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HomeMy WebLinkAbout0033 CROCKER STREET - Health 33 Crocker Street Centerville F/R 210 147 J I llll ® 2 UPC 12543o;.,,$,M9,v No. 53LO WASTiNGS. MN Z FAILED INSPECTION COMMONWEALTH OF MASSACHUSETTS w EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION mAp PARCE4 ' I �' LOT t , TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 33 20'c�G -A Owner's Name:-'' Owner's Address: A-ODD�a Date of Inspection: �'A Cthei�n LU Name of Inspect • (please rint) `j, r-11)10 Company Name. �-Mailing Address: (� '70 0 Telephone Number: �k- 7'-7/-� �9rl-'CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address reported below is true, accurate and complete as of the time of the inspection. Tile 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 /deeds Further Evaluation by the Local Approving Authority d! Fails Inspector's Signature: Date: Q The system inspector shall submi a copy of this inspection report to the Approving Authority(Board of flealih 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 a ****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. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: / Date of Inspection: / Qoo V Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 1 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 fiigh s.tatic"wate'r 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: 2 i Page 3 of I'I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM S I;M INSPECTION-FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection., 500 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: 4 3 e Page 4 of 1 I OFFICIAL.INSPECTION FORM—NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: C , r �Owner? -- Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes< No J Backup of sewage.into facility or system component due to overloaded or clogged SAS or cesspool Discharge or pondung 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 '/z 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 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. V 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 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.] `. (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 31.0 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—I WPA)or a mapped Zone I1 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. 4 Page 5 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SE WAGE:DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: V JY 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 vWere.any of the system components pumped out in the previous two weeks? _� Has the system received normal flows in th.e previous two week period ? VHave 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 constriction, dimensions, depth of liquid, depth of sludge and depth of scum? Was.the facility owner(and occupants if different fi•om 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 /— Existing information. For example,a plan.at the Board of Health. V _ 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)] 5 t Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL; SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: / Date of Inspection:_ FLOW CONDITIONS RESIDENTIA Number of bedrooms(.design): Number of bedrooms(actual): c DESIGN flow based on 310.CMR 15.203 (for example: 11.0 gpd x#of bedrooms): Number of current residents: Does residence,have a garbage grinder(yes or no): Is laundry on a separate sewage systems or no):- [if yes separate inspection required] Laundry system inspected(ye or.no)i Seasonal use: (yes or no):Ah .. Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy:J&) ✓ Zt COMMERCIAL/INDUSTRIAL/)t&- Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow('seats/persons/sgft,ew.): 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: OTbIER(describe):_ GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): �� If yes, volume pumped: - gallons--I-low was quantity pumped determined? ' 9 Reason Tor 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) _Irmovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copyof the DEP.approval Other(describe):�s � � ✓[x�i ___ � roximate age of all coia�pon nts,date inst fled if known)and source of information`. • Were sewage odors detected when arriving.at the site(yes or no)/ 6 Paee 7 of 1 1 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _ Q f Owner. Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iroiT AG PVC_other(explain): ` Distance from private water supply well or suction line: Comments (on condition of joints,venting, evidence of leakage, etc.): SEPTIC TANK: t/(locate on site plan) a Depth below grade.. d rx�".. F// Material of construction: oncrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list aae:_ Is age confirmed by a Certificate of Compliance(yes oi•no):_(attach a copy of certificate) © Dimensions: X S Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: r37G Scum thickness: 0 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: ?' Comments (on pumping recommen ations,inlet and outlet tee or baffle condition, structural integrity, liquid levels r lated to outlet invert vidence of leakage, etc. >i 6a. u GREASE TRAPS+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.): 7 • 1 Page 8 of 1 I OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: v J� Owner:` r/ Date of Inspection: f 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/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 (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 CHAMBERlocate 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.): 8 Page 9 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 1 � SOIL ABSORPTION SYSTEM (SAS): (/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: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, *9f/ CESSPOOL�esspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): 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.): 9 Page 10 of 11 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: Owner: Date of Inspection: �o SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the,building. nil 1 1/A -T ' 10 Page 11 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:4WC Owner: Date of Inspection: (� SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 1 Z—feet 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: hecked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: I 1] t, {�Yt�Y yea �t 4 Permit Number: Date: Completed by: � �x: HIGH GROUND-WATER LEVEL COMPUTATION f t Q / } Site Location: 3� ��iG� ����L� Lot No. � lk 4 Owner: 'rly/#Xf V Address: Contractor: S Address: ,��` /��Z?'7� i Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OA Appropriate index well.................... �B Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to D water level for index well ........................... month/;rear STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water r � level at site (STEP 1) ............................................................................................................. fK Figure 13.--Reproducible computation form. 15 ? vl fi { y. ' r � J ' a 1 s`a ji i # } 21' I 1fi } . � Y 4.y w"t i No. ,'�-. ► Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Miopooal *potem Construction Permit Application for a Permit to Construct epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 33 G _ Owner's Name,Address and Tel.No. 7Y�,RQ Y Assessor's Map/Parcel ;Z 1® - i 4 7 Installer's Name,Address,and Tel.No. 1�45 i(5(2� �j(Gi�UIYT 1 esigner's Name,Address and Tel.No. �QCX -�* $� R-Q 12. tj• c-'Aq-�—F►'Z L. o rL o BAN®vim LIA M1(1 Fo �"' 7AL 1�►Y! t���L07-631 Type of Building: Dwelling No.of Bedrooms 2k Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 5tto&M FAM. No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y48 gallons per day. Calculated daily flow gallons. Plan Date t� -Z-dq Number of sheets Z Revision Date Title Size of Septic Tank GX%STi#j6 sc;,oe> Type of S.A.S. (S) 560rj Gtt�M3ER,� Description of Soil O-391 :5 L a 3" - 3311 F -C, siqNo 138 11 IU S Nature of Repairs or Alterations(Answer when applicable) New anti-D cr'r 3 C,AAMQ3tV- .. / 4 fff �t'oN6 aN 'ALL 510�5 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 beAiby thi Bo d of Health. Signe d a Date Application Approved by Date Application Disapproved for the following reason Permit No. Date Issued Fee k THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .!' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zfppltratton for Mitpo.5af &pztem Construction Vermtt Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 53 C.(u'G k1a2 ST. Owner's Name,Address and Tel.No. T P—Q Y G C2 A cG Assessor's Map/Parcel C.cr'"I_R.v t LLrc IM IA_ -33 C.Q oC,kCGZ r ;Z 1 p - 1 tl 7 CZ-1-T'G2v Installer's Name,Address,and Tel.No. {7y-�.Si ORL 0(CAVAT esigner's Name,Address and Tel.No.0Q6TNEE21t01G w02k5 8_3 2-0 12 w . c.N�;17 1t:.l_o t2o sbN o,,.�t-H Mh �atz�s.�D+�t_c rah (500 4-n-63( Type of Building: "e Dwelling No.of Bedrooms 2 Lot Size 26,O00 sq. ft. Garbage Grinder( ) Other Type of Building 5WyLE VAM• No. of Persons Showers( ) Cafeteria(- ) Other Fixtures Design Flow y40 gallons per day. Calculated daily flow 22 O gallons. Plan Date S -Z`bt? Number of sheets Z Revision Date Title Size of Septic Tank Cx 0 5T,J6 IbOcv Type of S.A.S. (3) 550091 cNAMBrcXS`'- H __ Description of Soil O- n S>s s 3 33 U F-G SANO No�t . �38 t1 M S Nature of Repairs or Alterations(Answer when applicable) W-F- 1 F ISI-D w/ 3 e.NANl t2 4 ff -S ONG pN ALL. 1310CS .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 Certifi- cate of Compliance has been ' bothi Bo d of Health. SignedA v /ice Date � -oy Application Approved by Date i Application Disapproved for the following reason h I Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by/ , ,7� C at iljip/ 54. e haybeemconstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. /I dated kh 9 A) t/ Installer P�00C IX CAVATI O�) Designer EN I1J 'R1N WO2KS The issuance of tph�is permit s 1 not be construed as a guarantee that the sy __ will`f)G ction a designe(� Date 1� 7 I Inspector t� _ jq ——————---————————————— No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS igogafpgtem Con5tructionerrrtit Permission is hereby granted to Construct( )Repair(Upgrade( )Abandon( ) System located at 33 GR.0C•kP2 TT: ( EIJ77_:2 v I LLr- 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 focal provisions or special conditions. Provided:Co truct'on must be completed within three years of the date of thisot.. Date:_ Approved by _ ( f 0 i r TOWN OF BARNSTABLE 7 LOCATION CA. � s� SEWAGE #2!9x , �-/ VILLAGE Ce1�TCai t�"' ASSESSOR'S MAP A&LOT2���INSTALLER'S NAME&PHONE NO. `��✓�r°"'� ` SEPTIC TANK CAPACITY ®®a rpo e LEACHING FACILITY: (type)_ (size) Z, � I NO.OF BEDROOMS BUILDER OR OWNER e g PERMTTDATE: �� Q_p� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by ILI �33 r Town of Barnstable Regulatory Services Thomas F.Geiler,Director MAM inaiveras[�, � Public Health Division 6639. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-86246" Fax: 508-790-6304 Installer&Designer Certification Form Date: Z 64 Sewage Permit# Assessor's Ma \Parcel i y 141 g P Designer: el Installer: CLSC�`fAs�� Address: 12 U J l C''ro�S 1 2�U Address: M"T On was issued a permit to install a (date) (installer) r septic system at ) V Abased on a design drawn by �n (address) dated 2 G (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' certified as-built by designer to follow. N OFPETER T. ,y�ss'�y staller's Signature) ►NcENTEE CIVIL -o No,35109 9- 9FC/3TEA�� esigner's Signature) _ \ (Affix tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DMSION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc TOWN OF BARNSTABLE LOCATION � �ti��IZ�R., S SEWAGE t VILLAGE Cep-Te— &,I C e.- ASSESSOR'S MAP & LOTgh,0 il, INSTALLER'S NAME&PHONE NO. RosTo v6 Yam' v®® SEPTIC TANK CAPACITY CO,00 4rp t LEACHING FACILITY: (type) (size) rO/ , N(G.OF BEDROOMS v BUILDER OR OWJN�ER, PERMITDATE: q COMPLIANCE DATE: �1 .17 1) Separation Distance Between the: Maximum Adjusted Groundwater Table and 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- rr B 33 i F4�� 4, ` Comrnonweaith of Massachusetts - Executive Office of Environmental Affairs John Grad - D.E.P. Title V Septic Inspector Department of - P.O. Box 2119 - Environmental Protection Teaticket, MA 02536" w®iam;F.We (508) 564-6813 Governor Trudy Coxe - - B�erNary.EOEA Davld S. Struhs' Commissioner . . -- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART A CERTIFICATION _ Cer1v�ilsz, Property Address: � O��C.erA dRACI Address of°Owner: Date of Inspection: Io - `3 ql Title I Ins p@Ct01 (If different) Name of Inspector: Re . BOx 2119 Company Name, Address and Telephone �uemt, MA 02536 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: 11101 L—las"ses _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority 0Cc�/ Fails t ti T 0 - �0 Inspector's Signature: Date: ,§ , j� b, sue �y 9 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty h (30) days of c ngthis` inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system ow the report to the appropriate regional office of the Department of Environmental Protection. $ The original should be senttv the system ov,ner and topic ser; to the buffer, if applicable and the appro.ing autho:n. INSPECTION SUMMARY: ChecoB, C, or D: Aj �SYSTEM�PASSES: � 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. III SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, 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, 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. (revised 8/15/95) One VAnter Street • Boston,Massachusetts 02108 • FAX(617)SW1049 • Telephone(617)292-UW 40 Printed on Recycled Pepe } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART A - - CERTIFICATION (continued) Property Address: - - -. Dafe of Inspection: D] SYSTEM FAILS (continued): 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 t-imes 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] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 It of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 3 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B -. - _- - - CHECKLIST Property Addr;e.s(: 3.3 Q-6� _qk <A - - - Owner: 1� GSZ Date of Inspection:_ Check if the following have been done: L —Pumping information was requested of the owner, occupant,.and Board of Health. . R'one 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. C As built plans have been obtained and examined. Note if they are not available with N/A. L_The facility or dwelling was inspected for signs of sewage back-up. I The system does not receive non-sanitary or industrial waste flow tdThe site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. = 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. L-The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility o.• !a^ ' ^r(_inantc if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - - PART C - - - - SYSTEM INFORMATION - - Property Ad( rr 3� Cf v X Owner: a ' ICi ssmt - - Date of Inspection: /0 ' +q -!SJ - - _- ! FLOW CONDITIONS - - RESIDENTIAL: - Design flow_: bealions Number of bedrooms: Number of current residents: _ Garbage grinder (yes or no):-OL(j Laundry connected to system (yes or nok4—% - Seasonal use (yes or no): j Water meter readings, if available: l _f Last date of occupancy: �Q (`rlC hS G�Q . COMMERCIAL/INDUSTRIAL: M(l Type of establishment: Design flow: gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RKZQRDS and s rce of information: Stxp, System pumped as part of inspection: (yes or no)�� If yes, volume pumped gallons 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 1eu.� SUS L��G� a LA-a i- G 3 b,,-j <Zbs b��s Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 f - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) --_ "Property Address: Owner: Date of Inspe to r - SEPTIC TANK{ (locate-on site plan) Depth below grade: Material of construction: _4-6ncrete _metal FRP —other(explain) Dimensions: Sludge depth: - Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: O �1, Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition f inlet and outlet tees or baffles, depth of liquid level in relation to ou invert, structural integrity, evidence of leakage, etc.) O 1 , 1 GREASE TRAP:Q)(locate on site plan Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Scum tnic.ne �. Distance from top of scum to top of outlet tee or baffle: Dicta-ce from bottom nt crrim to bottom of outlet tee of battle- Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/!5/95) 6 9 r SUBSURFACE SEWAGE DISPOSAL_SYSTEM INSPECTION FORM - PART C _ SYSTEM INFORMATION (continued) _ Property Address: Owner: �,c ( - - Date of In iona�' L� TIGHT OR HOLDING TANK-.Z\p _ (locate on site plan) Depth below.grade: _ Material of construction: _concrete _metal FRP _other(explain) Dimensions: Capacity: gallons Design flow: aallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOXC�U (locate on site plan) Depth of liquid level above outlet invert: Comments: (note iLlevpi and distributwn i� equal e�;dence of solids car.�c.er, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropeTt ddress: _- Owner: MaC--sc6 1. Date of-Inspection: - ca i'Dt SOIL ABSORPTION SYSTEM (SAS)-A---` .(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: ` I - leaching pits, number:�V4 4 —��_. 1P—q� P4- leaching chambers, number:_ - leaching galleries; number: - leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Com ts: (n to condition o oil; signs of hydraulic failure, level of ponding, condition of vegetation,etc.) L--eQcr1 r� n CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: indicatoon of ground,•.a:e- inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 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.) (revised 8 15 95) 8 { .:� k� Cesa, wy. , .• = ' :� .. ?1. -* .`^J . ,t."!'"E. a� # --..�...-- - ..c `�s �rf s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:_ Ccoc,&c - Owner: -i ct' orlc'` �Date.of Inspe SKETCH OF SEWAGE DISPOSAL SYSTEM: - include ties to at least two permanent references landmarks or benchmarks - - locate all wells within 100' g q . to al C �� 31 DEPTH TO GROUNDWATER a Depth to groundwaterd� _feet method of determination or approximation: G'S me,Ds t Cn C,rt (revised 8/15/95) 9 No....?3.= 7.K Fim......../0 ..--..- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Workii Tons rur#inn ranfit Application is hereby made for a Permit to Construct ( ) or Repair (' ) an Individual Sewage Disposal System at: J r' O �' A r & .... - - w d ... ddressInstaller ' Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms.............S........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width-__-_..-____-___ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `" Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-____-__-__------.-----. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------................ -------------------------------------------•-----•-•----••-•---..............._......•-•-•--•------•......................................................... 0 Description of Soil...........................................•----------------------------------------------------------•------------.....-----------------------•---•---•-••------------ "� W --------------------••----•----- ------•-•-•------•-------•---•-•-----------------------•--• ----------- . -=.---- __�� U Natur of Repairs or terations—Answ� whe applicable �� _J6.4__'_._..... � . � =----------------------------------------------------------------------------••.----...........---. Agreement. The undersigned agrees to install the aforedescribed I idual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental —The undersigned further agrees not to place the system in operation until a Certificate of Compli ce een issue th board of health. a�� Signed .......................... '''r ''�'.. .�i �- � - ----- ----------- Date Application Approved B 4------------- ---- ---------- A =�-1� PP PP Y - ------ -- - Application Disapproved for the following reasons- ---------------------- --------------------------------------------------------------------------------------------------- -- -- ------------------------------- ----- -------------------------- ----------------------------------------------.................................................. ....-................................... ------- -- Permit No. ��---^---1-7y---------------------------- Issued ---_.....---------...D -- Date NO.. ��_:.��� Fps...... 10�...... w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Disposal Works Toustrurtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (' ) an Individual Sewage Disposal System at: --- ---------- ----- ----- -- o ................................' _.......__'._._.._.__......_...............____.......... "._'........._.....-:._......'_...:s" :..._..__'`................................. r a Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms... Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria P.I Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..........._gallons Length................ Width-_-.__--___-__- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,_l Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.___-_-_--_--__-..______ P+' ----•-•------------------------------------•----•-•---------......------••-•---•••--•........_-•--•-......................................................... ODescription of Soil...............................................................................-------------------------------•-------------------..................------•...----••--- x U -----------------•-•-•--•-------------•--•-••--•--•-•--•-•---------•-•--•-•-----•--•-----•--•-----•-.....---...•-•--•-•-•--•----....._._..-•---••--••--•-•-•-•-•-•-•---•.......--•--'•-•-•-------•-••--. UNature of Repairs or Alterations—Answer when applicable..,�h...�_._. _... . '__..._ � _.. , �1��� g................•-•--_. _...... Agreement: 17 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 aA een issued by the board of health. ��jj�� Signed . .--- ;(GlJ -9�� - D. 1.-. Application Approved By ................ :... ..----I�- rlG � Application Disapproved for the following reasons- -- ------------------------------------------------------------------------------------------------------------------------------- ................................ ---------------------- ........................ -------....... _- Permit No. .........7--2>--'----1 7y.......................... Issued . Date ......Dare.........................—...------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ; C9.elrti£icttte of (fompliance THIS IS TO CERTIFY, That the I dividual ,.Sewage Disposal System constructed ( ) or Repaired ( �) Installer _ at /C.ea. -----. .... l - 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. --------- - -- . 7.}7,,.... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ ..... ..I ' Inspector r....�. . -------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.....1.7.3..../..,7y- ........ Disposaal'/ parks TonstriutUaYt Prrutit Permission is hereby granted......<�� �1_ ._., .. a / /V.:................................................ to Construct ) or Repair ( ) an Individual Individual ewage Disposal System at No.. ��� •�� ?/, �1 f�.��2 eeA���1.,////�:.......... ......................... v Street y� as shown on the application for Disposal Works Construction Permit No._/_3-).7]4!Dated.......................................... •-•-'-----"'"-••------•--•. -• _-�------------------------------------------------------ L // _ ( e Board of Health DATEf -------•-•-•-•-•••-•••••-'" FORM 36508 HOBBS h WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE tP Q r C!�10N SEWAGE # -13 17 VILLAGE U ASSESSOR'S MAPLL&1,03� rL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �t (size) WO NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: y� r�(l)�G� COMPLIANCE DATE:—' `-G4—r&-S- Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 a h L) hi d 0 a ' a�t5 h�a� aye TOWN OF BARNSTABLE LO%rATION �! `�`� � SEWAGE # a-la . /y 7 VILLAGE LG =���: � ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. 1-//1'5 Altos CONS' 30--0 2 3 7 i SEPTIC TANK CAPACITY 1000 fAry�C T LEACHING FACILITY:(type) (size) 60 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ] $A,f.� VWA—Z Z-0 k)� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No o a �y LEGEND z ceat MorsV Ra �--� PROPOSED CONTOUR APN 2 1 O - 147 99 PROPOSED SPOT GRADE �° �° c AREA = 25,000± 5.F W� 110� EXISTING CONTOUR cker St w N�01 N W , w 110 EXISTING SPOT GRADE camp 1 ` p O TEST PIT o°o LOCUS 1Q ®,/f� BENCHMARK rA S / W EXISTING WATER SERVICE � tot 00 I -'""_ -.' Route 28 �6 _ a 15HE , /`� � — — LOCUS MAP N.T.S. I ...._-J ' STONE DR] SWAY GARAGE/ EXISTING S.A.S. I GENERAL NOTES: (TO BE PUMPED, FILLED W/ SAND, AND ABANDONED) \ I 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. ~ POOL 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS �,✓ N I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE EXI5TING TANK 1 J LOCAL RULES AND REGULATIONS. MAIN) r-� - x ✓r z I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR (TO RE TOP. EMAIN) 0 �, �r I TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. INV(OUT EL.=95.G5± NO. 33 / ' 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING a s I STY• �—� EN�N EROSE BEFORE WCONSTTRUUCTION HEREON NACONTINUESREPORTED TO THE DESIGN 2a ! WD.M. < 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. f = 98.8rJ y 6, THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF TOF t"< THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. IO I x 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. W 8.. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. O 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED �: TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. I. Q .. ..I I 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS _ 13.2' l IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. tv_ AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). /- 100.00' '\ N76"'50 W �P�~\� O F MAssq�y CROCKER 5TREET o PETER T. G� SEPTIC SYSTEM REPAIR UPGRADE .(30.00' WIDE) % o Mc NTEE CIVIL CIVIL 33 CROCKER STREET, CENTERVILLE, MA No. 35109' G/SZ �o Prepared for: Jerry Gerace, 33 Crocker Street, Centerville, MA RFE-� � BENCHMARK: STAKE * TACK 5ET 9 S /ON ECG Engineering by: Surveying by: SCALE DRAWN JOB, NO. 00.00 (ASSUMED) Engineering Works HOOD SURVEY GROUP 1"=20' P.T.M. 68-04 ��I o l 12 West Crossfield Road 18 Route 6A DATE CHECKED SHEET NO. 1, l Forestdole, MA 02644 Sandwich, MA 02563 (508) 477-5313 (508) 888-1090 8/2/04 P.T.M. 1 of 2 � r � r NOTE: TO PREVENT BREAKOUT, THE PROPOSED r TOP OF FOUNDATION F.G. EL: 99t FINISH GRADE SHALL NOT BE < EL:95.5 FOR A DISTANCE OF 15' AROUND THE (EXISTING) EXISTING �EXISTING F.G. EL: 99t PERIMETER OF THE S.A.S. MAINTAIN 2% MIN SLOPE OVER S.A.S. 36" MAX. COVER INSTALL RISER OVER D-BOX TO 3-500 GALLON L HINT CHAMBERS IN SERIES INSTALL RISER OVER CHAMBER/S EA INSTALL RISERS OVER INLET & OUTLET SHOWN ON PLAN AND SET COVER/S TO WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE SURROUNDED WITH STONE - ALL SIDES WITHIN 6" OF FINISH GRADE a, L =Y L =23"(MAX) 4" SCH 40 .PVC 4" SCH 40 PVC 2' LAYER OF 1/8" TO 1/2" EXISTING Ta" ® S= 1% (MIN.) 6" S= 1% (MIN.) ®®®$a ® DOUBLE WASHED STONE A'. ,�. 2' EFF. DEPTH ,� ®®® ® „ EXISTING EXISTING 1000 GALLON INV. ELEV,=95.44 W%~R RISER 3/4"-1 1/2 SEPTIC TANK INV. ELEV.=95.27 4' 5.2' 4' DOUBLE WASHED INV.EL: 95.65t EFFECTIVE WIDTH = 13.2' STONE INSTALL INLET & OUTLET TEES (EXISTING) INV. ELEV.=95.00 GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF--TITE, ZABEL, OR EQUAL TOP CONC. ELEV.=95:8 M. —BREAKOUT ELEV.=95.5 SEPTIC SYSTEM PROFILE INV. ELEV.=95.00 ®,� BOTTOM ELEV.=93.00 BRUN ®I 3' 3 x 8.5' = 25.5' 1 3' N.T.S. 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 31.5' T.P. EXCAVATION OR G.W. BOTTOM OF TP EL.=87.5 LEACHING SYSTEM SECTION 94S' (3) 5" DIA.OUTLETS PETER T. �Gs 1� 5.5" McENTEE A 1. DESIGN CRITERIA NoC1VIL 35109 15.5" E I I „ SOIL LOG NUMBER OF BEDROOMS: 2 BEDROOMS,. SOIL TYPE: CLASS I 1 2" DATE: JULY 29, 2004 DESIGN PERCOLATION RATE: 2 MIN./IN. D—BOXY° SOIL EVALUATOR: PETER MCENTEE C.S.E. NIA ,°"" INSPECTOR: NOT REQUIRED DAILY FLOW: 440 G.P.D. ,� DESIGN FLOW: 440 G.P.D. (for add'I capacity) 3 CLASS 1 SOILS f �, GARBAGE GRINDER: NO -�- LEACHING AREA REQUIRED: (440) = 594.5 S.F. y Elev. TP Depth INVERTCERE3 153000 Q Room � � NCB. 33 ' t 99.0 A SANDY LOAM 0„ .74 EJ®®E3®®®® 33" 7i i' �' I SEPTIC TANK PROVIDED: 1000 GALLON (EXISTING) E3®Ia®®®E® 5TY. :�' ✓ 98.7 10YR 3/3 3„24" ®®®®®®E3® B_ .FR SANDY LOAM �/p10YR 5/8 USE 3-500 GALLON LEACHING CHAMBERS IN SERIES 102" ( 'ZI 236, T�� m �$.BrJ 96.2 C1 33„ SECTION "' , ' ,� F-C SAND SIDEWALL AREA: 2(13.2' + 315) X 2 = 178.8 S.F. Q �h ••',� 2.5Y 6/6 BOTTOM AREA: 13.2' x 31.5 = 415.8 S.F. W� .� i h r *'Wr,," >20% GRAVEL TOTAL AREA: 594.6 S.F. a" KNOCKOUT f 20" DiA, COVER V!I � 92.7 C2 76" fk DESIGN FLOW PROVIDED: 0.74(594.6) = 440.0 G.P.D. 4" KNOCKOUT O 4" KNOCKOUT 62" I r n ( f 39 A { MEDIUM SAND 4" KNOCKOUT L _ _ - 2.SY 7/6 SEPTIC SYSTEM REPAIR/UPGRADE EL6N 13.2' ' 33 CROCKER STREET, CENTERVILLE, MA 87.5 138" Prepared for: Jerry Gerace; 33 Crocker Street, Centerville, MA 500 GALLON CAPACITY, H-10 LOADING S.A.S. LAYOUT Engineering by: Surveying by: SCALE DRAWN JOB. NO. CHAMBERS No G.W. ENCOUNTERED EngineedngWork,7 HOOD SURVEY GROUP P.T.M. 68—Q4 N.f.S PERC RATE: <2 MIN/IN. ("C" HORIZONS N.T.S. 12 West Crossfield Road 18 Route 6A N.T.S Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. (508) 477-5313 (508) 888-1090 8/2/04 P.T.M. 2 Of 2