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Home My WebLink About0030 CROSBY ROAD - Health 30 CROSBY ROAD, CENTERVILLE A No. 42101/3 ORA FED ESSEUE 10% a o 0 0 `-Hazardous Materials Inventory Sheet Checklist OOADate sical Street Address-Check database to ensure it exists —7- 7--l—Working Phone Number Actual Amounts-(le.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) Storage Information-location of storage,how long is storage for? If none,note that. Disposal Information-where and who?If none,note that. 1. "Applicant Signature-understand what is listed and noted �Staff Initial-any questions,know who to ask Vehicle-.Washing/Rinsing? -provide a vehicle washing policy and xpf nit-note that it was given 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 (cost30.0o for 4_year s).. A business you must do b M.G.L.-it Y ) Hess certificate ONLY REGISTERS Y does not give you permission'to operate.) Business Certificates are available TERS YOUR NAME i , town ,which Main Street, Hyannis, MA..02601 at the Town Town Clerk's O( Hall] Office, 1 FL., 367 ro...�u"xst¢wJ.t zC4d¢ -.. .. DATE•�� :Y' V J tfi2 t' Qn—rn! `��'�mt ', �..� Fit! in p! t t 1 APPLICANT'S C�\� n . YOUR NAME: am Bl1�SINE�SIS �' YOUR HOME A DREIN low WE SS: .` ] �l TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS IS THIS A HOME OCCUP •. ? rn'E OF BUSINESS ATION. YES �_NO Have you been given apprbva(frbm'the biiildan:g.di 6ior�? YES NO ADORESS'OF BUSINESS - MAP/PARCEL NUMBER Wheh starting a new business there are several thins you must do 9 In order der to be in co Barnstable. This form is intended to assist compliance with the rules and regulations of the Town of sist you in obtaining Rd. & Main Street],to make sure you y aining the information you may need'. You MUST GO TO 200 Main St. - [corner of Yarmouth have the h Y appropriate permits and licenses required to legally operate your business in this town. I. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to,this type of business. Authprized Signature** COMMENTS: 2` BOARD OF HEALTH This individual has inform f he p�cmZ e 'rements that pertain to this type of business. Authorized ature** COMMENTS: . " °-`` 1STOOIIIPLYWITHALL 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature.* COMMENTS: 6* Date:0q/Z1Z/08 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: C,40,ryL� BUSINESS LOCATION:_ II )I Um�q INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: �q�� CONTACT PERSON: 5O V 1 a(o� I EMERGENCY CONTACT TELEPHONE NUMBER:—50?) MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation:f Q Last shipment of hazardous waste- Name of Hauler: Destination: Waste Product: Licensed? a No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials 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 characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. 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 Misc. 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 Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint & varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): 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 No. �✓ / Fee 16 d ThE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HE`ALTH'DIVISION - TOWN OF BARNSTABLE, MA&SACHUSETTS Yes Zipplication for Mi$po.5a1 ,p5tem Construction 3joermtt Application for a Permit to Construct( ) Repair(� Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 3P Sb Owner's Name,Add s,a d Tel.No. I IU"N__K C� ac e Assessor's Map/Parcel Z5 Installer's ame,Addr ss,aad Tel. o.. 0 Designs ame,Address and TOel.o�D O MCl/—19 15` 7 Ma f,'' m'Uau Oz 53 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ZZ Design Flow(min.required) %o gpd Design flow provided aj gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 11096C,14fe Type of S.A.S. Description of Soil gX Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Ti e 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this oard f Health. Signed Date glit, k(, . Application Approve Date Application Disapproved by: _ `Date for the following reasons `Permit No. Date Issued o: �-t�`� / Fee /�CJ`✓ fi Entered in computer: s,< x TH.E COMMONWEALTH OF MASSACHUSETTS PUBLIC HEA TRbiVISION - TOWN OF BARNSTABLE,._M�►SSACHUSETTS Yes RpPlication-for TDi!6P0!5a1 *patent eongtructiort Permit � Application for a Permit to Construct O Repair( Upgrade( ) Abandon( ) ❑ Complete System Yindividual Components Location Address or Lot No. JV 56 �C Owner's Name,Add r and Tel.No. ��tN► �I� (�`� ever,�.r GJGe�"' Assessor's Map/Parcel 2Z — ' Z 5wr Installer's ame,Addr ss,atjol Tel.No. ��p~� O ! Designer's Name,Address and Tel.No.l � / !�CZ C S�-b� ►rjIT> a inn i 5 Ma Oz 5 � Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /� z 2 Design Flow(min.required) 3 30 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title }}flfl Size of Septic Tank 1 /1 1 JU4,dt^Type of S.A.S. :,. Description of Soil U Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 1 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 Tile 5 of the Environmental Code and not to place the system in operation until a Certificate of ' Compliance has been issued by this�Oardf Health. /�^�'�" / { Signed / Date Application Approved , Date s} Y 6 _ Application Disapproved by: Date for the following reasons " r (.f�., Permit No, Y�ia Date Issued I / Y0 THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE,MASSACHUSETTS Certificate of Comptiance -THIS IS TO CERTIFY, hat the On-site ewa e Disposal System Constructed ( ) Repaired ( ) Upgraded (�) Abandoned( rr11)by f!at 3V )r J64 I I! V has been constructed in accordance ^� j *with the provisio s of Title.-5 a—n the for Disposal System Construction Permit No. � to —3 dated � )—/14 Installer J��%i.�'l Designer A 6 ►l.yl! #bedrooms Approved design flow (� gpd The issuance of this permit shall not be construed as;a guarantee that the system will 1 fun fon as esigned. Date 1 `3 `° Inspector r No. �D Fee / THE COMMONWEALTH OF MASSACHUSEIL`1'S PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Migo!6al *psStetwCon!5trurtion Permit Permission is hereby granted to Construct ( ) pair ( �) U grade,( ) an ( ) System located at �, ,P�1 �,t 9l r'G't ( lam 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 d9te of this p t. Date Approv�ed by Town of Barnstable GF tHE tn. tiO Regulatory Services Thomas F. Geiler,Director * BARNSTABLE, « 9� MASS. �0 Public Health Division �EDMA'�A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 8-22-06 Designer: Shay Environmental Services, Inc. Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth, MA On 8-17-06 Robert Septic Service was issued a permit to install a (date) (installer) septic system at 30 Crosby Road, Centerville, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 8/16/06 (designer) XX 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 OF MgSS 9c. CARMEN: y�N (Insta is igna re) SHAY No. 1181 GISTER�O S4N17AR\NN -- esigner's Signature (Affix Design p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form __ _ Town of Barnstable r# Department of Regulatory Services — Public Health Division Date ` ,Ums 200 Main Street.Hyannis MA 02601 ff0 MJd� l Fee Pd. 6 l !,, Date Scheduled Time `oil Suitability Assessment for Spwdge T F Witnessed By:. Performed By: LOCATION & GENERAL INFORMATION C I Owner's Name �C � Location Address \e— ( ; Address �v CIvY 1� Engineer's Name el Assessor's Map/Parcel: NEW CONSTRU&nON REPAIR Telephone# _�A • Land Use Q� C\ Slopes(%) —' Surface Stones Y ft Possible Wet Area�—ft Drinking Water Well 1J �t ft Distances from: Open Water Body ` Drainage Way ft Property Line �_ft Other ft mensions of lot,exact locations of test holes&Peru tests,locate wetlands in proximity to holes) SKETCH:($tree[name,di ._� .� U;I dU i Depth to Bedrock Parent material(gecilbgic) Weeping from Pit Face _ . Depth to Groundwater. Standing Water in Hole: i 1 Estimated Seasonal high Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE in, Method Used: — � � nl I,A in: Depth td 5011 mottles; Depth dbaerved standing in obs.hole '' '' ' fr• Groundwater A�ugttrient Depth toiweePmg from side of obs.hole: ►`)�.� --=;n' A� factor,., �- AtU�droundwater Leval Index Well# Reading Date: index Well level .... PERCOLATION TEST �atp If tsb rime �° —°pM Observation Time at 9" t --- Hole# 1 t Ttme at 6" �- Depth of Pere Ditr y r O s Time(9"-6'7 — Start Pre-soak Time.0 End Pre-soak M91 i Rate MinJlnch Site Suitability Ass0sme0t: Site Passed` -- Site Failed; Additional Testing Needed(Y/N) Original: Public Hokh Division Observation Hole Data To Be Completed on Back--------- -you must first notify the ***If percola#on test is to be conducted within 100 of wetland,be ng. / Barnstable C44servation Division at least one r l)wedk p ° --__^.......Ln.•non \'� 'DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture i Soil Color Soil t Other Surface(in.) (USDA) (Munsell) Mottling (Strucre,Stones,Boulders. ten Gravel) 57) C1 McAS,R 2,SY DEEP OBSERVATION HOLE LOG. HoIe# �2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsiSten % ra e ID Y2-S W 1�,W �. sY -T+ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi to Gravel) I� . i 'DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisigncy, graXyl) i Flood Insurake Rate May: Above 500 year flood boundary No_ Yes . Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Natulta Otacurrin Pervious Material Does at least fo feet of naturally occurring pervious material exist in all ireas observed throughout the area proposed fbr the soil absorption system? S If not,what is the depth of naturally occurring pervious material? Certification I certify that on.��_(date)I have passed the soil evaluator examination approved by the Department of environmental Protection and t t the above analysis was performed by me consistent with . the required traini expertise and expe ' nc d s 'bed in 310 CMR 15.017. Signature Date e&ll Loxp QN3.EPnC%PERCf ORM.DOC OWN F BARNS'TABLE LOCATION G�a� 0 � SEWAGE# VILLAGE �ef/�/J �` L-�ASSESSOR'/�AP&PARCEL� �f INSTALLERS NAME&PHONE NO. I SEPTIC TANK CAPACITY b�. � ST v� _t,000 G )21\u✓t� LEACHING FACILITY:(type) (size) Z 7 f )61 ,c � ! NO.OF BEDROOMS OWNER PERMIT DATE: �' �� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ATLANTIC ENVIRONMENTAL P.O.Box 2384 � i Mashpee,Ma. 02649 Attn: Commonwealth of Massachusetts Date: 12/18/95 Town of Barnstable Board of Health 367 Main Street Hyannis MA 02601 From : Mr Michael DeDecko Po Box 2384 Mashpee MA 02649 Dear Board of Health Official; I certify that I have personnally inspected the sewage disposal system at the following address : 30 Crosby Road -Centerville, Mass. The information reported is true, accurate and complete as of the time of the inspection. I have not found any information which indicates that the system fails to adequately protect the public health or the Environment. If you have any questions regarding this inspection,please contact me at this number: (508)477-14-20. Thank you. . Sincerely, Michael DeDecko phone(508)477-1420 l I _ 77 O�C�EO Commonwealth of Massachusetts DEC 2 7 1995 Executive of Environmental Affairs DEP Department of Environmental Protection J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION DORM PART A CERTIFICATION Property Address: 36 Cotes 8y � Address of Owner: Co as e (if different) D ate of I nspection: %.i Z`q Name of Inspector: M,cVc,,-\ � Company Name, Address and Telephone number: RT ccv i o rnA NTH - , ^'1 p.0ox a�� ,µ��n Qee i 0 r+ . CsLb CERTIFICATION STATEMENT SCE, �Al'-`Lr ZO 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 -�` Passes ---- Conditionally Passes ---- Needs further evaluation by the local Approving Authority ---- Fails Inspector ' s Signature: Date: 2 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer,if applicable and the approving authority. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 36 C4-6sby V-A . Owners : Dateof Inspection: INSPECTION SUMMARY: Check A, B,C,or D A)SYSTEM PASSES: --?1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303.Any failure criteria not evaluated are indicated below B) SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced'or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determinate (Y,N,or ND). Describe basis of determination in all instances. if "not determinated", 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. -- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of H ealth). ----- broken pipe(s) are replaced ---- obstruction is removed ----- distribution box is levelled or replaced ---- The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): --- broken pipe(s) are replaced ----- obstruction is removed SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 36 Cejc,,b,� 2d, 0 wner : Date of Inspection: C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health , safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ---- Cesspool or privy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. -•-- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. ---- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ---- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analy- sis 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 notrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: --- I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. ---- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: J% �A,C_Q_'t co x Owner: Date of Inspection : D) SYSTEM FAILS (continued) --- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool --- Static liquid level in the distribution box above outlet invert due to an over- loaded or clogged SAS or cesspool. --- Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. --- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). number of times pumped --- Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. -- Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary 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 ana- lysis. 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. I ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 3a Cvsc>s�,t Q,, Owner: Date of Inspection : 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 - IPA)or a mapped Zone II of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CM 5.00 and 6.00. Please,consult the local regional office of the Department for further information. f_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 3o Ctc",\ to \L"- 0 caner: Q,,R n._.C-- Date of Inspection: N z�t11 ti S Check if the following have been done : - Pumping information was requested of the owner , occupant and Board of Health. - None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. - The site was inspected for signs of breakout. -K All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees,material of construc- tion, dimensions,depth of liquid, depth of sludge, depth of scum. X- The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods - The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM j PART C SYSTEM INFORMATION Property Address: 3 6 QLCO&b 'A � �4�w.►► 1 lam_ Owner: Date of Inspection: -i-\ -1 S RESIDENTIAL: Design flow : 336 gallons Number of bedrooms : 0 3 Number of current residents: vZ ' Garbage grinder(yes or no) : nod Laundry connected to system(yes or no): ye s Seasonal use (yes or no) : mb Water meter readings, if available: u\A . Last date of occupancy: Qur'e* COMMERCIALANDUSTRIAL : 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 P3%PING RECORDS and source of information ± ..................... ................................. System pumped as part of inspection (yes or no):...'P............ if yes, volume pomped: .................... gallons Reasonfor pumping ............................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 'bA Cabs Owner: G ,2 D ate of inspection: TYPE OF SYSTEM Y-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 ..�•ar��.:t4�.t�-�t s-t�.....�.`.Z�:�... ...c�,,ra.�n.�.,_...�-?�. .�,�c-�sz:s....�?.Rxsv:fr,:�..c�...�::�'-....Y:,..� Sewage olors detected when arriving at the site: (yes or no)....... SEPTIC TANK : .. T s...... (locate on site plan Depth below grade: ...L'�... Material of construction: ...lC.. concrete ......... metal ........ FRP........ other(explain) ......................................... Sludge depth :... ........... Distance from to of sludge to bottom of outlet tee or baffle:.... Scum thickness R . ................... .:`b............... 3 a' Distance from top of scum to top of outlet tee or baffle: ........l.A........................... Distance from bottom of scum to bottom of outlet tee or baffle :.....k'4. .:.:'......... 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.)................... p p_ ....... .�3.�a�Q.. .s�a�x.7►urc. —R. m� .+4 r` ... -......�'.. i t i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of inspection: GREASE TRAP : . (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FRP........other(explain).... . .......................................................................................................................................... Dimensions:............................... Scum thickness:........................ Distance from top of scum to top of outlet tee or baffle:....................................... Distance from bottom scum to bottom of outlet tee or baffle:................................ 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.)........................ ................................................................................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:...!? ... (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FR P..........other (explain).......... ..................... .................................................................................u.................. Dimensions ..... Capacity:....................gallons Design flow:...............gallons/day Alarm level:............................. Comments: (condition of inlet tee, condition of alarm and float switches, etc.) ................................................................................................................................................ ................................................................................................................................................. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 36 CQPsb6 Owner: C e,n,AA-r . Date of inspection: DISTRIBUTION BOK.yb.. (locate on site plan) r Depth of liquid level above outlet invert:... Comment: (note if level and distribution equal evidence of solids carryover,evidence of leakage into or out of box, etc.)..tal-mix.. 4.. ?. !uo ►b},.5�<r,.... �... sv ....,..la..£4.! .................. ................................................................................................................................................ PUMP CHAMBER:.. !` ... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.).................... ................................................................................................................................................ SOIL ABSORPTION SYSTEM (SAS):...�.s..... (locate on site plan, if possible; excavation not required, but may be approximated by non- intrusive methods) if not determined to be present, explain: ................................................................................................................................................. ................................................................................................................................................ Type: leaching pits, number: .�... .+�x.ta.. leaching chambers, number:........ leaching galleries,number:........... leaching trenches, number ,length:..................... leaching fields,number, dimensions:................... overflow cesspool,number:.......... Comments: (note condition of soil , signs of hydraulic failure,level of ponding, condition of vegetation, c�). Q13 , .ti .. . U. S.. .. ... . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property address: a o Coc,,-�o k� Owner: Date of inspection: CESSPOOLS:.....k ..5.. (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: ..................... Indicator of ground water: .................... 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 the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ... .......... Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) . ................................................................................................................................................ ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) r Property Address : 36 Cus sb Fr9 : Ca,--e"W• Owner: Q.62Qg � Date of inspection: x z SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100'. I OOo � v�I S•T I 000 9"I PST 6sit A O ` f ❑ C. OO �M•b1 L.�+•,. DEPTH TO GROUNDWATER: Depth to groundwater: . b...feet Method of determination or approximatirre: . V..S...�l�a .�c a.�...Sraa..arc c�4.rG�UR3��_ ..1.!J?/G4� �- .ar?�.C......:Y'!. ?' f....... A.....b`.I �....C�s�.... ...��:F.' ►. . ...� aa�dQg_n...... ,,�ca,��cf..t�u............ ................................................................... i.� 35 a No................ ....... s Fus......... • :I THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ` --.....OF......... � '03 AVVIiratiou for Dispau al 19orks Tomitrurtinri Fermi# Application is hereby made for a Permit to Construct (L.Jaf Repair ( ) an Individual Sewage Disposal System at• .... .............. . ........ r� .. �.._... --.. ocatio d ss o Lot No. Installer Address �� d Type of Building Size Lot _✓..Sq. feet V Dwelling—No. of Bedrooms._..._................. .....Expansion Attic ( ) Garbage Grinder P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) P4 Other hres -------------------------------------- W Design Flow............. .... ._____._._._gallons per person per day. Total daily flow____-__-.-- ... ......._.gallons. WSeptic Tank—Liquid capacity.` allons Length................ Width-______•_-_._.-- Diameter................ Depth................ x Disposal Trench—No. ................... idth.................... Total Length.................... Total leaching area..............---__sq. ft. Seepage Pit No........... ...... Diameter.._.__/. ... Depth below inlet.................... Total leaching area. ....sq. ft. Z Other Distribution box ( ) DosinzAank , ~' Percolation Test Result Performed by._ t.� '..1- -�f.....P..>144.12!�-Date___..__ Test Pit No. L minutes per inch Depth of Test Pit.._.__ y Depth to ground water- --�Azk, - P P �-fr------ P rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ® ,-- -•-f---. ------ - ------------- O Description of Soil....... . .. . ............ . U ---••--•-•-------------------- - ---- . ------------ ----.. .. . -••-------•-----......---•-- --- W -------------------------- ='. ------------------- ...............---------------------------------------------------------- ............................. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---- ---------•--•----••---...•----------- ------• = Agreement: The undersigned agrees to install the afo. escribed Individual Sewage Disposal System in accordance with the provisions of iITLU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in'- operation until a Certificate of Compliance has be issued by t bo d of health. Signed.-- ..... . ----- - ......"r' " ) '../- Da Application Approved BY r.... ..... -- --- ----------------------- d 7 s Date Application Disapproved for the following reasons--------------------------------------------------------•-----------------------•---------------------....._...-- ---•--•-----------------••---•-------••-----------------••-•------------....--•-----------.....-----•-------•-------•-----------------•----•----... -----••-----------------------------. Date Permit No....... �� .................... IssuecL......i...... .a` — -- ------- ----------- Date r. No........................ FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /� .....OF........ .'/..O_.XT-----! .----•-•-•------.-- Applirtttion for DiiiVas al larks Tomitrurtiott 1hrutit Application is hereby made for a Permit to Construct ((,,,,�--or Repair ( ) an Individual Sewage Disposal System at• d .. .., .- -� r' �,�- ........................................... Locatio - d ess Lot No. �� _._.... .. ::. .'.... ...... . .. -'' .. -------- '- fi r! /�..� -........ O ner ress 'f_ .� �- _ ------ ----- -------- ---.....•••••......-• K Installer Address Type of Building Size Lod__::_ :__:'...............Sq. feet Dwelling—No. of Bedrooms.._.................................Expansion Attic ( ) Garbage Grinder ^ aOther—Type of Building ............................ No. of persons............._.............. Showers ( ) — Cafeteria ( ) Q' Other_ tures................ ................. 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.._..,f. !'__... Depth below inlet.................... Total leaching area.:.% ......sq. ft. Z Other Distribution box ( ) Dosinglank ( ) { aPercolation Test Results Performed by., . .,..'..4..//��"_..: Date_.__..r.�/� 44! Test Pit No. I_�_�.minutes per inch De th of Test Pit.....,� p p �, ______.. Depth to ground water.._._ fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........_............... r- ---------------------- DDescription of Soil -�---- : ..•�. --1 �.t1: "_dam:>_ .. 7 ! -==m ••••-•--•--••••-••-•-•••••••-••--•-----••--•-......••.•---• ,- , W -------------------------- ;�- .........----�...�- U Nature of Repairs or Alterations—Answer when applicable.........................................................:................................... --------•---------------------------------•--------•------•---•--•----------------......--••--•-••-------------------------...----------------•---------------------------•--•-•------•------.......--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by t b d of health. Signed..' • :. . .... . .. ........................................... . D c� Application Approved BY ... . .... .......................... ------ Date Application Disapproved for the following reasons-------------------------------------------------------•-------------------------------------------.............. --....•......................•----------.....---...------------------•----•-•--------_--•••••--••---•-------•--•----•••-•--•----•......••--•••••••••----•--••••-•-•-•.................................. Date Permit No.----.g g_... 3 -------------------------- Issued.....1 - .................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................_OF..................................................................................... Trtif iratr of f impliFatta THIS IS TO I Y, hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......................... ... .... ............................•-------•---•--•---.....................----•---- -------------•----•-----------------•--- /^y Installer at......................... . ......•. ------- f� - _ �---- - 2------•--- - - has been installed in accordance with the provision; of TI"' F j j TheState Sanitary Code as described in the application for Disposal Works Construction Permit No.__ 1j_" _,3.., ........ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... a`. g ......................................... Inspector...... -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . �3 ..........................................OF........... No. S FEE.................•------ �i��u��tl urk� tt��rur�iun rruti# Permission is hereby granted -------------------•------------------------.....-----------•.--------......... .. to Construct ( , ) Repair ) an In 'victual Sewa al System -/ atNo.................o-Z ............. d�Q �. ..... ` � --------•--------•---•-----------------.......... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ------------------..................................... Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON AT - ... 1.I0 GA¢aAG� G¢tt►trp6cZ. G 34`� o^A%.Y FLOW a Ito x 3 73oG.Po P . SEPTIG TAwK 1 lip Ooo GA►L. a tJ t3• �. s � •, ot,SPo3AL PIT v4E �vco GAL. I ", ,y � Igo F,SOT TOA AREA• . f C A F• 'TdTAL- DESIGN TOTAL. DAI I-Y o G.Po ' =�vt P%RCO"TION gzATEt l•oIN ZMW o��655 'S 0 0 . Jt ~•y y ` � i Y?C f y �r W ILLIAM C. ZE No. 19334 VL LarT *0 SUM ou ?EMO.'E ALL U SU TABU r` , NIASECtAL I=oe 10F6t:T F IN ALL n 2ELT1DNS •O s TOP FNO9.a9,0\ 48 ?6>T 1 3bb2 � I�•� � 1 F� Hot. �6. ,g6•Jr ��.��`' ., Wqpe I` 10 o n LOAM 'A''� "./ DfST. INV. C, GPTIC. EL AA-0 L.EACtta,1 Mom. IT INV. : b i. n•S wlTu 4A,7 4q,9 A, 6TaNGr A° II GEwt-, IPIIso PL.0"1' P1.. ► PROFILE LoC4TIoIJ � 1 " •s i2 WO gCAL SC—ALM S?:>' VAM 14.1Z1• 4 JoWaT£E p�.AtJ REF�SM%A Cdc CEQTIFY TNI►T 'Kicxr SWoVYN 1'IG•¢GOW GOMPt.YS V4MA'114E S 1 of6t_IN E LZ>-T 1 A►.ID isr.'V AGK : 'TME ?LAN 'ROL S. TQUG 4 TOWN OF: `3 A� TAas_L AND I,-.:; ► cl-r W comaD77 WITNIIJ 't•N GLoop PLt>,IN -DP.�� t�uL�( Z51 1»'� BAXT61Z� IJ�(6 1 iZEG I S'T farIfni &Am D S u ltv 'Tull PL• IS wVT E3nSr o cId A osTlciWILLrr sMA'ss• IN.S•T'Q,UM6NT SV9-VeY -rNF n►=FSE'T5 SuoU►,D rn F=-rF a '^� 11C 4r �LIE �i -- AP�'•_1CA►-IT L. S• YCV6 T LOCATI IN � � 3cl SEWAGE PERMIT NO. VILLAGE In INSTALLER'S NA E A ADDRESS � I a U I L D E R OR OWNER DATE PERMIT ISSUED i0v 1-7 DATE COMPLIANCE ISSUED i "'_, '� �� r. � � � � �� a ,/ � ,�i ! 6 �� .� ��;, �, 2-16"DIAM. ACCESS MANHOLES ✓ S{ t x t . r T 't.-:•:J.�•�I:v lrl:s"•�:r.3n:`_u'.�•r• 4 �. ,..�1[''1.:.��r-r '� -` `'. �a'; :� _ tt - VENT PIPE (O Least 24 inches tall) .�� t:� i �;;�` .• _ ''Rr �-, Schedule 40 PVC w/Charcoal Odor Filter ^ *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. ` 10' min. from SECTION A -A INLET •' 3v Cr4sbY Rd Existing Foundation house to septic tank PROFILE VIEW OF ADDITION TO LEACHING SYSTEM ''• --� �-- '% OUTI T •b• �:` ''- ` �� TOP OF FOUNDATION = ELEV. 100.00 Assumed septic tank cows must be D-BOx cover must be within a In. of finished grads within 6 In. of finished grade �� ' • THE ACCESS COVERS FOR THE SEPTIC TANK, HirsTilai�Is . Grade over Septic- Tank - 96.00 Grade over D-Box- 9&00 Tover SAS- 96.00 3` of 1/8" - 1/2• Washed Peatton {! d' DISTRIBUTION BOX AND LEACHING COMPONENT y .- 3/4" to 1 1/2 Washed Crushed Stone �^ !.«.,v„�',�-'�;^;•�' r;^;^= T .:. M'.• SET DEEPER THAN 6 INCHES BELOW FINISHED GRADE SHALL BE RAISED TO WITHIN 6. OF • 0.02 3 HOLE H-to 4• PVC(CAPPED)wsPEcnoN PORT to BE STEEL REINFORCED PRECAST CONCRETE FINISHED cRAOE Ma r INSTALLED AND TO BE WITHIN 6• Greater PLAN VIE INSTALL 1UF-111E CAS BAFFLES OR EQUALS ST. BOX 3 um Cove T OF System- Elev. 63.76 OF GRADE { 10 EXIST. s-0.01 or Top Y•t i : ass any � EXIST. PIPE 1A 1,000 GAL. - 0.01' p S. h n c FROM EXIST. FOUNDATION 0 N SEPTIC TANK g SS' PK foot 0" Effective Depth 3-24• REMOVABLE COVERS � •s t }� } � � £ 1 4 -8206e INN.1p-1 sa.66b MpRa1E�,.P�±�br�p!i�e�•..��a,�� .. ? �s��k.�� :� �Yi'. / II �i e.sre, O.oi n 0 s, CONCRETE FULL FOUNDATT11ooNN_11 N H-10 II ui rn S Units ! 625' ■ 30' r•'ti.. ..,. ! ;, *4* 0.83' (10 Inches) Ti a) N o 3 - ' 3'min. dearanc.''+ :f GENERAL NOTES T M i 0 , 3 INLET 6• m1n� 2'min. Inlet to outlet Ir rxiT 6 in.of 3/4'-1 1 2" SYSTEM PROFILE ; compacted scone > " OUTLET 1. Contractor is responsible for bigsafe notification • T� t ,; 10•mh' U I and protection of all underground utilities and pipes. Not to Scale � 71s � � I rn 37,25 s' -7• g p,p 9 3.5 I 3.5 II Effective Length .�3' s' -�• 2. The septic"tank a diatri t#ion box shall be set 64?' SOIL ABSORPTION SYSTEM CSAS) � 4'-0• min. level on 6 of 3�4 -1 1p2 atone. 6 In.of 3/4"-1 1/2• p 1 Q' v ProNded s"Mel `• Liquid depth 32 3. Backfill should be clean sand or ravel with no oompoted,tone o EFPective vwlh INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN . - { stones over 3" in size. g NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE • 4 e 03 (OR EQUIVALENT) Not to Scale is system is subject to -inspection during installation This Bottom of Test Hole t El.v.-e7.00 • '' ••••• ' ' J by Carmen E. Shay - Environmental Services, Inc. NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10" e'-0" 4' -10" 5. The contractor shall install this system in accordance Groundwater Observed - NONE OBSERVED CROSS SECTION END-SECTION with Title V of the Massachusetts state code, the a and Local Regulations. approved plan 6. If, during installation the contractor encounters any - -- - TYPICAL 1000 GALLON SEPTIC TANK sail conditions or site conditions that are different NOT TO SCALE from those shown on the soil log or in our design installation must halt do immediate notification be made to Carmen E. Shay Environmental Services, Inc.' 7. No vehicle or heavy machinery shall drive over the - PERCOLATION TEST_ septic system unless noted as H-20 septic components. _ •-�- P 1 1378 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. s Date of Percolation Test: AUGUST 11, 2006 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. -� Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 10. All solid piping, tees do fittings Bholl be 4" diameter Results Witnessed By. DONALD DESMARAIS ( Barnstable B.O.H.) -� EXCAVATOR: Shay Env. Svcs. Schedule 40 NSF PVC pipes with water tight joints. Percolation Rate: Less Than 2 MPI ® 24" 11. MUNICIPAL WATER IS AVAILABLE TO THE SiTE and Surrounding Test Hole Properties. �® No. 1 T No.est Hole DEPTH SOILS ELEV. DEPTH SOILS ELEV. 0 98.00 0 98.00 NOTE: THE PROPERTY LINES ARE APPROXIMATE''�� '• �' �- Sand Loam AND --� `�• . `� Y Sandy Loam COMPILED FROM THE PLAN BY BAXTER do NYE, INC. '` `•.` `�� 0 10 tR 3/2 10 YR 3/2 ENTITLED " CERTIFIED PLOT PLAN OF LOT J1 CROSBY ROAD, CENT., MA" 0"-6" A s7.5o DATED NOVEMBER 5, 1984 s 0"-8` As 97.50 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN Loamy L�oamY IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 10 YR 6/6 10 YR a/6 THE SEPTIC SYSTEM INSTALLATION. 96 6"- 24" 8 98.00 6"- 24" B 96.00 i s �'• / . � Medium M i i ed um Sand i Sand NOTE: ANY STRIPPED OUT SOIL CONTAINING C WING LEACHATE 1e Y 7/4 2.e Y 7/4 FROM THE EXISTING LEACH PIT TO BE DISPOSED 24`- 132 C, 24"- 132 G OF AS PER BOARD OF HEALTH SPECIFICATIONS. LOT #5 96 �t EXIST. EXISTING LEACH PIT TO BE PUMPED DRY do 4 DRIVEWAY r � � _9 FILLED IN PLACE h 1 t - gyp• �, // t, '� ��" I I • O tt / i ASSESSORS MAP - 229 PARCEL - 125 / ZONING - RESIDENTIAL FLOOD ZONE C PROJECT BENCH MARK -- ; ^�__ I I Perc #1 " r TOP OF FOUNDATION L'" i i Depth Rate= 2:MP0 to 48 ELEV. 100.00 (Assumed I I Observed I / Groundwater Not Obs ed WETLANDS LOCATED WITHIN A 200' RADIUS No Observed ESHWT OF THE PROPERTY ARE AS SHOWN ADJUSTED H2O Elev. _ EXISTING ADJU None 3 BEDROOM 1 _- 1 HOUSE 98 i t LEGEND \ ALL OUTIET PIPES FROM THE DISTRIBUTION cox(HALL BE , #30 \ \ SET LEVEL FOR AT LEAST 2 FT. 12• CONCRETE COVER \\ \ 3 6"OUTLET v .ti•. .•.r, 2 KNOCKOUTS 8X0 DENOTES PROPOSED IST. �\ ` - a6• ouTLET t2' '"'� SPOT GRADE , t gal. \` I I ?, ,. :.� DENOTES EXISTING TEST`H6 E2 Septic Tank TEST HOLE\ \1 \\ X 104.46 ELEV.= �.00 2 . O ELEV.= 96.00\\ .�\ ,66• ,.75• SPOT GRADE ` I I PLAN SECTION CROSS-SECTION PL PROPERTY LINE ..t `\ +,.: . ..�•: \\� �\� ----94 I I PROPOSED CONTOUR ,,,�,,•;1�1 , • , +r, .. 3HQLE-DISTRIBUTION BOX - H-10 LOADING i Y, • • �Tv �- -'�.� NOT TO SCALE �r ' • SHED - -- - t•3;•..,T 97- -97 EXISTING CONTOUR D-Box s7.25' 6 I W I design Calculations ® DEEP TEST HOLE & PERCOLATION TEST LOCATION Failed1 Number of Bedrooms: 3 Equivalent to 330 Gal, a 330 Gal. Da Min. per Title V -- FENCE LEACH PIT \� I I Garbage Grinder: No q �� y ( / Y P ) I Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) `\\ I I I Septic Tank : - 2 x 330 Gol./Day - 660 USE EXIST. 1.000 GAL. Septic Tank. - PRIVATE DRINKING WATER WELL LOT #2 I o SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch\\ l\ Bottom Area: 0.74 gal/sq. ft. x 370 sq.; t. = 273.8 gallons REVISIONS \ \ I I Sidewall Area: 0.74 gal./sq. ft. x 78 sq.lft. 58 gallons \� �\ Providing: 331.80 gallons NO. DATE: DEFINITION Use: (5) INFILTRATOR HIGH CAPACITY H-20 KNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, \ \\ I I TO BE USE WITH ,E SIDES, AND 3.5' OF WASHED STONE � 4.0 OF WASHED STONE ON ON THE ENDS. NO STONE UNDER. I I = I LOT #, I I PREPARED FO R : PROPOSED 26,665 Square Feet SUBSURFACE SEWAGE DISPOSAL SYSTEM of GEORGE B . PACKER 30 CROSBY # ROAD 136.70' �' CENTERVILLE, MA 30 CROSBY ROAD �� --------- --"- ---------------------------- CENTERVILLE, MA 02632 PREPARED BY: 0J3---- �----------------- -- -------------------------------------------------------- �` \ s 96-�� ------------------------ --- �CA N� � CARNEY E. SHAY ------ R U�.,�. 2 8 --- o s U; L'NT�IRON�IL�'NTAL SERVICES, INC. ------------------- 60 FOOT RIGHT OF WAY) v � o. 1 o P.O. BOX 627 FCJSTE�w EAST FALMOUTH MA 02536 SCALE: 1"=20' SgNIrAR\P� ' TEL/FAX : 508-539-7966 SCALE: 1 "=20' DRAWN BY: CES DATE: AUGUST 16, 2006 PROJECT#SD-955 FILENAME: SD955PP.DWG SHEET 1 OF 1 I