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HomeMy WebLinkAbout0174 CEDRIC ROAD - Health 174 Cedric Road Centerville.....P A.= 149 082 ° 4 7 omrford, NO. 1521/3 ORA ��., 10% t No. aov •' FEE 5 0. 0 0 4 x Board of Health,," 33arnstable A SS. E APPLICATION FOP, DISPO n 'MRMUCTI®N PERMIT Application for a Permit to Construct( ) Repair( ) UpgradeXX Abandon(.) - ❑Complete System ❑Individual Components Location 174 Cedric Road Owner's Name Christopher Fredo Map/Parcel# 149-82 Address 1 7 4 Cedric Road Lot# Telephone# a Installer's Name Designer's Name g JC Engineering,Inc. Address Address 5 Roundhill BLVD. Telephone# ne are am, ass. Type of Building Dwe I I i n g Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons. Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow Design flow provided gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS Adding 2-500 gallon leaching chambers. 25 'X12. 9 'X2 ' The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to 1WetemZimnetion until a Certificate of Compliance has been issued by the Board of Health Signed r Date 1 0 1 8/0 i✓ � - Inspections No , -�..'�-�'�"`T':�;� FEE 50.00 COMMONWEALT14 ®r M SSAC14USETTS ry t Board'ofHalth, ""Barnstable "ASS. APPLICATION FOP, DISPOSAL. SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade3GX Abandon( ❑Complete System ❑Individual Components w s Location 1 74 Cedric Road Owner's Name Christooher Fredo Map/Parcel# 4 _ 2 Address 174 Cedric Road <+�,ni-ter i A tug Lot# Telephone# 508- a _. Installer's Name J P Ma o ber X Son Tnn- Designer's Name JC Engineering,Inc. Address Box 66 Centerville Mass_02632 Address 5 Roundhill BLVD. +�are am,t;ass.v Telephone# _ 7 — ��R Telirdne ' 2538 Type of Building 1DWe l l i rich Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building .y No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow Design flow provided gpd Plan: Date Number of sheets Revision Date Title Description of Soils) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS Adding 2-500 gallon leaching chambers. 25'X12.9 'X2 ' The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree to not to Ilacfi e system in fp7ation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 10/B/0 2Ila n/ Inspections w, , No. '~ F050.00 Board of Health, Barnstable MA CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s)XX:@ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded)�)a,Abandoned ( ) by: J.P.Macomber & Son Inc. at 174 Cedric Road Centerville.Mass. has been install in accordance-with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No �' n dated Approved Design Flow (gpd) InstallerJ.P. acoM& & Son Inc. ++ Designer: JC Engineering Inc. - Inspector: Date: t4 /r( n� F vfI The issuance of this permit shall not be construed as a guarantee that the system will function as designed..,, 550.00 No. t/fT ������ FEE- , COMMONWEALTH Of MASSAC14USETTS Board of Health, Barnstable MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(X) Upgrade( ) Abandon( ) an individual sewage disposal system at 174, Cedric Road Centerville,Mass. f n as described in the application for Disposal System Construction Permit No`�«. dated Provided: Construction shall be completed within/three years of the date of pK"s pe, Anit 1 local-conditions must be met. Form 1255 Rev.5196 A.M.Wkln Co.Boston,MA Dater // Board of Health 1 � 4-TOWN OF BARNSTABLE LOCATION' fig l^l L L/ SEWAGE # 04 VILLAGE (p Jem,l ASSESSOR'S MAP & LOT ,:! A"If f INSTALLER'S NAME&PHONE NO. 7 SEPTIC T r 'CAPACITY LEACHING FAciurf.: a o ' m CS (type) �, fn--�; (size) NO.OF BEDROOMS rr ` BUILDER OR OWNER C ri-J41fr, �/ 4 PERMITDATE: o COMPLIANCE DATE: ° !l U ? . Separation Dt — )3etween the: Maximum Adjuste' ndwater Table to the Bottom of Leaching Facility Feet Private Water Supp y�:.;.; 1„and Leaching Facility W any wells exist on site or witfun200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I 0 0 I s TOWN OF BARNSTABLE, ^LOCHTI0N "1 7� a^i(, ' 94 ` SEWAGE # VILLAGE ASSESSOR'S MAP & LOT_ INSTALLER'S:NAME&PHONE NO. _ NFUcl)m�e.f- r `7751 .73 f SEPTIC TANK'CAPACITY LEACHING;FACILI'TY'{type) �a C,� m ks (size) ' size ` ENO.OF BEDROOMS ` BUILDER OR OWNER C���.S� r PERMITDATE } o U COMPLIANCE DATE: ° .�l U Separation Distpce Between the: Maximum Adjustteed Cvo'undwater Table to the Bottom of Leaching Facility Feet V. —F" Private Water SupplylW61f and Leaching Facility '(If any wells exist- on site or wittiin-200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ Feet Furnished by = '�' f ' ,.�, o , 0 \ \ 1 �l � l �` ( �� �'��� v� k� � � � M I �.� � �- � �? � C���G �.. __ � . a _- — �' -- b` COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS (1� DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE HINTER STREET BOSTON. NIA 0_2I08 617-192-5500 NA'll-LIANI F WELD TRUDY CORE Govemor Secretary ARGEO.PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: 174 Cedric Rd, Centerville, MAdress of Owner: Carl Hill Date of Inspection: �--l.Y — `Q � (If different) Name of Inspector: Wm E Robinson Sr 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: WM E Robinson Septic Service Mailing Address: PO Box 1089 C'entervi 1 1 e r NIA 0263 Telephone Number, pS `. 7 7 5-A 7 7 A .. D CERTIFICATION STATEMENTI certify that I have personally inspected the sewage disposal system at this address and t he informatiue, accurate and complete as of the time of inspection. The inspection was performed based on my training annction and maintenance of on-site sewage disposal systems. The system: 6--Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails i Inspector's Signature: Z<-, L6 Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 314D CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] S TEM 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. Indi ate ves, no, 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance tattached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (zevieed 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:Hwww.magnet.state.ma.usldep �,� Printed on Recycled Paper w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 174 Cedric Rd, Centerville Owner: Hill Date of Inspection:vZ/, —g B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed� Y pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipeist are replaced Obstruction IS removed f C) F RTHER 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, safer• 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 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system ha> a septic tank and soil absorption system and the SAS 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER 1/ (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 174 Cedric Rd, Centerville Owner: Hill Date of Inspection: D SYSTEM FAILS: Yo must indicate ei;•:er "Yes" or "No" as to each of the following: 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. Yes No Backup of sewage into facility or system component due to an 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.,-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 _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LA GE SYSTEM FAILS: You ust indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The ow er or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program require ents of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 5 tf SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 174 Cedric Rd, Centerville Owner: Hill Date of Inspection:y —/,,7,"4 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. I/ _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. 4 _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 f .4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 174 Cedric Rd, Centerville Owner: Hill Date of Inspection: if--1'9-9 S FLOW CONDITIONS RESIDENTIAL: Design flow: 33 o a.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: Garbage grinder (yes or no): /+-c Laundry connected to system (yes or no): - Seasonal use (yes or no): Water meter readings, if Aailable (last two (2) year usage (gpd): 1996 — 51 , OOOg Sump Pump (yes or no):/f- 4) 1997 - 46, 000g Last date of occupancy: CO MERCIAUINDUSTRIAL Type f establishment: Design flow: gallons/day Grease rap present: (yes or no)_ Industri I Waste Holding Tank present: (yes or no)_ Non-sa itary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available. Last ate of occupancy: OTH R: (Describe) Last to of occupancy: GENERAL INFORMATION PUMPING RECORD and source of information: / ZZA 6i a— 60- > 4� Pal. Syster iK pumped as part of inspection: (yes or no)­O&6 If yes, volume pumped: gallons Reason for pumping: TYPE Of STEM 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information:��/t—3 tQQ d� r � Sewage odors detected when arriving at the site: (yes or no) c (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 174 Cedric Rd, Centerville Owner: Hill Date of Inspection: B ING SEWER: (Locate on site plan) Depth b low grade: Material f construction: _cast iron _40 PVC _other (explain) Distan from private water supply well or suction line Diamet r Comm ts: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grader Material of construction: _Vconcrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: C� Sludge depth: !9-4; Distance from top of sludge to bottom of outlet tee or baffla$L, Scum thickness: —� Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: A-►� Comments: (recommendation for pumping, condition of inlet and outlet tees o�pffles, depth of liquid level in elation to outlet invert, structural integrity, evidence of leakage, etc.) GR SE TRAP: (loca a on site plan) Depth below grade: Materi I of construction: _,concrete _metal _Fiberglass _Polyethylene —other(explain) Dimen ions: Scum ickness: Dista ce from top of scum to top of outlet tee or baffle: Dist ce from bottom of scum to bottom of outlet tee or baffle: Dat of last pumping: Co m ents: (reco mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural inieg ity, evidence of leakage, etc.) a (revised 04/25/97) Page 6 of 10 4 � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 174 Cedric Rd, Centerville Owner: Hill Date of Inspection: —/%'^4 9 TI TOR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (Iota on site plan) Depth low grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimen ons: Capaci gallons Desig flow: gallons/day Alarm evel: Alarm in working order _ Yes; _ No Date of revious pumping: Comme ts: (conditi of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: O Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP HAMBER:_ (locate site plan) Pumps i working order: (Yes or No) Alarms n working order (Yes or No) Com nts: (note ndition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 4 .r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 174 Cedric Rd, Centerville Owner: Hill Date of Inspection:.---15--9 / SOIL ABSORPTION SYSTEM (SAS): z/ (locate on site plan, if possible, excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:/ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, I el of pondi g, condition of veg lion, etc.) < ,1��' 6. �, nFcasl � CES OOLS: _ (loca on site plan) Num er and configuration: Dept -top of liquid to inlet invert: Dep of solids layer: Dep h of scum layer: Di ensions of cesspool: M erials of construction: I ication of groundwater: inflow (cesspool must be pumped as part of inspection) Comm nts: (note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRI _ (locate on site plan) Mater als of construction: Dimensions: Dep of solids- Co ments: (note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 174 Cedric Rd, Centerville Owner: Hill Date of Inspection: `- SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) /yam O o I / is (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 174 Cedric Rd Property Address. r Centerville Owner: Hill Date of Inspection: A-Y`i'19101- Depth to Groundwater/j�7- Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) A f� A (revised 04/25/97) Page 10 of 10 No...... .......... Fps..../......................... THEBD A �®A®HCOFUA�SSAC TuTS Appliratiuu -fur Di.ipuitt1 Works Cnuustrurtiuu Prrulit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: j L / & az'tYA ............................ •-----•--•-.......... --- ----------------------•----•--••-••••----•-••---•---------•••-•-------•----------..........--•--- L c iop-A�es or Lot No. Ow er Address 74t Installer f Address Q Type of Building Size Lot.....r/_ __Sq. feet U Dwelling—No. of Bedrooms....... .............. Attic ( ) Garbage Grinder ( ) a`L", Other—Type of Building ---------------------------- No. of persons_..._-__.-_.________.___-.__ Showers ( ) — Cafeteria ( ) 0.' Other fix ores ...................................................... w Design Flow.............................................gallons per person per day. Total daily flow--------- ......................gallons. tx Septic "funk—Liquid capacitJ/ gallons Length________________ Width_____......._.. Diameter__-.-_--._-__ Depth.__._____..._.. Disposal Trench—No. .../.................. W' ------------------ otal Afe th._ . . ........ Total leaching area---�O.`..sq. ft. Seepage Pit No............/_ ' a ---_-' �l ____________________ Total lea Ling " ea----._...........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ®0- %©� /'/' 7j— C�A Percolation Test Results Performed by----------- --------------------------•-•----------•--•-.•-------•-------- Date----•---------------------------------.. Test Pit No. ]................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-_.--._.._-___--_--_-_- O Description of�Soil r �' -�--------•--�r/''f � `` `'Y'-' '�------ � ----- -- y U - // w --- -' � - 1-�S i .. -------------- 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued��by��tthe b/g/gp�r-d�of he lth. Signed- I..... // Date Application Approved By-------------------------------------------------------------------------------------------------- --------------------....---------------- Date Application Disapproved for the following reasons:-------•---•------.-----•"------""-•-----------••------•----------------•---------•--"---••--•------•----------- ----•---•----•---•-----••--•----------------•----••-••--------•-•--•--••-•-•-------•-•------•------••-•-............•--------------•------------------------....----...........-------------••----•-•--. Date - --- -- - — ---- Date Permit No......................................................... � ssued--•------------- - No......................... ' 1; FEa.....f.t-�.....'....... THE COMMONWEALTH OF MASSACHUSETTS BOARD,-OF H TH / ._ .............OF...... .......................................................... d AppItrttttun •fux Uhipofitt1 Works Tomarnrti>QYt Permit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: 1; 414-1r l 119 � e4,, ,x2W ........----•----•••------••----------•--.....--•-•---•----•--•-................................. ........................................... ••-----......................................... _ ,,Loa'o •Ae��ssf���e � or Lot No. ............................n --......................................................... ................... ........................................................ ✓ Ow er' - --� Address ................ V Installer Address / d Type of Building -� Size Lot....... _�__t__-_______Sq. feet Dwelling—No. of Bedrooms--------- -__----------- ......._--------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) dOther fiat ires --•--------------------------- -- ..�•f W Design Flow.............:��.._._.__.__.._...._....._...gallons per person per day. Total daily flow.........>%-'�-_--_-_.__-_-_.-----.---gallons. W Septic Tank—Liquid capacit,_,r aallons Length................ Width................ Diameter---------------- Depth---------------- x Disposal Trench—No_ ____________________ Width?..__.___..___. otal Length... _____.. Total leaching area.... ._`'..sq. ft. ZX / l T7?1 leach' �ir --------------sq. it. Seepage Pit No............. Ia r- - t-•__-_•I�e 'elo'. fie ..----- z Other Distribution box ( ) Dosing tank ( ) d - �� `��' �l Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-__-____-_._-.__.___-- �14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water--.-..---_-----..---___. x --------- v = ----- °-------- -----•---.... -••-------------•------•-•------------- O � .escr ­ Description of Soil,_______ — -- `F---------v UW ---------------------= ---------------- ------------- ---------------------------------------------------------------------------------------------- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. / Signed... . a lc3�y 7 f Date ApplicationApproved By--------------------------------------------------------------------------------------------------- ---------------------------------------- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ...............••----------_....----•---•------------_..._....------•-----•. Date Permit No......................................................... '%-.., Issued Date THE COMMONWEALTH OF MASSACHUSETTS - 80ARD,,,0,F HEAL l� . W.I..pdifirate 'of 10.11,11mpliaurr Ty THIS IS TO CERTIFY)That the IndiAduarSewage Disposal System constructed or Repaired ( ) ==- = =f/= Installer -r�t'iLi�K� has been installed in accordance with t e provis ions of Article XI of Tfle State Sanitary oode as described i�the application for Disposal Works Construction Permit No.............. ......___c............._.. dated..- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FVX TION SATISFACTORY. BATE....= •---= ----------------- Inspector ---------•------------------•--• ......_ THE COMMONWEALTH OF MASSACHUSETTS , J BOARD�OF HE L 'r4/7 Ju1f * s�L Gt :.::................................OF................. ................................................................. No. ' FEE........................ Permission is hereby granted...... to Construct ( �)or Repair ) am Individual Sewage isposal System at No................... - iiL!t� f C�t t. •----- ----------•------......------------------.........--------------•-•-----•--•••------- Street as shown on the application for Disposal Works Constructio t o. ................. Dated. ...................... ti [ Board of Health-------------••-•---------------------•-----•-•----•- DATE.... k. - F FORM 1255 HOBBS & WARREN. INC.. ?UBLI gHERS i .�fr P': 1 a• ... _ s _ ,� t. 1 f b r r "+��'`� ci'+�y3N,, U y Y �,k 1 AW - t � - VVV... .;w 'rr + - •''S , fir+ r ; r f PiE%OS E L� z a:` ' tF + tfi•6 1M {t_; /�Pj.SOr���-+ �' �". i O L� t.. in• .f^ y ;�r -S yta�� i�, t ) t 2` '� � � '�� � ' Y 5,�\ � .Fri '3•`�Y� t thr �. /7 �"ofNo r � @ , i f- f +Z �y d f- k', I (G o r s�) ,Y R4 q.r $t 0CA27-1 CA/ COEiD7�� Fr� , >� '`id���®?� CE.ST/FY TN�iT T�•/E BV/LZ�/�c/dr' � ` •° OA/ 7f//3 A -A*V /S GOCAT rO OA/ 7TA ! jy OOGIA./0 A9-S --T<WOWit/ R-d&A'-BOM LaN0 YA.✓/gT. T 6 �:• qi " a! ;a OAw.it-! 7-0 TAVff- O.C./1A/4rw dR4I&" -0AIS711Cu4=7'Er Imo: AR OJ Lk s s. 248 r L •4A/D st/�V6YOBS T— -1-2piGyr.r3.�...� yt •k fiTE EEG.-' EYO1� 6 ~mow 7-1 LOCL1,T10 SFWO.C,E PERMIT k10. �/I l..L A G►E - - Z - 1 T -- --- - ----DATE PERMIT-l-55UED - _ ._O� --- ----DATE. COMPLI-WALE- I-SSUED. ;, _ Jai � a CONTRACTOR SHALL VERIFY SIZE AND 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 48.7' - 49.2' GENERAL NOTES CONDITION OF EXISTING SEPTIC TANK REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM FINISH GRADE OVER D-BOX= 49.5 4" SCHEDULE 40 PVC MIN SLOPE 1% 3/4" TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE FINISH GRADE @FND. EL.= 49•50' 49.03' 2" OF 1/8" TO 1/2" DOUBLE WASHED STONE 1. UNLESS OTHERWISE NOTED.. ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OVER TANK EL.= METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. 20" MIN. ACCESS COVER TOP OF SAS - 46.59' PLACE RISERS ON ALL CHAMBERS (TYPICAL FOR 3) 36"MAX. 9" MIN. TO 6" OF FINISHED GRADE 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD EXISTING 4" _ 45.76' 36" MAX. BREAKOUT EL = 46.26' OF HEALTH AND THE DESIGN ENGINEER. PVC PIPE 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL PROVIDE WATERTIGHT BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3" DROP MIN. 3„ 9„ _ JOINTS (TYP.) �^:. 00 0p000 00 00 �O O ::. 4' PVC IN FROM O CD 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS a Qa �� THAN ELEVATION = 46.26' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. 46.63' SEPTIC TANK 4" PVC OUT TO o o a 14" o LEACHING FACILITY T Qoa o o� UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE oo TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 46.93 46.27' MIN. � 46.10' 2 CD CD o � o0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 48" CONTRACTOR SHALL OUTLET TEE o � o VERIFY CONDITION OF o 6" CRUSHED STONE 1 0 0 0 000 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL, 16.4' EXISTING TEES ;22"ZABEL FILTER S �OVER MECHANICALLY o - _ 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED AND REPLACE AS !MODEL#A1801 HIP (GAS COMPACTED BASE 85 NECESSARY BAFFLE ON BOTTOM) 4'_ 4.9' �i PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND 5 OUTLET DISTRIBUTION BOX 25.0 (TYP.) READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED TO BE INSTALLED ON A LEVEL STABLE WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. ' GROUND WATER ELEV.= 38.09 12.9' BASE. FIRST TWO FEET OF OUTLET 43.76 EXISTING 1000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 2 - 500 GAL. CHAMBERS 5' MIN. 8. ELEVATIONS BASED ON ASSUMED DATUM OF 50.0' MSL OBTAINED LENGTH 8'-6" WIDTH 4'-10" DEPTH 5'-7" SEPTIC + -�` /� AN PROFILEDISTRIBUTION CROSS SECTION VIEW TYPICAL CHAMBER PROFILE H DETAILS CHAMBER END VIEW FROM NAIL IN TREE AS SHOWN ON PLAN. SEP 1 I C K PRO DI�S, TRI B TI N BOX DETAIL 'A���� 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION NOT TO SCALE NOT TO SCALE NOT TO SCALE THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE -- -" w - - - - LE AGENCIES. REPORT ANY AT 1 888 DIG SAFE AND ANY OTHER APPLICABLE TES IT D n TA DISCREPANCIES TO THE DESIGN ENGINEER. * 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE WATERTIGHT. �.� . INSPECTOR: p 1 ... �' SOIL EVALUATOR: John L. Churchill Jr. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR { ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN N. .� m , DATE: August 27, 2002 SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 0 Q A � I w� TEST PIT#: 1 t f ft Qei'Pa ��I 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS a ELEV TOP = 49.09' LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH ELEV WATER= >1 V BGS CASE THEY SHALL WITHSTAND H-20 LOADING, PERC RATE _ < 2 MIN/IN 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND 40 rd '. FINES. X48 25 � �� � � � ` � � �� �{ DEPTH OF PERC= 40°-58" �` +� e :' " ; 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND TEXTURAL CLASS: 1 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES i OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN JJ� .;3 COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN S. / �`� ° rr' r ACCORDANCE WITH 310 CMR 15.255(3). �` � �''� ��,t ��` �� 0 49.09' #^a FIII 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES � � � t�,p. r�, �, � , ' � 101, 48.26' FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. PATIO ;4 .F �, „D,oBOX �i �: �' 1 -- a `� A Loamy Sand MAP 149 ; D� PARCEL 82 10YR 3/2 16. PROPOSED PROJECT IS LOCATED WITHIN: xy ,. 14" 47.92' ASSESSORS MAP 149 PARCEL 82 16,500 S.F. EXISTING LEACHING PIT TO ,r,� ° � � " �p0 op BE PUMPED AND FILLED mk f r i WITH CLEAN SAND Loamy Sand " I{ B 10YR 5/6 17• OWNER OF RECORD: CHRISTOPHER FREDO ILO C S. A'� '40. ��O � r ° ,* ADDRESS: 174 CEDRIC ROAD 2-500 GALLON „f"' DSO �'G� IF � z r' �,�b 40" y 45.76' CENTERVILLE, MA 02632 .:,. LEACHING CHAMBERS , O �' EXISTING 1000-GALLON , j ,� Perc SEPTIC TANK, EXISTING r A-4.26' OUTLET PIPE TO BE CAPPED ? j 4 I 58 1 -•�.,, 9 _ , ,, J � ��;�,ro, M-C Sand 18. PLAN REFERENCE: BOOK 281 PAGE 72 L/P '' 2.5Y 5/4 - "'°"" ---- -- - - 1P- a C 19 ALL DISTURBED AREAS SHALL BE RESTORED WITH LOAM AND SEED. 4 No Groundwater 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY :4 . LOCUS PLAN Encountered FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY SHED 0 O 132" 38.09' f;�'s FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. TDECK G SCALE: 1" = 1000' EXISTING UNDERGROUND G DESIGN DATA ELECTRIC SHED EXISTING LEGEND 3� ;'>t"49.2�i ��'� 3-BEDROOM �.r' " ti. L' DWELLING �' REBAR/FND / E B.M. PROPOSED SPOT GRADES Nail in Tree ,L ;49.08 �� TOF = 50.34' - EXISTING CONTOUR Elev. = 50.00' 170. t.- T f .� / NUMBER OF BEDROOMS 3 0 PROPOSED SPOT GRADES Assumed �� �6'- \ r' h •` NUMBER OF PERSONS 3 O 06,% ;'� } !S� DESIGN FLOW 110 GAL/DAY/BEDROOM PROPOSED CONTOUR TOTAL DESIGN FLOW 330 GAUDAY � �(,; ----~--- EXISTING UTILITIES DESIGN FLOW X 200 % = 660 GAL/DAY CU �f / USE EXISTING 1000 GALLON SEPTIC TANK G G EXISTING GAS LINE EXISTING r UNDERGROUND ff /����� TEST PIT LOCATION UTILITIES - - /4��, Q I EXISTING SEPTIC TANK . f � O r �° oJ�� INSTALL 2- 500 GAL. CHAMBERS 4" SOLID SCHEDULE 40 PVC PIPE ELECTRIC BOX w ����,�o°o �f Py SIDEWALL CAPACITY DISTRIBUTION BOX h (LENGTH + WIDTH) (2 SIDES) (2' HIGH} (.74 GPD/S.F.} = GAL/DAY � (25' + 12.9') (2) (2') ( .74 GPD/S.F.) = 112.2 GAL/DAY 500 GAL. LEACHING CHAMBER ECG Q� BOTTOM CAPACITY G�, (LENGTH x WIDTH) (.74 GPD/S.F.) = GAL/DAY (25'x12.9') (.74 GPD/S.F.) = 238.7 GAL/DAY TOTALS. REV. DATE BY APP'D. DESCRIPTION TOTAL NUMBER OF CHAMBERS 2 PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING AREA 474.2 SQ.FT. PREPARED FOR: TOTAL LEACHING CAPACITY 350.9 GAL./DAY CHRISTOPHER FREDO LOCATED AT 174 CEDRIC ROAD CENTERVILLE, MA 02632 SCALE: 1 INCH = 20 FT. DATE: AUGUST 27, 2002 0 10 20 40 80 FEET JOHN L. cy� PREPARED-BY: � ^ CIIC�CLHILL JC ENGINEERING, INC. No 41807 5 ROUNDHILL BLVD. EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 SCALE: 1"=20' Drawn By: BMB Designed By: BMB I Checked By: JLC JOB No.272