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0116 ELLIOTT ROAD - Health
116 �'I'lYot Road 248-056 Centerville UPC 12543 No.53LOR m�V� SJ�aecvaFacdm SJ•CON HASTINGS. MN Names Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:-41-1 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHU SETTS Yes 2pplitation for M 0 aY *pstem Construction 3pertnit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./69 C LLJa T Q Owner's Name,Address,and Tel.No. Assessor's Map/Parcel CenT a ry.11C.10 p r�«- a' .. 173 _ a Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. N,c,�y Caon�c ri o*� / Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( �a Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 11—b gpd Design flow provided '341 2 gpd Plan Date Number of sheets / Revision Date N�N Title —� Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) � 1 v� e y 1r KC/ LP a�- jifiyA-f/ 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;t�..� Signed Date e Application Approved by Date ` Application Disapproved by Date for the following reasons Permit No. Date Issued _')14— Z. Fee W ITHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yew/ PUBLIC,HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS w Yitatiou�'for I8 0 aY BtPYIY �OYCBtCuttIOTC Prlltlt app p p P ' r Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./63 C '1'►./a r f10 Owner's Name,Address,and Tel.No. C,ewr C or�,.I 1C. y Assessor's Map/Parcel 0lkAp �, .. 173 �WA 1 Installer.'s Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Caoscrtic T,ow !�v,�ri Type of Building: Dwelling No.of Bedrooms Lot Size /8TOO sq.ft. Garbage Grinder( Other f Type of Building No.of Persons Showers( ) Cafeteria( ) l Other Fixtures �,/ r Design Flow(min:required) ,, kx,! gpd Design flow provided �/ 9 gpd y r Plan Date ��,p��'►► o Number of sheets / Revision Date N 1� r Title Size of Septic Tank Type of S.A.S. ^" Description of Soil f ``Mature of Repairs or Alterations(Answer when applicable) ,�� �• Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance ofrtheafore described on-site sewage disposal system in 1 t ' ' G 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.©f Health. - Signed -..Date-,-' P Application Approved by '. Date off..',/{ JQ Application Disapproved by "I Date for the following reasons L) 4 Permit No. 90Cx;,7 Date issued)"l 4 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 1"l t e e l eao S\ at /(,3 I I i tf r �t� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No310XI i 9 dated Installer A t c(Apt l &p-er Designer #bedrooms Approved design flow y g gpd The issuance of thij pernyt shall not be construed as a guarantee that the system wilfl l designed. Date 3 d Q Inspector _ �, 1 V No. .. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Disposal &pste o struction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 16,3 St I ►at 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:Constructioon t be completed within three years of the date of this permi' . Date � Approved�y rw� 1 - Town of Barnstable �S"EAQ �. Inspectional Services �nxsrnaLs, Public Health Division M"43 =bs . Thomas McKean,Director e , lEatrtA�s 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# � •� 5 Assessor's Map\Parcel 9:9 ZDD Designer: PJWN CAPS M(�tWtPIA INC, Installer: DON Address: ( A Address: On I was issued a permit to install a (dat ) (installer) septic system at I(Q:2 allOIT Q, 06NI-MV1 LL6 based on a design drawn by (address) Mg yI t,- A, OJAL& PC dated !WE !19 ZUZ.D (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. 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 co Hance with the terms of the IAA approval letters (if applicable) ��tH of Mass DANIELA. o OJALA (Installer's Signature) CIVIL No.46502 V� � � SS!orRaL Ems' (Designer's Signature) (Affix Desi'g e 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 DIVISION. THANK YOU. \\toa\depts\HEALTH\SEWERconnect\SEPTIMesigner Cerliflcation Form Rev 8-14-13.DOC JRN-22-2010 07:10 FROM: TO:150e7906304 P.2 I Massachusetts Department of Environmental Protection 1100153263 Bureau of Waste Prevention—Air Quality Decal Number i; Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 Whomfilin A. Facility Location When filing out fame an the computer,use ZOFIA MILKOWSKI-PASZAK only the tab kay 1.Name of Fecility to move your 118 ELLIOTT RD cursor•do not 2.5treet Address use the return I key. #"rA11-'k� 1 !✓V v i� MA► i 3,CILY 4.State 5•Zip Cade 8.Telephone Number INSTRUCTIONS S. Project Cancelled 1. This form Is only available for Check here if this project Wwm cancelled. online filing of project date rwisiVns. 2. —.... .. Enter project decal number, C. Project Dates 3. Validate that the project 07M31201 Z 07/24/2012 location is correct 1•Original tart Date mm/dd! (mm/dQ=) for the entered 07/26/2012 0712712012 decal. 3.I.tatest Ravieed Start Date(mrMddlyyyy) 4.t,4tnst Ranrlsed End Date(mm/ddyyyy) 4. Enter your new project dates. S. Certify your —— notiliaation. D. Revised Project Dates Submit date changes. 1=0612012 0810912012 1.Revised Start Date(mmldd/yyyy) 2.RavleodEnnd bate Dato mmld yyy) E. Other Project Revisions F. Revision History �Mw EDEP:0711312012 01:47:05 PM EDEP:07/18/2012 05:46,12 PM enf060drn-doc-rev.215J04 JRN-23-2010 04:06 FROM: TO:15087906304 P.2 I — Massachusetts Department of Environmental Protection 1100163263 3. Bureau of Waste Prevention—Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 When Important:filling out Vyhen A. Facility Location farms on mputerler,use Z co , OFIA MILKOWSKWPASZAK only the tab key 1.Name of Fecility to move your 116 ELLIo77 Rv cursor.do not 2.Stroot Addros4 use the return � w C� ✓v MA key. 3,Clity 4.State 5.Zip Gad® a.7eiepnone Number INSTRUCTIONS B. Project Cancelled 1. This form is only evailabie for E]Check here if this project is/was cancelled. online filing of project date revisions. 2, Enter project decal number. C. Project Dater, 3. validete that O712312012 07124/2012 the project location Is correct T.Qn oral Start Date(mmlddl�yj 1911911111 for the entered 08/0512012 � 08/0912012 decal. 3.Latest Revised Start-Ste tmmlddlyyyy) 4,Latest Revised End Date(mmldd/yyyy) 4. Enter your new project dates. 5. Cerfify your — notification. D, Revised Project Dates Submit data changes. 107&iO12 � 0810212012 1,Ravlsad StarfDa�dlyyyy) 2.Ravlmd End Date Date(mm/ddlyyyy) E. Other Project Revisions F. Revision History EIDEP:07113/2012 01;47:09 PM EDEP; 07/18/2012 05;46;12 PM CUE 07=0=15ioz PM onfO6pdm.doc rev.215M4 JRN-11-2010 05:34 FROM: TO:15087906304 P.2 R w Massachusetts Department of Environmental Protection /00153263 Bureau of Waste Prevention—Air Quality Decal Number Project Revision Notification --- For Asbestos Notification ANF-001 and AQ OB ImpWhen flin g out A. Facility Location 4 forms on ttto aamputer,use ZOPIA MILKOW8KI-PASZAK only the tab key 1•Name of Facility to move your 11 Q EI,LIO use the rereturn2TT RIP et do not .Street Addreae Ub key. SARNSTABLE MA city 4 State S-Zip Code B.T6lephone Number nan INSTRUCTION$ B. Project Cancelled 1. Thls form Is only available for Check here If this project Is/was cancelled. Online filing of project date revisions. 2. Enter project dcoal numbor, C. Project Dates —Validate that the prgact 0712312012 07/24/2012 the location Is correct I.Ori inal Start DRte mm/dd/M r' final End Data(;m1d¢/ for the entered decal. 3.Latest Revised start Date(mm/ddtyyyy) 4.Latest Revised End date(mm/tldWyy) 4 Enteryournew project dittos. 5. Certify your —._....._.._. .._......._._ notification. D. Revised Project Dates Submit date changes. 07/20/2012 1.Rovieed Start Date(mm/dd/yyyy) 2.Ra Oo -0 tq :tti (mm/ d ) E. Other Project Revisions ........... F. Revision Hlsta anf 6pdrn,doc•rev.215104 JAN-11-2010 05:34 FROM: TO:15oe7906304 P.3 I� Commonwealth of tlMassachusettS 4. Asbestos Notification Form ANF-001 oararrlt,mb®rw 'm "t A. Asbestos Abatement Description When ftlling out forms c4mputn,u 1 a is this facilityfee exempt-city,to=,district, municipal housing authority, owner•occupied only he tab key residence of our units or less?M Yes 0 No to move your cursor-do not b.Provide blanket decal number if appllcable: Blanket Decal Number use the return "0y 2. Facility Location: ZOFIA MILKOWSKI•PASZAK 116_ELLIOTT RD a."-"—Name avillytr A r BARNSTABLE 102532 a Cityfrown d.State 0.Zip Code f.Taieprione Number INSTRUCTIONS 3. Worksite Location: 1.All sections of t1118 SAME form mute be a.6ulldIng Name/Building Location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the facility occupied? Pl Yes ❑No DEP notificatlon re4uirOmont9 of 310 CMR 7 15 5, Asbestos Contractor: and the Division Of pccupaeonal AIR SAFE INC 61 ENDICOTT STREET Safety(DOS) a Name b Ad m g ce requiromenfs Of 4S3 - NORWOOD , 02062 7817623390 equ CMR 6.12 c.City0own d ip Code e.Telephone Number AC600464 g.Contract Type; ©written ❑Verbal f.DOS License Number FacilityContact Pirson I.Contact Person's 7111e JAIME E AMAYA IAS060847 6' a,Name of On-Site Su rviB rlForeman b.Su ervitsorlForeman D ertification Number 7. a.NName of Fro'ect Monitor D.Pro act or DOS Cartifigation Num e 9, NA _ i. a.N�a1me of Asbestos Anal icat l�rb I+�AA w 07123/2012 T112412012 © �' a,Project Start Data(mffird—dry Myy b.End Data Immidd 0 7AM-6PM ®N C.VVofK MUM Mon n a.Work houro S• un• 0 10. a.What type of project is this? ®c+ []Demolition ❑Renovation GD Repair ❑Other, please specify: b.Dmoriba 11. a. Check abatement procedures: Glove bag Encapsulation �o Enclosure ®Disposal only ® Cleanup ✓�Other,specify: EXT SIDING Full Containment b.Describe z ®d 12. is the job being conducted: Indoors? E)Outdoors? M aM I)iap.doc•1W02 A9bestos Notification Form•Page 1 of 3 Y JAN-11-2010 05:34 FROM: TO:15087906304 P.4 Commonwealth of Massachusetts -� 100153263 Asbestos Notification Form ANF-001 Decal Number tion Abatement Description cont. A. Asbestos p (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or 0 2000 a.Total p s or ducts pinear 15121 War su = eq�i c.Boiler,breaching,duct,tanK d.Insulating cement surface coatings Lln.R. Sq.ft. Lin.ft. e.Corruosted or levered paper f.Trowelisprayer coafings pipe insulation Lin.ft. g.Spray-on f1reproof1ng I h.Transite beard,wall board I.Clothe,woven fabrics in �,J i.Other,please specify: �n 2000 fL k.Thermal,solid core pipe EXT 31DINta innulaLioir Lul. L q.ft I.Specify 14. Describe the decontamination systems)to be used; NA 15. Describe the containerizationldisposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)( ; 6 MIL POLY SAGS 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: F— a.Name of DSP Official b.TWO �1^.'151t mmldd/ o Aulhoriaation giver# le.Name of 557M rciel If.Lip's Lx=al Title p.oats mm tl yyyy)ofAut onzation n.0 '1Naivar N Q 17_ Do prevailing wage rates as per M.G.L.c, 149,§26,27 or 27A—F apply to this project? Yes❑No B. Facility Description N 0 1. Current or prior use of facility: RESIDENTIAL —o 2. Is the facility owner-occupied residential with 4 units or less? Yes ( No ®� SAME � �' a.FaCilit Owner Name � b.Address �0 a o.eit frown d.Zip Code e.Tale hone Number area code and extension a.Nome of f=acilit wWr On-Site Manager h on.Sita Man or Address ®Q c.Cityffown d.Zip Coda e.Telephone Number(area code and extens on) anf001ap,doo•10102 Asbestos Nottllcatlon Form-Pa P. 011 JAN-11-2010 05:34 FROM: TO:150e7906304 P.5 �— Commonwealth of Massachusetts I � 100153263 I' w • • Decal Number 4, Asbestos Notification Form ANF-001 B. Facility Description (cont.) 5' a.Name_ame of G neral Contractor b.Address a Cit(Town d.Zi Code e.Tole hone Number area Code and extension f.Contras Worker's Comp,Insurer Polia Number h.Exp.rdtdte mmldtl i B. What is the size of this facility? v.Square Feet n Numaor of egpra C. Asbestos Tmnsportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary), AIRSAFE Note:Transfer a,Narne of r rter A Strrtiurs mueL comply with the c.Citq/Town d Zip Coda e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site; Regulations 310 CMR 19.000 a.NAme of Transporter b.Address Cit!Town d.Zip QW8 e.Tplp none Number 3. a.{defuse Transfer Station and Owner b Addre98 e.City/Town d.Zio Coda e.Telephone Number 4. MINERVA ENTERPRISES INC a.Final Dis osal Site Location Name b,Final Die osel Site Location Owner's Name 9000 MINERVA ROAD WAYNESBURG c Final Dip2osal it A d.City/Town OH _ 44888 ® e.state f.Zip Code g,Telephone Number ®p D. Certification The undersigned hereby Stater,under the [OF tIVALSIW o penalties of alt ofperjury,that he/she huse her rued the �N r i b.Authorized i netu l _¢ Commonwealth of Massachusetts regulations p for the Removal,Containment or •. PoaitiontTtle {{ gp 6ncspaufation of Asbestos,453 CMR 8.00 and 781)762.3390 .... AS 310 CMR 7.15,and that the information ., re contained In this notification Is true and correct R.Tole none Number f.Re reseniin to the best of his/her knowledge and belief. 61 ENDICOTT ®p .Addreas w ®,L INORWOOD 102062 ® h.City/Town 1.Zip Coda anM01ap.doc•10102 Arbeetcs Notification Form•Page 3 of 3■ I , Commonwealth Of Massachusetts Executive Office Of Environmental Affairs Department Of Environmental Protection TITLE 5 Official Inspection Form -Not For Voluntary Assessments Subsurface Sewage Disposal System Form Part A Certification Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C.Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma = �` Date of Inspection: 9/18/2007 c3 u LW E Name of Inspector(please print)Sean M.Jones#SI4522 v� w Company Name: S.M.Jones Title V Septic Inspection _ Mailing Address:74 Beldan Ln. Q Centerville Ma.02632 O S �1 Telephone Number. 508-7784597 CERTIFICATION STATEMENT \ I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: X Passes Conditionally Passes Needs further evaluation by the Local Approving Authority Fails Inspectors Signature Date: �Lc-� ( 6- The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 1 �1 f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(coNTwum) Property Address: 116 Elliott Rd Centerville Ma.02632 e Owners Name:C.Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 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. Comments: B.System Conditionally Passes: N/A 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 the 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 structurally sound,not leaking and if a Certificate of Compliance Indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or Obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with Approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(S).The system will Pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(coN wuED) Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C.Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 C.Further Evaluation is required by the Board of Health: N/A 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 310CMR 15.303(1)(b)that the System functioning in a manner that protects the public health,safety and the environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet y p rp e of Surface water supplyor 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 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C. Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of cesspool or privy is within Zone 1 of a public well. X Any portion of cesspool or privy is within 50 feet of a private water supply well. X Any portion of 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 pp,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _ X (Yes/No)The system fails.I have determined that one or more of the above criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large systems:N/A 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: Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you 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 CM15.304.The system owner should contact the appropriate regional office of the Department. I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C. Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 Check if the followiny,have been done.You must indicate`des"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 system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X _Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding 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 tee,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 Cis at issue approximation of distance Is unacceptable)[310 CMR 15302(3)(b)] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C.Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_3_ Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203 (for example): 110 gpd x#of bedrooms):_330 Md Number of current residents: 0 Does residence have a garbage grinder(yes or no):—no Is laundry on a separate sewage system(yes or no): no_[if yes separate report required] Laundry system inspected(yes or no):_n/a Seasonal use:(yes or no) no Water meter readings,if available(last 2 years usage(gpd): 7/1/06-7/1/07=36 gpd Sump pump(yes or no): no Last date of occupancy/use: 1/2007 COMMERCIAL/INDUSTRIAL:N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was this quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X 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) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be Obtained from the system owner) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1994 Were sewerage odors detected when arriving at the site(yes or no): No OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C.Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction: cast iron_X_40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Joints were in good condition no sign of leakage SEPTIC TANK: X (locate on site plan) Depth below grade:_6"_ Material of construction:_X_concrete - metal fiberglass___polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8`6"X5`6"X4`10"= 1000 Gallons Sludge depth: 7" Distance from top of sludge to bottom of outlet tee or baffle: 3.5` Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle:_0 Distance from bottom of scum to bottom of outlet tee or baffle: 0 How were dimensions determined:Opened covers and took measurements 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 was in good condition Does not need to be cleaned at this time but should be cleaned every 2-3 years. GREASE TRAP: N/A (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.): I� OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C. Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 TIGHT or HOLDING TANK: N/A (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:_X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_0" 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.): D-box was in good condition Water level was at bottom of outlet invert.No si ngns of hydraulic overloading. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C.Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 SOIL ABSORPTION SYSTEM(SAS):_X_(locate on site plan,excavation not required) If SAS not located explain why: Type _X Leaching pits.Number: 1-1000 gallons Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemitave system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Leach pit had 0 inches of standing water.A stain line was visible approx. F from bottom of pit.Leach pit has never had hydraulic failure. CESSPOOLS: N/A (cesspools 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: NIA (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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C.Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 5++ feet Please indicate(check)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 156 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: High groundwater was established by accessing the Town of Barnstable groundwater contour map. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Elliott Rd Centerville Ma.02632 Owners Name:C. Steven Hinckley &George Hinckley Owners Address: 110 Acre Hill Rd.Barnstable Ma. Date of Inspection: 9/18/2007 ' SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building 0 4 A ❑ FRONT. 3 2 1 B SEPTIC TANK D-BOX LEACH PIT A-1=18° A-3=18V A-4=1T B-1=17V 8-3=2T B-4=3W A-2=1 V 8-2=22,9" s Town of Barnstable �p THE 1p� hP���os Regulatory Services AB Thomas F. Geiler, Director 16.39. ••� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. ® � No.fN. Fss... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Di-lipwial Works Tatt6trnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair)(Xy) an Individual Sewage Disposal System at: .1.Lfi...RL1.iJQtt...RDad...C�ante.rSti l.1.0..---...--•....... ...............................................................................................•.. Location-Address or Lot No. HincU.ey.........................................................•-•-------•----- •••••---••---•••-•-••-------•--------•----•-------.......••-••--•-•--............................. Owner Address aZ-_P-.Ma c ombe r...Jr-----------------•-------------------------------------- --------•-------------------------------------......... Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—X No. of Bedrooms-----------------?_-------------------.----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............2.............. Showers ( ) — Cafeteria ( ) a' 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------------------..................--- a 04 Test 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+ •---•----•-•------------------------------------------------------------•------------------...............------•-----------------•-•••....-••••-•------•---- ODescription of Soil.................Sand............................................................................................................................................ x V -•-•••••---•---------------•-•-----•--•-•••••--•••-•-------•---••••••••••-------•••------•-•••-----------•-----•- -•---•••-•-------•----•-••-•--••-•----•------•-•--•-------•-•-•-•--•••--......•-••••-- W U Nature of Repairs or Alterations—Answer when applicable....-.Om i.t__c e s sp0 01 Install 1-10 0 0 ----------- ................................ g.al1an .ut-ion box...1-1.000 ga-llon leaching pity Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has b n )sue by the ar of health. Signed - ......- ' ... .. ..... to Application Approved �1ay ------------- ----------------------------------------- --------------------------- G 1 - _. ........_.. .. Date Application Disapproved for the following reasons- ----------- --------------------------------------------------------- ------------------------------------------------------ ----------------------------.....---..._........._........................._---------------- ---------....---------------------------------------------------------------...---------------------.. ........................................ Date PermitNo- ---------------------------------------------------------------- Issued ..... ............................ . ............ Date No.• q _ --l�D r Fxs..$,.....0.....0.0... -.....0... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrnrtion runtit Application is hereby made for a Permit to Construct ( ,) or Repair an Individual Sewage Disposal System at: C..entarx.i lle.................. ...-•-•-•-------••-••-•-•---•-•---•--•---•-----•----•-----•---•----'.. Location-Address or Lot No. Y_....................... ................................................. .................................................................................................. Owner Address a ?..:_P•,-1�1 ^_�J�]d�Ew'Y... ------------------------------------------------------- ...................................................•. Installer Address Type of Building Size Lot............................Sq. feet t, Dwelling---,L No, of Bedrooms------------------A------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.............?,-_-.----..---- Showers ( ) — Cafeteria ( ) dOther 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........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ t4 .....---•.......................................................................••-••--••-••---••-••...................................... --------------•---- DDescription of Soil.................S-a-rid............................................................................................................................................ x U -------•-•-•-•---------••-•-...--••---•••-••-----•....•---•----•----------••-•----•---------•--------•-••-•-------------•-•-...---------•-••---•--•------•---•-------•-••----•--•••---•---•-•-••---••--. W ................. -------- --------------------- ------------------------------------------------------------------------------------•-•----•-------•-•••-------------•--------•---••-- •---•.••-•-- U Nature of Repairs or Alterations—Answer when applicable.-----Omit cesspool Install 1-10 00 gallon--tank-•_1_-distribution box 1-1000 gallon leaching pit. ..............................................................------•----•----•--•.-•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia,ce has been 'ssued by the oar ,of health. Signed : .:.................k. ...... .1.......... Due Application Approved By— " "........`........ ................... . ...... .. - ..1/--`��'J................ Dve Application Disapproved for the following rearonf: ... ................................. .................... . .............................. ................ . -------------:.---------------------------------------------------------------------------------------------------------------------------------...............--------------------------------------------------------------- ........................................ Date --Permit No. .......-t........................................................... Issued ............................................... -- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ger#ifirate of C�ontpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired.(XXX) byJ..,.P.......Ma.. omber----Jr- .................... ... .......................... . ........... ........ . .....-- ................................................. It„t;diet 116 Elliott Road Centerville at . . ..... ................................. ... ........... ........... .............-----.-------........................................ -- -- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------------------------------------------------ dated ............_---------...................__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... ...'`... '_10._'._ ... ._.. --------- Inspector .--- a --------- ----------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No .. $-•-3 0-;00 Disposal Yorks Tonstrnrtion "rrntit Permission is hereby granted..J_.P.,.Macomber Jr'---•-••.............•--------•.._.. ................................................. to Construct ( ) or Repair (gX) an Individual Sewage Disposal System at No....116 Elliott Road Centerville Street as shown on the application for Disposal Works Construction Permit No'&....V:k:f. Dated.-- --- ........_._.... e.-- -- �-- .........,1Y1 `------------------------------------------ �f t✓ �t Board of Health DATE-----...--�------------------•--------------•----•---......-------------..... FORM 36508 HOBBS Lt WARREN,INC..PUBLISHERS TOWN OF BARNSTABLE gala-ooT 1 P� y23 �L�f 5 T f r d7 - hp _ 0V r 7i 1„7 E s:. r . o� Ak 1 f o Nr s. P• JQN 04 ' r Ll ' TOWN OF BARNSTABLE � I1ro�- C LOCATION SEWAGE VILLAGE G e lt1 reg y L l- ASSESSOR'S MAP & LOT )-y g_O S INSTALLER'S NAME & PHONE NO. A4 AC 0 t S ON SEPTIC TANK CAPACITY l O no LEACHING PACILITY:(type) p/.� (size) / 0 D 0 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 1"I oy tom.. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ,.� r- - .. I I s �/ �� . � � ��� ��\`�r� ��. SYSTEM PROFILE MARKED WITHCMAGNETICTTA E OR NO ALL SHALL TES OTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. V o 4 s� 9h ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS NAVD 88 hoo 2" PEASTONE OR GEOTEXTILE 1Q 041 s� \ FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 29.6 Pine 27.0' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 26.0 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. PRECAST H-10 WATERTEST O'BOX FOR LEVELNESS BLOCKS OR R111SERS (TYP.) MIN. 2" WALL THICKNESS PRECAST RISERS 4. DESIGN LOADING FOR ALL PROPOSED PRECAST ,n d 25.19 4"OSCH40 PVC MORTAR ALL INVERT IN 23.37' UNITS TO BE AASHO H-M ��eR PIPES LEVEL 1 ST 2' COMPONENTS j� ;- ENDS (NP') SIDES 24.2' 5. PIPE JOINTS TO BE MADE WATERTIGHT. Locus 10" EXISTING 14" 00000 °�e °'. • . .. °'. ` ,. • o 000000° o m®®® ®®®® ®®®- ®®® o °0000° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE TEE SEPTIC TANK** ' " °o°° TEE 23.86t * o 0 0 0 o a 6" MIN. SUMP ° o o° mmmmmm®®®®® WITH 310 CMR 15.000 (TITLE 5.) �+0 0 0 0 0 0 Q oog°o°o° mmmmmmmmmmm L]mmmmmmmmmm , GAS BAFFLE::• � � a�a o_ 12" MIN. INT. DIM. n��. ^ °o°o°o°o mmmmmmmmmmm mmmmmmmmmmm Oo°o°o°o (\ 0000000000000000 / - 23.64 23.47 22.2' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE USED FOR LOT LINE STAKING OR ANY �fiw �tia f OTHER PURPOSE. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL LEACHING CHAMBERS BY ACMELPRECAST OR EQUAL ra ey ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED 8• PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' COMPACTION. (15.221 [2]) 9. COMPONENTS NOT TO BE BACKFILLED OR Craigville Beach Rd. CONCEALED WITHOUT INSPECTION BY BOARD OF ( 2 % SLOPE) ( 1 % SLOPE) HEALTH AND PERMISSION OBTAINED FROM BOARD Ma OF HEALTH. FOUNDATION- EXIST. SEPTIC TANK 11 D' BOX 12' LEACHING FACILITY 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP /`1r"p 14.7' BOTTOM TH-2 VERIFYING THE LOCATION OF ALL UNDERGROUND & NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ** SCALE 1"=2000't INSTALLER SHALL CONFIRM MINIMUM WORK. *THE INSTALLER SHALL VERIFY THE SEPTIC TANK SIZE AT 1000 GALLONS LOCATIONS OF ALL UTILITIES AND ALL AND ITS SUITABILITY FOR RE-USE. 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 228 PARCEL 200 BUILDING SEWER OUTLETS AND REPLACE WITH 1500 GALLON SEPTIC BE REMOVED BENEATH AND 5' AROUND THE ELEVATIONS PRIOR TO INSTALLING ANY TANK APPROPRIATE TO SITE PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS C C AND REMOVED OR PUMPED AND FILLED WITH CLEAN SHOWN ON COMMUNITY PANEL #25001 CO564J L E E I V V SAND. DATED 7/16/2014 99- EXISTING CONTOUR D j X 99.1 EXIST. SPOT ELEV. -[991- PROPOSED CONTOUR 198.4 N co ] PROPOSED SPOT EL BENCHMARK DO MAG SET TH 1 �O EL. = 25.17' TEST HOLE 1 Y � J� SLOPE OF GROUND SYSTEM DESIGN: COL) UTILITY POLE �� q FIRE HYDRANT GO �, GARBAGE DISPOSER IS NOT ALLOWED e NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD o USE A 330 GPD DESIGN FLOW SEPTIC TANK: 330 GPD (2) = 660 TEST HOLE LOGS TH2 �} TH 1 a o **RE-USE EXISTING 1000 GAL. SEPTIC TANK ENGINEER: CRAIG J. FERRARI, SE #13871 LEACHING: WITNESS: DON DESMARAIS ��-.1 ��', o ( ) ( ) SIDES: 2 25 + 12.83 2 74 = 112 GPD DATE: 9/10/20 0 PAVED' d's 28 BOTTOM 25 x 12.83 (.74) = 237 GPD DRIVE ' p , PERC. RATE _ < 2 MIN/INCH r��I I TOTAL: 472 S.F. 349 GPD � I CLASS I SOILS P# 20-179 g 26 L�; USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) WITH 4 STONE ALL AROUND ELEV. ELEV. 37 k p" 4 25.7' p" 25.4' - A - A / LS LS EXISTING MA 10YR 4/2 10YR 4/2 DWELLING APPROVED DATE BOARD OF HEALTH 4" 6» TOF = 29.6 B B LOT 9 D 18,500t S.F. TITLE 5 SITE PLAN LS LS - � OF 12" 10YR 5/6 24.7' 18„ 10YR 5/6 23.9' DECK 163 ELLIOT ROAD CENTERVILLE, MA PERc C C pp M 26 10 PREPARED FOR 41 OI"Pygs����, ER_ ' DREW MS MS M P^ ��N OF Mtissy�� o� s DANIELA. N / O'ALA DATE: SEP. 11, 2020 10YR 7/4 10YR 7/4 46502 No.` No AU080 � -p � c �¢ �'. "D :" :°T ST� � off 508-362-4541 fax 508-362-9880 �ONAL.E \O SUfZVE�/ a vw P O downca e.com down cope engineering, inc. 132" 14.7' 120" 15.4' T� ( ( civil engineers NO GROUNDWATER ENCOUNTERED Scale. 1 = 20 Q� _t` land surveyors 939 Main Street ( R to 6A) 0 0 2 3o Er 19 v DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 DCE #20-235 1b �� 20-235 DREW.DWG