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HomeMy WebLinkAbout0009 CEDRIC ROAD - Health 9 Cedric Road, Centerville r 1 i � llT/1/L�Cli� s y UPC 12543 a No.53LOR o�PoS7•CON`'J�� HASTINGS, MN TOWN OF BARNSTABLE LOCATION qk � `��� � �SEWAGE# VILLAGE� .1���J' iVsi�\\ ASSESSOR'S MAP&PARCEL g INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (-Size) $" A NO.OF BEDROOMS (1 OWNER� ►�.�9.rtiac�6 r r c c�z� PERMIT DATE: COMPLIANCE DATE: "'7' 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility > 57 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ���.�� �� �a�s� � J --row,,i. f, w � ��-� v�e��' w�``G � J ® v! � F. y� r ,v,f+ � � 1�. �`' - 1 r' �� ' •,� , � ,,. ,�.,�, �, a �� � �� ` r � � - � � � � 3� Y .' 1 No. / 13 Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS _ 2[ppYication for'bisposal 6pstem construction Permit Application for a Permit to Construct( ) Repair(;/Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. CC B'o� Owner's Name,A dress,and T 1. Assessor's Map/Parcel Installer's N e,Address,and Te.No. S"n. 'ff`'QnS:5 Designer's Name,Address,and Tel. ©—2 j;l Type of Building: Dwelling No.of Bedrooms Lot Size �T�' sq.ft. Garbage Grinder( ) Other Type of Building So c::-_4�? No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) C7�) gpd Design flow provided_y `� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1SQ � k pe of S.A.S.� +,,,t�. � c ,,,,�,, r.,/ •� Description of Soil Nature of Repairs or Alterations(Answer when applicable) j,. t,,o t� �, �.•�— Q �D2-- 1 �in" 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 alth. Signed- Date / Application Approved by Date Application Disapproved by Date for the following reasons Permit No�O�;L/ Date Issued y r ew No. / / F'. , Fee �.� dJ d'..- THE COMMONWEALTH OF MASSACHUSETTS Entered;ncomputer: Y es PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS l lYiLatIOYC fD � dal 6"tern Construction 3permit ; Application for a Permit to Construct( ) Repair(01"Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. C t°`�G. 'V44CU Owner's Name,Address,and T 1.No.71 y_ Assessor's Map/Parcel ^� Installer's N e,Address,and Te.No.$-tZ Designer's Name,Address,and Tel.14o.$b?t-3G p,,q'3/l F_A�e_4 Cr'+►-1"C_, :t� %.--r-- A %,%G Type of Building: Dwelling No.of Bedrooms _ Lot Size , 77 sq.ft. Garbage Grinder( ) Other Type of Building Q Cj No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided gpd F - Plan Date Number of sheets Revision Date Title Size of Septic Tank, QQ G4 �� �-s't pe of S.A.S.�S. Description of Soil �G--E. ✓ f Nature of Repairs or Alterations(Answer when applicable) t l 1�h d C�j �/� R ��© �.,�.��ni lam. N"�G ✓� C+ �� vp.d.r LA--t h r� e,-,I 7 r R Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of tLealth. Signed Date S" r Application Approved-by, Date Application Disapproved by Date for the following reasons - Permit No�p Z) 1 / - Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage-Disposal system Constructed( ) Repaired( Vr Upgraded( ) , Abandoned( )by e_�� './_�e., ._ . at� ��,��t`� e., > has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N . , j-- dated Installer c;1,-�-ha;—_ .s <z #bedrooms _ Approved design flow j gpd The issuance of this permit shall not be construed as a guarantee that the system will771/r.(6 designee;`d. Date �(6-? 1) InspectortYi-.� No. a 13 cl;k_ Fee /�",e) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pBtrm Construction permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) > System located at C3;t! s 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 completed within three years of the date of this permit. Date APProveB by Town of Barnstable Recto Sorvices K R1@hard Va s@a1k1nt@ Dir@*t@r -Public Hoalth Division Thomas Mean9 D1roct®r 200 Main Buff HY11DR159 MA 02001 ®fey: 500=162=4644 Fai 508=790=630.4 fiqptiogyOffifital d6i)(41- s � � /� b.@dm &d@§igndfgtwnby Mtmte L9 dates 1 7-O LI � A . �yo r@ mood i[bov@ wu t�11od §ubstmOall � to the desip wh1oh may 1h@1ud@ ftfiflor AP Proved 6cirtgoo ffu@h a 1ftord Wowtion ®1 tho d1otribution box mWor ®moo twAk. St out (if requt ) wn Wpwwd @nd the §@11§ +ere fowl oatidatofy: I @elf►► that the septic a atom rofor ad above wo tafled with m or @hanged (Lc water t 10' 1atif�f� ooftion of the SA ®f any V@f d W1 M®Nt1®ft Of MY @OMPOf1@f It ®f the§ept1@ By§t ) but in mor&nw with stag & Lowl 1e at : Plim MAi1off Of g fi@d wbullt by d@stp@r to Wow. Strip out(1f re wu Impmed md die @@11§ Were find ®atidc1®r+: 1 c@Mfy that the qstom refereed above wu constrwod 1fl @mpfl@A@o with the term cif th@ AA approval 1@tt (if App11od1 le) . aki _ 2? 1�1 710 ON P@t t � l T >t: Commonwealth of Massachusetts -139 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Cedric rd c Property Address a•• Karen Newman Owner Owner's Name / ,� information is Centerville V Ma _02632 10/31/16 required for every - _ � page. City/Town State Zip Code Date of Inspection I\7 W 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. General Information 61-4f Q6770 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return key. Name of Inspector DiBuono Sewer and Drain ,ae Company Name 8 Johns path Company Address S Yarmouth Ma 02664 City/Town State Zip Code 508-364-9587 _ S103522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further E _ ;a 'on-by the_Leej pproving Authority 11/2/16 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �0 ffoixi vs Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 9 Cedric rd _ Property Address Karen Newman Owner Owner's Name information is required for every Centerville Ma 02632 10/31/16 wpage. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates-that,any-of-the failure criteria described in'310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments.- System contains a 1,000 GI septic tank as well as a concretre distribution box and 24 plastic infultrators. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain-below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •''v 9 Cedric rd Property Address Karen Newman Owner Owner's Name information is required for every Centerville _ Ma 02632 10/31/16 page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due ,to broken or obstructed,pipe(s).or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal S stem Form - Not for p Y Voluntary Assessments 9 Cedric rd Property Address Karen Newman_ Owner Owner's Name -- information is required for every Centerville __ _ _ Ma 02632 10/31/16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system y , 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 wi thin' 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than h daY flow 15ins•3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Cedric rd Property Address Karen Newman Owner -------- --- --- ----- --- - ------- Owner's Name information is required for every Centerville _ Ma 02632 10/31/16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped.- ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP_certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered'a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts r W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Cedric rd Property Address Karen Newman Owner Owner's Name — —" information is r6quired for every Centerville Ma 02632 10/31/16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the,previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System"(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3-- - Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Cedric rd Property Address Karen Newman Owner ----- ..... ---. --- -- Owner's Name ,information is required for every Centerville — _ Ma_ 02632 10/31/16 page. City/Town _ State Zip Code Date of Inspection D. System Information Description: System contains a 1,000 GI septic tank as well as a concretre distribution box and 24 plastic infultrators. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 218 Gpd Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: — Design flow (based on 310 CMR 15.203): ---- ------------- Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 a Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System'Form - Not for Voluntary Assessments 9 Cedric rd PropertyMdress _ Karen Newman Owner Owner's Name information is rettuired for every CitCenterville _ _ Ma 02632 10/31/16 _ _ page. y/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information I� Pumping Records: Source of information: pumptd 2013 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? - --- --------- Reason for pumping: ----- Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Cedric rd Property Address Karen Newman Owner -- ---— -- _...__..--- -------- ------ Owner's Name information is required for every Centerville _ Ma — 02632 10/31/16 page. City/Town - -------._---- State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 5 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): --- Distance from private water supply well or suction line: feet — Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof Septic Tank (locate on site plan): Depth below grade: -- -- feet Material of construction.- concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, list age: ----. _ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No° Dimensions: Sludge depth: -- t5ins•3/13 7itle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts F Title 5 official Inspection Fo rm _ — Subsurface Sewage Disposal System Form - Not for VoluntaryAssessments \a 9 Cedric_rd _ Property Address — - ---—- Karen Newman Owner Owner's Name information is required for every Centerville Ma 02632 10/31/16 page. n ------ ----a Cit /Tow Y State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42 Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, iliquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of Ieakinq,Tees and or baffles in place at time of inspection. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Cedric rd Property Address Karen Newman Owner ---- ---- -- - ---- -- ----- Owner's Name information is Ma 02632 Centerville 10/31/16 required for every ---------_....---_...-----.. - _ ---- __. , . page. CltylTown _ —_ _State Zip Code Date of Inspection D. System Information.(cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and levels are normal. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: - Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: ---- -------.. ----------------- - gallons Design Flow: — --_ gallons per day Alarm present: ❑ Yes ❑ No Alarm level: -- --- --- --- — - Alarm in working order: El 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form — 6 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Cedric rd Property Address Karen Newman ---- -- -- ------_______.._----------------._----Owner Owner's Name information is required for every Centerville Ma 02632 10/31/16 page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): __._._..---------- Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Karen Newman o Owner OwnWs-Name information is required for every Centerville Ma 02632 10/31/16 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) E] leaching pits number: El leaching chambers number 0 leaching galleries number: � 0 leaching trenches number, length.- 0 leaching fields number, dimensions: 453 Sq Ft Fl overflow cesspool number: Fl innovadve/a|ternad«enys&am � Type/name oftechnology: ------'--'---- Cnmmento (note condition of soil, signs of hydraulic failure, level of ponding dump soil, condition of vegobohon. etcj� ' ' � �������� __ ' Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration | Depth —hop ofliquid to inlet invert Depth of solids layer Depth of scum layer | Dimensions of cesspool | . Mab»ho|n of construction Indication of groundwater inflow El Yes NoTille 5 Official inspection Form:Subsurface Sewage ` ounos" oysw=-mo 13m,r Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments lea' 9 Cedric rd Property Address Karen Newman Owner ---- -..------------- --- ...... wner's Name information is Centerville required for every Ma 02632 _ 10/31/16 page. City/Town _ State Zip Code Date of Inspection D. System Information (Cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No ponding no break out Privy (locate on site plan): Materials of construction: - - - --------------- Dimensions ----- - ------- Depth of solids --- — Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Cedric rd _Property Address ..--------_..---- ---------- - —— Karen Newman Owner -- --- - -_ .. ... .. _. ----- ------ ------- Owner's Name information is required for every Centerville -- Ma- 02632 10/31/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Cedric rd Property Address Karen Newman Owner Owner's Name information is required for every Centerville _ Ma 02632 10/31/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed. 11/23/10 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I I yo) z I. f TOWN Or BA RNSTARI,I�; LOCATION -S[..1�AGE VILLAGE C1o� - __-----/1SSF�SSOR'S MAP&PARCEL/? „�Z h'------- INSTALLER'S NAME& 1 l IONE NO. SEPTIC TANK CAPACI"I'Y LEACHING FACILITY; I NO-OF ) __`,��, •:. . �.r!. �� (size) _ . i3EUROOMS •� -,?-----_-,-- - ✓ r OWNER PERMIT.DATI;: -- ...__._.... -..._._ ---._... .._ — _ _..... _ _-- -- COMPLIANCE I)AT'E: `Separation Distance Be(wccn the: Ivlaxitnurn Adjusted Groundwa "'able to.t6c 13uttom o1'L,caching Faci.lily f t Private Water Supply Well a ter nd ter site or wilhitt 20p feel of IcachingLe�lcililltfacililtyl)- (II any wells exist Oil ----Feet Edge of Wetland and beaching F'acilill'(flan we; --__. 3 tlands exist within 300 feet of leaching facility) --- FURNISH ED '13Y �.y;/ ���,�. ` _.. ---------Feet _ . ....,. Erb F Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a „ 9 Cedric rd Property Address ---------------------------- Karen Newman Owner ----- ._._..- _ .. _... -... --------------- Owner's Name ----- information is required for every Centerville Ma_ 02632 10/31/16 page. City/Town ---------__ -_.__-.. State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. Fee �90 THE COMMONWEALTH OF MASSACHUSETTS Entered in comp ter: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplication for ]Disposal *pStem Construction 3pPrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. '/'C9epri-Rd`Ce4 4ef v;//P_ Owner's Name,Address,and Tel.No.S •4A29-SrsZ.0 Assessor's Map/Parcel a /38 t Pt'LI►� 9 t1G - Clseni ���e 3 nstaller's Name,Ad,dres�ss and Tel.No. 3716'p Designer's Name,Address,and Tel.No. Oxon ' w: ineed djRin 6 ; !s A o & je a � ��9 Type of Building: Dwelling No.of Bedrooms J Lot Size /51 369 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r� Design Flow(min.required) 33c) gpd Design flow.provided 3 gpd Plan Date I�biL(r1. P� /� ;DO 1 d Number,of psheets j Revision Date Title Ptj,4n O�—) or Size of Septic Tank t7)(P�-j MJ j7Y)!i j Type of S.A.S. jc! Description of Soil gAd 150,1 4e6 y Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environm ode and not to place the system in operation until a Certificate of Compliance has been issue this Board of d b Heal ed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 4WILDate Issued Fee No. Y r s THE COMMONWEALTH OF MASSACHUSETTS Entered in comp to ! ' PUBLIC HEALTH, DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[pplitation for 33ispoBal *pBtem ConstCUttion j3prmIt \ Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. -? Ce�u r;c Rel_CIe-r)k rv/Ile- Owner's Name,Address,and Tel.No. 5 Oa-V,2g-gj�%gyp Y Cpdr1G �. �e/ X 464 Assessor'sMap/Parcel - ��"I�KlU! Installer's Name,Address,and Tel.No. 5�6 9 4. Designer's Name,Address,and Tel.No. (Dt-610#�C4A1SfrZX$1 o#'1,ind gt5t,44:"T 6uale e_Erarrwfari� f39*q;1�_917 G Type of Building: . n DwellingNo.of Bedrooms _ '°*�.,_.Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No."of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) � (� gpd Design flow provided .3�� gpd Plan Date � i bry,�►or 19 Number of sheets Revision Date Title ti Size of Septic Tank �yi �. �� G�f1 Type of S.A.S. jq Description of Soil �R �,,,� �„` <+! r� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmentat"ode and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health./ ig ed /� Date / { Application Approved by ( Date VV Application Disapproved by Date for the following reasons Permit No. Date Issued ___Aa/0 =YV4 THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE,MASSACHUSETTS CPttlfltatr of Compflante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�}� Upgraded( ) Abandoned( )by ® �(��, in -I rnkC_ atQ r?,C e4'4er i I/& has been const cted in ac ordance with the provisions of Title 5 and the for Disposal System Construction Permit No "" ed Installer Designer #bedrooms Approved design flow ��1 gpd The issuance of this permit shall/nnot b construed as a guarantee that the system wi'1'l`funct'o esigned. Date 16 fU Inspector ----- - - ----- ----- ------------- -------------- -- - ---_--------------------------- NoI^ Fe OL— THE . COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Disposal *pstrm ConstCULtion VPrmit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at i i 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:Const ctio ust be completed within three years of the date of this permit. Date Approved by • FROM :down cape engineering inc FAX NO. :15083629880 Dec. 10 2010 10:14AM P1 gulat + � � ,kr.olvrata Gi'. b�ci)~�;r•, i):fl9•��'C:o�i' I4 nr.�trrsra�o..�, E p d WAi,S. �u/ s�tiRi3l.l1�: l �s:a�k�ltn �r<}�ndi. tani?n ?:1,b41 R'Nliiion bl�rer�11', &9y��krn°, TVI/'�QD2fi�?lL Qf.&,,e: 50F,11t62-�611 Fax: 309-790.f-i304 7a�sn�:a�mu'n� HAe��'g�nnc:�-�:�;'rdii�sa�a�taahnn iT+'i�>l:'�ur: Dole. L.j v\, Q. 1t'IQGr� T[¢um�'��llll d: �C)044/0 A4��+. wa: issued ape mn'.[ _c>iris(all a d�otel (ulstall�:g) serti.c:syste-m at Q.r C Q 'msed ou a dcsigu drawn by i:r�iclre�;s) , �Arl1 t/ a, r`. �L.J rl�teci 1� /9 //c) - - isiglarr .1 cel.-Li.l'y that the ser-do sysL(:TIl ri.11rE:IiL'ed above as 'ha.stal..l.ed s,-ubstunliitl.ly ac'cordiuL , to the deslgz4 iy.Ei.cF► may include. minUT approv;d c),iu.Lges sucla ns tatel:ai. 1•elcicuLiol:t of the dis'trihuLiou l ux Ltd/o.r..sertic;:anic. l ec.rtil� th'A lho, sE:lic: systm .refel:e serf ali,ove.was MsLttlled. with major eJa,iuge-,i (i.-c-- }Fre,tlt.r tlla.,n. 10' I-,IlMd rE%loc at cm of the 33ht3 Or stay vett.acai reic>c:KtLtoil of any GC1t7i}7nl��,xif o-F the s(:pt1C: system)but in ar_cord'arice. W3tl'1 stab. k, LOV,,91.R'e1?131-lti0llN. l'laT1.Tt' lSloil 01: cerfi 1.1td its built:by desip., er i:n lollo'w'- n,�1'Ast4' `l�G+ter"----•-�-9�5 'ANit t rl (l.Gstuller's Sif rl331e) civil ��}C:i1�,71C%I'�u i1f711ri'�Lll-t�. tt��li%��)e'�)i?Elt%T'ti iit3:lf!'�J 1-icic:) " _ x_a.,.u;AS'R—Rr:tiURIN' 11) i Aft STABLE PUBLIC :ALPAL I'll lr[�o���niv=....._.r;ERTIr,,�q Ct TIT,-0_F?. C0WLi iC,, WiiLj,.i°t Yj' :-C ii�731 ,119 U-11UTT, BOTH THIS„l{c RAI AND L-4-WTnJ.'k CARE) , TI—E l[k 1:EIVED 1$X'Q'F6> O:.H.catth/5r.,pY.i:.rT>e°ie�cr Cnrz:GWz;o�i ror•�_�-?.G-O,+,do�; TOWN OF BARNSTABLE LOCATION SEWAGE# t?/D VILLAGE e j, Ile ASSESSOR'S MAP&PARCEL/37- .INSTALLER'S NAME&PHONE NO. a//, i� SEPTIC TANK CAPACITY /"00.0 LEACHING FACILITY: (typ e- t/r (�y� (size)br 7 sr.6'T NO.OF BEDROOMS 5 OWNER e / PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on _ site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within �. 300 feet of leaching facility) Feet FURNISHED BY r� 7' �Q i s . /o 7 go <( I M T6wn of Barnstable iKE ,'ll�epa`rfm' ont of RegtllPublic Healik'My's �touy Services ioli ](Me � 1" g 200 Main Street,Hyanuis MA 02601 rpy�. ti� aJ? Fee Pd. a Date Scheduled_ l 0 Time 0Soil Suitability Assessrizentfor Sewage 4sposal - Spr Pcrfonned By: GE �/✓1�-+ Witnessed By: " LOCATION ark GENE'R §.JL ENTORMA7CI Location Address Owner's Name w / Address Assessor's Map/Parcel: "� / ° Cngiiteer's Name LA) NEW CONSTRUCTION REPAIR Telephone it Laud Use Slopes(%) Z�C) Surface Stones Q C V Distance's from: Open Water Body ft Possible Wet Area fl Drinking Water Well ft Drainage Way A,1,4� —ft Properly Line 76 ft Other ft S��JLl +T CH' (Street name,dimensions of lot,exact locations of lest holes&pert tests,locale wedunds'i d n pro)dnuty to(toles) ���ii✓ �~` mod TsZO i 4f Li.�.� �Z Parent material(geologic)_ V�W� ~� Depth to Bedrock ` Depth to Groundwater. Standing Water in I101e: -tjo N Weeplltg I)-bill Pit Fit" Estimated Seasonal High Groundwater Dl TEMU NATION r OR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: /�" In, Depth 10 SQ11 amid-s: IIL Dcplh to weeping from side of obs.hole: -__ Ill, Gromldwater AdJus(hlent„a�,_,„,•_,�,•__ft. Index Weil 0 Reading Dale: Index Well leYnl._,__ Adti.fact,),' A41.CRAIlldwatel'Unv l�R PERCOLATION 7CEST � ADtaghs:,_; Timm /n Observation Hole tP fe rinse nt 9" Depth of Perc aTJ t, Tlmc at 6" /0•Z�— Start Pre-soak Time @ �a 40 Time(9"-6') End Pre-soak { Rate Min./Incll r Site Suitability Assessment: Sile Passed _ Silg-Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Colnpieted on Back--- - -- ***If percolation testis to be conducted within 100' of wetland, you ,)lust first Uotify the. Barnstable ConserVatloll I)iV1Si0II It le lSt 011C (1) WCC1C prior t0 beginning. QasEPTIC\PERCP0RM.DOC DER Depth from llb.OBs]E](2VA'�'I®I�T�g®L i-LOG Soil Horizon Soil Texture ��®la?#, Surface(in,) Soil Color Soil• Other , (USDA).. (Munsell) Mottling (Structure,Stoncs;Boulders, ` A C• ieYn � I Con istene I%' ravel rM ye -- /Za C A444 'ff r)i qr - DER P OBSERVATION-ROLE' LOG Depth from Soil Horizon Role ff Surface(in.) Soil Texture sail Color (USDA) Soil Other (Munsell) Mottling (S'tructure,Stones, Boulders. d lP Consis enc %Crave) Z - --—_ 2/ZU D1CICP ®BSERV��"I�N k3®LE Depth from Soil Horizon L .-giC9](? Surface(in.) Soil Texture 5011 Color. soil 5oi I (USDA) (Munsell) Mottling Other Boulders. Consistency %(3-ayr l C J . S. l ' 'J � 1r• , Depth from Soil Horizon Hole# Surface(in.) Soil Texture F ,,Soil Color soil (USDA) ,• Other (Munsel)) Mottling (Structure,St oneS; Boulders, Consistency %Orav� rl � F" v --, J Il 1®od]fnsaPrance Rate Above 500 year flood boundary No— Yes——P\- �i f Within 500 year boundary No Yes ' Within 100 year flood boundary No Yes ]i�elrtpu of 1`�rtturally�cca�rring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed Por the soil absorption system? If not, what is the depth of hatttrally occurring pervious rnatorital? I cerN�/ that on ...: (date)I have passed the soil evaluator examina[ion approved by the Department of Environmental.Protection and that the above analytsis,was performed,by me consistent with the required training, expertise and experience described in CIO CMR 15.017. �. Signature (i1•t G Datb Q:IS.EPT1C\PERCFORM.DOC ........... ........ - --------- --1 11/161, - 21'-11 13/16"- 3,-3 51b" 4'-1 1 13/16" V-5" 3- 4--11.1 2MOPH 2b400H ---------- 9068 Qs- 524R C? in m IQ V, Tl cn Ln Ln J LL LIVING AREA q2b 50 FT ro v Commonweatfh of MassachusettsFVF r • ExecufNe Office of Envlronmentol Affairs MAY' Department of T 1 pp Environmental Protecti� H�To rTAa<< WWlam F.Weld o Core Arpw Paul wu"i � spa • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Addreee 9 Cedric Road Centerville ,Mass . Addseas of owner. Date of Inspection: 4/14/97 (If different) Nameofln,pector. Joseph P.Macomber Jr. Company Nacre,Addrew and Telephone Number. J.P.Macomber & Son Inc. cEItTIFI 66 Ceenl,A,eerMville ,Mass ,02632 508-775-3338 I Cart*that I have personally inspected the sewage disposal system at this address and that the information reported below is true,aocurata and Complete as of the time of inspection. The inspection was performed based on may training and experience in the proper Auction and maiatsnance of on-site"wage disposal systems. The system: ._. Conditionally Passes Needs Further Evaluation By th-eI L�oW Approving Authority _ Fait � Inspector's 8lgaature: G ' Date: Tba System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is.a ah&M gstam or has a design Dow of 10,000 9Pd or greater,the inspector and the system owner shall submit the rePort to the appropriate regional office of the Department of Environmental Protection. - Ths original should be sat to the system owner wd oopba sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A B. C,or D: A) SYSTEM PASSES: _k_ 1 nave sot found a�information which indicates that the system vioLtes any of the tatlu v criteria u daIInw is 910 CMR 15.303. A�taihrre criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: Ons or more system oomponaats need to be replaced or repaired. The system,upon Completion of the replacement or repair, Passes inspection, Indicate yea, no,or not determined(Y.N,or ND). Describe basis of determination in all lnstancee. If"not deter nined•,explain why not) The Mltic tank is metal,cra:ked,'"cturally unsound,shows substantial inAltration or ex ltration,.or tank Ujiure is imminent. The system wiU pans inspection if the existing septic tank is replaced with a conforming septic teak as approved by the Board of Health. (rented 11/03/95) 1 One Winter Street a Boston,Masaachu►etts 02106 Is FAX(617)$56-1049 a Telephone(617)292•5S00 0 rmied on Raryded Papa • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontlnued) Propestymcire" Cedric Road Centerville ,Mass . Owner eorge Fonseca Date or Insp"tiow 4/14/9 7 B)SYSTEM CONDITIONALLY PASSES(coatiauad) Sewar backup or br"kout or h0h static water level observed in the distribution boa is duo to hrvkon or obstructed pipes) or duo to a broken,settled or uneven diAr3ution ban. The systam will pass inspection if(with approval of the Board of Health): broken pipe(&)art replaced obstruction is removed distribution bar is livslled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pa&& inspection if(with approval of the Board of Health): broken pipes)art replaced obstruction Is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTEU j_ Conditions exist which require Anther evaluation by the Board of Health in order to dster&tine if th1 system is failing to protoa Lh& public health,safety and the eaviroamaat. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINER THAT TILE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: a Cesspool or privy is within 60 foot of a surface water AV Cesspool or privy is within 60 foot of a bordering vegetated wetland or&salt marsh i) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER. IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. Ab The system has a septic tank and veil absorption system and is within 100 feet to a surface water supply or ti-mrtary to e surface water supply. �Q The system has a septic tank and soli absorption system and is within&Zone I of&public water supply well A(Q The system has a septic tank and&oLl absorption system and is within 60 feet of a private water supply wail 426 The system has&septic tank sad veil absorption systam and is Is"than 100 feet but 60 feet or mono bum a prmats wane supply w4 unlee&a we11 water analysis for ooliform bacteria and volatile organic compounds indkatw that the wall i& &" from pollution from that facility and the presence of amm air nitrogen and nitrate nitrogen is equal to or leas than 6 ppm 3) OTHER (revised 11/03/95) 3 a • r ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddre" 9 Cedric Road Centerville ,Mass . 02632 Qwnet. George Fonseca Date of I=P"Uon: 4/14/9 7 D) SYSTEM FAILS: �r2 I have determined that the system violates one or more of the following failure criteria as defined in 310 CI M 15.303. Tba 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"wage into facility or system component due to an overloaded or clogged SAS or cesspool. �Q Discharge or ponding of einuent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. LO Static liquid level in the distribution boa above outlet invert due to an overloaded or clogged SAS or cesapooL Liquid depth in cesspool is Is"than 6"below invert or available volume is less than 1/2 day flow. .&0 Required pumping more than 4 times in the last year N0_1 due to clogged or obstructed pipe(s). Number of times pumped ,& Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. �[Q 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 60 feet of a private water supply well. Any portion of a cesspool or privy is Is"than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has boon analysed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,sunmonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system sesvoo a facility with a design flow of 10,000 gpd or greater(Large System)and the system it a significant threat to public health and safety and the environment because one or more of the following conditioas eslet: the system is within 400 feet of a surface drinking water supply &P the system is within 200 foot of a tributary to a surface drinking water supply Ub the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owaar or operator of any such system shall bring the system and facility into NU compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional offlos of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST propertyAdares09 Cedric Road Centerville ,Mass . 02632 Owner. George Fonseca Date of Inspeotioa:4/1 4/9 7 e Check if the following have been doer ZZ::�=compondnu a was requested of the owner,occupant,and Board of Health have been pumped for at least two weeks and the system has been receiving normal now rate, during that period. Large volumes of water have not been introduced into the system receatby or as part of this inspection ;4*"rf'4 plane haw been obtained and examined. Note if they are not available with N/Ality or d was ins for of wen welling pecbd suss age back-up. . The system does not read"non-sanitary or industrial waste now ,�Ths$ite was inspected for suss of breakout. �Z�AIUIoomponanu.Cluding the Soll Absorption Systems, haw been located on the sits. tank manholes were unwvered,opened,and the interior of the septic tank was inspected for condition of baIDes or toes,matarial of construction,dimensions,depth of liquid,depth of ahulp,depth of scum. 27U sise and location of the Soil Absorption System on the sits has been determined based on or • prozimatsd by non-intrusive methods. The facility owner(mad ooasPants,if different from owner)were provided with information on the proper mainteaancs of Sub. Surface Disposal System. (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddxr." 9 Cedric Road Centerville.Mass . 02632 Owner. George Fonseca Date of Inspection: 4/14/97 FLOW CONDITIONS RESIDENTIAL- Design, now =ieAe -1 • Number of bedrooms: '` * Number of omreat resldenta: x Garbage grinder(yes or Laundry connected to system(yes or no): s Seaso Water al use readings, if available•_lid c ew Water meter JW*"d-? / S Lan date of occ upaacy::6�z� COMM ER C IAL/I ND U S TRIAL: Type of enabliahment: .0* Deeiga flow:,j10 PWona/day Grease trap present: (yea or ao)L.)-)q Industrial Waste Holding Teak present: (yea or no)d2,:4, Non-sanitary waste discharged to the Title 6 system: (yea or no)-, j 4 Water meter readings, if available:_ Ad y Lan data of occupwwr. A14 OTHER: (Describe) AIA Last data of occupancy: n%rt GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped"Pan of inspection: (yes or no) If yea,volume pumped: /Oeb ns Reason for pumping:- „Iz•'7 0t--1i o TYPE OFF YSTEM _., BeDtie taaWdistr0ution box/soil absorption system _61d Sim oeespool —22d— Overflow cesspool Privy Shared system(ya or ao) (if yes,attach previous inspection rsoords, if say) other("plain) APPRO)aMATE AGE of all components,data ia.stal W(if known)and source of informatics: Sewage Odors detected when arriving at the site (yes or no) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C• - SYSTEM INFORMATION (continued) Property Address: 9 Cedric Road Centerville ,Mass . Owner: George Fonseca Date of Inspection: 4 114 19 7 SEPTIC TANK: (locate on site plan) Depth below grade:_og Material of construction: concrete _metal _FRP _other(explain) Dimensions:_ Sludge depth: Distance from top of s dge to bottom of outlet tee or baffle: O_ Scum thickness: (J ^l Distance from top of scum to top of outlet tee or baffle: V Distance from bottom of scum to bottom of outlet tee or baffle._ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffle. depth of liquid level in relation to outlet invert structural rity, evidence of leakage, etc.) Pump segtie tank every 2-3' years : Inlet & outlet'-tees _-'are ; n j,aC'P :,,e tic tank is structurally ,S,pud• The septic shows iropccoTv" is was for m Zn enance pur os .s on y. GREASE TRAP. 4bit— (locate on site plan) Depth below grade:'/y/4 Material of consimrti6n.4/94:oncrete _metal _FRP_other(explain) Dimension;- Scum thickness: ' .. Distance from top wi scum to top of outlet tee or baffle:IV/? Distance from bottom ni srum to bonnm of outlet tee or trahte ,01' Comments: (recommendation for pumping, condi—n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.i_�^ C rease trap is not present. (revised 0/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) propO1.t,Addrem 9 Cedric Road Centerville ,Mass . O uer. George Fonseca Date of Inspeotion4/1 4/9 7 TIGHT OR HOLDING TANI{s�jiW� (locate as rite plan) • Material of constructioW.4400ncrete_metal_yRP othar(esplain) Dimensions: A)14 Capacity: A),* gallons Design flow:_,U)4 gallonrJd�Y Alarm level• Comments: (condition of inlet toe,condition of alarm and float switch",etc.) lightor hoiing tanks are not presen . DISTRIBUTION BOX: (locate on sits plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is wm&L evidence of solids carryover,evidence of leakage into or out of box,etc.) D-box is level with one outlet in use : No evidence of solids carry over. o evi edence of eakaee in or out of the box PUMP CHAMBER:—!j ?'C. (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Pump chamber is not present. (revised 11/03/95) q . U SUBSURFACE SEWAGE DISPOSAL SYSTKW INSPECTION FORM PART C SYSTEN IMRMATION(ooatlnuad) PsopwtyAddr,,a 9 Ceddric Road Centerville ,Mass . Own" George Fonseca Date of Iasp.oNoa: 4/1 4/9 7 SOIL ABSORPTION SYS= 00094 cm efte PIA4 if possible;e:oavation not tequbvd,but my be approximated by a0a4atruaivs methods) It not determined to be prwant,eaplaiw TyPw L"hin pits,number L+chia j chambers,aumnan leach pLaUs,number — le"hinj trenches,numba lanith: wwla"oaaspooL number. V Cammants: (note condition of*4 mine of hydrauiio&Uurs,level of pondin&00ad1110a of ve�etation,ete.) Medium sand to fine sand: No suns of hvdraulic failure or pon ing: A11 vPUPtat nn Js normal CEWPOOLS:I Uocate on site PILO Number and ooafipratios Depth-top of HquW to inlet invert: Depth of solids Lyar.�_ ' Depth of scum Lyor. Dimaasi0ns of oaspool: Idatasials of comstr'Iction:�_ In kadon of pouadwsur. AIA inflow(00spool must be pumped sa Part of faspedioa) AIR A)J9 a, .4 COmmauta: (note coaditka of soil,sigu of hy&aulie(ai)un,level of poudia&ooaditioa of vrgetatioa, etc.) dessnooTs are not presen PRM: Oocate on sits PIW UALwi.L of oonss:ticti0a_ .�/� Depth of so8da:_&g*. Comments:(note o0adWOn of 64 61P&of hydraulic Wurs,level of pondia&condition of"pinion, Privy ig nnt, nrPecnt (revised il/03/95) • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L'_SPOSAL SYSTEM: include ties to at least two permanent references landmarks. or benchmarks locate all wells within 100 ' Centerville Osterville Marstons Mills Water Company 428-6691 0 td DEPTH TO GROUNDWATER depth to groundwater rpth_od of determinaction r approximation: /ERAL NOTES . t3 Cv� s LG�S c0 00 0 ,' aT%DytJS.SGt/itl..4R�; � Per / ,� P� ? 0 0 0 O c 0 or) 0 i . %�S ,EtD 3 ssoorst . „ .rv�.roi� 0 0 0 0 0 0 0 2¢ /A/7`NE Sy�TEM. TO BE OA SC/-1ElY/L� 4D}?l�C ¢� Z. _,� __.. OES/G AI C_ R/TERIA :L lIN-�YTABLE AMTF R/AL .- Th1,FIIV ,5R7-ELZ�- A770N i �{/UMB.ER 0�=BEOROD�t�15 3 /L!5 0,C O ',4A10 F. Cf�'�ILL . I cry P�.?SO�t/S GER��0A 001ti 6RgAA ULAR - AIA DER =E BGARG'Dvc lg64L TN t3 59 4 0T/,"/ED 'S INSTALL ED,4�Q, Ctq TD CD�QT/D�c/ f?ATc C'�CULAT/4It/S '/ FO.PI�t/SPECT/ON. Q�6�'R!/AT/O•t/S By!' •J•��`'CFS fo�/�oc/ f30TT?�M = 76:� �'K �TtiER.1 ISE AIOTE0 AZ-L AA4WSTABGE BOARD AC A ALT!-l ��- �OMPOrVENTS _511AI t3E 9_ ,APPL /CAiI,'T': R..*44*Ywv BZ&Ar OwELL/�t/cLocATiow y' BE APPL/CABLE . s mar/iv THE / 000 GZA�iv Ro z:;1o5 _S�'WAGE 5 Y-5 LoC,4T/c _ �j ;�'. ' �o it Y Lor /8- �F�•�'/� �0�4p " F CR/A/DER WILL 11or .E f. �f C�iS/TF.e ✓/LGLc ���J�S7i9$L.� "A 5S. o/v rN� s�s 7-En. n - .30 TZ p — - � I A L L CA Fes` �7 ,�ll',,= Y CO,,V-5/L 7-�; ,N 7- �J In IN .000 "1 11 ��', p 5/ J'• moo! t Li 04 I J 0 V ' Oi /g TOWN OF BARNSTABLE LOCATION �f l�ol�'PG SEWAGE # VILLAGE �CY'd✓���G. Z,--M SSASSESSOR°S MAP & LOT / INSTALLER'S NAME & PHONE NO. SEPTIC TANK CA PACITY LEACHING FACILITY:(type) (SLze) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ra• a vl-.n r.n a �r^r r.n_ V,.� ll.. I 0 't Cedtic. rd ery sl No... .� Fu `,�, .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � WI ......".......OF............ .- ..." - ,P�,S!.�c....... ApphrFatiun for UiopuuFal Workii Tonstrurtion rumit Application is hereby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal System -- _1 ....cateIc_._. �j2................ ..•-•........ _o.. .. _q............. ._ ..........----•--..... . Lot ---- -- - tion- dI€ss or Lot No. ....................................... ........................................... .........-•--•-----------..................... Owner Address ................................ 7� Installer Address Type of Building Size Lot.15_:3. z-....Sq. feet Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( ) `04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .................................. W Design Flow................► ..................gallons per person er day. Total daily flow...............3.s...0...............gallons. WSeptic Tank—Liquid'capacity/00.gallons Length_Y-6..._ Width- `/ ' Diameter................ Depth..5.�=`f". x Disposal Trench—No..................... Width......`........... Total Length..........I......... Total leaching area....................sq.ft. Seepage Pit No,........ .......... Diameter-0..:D..._ Depth below inlet...(g_._710..... Total leaching area.Z(e. ...sq. ft. Z Other Distribution box ( V/ Dosing nk �n ) aPercolation Test Results Performed by..._ .I�_ .., ✓ ................ Date.....$.'g..' .---..--___. ,4 Test Pit No. 1. &..._._minutes per inch Depth of Test Pit-:_�!f 4...._._ Depth to ground water........................ 44 Test Pit No. 2__-_--`~ c---......minutes per inch Depth of Test Pit.../ _4q........ Depth to ground water----------------- —" ._ a+ ---------------I--•---•- �.. �t -----•---------------- - it-----------•-•• O Description of Soil_ /.... -`Z� - T `�4J'E�•- �--- ... ..._.. F1ti15 ----------------........--------------------------------------------------------------------------------------------- V ...- . y xG._....Z f Rz. t 9---'-/�� ,� >� s --------------- V -Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. -----------------------------------•-------------•-----------------•----------••--------------------------....-------------------------------•-----------------------------------------------•---.•-•-- Agreement:The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— dersigned further rees not to place the system in operation until a C tificate o Co 1' nce h s b e 's ue b th o d of h LL. lApplication Approved By---•---•------• -••••-•.... ----•-. ��- te Application Disapproved for the followin r ons:................................................................................................................ ....----••-•------•-......••••---••••---......••----•--••-•--•-----•-•••.....••----------------•---....--•-----•------------------•---••--....._...-•--•----•••-----•--•----••--•....--•---••---....:r Date Permit No........... -----•------- Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --------------------- r_. ..........:......-•-----------.-...._..........- ApplirFatinn for Elhipaii al nrk,5 Tomitrnrtiun rantit Application is hereby made for a Permit to Construct ( I-If or Repair ( ) an Individual Sewage Disposal System a .....IC.................. --------------- --------------ham..�,<..�..�.... ......... ..... -•••- - rycation-A dress. or Lot No. - ....... ....... ...........------------- Owner Address W Installer Address t UType of Building Size Lot___15�_3_'6._-7.::...Sq. feet Dwelling—No. of Bedrooms......_-..................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—,Type of Building No. of persons............................ Showers g ------•-------------•------- P ( ) — Cafeteria ( ) 04 Other fixtures ---------------------------------------------------•--•••-•--•-•----•----••--•---------...-•-••••---------••--•-•------•--....---•----•.......---•--•- Desi Flow--------•••-•... - .:._... .� W Design .........gallons per person per day. Total daily flow................ ..2>-O.._...__......gallons. WSeptic Tank—Liquid capacity—/ gallons Length._6f)..:.6..". Width'%.:'_jU Diameter---------------- Depth_._, __4 f x Disposal Trench—No. ................... Width.................... Total Length.._........;._...... Total leaching area....................sq. ft.` �U• .. � Seepage Pit No.................... Diameter--- `��.._ Depth below inlet...--? ___. Total leaching area...Z.61_Z_sq. ft. Z Other Distribution box ( t/f Dosing t. nk ( ) 1 ~' Percolation Test Results Performed by f G__�� C........��'.'�. t _l�............... Date.._.._ ___:_...:: _........__.. aTest Pit No. 1_.`_�-____minutes per inch Depth of Test Pit....j'f� !.�_... Depth to ground water........................ f=, Test Pit No. 2_.!�°k-----minutes per inch Depth of Test Pit...J�IA....... Depth to ground water..__._..-"'_'........... a ----------------------=--------------- ................................, O Description of Soil_.`... _L� .......- .................. V ` ✓... ----- - x ------Z- -------------,---------�'-- �' i--z9--- - ... ... C-4.= ° ...._� f f�J i�----------------------------------------- U Nature bf Repairs or Alterations—Answer when applicable............................................................................................... --------•-----------------------------•••--•-----•---------•--•••••-------•------•-•......•-•-----•----•--••••-•---•---------------•----•----••-•---•-•----••--•-----•---------•--•-.........•.....-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT iL 5 of the State Sanitary Code—the ndersigned further a sees not to place the system in operation until a Ce"tificate o C71n• e h s beeMAs'Se /b h , o d of health. gn / ---......- --• ---•- . - •. D toApplication Approved By---••------- ---. ..... •-• • ••-- -•---- ateApplication Disapproved for the re sons------------------------ .................. .............................•-•--•-•----...----...--------------•--------------......---------•---•----•--•••-•••-••---•--•----• -------------------------------•------•-•--•-----•----••_...._ -a Date Permit No.-••-•-•��.....•• ------...._. Issued---•------------•--•-----•••••..............Date.....•. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH "" ..... --------.OF........! �.... .... .... ....................................... TUrrfifiratr of TuntpliFatty THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) egot Inst Iler at ---•--•........•- ✓..---.._4 -----------------------------------------------•--•---------------------...•..------•---------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------------- ........ dated__-.._-_1_. �(G------------ - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA�_.�_ANLE THAT THE SYSTEM WILL,/FUN TION SATISFACTORY. DATE.............. l a.................................... Inspector....._..__�....-------------------•--••-------•----------•--•-•---.....-------- FN G;rV FIE V� fM,"S'f o THE COMMONWEALTH OF MASSACHUSETTS C CID-T k F, S etlr <O Iv»1_' rO(vi�OARD OF HEALTH No .g . 3 ...........................................OF..................................................................................... ... FEE ......... .._ i �rn� I, nrk 01nnitrnr#ion rrntit Permission is hereby granted........----=:_-__-`- ....-• ...... -------- ------------- •................. ............. ...---------------------- to Construct ( or Repair ( ) an Individual Sewage Disposal System at No.................67_:........ C E(�.a[.(.......... ..!)=-•--------- — V ' ► C. Street as shown on the application for Disposal Works Construction Permit No.. ................. Dated....!._ _. .�r............... .............................. DATE..... � .............................................................. d of ea t FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS Ir Vl LASE PARCEL NO.- g 114S ; A LLFR'S r NAND A . ADDRESS KENNIM TRUCKING WEST BARNS"CABLE, MASS, 0266a_ 6 U I L D E R 04 'rEL. � 5 e ® ATE COMPL-,lANCR ISSUEO� � � �/� - .�, - - . , t __ -- w� � � 1 �, � - - s . ,� - _- +' � � _. __ LEGEND CENTERVILLE 5� PROPOSED CONTOUR OPT ® PROPOSED SPOT GRADE O EXISTING CONTOUR LOCUS STq + 96.52 EXISTING SPOT GRADE q cF�pO W— EXISTING WATER SERVICE }. TEST PIT QUO' 4� SCALE: 1"=20' O �O O 65 G 6= \ / \ LOCUS MAP , LOCUS INFORMATION PLAN REF: 257/094 TITLE REF: 31361/0247 G of g 0 \ PARCEL ID: MAP 172 PAR. 138 PROPERTY IS IN ZONE II, IS IN ESTUARIES PROT. �o a FLOOD ZONE: PROPERTY NOT IN FLOOD ZONE ® / SEPTIC SYSTEM/ /• \ G _ \R REPAIR PLAN a� ,/' EXIST. 1,000G �� o W/ G \ LOCATED AT: h SEPTI TANK N al 9 CEDRIC ROAD G CENTERVILLE, MA i PREPARED FOR E \ISL NG SANDRA RODRIGUES/ ow °\ READY ROOTER EXC. i APRIL 13, 2021 64 / TOP OF , EL = 6 5.5 4-I- — � r 1% OF Mgsf9CyG DARE M R —65 �-- LOT 18 AREA = 15367 sf+- MEYER 8C SONS, INC. PLAN BOOK 257 PAGE 94 BENCH MARK P.O. BOX 981 PLAN ASSR MAP1 72 POL 138 TOP OF FOUNDATION 65.54 EAST SANDWICH MA. 02537 SCALE: 1 in = 20 ft BARNSTABLE CIS DATU PH: (508)360-3311 0 20 40 FAX: (774)413-9468 O 10 20 40 meyerandsonstitle5@gmail.com r SHEET 1 OF 2 J 1894 ELEV. TOP NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS FOUNDATION: BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE (Existing) = FINISHED GRADE (65.0) 65.54 F.G.EL: 65.40 F.G.EL: 65.40 F.G. EL: 65.0 •�` "• MAINTAIN 2% MIN SLOPE OVER LEACHING AREA F.G.EL 63.47 2" OF 3/8" DOUBLE WASHED STONE OR FILTER FABRIC 3/4" - 1-1/2" t DOUBLE WASHED STONE 6" " 4" SCH 40 PVC 1o"I ®®®® 13®®® ® S= 1 7 MI ®®®®®��®®®® TEE'S ARE TO BE 14 INV. 61 .75 s ( N�) 4" SCH 40 PVC 2' EFF. DEPTH ®®®®®®1®®®® INV. 62.20 INV. 61 .58 4' 2 X 8.5' 4` GAS J' EXISTING OUTLET BAFFLE PROPOSED DB-3 DISTRIBUTION BOX EFFECTIVE LENGTH = 25' INV: 62.45 AM (1-120) INV. ELEV.= 61 .43 EXIST. 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON �,�� OFss9� BREAKOUT OUTLET TEE AS MANUFACTURED BY ELEV.= 62.43 NOTES: TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV.= 62.43 1) CONTRACTOR SHALL. VERIFY ALL EXISTING N 114 INV. ELEV.= 61 .43 f ®® PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO ST ®®®®®®®®E3®®®®® GRADE ON A MECHANICALLY COMPACTED SIX '�NITAR�a� BOTTOM EL.= 59.43 ®EM®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN 3.75' S FT. 3.75' 310 CMR 15.221(2) \ SEPARATION 4.43 FT. 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK (4ft suitable soil below leaching) EFFECTIVE WIDTH = 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, 18ft to GW ObS at El. 37, per GI ) DAMAGED OR UNDERSIZED. SEPTIC SYSTEM PROFILE 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 55.0 _ SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) SOIL LOGS P#: 13132 GENERAL NOTES: DESIGN CRITERIA **IN ESTUARIES PROT.** DATE: NOVEMBER 18, 2010 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR: ARNE OJALA, CSE BOARD OF HEALTH AND THE DESIGN ENGINEER. SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS WITNESS: DAVE STANTON, BARNSTABLE HEALTH DEPT. OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS. DAILY FLOW: 110 G.P.D. X 3 BR = 330 G.P.D. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Elev. TP-1 Depth Elev. TP-2 Depth TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE GARBAGE GRINDER: NO (not designed for garbage grinder) DESIGN ENGINEER. g� gpd, USE EXISTING 1,000 GAL SEPTIC TANK 65.0 A 0" 65.0 A 0" 4. ANY CONDmoNS ENCOUNTERED DURING CONSTRUCTION DIFFERING SEPTIC TANK: 330 x 2009E = 660 SANDY LOAM SANDY LOAM FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN IOYR 2/1 1OYR 2/1 ENGINEER BEFORE CONSTRUCTION CONTINUES. LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 64.50 6" 64:50 g" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B SANDY LOAM B SANDY LOAM 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' 10YR 5/8 " IOYR 5/6 HEALTH Fo oPER NSPE�CTIONS DURING CONSNOTIFY THE TRTRUCTIONN.. OF STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 61.50 42 61.50 C C 42" 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. BOTTOM AREA: 25 x 12.5= 312.5 SF B.ALL AC DISTURBED DURING SHALL PERC TEST LOAMY LOAMY TO A O mON AREED OTWE OWN AND CONTRACTOR. SIDE AREA (25 + 12.5) X2X2 = 1505E SAND SAND 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE IOYR 7/4 tOYR 7/4 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D CONSTRUCTION. DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 55.0 120" 55.0 120" 12. THIS PLAN IS TO BE USED 1 FOR SEPTIC SYSTEM PURPOSES ONLY PROPOSED SEPTIC SYSTEM UPGRADE PLAN AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. ('C2' HORIZON) 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 9 CEDRIC ROAD, CENTERVILLE, MA NO GROUNDWATER OBSERVED 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. 15. ALL PIPING TO BE 4' SCH 40 0 1/8-/FT (UNLESS SPECIFIED) Prepared for: Rodrigues Ready Rooter Exc. Design and Site Plan by: SCALE DRAWN DATE MEYER,&SONS,INC. N.T.S. DMM 04/13/21 PO BOX 981 EAST SANDWICH,MA 02537 REV DATE CHECKED SHEET NO. 508-382-2922 DMM 2 of 2 SYSTEM.STEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE.OR COMPARABLE MEANS FOR FUTURE LOCATION. Thee ponds PROVIDE MIN. 20" DIAM WATERTIGHT (NOT TO SCALE) 1. DATUM IS APPROX. NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORTS TO Ra e Lane 2. MUNICIPAL WATER IS EXISTING r TOP FOUND. EL. 67.75' WITHIN 3" OF FINISH GRADE Locu \ 9sh/e Z 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE (REQUIRED VER SYSTEM 67.0 a o oho PRECAST H-10 4. DESIGN LOADING FOR ALL PROPOSED PRECAST RISERS (TYP.) UNITS TO BE AASHO H-10 2'0 65.6' 4"OSCH40 PVC /! PIPES LEVEL 1 ST 2' 5. PIPE JOINTS TO BE MADE WATERTIGHT. CL a 64.03' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10" EXISTING 14" TEE SEPTIC TANK** TEE WITH 310 CMR 15.000 (TITLE 5.) * 64.2j1 ' 00-0-066" MIN. SUMP 63.70'GAS BAFFLE::` °o°o °o°o° 12" MIN INT. DIM. 0 67 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND6 63.74' NOT TO BE USED FOR LOT LINE STAKING OR ANY o 63.03' OTHER PURPOSE. - 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Cl- OVERALL DIMENSIONS TO OUTSIDE OF UNITS: 24' X 11.3' 6" CRUSHED STONE OR MECHANICAL (NO STONE PROPOSED) 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [2]) 5 83' HEALTH AND PERMISSION OBTAINED FROM BOARD SLOPE) ( 1 % SLOPE) OF HEALTH. LOCUS MAP 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION EXIST. SEPTIC TANK 17' D' BOX 6' LEACHING CALLING DIGSAFE (1-888-344-7233) AND NOT TO SCALE FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & * **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT BOTTOM TH 1 EL. 57.2' OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL WORK. ASSESSORS MAP 172 PARCEL 138 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE (OR H-20 , 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SEPTIC TANK IF IT WILL BE SUBJECT TO VEHICLE LOADING). SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND ci(��".6o , SAND. 99 - EXISTING CONTOUR �o X 99., SYSTEM DESIGN: EXIST. SPOT ELEV. I1m 99 PROPOSED CONTOUR �� GARBAGE DISPOSER IS NOT ALLOWED 198.4] PROPOSED SPOT EL. 1� AV ��" DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 110 GPD TH1 01 G -x-&s�9- - -%-&�50 _ USE A 330 GPD DESIGN FLOW TEST HOLE GEC 9 1 , _ .Q6.98 x�5-76 2� SLOPE OF GROUND 65.56 ' A-49 2 SEPTIC TANK: 330 GPD (2) = 660 1'65 52 6 "6 6754 6� . ��g67.64 -A UTILITY POLE �3 66• 1.10 O\6 .19 ' . 9 OAKS O RE-USE EXISTING SEPTIC TANK** 7 ' �� x�5.19 .17 x 5 -97 \ C FIRE HYDRANT / i _ x c.�6 - ><67.79 LEACHING 67. 3 4.72 SF LF x 4' LENGTH = 18.88 SF PER STD. 7. 8 ■ 7. 9 NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING I / //101 00 1 x \\ O / X .89 R x QUICK 4 UNIT ,� 6 so 1 3 � �� I� 330 GPD/0.74 GPD/SF = 446 SF LEACHING TEST HOLE LOGS 66.03 66.53 _ _ 8 �67.91 REQ'D ®6�k.62 66.59 1 P. IN ES S x 67 �7.45 24" WHT " 8.1 446 SF/18.88 SF/UNIT = 23.6 UNITS ENGINEER: ARNE H. OJALA, PE, SE i 66.58 - PINE OAKS \\A 68 x'64. 66.37 EXIST. WITNESS: DAVID W. STANTON, RS ah 66.41 ST 0 N 67.57W x 68.11 00 THEREFORE, USE GRAVELLESS SYSTEM OF (24) 6 STANDARD QUICK4 UNITS IN FIELD CONFIGURATION DATE: NOVEMBER 18, 2010 67.3 - 3 - 68.10 OF 4 ROWS OF 6 UNITS x 65.61 PAVED PERC. RATE _ < 2 MIN/INCH x 66.09 ^ DRIVE 3 67.42 x 67.59 24 UNITS x 18.88 SF/UNIT = 453 SF> 446 SF CLASS I SOILS P# 13132 66.86 453 SF (0.74) = 335 GPD (OK) �0, x 6 67.78 ELEV. ELEV. EXISTING DWELLING x 68.17 O" E:P67.2' O" 67.2' TOP FNDN. = 67.75' BENCH MARK - CORNER x 67. 1 MA A A x os 66.s4 APPROVED DATE BOARD OF HEALTH BRICK STOOP EL. = 68.1 SL SL 6" 10YR 2/1 6" 10YR 2/1 - - TITLE 5 SITE PLAN OF B B 7 ^� SL SL 9 CEDRIC ROAD 42" 10YR 5/6 63 7' 42" 10YR 5/6 63.7' CENTERVILLE LOT 18 PREPARED FOR 15,367# -SF " PERC C C �� �ZH OF A,1gs 9c ��N OF MgSs � -` � BORTOLOTTI CONSTRUCTION/ i_ DANIEL CN, o -'0 . A. r� DANIELA. �N NEWMAN LS LS JAB o OJALA �No.4098 P ` N0 VIL NOVEMBER 19, 2010 10YR 7/4 10YR 7/4 � ����,I` �� �qP�, •��,ti a� / s�s9 off 508-362-4541 DANIcL �i 7`V - tiG fax 508-362-9880 %��DANI�LA. � F. OJALA downcape.com I� OJALA ° CIVIL " Na."�r0964u. N F�602 down cape engineering inc 120" 57.2' 120" 57.2' quo ��° �w FE �© G,S G.a civil engineers Scale: 1"= 20' �� land surveyors NO GROUNDWATER ENCOUNTERED _° s� rya 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. -257 0 10 20 30 40 5o FEET YARMOUTHPORT MA 02675 j i O 61 r '• a INLET KNOCKOUT 0.' 3 - 1 ',/ODD >9GLC'h/ ,�EfTTJ' .;q�ti.E; � - --_.. .__ - - �•` "- � t , _.J � a • •a ram, ' • a �) • 0 Do 0 0 �1 �� o � o ooD+ TOP 53Xo 0 SEWACE SYS* re" RR,0,40rIL 4E ,O,erA IL S 10 . C, 0 0 : � O O O O o 0 o.�D ! _. _ ,���✓/sue CR L>25 _ . 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