....................gallonsp r day. Total di ow................. gallons.
WSeptic Tank—Liquid capacity-'P`;,�gallons Length... ........ Width__ `.':... _.. Diameter...... ......... Depth... --------
Disposal Trench—No.................... Width.......................... Total Length.........._......... Total leaching area....................sq. ft.
Seepage Pit No . Diameter. .. "._.__ Depth below inlet...i i .... Total leaching area. _.s t.
Other Distribution box Dosing tank "'�
a Percolation Test Results Performed by.......=�------ *_ .._.._. "ter................ Date_ �r'� <' �%'
•---
Test Pit No. 1_.� &_.minutes per inch Depth of Test Pit, '% _Y.. Depth to
test-Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...................
---------.... -----------• .........................................................
O Description of Soil..... '-.... ..................................` .... < ..
- .
✓- .Ag " - "`.�9 ^tea ....
W ----------------------........................................................................................ --------------- •-----•------•---•------............................................
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
•---•---•••--------•••••-•...----•••-------•---•-••------••--••••-••••-••--•---•----•.....................•-------------•••••---•----•-•---•••••---•••••••---•-•-------•-•-•••••••--•••••-•--•......-•--
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance.with_
TITLE 5 of the State' a:nitar Code— The undersigned further agrees not to lace the�s stem in
the provisions of �.�:.-.� y g g p y
operation until a Certificate of Compliancghas been issued by the board of health.
�D- ,
Application Approved BY _=-- `.A el...�.4
v�-• - .......................... -•••.b-•-�"...Date�..
,�•D_ate
Application Disapproved for the following'reasons:..................••----•------••-•------••----•---•---...-•...................................................
---------------------•------•-----•-•-• ........................--•-...`_'........ ......-•-•-•.
Date
^s
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
................./ 1.......OF........... ... .. ..........................................
T' rrtgfiratr of ToutpliFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repairedby ( )
------------ein
.-•-- ---.--...--- ----------•--- •----------•--------•----•----•----
at
'r l '.._ .. j"---- ----- nst�lle�r -- - /_ �f "t ✓ h
has bee ins ,lledaccord ce with the provisions of TI � >` Th to Sanitary Cod as described in the
application for Disposal Works Construction Permit No.__...�.• "'f` �-7Ce
dated- - ---•••...
THE ISSUANCE OF THIS'CERTIFICATE SHALL NOT BE CONS ED AS A GUARAWEE THAT:THE
SYSTEM W����ON SATISFACTORY
.............-•.•-•-- •--• ..................••-•--•--•-- --•-•••-•-•.. Inspector..................................... ,,--------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C7;)-
.,tt.. .......OF..........:O�L.,r..........
� e ` ...................
FEE........................
taa1 lz$ iitrainn Virrmit
Permission`is hereby granted....... ........ �!Pd
. "--------------•-------------------------------........ ... • ...................
to Constru ( or pair ) an Indivi 1 Sewag isposal Sylst > �
at No.--' `" �a.C��! _ ..._. L. .. !------ -----------------•---
treet /
as shown on the application for isposal Works,Construction Permit N ............. ate _...4-_'f- .. .......
a /3 7......................................
Board o Healt
DATE--------I-------•----••-------•-----
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
Z 0!7 9 _[ __�.._�_- ..�_._ - - - - - - _ _ _ -- -- - - tree V Ur7
f
@ t ,
4 6 a .•._ /77 ct e r 1-0
%i h e w z, too
SSA , c 37a 5Al ors i __ ... ..._. _....
_
•
4 f
7.70
. 1.l � +L..� ! e �
pr-o p o s e a/ g r-o u r7 crr P r o f i le- 0 �-/f
5 C H E O. 40 P. V C. 4Q F G. O IU./ -- . err, "
EQu�,►L TU $APT/G �r-r�;ne'rrrurrt Y4 ' par faot ) �f 1R - %z" wessha�' Sfprrdt
411
• r
/ST_ DX •� • G'c�a a
/000 GAL. SC-PTIG rAA/A4 `
._ Gal ex s/f a ad S t0 a A •
15
\ N �V
Df2 la tom• G�fE G !�TP�,-
E , D T
rio cr/sposar ) —.
ae c le A ?-4s- _ _C !io)//v.�iA/c /-' bt//T AJ E S 5 i _U C. M U�e,�'f-t_M� cc c�r-1 f
V� S s�� o�,; F� c.w A?Agr�
" Pr°Po ��`,r 5 &A: T1 C- TA1V.k �?? x / '5 -
OATuM M.sL•
�v3�'�` .E GCSE /oo GAG. T,9A-/K Tt�ST JyO.L E
�o —�--
O G' L EAG H P/T:
DiAq /O.
AD r09
�r9G 5 j DAY
0- \ E3oT roM £3G. S.F. /.:7 ) _ _ _� �.:� ..
6AG5.
L- DT
i
. 10 L
pp 1
moo- oo, Y,J - 2G.G
-
� ' 'k � �' rrGorsr •
�)ti� o/v T.ti6- G,e O vrvD A9,5
S / Tom-- S �' t•4. G - f=1 /t..e -.. ~-
5/-7 O!A/AJ O N TN/5 C L A N 4W/L L D� -r- /�/ ��ry c7 / 3
GJ1tJFDlit'M TU THE B<//L C�//.iG SET- F 0 c'� - -z-- P/- Fi / �Ff a��.
BAGk �'EQU/re�'ME/tJTS DF THE L` U!'!/ � c �' / V� ' /' OLD
_ c
a s r es fa c A--
T o w/v o f f - A-/ n�� �' I
E' er c�v; E' EME /tJTS r- I
� ! /
co,e : C� =' / � / fIA FSN0fAJ1V CF9TE
�
A/ I E ,q L_. 1t.-//A./' 5 o G
Fa .S T ra ,1../AJ/.S , M� N c. .
5 C r9 L E
e- -A s t i r-7 c/ c o r7 '0 L" O F H E A L T H
—o -- o-_ 0 -0 proposed Contours AC A/,7"rq,ramLt
--
I
SYSTEM PROFILE TEST HOLE LOGS
TOP FNDN. = 40.5' Nor ro SCALE)
-
ACCESS COVER TO WITHIN 6" OF FIN. GRADE
. : ACCESS COVER (WATERTIGHT) To ENGINEER: ARNE H. OJALA, PE
DAVID STANTON, SAM WHITE
WITHIN 6° OF FIN. GRADE
39.6' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 38 8' WITNESS:
* DATE: FEB. 14, 2003 0
=31,6' RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE
FOR FIRST 2' MAX. PERC. RATE = < 2 MIN/INCH
36.4 PROPOSED 3
� 9, 4
GALLON SEPTIC CLASS I _ SOILS P# 10429
35.70' H-2o H-20 35.8
TANK (H 10 ) cns encr�e oo�� �_ O..;.: .. 35.26
35.09 ooclm 0 I� or� a
MIN 34:94' E7 � E7 C3 0 Cl C) E7
[�]
( 2 % SLOPE) �____6" CRUSHED STONE OR MECHANICAL 0 CO � M C7 E CO ED C7 O„ v E��, OJ�Q� LOCUS o
:"T
COMPACTION. (15.221 [2]) 8 2' 71 0 m 71 0 E7 E7 m ED '
. 0 32,94 A � -
DEPTH OF FLOW = 4 ( 1 % SLOPE) ( 1 % SLOPE) �T
NOTE: 2 INVERTS OUT. ALL
TEE SIZES: 3/4 TO 1 1/2 DOUBLE WASHED STONE SL
EXIT PIPING MUST BE INLET DEPTH 1 6" 1OYR 3/2
CONNECTED TO PROP. DEPTH
OUTLET 14. "
`SEPTIC TANK. SECOND LOCATION MAP NO SCALE
CESSPOOL LOCATION Bw
UNKNOWN
LEACHING LS
FOUNDATION- 35' SEPTIC TANK 19' D' BOX 17' ASSESSORS MAP 188 PARCEL 90
F,,^01_ITY 24„ 1OYR 5/6 36.5
i
4.44'
i C
i
�vri
MSC
l� 35.a�\ _ SAND
fig' 1
( 6' 2,5Y 6/4
LOT AREA
\ \ 25,542f SQ. FT.
r \ 0.59f ACRES t
0
o _
o� \ 120" 1 28.5'
+•34,3 NO WATER ENCOUNTERED
3 ►�0 \
NOTES:
3,7
8.5 NOT ALLOWED ASSUMED
33.3 SE TIC DESIGN: (GARBAGE DISPOSER 1S ) 1 . DATUM IS
4e 33.3 \
3s.7 DESIGN FLOW: _3 BEDROOMS ( 110 GPD) = 330 GPD EXISTING
0 2. . MUNICIPAL WATER IS)WATERLINE / US7 A330 GPD DESIGN FLOW
3 % IN FRONT/f `ro 3. MINIMUM PIPE . PITCH TO BE 1/8 ' PER FOOT.
- h ,, . ..,
l il„ e t-,4 11�. JJU (,PU L - �?�U �. Dk,,�c-, Y ! �_P�,3 7,..�a„ .�"�,,,�I`. _,`.�.� r s,a...:r,�e �,,,,�t g`J . J CG t-SNJI`r.... f r;:1
\ INVERT our 39.7 US_ A 100Q GALLON SEPTIC TANK' (EXIST)
SEPTIC TANI< AND H-20 FOR D'BOX AND LEACHING CHAMBERS.
4.7 "
EL. 3s.a' S. PIPE JOINTS TO BE MADE WATERTIGHT:
LErCHING: 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
\ \ EXIST, DWELL. 39.4 S 2(30 + 9,83) 2 (.74) _ 118
3a \ TE 40.5' 0 ;DES: ENVIRONMENTAL CODE TITLE V.
393 ao,1 30 X 9.83 (.74) = 218 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
,
3 \ 38.6 BOTTOM: USED FOR LOT LINE STAKING,
\
\ \ \ PAT K O TO''AL: 454 S.F. 336 GPD 8. PIPE FOR SEPTIC SYSTEM TO SCH, 40-4„ PVC.
a 5 DECKS �`� 0 US (2) H-20 500 GAL. LEACHING CHAMBERS (ACME OR 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
\ 36. INVERT OUT �11-1
3 \ \ 1 EL. 36,6' qp ' �. 39.3 + 39.9 EC JAL) WITH 2.5' AT SIDES, 4' AT ENDS, AND 5' INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
--- FROM BOARD OF HEALTH.
\ \ 39. + 39.9 BE' WEEN -UNITS
10, CESSPOOLS To BE PUMPED AND FILLED WITH CLEAN SAND OR
39.8 9.139.9 _ REMOVED AS NECESSARY.
FIS POND AREA
3 . o. C 40
\ ( 100.0 PROPOSED SPOT ELEVATION
\ 8.5 (TO B QVED l v� ��s� TITLE 5 SITE PLAN
-� 100x0 ° EXISTING SPOT ELEVATION
` 37 \\ + .9 + 39.7 + 4n.4 100 - of 1 9 BUMPS RIVER ROAD
cr 38.6 0--- -0 PROPOSED CONTOUR _
O \\ \ \ 6„ OAKS + .a + ao,7 IN THE T. WN OF:
i
F
p 38.6 (CAN BE�'��C� \ REMOVED) - 100 EXISTING CONTOUR
38.5
( CENTERVILLE) BARNSTABLE
F + 8.9
1
38.7 + ao.5 PREPARED FOR:
BORTOLOTTI
39.8 GRAVEL DRIVE ,7
AND PARKING CONSTRUCTION/PEREIRA
r
_ l BOARD ❑F HEALTH
Il 38 7
� 20 0 20 40 60 Feet
+ 41.6 SN ° MA
a A-lPRDVED DATE
38?
\
1" = 20' DATE: FEBRUARY 14, 2003� 9 SCALE _
\ i
Ir
off 506-362-4341
\ / O fax 508 362-9880
\ / --
H AR NAIL TIN
/ Of
N MARK LSE H BENCH oF'" t
N + -9ao.7 FENCE POST. EL. 40.3 down cape engineering, Inc, N �a'r\.l,p ` Mgrs�`
a t RNF \SJ a� �c� ARNE
CIVIL ENGINEERS � o�ALA
�D,IAt.A ,� Q .�
4 0 26'
+ 42.2 LAND SURVEYORS is
.:. . 939 vain st, yormouth, mo. 02675 J
03-037 ARNE H. OJALA, P.E., P.L.S. DATE