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0094 CHILDS STREET - Health
94 Childs Street Centerville A= 249 - 134 SMEAD No. H163OR UPC 10259 smead.com • Made in USA AeAok TOWN OF BARNSTABLE SEWAGE # VILLAGE C ti+%� �"� ��Gv. ASSESSOR'S MAP & LOTo2 Vf j3 IN NAME&PHONE NO. ?457'011-6 4;"- SEPTIC TANK CAPACITY /®®67 c LEACHING FACILITY: (type) Y ���0} (size) NO. OF BEDROOMS Bu1LDER OR OWNER PERMITDATE: 't7> �'I COMPLIANCE DATE:.1-2——0. dr`7 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 2W feet of leaching facility) Feet Edge of Wedand-and Leaching Facility(If any wetlands exist within 300 feet of leaching'facility) Feet Furnished by "� i Q a i q -3 3C Q_ jr.2,3 � Town of Barnstable P# /L lime Department.of Regulatory Servic Public Health Division Date J -Z. ° �ie3y a�e� 200 Main Street,Hyannis MA 02601 Ep Md Date Scheduled � J Time , Fee Pd.�F/O 0` 0 0 Soil Suitability Assessment for Sewage Dis osal \ Performed By: A / � �n� �& Witnessed By: LOCATION& GENERAL INFORMATION Location Address lelb Owner's Name,--- s Ce Hrt/i J`Q Address �G 6 n" Assessor's Map/Parcel: q 13 9 Engineer's Name p dE.ie�I41e '7J-ee NEW CONYMUCTION REPAIR Telephone# CS e 'q 7�/5 3�3 Land Use IDS CAX� h^c,. Slopes M Surface Stones �/A Distances from: Open Water Body 7_:�00 ft Possible Wet Area C10 ft Drinking Water Well-:? I�� ft Drainage Way 7-30ej ft Property Line �Z ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes) 01 714 i Ld G�-1 I L P s S_TTZC i C)lParent material(geologic) oo-t wcx S Depth to Bedrock 7( 2 Depth to Groundwater. Standing Water in Hole: N` ~ Weeping from Pit Face t Estimated Seasonal High Groundwater 2"(a DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: /V � t' Depth,Observed standing in obs.hole: in. Depth to soil mottles: in, V Depth to weeping from side of obs.hole: in, Groundwater Adjustment fr Index Well# Reading Date: Index Well level Adj.fhetor Adj.Groundwater Level,R PERCOLATION TEST Date, Time.ve.� `r Observation Hole# Time at 9" Depth of Pero ^' "5 Time at V' lC+ I 'Time(9"-6") t -- Start Pre-soak Time @ t — End Pre-soak • 2,1 Rate Min./Inch 1^� I VN /)( Site Suitability Assessment: Site Passed /� Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100,of wetland,you must first notify the Barnstable Conseirvation Division at least one(1)week prior to beginning. Q:\SEPCIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, -ve Y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) 12. SL 1G `'fL2 36" 1v�1�Slc C Y12 6�� 1 CU c,: DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistengy. Gravel). • •�r. 1 III DEEP OBSERVATION HOLE LOG Hole# + Depth from Soil Horizon Soil Texture Soil Color Soil - - Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. o s' t Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes !_____ Within 500 year boundary No Yes, Within 100 year flood boundary No-X— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? _— If not,what is the depth of naturally occurring pervious material? Certification I certify that on i V c�q 5 (date)I have passed the soil evaluator exathination,approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tr ' ing,expertise and experience described in 3 10 CMR 15.017. Signature Date i Q:4SBPTICVBRCFORM.DOC Flazaruous i Date Physical Street Address-Check database to ensure it exists Working Phone Number LLor Actual Amounts - ( ie. gas being used to fuel machines, thinner to —�"I , clean brushes all count as hazardous materials-no blanks) AI A- Storage Information - location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 5"."Z r� Fill in please: art APPLICANT'S YOUR NAME/S: h BUSINESS YOUR HOME ADDRESS; 9c �-� 3 TELEPHONE'#. Home Telephone Number tTT NAME OF CORPORATION: —&- 'r 6 NAME OF NEW BUSINESS TYPE OF BUSINESS S �^✓ IS THIS A HOME OCCUPATION? X YES NO ADDRESS OF BUSINESS V► i / MAP/PARCEL NUMBER ,�47� l y (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to m-ke sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COZa�l ISSIO ER'S OFF MUST COMPLY WITH HOME OCCUPATION This indivih e info ed an e�ie irements that pertain to this type of busines MULES AND REGULATIONS. FAILURE TO Aut d Signatu re COMPLY MAY RESULT IN FINES. C MMENT or' > > ! Y aC. ` 2. BOARD OF HEALTH This individual has been-in Armed of the permit requirements that pertain to this type of business. Mk1ST COMPIY WITH ALL Autho�'zed ign ture** HAZARDOUS MATERIALS REGULATIONS COMMENTS: ,&A S la/t S 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: ' Date: ,5/z-o/ 1� '~ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM 0 NAME OF BUSINESS: '- �t�► e�-5 BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: ..�bL�.v-,, EMERGENCY CONTACT TELEPHONE NUMBER: S�' �,��` �� MSDS ON SITE? TYPE OF BUSINESS: 'SQrV INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: 14oy v- Last shipment of hazardous waste: _ 'Yen-re/ Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristic n s and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products:.grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents J Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signatu Staff's Initials 11� No. / 7 Fee C/o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for Otopooal *pgtem Construction Permit Application for a Permit to Construct(,/)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.C?q e-N 1 tos ST 14 YP'NP)S Owner's Name,Address and Tel.No.T"1 rA P: o t3 [ ti-I�L� H�ANN1s�g P-SW, Assessor's Map/Parcel . 2_4 Q _ 134 Installer's Name,Address,and Tel.No. }?ASTorZX rjt caar.all Designer's Name,Address and Tel.No. th1 b 17JN la£fz j,.�y C5 P® (3 Cp . ►Z%q Fe STo µ vim, 9 Z W c 1�55 1t�uD 7r0T1Zs_rV q4,& /v44— CSu Y7,S -S3 0-v agl9 ,5o$) 97?- S3/3 Type of Building: Dwelling No.of Bedrooms _ Lot Size 7-0, 00(o sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �/I/7- gallons per day. Calculated daily flow h ' gallons. Plan Date a- !- o'�` Number of sheets Revision Date Title Size of Septic Tank PFLOP T5-A 1500 ql Type of S.A.S. 330 1NP)l-T' A7MY-, Description of Soil SIZ PI-A-t-IS Nature of Repairs or Alterations(Answer when applicable) -U E � ®T' S YMNA 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 Certifi- cate of Compliance has been is th' oard of Health. Sign A -C,n 1A.T1 r� Date Z- - Application Approved by Date Application Disapproved for the following reasons Permit No. '—"� Date Issued --- — ————— 1 •-7 oy( �- N cJ / d ` No. oW �. Fee 6 i� THE COMMONWEALTH OF MASSAC51R SETTS Entered in computer: . r Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZI pplication for ]i5poe al *p5tem Con!5tructiou Permit Application for a Permit to Construct(V/)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.9Lj C 1•I tLdS 'ST H YOW)S Owne?s Name,Address and Tel.No. -ri t- • I CbG PC- P. c� 9cuc t-tl(, HYflN11J0c?a2-r HiA. Assessor's Map/Parcel Zy Q — 13 L Installer's Name,Address,and Tel.No. ?AS-Toab rX ce..r/A-Ti Designer's Name,Address and Tel.No. 'U-N 61 E e< a G (30 L t,) G(L��S F�t.!_c(� �oRZ�STDI�L. M✓}r C?l -S3 c�-v aJl9 7- S3/ Type of Building: Dwelling No.of Bedrooms _ Lot Size ZU, 00(o sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1-1,41 7- 1 gallons per day. Calculated daily flow �/���' gallons. Plan Date a - 1- o Number of sheets Revision Date Title Size of Septic Tank T41clPO5r,6 150c.� 91 Type of S.A.S. 33u 1N���r2a�v�zs Description of Soil SZ3Z:T, j)LAt-JS Nature of Repairs or Alterations(Answer when applicable) U P69-A O'S oT S l M 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 Certifi- cate of Compliance has been is e th' oard of Health. Date Z- _' /0_ Application Approved by� _ ` Date c;1/ 6 Application Disapproved for the following reasons Permit No. c� "Gq 4' Date Issued ^� ————————————————————————————— ------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( V)Repaired ( )Upgraded ( ) ��Abandoned( )by PA ST6 RZ -EX Cos,V An tl� at qN C H 1 L.DS �i, N�q A has been constructed in_acgordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,-M 7��/6�dated a/6 I Installer PAS'T<T 2_G -5--X GA vn-')0'Y1_j Designer C4V4VIV_C-ZO-� G"<-IY2^ The issuance of this permit shall note be construed as a guarantee that the system wil function as designed Date �( J Inspector s�---�'--� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mopo!af *pgtem Con5tructiou Permit Permission is hereby ranted to Construct(1�')Re air( )Upgrade( )Abandon( ) System located at YY Cry/40 5 1 ) MA/ IwJ 5 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the datep off this per\'t. Date:_._ � / Approved by,- `�' Town of Barnstable �f HE Regulatory Services Thomas F. Geiler,Director * snxxsTnatt~ Public Health Division 039. 1 'ElFc.t " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 2 i 3 17 Sewage Permit# �' 7 ry Assessor's Map\Parcel 2 3 PEk� MLZ,F-e.t Designer: �.�✓tA�ntC/':nc LA)&e- A% Installer: P(As+Vre �. f7`�'e a Address: �Z• W- CCW s S-'•tQ 1 Address: • y• Roy On y,2 2 eo,s V-0 r'—' E�'0�-1J6%4 Ao'Vms issued a permit to install a (date) (installer) _ .. septic system at C •�6 i'�s ��' Cen+ V6 LC based on a design drawn by (address) dated Z t ' 0 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or ty certified as-built by designer to follow. ti (Insther's Signature) Q PETER T. McENTEE ` CIVIL /r No. 35109 PSI ( esigner's Signature) (Affix Design ) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF ( I COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION .4 Z- 2 A� W O TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM /3 PART A CERTIFICATION Property Address: 94 Childs Street Centerville MA 02632 - Owner's Name: Timothy O'Keeffe Owner's Address: PO Box 476 Hyannisport MA 02647 -a Date of Inspection: January 9,2007 Job#07-04 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. '; ; Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 +�J Telephone Number: 508-428-1779 CERTIFICATION STATEMENT 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 arrt,p;DEF!1►nri� approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste �-��'0I, 117,4 Passes c p� PA IuK Conditionally Passes = • m. Needs Further Evaluation by the Local Appro 'ng Authority E X Fai ir CO Z Inspector's Signature: Date: 1/9/07 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. Notes and Comments: Cesspool and overflow pit,overflow had previously been full to top of structure. ""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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 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: 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. Answer yes,no or not determined(Y,N,ND) in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: ` Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 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 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: I Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X— 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 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma _Yes_(Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _ _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection'? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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? _X _ 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: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. _X _ 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Unknown Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Last two years occupied— 125,000 gal.= 171 gpd. Sump pump(yes or no): No Last date of occupancy: One year prior to inspection. COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Owner Was system pumped as part of the inspection(yes or no): 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 _X 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) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Overflow pit installed: 10/31/90 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: V Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: No (locate on site plan) Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):, Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number: leaching chambers,number: _leaching galleries,number: leaching trenches,number, length: _leaching fields,number,dimensions: _X_overflow cesspool, number: One 6x6 precast pit. _innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Liquid level previously at top of structure,pit has no effective leaching CESSPOOLS: XX (cesspool must be pumped as part of inspection) (locate on site plan) Number and'configuration: One w/overflow pit. Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. Childs Street Water Service 41 . ....... ........ .......... ............ .................... .................... ... .......- ........... .......... ............ 37 30 43 Page 1 l of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 Childs Street,Centerville Owner: Timothy O'Keeffe Date of Inspection: January 9,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record-If checked,date of design plan reviewed: _Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _Accessed USGS database-explain: You must describe how you established the high ground water elevation: A pert test will be performed prior to repair to determine groundwater elevation. A' i ��It4 No._ �,2,_--•,c f...� �� " #OA THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE K //V AVVIira#iun for Biupuuttl Workii Tonu#rnrtiun rrut"d Application is hereby made for a Permit to Construct ( ) or Repair (,k) an Individual Sewage Disposal System at: Location-Address of?Tot No. Owne. ddress - w a9vs � ,......... . - ................................ ..•-•-•-...... Installer Address Q Type of Building Size Lotc=:�4_11�1_____.Sq. feet Dwelling—No. of Bedrooms_______________.....................Expansion Attic ( ) Garbage Grinder ( ) 0er4 Other—Type of Building ------- ......... No. of persons____________________________ Showers ( ) — Cafeteria ( ) C4 Other fix�ures -------------------------------- - w Design Flow.............. ....................gallons per person per day. Total daily flow---------k--? ®.....................gallons. WSeptic Tank—Liquid capacity/WK_gallons Length---------------- Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width-------------------- Total Length.___________._---- Total leaching area_____-__.___________sq. ft. Seepage Pit No.______.__,l______ Diameter.___._ _._ Depth below inlet___.___....____ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_____-_---_________-_--- Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--_______________--___. --------------------------------------------------------------------------------•------------•---•--........................................................ 0 Description of Soil........................................................................................................................................................................ U ------ ------------------------------------------------------------- •-•-------------------------------------------------------------------------- -------- ------------------------------------ •-----_--- W --------------------------------------------------------------------------------------•....--------------------------------------------------------•---------•-----------------------------------••---- U Nature of Repairs or Alterations—Answer when- ----- applicable --- pplicable-----_ U l- 1x_ °/ __-D(J,�f �DLe/ 1'U ski 11Q�1 �f i�- �-Js ?.' ----------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as been iss d he board of health. Signed -_ --- . ----- . --- - - -- --------------- ........�� 13 I Application Approved By ..--------- �-- - t --I��"...3./...�...74 A n Date Application Disapproved for the following reasons: ............................................................-------------------------------------------................................ --............................................................................................................. .................Dace---------..-.-.-. PermitNo. .-------.. e...- ..:1--...-/....2---------- Issued ................................................---� Dace i s THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH ; TOWN OF BARNSTABLE Appliration for jBis oral Works Tonstrnrtinn 1hrmit (f Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal _ System � -�--G2 EO/�D0_5 .9 � / 7Z�SL�)iZ ---- L/..C...C..E...�....M - ------------------- y ------ C---------------------------------- -------------- --------------------------- -•---........------.......------------......••.._................. ........------------......------.........^-------------------•--........................--•--••-- �cl L��S JG.` � &Y �jy �ddress --------------------••-•--•-•----•--------- ----....--------- ' !!�.........L.�:..:._..........._5::.. Installer Address 10— Type of Building / Size Lott-®_ _:=-Sq. feet Dwelling—No. of Bedrooms.............. .......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .......;,C!;�,5......... No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----•--------- ----------------------•--------••••-..•---------------------------------•---------------------•-••••---•-----------•.......--------•- w Design Flow................�av -.__----------_-gallons per person per day. Total daily flow.__.._._.`3�o.....................gallons. WSeptic Tank—Liquid'ca.pacity.,! 4.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. i s 3 Seepage Pit No..........Z----- Diameter........ __._._ Depth below inlet............... Total leaching area-...............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit...........--....... Depth to ground water........................ LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C+ -••--•---••-----------------•-•-------------------------------•-...•----------------•-•-•-•--•---•-•----•...---............................................. 0 Description of Soil-----------------------------------------------------------------------------------------------•--•-------------------------+----•--------------------------------•-- x �., w UNature of Repairs or Alterations—Answer when applicable._��UP__ _�`�/L_ .._. C .._ /- ? l0lel jo Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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. LSigned .... / � .. ...... ... /..... ....................... Q .. Application Approved BY p1!� - - f� ie Application Disapproved for the followi�'g reasons: .............................................................-------------------------................----.--------.----.---............................ .......................................... --------------------- ----------------- ........... �e PermitNo. l +� 9• Issued ------------------------------------------------------- ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C'Ieritft.catr of Cnmlaliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----------------------.......... '1��12? t d Z 7........l •UPS ---------= r t -----------------------------------....----------...----------------------------- ----- Installer at ... ... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......��.... V 0).. _.. dated ................/f..............-.---.-.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS�TRUEd AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ' ' , I " J ! �_._ DATE '-0� -------------------------------------------- ------------ Inspector .... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ^1 TOWN OF BARNSTABLE No.... -._: .�.` FEE.. .......... Disposal Marks Tun#rutilan 11rrmi# Permission is hereby granted.............. I........... Sl....../{l/�'.................................... to"Construct ( ) or Repair (A,) an Individual Sewage Disposal System at No. 9 ............ ze1'1----4- .S:-----..k.5 ............ �� v>L ........................... Street as shown on the application for Disposal Works Construction Permit Nod�-�.97: Dated.......................................... •----•---••-----•---.......�_.-•-----.....a..........................................................of Health DATE... ..�' --------------------•---------- FORM 3850E HOBBS&WARREN.INC..PUBLISHERS - vNFC TOWN OF BARNSTABLE LOCATION SEWAGE # 90— VILLAGE ASSESSOR'S MAP 6Cz INSTALLER'S NAME PHONE NO. 49 '7�wZ (5�5A- SEPTIC TANK CAPACITYLl LEACHING FACILITY:(type) f>/%— �� (size) NO. OF BEDROOMS PRIVATE WELL OR UBLIC--WATE BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No : . �i � � •����- ,` �, ._ y� � f� t LOT 71 ILA RY Ltf-A __O CARNSTABLE szs so, fiT O D.. 02-26-07---- 129.91' _ t 06 - sarx c/ V L/ ASPHALT DRIVE DIVISION pu -a o - -rr - - .LOT 9 M =TrC Site Plan o F' - LOT 7 I . �.:ND.. K/681k.:..PYnpoS.E.D=�.." .- _..5r_+SLTr.% ��'�1-'p�• Wa r O 7 I %-USDUI- O ,N - © WIM,nV�»N��Fsxa,- x S'-=8�slrx Kr+oE¢Sed GTeJ 2&2 4Z.4 _A):16Ea B4 .-1W 3W3I4- ',I � = o I 5K �ri¢ar �- o•w� o".- _3KS-�4�Z }-EylTFornictlnF'n-r- I J.U FF02lLy2x�crrx-' - - - - O(i 5>� Sk jO l N I O _3L,oEKS...._ L O.SL_b 8 :L'G52QFd-yT Ttztiut" L -1 !- L_J EMIEl1X &-1Qr-P. I �nvmca,— A F _ IZ 2"i 121-t"iy15QP��IIIIYE-' �- - �lT-vocva�rmu-m0. _ I _...�lr��o-rnlc,ztl.-: ..:. // `- ' 2-c��• -- --.__,�--------- I General Notes: ------ --- - - - 1.All work to be performed in accordance with Massachusetts State Building Code,780 CMR, Eighth Edition,IBC 1009,and applicable codes included by reference.Framing to be in -...rr .4ao2_ nw-ca-ovc9_.rltvr ! GL- Cn.- accordance with the American Wood Council Wood Frame Construction Manual,110 MPH r Zone.All work to be as approved or directed by local authorities havingjurisdiction. rnt:oNlySYo ---��-iL•— �^rrc.7uG _EYtY21riG �v�veY k lrC4F1J =- =-KOCM _ 2.Contractor to secure all permits,and to arrange for inspections by local authorities having �7:vr5nrsr.-"F1:1-071•Y I O jurisdiction,as my be required. 3.Work to be leRLin clean condition,read for use and occupancy.n, Y panty.All debris to be disposed off Osite in a legal manner. -4.Contractor to install or upgrade a0 plumbing,electrical,heating and venting systems as _ O required,per code.Install and upgrade all fire protection systems per applicable codes,or as may be required by local authorities having jurisdiction,including smoke and carbon monoxide detectors. 0e Andrejs R Strikis w. Architect 85 Rher Vl-L-,C--rville,MA 02632-Telephone:(508)790-0920 Floor Places I 1. 94 Childs St•eet,.Centerville,MA 02632 'Al - I b LEGEND LOCUS _ � � WFsr M,q#V 7r, 78 � � ` PB 166-PG 25 PROPOSED CONTOUR EXISTING CESSPOOLS (RECORD LOCATION) TO BE PUMPED & FILLED WITH SAND F7-9-1 PROPOSED SPOT GRADE Pine /0 �,�'' EXISTING CONTOUR 000 `" e-a 5040 17'50"E TEST PIT � 4 Carbtto Ave �p•�i, �e77 --- W EXISTING WATER SERVICE °\a own m o -- t1i -- EXISTING OVERHEAD WIRES APN 249 — 134 BENCHMARK 20,000.-t5F LOCUS MAP N.T.S. r ;4 'o ,p ,ti GENERAL NOTES: R� 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 1UUj _ r i �r j'` BOARD OF HEALTH AND THE DESIGN ENGINEER. ` , r PROVIDE 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS CLEANOUT OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE /No. 94f _ . LOCAL RULES AND REGULATIONS. ►n / /' J�/ r�-i -' / ' W ` _ 3. THE SEWAGE DISPOSAL SYSTd=M SHALL NOT BE BACKFILLED PRIOR SN r {� TO- INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE ,WD. FRM , _ 4�j�Kq�xVI ff �? N DESIGN ENGINEER. T,p"�,a 1Ot 62' r LINE(Tt'I'.) N 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING �p , 'o, t FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN / r/ / /r � � � •. �S,�l / r r`/ �, � ENGINEER BEFORE CONSTRUCTION CONTINUES. J ° •'' � , _ + 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. _ Ar 0���, ` ��-�� 0` -- I00 00 p 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF Tj > �'� �� ,� � � PROPOSED `j A THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF �• v1 "\ J' SEPTIC TANK HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. lu N O ' 7. WATER SUPPLY PROVIDED BY TOWN WATER. INSPECTION 22 PORTS 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. o h--10'-�{ All REMOVE 14' OAK u __ t_ `s n,.' 9. ALL AREAS DISTURBEU DURING CONSTRUCTION SHALL BE RESTORED i ! �'F': -.---- . .- - yr & 13" PINE TREES u TP-2 ':' TP 1`. t,,5 I TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. ,D BOX 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY I. r l THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING . ._PROPOSED .S�;A4S..` CONSTRUCTION. --36.8' " .. 25.9' r 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. 154.00' � �'� _ +99 AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). ?4 N04°7'50"W ," ;x ,r' 12. SUBJECT SITE LIES WITHIN A ZONE 2. ` O � A d' ` ETE T. PROPOSED SEPTIC SYSTEM UPGRADE ,9PArVENT p 00 EDGE McENTEE CIVIL 94 CHILDS STREET, CENTERVILLE, MA i No. 35109 Prepared for: Timothy O'Keeffe, P.O. Box 476, Hyannisport, MA 02647 BENCHMARK: I o CHILDS }t STREET WATER 5HUT-OFF AT HYD. R&ISTE`�E �� Engineering by: Surveying by: SCALE DRAWN JOB. NO. FLOOD PLAIN DESIGNATION ELEVATION = 100.08' �F �� Eng1nwdnq orks Hood Survey Group 1"=20' P.T.M. 11 1-07 Community-Panel No. 250001 0005 C i (A55UMED DATUM) 12 West Crossfield Road P.O. Box 1724 Map Revised: August 19, 1985 �` Forestdole, MA 02644 Mashpee, MA 02649 DATE CHECKED SHEET NO. Zone "C" (508) 477-5313 (508) 539-7799 2/1/07 P.T.M. 1 of 2 ICI : I , �• i NOTE: TO PREVENT �BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.97.90 FOR A DISTANCE OF 15' AROUND THE T.O.F.=101.62 FINISH GRADE: 100.6t PERIMETER OF THE S.A.S. (Existing) EXISTING F.G. EL.100.1 t F.G. EL.100.2t ,. MAINTAIN 2% MIN SLOPE OVER LEACHING AREA 36" MAXIMUM COVER INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D-BOX TO INSPECTION RISER PIPE TO WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE SET TO FINISH GRADE L = 31 L 12' " 4" SCH 40 PVC L = 4' 6" 4" SCH 40 PVC 4" SCH 40 PVC ® S= 2% (MIN.) 10" 14" ® S= 1% (MIN.) 6 ® S= 1% (MIN.) �. 48" LIQUID o 0 0 0 0 0 o e o 0 0 0 0 0 0 o e o o e o e LEVEL INV.=97.75•,•a.; Y o e o 0 0 0 0 0 o e o 0 0 0 0 0 0 0 0 0 0 GAS PROPOSED INV.=98.00 BAFFLE D-BOX INV.EL=97.40 ' INV.=97.62 INV.=97.45 PROPOSED 1500 GALLON SEPTIC TANK 3.5' 4 INFILTRATOR 3050 UNITS 0 89.5"(7.46')/UNIT = 29.8' 3.5' --- NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION. EFFECTIVE LENGTH = 36.8' TIE-IN TO EXISTING 4" C.I. PIPE 2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL .I. AND TRUE TO GRADE ON A MECHANICALLY COMPACTED SOIL ABSORPTION SYSTEM PROFILE OUTSIDE HOUSE, INV" C SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN H.1s 310 CMR 15.221(2). 3) INSTALL INLET & OUTLET TEES AS REQUIRED. � 2" LAYER OF 1/8--1/2" 4) GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE. BREAKOUT EL. = 97.9 -* DOUBLE WASHED STONE PIPE INV. EL. = 97.40 (OR APPROVED FILTER FABRIC) EFF. DEPTH = 2' -.�- 3/UBL SEPTIC SYSTEM PROFILE WAS (3) 5" DIA.OUTLETS BOTTOM S.A.S. EL.= 95.40 DOUBLE AS STONE t5.5" " �2" N.T.S. CHAMBERS ARE TO BE SET 5' MIN. ABOVE GROUNDWATER 3.5' 4.2' 3.5' LEVEL ON A SAND BASE EFFECTIVE WIDTH = 11.2' i 0 �- 12" NO GROUNDWATER AT EL:90.1 (TP-2) 15.5" W. 6" SOIL ABSORPTION SYSTEM SECTION TH.T.S. H-10 LOADING 2" D-BOX ` SOIL LOG DESIGN CRITERIA , �' ; DATE: FEBRUARY 1, 2007 (P-1 1 625) NUMBER OF BEDROOMS: 4 BEDROOMS SOIL EVALUATOR: PETER T. MCENTEE P.E. SOIL TEXTURAL CLASS: CLASS I WITNESS: DON DESMARAIS-HEALTH AGENT DESIGN PERCOLATION RATE: 2 MIN./IN. 7777 DAILY FLOW=DESIGN FLOW: 440 G.P.D. Elev. TP- I De th Elev. TP-2 De th / % f �� -� GARBAGE GRINDER: NO r'/% 1 1/Z cJN,/ ` 100.5 A LOAMY SAND On 100.E 0" SEPTIC TANK REQUIRED: 1500 GAL. CAPACITY 10YR 4/2 FILL LEACHING AREA REQUIRED: 440 = 594.6 S.F. / WD. 12,. ( ) /T.O F. ® 101 62'/ !r 99.5 B 99.6 12" .74 - A SANDY LOAM _ } �` ` '/i SANDY LOAM 10YR 3/3 USE 4 INFILTRATOR 3050 UNITS AS SHOWN / 10YR 5/6 ' [[ �. 99.1 e 18" SIDEWALL AREA: 2(36.8' + 11.2') X 2' = 192.0 S.F. 4.5' DIA ACCESS PORT FOR INSPECTION. L-...........; SANDY LOAM BOTTOM AREA: 36.8' X 11.2' = 412.2 S.F. INLET END 95" _ 97 6 10YR 5/6 36 TOTAL AREA: 604.2 S.F. (OPEN) $ 97.5 36" INSTALLED LENGTH �O C2- 8, �1� �, C PERC DESIGN FLOW PROVIDED: 0.74(604.2) = 447.1 G.P.D. i 54" •� `�" PROPOSED SEPTIC SYSTEM UPGRADE 30" ---tij---- ------ - M-C SAND 10YR 6/4 M-C SAND 51" INFILTRATOR 3050 N I I 10% GRAVEL 10YR 6/4 94 CHILDS STREET, CENTERVILLE, MA ,- PROPOSED I 10%GRAVEL NOMINAL CHAMBER SPECIFICATIONS 11 ------ S.A.S. ------ I Prepared for: Timothy O'Keeffe, P.O. Box 476, Hyannisport, MA 02647 SIZE (W x H x INSTALLED L) 50" x 30" x 89.5" I+-- 36.8' -�{ Engineering by: Surveying by: SCALE DRAWN JOB. N0. WEIGHT' 80.0 LBS. 90.5 ( 120" 90.1 126" Engl wdngWorAy Hood Survey Group N.T.S. P.T.M. 111-07 INFILTRATOR 3050 CHAMBERS S.A.S. LAYOUT NO GROUNDWATER OBSERVED 12 West Crossfie Road P.O. Box 1724 2644 Mashpee, MA 02649 DATE CHECKED SHEET 0 Forestdale, MA NO. N.r.s. PERC RATE <2 MIN/IN.("C" HORIZON) (508) 477-5313 (508) 539-7799 2/1/07 P.T.M. 2 of 2 I L)