The URL can be used to link to this page

Home My WebLink About0264 CAP'N LIJAH'S ROAD - Health 264 CAP"#' LIJAHS RD, CENTERVILLE A = 193 113 Aff UPC 12534 No. 2-153LOR � HASTINGS, MN TOWN OF BARNSTABLE LOCATION Cr n I�C�1n SEWAGE Q z VILLAGE nnn_g 1.� ASSESSOR'S MAP&PARCEL say-a��l - INSTALLER'S NAME&PHONE NO. ��, J CC Z_,`S � SEPTIC TANK CAPACITY 060 C LEACHING FACILITY.(type)/,. NO.OF BEDROOMS '`�' OWNER PERMIT DATE: �Q _ - 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 1 site or within 200 feet of leaching facility) ,v Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 7 300 feet of leaching facility 1 Feet FURNISHED BY �Z— I 1ui^L� ►D�� 19,�s ��y.s 94 Js C��Sr o l �0oosa` 0 ©F VvaP-Se Fee 100 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation fgr lasposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade>< Abandon( ) ❑Complete System Xndividual Components Location Address or Lot No. a 1 r Owner's Name,Address,and Tel.No. i 9 LEA s . I�� Tiri fa 1�k 1 4oI k-1S Assessor's Map/Parcel kci3 Installer's Name,AddresA,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: 1 Dwelling No..of Bedrooms �— Lot Size ��-t�'g sq.ft. Garbage Grinder( Oyt,c�. Other Type of Building _ J�f�l No.of Persons 3 Showers( cafeteria(:/f Other Fixtures [Xj_Qt,;j.-1Mr),. .c�� p� t,� LL�;•��-. Design Flow(min.required) `�/(.D gpd Design flow provided � ,3 . �� gpd Plan Date — , Number of sheets Revision Date Title c\ C_ r 1 Size of Septic Tank �, t� F%e Type of S.A.S. fi— LC Description of Soil Nature of Repairs or Alterations(Answer when applicable) m Date last inspected: Agreement: The undersigned agrees to ensure the constructiio anad mai ce of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env'r fimenta ode a d of o place the system in operation until a Certificate of Compliance has been issued by this Board of Healt . Si Date l" czs,—cX Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued - ----------------- l Fee /do THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ��t•, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS i x k . 21pplicatlon for,-Mispo$ai *pstrm Construction Pffmit r , Application for a Permit to Construct( ) Repair( ) Upgrade j Abandon( ) ❑Complete System N Individual Components Location Address or Lot No. (� r Owner's Name,Address,and Tel.No. t Assessor's Map/Parcel 31 1 C� Installer's Name,Addres�s-,7 and Tel.No. Designer's Name,Address,and Tel.No. otu`a�r4-��kg�3 �a4� 5�? Type of Building: 1� Dwelling No.of Bedrooms Lot Size SO,—+tR6 sq.ft. Garbage Grinder( h)1f A 12 Other Type of Building I P, No.of Persons Showers( j).*Cafeteria(✓f 'r Other Fixtures (fie.►G-�t7�v t ,. k��r(4 P h dJ e s1 l._r+v e��cz-, Design Flow(min.required) gpd Design flow-provided gpd ,- Plan Date '_2 y14-� C�r�� Number of sheets _fir, Revision \Date Title Size of Septic Tank (1LY>0—eA Fv t -C Type o'}S.-A.S. Description of Soil 4,cZavc A )ZO -his An QA nK. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: '. Agreement: t The undersigned agrees to ensure thgk.constructiomand main enance of the afore described on-site sewage dis sal system in ¢ accordance with the provisions of Title 5 of the Enviro e to 1 od ald o to place the system in operation until a Certt ficate of Compliance has-been issued by this Board of Healt. N Date `Application Approved by ti Date / Application Disapproved by Date a ;.a for the following reasons 1 �.w- ' , Permit No. Date Issued �-- f THE COMMONWEALTH OF MASSACHUSETTS 4 BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded - Abandoned( )by at 1 c� C �f1 U\t G� � has been constructed in accordance f with the provisions of Title 5 and the for Disposal System Construction Permit X1 dated f 1 C ` Installer in-�� 1 u. {�V t Designer ,r., 9 #bedrooms �.1 Approved design flow 0 gpd The issuance of this permit shaot be construed as a guarantee that the system wi cti esigned. Date 1 Inspector No. - Fee THE COMMONWEALTH OF MASSACHUSETTS T PUBLIC.HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( ) System located at U L\ Coo�D N GV11 ri �.0{-ar l� 3 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. r' Provided:Construction must be pmpleted within three years of the date of this permit. Date Approved bt � '�� Town of Barnstable °F`"E'Ow Inspectional Services annwsrABLIE Public Health Division 9� M6 9 � Thomas McKean, Director prenya 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer & Designer Certification Form i /I Date: '��' Sewage Permit# anZ,l-, ®W Assessor's Map\Parcel I T� ^ I /� z� Designer: Installer: �� &J�J C3 CJ Address: 0261 Tf un 41alzAry-,e) Address: A!A1cJAJLW Cam' Z C; m T On�Q-�, v , -b1 C5 was issued a permit to install a (date) - installer) � c c septic system at GPI, based on a design drawn by (addr ) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the' distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i with the to rms of the p o le s (if applicable) J. S , (Inst is ign r ) t4 : 1 R©1s RAN IT (De ' er's ignature (Affix Designe sump Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. ^� Woa\depts\H EALTIAS EWER connecMEPTIC\Designer Certification Form Rev 8.14-13.DOC TRANS. NO.: L CITY/TOWN: APPLICANT: AD:DRESS: W_"A DESIGN FLOW: C} gpd REVIEWED BY: � DATE: 5 N/A OK N0 GENERAL l..e,.,ral botrridaries denoted [310 CM,R ]5.220(4)(a).] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(tr)] V Locus Provided [310 CMR 15.2204(t_)] Plan proper scale`? (I"=40' for plot plans, I" 20' or fewer for components) [310 CMR )5.220(4)] Easements shown [3)0 CMR 15.2.20(4)(b) System located totally on lot served [310 CMR 15.4050)(a) for / upgrades]- If nol. a vcu-iarrce iS req uil,ed 1310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc..) �i [310 CMR 15.220�(4)(d)] .� Location.alt buildings existing and proposed 310 CVMR 15:2200)(01 Location and dimensions of system components and reserve areas. 1310 CMR 1,5.220(4)(e)] u' System Calculations [310 CMR 15.220(4)(f)] daily flaw septic tank capacity 'required and provided) soil absorption System (required and provided) whether system designed for garbage grinder 7 . North arrow [310 CMR 15.220(4)(g)] Existing and wro)used contours [310 CMR 15.220(4)(`r)] -ocation and loo ofdeep observation holes (existing grade el. oil each test') [310 CMR 15.220(4)(h)] Names of sail evaluator and BOU .representative. (310 CMR, V/ 15.220(4)(h) and (i)] Location and date ofpercolation tests (performed at proper elevation`?) 31.0 CMR 1.5.220(4)(i)] r'� Percolation test results match loading rate? [3 10 CMR 15.24.1 Certification statement b by Soil Evaluator 310 CMR_ 15.220(fti)] Observed and.Ad Listed groundticatcr(method for adjustment given or indicated) ]310 CMR 15.103(3) and 310 CMR 1.5.220(4)(n)] ,Address. Shcct 1 of 7 _NIA OK NO Location of'every water supply, public and private,.[3 10 CNIR 15.22 0(4)(k)] within 400 feet of the proposed system location ill the case of surface water supplies and gravel packed PL[I.)l iC rater'su1�1p1y within 250 feet ofthe proposed system location in the case within 150 feet.of the proposed system location in the case of,private. water su ply wells Location of al I surface waters and wetlands located ill) to 100 ft, beyond setbacks listed in 310 CMR 15,211 and any catch basuls, located within 50 ft. [3 10 CMR 15.220(4)(1)] Water lines and other subset face, LullifiCS located [3 10 CMR 15.220(4)(m)] (if water line cross see 310 CMR 1,5.2 11(I)[I Profile of-system showing invert elevations of all system components and the bottom ofthe SAS 13 1() CMR I 5.220(4)(ofl Stamp ol'designer [310 C'MR l52'_)0(I) and 310CMR 15.220(2)] Stamp of Regis tered Land Surveyor(i*equl.rccl it-construction activities within 5 ft.. of lot title) [31.0 CMR 15.220(3)] Test Holes adequate (two in,each of-tic primary all(] reserve unless trenches as perlilitted in )10 CNIR 15.1021(2)) or as approved for all upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of'sultable Material? [3 10 CM R 15.103)(4)] Test.Holes adequate to confirm adequate ;,joundwater separatioiV [3 10 CM.R 15.103(3)] Benchmark within 50-75' of systern [3 10 CMR t 5.220(4)(g)] Materials specifications noted'? [various sections of3 10 CMR -I-S.000] System con.ipouents not> 36" deep (unless Local Upgrade Approval.or LUA requested) [310 CN,1R 15,405(t.(b) Shen of L AM AC� ................... N/A ®K NO SE.PTIC 'CANK Size 0K.? [310 CMR 15.22 3(1.)] ' Inlet tee located ten inches below flow line [3.10 CMR I5.227(6)] Cutlet tee 14" or 14" - 5" per toot for increase ff depth 1.310 (..'.MR 15.227(6).] Cutlet tee with gas baffle or approved 1.1lter [310 C:MR 15.227(4)] Note regarding, installation on stable compacted base 1310 CMR. � 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) 310 CMR 15.227(2)] ' 1111et/0utlet elevations at least I T' above high groundwatcr (except as describe,(] :310 CMR 15.22745)) or permitted for V Upgrades under Ll1A 1310 CNIR .15.405(1)(k)] MInimeu:n coy=e,r 9" (hanks buried more than 9" must h.avc,risers on all openings and on the;d-box) [310 CltIR 15.2221,W) and 31.0 CMR 15.232(3)01 ] Three access covers (inlet and outlet must: be 20" or greater) - middle access at least 8" (by 7/07) [310 CMIt 15.225(2)'] Access to within 6 " of grade v/ two for systems >1000 Tpd [310 CMR 15.225(2)] All at-grade covers secured to unauthorized access? [310 CMR. 15.22s(2)] > 1_0 I't from building foundation [31,0 CMR 15.2:1 '1(1)] Buoyancy calculation.Rec aired Done [310 CMR 15.221(8).] 11-20 Where appropriate'? [310 CMR 15.226(3)] Setbacks front resources [310 CMR 15,211 ] lYtilti-Coin arf�e�t'I'�nks, Required when other than single-family dwelling or I'low>1000 gpd [310 CMR..15.223(l)(b)] First compartment 200% daily f10-,v; Second compartment I00"O y/ daily flow [310 CMR 15,.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 C'MR. 15.224(4)] _77 ;1dclrGss Sheet 3 of7 ... . t N/A OK NO BUILDtNG SEWER AND CD`9 HER^R WINC Located at least ten feet from any water line? [31{) C NIR V/ 15.222(2)] Disposal piping at least 1.8" below water Ime (when water and sewer cross,see 310 CMR 15.21 l(1)[l]) ✓ C.Ieariouts required/provided '? [310 C1tIR. 15.2222)(8)] "Thrust blacks specified in force mains`.' 310 CAIR 15..221(fi)(c,)J Slope of sewer line not less than 0.{)1 0.02 preferable O 1310 CMR 15.222(6)] � Proper pitch on all runs? ( 005 within gravity-distributed trerrche.s V/ and beds) [310 CMR 15.251(9) and 310 CNIR 15.252(2)(c)] Siphon robletrir(leachfleld below PUMP chamber) Endca ps or vent manifold specified? Sale and orientation of discharge holes specified? (not smaller than 3;8" not larger than 8") [310 C:'MR 15.'S 1(8) and 310 v CMR 15.252(2)(h)] Materials specified (310 CMR 15,25](5) specifies various pipe types allowed) DISTRIBUTION BOX Stable compacted byre [310 C'Ml�l 15.221(2) and 310 CMR VII, 15.232(2)(a)] Splash plate or baffle tee required on it let,/ prov<ide(V (when pressure sewer to d-box or steep Ditch of gTavity sewer.) [ 10 C .R. 15.323(3)(a)] Riser ii'dee er than 9" [310 CMR 15.232(3)(f)] Reside minin-lum dimension 12" [310 CMR [5 232(2)(h)] Minimum SUMP b" [310 CMR 1,5.232(3)(e�)] Watertight cover if<2000(, d);waterprool`rrranhole rl '•'000(, [310 CMR 15.232(3)(d)] Y1) fI'.G AOlJ C. S Capacity(emercy storage above: working design flow)`? 1,310 CMR 231(2)] Pro-per setbacks [310 CMR 1.5.21 1 (same as septic tanks)] Watertight 20-in miniuril access Manhole at least 20" MUST BE � TO GRADE 1-310 C"MR 15.231(5)] Service components accessible (not too deep with pipiiig).", V/ disconnects accessible) Alarm floats - alarm on,circuit-separate from pumps specified? Exceeds two units inust ha c, two> pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] Stable Compacted Base [310 CM 15.221(2)] E3uovrrncy calculations needed ?-Provided" [310 CMR 15.221(8)] Address_. � � r(7 .....1--� _�'?> "`ti Sheet 1 of 7 q N/A OK NO SOIL ABSO'RPTlgN,$$ 'S"TE119S( A GENERAL Calculations correct`' d feet of naturally occurring material demonstrated? [31:0 CMR 15.240(l)] v Req aired separation to groundwater'? [310 C.NJR 15.2 12)] Aggregate s iecil led as double washed 310 CMR 15.247(2)] Systern Venting required/provided? (system under dr iveNyal, or 36" dce ) [310 CMR 15.241 Inspection ports specified and within 3"ti.nal grade? 1310 C`MR. 15.240(1 3)] Breakout regtrirements met? (h Er violation of breakout elevation within 15 ft of SAS sunless barrier) [310 CMR 15,2 1 1( 1)[4] and ✓ Guidance Docurrlc:nt] GAI LEi IES,Pl 'S,C1E IY713 i25 31€}CN112 1 .2 3 Chambers and Gal. ur trench corrfit",uration SLIpPlied with inlet every 20 ft. [310 CMR 15.25.3(6)] Each structure with one inspection manhole-(if:>2000 gpd must f be to grade) [310 CMR 15.253(2)] Aggregate F minimum-4' maximum. 1310 CMR-1> 253(1 )(b ] 2' sidewall credit rriaxintunr [310 (.,',MR 15.253(l )(01 y In bed conti LIFati.orr, inlet every 40 sq. ft, [310 CMR 15.2530)] .. TRENCHES 3.10 CNIR 15.251 Width 2' minimum 3' maxinlunn [310 C;MR 15.2510)(b)] 100 feet - maxinnum length [310 CMR 1.5.25l(l)(Er)] Minimum .separation 2x effective depth or wnith whichever ,greater (3x if resea,ve between trenches) [.310 CMR 251(1)(d)l Situated along contours [310 CMR. 15,25t(2)] .Breakout OK? [3 10 CMR 15.21 l(l)[4] and (luldance Document] RED SAS(Maximum size of be#or&ld 5009,,gpd) mimmum 2 distribution fines [310 CMR 1.5.252(2)(a)] Maximum separation between lines 6' 1'310 CM R 15,252(2)(d)] Maxirrtrrm separation} beweven tincs arrtd outside of bed 4' [310 C"IMR 15,252(2)(c)] _ Aggregate depth below dischargc pipes 6" minimum, IT' maximum. [310 CM.R 15.252(2)(g)] Separation betwectr beds 10' rllirtirraunn. [310 CM.R. 15.252(2)(0] V/ Bottom area used in calculations only [3I0 CMR 15.252(2)(1)] Acldresc�: .._ ...._�--i. C'� 311 � Sheet 5 47 N/A OK N€7 DJ'D ,rH_E PLAN INVOLVE 4 Pressm e.Dosed System " Provided pump and piping V/' calculations as requircd 13 1.0 CMR 15 `720(4)(r)] Pressure dosing required on all systems ~2000gpd or alternative systems under remedial approval 1310 CNIR 1.5.254(2) and l/A Remedial Use Approvals] If used in graveness system - make sure jet is directed as not to V/ sa>cu soil interface [Guidance Documcia] Inspections once per year (s_ysterns< 2000 gypd) or quarterly (-2000gpd) goad to note on plan [310 C:MR 15.254(2)(d)] Corrstrrrezifn; in .fill - Did the plan specify, that the fill shall in.c%t the speeif cation (A'310 CMR 15.255{;)" tin ervious barrier andlor rctaining wall.'? [GUidance Document] lnxpervious barrier inst;allatu}n Must be sul)ervised by � designer [310 CMR 15.255(2)(b)] R-etaining wall must be designed by Registered Prolesslonal Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3;1 ? [3 10 CM R 15.155(2)] Breakout requirements inet? [310 CMR 15.252(2:) and Guidance Document] At least 5 ft, from impervious barrier to edge, o(SAS ( 10 ft. recommended) [31.0 CMR 15.255 (2)(e)] Gravelles,s Syst6n f f 4�ppmiial L eti`czrsJ Check DEP Approval letters for credits and dcsigni conditions If used with pressure dosing do not allow pressure disc.ltarge V/' to Scour sail interface. Alternative Selftic S stun J11.4 9 r r rival Letters/,< W,as D P Approval,Letter provided and./or]rave you reviewed the letter for conditions' )s the technology being properly applied and does it meet all DEP Approval Conditions'? ` Is there a note: oil the plan regarding the requircnient for perpetual maintenance agreement`) l Anv alarms involved on separate: circuits Did the applicant submit an operation arid. mainteriance / manual? �/ I las ap liCanisubnxitted a copy of a mainteriance Are the variances listed on the plan '' {,310 CMR 15,2220 (4)(q)] RhS Stamp necessary on plan if a component is xvithitl.five feet of property ling. [310 CMR 15.41.2(4)] New construction or increase:(]flow proposed- [Refer to 310 CM_R 15.414] Sliect 6 ot'7 73 .. ,+G. . 9 � N/A OK NO A fro en'SetnsitiveAreas - 1s the System in a Designated Nit oxen Se-nsitive Area (,lonc 11 for a public supply well)? [310 CM1Z 15.214, 310 C"NIR 1 5 215 and 310 C.YIR 15.216 - also refer to folic} regarding upgrades of Such existing s stems] Is the,syste;n:i proposed on the same lot as served by private well ? V/ 1310 C M R 15.214(2)] Are the nitrogen loads proposed in compliance'' 1310 CMR 15.216(1)] Miseellune'ous Pumping to septic tank ? [ 310 C'.M..R 15.229] Shared System [3.10 OMR 1 S_2r10] cidresti—.+ '.,.. ._h... _..`j.— ..... Sl�eec 7 of 7 �� . � (�� lay � ^ _ -• . 5 J �•I i K 'b [ 0 • ..i` � II _.' - .ttDt�bJr_ f I: .ELJ:T.�1 � � � I i�,��—�'�: vi- aGk j N o • - 7 12. OL I. ' 7JbW it t • 1� ' xt hT. .� ;�. � � . . . • - _ •o, �1 III -�� .11 � �C7�--_ 'Jl rtrwJ_ •S?%2D:'G,v�o . —1Ke�- �.Y.=�.2:.��:.,,�... � Vp`}-L••t �.�•4PH'J � o_�.Ks�o't�l I DONALD I. IEYR X 79 P.6 ee..6t 30.Y.meuM,AU a7b61 ALfSD11)M-.Qf6 . .��1 ate.\al . • Tv i ! I f i •' L' i t I --.�-! * —.�•�'ar4�-e- d.•:8_ m'.-'2"0' _`_ � Try• i -- ----_---- ------- - 7-i' 9;�9 2 at r r c1 TTiS`2 tj G JfLT�1 q•� f' o u _.... i o 9•-0. ,18..0. L ,. L .. Ir-dta7h:�. :�Rp.4Sh._a�q:.gCa'�,!��- ''2'c.�•� ram— t' �-•� ¢•�' �, J t �i lh� AID: - n,I6�bhl� . .. -..�A.��..4;'�_o�. ._.-.�zb►� -�__�._�. Jz��b:rid,. ; DONALD I :MEYE :;- .a_z�: . �� PmfrstloJfel9uildrngAesigxer _ So 11ia,edh:►iA OIb61 • - - rscll ijti3re • 7 r •: m S I p '�(P _ n T� lJlJl, EKI _ 3 ..:.. -41 v pw f p� �xtnt. 4 YiN� o41' I : t.t 1 Gb�: fErcr�' Q J l p�- L U 2G 11 � T , I ME OONALD Y R 9 . I �,� Professrona!gulfdingDcsgner PD.uBe+ 3o Y M MA PTLb/� ��pA i � c � � I 1 I - T. 7-- a�2 2 0 7-6 d F-�r o f.. /n, Q L ' - L ; 1 ' 7° h o utlgNT/L• I r L �;;,:. ,..�, � �. _- ... � ,:,",11 d"1'Id/..' 15.5�2_lldj,$_.rr •,,_ZC _ter ,ML U*n II )ONA U / /99 -//3 Commonwealth of Massachusetts �n Title 5 Official Inspection Formry 111 M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / 264 Cap'n Lijahs Road w�f u Property Address ark Denise Johnson Owner Owner's Name 6= information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection `J sl:o� 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 filling out forms A. Inspector Information on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on,my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. 0 Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails t oapnmN srorea Merin wa% Brett Hickey o.:�-�� .o.o...maa �®„�� ..F�s 9-10-18 '�pae:ID10.03.10 0i6:C0-01W Inspector'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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �tl Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑E 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: The system was in working order at the time of inspection. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 L Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �/� 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Titie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road v Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 ❑ a Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary'to a surface water supply. ❑ a Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ E 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 2000 gpd- 10,000 gpd. ❑ El 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. 5) 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �n p Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ E Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 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? ❑ O Have large volumes of water been introduced to the system recently or as part of this inspection? O ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ E Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? R ❑ Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ El 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: El ❑ Existing information. For example, a plan at the Board of Health. ❑ El approximation 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts i Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road v% Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection. D. System Information 1. Residential Flow Conditions: 4 4 Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440/gpd Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes No Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes [E No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: ***2016-241,000gallons 2017-164,000gallons*** Sump pump? ❑ Yes H No current Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 it Commonwealth of Massachusetts �y Title 5 Official Inspection Form �= 1.. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road u Property Address Denise Johnson Owner Owners Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Owner- date of last pump is unknown Source of information: Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 cry Commonwealth of Massachusetts �= Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: new SAS added to existing tank in 2010 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 4' Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �d ip Title 5 Official Inspection Form 4'p�- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road V Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 3' 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 1 Dimensions: 000gallons 10" Sludge depth: 26" Distance from top of sludge to bottom of outlet tee or baffle Err Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 10" Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �o Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 11 of 18 L i Commonwealth of Massachusetts �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Orr Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence.of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 I_ I • Commonwealth of Massachusetts ,p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road V� Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: (5) 3050 's ` 0 leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road V Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leaching was in working order at the time of inspection. Leaching was 1/2 full when viewed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 I f Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road v� Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 L I Commonwealth of Massachusetts �A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............ 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 Asbuilt Ground water profile y W Rear B 31 A 3#22" Al-16' B1.25' A2-21' 82-22' SAS A3-25' B3.27' >9' A4-38' 84.38' 3 >5' Insp.port 4 t5insp.doc-rev.7/26/2018 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 l_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑0 Check Slope ■❑ Surface water ■❑ Check cellar ❑■ Shallow wells >5' below SAS Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record March-15-2010 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: A plan on file with the Board of Health was used. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Cap'n Lijahs Road Property Address Denise Johnson Owner Owner's Name information is Centerville Ma 02630 9-10-18 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ■0 A. Inspector Information: Complete all fields in this section. X■ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ■� C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ■❑ D. System Information: For 8: TighWolding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 L f VIE Town of Barnstable P# Department of Regulatory Services nARN917AeLIS, : PubIic Health Division Date > r639- ems$ 200 Main Street,Hyannis MA 02601 Date Scheduled `� ( n Time I Fee Pd. '' Soil citabilidy Assessment for Sewage Disposal Performed By: i 'P—V`/1 I - t f) /, biZ, ��• Witnessed By: r��, i� LOCATION&GENERAL INFORMATION Location Address �etl: Owner's Name L'6a�-)., �t�1.75 �Lci G'e✓rl-�.r^vsi\ it-(f'{- Address O`t' C 1-+, C��,aezu,Yte �t r� Assess or's Map/Parcel: Iq )j r^' Engineer's Name NEW CONSTRUCTION tl it i REPAIR Telephone# �50 T lend Use !sit 1.l%•()�_ t3� Slopes(%) i -2,J Surface Stones N 1'+ Distances from: Open Water Body 7y�-' 'a— ft Possible P+e[Area ft Drinking Water Well P FYft - Drainage Way _l�1 _-.It Property Line 115, it Other_ y\j Z y4 ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ��xNE✓2_ K�• r TVL a ti 17�5 z2 . CAP; Ll�as � Parent material(geologic) �ZJe_'l��7� Depth to Bedrock Depth to Groundwater. Standing Water in Hole'':j``V c:ti(.lC � j Weeping from Pit Pace - r—wT^ob r� Estimated Seasonal High Groundwater `"Y4 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: —it). Depth to SQII lrlQttl@S[_ ,^--_in. Depth to weeping from side of obs.hole: ___.._-_ _in. Groundwater Adjustment Index Well# Reading Date: Index Well level Adl.factor.Adj.Croundwater U.vel PERCOLATION TEST Date�?-1 , 'rime LI Observation _tom l Hole# +�'' 'rime at 9" _,,,1.-��d.� .. /� Depth of Perc ' Time at G' Start Pre-soak Time @ (}r'� Time(9"•6") Lt(�t�T -✓r. End Pre-soak s 0 4- f� Rate Min./Inch Site Suitability Assessment: Site Passed /. ` Site Failed: Additional Testing Needed(YIN) Original: Public Health Division �� Observation Hole Data To Be Completed on Back----------- 1 ***If percolation test is to be conducfed within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. QAISEPTICV'ERCFORM.DOC .Y DEEP.OBSERVATION HOLE LOG Hole# I_ Depth from Soil Horizon Soil Texture Sdil Color Soil Other ° Surface(in.) _ (USDA) (Munsell) Mottling (Structure,Stones;Boulders. , _ Consistency,%Gmvel) fry rc i c� C �. ✓Q 5l DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) o to -INq C, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, o Gravel) DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, ra Flood Insurance Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No 4 Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervto material exist in all areas observed throughout the area proposed for the soil absorption system? P S I.' If not,what is the depth of naturally occurring pervious material? ij. _ Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro ent o ion and that the above analysis was performed by me consistent with the required trainin ,exile ise all ex le ce described in 310 CMR 15.017. Signature Date Q:SEPTIQPERCFORM.DOC No _ Fee • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYication for Noposal *pstrm Construction permit Application for a Permit to Construct( ) RepairX Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or LotNo. A P ti LI,j A S Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. cry-q31 O Designer's Name,Address,and Tel.No. Sri Ll _ \Ali Type of Building: Dwelling No.of Bedrooms �- Lot Size sq.ft. Garbage Grinder Other Type of Building ��; ;, ii t 1�\ No.of Persons Showers OZ) Cafeteria(y ) Other Fixtures Lawn , �� t r�l-�r� �•�1� C� � Design Flow(min.required) 4-/-�{j gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank T t G 7 Type of S.A.S. Description of Soil - Nature of Repairs or Alterations(Answer when applicable) _PQ 941C `�1_0 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. , Sign Date Application Approve by Date Application Disapproved by Date for the following reasons Permit No. Date Issued � y No� J�CJ """ Q i •� »�" .. Fee a Y jo i t-HE COMMONWEALTH OF MASSACHUSETT$ Enteredinc mputer: Yes E' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHYSETTS. d pplication for Misposal 6pstem Construction permit Application for a Permit to Construct( ) Repa Upgrade( ) Abandon( ) ❑Complete System Afndividual Components Location Address or Lot No. C A p")\ L. w_ Owner's Name,Address,and Tel.No. Assessor's Map/Pareel Installer's Name,Address,and Tel.No.PH 9 , -9 31 O Designer's Name,Address,and Tel.No. �9l l) c>nD 9-/4%ix �s y CA2�v,Ev1 �_ S��AY Type of Building: Dwelling No.of Bedrooms , ,C- Lot Size sq.ft. Garbage Grinder(r* Other Type of Building 1 ram,\ No.of Persons _3 Showers(V Cafeteria(K) �.Other Fixtures ,nur_ �c, ,- 6,2 ,_ Design Flow(min.required) gpd Design flow provided gpd Plan Date o�j��,� � Number of sheets Revision Date Title �1 C 6Q ()\Csyw�:Ow Q L,_)C;::::Q 7—'A Size of Septic Tank ��L 1 cT Type of S.A.S. C� \ — Description of Soil f 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 +�f accor'flance 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. r Signed Date Application Approved by v Date Application Disapproved by Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS STD 4 BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired X) Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. "6:��dated _1 10 Installer_ M R�J►.1`Z P4S2 r;�J�i Designer ,A Su M #bedrooms , Approved design flow 44(7 gpd The issuance of this permit shall not be construed as a guarantee that the system willX c oJn as de's'g ed. Date y per A Inspector ) ,,/y� ,, ------------------------------------------------------------------------------= --------------------- No. f / Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS -Misposal *pstem (Construction permit Permission is hereby granted to Construct( ) Repair(X) Upgrade'( ) Abandon( ) System located at Z,&4 ( A P'iy L% 7b. 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 comp eteedy within three years of the date of this permit. Date d �7 1/C/ .,> Apprrooved by �� TOWN OF BARNSTABLE LOCATION a(,!5 CAP,m LijethA's 'Ra - SEWAGE# 2-y 1 VILLAGE ASSESSOR'S MAP&PARCEL 19 Z1 — I �e-2> INSTALLERS NAME&PHONE NO. MPIMOY �OAVq-bws — SEPTIC TANK CAPACITY L��c g'r. 6 00c) ng\ Ancoz� p �►►AM(3�4.5 LEACHING FACILITY:(type) y u 3�W �Tbn1E (size) NO.OF BEDROOMS OWNER �'n+A s S OzV V4�I PERMIT DATE: I PA COMPLIANCE DATE: i3 t5 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S "d' Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) f�- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A Feet FURNISHED BY 4 L l TIIA rO'OT 1 2 2 c3 a 5 2-4 I P3 9P Pber r Town of Barnstable OFTHF Tpy, Regulatory Services y ti y O,* Thomas F. Geiler, Director BAMSfABLE. MASS. i6g9. Public Health Division Qj �� ArEDnM'�° Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Shay Environmental Services, Inc. Installer: MRNNlr( S Address: P.O. Box 627 Address: FR ,A mom \A East Falmouth, MA 02536 e WaAc,� uTN v.�� o q On R_!g (d M,Pny-*a was issued a permit to install a (date) (in ller) n septic system at a(oy RP'PS Ll NR%Or'S based on a design drawn by (address) Shay Environmental Services, Inc. dated 3b3 Io (designer) Z> 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. 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. H OF U4 i �rrJ�6 Q/ CARMEN n (Inst er's Signature) E. la SHAY Flo. 1181 CAN >CnO A/-% 0 �FGfSTE�yti S Pia (ResIgiie_r's Signature) (Affix Desi p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION a(,6 CAP'N LIsp,,,A'S _SEWAGE# 201 O}� VILLAGE C.,en s2cvi�1e ASSESSOR'S MAP&PARCEL 19$ — 1 3 INSTALLERS NAME&PHONE NO, MFlwt014 AA- SEPTIC TANK CAPACITY �Lat gT. I ,Od0 �ciq\ Anc)k cNpN.pyti4S LEACHING FACILITY:(type) b W �Tbn1E (size) NO.OF BEDROOMS OWNER t3GZPFIt�{ PERMIT DATE: S I aA tD COMPLIANCE DATE: i3 (a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility I Feet Private Water Supply Well and Leaching Facility(If any well;exist on site or within 200 feet of leaching facility) A_Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ` /� R Feet FURNISHED BY nfy sr4l Z RRv�O W S pswe of t�s, • 3 O t�nooGl p 04sc' R 3 ` 10 (to TOJ7 a 2Z -Da as 2-4 ,Z►3C-1p �as9P @T http://issgl2/intranet/propdata/prebuilt.aspx?mappar=193113&seq=1 9/7/2018 Q LOT Z6 Qz It zs• I 31.a C' 1 39" p 1 oT 27 � N i 75 5$7s 1 23, /29.5/ 3 i - L-QT 2a i { Scale 1" 40�. Certified Plot Plan Being lot # 27 as shorn on a subdivision plan entitled ; I, hereby certify that j 'Crosby Hill East" in Center the existing foundation ville, by Charled N. Savery location is correct as Inc• , Hyannis, I., ass. , dated shown and does conform Aug. 21, 1973 and recorded With the building setback ; Barnstable Registry of deeds at� OF requirements of the Town in book 277 page 9$. o$�� Jr of. Barnstable. ; Dec. 3 , 1975 i c 1ACK90N' I ,, pa.8937 ti Builder: �9Fo�sTE�� e Charles F. Stanley f �° SUfo Signed Centerville, Mass. I No........0/ ........ FE$ .................. THE COMMONWEALTH OF MASSACHUSETTS B ARD OF HEALTH --OF.................................... ............................................... o Application -fur Uiipuoal Works Tonotrnrtinn Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: s 6, ---°�-7.....C .. .............................. ffl 53�//3 ' ( Locfit on•Address C U or Lot No. ............ �� -- ................................................ ----••-.................... .�i --..... w ---•----•--....._ .._. .C�lN: Address !...--•.................................. ...•----------•---............••-••.��..... --••••-----•......•-•••••••---••-------•••. Installer Address /S�d%� U Type of Building � Size ----Sq. feet Dwelling—No. of Bedrooms............................................Expansi° Attic ( ) Garbage Grinder Other—Type of Building ---------------------------- No. of persons......S................... Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------------------ w Design Flow........ .............................gallons per person per day. Total daily flow............................................gallons. fY Septic Tank—Liquid capaciO_--_------gallons Length.................Width----------- .... Diameter------. ........ Depth--------- - - Disposal Trench—No.,0`6 Width.................... Total Length.-:................. Total leaching area_-��pO_ `__ss. ff. Seepage Pit No..................... Diameter-------------------- Depth below inlet........................ Total leaching area------------------sq. ft. z Other Distribution box (�j--- Dosing tank ( ) �,d- /ae/A - 2- / �,- - 7,e aPercolation Test Results Performed by------------- --------------------------------------------------------- Date--------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water-._-___-__-__-___-_.---- (� Test Pit No. 2................minutes per' inch Depth of Test Pit.................... Depth to ground water........................ tYi -•- .... - x -------------- O Description of Soil-----------0. ................................. ---••----. ----- �?--Z i ` � 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 Article NI of the State Sanitary Code— The undersigned rther agrees not to place the system in operation until a Certificate of Compliance has bee • s by the boardhealth. ._ Sign e __ ----------- Date •--- -- ---------------------• ........... •-- Application Approved By 7 Application Disapproved or the following reasons:.-•--•---------•---•--.---- ---- ------------------------•--•---------Da.-.............-- PP PP f f 9 ---•-•-•-•-••••-••-•-•----------------------••------••---------•••-••------------••••--•----••••••••-•••.---------------._....__..._..........---------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date _• __- --- ..u-.u�.��us� - �.�.... -- ------------------------------- 7 I � � No...... •_l�.... F:nc...M................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......_..... ... _..............OF...............................I...............--------........... ...................... Application -fur Ui,ipuittl Works Towstrurttun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys em at: - -.--- o L -•----lion-Add dress ------------------------ -•--•--•-••---•-------------•••------------•--...._..•-••••--•--••--------••----••-•......_---_.. � or Lot No �..��w rr�, ----•Address a .................�----�- /��•' - ¢--.._-----•-----•---•--...-.._...----' _...-..__..._...._-..__..._.--••----.• --•---"..----r......................._.. Installer Address UType of Building Size Lot. -%,<._- "��--_-Sq. feet �-, Dwelling—No. of Bedrooms------ --------------------------------Expansion Attic ( ) Garbage Grinder ( aOther—Type of Building ...____".-_"--_"-_-_"-___.-- No. of persons---"__!_o."------------------ Showers ( ) — Cafeteria ( ) a' Other fixtures ________________"_-__"--_.._._ _. W Design Flow........................................// _.gallons per person per day. Total daily flow..... WSeptic Tank—Liquid capacity_.""-----gallons Length________________ Width_"-_---_-..._. Diameter................ Depth_._..___._ x Disposal Trench—No.�.I �......._. Width-------------------- Total Length.................... Total leaching area..'��rsq_ f't. Seepage Pit No..................... Diameter.................... Depth below inlet......._............ Total leaching area------------------sq. ft. Z Other Distribution box (—j-- Dosing tank ( ) p,6- �G - a - / - Al, aPercolation Test Results Performed by-------------------------------------------------------------------------- Date------------------------- --•-.--------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water_..____"---_".-_._....-- f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ --- ------------- Description of Soil--------- - --------------------------- ..................... -- ------ -- Vs --- d -• , -�- ----% W x --------------------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature 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 Article XI of the State Sanitary Code—The undersigneSfurther agrees not to place the system in operation until a Certificate of Compliance has bee 4ssX. d by the bo health. Sign e _ ------------------------ �, �t Q } / Date / Application Approved By...'..- . �Er�'( ------•------- ate Application Disapproved for the following reasons:.............................. -•--•.............-•--•-•--•------------•-.-----------••._....-•------ ....--•......---•......................••--•••--••-------------•-•-••--------•---•-•••--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH. r i l-rLl L...........OF........ �^ / Trrtifiratr of ffoutphatta T S ) �f� " FY/That the Individual Sewage Disposal System constructed �r Repaired ( ) b - «. -- - ------- ------------------------------ ------ - y----- - � a .� ` /' � � � /r to -- at' f�=�/ 7•--• l�cy y1'f" ri-ffl t' ...�--`.....-"---._...--•-----------•------------------••------------•-- has been installed in accordance with provisions of Art' XI of Th State Sanitary/ de as described in the application for Disposal Works Construction Permit No. _ ��,.._...../�__ ._._..__. dated. x.._ j.:/_ ?_2Z ..... THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------/ ....... .-•-..... �.......................... Inspector------- .--tz�-•- .--•-----•-•----------------------•------...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l° ....... ...la. ..�1.........OF........... L2 � ..... FEE/_(/ mutt u k ntr rtiu$trrntit Permission ' ereby granted-------- ._.. ......... ............... to Constru �. or Rtr ;)tea -Individu Se a e Disp Systerd at No... .. .`z-7.... .�'��Y----- ---f l /f dam '------- !1 Street as shown on the application for Disposal Works Construction e it No ;�.,_.. _�_ Dated_ ,t- """"3._/"97,1 --- .. ...• . . ..... F •... "--_------------------------- 7 ......................................... Board of Health �C/ DATE----:� -. ..............` --- FORM 125 HOBBS & WARREN. INC.. PUBLISHERS oF� Town of Barnstable Department of Regulatory Services RAM : Public Health Division Date . � s639 �� 200 Main Street,Hyannis MA 02601 prFD M►`l� Date Scheduled Time .I Fee Pd. a Soil itabilaty Assessment for Sewage Disposal ,n Performed By: S-Aby Witnessed By: V 14Z LOCATION& GENERAL INFORMATION Location Address C4.fp4, `, �h S Owner's Name J`cy�,Q� IO2za_n Address d y P+. Assessor's Map/Parcel iLl�j 113 / Engineer's Name ��„m e,-., NEW CONSTRUCTION REPAIR ✓ Telephone# !90 g CIFOV 7'j 98'8- Land Use Se(�,D(1�►=c C�\ Slopes(45) 5 c7G Surface Stones_ 61 f� Distances from: Open Water Body_�A ft ft Possible Wet Area�L1JL¢-- ft Drinking Water Well /V�f!'ftDrainageWay Property Line ft Other A)jA ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ®�Ni✓2- d 9 1 • � C�9'A wou-s ZZ CA-Pnl �jAtls Parent material(geologic) C L)TL0 P,6 Depth to Bedrock 'All Depth to Groundwater Standing Water in Hole:Ne3M (a%jNn Weeping from Pit Fa$e Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: __ id, Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment f[. Index Well# Reading Date: lndex Well level Adj.factor- Adj.Groundwater Level PERCOLATION TEST bete o?-1 Thee ILI Observation 11 i Hole# Time at 9" � Depth of Perc Time at 6" /r S Start Pre-soak Time @ '®O A►A Time(9"•6") `t M End Pre-soak ' Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. .Q:\SEPTIC\PERCFORM.DOC i f DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) Lomv V:-,t - dL pep, C l M-C .,Z.e 5 I Saza Mod, DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) 16 ye- 94D le DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, o Gravel) ` DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten ra Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No.ry Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro n o ion and that the above analysis was performed by me consistent with . the required trainin ,ex a 'sea, ex i ce described in 310 CMR 15.017. •Signature Date oZ Q:\.SBP'nCIPERCFORM.DOC BORTOLOTTICONSTRUCTION, INC. MAR ,.- 99' -:765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 508-771-9399 508-428-8926 FAX: 508-428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO ` PART A E CERTIFICATION Properly Address: Date of Inspection: 3 Ins tor's N, ne: Owner's Name and Address: J t ra _CERTIFICATION TAT MENT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal tems. The System: Passes Condidonally.Passes Needs Further Eva do By- e Local Aproving Authority , Fails z Inspector's Signature: All l �_...-Date: The System Inspe r shall submit a copy of this inspection report to the Approving authority within thir- ty(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 submil the report to the appropriate regional office of the Department of Envirorunental Protection. The original should be sent to-ithe system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: ARY• A)SYST"PASSES: V I 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 system components need to be replaced or repaired. The system, upon comple- tion of the replacement or repair, passes inspection. Indicate yes, nor,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 exfiltration, or tank failure is inuninent. The system will pass inspection if the existing sep- tic 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(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - l - i SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM w# i PART A CERTIFICATION (conlinned) ,o - -aa d.4. Y Broken pipe(s))re laced rt .9 Obstruction is removed Distribution Box is levelled or replaced r obstructed i s times�year due to broker o p Pe( )• e System required pumping more than foury The P P g Y eq The system will pass inspection if(with approval of The Board of Health): Broken ire s are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: it further evaluation b The Board of Health in order to determine if ' ns exist which require e Y Conditions eq 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 water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF+HEALTH-(AND PUBLIC WATER SUPPLIER,.IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A.MANNER,THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT..,, The system has aseptic 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 acid 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 50 Feet or more from a private water supply well, unless a well water analysis for coliform 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 defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health 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. . Static liquid,level in the distribution box,above outlet invert due to an pverloaded or clog- ged SAS or cesspool. Liquid depth:in cesspool is-less than G"below invert or available volume is less than 1/2 day ltow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s): Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CER•I•IFICATiON (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 pipe(s)are replaced Obstruction is removed R 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 water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 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 Zane 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 50 Feet or more from a private water supply well, unless a well water analysis for coliform 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 defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health 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 Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (conlitmed) , Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or pritiy 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 criteria 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(lie following conditions exist: The system is within 400 Feel 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 Il 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 groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of die Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: ping information was requested of the owner,occupant, and Board of Health. None of the system components have been pumped for atleast 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. 9s-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. tfThe site was inspected for signs of breakout. _ All system components,excluding the Soil Absorption System, have been located on site. The septic tank manholes were uncovered,opened,and the interior of the septic tank was fin- ed 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 existing information or approximated by non-intrusive methods. -3 t 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(conlinued) 1e The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION / FLOW CONDITION$ RESEDIENTIAL• v Design Flow: Ilons Number of Bedroou�s:___i�_ Number of Current Residents:_ Garbage Grinder: Laundry Connected To System:—i Seasonal Use: .c w Water Meter Readings, if a 'I le: Last Date of Occupancy: 1,4 Al A COMMFR LAIJIND UST IAL.s /_k) Type of Establishment: Design Flow: aallonstday 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: GENERAL INFORMATION PUMPING RECORDS and source of information: System Pumped as part of inspection: ,(_ if yes,volume pumped: V gallons Reason for pumping: - TYP VOF SYSTEM: J/ Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): A)?AROXIMATE AGE of all components,date installed(if known)and source of information: Sewa a odors detected when arriving at the site: 4 y;., .... :df - ... t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: " Material of Constnrction: ✓concrete metal FRP Other (explain) Dimisions: ,S',�(o' )f 5' Sludge Depth:_ " Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: Sri Distance from bottom of scum to bottom of outlet tee or baffle: — Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, �Iepth of liquid level it to fret invert, structural integrity, e�dettcc of leakage, et .) / tt'zi 1JtJ � N GREASE TRAP: A)0 Depth Below Grade: Material of Constnrction: concrete metal Fi'.P Other (explain) _ — — — — Dimensions: Scunr Thickness: Distance from top of scum to top of owlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, stnuctural integrity,evidence of leakage, etc.) TIGHT OR HOLDING TANK:_A.20 Depth Below Grade: Material of Cominiction concrete metal FRP I'rher(explain) Dimensions: Capacity:_ eailornrs Design Flow: gallons/day Alarm Level:Comments: (condition of inlet Ice,_condition of:rlarm and (loat switches, etc.) DISTRIBUTION BOX: ✓ Depth of liquid level above outlet invert: L. Comments: (note if kevel and distributioniiequal, evide a of�ds cir over, evidence I I akage into or out pf box,etc.) PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump clranrher,condition of pumps and appurtenances, et .) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SVS'I'F:M INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS):j (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: Comm ts: (note condition of soil, igns of hydraulic failuin level o ponding,condition of vegetation, etc.) , lLE�Z`6 c „ i� CESSPOOLS:—�20 Number and configuration: Depth-lop 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 soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) -6- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. r // � . 71�' I� �(P�� S 3� 3 DEPTH TO GROUNDWATER: Depth to groundwater: 2 Feet Method of Determination or Ap roxiTation: ell - 7- I ?1+7- 2 rO,� 25as. ?$,!�µ _ i 2 A7>Siif7 r 1 � . _ Q B a a 13 d , AI'ista1.: 26 "N ^Y `.Ciao --- �:. F ' A .. �. 7 a.. �'t 2 tin utl� /1r• j � I�Eb klXaM- : :. .. �cssa 534-1Z2�$ gLOOTL 12r�5�bLIU •�: ... ,' � r._�� d+a"f_O: ,.. . - �. _}�a'r'7-fit- �.�� A2��S# Mds'.� .. ti ALA M w O professi1 . $alydtn D 06, ow Isos►s9r.s�s t•72.-m.: :- _ I - Aw - jib — - N ' e i c ..r. i F I ' I I •>bro J r- 2@NLaYl r blr ' .. ► .. I 'tea v _.._ j_ Ad - - 1 � •7Y" � ra N � � �-,L�iocx.�;; IZU 777, OVA r - : � 4 r _ NALD I. IWR ., is Nit + Precessional EUtldtn Vest er g y� ",� ova"t...,..r1�:._........:.............v._..r:...-a.. .��._.......,e..- ... .,.,...-,..,._ J Stanton, David From: Stanton, David Sent: Thursday, March 18, 2010 9:37 AM To: 'carmenshay@gmail.com' Cc: HeathDeptMailbox Subject: 264 Cap'n Lijahs plans Good morning Carmen, Before the permit can be issued for 264 Cap'n Lijah, the following needs to be revised on the plans and re-submitted: 1. The lot line between #264 Cap'n Lijah &#20 Oxner must be shown, OR documentation that the lots have been legally combined and therefore a lot line is no longer present between the two properties. 2. The plans state"Groundwater Observed @ 144", This needs to be changed to"No Groundwater Observed @ 144 3. The profile shows "4 units"of chambers, but the plans show 5 units of chambers. 4. The profile shows 36' long overall. It should be 43'. 5. The profile shows 4'of stone on the sides, but the plans only show 3'of stone on the sides. 6. The profile shows 12' of effective width, but the design only shows 10'of effective width. 7. The plans say"40 Mil. Polyethylene liner from elev. 97.00 to 93.00..." Per Tom (on behalf of the Board &the "Variances for septic system repairs which may be granted by the Board of Health Agent or by a Health Inspector" policy)this is not sufficient for their opinion of installing liners between a foundation and an SAS. The invert elevation into the SAS with a 2' Maximum effective depth would be elevation 93, which would place the liner above the SAS. 8. "Cultec 3050" does not appear to exist or have approval from Mass DEP. Infiltrator does make a 3050 model that is approved by Mass DEP. 9. The owner of the property is "Riordan", not"Riodan" On another note: As for the number of bedrooms (4 existing per assessors &floor plans) at this property located in the zone of contribution to saltwater estuaries with less than 40,000 of land, a 4 bedroom septic design is OK. Building permit 40469, issued on 8- 17-1999 for 264 Cap'n Lijahs Rd to go from 3 to 4 bedrooms total was approved by Health Inspector GH with septic permit number 76-414. During the recent septic plan review process for issuing a septic permit, it came to our attention that the septic permit(76-414)was not the correct septic number for 264 Cap'n Lijahs rd and that the permit for 264 Cap'n Lijah rd was actually 76-64. It is the opinion of Tom that the Board would also back his decision to allow the 4 bedrooms as building permit 40469 was issued in error on the Health Divisions end and not the property owner or contractors error, so a new septic for 4 bedrooms will be OK. David W. Stanton, RS Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508)862-4644 Health Dept. fax (508) 790-6304 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map - Parcel �/, �' Permit# lJ Health Division /7 �.P��L q,�dro,-),Date Issued Conservation Division cal ��, �.,,,r,,Zm't-Fee �`��9 �o Tax Collector '+t �� 1 r-rV k f R Treasurer l Sf �,�ror. .�*u SEPTIC SYSTEM MUST BE Planning Dept. k � ;sfN,ll iNSTALlWMPaLIANCE Date Definitive Plan Approved by Planning Board a Dew° ENVIRONMENTAL CODE AND f,�,, Historic-OKH Preservation/Hyannis TOWN REGULA N9174 d Project Street ddress C 'yf - Lin � , Village 4; ► I Owner �� 42 y't� tC ciy Address !� Telephone 4 /0 Permit Request zahkoAAXI r �. Square feet: 1st floor: a 'sting /;i�y proposed 2nd floor:existing 640 proposed /�Total new Estimated Project Cos /90 M8 Zoning District Flood Plain Groundwater Overlay Construction Type m ,kR Lot Size / &7 Ste-, Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Age of Existing Structure 7-4 ,,per,,f Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: EMFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) y Number of Baths: Full: existing Z new Half: existing new 8 Number of Bedrooms: existing_ new Total Room Count(not including baths): existing KP new First Floor Room Count 5 Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air: Oes ❑No - Fireplaces: Existing'- - -New Existing wood/coal stove: ❑Yes )<No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:4,existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name -P tl "A / Telephone Number Address L4o,.e License# 0 `� Home Improvement Contractor# 77 Worker's Compensation# C) 13 4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO `Gv h1.uv�� ZZ f' SIGNATURE DATE �r .�� ram, r� � �� 3. 2 ��i 1�. 2S 4"✓. M� -tl` I - Jz sty• '.N 2 — V ild•_o S. o. F.W • 11 � .,2@NW72bl� t I b.�_� .� • + � - .�.. 1 1,., I '�.�.w 4I �NT a gd�,.'2ur. +P ti c1J •�Zf �y�1� I ueW o; � ;� b ---- • I I .. �1 2" - �a�[ta�i 4 � _ tii ja.[s-,." �lafoT l2 -. ocr ' �dpr. (s ' ' c 1. : [A x i I J m [ .. ,pr l 1(�.X .L7Jb'IC>iClJbli.J): dip" V : - 0- tR, .. •' i � ..' ,: .; .�`� .. ,. :': �'1 �f5(181347152. llSbbl r + + ' 1 I• 1' r i _.�_. a o- a•. o r �•� � r' '� � S 2 20 _rr-� 1_�� - ' + I ITn I 57-12 T7. CL VD Iwo 1 4: —.... tin uti��„T �..:�_�y•� �_1'y� :.. � .- ��t�Ae��-�� 5 pia*n ��.I�i1:I,�,.,M� � .. ... .. , ��1.._61Gb• ',l�q f_0.::,. - t�11:L1� �:Ld..:.C. A MYE , u PwfessloLns lB0g!ngDesf&- . ., �0 :.Pb.Bex311. � (5�9�9j45I96 Y 502474 tAu 2'10 04671 cttab� all AfW n Lp tbm Vreftty 3W We, CHARLES F. STANLEY and JOAN C. STANLEY, husband and wife, as tenants by the entirety, both of Barnstable (Centerville), Barnstable County, Massachusetts, f for the htU aoAddemtion of $8,500.00' Paid h"y RSM =W WILLIAM O. RIORDAN and ROBERTA J. RIORDAN, husband and wife, as tenants by the entirety, both of Capt. Elijah Road, Barnstable (Centerville), Barnstable County, Massachusetts, wit►49WOM ttbmuU. a certain parcel of land situated in Barnstable (Centerville), Barnstable County, Massachusetts, more particularly bounded and described as follows: NORTHEASTERLY by Lot 33, as shown on plan hereinafter mentioned, 127.32 feet; i EASTERLY by Oxner Road, by two lines measuring a total of 100.55 feet; SOUTHERLY by Lot 31, as shown on said plan, 127.23 feet; and WESTERLY by a portion of Lots 27 and 26, as shown on said plan, 150.12 feet. Together with a right of way for all purposes for which ways are commonly used over the Ways as shown on said plan. The above-described parcel is shown as LOT 32 on a plan entitled "Plan of Land in Centerville Barnstable Mass. for Charles F. Stanley, August 21, 1973" duly recorded with Barnstable County Deeds in Plan fi Book 277 Page 98. For our title, reference is made to the deed of Sumner Crosby and Evelyn Crosby to us, dated September 4, 1973, recorded with said Deeds, Book 1928, Page 8. The above conveyance is made subject to the condition that no dwelling shall be built upon the granted premises without first submitting plans and specifications to the grantors for their approval, and approval shall:.not be unreasonably withheld. C OLNWEALTN OF MASSACHUSETYS o i � MAN•r•T1� � NUNN 1. our haodamdMdstbb 1%t dgof rrrh A,p,tg77 A" Z es F. Stanley Barnstable, N, i A7ai'cA 19 77 aL4;4 Tho Pavandly aPPnfed tba do"v="d oan C. Stanley CHARLES F. STANLEY and JOpp�� C. STANLEY and aelmowhidow fhe foredohg In to be thei and be6ore aoa. ' Y7 weN�ss NeMgr Mo.�l, �yli RECORDED MAR 2 W Town of Barnstable Geographic Information System March 16,2010 193136 v,•. w a a•,. #283 193147 *�� #290 193135 �,. 193120 .�' Y 94 193112 193119 d�� #14 0 193133 #261 IS 4 . Jky � �� 193113 gyp- a 193118 F 04193132 1 193114 "^ 193121 �s #250' 921 � 183117 #30 �9 0 193115 *70 0 26 Feet ¢ � 193122 , �193116 rr #33 pR #60 a DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:193 Parcel:113 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:RIORDAN,JAMES A&SONJA J Total Assessed Value:$515200 , are only graphic representations of Assessor's tax parcels. They are not true property Co-owner: Acreage:0.36 acres Abutters E Buffer w S A boundaries and do not represent accurate relationships to physical features on the map Location:264 CAP'N LIJAH'S ROAD such as building locations. - TRANS. NO.: 1 �� CITY/TOWN: �n �el� APPLICANT: r ( I ADDRESS: DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO r . F •; x e't � �� ,�� +'tea .n,+t. ��.. ,, . x�a'� ��roc�a<.�t.k«�z f,� '�x�s<, �_ �[�1 Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"= 20' or fewer for components) [310 CMR 15.220(4)] V� Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310,CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(0] daily flow „o septic tank capacity (required and provided) soil absorption system (required and provided) ✓ @' 36 whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] L s !d,'� Location and log of deep observation holes (existing grade el. on �� 4 LW each test) [310 CMR 15.220(4)(h)] I'�� Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper �� elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] y Address_Z-�'-'A- Sheet 1 of 7 N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR 15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] v Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benclunark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] - — System components not > 36" deep (unle Local Upgrade d t„ pp pproval or LUA requeste )[310 CMR 15.405(1(b)] -� ftV, � - P Address 2-6-4 6-1?r�'3 I"i,�ft y�5 Sheet 2 of 7 N/A OK NO Size OK? [310 CMR 15.223(1)] g Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 1.2" above high groundwater (except as described 3 1.0 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] / '�" Access to within 6 " of grade - one port for systems<1000gpd, two for systems >1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? 1.31.0 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Required when other than single-family dwelling or flow>1000 � gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% ' daily flow [310 CMR 15.224(2) and (3)] "U" pipe tluough or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address 24,;,q C46,� Sheet 3 of 7 N/A OK NO 'SObILBSORPI ION°SYSTE�1'IS SAGENEL �� :,�.,_�,-� _A...�, Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(l)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.2411 Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] GALLEIES PITSCILAMsBERS310�CMR�1`52`5'3;� � h1z f _ ,, n Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I' minimum- 4' maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)1 E _TWA, N , _ . .u ._ _ Width 2' minimum T maximum [310 CMR 15.251(1)(b)] 100 feet - maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated. along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] ]B�ED�SA�Sg(Maximurn�si�e�of�Ued�or minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] % Separation between beds 10' minimum. [310 CMR 15.252(2)(f)] 1/ Bottom area used in calculations only [310 CMR 15.252(2)(1)] Address Z-LA C" L,J ice' C24- \e-Al L A\v'_ Sheet 5 of 7 N/A OK NO fi Pressure Dosed Systenx ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems >2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems< 2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fall - Did the plan specify that the fill shall meet / I I the specification of 310 CMR 15.255(3)? �-" ,TI„\4 Bb Impervious barrier and/or retaining wall ? [Guidance Document] 4rS Impervious barrier installation must be supervised by ✓ q�� designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] f� Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] GYaVell'eSSisS$te112a'U� f�) a0 alLefteYS i x" 5t , t x. 4 'r £ f Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? L� Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan ? [310 CMR 15,220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.414] Address Sheet 6 of 7 N/A OK NO NItYOe/1fiS�eilsltl€VL'.�I2C1S 3s o � �� ea' cv x ? # \ \ �n Is the system in a Designated Nitrogen Sensitive Area (Zone Il for �b a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and / 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? 1310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR / �ey.15 216(1)] V 11lcscellrCl7le011S "� arc y p .Z" zt xy �q Pumping to septic tank ? [ 310 CMR 15.229] Shared [System 310 CMR 15.290 Y ] +0 ew *W01 Address_ Z6 �ae,r) bj-V)4 Sheet 7 of 7 r E.R ,,ROAD _ __ _ �a -10 - GENERAL NOTES XN o s �� O "--_' " °"°'°'''yak. 1. Contractor is responsible for Digsafe notification, Verification of Utilities SAS TO BE COVERED WITH (40 FOOT RIGHT OF WAY)�� - -„� _ '" " ' and protection of all underground utilities and pipes. FILTER FABRIC ____ + 67 �t0 2. The septic tank ________________ _ _ -��D"b8 __ .�' p amyl distri ution box shall be set ' ;- __�o { level on 6' of 3/4 —1 tp2 stone. 2.66 ' ; 4 , `' 3. Backfill should be clean sand or gravel with no stones over 3" in size. \ - - - a 4. This system is subject to inspection during installation L 48.00 ; i 264ca�nUjah�sRd® by Carmen E. Shay — Environmental Services. ne enUy viewed 5. The contractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan \`y { and Local Regulations. HOLE gz \ Rd 6. If Burin installation the contractor encounters an LOTS #27 & #32 x y 9 Y 1.- sa.00 30,788 square Feet +/- w i soil conditions or site conditions that are different `\ to ; from those shown on the soil log or in our design ; \ . N I mesu,a�n��LOT #33 � \ � � o , p installation must halt & immediate notification be made to Carmen E. Shay — Environmental Services. LOT #31 1 L❑CUS MAP 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. \` 8. Install Tuf—Tite gas baffles or equals on all outlet tee ends. ;TEST HOLE#1 � i \; + 0 30 60 70 9• All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. i Co `\� i `\ 10. All solid piping, tees & fittings shall be 4" diameter Schedule 40 NSF PVC pipes with water tight joints. SCALE: 1 "=30' 11. Municipal Water is Connected to ALL OF The Residence and Abutting w D—Box IN GROUND �` `� ' Properties Within 150 Feet. SUBJECT SITE IS TIED IN TO TOWN WATER • ` `\ ` THE PROPERTY LINES ARE APPROXIMATE AND VENTS POOL r Y `\ \\` PIPE r • ; \\ \ COMPILED FROM THE SHAY ENVIRONMENTAL SERVICES, INC. OF MASHPEE, M ENTITLED: "PROPOSEWD SUBSURFACE SEWAGE DISPOSAL SYSTEM" p 85D 24' 20 W DATED MARCH 15, 2010. AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 94----- 1 \ .\ ``�� 38.8 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN ` THE SEPTIC SYSTEM INSTALLATION. 66.73�`` `` \ ` ` EXISTING LEACH SAS TO BE PUMPED OUT AND FILLED IN PLACE NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE -#- D 24 20 1P �`` �` �` �` �`\ ` FROM THE EXISTING SAS TO BE DISPOSED 92------ \ Fall � ` \ ` `\ SAS \ \ `.� \ OF AS PER BOARD OF HEALTH SPECIFICATIONS. 90 0 DECK 0 3 SEASON P LOT P LAN \`\ `\ I y EXIST. gg SER�TICTIWK ROOM OF PROPOSED SEPTIC SYSTEM UPGRADE y , 1 \ Cb •� LOT #28 LOT #26 i i i ` C4 Esrsrnvc �, PREPARED FOR 4BEDROOX TINA & NICHOLAS PERIVOLARAKIS cct333 04 401 SOUSE 1 b w #264 AT 264 CAP ' N LIJAH ' S ROAD 1 ' ASSESSORS MAP 193, PARCEL 113 PROJECT BENCH MARK TOP OF FOUNDATION ELEV. = 100.00 (Assumed) C E N T E R V I L L E MA y y t 1 � m% i ce i i i OF kt43G ra o ; q ; ; EXIST. I �' } PREPARED BY: f 1 I DRIVEWAY ' SHA Y ENVIRONMENTAL SERVICES ------------------------ -; -----------;r'��---------`34D 30 31"R ----------—-`--'y ` l�`-----\\\- � z E P.O. Box 1576 1 ----------------------- �ANITAR`P� MASHPEE, MA 02649 ` TEL/FAX : 508-294-7498 �d I CAP'N LIJAH'S' R OA j� o SCALE: 1"=30' DRAWN BY: CES DATE: MAY 24, 2021 (40 Fool RIGHT of WAY) PROJECT#264 Cap Lijah FILENAME: 264 Cap Lija .dwg SHEET 1 OF 2 l w i SAS TO BE COVERED WITH VENT PIPE ((®Least 24 inches tall) 10' min. from "NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule48 PVC w/Chorcool Odor Filter FILTER FABRIC SECTION A A EXISTING Foundation house to septic tank wthtn 68fof GRADE PROFILE VIED OP LEACHING SYSTEM Septk must be tank covers must be D-BOX cover must must have riser and be ti within 6 in, of finished grade wthin 6 in. of finished grade Grade over Septic Tank- 98 25 lade over D-B - g8 O0 made over SAS- 98.00 /// p•to r 1/2• ►awd awmed BOone 'of r/a•- r/s" Wadwd r.aei ne S - 0.02 3 HOLE H-10 INSPECTION cover must be DIST. BOX TOP OF SAS- 96.00 within 6 in. of finished grade EXIST. PIPE 011 o EXIST 1000 GA ION SEPTIC TANK c`+ 15 am n FROM FOUNDAT sO o o r'n�u.yt aer„en P.an..wr.. a, e► o 0 0 0 0 0 H-10 0 0 0 0 0 0 0 11 as sen. to to to 0 0 0 0 0 0 CONCRETE FULL FOUNDATIO Yy it y y it II rn SYSTEM PROFILE Not to Scale c c m 4. I_ 4, g" P vIDED S Units 6 '0� 30' 3.5 - �--' III` 1 B In.of 3/4"-1 1/2" S » NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE compacted stone Effective Width $ 7' 4 Effective Length ' is Bottom of Test Hole 1 Elev.= 87.00 SOIL ABSORPTION SYSTEM (SAS) LC-6 H-20 LEACHING UNITS / WIGGINS PRECAST Not to Scale 2-18' DIAM. ACCESS MANHOLES 6' P E R C O LAT i O N TEST ALL OUTLET PIPES FROM THE asTRieunaN Box SHALL.BE SET LEVEL FOR AT LEAST 2 FT. 12" CONCRETE COVER �' "'- �` •. Date of Percolation Test: MAY 20, 2021 Perc #1 (.''. i ,�-,,.•r„�,,, b Test Performed By. CARMEN E. SHAY, R.S., C.S.E. Depth to Perc:30" to 48" KNoacours OUTLET i T Results Witnessed By. Donald Desmarais-(Barnstable BOH) Perc Rate= 2 MPI ASSUMED _ — '- 5.5' •' EXCAVATOR: CARMEN SHAY Groundwater Not Observed r OUTLET 12• IMI� / — ou Percolation Rate: LESS THAN 2 MPI ® 30" No Observed ESHWT 6• a ': ADJUSTED H2O Elev. = None ' ' 'w 2 15.5• ~ 4" - SCH. 40 Te >. r'� THE AccEss covERs FOR THE SEPTIC TANK, Test Hole Test Hole 2.0• DISTRIBUTION BOX AND LEACHING COMPONENT -:;�: ,- :�- .- T DEEPER AN 8 INCHES BELOW FINISHED 1 NO 2 TH PLAN SECTION CROSS—SECTION ' `r:r-•'' ~ ' GRADE SHALL BE RAISED TO WITHIN 6" OF DEPTH SOILS ELEV. DEPTH SOILS ELEV. STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. 3 HOLE H-10 DISTRIBUTION BOX PLAN VIEW INSTALL TUF-T 0 9800 0 TE GAS BAFFLES OR EQUALS Sandy Sandy 98.00 Loam Loam 3-24"REMOVABLE COVERS 11 10 YR 3 2 // 101R 32 0"- 6" Ap 97.50 ° 6" AP 97.50 • .min., ar�a +..•e' . 4. Loam PLOT PLAN 3" min•clearance ty INLET Sandy Sandy 8" min.r12" min. Inlet to outlet 6"min. Tto"min. BW Liq'u level r`• OUiLET 10 1R 5/6 10`R 5 6 L�JJ 6"- 3D" 95.50 6"_ 30" / 95.50 OF PROPOSED SEPTIC SYSTEM UPGRADE '.' E ' ' 4•-0• min. Sand Sa Med d PREPARED FOR c 3 asp :• Liquid depth 2.5 Y 7/4 2.5 Y 7/4 a= J; D"_ ,32" D"- ,32" B7.Oo T I NA 8c N I C H O LAS P E R T VO LA RA K I S AT CROSS6 SECTION END-SECTION 264 CAP ' N LIJAH ' S ROAD TYPICAL 1000 GALLON SEPTIC TANK PARCEL ID: 193/113CENTERVILLE MA Design Calculations Number of Bedrooms: 4 EXIST. -4 PROPOSED Equivalent to 440 Gal. Day Garbage Grinder: No w PREPARED BY: Leaching Capacity Proposed: 440 Gal./Day Minimum f. Igt�OFa;nr Septic Tank - 2 x 440 Gal./Day = 880 USE EXIST 1,000 GAL. Septic Tank. `�l '° SHAY ENVIRONMENTAL SERVICES SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Sidewoll(ENDS) Area: 11' x 2' = 22 SF m Bottom Area: 0.74 gal/day/sq. ft. x 407 sq. ft. = 301,18 gallons/day 22 x 2 ENDS = 44 SF Sidewoll Area: 0.74 gal./day/sq. ft. x 192 sq. ,ft. = 142.08 gallon/day Sidewall(Side) Area: 37' x 2' = 74 SF P.O. BOX 1576 Providing: =443.26 gallons/day 74 x 2 SIDEWALLS =148 SF ` 74 MASHPEE, MA 02649 TOTAL SIDEWALL AREA -192 SF SANITA TEL/FAX : 508-294-7498 - Use: (5) LC-6 H-20 CONCRETE CHAMBERS, HAVING A 1' EFFECTIVE DEPTH,(3' W x 6' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND Bottom Area: 37' x 11' = 407 SF SCALE: 1 "=20' DRAWN BY: CES DATE: MAY 24, 2021 3.5' OF WASHED STONE ON THE ENDS AND 1 FOOT OF STONE UNDER ENTIRE SAS . PROJECT#264Cap Lijah FILENAME: 264capLijah.DWG SHEET 2 OF 2 2-tee DIAM. ACCESS MANHOLES 3" of 1/8" - 1/2" Washed Peastoner r, ;r b � . t 3/4" to 1 1/2 " DOUBLE Washed Crushed Sto u) �► T r! f *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE (0 Least 24 Inch" tau) • INLET Schedule PVC w Charcoal Odor Filter s ' 10 min. from 4 PVC (CAPPED) INSPECTION PORT TO BE INSTALLED AND TO BE WITHIN 6 OF GRADE t „ J of T IT Existing Foundation house to septic tank \ � >iR /+�` � i' TOP OF FOUNDATION • 20" Min septic tank cows must be W f7 r wet be (Assumed) wRhln a of Grade ., � THE ACCESS COVERS FOR THE SEPTIC TANK, ELEV. 1 D0.00 Assumed with(n a in of ffnhhed grade �. DISTRIBUTION BOX AND LEACHING COMPONENT !'::^7•d , '•? +� •.•.;,`r•. SET DEEPER THAN a INCHES BELOW FINISHED c1.w,,r4 1. Orode over Septic Tank-90.2E Grade over D-BoK-90.00 I over 9A3- 00.00 .%'I 3 NOIE H-10 ,r,- -+v,;+�•,t�-• �--r�+•r, i+•--•�' "1 , 'py. DIST BOXf GRADE SHALL BE RAISED TO WHIN r OF E qk 1 R 3 s. 0.02 STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE 3' Madnwm cove 24'1 Ef fective PLAN VIEW INSTALL Mr-TITE GAS BAFFLES OR EQUALS S ; EXIST. S-0.01 or Greater Top OF System-Elev. -93.80 1 Exttt pipe N 1.000 GAL. S. . . Sidewalt 3-2e REMov COVERS FROM ExisT, FOUNDATION ol`, g SEPTIC TANK 1C n 0 f 5 Units @ 7' =35' I CONCRETE FULL rouNL1A ��' H-10 GENERAL NOTES $ o 2 EFFECTIVE DEPTH Not FO SCaI@ m1n. deoranoe ', ,13•fu • u EffeCtly� Len th INLET a min 2•min. Inlet to outlet r m� VERIFICATION B in.of 3/+•-1 11/2- � � > 8 9 - ou= 1. Contractor is responsible for Digsafe notification, SYSTEM PROFILE , > o a"i, 3 3 ; LRMTewl-' p compacted•ten• > o iA 3' r mIn q• ;: and protection of all underground utilities and pipes. Not to Scale u • W_r *. :'s -7• 2. The septic tank a 4 diatri #on box shall be set O u SECTION A -A NOTE: SEPTIC TANK do D-Box TO BE CONSTRUCTED ON LEVEL COMPACTED BASE 4._0. mks level on 6 of 3�4 -1 1�2 stone. s Efriei' ' PROFILE VIEW OF LEACHING SYSTEM •� y u4va depth 3. Bockfill should be clean sand or gravel with no NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6• BELOW GRADE a in.of 3/4•-1 1/2• V separation ft%Ided $ ° stones over 3" in size. compacted clone so From Bottom of$As to ,s SOIL ABSORPTION SYSTEM (SAS) +' J m 4. This system is subject to inspection during installation Bohan of Test Nola o 3050 INFILTRATOR CHAMBER H-�20 EQUIVALENT) '• ,. .,,•.,. •.� .t. .; , �: . ,t by Carmen E. Shay Environmental Services, Inc. Bottom of Test Hole 1 Elev.- 88.00 NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30" /EFFECTIVE HEIGHT IS 24" �_0• +' -10• 5. The contractor shall install this system in accordance CROSS SECTION END-SECTION with Title V of the Massachusetts state code, the approved plan Groundwater Observed - NONE OBSERVED and Local Regulations. TYPICAL 1000 GALLON SEPTIC TANK 6. If, during installation the contractor encounters any soil conditions or site conditions that are different NOT TO SCALE from those shown on the soil log or in our design installation must halt & immediate notification be made to Carmen E. Shay - Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the ,,tt -D g 0 PERCOLATION TEST septic system unless noted as H-20 septic components. j1V ff R �'h` - ,� �10 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. - Date of Percolation Test: FEBRUARY 17, 2010 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. (40 FOOT RIGHT OF WAY)lq6 �'" Test Performed 8 . CARMEN E. SHAY, R.S., C.S.E. • _,-�.•-" � ,,�57++� ��..-'' ,�0`� ..' r Y 10. All solid piping, tees & fittings shall be 4 diameter Results Witnessed B . David Stanton - Bamstable BOH 5� / Schedule 40 NSF PVC pipes with water tight joints. -----__-_-- 20D EXCAVATOR: Shay.Env. Svcs. Percolation Rater 2 MPI O 60" 11. MUNICIPAL WATER IS AVAILABLE TO THE SITE and Surrounding 52• Properties. NO PRIVATE WELLS WITHIN 150 FEET of PROPOSED SAS ''� ' Test Hole Test Hole No. 1 No. 2 L _- 48.00 \ DEPTH SOILS ELEV. DEPTH SOILS ELEV. � 0 98.00 0 98.Oo THE PROPERTY LINES ARE APPROXIMATE AND i % f COMPILED FROM THE PLAN BY FRRED 0. SMITH % L ` FILL FILL MA, ENTITLED CERTIFIED PLOT PLAN OF 264 CAP N LIJAH S RD CENT. N/F JAMES & SONJA RIORDAN " DATED DEC. 3. 1975 BY THOMAS JACKSON, RLS 0-36 95.00 0"-30 95.50 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN t - LOT 32 ter IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 1 t ` # l� t THE SEPTIC SYSTEM INSTALLATION. 15,201 Square Feet +/- �`. as i 10 YR 3/2 io M 3/z 3r-42• A e 94.50 30"-36" A• 95.00 vs 1\7 �� •s i Sonar Ls,dr NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 10 YR 5/0 10 YR B/B FROM THE EXISTING LEACH PIT TO BE DISPOSED 42"-60• Be 93.00 36"-5W Be 93. OF AS PER BOARD OF HEALTH SPECIFICATIONS. c LOT #31 1 t I Mod-Coarse Mod-Coarso Sand 15 Y 7/4 L3 Sand �/4 EXISTING LEACH PIT TO BE PUMPED DRY & LOT #33 I y I \ 1 ` G G FILLED IN PLACE O t \ 1 60•-144 .00 50•-144" 88.00 PO ASSESSORS MAP 245 PARCEL 066 ZONING - RESIDENTIAL Perc #1 Depth to Para 60" to 78" Perc Rote- 2 MPI NO Groundwater Observed O 144" - I IN GROUND t `� t __ No Observed ESHWT NO WETLANDS ARE LOCATED WITHIN A 200' RADIUS POOL ADJUSTED H2O Elev. None OF THE PROPERTY `� ` 85 p 24 WIT ALL TbBI°�TKs+s�oK s�iAu e�E k N aR win/OR AT LEM a rt 12• . aDHp1ETE K LEGEND � xHocic ouTtEr *. 94------- 1 OUTS ar ,r siLET 8X0 DENOTES PROPOSED 127.72. �`` \` ouTun r SPOT GRADE t50.1�\ Fatted ` ` foe s' Fd)ked Pit X 104.4E DENOTES EXISTING TEST HOLE �f2 ,Z6Lecao �` ��\ `�` 1a • 4• - SCH. 4o r 1.7 SPOT GRADE 7qPLAN SECTION CROSS-SECTION 92 ------ - �.�\ ELEV.- 98.Oo �� e1 �`\ �\` �bQT #27 ��\ PL PROPERTY LINE ` r5 e i 3 HOLE H-10 DISTRIBUTION BOX \\ 15,587 Squo�e Feet +/- �` ----{�j"7-1-- PROPOSED CONTOUR 90---- _ \ �r 'r1 --- -- `` � \ \` �\ ` NOT TO SCALE D-Box `\ 97------97 EXISTING CONTOUR Design Calculations TEST HOLE(1 O � `� `� `\ELEV.=r98. o DECK DEEP TEST HOLE & \ i- p • �`\ �`\ r► PERCOLATION TEST LOCATION NOTE: 15' Breakout met ® Elevation 93.0 ' t 3 SEASON \ \ \� �� S' , �` Number of Bedrooms: 4 Equivalent to 440 Gal./Day 1 O ROOM Garbage Grinder. No FROM TOP OF SYSTEM TO BANK. \, 1 `� sew `\` LOT #28 Leaching Capacity Proposed: 440 Gal./bay Minimum (Min. Per Title V) FENCE t t ► `� CN! �� Septic Tank : - 2 x 440 Gal./bay - 880 USE EXIST. 1,000 GAL Septic Tank. SOIL ABSORPTION AREA: Using percolation rate of t2 min./inch PRIVATE DRINKING WATER WELL # Bottom Area: 0.74 gal/sq. ft. x 430 sq. ft. - 318.20 gallons LOT 26 j 1 j w 04 O Sidewall Area: 0.74 gal./sq. ft. x 212 sq. ft. - 156.88 gallons REVISIONS BXISTIIVG I q Providing: - 475.08 gallons (Subtract 15 gallons for Liner - 460.08 GPD) 4 B8'DROOdf � � H � 40 MIL POLYETHYLENE LINER ; w I HOUSE Use: (5) 3050 H-20 INFILTRATOR CHAMBERS. HAVING A 2' EFFECTIVE DEPTH, N0. DATE: DEFINITION FROM ELEV. 95.00 to 91.00 AND L I 1 f #264 � I (4' W x 7' Q TO BE USED WITH 3' OF WASHED STONE ON THE SIDES AND TO EXTEND 10 FEET PAST I I 1 1 4' OF WASHED STONE ON THE ENDS. L-SHAPE AS SHOWN. A SHOWN #1 3/24/10 Per email by Dave Stanton SAS S NOTE: Subtract 15 GPD from Calculation I PROJECT BENCH MARK For Liner Placed Adjacent to End of SAS TOP OF FOUNDATION I I Chi ELEV. _ 100.00 (Assumed) , I N I I , Cq i ` I EXIST. I I DRIVEWAY I ; PROPOSED y I PREPARED FOR : SUBSURFACE SEWAGE DISPOSAL SYSTEM :34D 30' 31»E �`'' y ; �' JAMES 8c SONJA RIORDAN 264 CAP'N LIAJAH'S ROAD t -------------- --------------�� `� % `\ ��-----------��---------------- .;--------------��------- --------------- ----------------- CENTERVI LLE, MA #264 CAP' N LIJAH 'S ROAD 0 20 40 50 %� g CENTERVILLE, MA 02632 PREPARED BY: CA P '1V L IJ.A H' ,S R OA-D Ili OF „ (40 FOOT RIGHT OF WAY) s C14RHEN R. ,ISHA Y SCALE: 1 =20 �r TE L 5 0 8-5 7 2-49 3 9 E: �' �'NYIRON�lENTAL SERVICES, INC. A ^, OVER THE COUNTER VARIANCE REQUESTED: N . 1 r 185 ASHUMET ROAD 01SjER�° MASHPEE, MA 02649 1. REQUEST A VARIANCE TO INSTALL THE SAS LESS THAN 20 FEET FROM BASEMENTTO THE DWELLING- A 40 MIL POLYETHYLENE LINER HAS BEEN PROVIDED s�NiTAR1P� TEL/FAX 508-539-7966 2. REQUEST A LOCAL UPGRADE APPROVAL To Put AN SAS SCALE: 1"=20' DRAWN BY: CES DATE: MARCH 15, 2010 GREATER THAN 3 FEET BELOW GRADE, A VENT PIPE HAS BEEN PROVIDED. PROJECT#SD-1172 ILENAME: SD1172PP.DWG SHEET 1 OF 1 I i l 2-16' DIAM. ACCESS MANHOLES A 3" of 1/8" - 1/2" Washed Peastone :��r. ,�•c.:��r~'�`:.�:.�:�. .,; sj°, 3/4' to 1 1/2 " DOUBLE Washed Crushed Sto "NOTE: ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. VENT PIPE (0 Least 24 Inches tdl) /^ Schedule PVC w/Charcoal Odor "ter • RIM 10' min. from 4 PVC (CAPPED) INSPECTION PORT TO BE Existing Foundation house to septic tank TOP OF FOUNDATION ELEY. 100.00 (Assumed) 20" Min Septb tank Down must be D-BOXww Grmadi INSTALLED AND TO BE WITHIN 6" OF GRADE `-- ; W # r. ` f within 0 in. of finished grade THE ACCESS COVER!FOR THE SEPTIC TANK. Grad*ow Septic Tank- 9e,20 trod*am D-Box-98.00 ( over SAS- SLOO :. 3 HOLE H-10 DISTRou noN BOX AND LEACHING COMPONENT .. '1► DIET. BOx .r�M .��,,;•-�d�-•r•�,.,.�♦,.,•M1.. ` INCHES BELOW ... GRADE SMALLK RAM TO; j 19, �+ HED STEEL REINFORCED PRECAST CONCRETE FINISHED ORADE s 0.02 INSTALL nr-niz OAS BAFFLES OR EQUALS s Ymdnxen Cowr 24" EffectiveExW PLAN VIEW _ J Top OF Syet*m-Elw. •93./f0 # . . p N 1a 1,0 01 GAL. s-aoN or Qr ot*r Sidewall 3-24•RD=av COMB l FROM ExtsT.FasNDATmN � g SEPTIC TANK ram, to• 4 Units T =28' � `� � i H-10 *` � � coNCRErE "a o "� 2' EFFECTIVE DEPTH NOt t0 Scats 'min olearanoe -••r•.� +• rrr. ` GENERAL NOTES • g Effect ength INLET min, 2•min inlet to nowt r 13' rsT SYSTEM PROFILE $ 0 In•o+3/4-i 1/2" $ r > L. j} VERIFICATION compacted*,,,1e > o O/ 4 4 iTe,,�-- ouTLcr- -}{- T 1. Contractor' is responsible for Digsafe notification, Not to stoic 'c , °' 6 ndw ,r �J ;: and protection of all underground utilities and pipes. 3 1 2' s SECTI N -A -r :' -�• 2. The septic tank / J distri ution box shall be set NOTE: SEPTIC TANK O D-Box TO BE CONSTRUCTED ON LEVEL COMPACTED BASE > S EtF Vldth 4. .min. level On 6 of 3 4 -1 1 2 Stone. s= PROFILE VIEW LEACHING SYSTEM _ uwa sae+ 3. Backfill should be clean sand or gravel with no NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE a In of 3/4'-+ 1/2' S$*p*�t(*,,ProNd.e $ ,+ e. stance over 3" in slZe. compacted *ton• 4 Fran salts*d sAs to S L ABSORPTION SYSTEM SAS o Bottom a Tat Haw : 4. This system is subject to inspection during installation $ CULTEC 050 INFILTRATO CHAMBER H-20 (OR EQUIVALENT) , • .t .; . : »: •. < ' J by Carmen E. Shay -,Environmental Services, Inc. Bottom of Test Hole 1 Elev.- 8e.00 N OVERALL INFILTRATOR IS 30" /EFFECTIVE HEIGHT IS 24" +•-+ 5. The contractor shall install this'system in accordance END-SECTION with Title V of the Massachusetts state code, the approved plan Groundwater Observed - NONE OBSERVED CROSS SECTION and Local Regulations. TYPICAL 1000 GALLON SEPTIC TANK 6. If, during installation the contractor encounters any soil conditions or site conditions that are different _ NOT TO SCALE from those shown on the, soil log.or in our design installation must halt immediatenotification dt be -. - made to Carmen E. SEnvironmental, S i hay , Services, Inc.Inc 7..N v i I r o eh c o h machinery sisal drive h _ N1 m i ! e over t • eavy ry septic System unless" not' as H 2 septic components. OA 17 __ a- u PERCOLATION TEST p � $gat noted 0 pia ca . pane Nr. R --- �� e� 8. Install Tull-rite as baffles or equals on all outlet tee ends. OXN g --- Date of Percolation Test: FEBRUARY 17,;2010 9.: All Distribution Lines-shall be a diameter Sch. 40 NSF PVC pipes. HT OF WAY) 6 ,-- -- --- OT RIG - - ,w Test Performed M _ 0 FOOT d B : CARMEN E. SHAY, R:S.,; C.S.E. 4 - - W - Z Y T .. 10. All IKl piping, to , n h ' i + - 7 - 0David � P P gi ea do-fittings shall be 4 diameter ..s -- 5 ,1 Results Witnessed B . Stan on - rn-_ -- - g � Yt Barnstable a eOH __- - 5joints. Schedule_40 NSF PVC pipes with water tight ---------- � - Op . EXCAVATOR. Shay Env. Svcs. . : P P 9 _ Percolation Rota: 2 MPI O 60" �, 11. MUNICIPAL WATER I5 AVAILABLE TO THE;SITE and Surrounding R -•irQU. --r 52. - --- _. Properties. NO PRIVATE,WELLS WITHIN 150;FEET of PROPOSED SAS -.- Test Hole est Hole' P _.. \ No. 1 � Na. 2 ----' L _48.00 \ ... ,' . ; \ DEPTH SOILS ELEV. DEPTH' SOILS ELEV. . CIE. 0 9aoo o Baoo THE PROPERTY LINES ARE APPROXIMATE AND COMPILED FROM THE PLAN> BY ERRED 0. SMITH FILL FILL MA,, ENTITLED CERTIFIED. PLOT PLAN OF 264 CAP N LIJAH S RD CENT. 1 1 1 \ D DEC. `197 TH A ► DATE E 3i O BY OMAS J CKSON, RLS ► 0 38 0" 30' 115 50 \ AN I T_INTENDED t \ D S NO TO BE A SURVEY PLOT PLAN t 1 s°"dy saNNdy IT SHOULD B USE FOR N PURPOSE OTHER N t \ l Loan, =d 0 LD E D 0 UR E 0 ER THAN 1 i \ LOTS 27 & 32 THE SEPTIC. SYSTEM- INSTALLATION. t 1 \ �♦ i - I 1 � 3Q,78t3 Square Feet +/- � vs 1 10 VA 3/2 10 M 3A i ♦ tC ► A - 1 \ ♦ 38-42 * 4,50 As, 9&Oo 1 _ ♦ IV ' 1 X i 1 Sand 1 l O NOTE..: . ANY STRIPPED SOT CONTAINi HA _ 1 _ ► OUT. 1. NG LEAP HATE 1o,r+t a _ !� 10 rR` ; 1 'FROM THE EXISTING eN E EX NG LEACH:PIT TO BE DISPOSED . F t i 42' 80' Be 93.00 _ e. 93. 38 50' OF PER BOARD OF HEALTHSPECIFICATIONS. LOT 31 AS EAL_ ' i 1 W 1 Mod-Coarse Mod-Coarse = -i 3 1 1 I Sand' Sand • \ 1 t EXISTING LEACH PIT TO BE PUMPED DRY dt w \ \ is Y 7 4 L0,Y 7 4 _ p \ FILLED IN PLACE LOT 33 1 \ \ _ G _ a, i 80 144 .00 SO 144 88.00 C+ `\ j �\ ASSESSORS MAP 245 PARCEL 066 -ZONING RESIDENTIAL ♦ t Pare #1 Depth to Pere 60" to 78 f � \ P 1 o c \ • � Groundwater Observed O 144 - • , 1 IN GROUND .. G UND \ 1 NO WETLANDS ARE LOCATED WITHIN A 200 RADIUS 1 S t s ADJUSTED H v n 1 S 20 Elev.. No • \ P OF THE PROPERTY POOL \ E E 1 \ \ 1 1 t \ . f. z 0 ALL aunr<T PIFE!FROM 241 _ \ Das.iN,laN OOx salt BC N 5 r_ ooNalclF ooval ► FOR A Fr. \ ><f LE1iO. T Lrnsr: LEGEND E EN D ---- .� IallocicauTs 94 - t \ c - ear 1r nsT 8X0 DENOTES PROPOSED atmsT SPOT GRADE \ 6673 1 \ Fa d \ DENOTES EXISTING \ 10`b' _ X 1Q 46,. 4.♦ 4 SCN. T Lea Pit \ \ 40 t. SPOT' GRADE 0 l� -TES�1' BOLE 2 \ PLAN SECTION S 2 \ \ AN SE TI CROSS-SECTION •ryry//''�� n, \ .LlSiLZ 2 _ \ 9 2 \ PL ; i PROP LINE \ \ PROPERTY E \ \ HOLE 10 D ti \ \ . -.-L1. DISTRIBUTION BOX \ \ `_ \ PROPOSE CONTOUR 9 _ \ ?`�- D 0 _ \_ ♦ NOT TO SCALE _ 0 Bo ♦ - ♦ EXISTING' ♦ \ \ 97 97 S ♦ De Nan\ s I�1QL HOLE _ . TEST LE 1 O \ . DECK ' DEEP TEST HOLE` se. \ELEV � . o ♦ PERCOLATION T T T\ ES LOCATION I 3 SEASON \ ♦ \ r 0 NOTE: 15 Breakout e levatl n 93. \E u met E o 0 ♦ \ 3 Number of Bedrooms. 4 Equivalent to 440 Gal. a ROOM \ ♦ � q /D Y f \ Garbage Grinder. No .FROM OP OF SYSTEM TO BANK. � _ ► ♦ T ► ► e \ ♦ FENCE LOT 28 gg E E ' 1 1 � ♦ Leaching Capacity Proposed: 440 Gal. a Minimum Mtn. Per.Title l---- - 1 C! - t Septic Tank.. . 2 x 440 Gal./Day a 8t30 ;.USE EXIST. 1 000 GAL tic.Tank.: ♦ eP /D Y �P i ♦ SOIL ABSORPTION AREA. Uaki percolation rot of min, n - t • Q cis PRIVATE 1 � DRINKING` WATER' WE rLL ! \ , � Bottom Area. 0.74 al ft. x 430 � 31 O II LOT 26 1 t � �. 9 /M sq. ft. 8 2 ga on• 1 I O 1 �' TING \ V'? Sidewali Area. 0.74 gal./sq. ft. x 212 Sq. ft. 158.88 gallons �� XIS G 1 Providing: m 475.08 gallons 1 �� , q � g g REVISIONS 1 1 4 9RDROO�f I tee t � 1 tee y w 40 MiL POLYETHYLENE LINER EousR r �� _ � NO. DATE. Use:. (5) 3050 H 20 INFILTRATOR CHAMBERS, HAVING A 2 EFFECTIVE-DEPTH, DEFINITION FROM ELEV. 97.00 to 93.00 AND 1 I ! y _ ! 1 , 1 #284 � i (4 W x 7 L) TO BE USED Wl 3 WASHED STONE ON THE SIDES AND TO EXTEND 10 FEET PAST. f t I . t I 1 4 OF WASHED STONE ON THE ENW L-SHAPE' AS SHOWN. SAS AS SHOWN i I 1 t PROJECT BENCH MARK TOP OF FOUNDATION ELEV. 100.00 (Assumed) �I` N` D IST.AY q ; I I PROPOSED lol/ y , I f PREPARED FOR : y SUBSURFACE SEWAGE DISPOSAL SYSTEM ' `34D 30' 3 i►"E I 1� O F ' ;�♦ JAMES 8c SONJA RIODAN --------------------------- -------------- =-.-------- ------ ------- ----�- 264 CAP N LIAJAH S ROAD \I \ --------------------------- #264 CAP' N LIJAH 'S ROAD CENTERVILLE, MA 0 20 40 50 o CENTERVILLE, MA 02632 PREPARED BY: C�4 P N L_%.,rA.H' S` R OA IJ _\ti OF SCALE: , 1"=20' (40 FOOT RIGHT OF WAY) CARHEi V Es SHA Y �o= N "c TE L # 5 0 8-5 7 2-49 3 9 i ENVIRONMENTAL SERVICES, INc.41 OVER THE COUNTER VARIANCE REQUESTED: u. • 1�s1 ,� 185 ASHUMET ROAD MASHPEE, MA -02649 1. REQUEST A VARIANCE TO INSTALL THE SAS LESS THAN 20 FEET FROM SANITAR\P� BASEMENT TO THE DWELLING- A 40 MIL POLYETHYLENE LINER HAS BEEN PROVIDED TEL/FAX 508-539-7966 2. REQUEST A LOCAL UPGRADE APPROVAL To Put AN SAS SCALE: 1"=20' DRAWN BY: CES DATE: MARCH 15, 2010 GREATER THAN 3 FEET BELOW GRADE, A VENT PIPE HAS BEEN PROVIDED. PROJECT#SD-1172 ILENAME: SD1172PP.DWG SHEET 1 OF 1