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HomeMy WebLinkAbout0141 CAP'N LIJAH'S ROAD - Health 141 Captain Lijah's Road Centerville A = 192 168 i UPC 10259 No. H1630R M .r� HASTINOY, 4N No. s a�J C , _ Fee /0 V THE COMMONWE-/ .AtfH 6F MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS RppYication for Misposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(✓/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 191 Gzpi- ^I(7 Owner's Name,Address,and Tel.No. J _10-5eph-Eea rdo n Assessor's Map/Parcel Cer7 of v/�� ller' Name,Address,and Tel.No. S0& q T7-D663 Designer's Name,Address, Tel.No.-SD9.3&z_/iS q C[1V ai ro �wCaPe s �1 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building _e�5 i dj f D No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3,30 gpd Design flow provided gpd Plan Date�(7] (� Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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. t� Sign Date I i Application Approved by Date Application Disapproved by Date for the following reasons Permit No. / QL OL Date Issued -7 1 — /ac/ No. /7—" / �! �� .,Y--n' 3r.. .t. ,r, . Fee l THE CO`A1IMOIQ E�FUaF MASSACHUS:EIS Entered in computer: J Yes' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS . 0[ppllcatlon for Disposal *pstrm Construction 3perrnit Application for a Permit to.Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I GzpnkJ,614-5 eD Ow ' N me,Address,and Tel.No. Assessor's Map/Parcel Ins ller' Name,Address,and Tel.No. ,JD�`N)7-U�3 D igner's Name,Address,and Tel.No..,50 9-36,2 "/5 q . 4'x CC1VC(_P6 uwn C Eocl i eC_be� v In a fnsf �_ 3 9 -�c�c n s f, . a�rn� &-'j Type of Building: Dwelling No.of Bedrooms -^� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building K�'S/G��.� ��No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title i Size of Septic Tank "" , �/ Ty e of S.A.S. i Description of Soil L V Nature of Repairs or Alterations(Answer when-appPica le Date last inspected: Agreement: J j The undersigned agrees to ensure_the.o©nsttuctionrand-maintenance of the afore described on-site sewage disposahsystem in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a-Certificate of j Compliance has been issued by this Board o ealth. Signe Date Application Approved by r Date Application Disapproved by Date for the following reasons Permit No. ';Z0/ � � Date Issued / 1 1 ba- - - �- -------------- -------- - - - - - - - - -= THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Y. Certificate of Compliance THIS IS TOCETIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ✓ Upgraded( ) Abandl one ((d( by i Tl Ik` at 1 o has been constructed in accordance ff i with the p�oa�sions of Title 5 and the for Disposal System Construction Permit No.���a�� ated ?t�1 � � e�"' nq #bedrooms Approved design flow gpd The issuance of this e rit�sh/all of a/c-o�nstrued as a guarantee that the syste�11 fun i n e 'gn d. Date O` 6 Inspector ---------------- -- ----- - ------- - -- -------- ----- - - --- --- - --- -- ----- No. `Fee .. . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal �&_ pstrm Construction permit Permission is hereby {granted to {. _6 Construct( ) f Repair( ) Upgrade( )t Abandon( ) System located at 1 ( CGh D t 2a ( . rl!(,_�\j and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be ompl tJed thin three years of the date of this permit. 1 Date �� J Approved by V A TOWN OF BARNSTABLE LOCATION ca p'N L i is h'S Rd SEWAGE# c9ol 01 ' a/J. .VILLAGE C,;A4C r U:11L ASSESSOR'S MAR&PARCEL J 9,1 • 14$ INSTALLER'S NAME&PHONE NO. (�$ EXCaya-1 i o.J LI')7.OGS SEPTIC TANK CAPACITY �p00 4n.I LEACHING FACILITY:(type) �fpp 90.1 c Lot,S 3) (size) /O x 30 x 2 NO.OF BEDROOMS OWNER PERMIT DATE: '9 Z COMPLIANCE DATE: Z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY f� 141-Z°7' AZ 3,2'6'' Vr Oni a3. 21 ' 83' 3y`8 Ay- �ql ,q4 "Z ` FROM :down cape engineering inc FAX NO. :15083629880 Jul. 30 2012 11:18AM P1 12- T1,S F T' 4." far t ialm, V11*6".h'e"all't Dbcsetur CIA. 21JO'Afain NMLA.a.4601 Fax: A8-790 6304 Cc!7�uChewtmu Form Daft- 7/e/4i D,epAgner; -dslress' St— oldrns A Oil TWIS lXEUM I Y)tTlail to 3'.T1:4;.a11 a (date) ke bned on ai design dnocmi by I cn3tuy"'L'u't the Nq cx) dillK to. ptir, SYsfelll Tdcr(�-ar_-,H al)(we, was Lataflud,slib-9fml a117 3 r I, WLi-,b may inc-d-Mm miror _Jppjo-V(ld : o thi . . Sljfjj EIS j,'.jt(:j,9 I el(I(�a C1ou f- e ge 01,P V4.1 imljoT changcs (i.e. cuft]15r that the rzfurouncd allove, Vies i2as—talled Witid ratr. of Lhv SAS Of acy vm-tical lr�-lccatioll.of atq cr)-mjx)nn.n1 c--. than. 10' tel of thE7, epti.crIVAI',Lcl) but in lNjth SLtit-,& Local Reg-ulaffi;un.R- Nan f uvjg.('o:n 01 DANIEI, OJALA ills P)eT,., 1!7i CIVIL o.465 2 ISTV k '7(3 Vj/ 'I NAL� .09 Oz ture, :RT Pil. &1,37T.RN --E PUBLIC S WRY( A.ND jjl�-Afffff CILW) ATtE TM C)N.CKJAN(7 NVIU-,_S07 -5-3 1-" -f LION. 04AI"Ut fOU R-L ef BY IPFFE Cn 6JImtiou POTT-n T 26 04.do-7, /YT . (1)k If I Tuwu of B a'nsta.ble P#_ �g THE P(jr )Departmp➢1t of Regulatory Services PublicJ[� �J1>tll� I�iI�IlSa��� Date � °u HA}iNgrAH4E, a . 200 Main Street,Hyanuis MA 02601 Date Scheduled Time_ [—� ]Pee Pd. `oil Suitabil ityl Asses�`��p�l�nt for ,�'t>�wag Disposal Perfonned By: '! _ 1Vllnessed By: ]LOCATION & GENE RAL INu OIUV.VA7 ION Location Address L I t Owner's Name LA) _ )n /Sk Ce Address Assessor's Map/Parcel: /?2/lbd Cngiueer's Name NEW CONSTRUCTION ' REPAIR J Telephone It (150e � Land Use. " rim slopes(°/o) 0 Surface SluocN Distance's from: Open Water Body R Possible Wet Area It Drinking Water Well --eft Draiha.ge Way '^ Ft Property Line /0 ft Olher t;1 SKETCH, (Streel came,dimensions of lot,exact locations of test holes Sc.pert tests, locale wetlands i11 proxinuly to Boles) qrtj l � t� e Parent material(geologic)_�t Wll��t Deplh Lu Budroclt, _ Depth to Groundwater: standing Water ill 1-101e: Ajo A) Weeplhg Il'0111 Pit Ptlue /r✓� Estimated Seasonal High Groundwater D ET ERIVINIA7i'ION FOR SEASONAL JE'J[I[Gl<-3( WATIER TABLE l�lelhod Used: Depth Observed standing in obs.bole: In, Dept11 to sell It19lU.g81 _:__ III, Dcplh to weeping;From side oFobs.bolt: M. druuuJwutet.Ad�uBlment ��_ - Ft'. lndcx Well✓# Rcading Datc: Index Well leVal__;_,,,,,• _ Ad�l,ftletov� Adl,(7t(All1dWl1tdr UVId IVERCO LATlCON TES.Q' �Dad� `)l'lulm Observation Holc ff Time,at 4" ll Depth of Perc _ Tln'tp at 6" Start Pre-soak Time @ I i(Jy _ Time(9"-6") End Pro-soak // 2- Rate Min./inch Site Suilability Assessment: Site Passed Sile',Failed: Additional Testing Needed(Y/11I) Original; Public I-lealtli Division Observation Hole Data To Be Cotnllleted on Back----------- ***If I1ercolatiom testis to be conducted will du 100' of VVellland, you r➢➢➢islt firsit Uota@y tll➢c. Mirnstable Conserviatloll I)ivisloll at least 011c (1) weelt: prior to beg➢➢p➢-➢➢ ig. Q:\SEPT(C\PERCPORM.DOC .1 )ET",lP'-OBS]f']f�VATIO g]f®]C 1L� LOG ole Depth from Soil ITarizon ]D #' Surface(in.) soil Texture Soil Color Soil (USDA) (M . Other ansell) Mottling (structure,Stones'; Boulders, Con isto c ravel .. —120 � • �IVGc�d� , G�c,� D1E]CP ®pS]E7fRVATION HOLE LOG Depth from Soil Horizon Soil Hale # Z Surface(in.) Texture Soil Color �'-- (USDA) Soil e ) (Mansell) er Mottling (Structure,Stones, Boulders, Consis enc %0 avel L A ll p DCIEI�®TdSEq R�TA7C]FOnNNT �O- - L®rG De th from Soil Horizon Hole#• Surface(in.,) Soil Texture Soil Color (USDA) Soil (Munsgll) her Mottling (Structura,iStones,Boulders. Consistency, pr veil Deplh fiam Soil.Horizon Hole Surface(in.) Soil TWore Soil Color Soil (USDA) ., Other (Munsell) Mottling (Structure.Stones', Boulders, Cons' ten ,o�dL J 1®od rnSa rance][Pate Map. Above 500 Yea r•flood boundary No Yes�X Within SOD year boundary No yes, Within 100 year flood boundary No� Y�5 Denth of Naltuirally Occurring P,gu'va__ �_ous aterial Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the. area proposed for the soil absorption system? If not, what is the depth of naturally occurring lervious mat81,1a17 w Cu?ti'tlfac�>GiooD (� A certify that on !1Q (date)I have passed the soil evaluator examination approved by the Department ofEnvironm rltal.protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in �10 CIVR 15.017, Signature's Date �• Q:\S,L_PT1C\P$RCroaM.DOC No. 2 " �55� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye��L� r' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z[pprication for 30ioaaf *pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade )Abandon( ) ED Complete System Xlndividual Components Location Address or Lot No. I(�ii+�-i 1'1 Jam'�S Owner's Name,Address and Tel.No. Assessor's Map/Parcel G v° e' �j?,j 5co, 97 15-IL, r'5 �eAress,and Tel.No. Designer's one,Address an Te�Ir ames Nav5-� � — T rt s� 11�� W. 7rov� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow V 4 0 gallons per day. Calculated daily flow n gallons. Plan Date Number of sheets , Revision Date Title Size of Septic Tank,9/X! /6D0 Type of S.A.S. c e S Description of Soil Nature of Repairs or Alterations(Answer when a plicable) r ' - s �� S Zvt�cff S Q / Date last inspected: DESIGNING ENGINEER MUST SUPERVISE Agreement: INSTALLATION AND CERTIFY IN WRITING The undersigned agrees to ensure the construction and maintenanceA r��e �se �ee ��al system in accordance with the provisio s of Title 5 of the Environmental Code an n ���9& in operation until a Certifi- cate of Compliance has been is ed by is Boaz . alth. Signed Date o2l Application Approved —S� ' Date Application Disapproved for the following reasons Permit No. Date Issued <Z d ' �No. �t� 2 i" f�4 ,. ' Fee mil! THE COMMONWEALTH OF MASSACHUSETTS Entered,in computer: 1ei�C� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for �Oioponl *p6tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade )Abandon( ) ❑Complete System K]Individual Components Location Address or Lot No. '�,� l>0(,c',j n LA 0+s Owner's Name,Address and Tel.No. . I` Assessor's Map/parcel 9,Z " (ag Installer' Name ress,and Tel.No. Designer's ame,Address and Tel.No.. �a,�nes�avl Cam+ 5`T avin6v- Mq Ce'60 t t 4 iddleboro�^ CA az3q� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other` Type of Building No.f,f Persons Showers( ) Cafeteria( ) Other Fixtures a Design`low e/4U gallons per day. Calculated daily flow rya gallons. Plan Date ""' mob -- Number of sheets Revision Date t Title Size of Septic Tank YIX I /6M t-/ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) I 4 4a ' j,a_h l - 'r w 'sAewe 5 a e CIS i Date last inspected- Agreement: r The undersigned agrees to ensure the cgnstruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisio s 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 Boar go H7alth. Signed l.Yi /� Date Application Approved ""� Date Application Disapproved for the following reasons Permit No. .��' Date Issued a A a --w --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-jte ewagy Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by / ;..�2 _A .!ITS at Q -fQ/Yl ,;9 '_5 /Z has been constructed in accordance with the provisions�'f Title 5 and the for D¢i-s�osal System Construction Permit N !G 6 -$.6r ated Installer bt ,�ifi� ��Ltf'/t�7 Designer The issuance of this permit shall not be construed as a guarantee that the syst jQL, ill function as desi -ne j Date I�'i���,� Inspector c��J ,�P ��/C.. V, 1 " -y +� « _ _ No. �3 ��' ��.� — -------- —.-Fee J`�' Cr. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS miq;pogar Opotem 5truction Permit Permission is hereby granted to Construct( `)Repair( U grade( ) bandon System located at / CI CLC� L-/ ' Q /�°' 17 h Ll and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to 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 ermit. Date: .,yam' /�' �--,. Approved b ;r'�.,._ / ��i 1.a� • , f ` Ec. TOWN OF BAR(NSTABLE� _a0 LOCATION I `1� C N �,I-T�`V�% { 1 � ((SEWAGE # _ t 4 VILLAGE �� �-- ASSES & LOT INSTALLER'S NAME&PHONE N � SEPTIC TANK CAPACITY LEACHING FACILITY: (type).::9C?10� 'i �f (size) NO.OF BEDROOMS G BUILDER OR OWNER s PERMIT DATE: —a i-U COMPLIANCE DATE: 2 " S U Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 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 Feet within 300 feet of leaching facility) Furnished by A '�2oN $, 1, D 0 N -LO o -C. r 6 February 25, 2002 James A. Pavlik Outback Engineering 106 West Grove Street Middleboro, MA 02346 Town of Barnstable Health Department 367 Main Street Hyannis, MA 02601 Subj : 141 Capt. Lijahs Rd., Centerville, MA Septic System Inspection To Whom It May Concern: An inspection of the newly installed Title V septic system for the subject property was conducted. I hereby certify that the new septic system has been installed in compliance with the approved plan, dated 2/18/02. Very truly yours, Ot mes A. Pavlik, pezi /CLJ l) 1-4 fill Cz BORTOLOTI'I CONSTRUCTION,INC. 9 99 765 WAKEBY ROAD,MARSTONS MILLS,MA 02649 4e" 1 8 508-771-9399 508-428-892G FAX: 508-428=9399 `ly�F"T19�� w . Sri � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ®� PART A ,B CERTIFICATION Property Address: ` Date of Inspection: Inspector's am qwpees Name and Address: i I certify that;I have personally inspected the sewage disposal system at this address and that the informa- tion repotted below is true,accurate and complete as of the time of inspection. The inspection was per- formed basgd on my training and experience in the proper function and maintenance of on-site sewage disposalems. The System: Passes „ Conditionally Passes Needs Further Ev on y Local Aproving Authority • !Fails Inspector's,Signature: Date: The System!inspector shall submit a copy of this inspection report to the Approving authority within thin ty-90)days,;of completing this inspection. If the system is a shared system or has a design now 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. ViSPECTION-%UMMARY. A) STFA PASSES: J have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more a system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes,1nor,;or not determined(Y,N,OR ND).Describe basis of determination in all instances. ;if not determined",explain.why not. The septic tank is metal,cracked,structurally unsound,shows substantial Infiltration or lexfiltration,outank failure is imminent. The system will pass inspection if.the existing sep- 1tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water.level observed in the.distribution box is due �to broken or obstructed pipe(.-)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): a a , ~It SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipes):are.re flared _ _.....,. . Obstruction is removed 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 the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface;eater Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh.' 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM LS VUNCTION- ING IN A MAN4X f R THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENTS•' The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. `• The system has a septic tank and soil absorption system and is with a Zone I of a public ' water supply well. The system has a septic tank and soil absorption system and Is within 50 Feet of a private water supply well. . The system has a septic tank and soil absorption system and is less than 100 Feet but 30 Feet or more from a private water supply well,unless a well water analysis for colifo;m' r bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less` than 5 ppm. D)SYSTEM FAILS: �. I have determined that the system violates one or more of the following failure criteria as defWed in 310 CUR 15.303. The basis for this determination is identified below. The.Board of IiealthN should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. a Static liquid level in the distribution box above outlet invert due to an'overloaded or clog-� ged SAS or.oesspool. Liquid depth`in cesspool is less than 6"below invert or available voiume is less than 1/2 i' day flow.r Required pumping more than 4 times in the test year NOT'due to clogged or obstructed pipe(s). -Number of times pumped -2- i p 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. 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: The following criteria apply to a large system in addition to the crite is above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant. threat to'public;health and safety and the environment because one or more of the following conditions exi C __L_Theaystem'iiwithid400 Feet'of a"surface drinking water supply . The-systerriis within 200 Feet of a tributaryto a surface drinking.water,t;upply T The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped,Zone II of a public water supply well?* The owner or operator of any such system shall bring the system and facility into full compliance with the goundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST C if following..have been done: Y1`; Pumping information was requested of the owner,occupant,and Boaid of Health. . one of the systeih components have been pumped for adeast 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. ! _IZAs-built pIMn lave been obtained and examined. Note if they are not available with N/A: �� facility or dwelling was inspected for signs of sewage back-up. e system.does.not receive non-sanitary or industrial waste flow. _The site was,inspected for signs of breakout. system components,excluding the Soil Absorption System,have been located on site he septic",manholes were uncovered,opened,and the int6iior of the septic.tank was,in -I spe.td or condition of baffles or tees,material of construction;'dimensions,depW of liquid,` _,th of sludge,depth of scum. size and,location of the Soil Absorption System on the site has baste determined based on existing information or approximated by non-intrusive methods. 3, s ig NA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) L,- a facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE.DISPOSAL.SY.STEM.INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL! Design blow:2 30 allons Number of Bedrooms: � Number of Current Residents' ' Garbage Grinder:_ Laundry Connected To System;�2 Seasonal Use: Water Meter Readings,if av ilable: Last Date of Occupancy: �;�n n �p COMMFRCLAIJIND i4TRIAL•. ' Type of.Establishment: Design Flow:_gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER:'' Describe) Last Date;of Occupancy: : P ' GENERAIL INFORMATION ii�TMPIINiG RECORDS and source of information: System Pumped as part of inspection: if yes,volume pumped: gallons Reason for pumping: TYPE F SYSTEM: TYPE Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): ROXIMATE AGE.of al mponents d t .installed(if kno n)and siLurce o information: a. SewA ge odors dete6ted when arriving at the site. _ -4- �i �.Cj' y(y��FY Y .4� 1 �YR�* �, #T.S..+��* L'tfF'N' 'A� ��,� '� t" 4 v 4_�QJ7 Y )lrvP�} {, •-. r.,, 1&.'.inns w �'�jw� „` ^t G '� ' .3M�" '�si ", r ",-r,� fi,.. ,. 9 .. t7av' x^`1 -: t ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. / GENERAL INFORMATION (continued) SEPTIC TANK: Depth below.grade: Material of Construction: concrete metal FRP Other (explain 1 i _ Dimislo is:' S' S' Sludge Depth: Scum Thickigess:_��� Distance from top of sludge to bottom of outlet tee or baffle: 3y Distance from bottom of'scum to bottom of outlet tee or 6adic _ ` 'T ' Comments:(recommendation for pumpml;"s condition of inlet and outlet tees or baffles,depth of U aid l in Ition too et invert,structural integrity,evidence of leakage,etc. Q ' io REPS + Depth Below Grade: Material of Construction: concrete metal FRCP Other (explain) — . — Dimensions:_ _ Scum Thickness: Distance from top of scum to top of outlet tee or baffle: :comments:.(recommendation for pumping,condition of inlet and outlet tees of baffles,depth of liquid level in relation to outletinvert, structural integrity,evidence of leakage,etc.) TIGHT OR HOLDING TANK:- Depth Belot Grade: .. . .. . Material of Construction:_concrete—metal FRP Other(explain) imensions. Capacity: gallons Design Flow:_ gallons/day Alarm Level: x C61nments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_—Z, , Depth of liiwd level above outlet invert: /'1 /�yf �p,�� Comments: (note if 1 and distrib d en on s egfial,ev' c of solids ca over,evide ce of leaka a into or out of box,gtc.) PUMP CHAMBER Pump is'in working orders Comments: (note conditionAof pump�chamber,condition of pumps and appurtenances,etc.) 5 r 1. r s, sew,.,,. .• ,'.,r:,-.,. ;,h .,. ,. ,.a. . ,, � ; �Y .. .. � f y,l >•t�'; p,�S7.r�,`" .. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION(continued) SOIL ABSORPTION SYSTEM(SAS)•• tl� (Locate on Site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) I-If not determined to be present,explain: Type: ' s Leaching pits,number: / Leaching chambers,number: Leaching galleries,number: Leaching trenches,number, length: Leaching fields,number,dimensions: Overflow cesspool,number: Co ts, (note condition of .signs ydr ulic failure level of pondin , onditi of vege do etc. I IF - .."CICSSPOOLS-AL ' Yi 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) .i Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, H: etc.) PAIVY 1terials of construction: Dimensions: _ Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) t N -6- t SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCHOF SEWAGE DISPOSAL SYSTEM: Include;ties to atleast two permanent references, landmarks or benchmarks. Locate all wells.within 100 Feet. 4(4, DEPTH TO GROUNDWATER: Depth to groundwater. / 7 Feet Method o Detbrmination or Ap rom Lion: � ® i z -7- 5/25/01 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated o�, concerning the property located at Caw kYV//lt*—'meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 63 f y B) G.W. Elevation J +adjustment for high G.W. _ DIFFEREN E BETWEEN A and B SIGNED : DATE: NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future witho engineered septic system plans. q:health folder:percexmp E� TOWN OFBARNSTABL%,j )Q D_b //) 1 LOCATION I A\ CW N h�`T�V1 (SEWAGE # �r�-tto� VILLAGE 1 1 �— ASSES & LOT _ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ED LEACHING FACILITY: (type). U� "r' fL (size) 1Y, k�, / NO. OF BEDROOMS G' BUILDER OR OWNER S .o PERMITDATE: 241'n;t- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Fe t Private Water Supply Well and Leaching Facility (If any wells exist ` on site or within 200:feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by At F o fjT- O «r z,� �1 - TOWN O BARNSTABLE r LOCATION SEWAGE # VII.LAGE ASSESSOR'S & LOT A4. I Zy,SC;jjJ/�t;`NAME&PHONE NO. SEPTIC TANK CAPACITY QiZ&rXJVJi2 J LEACHING FACILITY: (type) ) (size) /A/Df9 NO. OF BEDROOMS BUILDER OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to-the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r 00, �LP a u'' LOCATION SEWAGE P RMIT NO. VILLAGE b I N S T A l L E R f AME i ADDRESS BUILDER OR OW llt DATE PERMIT ISSUED =7,? DATE COMPLIANCE ISSUED 7_11-7 �,' SL,du r V 5 ` ZOT /3 20, 88 0 32 (\J. 0 ' VC, �,ZN Of THOMAS yG KE1.1EY CERTIFIED PLOT PLAN tic suRv�° LOCATION .C� {�.TE f. , •. SCALE DATE THOMAS E.KELLEY CO. PLAN REFERENCE -457.%3. �ly'V ^C ENGINEERS-SURVEYORS Z 77 r.4T6. 346 LONG POND DRIVE �tij�l �T/DC) /z.��S3�QQ fp/ .. SOUTH YARMOUTH,MASS- 02664 /.9A. I CERTIFY THAT THE, Y.? v �� . .. N . =y SHOWN ON THIS PLAN IS LOCATED ON THE GROUUND C4P'A) LjJ7'Q-q f Pc>/94) AS SHOWN HEREON AND THAT IT CONFORMS TO THE SET K R.10 �E THE TOWN OF ✓ ✓LtAGUSTERED C WHEN CONSTRUCTED. DATE , rt PETITIONER: R. LAND SURVE OR TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS CAST IRON � , • PIPE (OR _ 12"MAX. 4"ORANGEBURG(OR EQUIV) EQUIV.)— MIN. PIPE- MIN. LEACH ° PITCH 1/4"PER.FT. PITCH 1/4'PER.FT PIT ono � PRECAST o IN V T L o Q ; ,:: LEACHING '0 EL• "�� INV T . INVE T p . e•: PIT OR SEPTIC TANK ,/3 DIST EQUIV. a INV����T EL. BOX ELF 7 . >x �: o; EL.`T �. GAL. INVER INVE T w w Q ::�• 3/4"TO I I& EL . e u- D ;;, WASHED I / w STONE PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOGS WITNESSED BY : DATE . Co/7�... TI ME`/.t�� � . uC. �JG. /ZF'�'J . T BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ��. i �. . . ENGINEER ELEV. . . . . . . . . . . ELEV. . . ... . . . . . Gc Lot), en DESIGN DATA NUMBER OF BEDROOMS Sv3-�fltL, TOTAL ESTIMATED FLOW ��3©©Q . . . GALLONS/DAY BOTTOM LEACHING AREA /.oj.SD . SO.FT. /PIT SIDE LEACHING ARE,,A . .�CJG�•Sd. SO.FT./ PIT F"�/ GARBAGE DISPOSAW���/2./& .. .(50% AREA INCREASE) TOTAL LEACHING AREA .240.7.00 SQ.FT AJ 5 144 PERCOLATION RATE 4E-�5 TN�V MIN/INCH �JJ LEACHING AREA PER PERCOLATION RATE `�SQ. SQ.FT. Ah,> WATER ENCOUNTERED NUMBER OF LEACHING PITS . 0/440r _ .IUD y!4 AZ APPROVED . . . . . . . . . . . BOARD OF HEALTH /SOftXotis.t. . . DATE . . . AGENT OR INSPECTOR to 7-A./ TH®13-F-Ki.L£7T rM. �E>3lEY ENG1I'MBN—'SIJR C.� i f!/G r III /• SOUTH)2mmouTH,ASS, - PETITIONER � ''•o"4 it �� y"�'�R.i•"� /� F;� - • ?k LOT / 24, 88 6 A OF THOMAS yG KEU" H q ''C 10 CERTI FI ED . PLOT PLAN. suR��+°P LOCATION .CTE�!/IC�G��. 5•.. , SCALE . DATE..;4.' 4' THOMAS E.KELLEY CO. PLAr�N�7RJE�FyER�ENCE .•� "/,. ., �9T . ENGINEERS —SURVEYORS /. /. ! .��c7�• .�� �'� vU ✓. . . . . . 346 LONG POND DRIVE ti/�/,Q �ld� R0�0)%3� d!l?tq, , , , SOUTH YARMOUTH,MASS. ,77 02664 I CERTIFY,THAT THE SHOWN ON THIS.PLAN IS LOCATED ON THE GROUND, �GY�v AS SHOWN.HEREON AND THAT IT CONFORMS THE C'�r�-�rJ L�,rANJ . SETWR 0�d./I I Q�THE TOWN Of !JrG". WHEWCONS TRUCTIM. ,t G� lo ✓ DATE PETITIONER: + R OISTERED LAND SUR OR • I, 1 �-EL. c4mm TOP OF FOUNDATION _ CONCRETE COVER CONCRETE COVERS e o 4'�CAST IRON I: "MAX. ° _ �. 12"MAX. PIPE (OR 4°ORANGEBURG(OR EQUIV.) EQUIV)— MIN. PIPE- MIN. LEACH ° PITCH I/4'�PER. PITCH 1/4'*PER.FT PIT PRECAST o'c �INVV�T} LEACHING `'0 EL."i�•.�� INV T INVE T oe w e:4• PIT OR SEPTIC TANK EL ,/3 DIST. EL47 >_ EQUIV. ►- o� EL GAL. INVER BOX INVE T w w O �:�� 3/4"TO I I/2 �' WASHED STONE PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE .5��/7�... TIME& /2/ � BOARD OF HEALTH t �J� TEST HOLE I TEST HOLE 2 �.w�i�C�. . . ENGINEER ELEV. . . . . . . . . : . ELEV. .. . . . . . . . . ('`'"'IDrn DESIGN DATA Sar NUMBER OF BEDROOMS /.N . . . ' SUa"�flIL TOTAL ESTIMATED FLOW 3Q . . GALLONS/DAY t S.� N� BOTTOM LEACHING AREA 7o,.Sa . SQ.FT. /PIT SIDE LEACHING ARE,,A��. .�C��i•.Sd. SQ.FT./ PIT i VIA F�' / GARBAGE DISPOSAW,0/1 . .(50% AREA INCREASE) TOTAL LEACHING AREA .7��.QQ SQ.FT • a // 144 PERCOLATION RATE 4/-E . TN4V Z. MIN/INCH LEACHING AREA PER PERCOLATION RATE �50. SQ.FT. WATER ENCOUNTERED NUMBER OF LEACHING PITS APPROVED . . . . . . . . . . . BOARD OF HEALTH DATE. . . . . . . . AGENT OR INSPECTOR 7 00 to GJ•`�. . ZHOAIAS T.4CE3 LE7 M. Y � ENGI11®3R�-BUR � 346 U k-wG4N 1VD SO UTH YAiI&IDUT'H,Aku& - PETITIONER : b14464 No...._. . .5 ...... Fxs...... .. . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF H EALT .............OF.........- G . . W................................ ApptirFation for Disposal Morks Tonstrartinn rranit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:f / J ............................................................ _. ................... - ..................................................... Address 4..............._ .......... .......... r ... y p/ ....... __.... Owner Address ..............•-------•----•--•--•----^-•-•------......---••--•-•-•--••-••-••-•...--•--•---•---•• ....................... '_....._.....-•---..........._..:.................. ...._......._..... Installer Address ' dType of Building Size Lot__ _ _�'� ......Sq. feet V Dwelling—No. of Bedrooms........�3...............................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons........ ................. Showers — Cafeteria Q' Other fixtures -------------•• ......-•-•••......-•--•••••••••--•--.....---•--•-•-••---••-•--•------- ............................................................. W Design Flow..............S ...:..._...__..__.gallons per person per day. Total daily flow...... .........................gallons. 04 Septic Tank—Liquid capacity.,5 0�gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width ....... Total Length............,....... Total leaching area..... �_.h"sq. ft. Seepage Pit No....... .... Diamete .�..�Siz:�gDepth below inlet........L........ Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Resu1t�S�,�S Pe orme :............................................ Date.-_._._....__._.__.._ _ --•- re� ,moo z� Test Pit No. I..._...........minutes per inch ep�li of, Test Pit____________________ Depth to ground water--___-_____-_-_.._--_--- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-____.. �. Descriptionof Soil .- /�z yju --------------- -----------------------------••-------------..__.--_------••----•---------------- , W -----••---••------------------•----------------•---•--•-•••----•----•-----•----•---•-----•--••••-•--•-••-•-••••------•-•••-----•...-•••••---------•----•-•-------------•---••--------••-----•--•--•--•- VNature of Repairs or Alterations—Answer when applicable............................................................................................... ..........................-•-------.........---...---------------------------------..........................-----------------------------------------•---------•------ ............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i TT I.;,;. 5 of the State Sanitary Code—The undersigned further agrees not fo place the system in operation until a Certificate of Compliance has been issued by the board'o9heal T l �j Signed... N '-- E •- ....................... -( a l-• Date ApplicationApproved By............................... ---=•-----...--•---._....-•-•--•---........._..............._..__. Date Application Disapproved for the following reasons:.........................................-..................................................................... ................•----•------_..._._...•--....-•••-••••-•••--•---•-----•--------•-............---------••-- Date PermitNo......................................................... Issued--- `- T`_........................ Date NO - SETTS THE•COMMONWEALTH OF MASSACHU .��.............._ BOARD' OF -IEALT :a .... . OF...... ........................... A irtttilan.;lnrtua1 Works CaMtrrtuarrmit Application is hereby made for,a.Permit to-Construct ( ) or Repair ( ) an Individual .Sewage Disposal System`at" # ,+ Aress i�' or Lot y G,r�►► _ W � �Owner Address T ................... ......... .................. Installer Address Q Type of Building 4'Size Lot..... .. _ Sq: feet aDwelling—NO'. of Bedrooms......... ........................_ Expansio Attic ( ) Garbage Grinder ( ) Other—Type,e of Building No of.... persons pI yp g ---------------------------- P Showers {, ) — Cafeteria ( ) a' " Other fixture ...._. `. d W Design Flow........... ......................gallons per person,;per day. Total daily flow ... : gallons. WSeptic Tank—Liquid capacity 1,0�'4'gallons Length ' __._... Width_ _____________ Diameter_'..........................._._. Depth................ .Disposal Trench—No.................... Width.. ............ Total Length ---- Total leaching area..... en..' �'!_._ _'sq. ft. Seepage A.Pit No......._I.......... Diamete Depth below inlet........ ...... Total leaching area..................sq. ft. Z Other Distribution box ( •)`" Dosing tank ( ) Percolation Test-,Result Pe orme Date.............. ' -. Test Pit No. l... ...........minutes per inch, ,ept?h of Test Pit Depth to ground water......... 44 Test Pit No. 2................minutes per,irielr Depth, of Test Pit.......... Depth to ground water................. a..•, === O Description of Soil.....- k� ,ct )'tGr �` u J... ._._.__.._. ._ .__.__ _____...____.______.._________________._____________.__ +........................... _____.__ a• .................................................. .: yet v :- U Nature of Repairs%or Alterations—Answer when. agplicable...................................................................................... .......__- Agreement: 5 The undersigned agrees to install the aforedescribed Individual"Sewage Disposal System in accordance`with the provisions of TITLE 5 of the `S,tat6.S,ailitaryiCode'—The,.undersigned further agrees not to place the system in operation until a Certificate of Compliance hA been iss b the: ar`_ h, Signed .... . .•. •. ---- •------------------ 1 y f Application Approved B -••--•-•-••.............••---------•----•........-•------•-----••---•---•------•------........-- --•--•--•-••.....mate y ---...--••---- + Date Application Disapproved for the following reawons:..............................................................•.._.•-_-_..•---------....._......._-__........... .. ........................•••----- -•---•••-•--•..----•--•-•-------...-•--.._....._........ ••••-•••--•---•-••••----•••--------•----•-•--••-•••----••--•--•••--••-••----.................. Date `v Permit No............ .. •• Issued_................................•-------••-•----•-^^ ................................•....Date THE COMMONWEALTH OF MASSACHUSETTS y. BOARD OF HEAL H f $ :.......O F........., :.. .L' ............ P ... ............................. 'ems Trrtifirate of Tompliattrr THIS, TO ERTI That the Individual Sewage Disposal System constructed ( or'Repaired'( ) by... � - 0-Install „_..... r .. rat. --./ . . . . ' -ell . vt, � r, .. x has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described_iti fl�ie application for Disposal Works Construction Permit No .. .....X da.ted_- . .�// .t" .h.f`�..,_..... THE(ISSUANCE OF THIS CERTIFICATE SHALL"NOT BE CONSTRUED AS A GUARANTEE THAT`IHE SYSTEM-WILL FUNCTION SATISFACTORY. DATE...-- • l ...7, .....-•............. .....--------•--•---- Inspector ------------ THE COMMONWEALTH OF MASSACHUSETTS z ♦ BOARD OF HEALTH ay s ..........� OF..... VM ................................. ..................... 1__... ' No.....c �. ..... ' FEE.......................... S Permission is hereby granted.:_.. (+ e-F.................. --i --.,-..... ?.... to Const ur ct (X ) or Repair ( )f + an Individual Sewage Disposal Syste�; at No. - 1'"':..._._._. 3-- b" Lr �r , ` StreetL f G �t as shown on the application for Disposal Works CoEQ', ct Qn"Pe raiitg No .,Dated '.. .:_."............ W 4 S �eY ............................................ ..�. !. •'ti -• ' a Board' .HealtT `„- u DATE:.. FORM 1255 H.OB" & WARREN, INC., PUBLISIERS'%V:. "At"�+`rs?,,• „- - p, BENCH MARK: TOP OF FND. Lpcus 'i ELE.= 64.50 �R►ti ST• �P� (SAS) SHALL BE Opp V\ MANHOLE COVERS TO EXTEND TO 12.17 WIDE .0' LONG SrgC�� . < WITHIN 6' OF FINISH GRADE N -ZO LOAD I I. 2 DEEP 2% GAS BAFFLE REQ'D -2a LOCUS 62.0 2X - LoAD►"aV EL=60.81 61.8 60.75 D.B. '� 2" PEASTONE TOPPING GENERAL NOTES: USE EXIST. 60.53 U. - --_- - --_-_-- - c 1,000 GAL 60.36 60.3 CAP ENDS ELEVATIONS SHOWN BASED ON U.S.G.S. DATUM. SYSTEM PIPE SHALL BE EITHER C.I. OR 11' s• c�usHEn TONE 5, _- _- __ ____- _ SCHEDULE 40 P.V.C. -r - - =`• �- 3�4' DOUBLE WASHED - THE BOARD OF HEALTH SHALL BE NOTIFIED 7EL=58.31 NONE ALL AROUND PRIOR TO BACKFILUNG OF SEPTIC SYSTEM. 10, --} - SEPTIC SYSTEM STRUCTURAL COMPONENTS SHALL BE CAPABLE OF WITHSAdNDING A 20' MIN. 2.0 30.0' 0'�— - H-10 LOADING, UNLESS SPECIFIED OTHERWISE SEPTIC SYSTEM UNDER DRIVEWAYS SHALL SOIL TEST LOG COMPLY WITH A H-20 LOADING. PERC RATE-< 2 MIN/INCH PROPOSED SEPTIC SYSTEM USE FOUR (4) INFILTRATORS - THE DESIGN AND COMPONENTS OF THE SEPTIC MODEL NO. 3050 CHAMBER SYSTEM SHALL BE IN COMPLIANCE WITH THE ELEV.- 83.0 NO SCALE WITH 4.0' OF STONE 0 SIDES STATE OF MASSACHUSETTS SANITARY CODE DEPTH A WAMY SAND YR 5/2 & 2.0' OF STONE 0 ENDS TITLE V. AND SHALL BE IN COMPLIANCE WITH 5 a WAMY SAND MW e/a NO STONE AT BOTTOM THE LOCAL BOARD OF HEALTH RULES AND 30• 80.5 REGULATIONS. -THE CONTRACTOR SHALL BE RESPONSIBLE FOR Cl SAND 10M 7/0 LOCATION OF ALL UNDERGROUND UTILITIES AND [,J 13 RE AK 0 UT' r'C' I P_,LE SHALL NOTIFY DIG - SAFE PRIOR TO CONSTRUCTION. 120' 53.0 - NO GARBAGE GRINDER SOIL TEST CONDUCTED ON DECEMBER 11, 2001 r �j _ _ V T�l 1�`� e BY BRIM CELIA. SOIL EVALUATOR J WITNESSED BY: DAVID STANTON, AGENT. I S� / p(t DESIGN CRITERIA: BARNSTABLE HEALTH DEPARTMENT 1 BOTTOM 34' DESIGN FLOW NO �2.,0 O _ 4 BEDROOMS AT 110 G.P.B. NO WATER OBSERVED •120' TEST -� DAY 440 G.P.D./ 3 J N . ^ REQUIRED SEPTIC TANK: HOLE ` . `. d a v ,. EXISTING 1.000 GALLON SEPTIC TANK PROVIDED NONE DESIGN PERC RATE <2 MIN/INCH nn M i ^ SIZE OF REQ'D (SAS) AREA = 440/0.74 = 595 S.F.r\? I C� J� N/v ;r� � SIDEWALL 2)(2) 34)+(2)(2)(12.17)= 184.68 S.F. '`� BOTTOM �t2.17S(34) = 413.78 S.F. LEGEND: z SIZE OF LEACHING FACILITY PROVIDED: 'I EXISTING CONTOUR --------- ¢' - 413.78 S.F. + 184.68 S.F. = 598.46 S.F. EXIST SPOT ELEV 62.0 5 e WATER SERVICE W—W— EXIST. TEST HOLE 10 _�<' 4 ' D{'_A E,c I 57, EFFECTIVE DEPTH: 2' GAS SERVICE G—[, V ��- — • EFFECTIVE LENGTH: 34' BENCH MARK OHM `JA ELL) 7410 K O O EFFECTIVE WIDTH: 12:17' tip OUTBACK ENGINEERING r__ - — 106 WEST GROVE STREET MIDDLEBORO, MA 02346 NOTE: ' J \V PA`'� (508) 946-9231 w � aM 1� PRIOR TO INSTALLING THE NEW (SAS) THE CONTRACTOR SHALL PUMPOUT THE LEACHPIT IV ens PROJECT: SEPTIC SYSTEM REPAIR AND BACK FILL WITH CLEAN MEDIUM SAND „ eP[;e� � •r 141 CAPTFORAHS RD. IF A LEACHPIT IS FOUND WITHIN THE SAS ~` "2/ 2 Jp AREA IT SHALL BE REMOVED. a,ro MAP 192 / LOT 168 T� I� c �I.��. = c�4,5 < 4., s , �\ 4-1 —0 DENNIS DRISCOLL 141 CAPT. LIJAHS RD. r®� CENTERVILLE, MA 02632 r� \ Q ' o PLAN ---- -- - --- _ 1 - - ----- - - I ALL SHALL TEM SYSTEM PROFILE MARK DS WTHC MAGNETIC TTAPE OR BE NOTES CZ, TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT ( 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE WATERTIGHT'COVER TO WITHIN 3" OF GRADE PROVIDE WATERTIGHT COVER TO GRADE TOP FOUND. EL. 65.6' (H-20 CONC. COVER) 2" PEASTONE OR GEOTEXTILE (H-20 CAST IRON) 2. MUNICIPAL WATER IS EXISTING Dak Street \ FIL ER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 63.9 por)ds H-20 D'BOX BLOCKS OR 4. DESIGN LOADING FOR 500 GAL. CHAMBER Three PRECAST RISERS UNITS TO BE AASHO H-M Locu Wequaquet 63.1' 4"OSCH40 PVC MORTAR ALL H Late PIPES LEVEL 1ST 2' 2 25' COMPON(ETNTPS. L. 60.6, 5. PIPE JOINTS TO BE MADE WATERTIGHT. ENDS SIDES 61 .6' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE a EXISTING ,: °` 10" 14" °o°ono°o „ 00000000 WITH 310 CMR 15.000 (TITLE 5.) o TEE SEPTIC TANK** TEE r 1� o 0 0 ° ®®®® ®®®® ' ®®®® -®®®® ;00000000 Q o°o°o°o°o°o °o°o°o°o 0000000o r a O QO 0000000000°0 >°o°o°o°o ®®Q®®®®®®®® ®®®®®®®®®®® , o ° ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND .c _ o `o GAS BAFFLE..,* ° ° ° 0 °- NOT TO BE USED FOR LOT LINE STAKING OR ANY >°o°°°o°° °°O°°°° 58.6 0 o v .} ; 60.97 60.8 °°°°°°°° °o°°°°°° OTHER PURPOSE r r o a •::;`,..r .:-,• <• 6" MIN. SUMP L C )12" MIN. INT. DIM. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. • 3/4"-1-1/2" DOUBLE WASHED STONE H-20 500 GAL, LEACHING CHAMBER.BY ACME_PRECAST OR EQUAL. �� y � o (3) UNITS REQUIRED ALL AROUND PRECAST STRUCTURES 1 9. COMPONENTS.NOT TO BE BACKFILLED OR c Cb . 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30'. X 9.83' CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 (2]) 5. HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. ($ % SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION- EXIST. SEPTIC TANK 9' D' BOX 15' LEACHING ' 53.6' BOTTOM TH-1 & 2 VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP FACILITY- NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF y �-O WORK. NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 192 PARCEL 168 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE SHALL BE REMOVED 5' BENEATH AND AROUND THE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE PROPOSED LEACHING FACILITY. CONDITIONS IF.NOT SUITABLE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE AND REMOVED (SEE NOTE BELOW) IMMEDIATELY GRANTED-BY THE BOARD OF HEALTH AGENT OR i f BY HEALTH INSPECTOR LEGEND- PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED 99- EXISTING CONTOUR BY THE BOARD OF HEALTH REVISED DURING A PUBLIC EXISTING LEACHING SYSTEM (INFILTRATORS IN STONE) IS IN AREA OF HEARING HELD ON AUG. 4, 2009 - X 99.1 EXIST. SPOT ELEV. PROPOSED SYSTEM. ALL COMPONENTS, STONE AND UNSUITABLE SOILS REQUIRE REMOVAL PRIOR TO INSTALLATION OF PROPOSED SYSTEM. ENGINEER --�-- PROPOSED CONTOUR TO CONFIRM SUITABLE REMOVAL AND SOILS PRIOR TO INSTALLATION. 2) FAILED SYSTEMS ONLY : SEPTIC SYSTEM COMPONENT TO FOUNDATION SETBACK, IF AN IMPERVIOUS LINER IS DESIGNED 198.4] PROPOSED SPOT EL. AND INSTALLED (10' OR GREATER ALLOWED). TH1 PROP. VENT WITH CHARCOAL FILTER AND BUGSCREEN (FINAL PLACEMENT BY TEST HOLE EXIST. CONTRACTOR WITH HOMEOWNER CONSULTATION .76 CONC. COVER 2Z; SLOPE OF GROUND OAKS (TYP) 15 •4 8" wH. PINE SYSTEM DESIGN. x UTILITY POLE LOT 13 3.94 x 63,5, 3 6,3 9 G WIRE 15,143 SF x 61. 6 _ GARBAGE DISPOSER IS NOT ALLOWED FIRE HYDRANT x 64.35 � � :- 0 U.P. NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING - _ 64..71 =? 09 Si0 x 4. 64.E 1' 6 X x c N r LO�ir': 3'EEuROOnRS 'i 10.:GPD = 330 GFD . s / USE A 330 GPD DESIGN' FLOW k4.35CRgt TH 2 Q -NOTE: LOW D 63.96 OVERHEAD UTILITY TEST HOLE LOGS o 4.53 Rod O LINES SEPTIC TANK: 330 GPD (2) = 660 4 25. -� 94 RE-USE EXIST. SEPTIC TANK ** ENGINEER: ARNE H. OJALA, PE, SE / �9 4.91 / LEACHING: WITNESS: D. DESMARAIS, RS o� 6 . 1 0 63.74 L EXISTING DWELL. o r SIDES: 2 (30 + 9.83) .2 (.74) 117.9 GPD DATE: 6/13/12 TOP FNDN.'= 65.6' 65.64 °o o I BENCHMARK: C. BASIN BOTTOM 30 x 9.83 (.74) = 218.2 GPD PERC. RATE _ < 2 MIN/INCH /. APPR 4.05 3•P5 AT ELEV. 63.8' EXI 1 / TOTAL: 454 S.F. 336 GPD CLASS I SOILS P# 13670 51 �� 5a-- - D' 64.2 BRICK WALK___ / •x 4.26 USE (3) H-20 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 64. ELEV. ELEV. =1 W 36 63.70 WITH 2.25' STONE AT ENDS AND 2.5' AT SIDES �# / 0" 63.6' 0" 63.6' 12 OAK x 65.1 1 ' C 8 cq� 64 46 8 / / 64.50 FILL FILL a 64.39 #63.58 (� MA J x 64.96 4.60 6 .39 APPROVED DATE BOARD OF HEALTH 64.50 / (� 37 $" $" x 65.23 I cR .24 / A B A B 151 8" QAK �4.91 �.\�4o,�, xs\�6 Q TITLE 5 SITE PLAN / / 43 FL GPOLE � / 7 PROVIDE 21 OF 40 MIL LS LS LINER AT 5' OFF SAS IN WN. TOP AT EL. 65 \ 4.03 / J OF 12" 10YR 4/2 12" 10YR 4/2 AREA 0, BOTTOM TOM AT EL. 58t 5.00 63,21 z 141 CAFN LIJAH'S ROAD 63.25 Q CENTERVILLE v / LS LS ! PREPARED FOR a / o= DANIELA- ---- DANIEL ` M/M MARK� WALSH � a 10YR 5/6 10YR 5/6 / ¢ o OJALA /o A. .� / d �' IVIL <" /�OJA uI 30" 61.1 30" 61.1 63.5o No.4o a o o. 80 4 JUNE 15, 2012 C C -� s' �q F off 508-362-4541 W OCCASIONAL C'�(�I J o n 9°sG r q y fax 508-362-9880 / W/OCCASIONAL � ANIELA. s ,/o ANIEL G PERC MFS CLAY LUMPS MFS CLAY LUMPS o OJAfA o A. � , downcape.com CIVIL OJALA N down Cope e�►g/neet/ng INC. 120 2.5Y 7/4 53.6' 120" 2.5Y 7/4 53.6' °°�� E � °o�s0000v civil engineers Scale: 1"= 20' land surveyors NO GROUNDWATER ENCOUNTERED h�1j/ZoIZ- _-_-- f 939 Moir. Street ( Rte 6A) >2- 155 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA. 02675