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HomeMy WebLinkAbout0040 ELLIOTT ROAD - Health 40 Elliott Road Centerville P A = 248 171 No. 4210 1/3 ORA R���fiaC CYI.I 100 it lam- �: ' � h ��i.���'L'�,' f, ,: t' r- 1, C �. �,: I / t No. ✓ r® Fee �® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLatlon for ;Disposal 6pstrm Construction 3pPrmit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4 O C\V vt�C V Owner's Name,Address,and Tel.No. Assessor's Map/Parcel C Q\ 1AWk_ Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. A o� ►3 a Type of Building: Dwelling No.of Bedrooms Lot Size I(0® sq.ft. Garbage Grinder(i 6 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r� Design Flow(min`.required) 230 gpd Design flow provided J S � gpd Plan Date \ 1 k ;3 \ Number of sheets \ Revision Date Title Size of Septic Tank (? S� %U bC� Cs`.t, Type of S.A.S. � (.� Description of Soil 2�, 6G.fS��`�Cj fi GrrAr�_<- Nature of Repairs or Alterations(Answer when applicable)—A A(3 V L G (o ��2c,C,�lhc, �,�c y�►(�tr'a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. gne Date h Application Approved by - Date Application Disapproved by Date for the following reasons Permit No. �-®��Y '- 6 l Date Issued J No.�! !O l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC:HEALTH DIVISION - TOWN�OF BARNSTABLE, MASSACHUSETTS 0[ppYitation for disposal 6pstem Construction J)ermit Application for a Permit to Construct( ) Repair�) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. y C) C-tt 2 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel n Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. l ►-� �,.i.n�5 sro s� a o o bq S�cvt S S 3 d 13 a Type of Building: Dwelling No.of Bedrooms Lot Size 13 I(o 0 sq.ft. Garbage Grinder(A�C) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 13 d gpd Design flow provided S gpd Plan '. Date � \ 3 1 \ Number of sheets Revision Date Title ` Size of Septic Tank Sse k O()U Type of S.A.S. LA L L De cription of Soil cn p r Gc f r,,j Gmv-y. Nature of Repairs or Alterations(Answer when applicable) XC] U Cc, �o L,2G,ui r, c. , S-1m)rJL 1J Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. g Rd, Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. -c l `4 —C) 1 ) Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by�C ks G at L1 <� `L' l� 0 )k\ Q8 C_X/\1k(TQ\_�\ , has been constructed in accordance ' ] with the provisions of Title 5 and the for Disposal System Construction Permit NoDC1y_0/ dated Installer .So6S�, Designer #bedrooms Approved design�flow gpd The issuance of this p it*hn be nstrued as a guarantee that the system 1 ction as designed. Date Inspector A( f ------------------------------------------------------------------------------------- ------- ---------- -------- --- �1--------------- No. / G /I Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Nsposal 6psteitt Construction permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon System located at�� \\�0 2 tJ C-2�kC w and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be cojplet d within three years of the date of this p�rmit. Date / Approved b. Town of Barnstable Regulatory Services s Richard V. Scali, Interim Director gAMST"M � Public Health Division & 39- Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Officer 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form l Date: Icy Sewage Permit# � 6 \ Assessor's Map\Parcel l` 7 Designer: SizrpNrr' A• !-+A-45 PE_ Installer: scsz.,.N6 �rr,'.1/� PJ1 v Address: 4 2 3 ��� (0.4 Address: k 13 y`C On /3 S`C� F \C was issued a permit to install a (date) (installer) septic system at l,[0 \ �� �`6�" 2.J Cv+1\,- based on a design drawn by (address) �rf�w A. Hf+44S, Pd dated \\(-1 / (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. Strip out (if required) was inspected and the soils were found satisfactory. r 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in cgmpliance with the terms of the IAA approval letters (if applicable) W 7 r• 6' e 5 Y (Installer's Signature) til4fa jf esig eer's Signature) (Affix Designer's Stamp 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. ORAF� 351 White's Path ®�®, So.Yarmouth,MA 02664 334 Tremont Street 508-760-1070 FAX 508-760-5716 PRECAST CONCRETE PRODUCTS Carver,MA 02330 1.9Q0-439-D956 4� 20" 61A COVER 1"3 0" t2" -40 LC,6 .. VT LCIa S Cam , , VI 4" 20" Q!A i. - - - - - - -- - +�a 41 tj 72" SIDE Vt _. •r µ 2G DIA .y L �' r 7 2" _ PLAN VIEW 4 SPECIFICATIONS 4. CONCRETE COMPRESSi+E STRENGTH 2. 4,00 _P.S.J. ,AT 20 DAYS 3. REiN OR M�N� fit Wm L1�2�-93 4.) soft 40 H-20 LOADING TOWN OF BARNSTABLE LO ATION 0 C��10 �-� SEWAGE# ECG VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. `SC S�� C1 SEPTIC TANK CAPACITY e (5'k k 0 U 6 LEACHING FACILITY.(type) f.l,(0 C;KC�Apt4size) O f tJ X e 4 NO.OF BEDROOMS OWNER �OVr, Rd W� a PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /n Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) �C Feet " Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ` / Feet .FURNISHEDBY I6 , 1 a � �a so DEEP OBSERVATION HOLE LOG -Hole# F m Soil Horizon Soil Texture Soil Color Soil Other in.) (USDA) (Mansell Mottlin g g (Stnucture,Stones'Boulders. onsistency qb t3ravcil f l DEA P OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten % ravel �L A 27 0 1DE,EP OBSERVATION]MOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in-) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i to cy,95 Qraycl) ]DEEP OBSERVATION IIOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Qraygl) Flood Insurance Rate Map: Above 500 year flood boundary No— Yes 'Within 500 year boundary No Yes Within 100 year flood boundary No Yes , Dentll of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Vt✓5 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 that the above analysis was performed by the consistent with . the required train ertise and experience described in 10 CMR 15.017. Signature Date QASP P1'1CWERCPORM.DOC as Town.of Barnstable r# Department of gtegidatory Services : .wizen t$ F Public Health Division Date q rayg�1v� 200 Main Street,Hyannis MA 02601 j Date Scheduled f Time Fee Pd. Soil Suitability Asse,ssrnentfor Stew DIS Performed By: Witnessed By: LOCATION& GENERAL INFOIBNI. TION Location Address �\ Q'� t,\ Owner's Name-o1 , �U M C�C> Address `t\ Assessor's Map/Parcel: � Engineer's Name NEW CONSTRUCTION REPAIR V Telephone# Land Use �.c:5':JCa'' �A-Z-. slopes 9'o �-Z-- C: p ( ) Surface Stones � Distances frond: Open Water Body ft Possible Wet Area ft Drinking Wafer Well ft Drainage Way ft Property Line /y ' ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Peru tests,locate wetlands fn proximity to holes) 1 d` CD Parent material(geologic) C�t�'ik+ 5 /4- Depth to Bedrock Depth to Groundwater. Standing Water in Hole: !f�'°'' Weeping frotn Plt Flice `°- Estimated Seasonal High Groundwater DE+'I'�,RMI CATION FOR SEASONAL I� GH WATER TABLE +� ,Method Used: �� Depth Observed standing in ohs.hole; Itt, Depth to soil mottles; In. Depth to weeping from side of obs.hole: fit. Groundwater Adjualment fit. Index Well# Reading Dnte: Index Weil level;. Adj.factor, Adj.Urnuttdwaler Level e PEI RCOLATION TE ST Date P /� Observation ` Hole# / Time at 4" _ Depth of Perc p y g De Time at 6" Start Pre-soak Time @ Time(9"-6" _ End Pre-soak G Rate Min./Inch G 7— Site Suitability Assessment; Site Passed t/ Site Pailed: Additional Testing Needed(Y/N) Original: Public health Division Observation Hole Data To Be Completed on Back---------- ***lf percolation test is to be conducted within 100' of wetland,you midst first notify the Barnstable Conservation Division at least one (1) week prior to beginning. q:�serr[cv>ElicroaM.Doc .i a ;'• �� eta COMMONWEALTH OF MASSACHUSL'I"hS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION � d e� i�1M SJ1b TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY A D SUBSURFACE SEWAGE DISPOSAL SYSTEM FO k PART A �{ CERTIFICATION Or, 5 2002 TOWN OF BARNSTABLE Property Address: 40 ELLIOT.RD'CENTERVILLE,MA 02632 `7 LIg I-] I HEALTH DEPT. Owner's Name: NORMAN RAMONO Owner's Address: 40 ELLIOT CENTERVILLE,MA 02632 (D Date of Inspection: 7/16/02 Name of Inspector: (please print),;' JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: `KO. BOX 2119 TEATICKET, MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 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 cf the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 1.5.340 cf.Title 5(310 CMR 15.000). The system: X Passes° _ Conditionally Passes _ Needs Fury Evaluation by the Local Approving Authority _ Fails tr l Inspector's Signature: Date: 7/16/02 The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspe tion. If tile'system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner sha11 subnlit the report to the appropriate regional office of the DEP. "rile original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECI 10N. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes conditions at the time of inspection and under [lie conditions of use at that lime.'Phis inspection does not address how the system will perform in the future undo•tae same or different conditions of use. T41, S 1,• r,,II no Y Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 'v s , `` :r ;CERTIFICATION (continued) Property Address: 40 ELLIOT RD CENTERVILLE,MA 02632 Owner: NORMAN RAMONff� , Date of Inspection: 7/16/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: , X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. t, Comments: SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally.Passes: _ One or more system compdnents 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. t n/a The septic tank is metal andover 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits ;. substantial infiltration or exfiltr''yation 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 A,s available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or''u'neVen distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ o 'structi6n is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pump ng 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: n/a • R r Page 3 of 1 1 ' OFFICIAL INSPECTION FORM- NOT FOR VOLUi 4TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM 11,SPECTION FORM PART A CERTIFICATION(continued' Property Address: 40 ELLIOT RD CENTERVILLE, MA 02632 Owner: NORMAN RAMONO Date of Inspection: 7/16/02 C. Further Evaluation is Required by the:Board of Health: _ Conditions exist which requirefurther 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 witil 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: 1 _ 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 r,-f Health (and Public Water Supplier, if any)determines that the system is functioning in a ,Wanner 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. e _ The system has a septic tank and SAS and the SAS is within a Zone I o;a;public water supply. _ The system has a septic tank an'd SAS and the SAS is within 50 feet of a pi ivate water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet out 50 feet or more from a private water supply well". Method used to'deteriinine distance n/a "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 f,cm 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: n/a ,w i r ,i' `2 ;f ' Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 40 ELLIOT.RD CENTERVILLE,MA 02632 1. . Owner: NORMAN RAMONO" Date of Inspection: 7/16/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. _ X Any portion a. the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy,is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a+cesspool or privyis within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with .no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma (Yes/No)The system' 'fa ls.;I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system,fai.ls. 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 sys tem;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: (Tile following criteria apply to large"systems in addition to the criteria above) yes no X the system is within 400 feet of a.surface drinking water supply X the system is within 200 feet of a.tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered,,".yes",to any question in Section E the system is cunsidered a significant threat,or answered "yes" in Section D above the lar'bc systein 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. e i .i Page 5 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 40 ELLIOT RD CENTERVILLE,MA 02632 Owner: NORMAN RAMONO Date of Inspection: 7/16/02 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwellpg inspected for signs of sewage back up`? X _ Was the site inspected for signs of break out? X _ Were all system components, excluding the SAS, located on site'? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information"For example,'a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J i� s!� } xa , S Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM iNSPECTION FORM PART C SYSTEM INFORMATION Property Address: 40 ELLIOT RD CENTERVILLE, MA 02632 Owner: NORMAN RAMONO Date of inspection: 7/16/02 y. FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no)`. NO Seasonal use: (yes or no): NO n Water meter readings, if available(last 2.years usage(gpd)):-�a- 0 p- `q lOC(� Sump pump(yes or no): NO ODD Last date of occupancy: n/a I�i COMMERCIAL/INDUSTRIAL Type of establishment: n/a ' Design flow(based on 310�CMR 15.203) ,n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available:,n/a Last date of occupancy/use: n/a ' OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons-',How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box, soil a6so.ption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach.previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the©EP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of inforrnazion: 30 1'LAM Bl' OWNLIt Were sewage odors detected when arriving at the site(yes or no): NO 3 i' A Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 ELLIOT RD CENTERVILLE,MA 02632 Owner: NORMAN RAMONO Date of Inspection: 7/16/02 BUILDING SEWER(locate on site plan) Depth below grade: 18" - , Materials of construction: Xcast,.iron 1_40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on 'site plan) Depth below grade: 12" Material of construction: Xconcrete.—meta I_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is agelconfirmed'by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7"'''W 4' 10"" Sludge depth: 3" a Distance from top of sludge to bottom.of'o.ut let t tee or baffle:31" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY`TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site'plan) •i Depth below grade: n/a Material of construction:_concrete_meta!'-_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top'of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inleit and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc) n/a ..4 � iJ l Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 ELLIOT RD CENTERVILLE,MA 02632 Owner: NORMAN RAMONO. Date of Inspection: 7/16/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a ` P J DISTRIBUTION BOX: X(if plesent�must.be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a ., 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.): NO D-BOX PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no):'NO' Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): n/a Y- I .. L 3 �! R i Page 9 of 1 I OFFICIAL INSPECTION,FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I NSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 ELLIOT RD CENTERVILLE, MA 02632 Owner: NORMAN RAMONO Date of Inspection: 7/16/02 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a !eaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a s5i ; i innovative/alternative system Type/name of technology: a/a Comments(note condition of soil,'s'i�ns cf hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF FAILURE.THERE IS 8" OF LEACHING LEFT IN PIT.THERE IS 2 FT OF STONE AROUND PIT. BOTTOM 1S AT 8 FT. CESSPOOLS: (cesspool must be`pomoed as part of inspection)(locate on site plaii) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a 't Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) 5 s Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,coac"i Ion of vegetation,etc.): n/a y- e f p t Page 10 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 ELLIOT RD CENTERVILLE,MA 02632 Owner: NORMAN RAMONO , Date of Inspection: 7/16/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage'di"sposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where'public water supply enters the building. �C 1) A 4, e <. •I� �t` NO Page I 1 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE_SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 ELLIOT,RD CENTERVILLE,MA 02632 Owner: NORMAN RAMONO Date of Inspection: 7/16/02 f SITE EXAM Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain:�n/a You must describe how you established the high ground water elevation: HAND AUGER- 10+ FT. s s r c i 1 , ik TOWN O AF BBARNSTABLE � LC,< 'VIION�1 O EMA)f- 1`� SEWAGE # AGE SU LC Q f V tom- ASSESSOR'S MAP & LOT Z� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) ( ( NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 TG � �l���oz IA G' AC a � D (g 6A s ACCESS COVERS MUST BE WJ THIN 9 MINIMUM, I N VER T EL E VA T l ONS : DESIGN CR l TER l A : GENERAL NO TES : 6- OF FINISH GRADE 3' MAXIMUM COVER FIRST 2• TO INVERT OUT SEPTIC TANK: 97.8 DESIGN FLOW: BE LEVEL MIN 2' OF PEASTONE INVERT IN DIST. BOX: _97.37 3 BEDROOMS AT 1 JO G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION OR FILTER FABRIC INVERT OUT DIST. BOX: 97.2 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. ff�T //""' 4" DlAM PIPE INVERT IN LEACH CHAMBER: 9T. l 3/4" - 1 1/2" D 1 A. NO GARBAGE GR l NDER 2. VER T l CAL DATUM IS ASSUMED. FOR BENCH MARKS 97.8 97.2 $08 /2" DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 96. 1 SET. SEE SITE PLAN. GA S �/ 97.37 11 51 97, 1 96 1 ADJUSTED GROUND WATER: N/A BAFFLE SEPTIC TANK REQU l RED: OBSERVED O GROUND WATER: N/A 330 G.P.D. X 200% - 660 GAL. 3 OUTLET 4 LC-6 LEACHING CHAMBERS J. ALL CONSTRUCTION METHODS AND MATERIALS AND EXISTING D-BOX W/3.5' STONE AROUND. 10'N x 38 '1 x 12'd BOTTOM OF TEST HOLE #l : 90 `1 SEPTIC TANK PROVIDED: I000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1000 GAL CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6- CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DES l GN PERC RA TE C 5 M l N/INCH PROF l L E : NOT TO SCALE SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER N EFFLUENT LOADING RATE 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF W1TH- STANDING H-20 WHEEL LOADS. PROVIDED: 4 LC-6 LEACHING CHAMBERS W/3.5' STONE AROUND.' A-476 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 476 S.F. x 0.74 - 352 G.P.D. APPROVED EQUAL. _ 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED PRECAST CONCRETE OR APPROVED POLYETHYLENE. BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER r SOIL TEST PIT DA TA & OUTLE�-FOR LEVEL WHEN THERE is MORE THAN ONE t� I ND I CA TES �_ I NO I CA TES f� PERCOLATION = OBSERVED 7. BEFORE CONSTRUCT/ON CALL "DIG-SAFE". �\ TEST - GROUNDWATER 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. UP 2231150 \\ \ TP P#/418/A TP #2 FOR L OCA T 1 ON OF UNDERGROUND UT I L I T I ES. #1 HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR �,3_02_ roo-`-_ 0" 100.4 0" l 00.4 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION _ �' A LOAMY I DYR A LOAMY IOYR SAND 3/3 SAND 3/3 OF THE SYSTEM TO ALLOW FOR SCHEDUL l NG OF THE CONSTRUCTION INSPECTIONS. CATCH BASIN a ) 0611y MAPLE /0" - - - - - - - - - - - - - - - - - - - - 99.6 12" - - - - - - - - - - - - - - - - - - - - 99.4 ( L OAMY J O YR LOAMY I O YR BM. CONCRETE STEP/ O SAND 5/8 O SAND 5/8 9• EXISTING LEACH PIT TO BE PUMPED DRY AND _ EL-I00.83 -� 26" - - - - - - - - - - - - - - - - - - - - 98.2 24- - - - - - - - - - - - - - - - - - - - - 98.4 BACKFILLED. roo e /� C/ MED-COARSE IOYR C MED-COARSE IOYR EXISTING SAND AND 6/6 SAND AND 6/6 / � �0� \ ! SEPTIC TANK\ r GRA VEL GRA VEL/ LOT 6 � LEACH � w / `PIT 2 t t+ 13. 160+ S.F. I ; l 44" / 22• c, / o 1 1- +to ® roo. r �-� cV 0 b k ( \ h �a w Q `� / I20" NO WATER 90.4 120" NO WATER 90.4 `o DA TE: NOVEMBER 18. 2013 ; r" M c r �/ TEST BY: STEPHEN HAAS M ' 12-PI S. WITNESSED BY: DONNA MJORANDJ d s *t1 '°A O O#/�E PERC RATE: C 2 MIN/INCH R•ar 04R40f ( 100-2 ° / +l00.4 Q.. t 4 LC-6 LEACHING CHAMBERS W/3.5 f / STONE AROUND j0 l j!t'`14 1 TP#2 L t tP#! f: S6 36-� 100.7 S E P T I C S Y S T E M D E S I ON ( SHfO 40 ELL / OTT ROAD MAP 248 . PARCEL_ 1 7 1 r _ - "� _ BARNS TABL E7 . ( CEN TER V / LLE ) MA . 60VIE 28 PREPARED FOR �FsT LEGEND ...JOHN ROMANO �N sT�FFT ■ CB CONCRETE BOUND 2 H E Y W O O D STREET . SHREWS B U R Y . MA 01545 P/ E TREE -W WATER L I NE L O HYDRANT SCALE : l 20 ' JANUAR Y 1 3 . 20 14 " -G GAS L I NE S�Pq OHW- OVER HEAD WIRES S T E IP H E N A . H A A S �o A -0 LIGHT POST -E-- UNDERGROUND ELECTRIC LINE E N G I N E S R I N G , INC -T- UNDERGROUND TELEPHONE LINE 923 Route 6A o -CTV- UNDERGROUND CABLEV i S ION LINE �/�4 %��' / 508�� Y ci r mo u t h p o r t MA 02675 n ��� \ 362-8 'I 32 � -I-40.4 SPOT ELEVATION � ♦ C � 40 ••.._ EXISTING CONTOUR / L V 1. V J i /C lVl /-A A /� 0 I0 20 40 40 PROPOSED CONTOUR JOB NO: l3- l03 7G CIi Ps�iS(,n�7` 36 roI1, te,o,n /o - -" vont tX 6 ,e a _ 10. / /� /F b r fit �°a 6t�r f of,.( �rrr,.,� �v� I ; ; f�_� i � +'v, W1 7D /1GA J i flab` roll- 5/111.c 10 Cy f y CCic /S // Gr rG+1[t4 f"J rT r G//0'1/1 ,Fly G� �des�.+r�r ,�' �'.�i'«*`!�'�ri' �-......�' •�-�-•--^- ._......�. ell I, Li—o"���ol I _ 7-A I'a ve�-f f li t Y "#m Opp 7,4 ra rt�+ .�__,.r.,._..,r,...._.... ....._ -. .. 1. f j ram^—•--- 1 �. .___:_.. t I �fs 1`f ,�o�,��o � moo' ��/�►�*'� ,�� �,►,��-, /� SCALE-- APPROVED BY: DRAWN 8v G DATE: REVISED ,;. od _. 00i1WING NUMBER Lon//onf's COin�°" / Line �1�Ca/f my V'sl v 3 �J f;, 3 Pe Qlfd ua c�.7 I -1,4 re i P I Jon _ ? U P� /S5/ �amc L. 1tE D Y L I � c- y / are .1✓d:,.✓ �.�t' � 1%P,:,Ej+atT /t/1•`fty^ rr`f / pf ,rf 4 `• gyp B., ,lX+/�f'/' t L i I � • 1 f ' 1 Y s 0, Si►c O /�" / /'a'rfy / �r _,� !ram` �,►:,�`r�'�� /Yl SCALE: 1 APPROVED BY: DRAWN BY DATE: "' REVISED DRAWING NUMBER S/S't:r - cow yr' tl t �`//r`r i 3 fr-r r1" Gr9f1/904-( r4h 1 ofa-e GG't�IPrs sv acr r �"r"Ar9> � I ,�, n.fiw fa s zvopor f 2nrA A- / 1431 I �/�� � /a�a't�► i—_-------.--gip"____ ._.. _ '-- -- - 75 „ ___---_---� op j v ni �a I i • f, , I y 7o Zn� 7�o s/owl "?Awe leul --I — �n 9/r 'f S 7" o r s 1 3 No1`� - wall r,s�rs - f� fo /`y G� 41 T-•11zl-I G ! Dut o r 941/ oe fu g �-�y�/l;� �y' 1-1r,c GG�! � f«�/� •�® Q't� oR m / f l y y CCf7 //3d 7 , D 412 i enc4se f e a�/;,,�y SO 7` to 6 e Xe a F SCAIEZ = APPROVED By DRAWN BY r" DATE. REVISED DRAWING`G NUMBER .. ... . ::';.; . ..- _ ,..rc.:..��c+----scrs:ze�-.,.-r,-..^:::u�--.n-.,�=. ...,.:'.us.,c•.,...zw.-.,-,,.-...o ,_,.<._...sv,.,. .G., .. .-.... ... .__..- .. - -