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HomeMy WebLinkAbout0429 ELLIOTT ROAD - Health LOT # 7, 429 ELLIOT RD, CENTERVILLE A=227-109 k P. R UPC12M4 ' No.2-153LO HASTINOS,UN e s T No. 001 Fee /00— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: l PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es 1 21pplitation for Disposal *pstrm Construction i3Ermit Application for a Permit to Construct( ) Repair( ) Upgrade C✓ 'Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.4(;ZA- L t b° Owner's Name,Address,and Tel.No.i sa•� L dI �tt;�' 4R�. C�v.v�rt>:1.1L. Assessor's Map/Parcel GI a 7 (Oq ✓4 n7`' (- `ts"Y- C 7 Installer's Name,Address,and Tel.No. R.c--a�e r ' 'Designer's Name,Address,and Tel.No._°i3—,, EK 3 a1 S s..3b. ..�vC O�S�2j P.c7o Css�c ��'I 5 Z. 3 rrcLc Vva thA Da Slo Type of Building: Dwelling No.of Bedrooms Lot Size 33, R6,,3 sq.ft. Garbage Grinder( ) Other Type of Buildings, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33© gpd Design flow provided 3 7 7 gpd Plan Date ��'a�r(C7 Number of sheets f Revision Date SZ Title Size of Septic Tank $�® �K:9,S Type of S.A.S. 3 ' S 4a 6 v\lo. I,y_ ® Description of Soil G -^ 3 Nature of Repairs or Alterations(Answer when applicable) (A-n)c,) 'Q- 2cc)k 3` sTow� 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. rpKdA Date VN a Application Approved by Date Application Disapproved by4 Date for the following reasons Permit No. p 16 Date Issued r J No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,1 MASSACHUS�ETTS- � r \ ' ftplicatlon for NspoBaY 6pstem Construction 3permlt Application for a Permit to Construct( ) Repair( ) Upgrade{{/f Abandon( ) ❑Complete System ', ❑Individual Components Location Address or Lot No.4( A Owner's Name,Address,and Tel.No. S Assessor's Map/Parcel a�7 CD (����►i�/l `7P(_ Y�'Y_ C 7 Installer's Name,Address,and Tel.No. �c e ,'MY;T-_ '•Designer's Name,Address,and Tel.No. ..ti 7 ,/ S-4- .iw.©J P.�, C' ,c �C17 .S.z, 3 cc �.�t"w 4n-9 S-G`� Type of Building: Dwelling No.of Bedrooms 3 Lot Size ��i� `2?C=, sq.ft. Garbage Grinder( ) Other Type of Building g No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) 33 0 gpd Design flow provided 3 7 gpd Plan Date 3 L Q--((U Number of sheets 1 Revision Date Title Size of Septic Tank ( $�C� �,,� p K; ;",�<1 Type of S.A.S. Description of Soil s�-� .• ��, V ,. Nature of Repairs or Alterations(Answer when applicable)Ste. , k ,�. �, u- 7D 2,nX cS, QA S 3 - k l- 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. Sign d Date OA-4 Q u t n Application Approved by 4./ ' Date .Application Disapproved by Date for the following reasons Permit No. �� _ O� 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(Vf Abandoned( )by �, a� car`N --r- at `c C ' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.a°/° /?� dated Installer _ �, Designer #bedrooms Approved design flow Q?o gpd The issuance of this pe it shall not be construed as a guarantee that the system will 1 fun•tiro n as designed. Date U t 1 Inspector / kw.. No. 0I0 f Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction i9ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade(V*)� Abandon( ) System located at L4 eQ,:�, 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. r Provided:Construction must be completed within three years of the date of this permit. Date / //(, Approved by• �v TOWN OF BARNSTABLE LOCATION yp!j E SEWAGE# Q310— VILLAGE Gc .,icT y�,<�P ASSESSOR'S MAP&PARCEL : INSTALLERS NAME&PHONE NO.. zy 'T ,c . SEPTIC TANK CAPACITY 1 S Cam® �((0, 5 f LEACHING FACILITY:(type) �,^�rc:� (size)'a -$-00 Caj NO,OF BEDROOMS OWNER PERMIT DATE: ( 5�QpI Q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7 S 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 BYSa,� J •act= �G a ��+ �®�6�, ,• ,� .� . r OLA L = Gc�c,t4 Town of Barnstable ti Regulatory Services Thomas F. Geiler,Director BARN&rABM + Public Health Division MASS. 639. 0. � Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 5/11/10 Sewage Permit#_DoiO _ (OC( Assessor's Map/Parcel 227/109 Installer& Designer Certification Form n Designer: Bennett Engineering,Inc. Installer: Address: PO BOX 297Sagamore Beach,MA Address: �l C�,��x -3 7r 02562 On Ch oce5 c...&,_2, r was issued a permit to install a ate 4nstaller) septic system at C n,, , based on a design drawn by (address) , Bennett Engineering,Inc. dated 3/25/10 (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. Stripout (if required) was inspected and the soils were found satisfactory. X 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. Stripout (if required) was ins d the soils were found satisfactory. OF RICHARD to y5� CHURCHILL installer's Signature) 0 STR 4CURSL W I ST (Designer's Signature) (Affix Designer's Stamp re 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. gAoffice formsWesignercertification form.doc LOT 6 #423 ELLIOT ROAD / / LOT 6 W MAP 227 PARCEL 108 #423 ELLIOT ROAD �cr N/F MAP 227 PARCEL 108 .p DAVID A. SANDELL / 3' / N/F DAVID A. SANDELL a W .1 I LOT 7 MAP 227 PARCEL109 33,863 SF± EXISTING I / INSPECTION PORT 3 112 W EXISTINGcc EXISTING OF OOgs 4t ANK �� D2BOX 1 SINGLE 0 5 4 FAMILY DWELLING LOT 8 O 911 \-"EXISTING #429 . #435 ELLIOT ROAD ;� 0 1 3 SEPTIC TANK 3 BEDROOM MAP 22N/PARCEL 110 3 WF z TOF=27.43 MARY J. QUICKEL - 1 LL 0 6.0' iO 3 I c') EXISTING 6.s' GARAGE 0.5' 9,FLR=26.05 -- --7 F �M fps i 8 O EXISTING SOIL ABSORPTION EXISTING SYSTEM VENT S57 40'00 E 110.00' ELEVATIONS SWING TIES DESCRIPTION INVERT A B C DESCRIPTION S-TANK IN 23.98 1 - 14.8 13.1 S-TANK COVER S-TANK OUT 23.68 2 - 13.4 18.0 S-TANK COVER D-BOX IN 23.50 3 - 7.6 23.5 D-BOX CENTER D-BOX OUT 23.32 4 - 13.7 25.9 LEACHING CHAMBER CORNER LEACHING CHAMBER IN 21.77 5 - 17.0 29.8 LEACHING CHAMBER CORNER BOTTOM OF SAS EL. 19.77 6 16.7 20.4 - LEACHING CHAMBER CORNER *GROUND WATER EL. 2.5 7 12.7 17.7 - LEACHING CHAMBER CORNER SEPARATION >6' 8 2.0 22.9 - SYSTEM VENT * Ground water determined by elevation of 9 - 19.4 32.7 INSPECTION PORT standing water in wetland 120' to the southeast. WE CERTIFY THAT THIS SEPTIC SYSTEM HAS BEEN CONSTRUCTED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED DESIGN PLAN AND MEETS THE REQUIREMENTS OF THE TOWN A REGULATIONS, AS-BUILT. AN OF SEPTIC AS-BUILT MAP 227 PARCEL 1,09 RII;araRo�a 429 ELLIOT ROAD G�;URCWiLL �v Td31CTL°RAL c CENTERVILL-E; $`o 4C6 BARNSTABLE, MASS SCALE: V=20' DATE: 05/10/2010 DESIGNER BENNETT ENGINEERING LAND SURVEYING,ENGINEERING,&DEVELOPMENT SERVICES PO BOX 297 TEL.(508)888;4868 SAGAMORE BEACH,MA 02562 FAX.(508)888-4867 INSTALLER 0 20 40 - 60 OB NO: 0611 -o LOT 6 #423 ELLIOT ROAD / LOT 6 MAP 227 PARCEL 108 / / p423 ELLIOT ROAD N/F - MAP 227 PARCEL 108 OA%AD A. SANDELL / 3 / N/F DAVAD A. SANDELL c� w I LOT 7 MAP 227 PARCEL109 3 33,863 SF± EXISTING INSPECTION I PORT 3 •N IN wso EXISTING or'Cogs OM��� �� D Box C EXISTING K SINGLE 0 5� 4 FAMILY o ---- O DWELLING LOT 8 I 9-f; \--EXISTING #429 435 ELLIOT ROAD i U 3 SEPTIC TANK 3 BEDROOM MAP 227 PARCEL 110 3 i W N/F ;z TOF=27.43 B MARY J. OUICKEL I ;0 i / ILL O 6.0' 0 3 I_ EXISTING 6.6' GARAGE 10 gam' 91 FLR=26.05 7 Wer fDC 8 0 EXISTING SOIL ABSORPTION EXISTING SYSTEM VENT S57 40'00'E 110.00' ELEVATIONS SWING TIES DESCRIPTION INVERT A B C DESCRIPTION S—TANK IN 23.98 1 — 14.8 13.1 S—TANK COVER S—TANK OUT 23.68 2 — 13.4 18.0 S—TANK COVER D—BOX IN 23.50 3 — 7.6 23.5 D—BOX CENTER D—BOX OUT 23.32 4 — 13.7 25.9 LEACHING CHAMBER CORNER LEACHING CHAMBER IN 21.77 5 — 17.0 29.8 LEACHING CHAMBER CORNER BOTTOM OF SAS EL. 19.77 6 16.7 20.4 — LEACHING CHAMBER CORNER *GROUND WATER EL. 2.5 7 12.7 17.7 — LEACHING CHAMBER CORNE S PAR TIO >6' 8 2,0 22.9 — SYSTEM VENT • Ground water determined by elevation of 9 19.4 1 32.7 NINI S E�C710N PbRf standing water In wetland 120' to the southeast. WE CERTIFY THAT THIS SEPTIC SYSTEM HAS BEEN CONSTRUCTED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED DESIGN PLAN AND MEETS THE REQUIREMENTS OF THE TOWN REGULATIONS, AS—BUILT. OF SEPTIC AS-BUILT RICHAR�IA MAP 227 PARCEL 109 �� . CHuRCHILL 429 ELLIOT ROAD p' mUCTC1 at. CENTERVILLE, ��o•4L6�o BARNSTABLE, MASS. g 4 lST � _.�n SCALE: 1 —20 DATE: 05/10/2010 DESIGNER'V'`y" vq`w� --� BENNETT ENGINEERING LAND SURVEYING,ENGINEERING,8c DEVELOPMENT SERVICES PO BOX 297 TEL.(508)888-4868 SAGAMORE BEACH,MA 02562 FAx.(508)888.4867 INSTALLER 0 20 40 60 OB NO: 0611 _ 7 LOT 6 0.� #423 ELLIOT ROAD / LOT 6 MAP 227 PARCEL 108 / / #423 ELLIOT ROAD N/F MAP 227 PARCEL 108 DAVID A. SANDELL / 3 / N/F DAVID A. SA.NDELL c++ 1 � - E E. 3 _� I LOT 7 MAP 227 PARCEL109 3 a 33,863 SF± EXISTING I N INSPECTION PORT 3 N W wso EXISTING or'� FROM D-BOX EXISTING OASTAC BANK �. 2 SINGLE 1 0 5� 4 FAMILY 0 1 ---- o DWELLING LOT 8 I o 9-�; I \---EXISTING #429 #435 ELLIOT ROAD ; 3 SEPTIC TANK 3 BEDROOM MAP 227 PARCEL 110 3 ,111 N/F ;z B TOF=27.43 MARY J. OUICKEL I , U 0 6.0' LL I O 2XISTINC 0 s.s' GARAGE 10.67�r' 91 FLR=26.05 -- --- F 7 F �M£pO � 8 O EXISTING SOIL ABSORPTION EXISTING SYSTEM VENT 557 40'00 E 110.00' ELEVATIONS SWING TIES DEOGRIPTION INVENT A 8 c DESCRIPTION S—TANK IN _...�..... ,�.. -23.98, 1 .1. .8_.=13:1,,.,SrTANK COVER S—TANK OUT 23.68 2 — 13.4 18.0 S—TANK COVER D-BOX IN nzo _ 3 1.6 23.5- D-13BX CENTER D=BOX OUT 23.32 4 — 13.7 25.9 LEACHING CHAMBER CORNER LEACHING CHAMBER IN 21.77 5 — 17.0 29.8 LEACHING CHAMBER CORNE BOTTOM OF SAS EL. 19.77 6 16.7 20.4 — LEACHING CHAMBER CORNER *GROUND WATER EL 7 12.7 173 = LEACHING CHAMBER CORN€ SEPARATION >6' 8 2.0 22.9 — SYSTEM VENT * Ground water determined by elevation of 9 — 19.4 32.7 INSPECTION PORT standing water in wetland 120' to the southeast. WE CERTIFY THAT THIS SEPTIC SYSTEM HAS BEEN CONSTRUCTED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED DESIGN PLAN AND MEETS THE REQUIREMENTS OF THE TOWN REGULATIONS, AS—BUILT. OF SEPTIC AS-BUILT U RiGRARDM rl- MAP 227 PARCEL 109 V`Z c-sinciaL ' 429 ELLIOT ROAD Z16 'Tli"JCTLRAI. a,, CENTERVILLE, Y 1Wo.4U596 BARNSTABLE, MASS. �y' 6"lb` SCALE: 1"=20' DATE: 05/10/2010 maim �5t1 } DESIGNER BENNE'T7 ENGINEERING LAND SURVEYING,ENGINEERING,&DEVELOPMENT SERVICES Foam PO BOX 297 TEL.(508)888.4868 SAGAMORE BEACH,MA 02562 FAX.(508)888.4867 INSTALLER 0 20 40 60 08 NO: 0611 Town of Barnstable P# Department of Regulatory Services BARntsreste, Public Health Division Date MAM p. 039. 200 Main Street,Hyannis MA 02601 Date Scheduled .2 o Time o 3d �► Fee Pd. v Soil Suitability Assessment fog" Sewage Disposal QQ( Performed By: Witnessed By- dytAV. J 4,--�7+q /�✓, LOCATION & GENERAL INFORMATION Location Address 429 Elliot Rd.,Centerville Owner's Name Carole R.Bloom Address 429 Elliot Rd.,Centerville Assessor's Map/Parcel: 227/109 Engineer's Name Bennett Engineering,Inc. NEW CONSTRUCTION REPAIR __><_ Telephone# 508-888-4868 fax 508-888-4867 Land Use Slopes(%) Surface Stones Distances from:Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line 1,C) r ft Other ft SKETCH: (Street name,dimensio s of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) l X A n LL 1 0 Y P ti Parent material(geologic) Depth to Bedrock ✓'dN Depth to Groundwater:Sta ding Water in Hole: /"OA14 Weeping from Pit Face No Ms Estimated Seasonal High Groundwater (,. +. DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: /0 Depth Observed standing obs.hole: Depth to soil mottles: in. Depth to weeping from side of obs.hole: Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj factor Adj.Groundwater Level PERCOLATION TEST Dated 2 oTime 27 17 Observation f Hole# / Time at 9" Depth of perc J G Time at 6" q r Start Pre-soak Time @ s`7 ' I7 Time(9"-6") End Pre-soak L Rate Min./Inch L Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original:Public Health Division.. Observation Hole Data To Be Completed on Back———- ** *If percolation test is to be conducted within 100' of wetland, you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Soil Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel Q�3 A SL /orR 3 .2�( 91 LS 34-/2d G yl? � 6/0AVrL DEEP OBSERVATION HOLE LOG Hole # 7— Depth from Soil Soil Soil Color soil (Xher Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. °ro Gravel b- 3 S` �oy22/f 3 - 2 2 /y ` z- 2-Z --7 A13 /oy2 2/ s /o y/L 7/G 3y- / 2o C. s A) /L�3 DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Soil Soil Color Other - Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Soil Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. %Gravel) i Flood Insurance Rate May: Above 500 year flood boundary No yes Within 500 year boundary No ✓ 11 Yes Within 100 year flood boundary No Yes Depth 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? L/r!; If not,what is the depth of naturally occurring pervious material? Certification I certify that on Nov 12,2002 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trai�pertise a perience described in 3 10 CMR 15.017. Signature Date Q:\SEPTIC\PERCFORKDOC t Commonwealth of Massachusetts W Title 5 Official, Inspection Form _ Subsurface Sewage Disposal System Form - Not for1VatlluntaryAssessments 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632 03/04/10 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Ins=,tpection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to rove your Timothy Bennett cursor-do not Name of Inspector use the return key. Bennett Engineering Company Name reb PO Box 297 Company Address Sagamore MA _ 02562 emm City/Town Sttate Zip Code Telephone Number Liense Nurmber B. Certification 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 ft.lnction and maintenance of on site sewage disposal systems. I am a DEP approved system iiinspecitor pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails Needs Further Evaluation by tnc L^r.al Anoroving.A.Th, Inspector's Signature Date The system inspector shall submit a copy of this inspecAion.report-to the Approving Authority(Board of Health or DEP)within 30 days of completing this insipection:,_ If fhe system is a shared system or has a design flow of 10,000 gpd or greater, the inspectmr and tthe,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 app:rroving authority. This report only describes conditions at the time ofiinspection and under the conditions of use at that time. This inspection does not address how.Ahe-system will perform in the future under the same or different conditions of use. l5ins•09/08 Title 5 Official Inspec5on Form:Subsurface Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable KAA 02632 03/04/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information w1hich indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to brae replaced or repaired. The system, upon completion of the replacement or repair, as approvved by. . the Board of Health, will pass. Check the box for"yes", "no" or"not determined"(Y, N, ND)for the following statements. If"noJt determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved byy the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certifica:tte of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pa-age 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Sy!5tem Form- Not for Voluntary Assessments a 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632 03/04l10 every page. City/Town State Zip Code Date of Irnspection B. Certification (cont.) B) System Conditionally Passes(coot:): ❑ Observation of sewage backup or (break out or high static water level in the. -distribution box due to broken or obstructed pip(e(s)or due to a broken, settled or uneven distribaution box. System will pass inspection if(with apprroval of Board of Health): ❑ broken pipe(s) are rreplaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is remosved ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumpiing more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspectionAf(with:approval of the Board of Health): ❑ broken pipe(s) are rreplaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(E}_xplain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which requif9re further evaluation by the Board of Health in carder to determine if the system is failing to protect pubECrc health, safety or the environment. 1. System will pass unlesas Board of Health determines in accord ance,-with 310 CMR 15.303(1)(b)that the systenn.is not functioning in a manner which wilf,rprotect:public health, safety and the environmemt ❑ Cesspool or privy is3 within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetlandd or a sallt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewa-age Disposall`System•Page 3 of 17 Commonwealth of Massachusetts m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessm, ents 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632: 03/04/110 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Pubsilic Water Supplier, if any) determines that the system is functioning in a manner that protects t1he public health, safety and environment: ❑ The system has a septic tank and soil absorption system ('SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ .. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less;than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified Raboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and niitrate nidrogen 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No" to each of the following fmr all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the suaface ofthe grownd or surface waters due to an overloaded or clogged SAS or c-esspooil ® ❑ Static liquid level in the distribution box abode outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than ''Y2 day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Noftfor Voluntary Assessments 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA02632 03/04/10 every page. City/Town Stait Zip Code Date of Inspection B. Certification (coot.) Yes No ❑ ❑ Required pumping more trAan 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of.the.SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of.cesspool orrprivy is within 100 feet of a surface water supply or tributary to a surface waterr supply. ❑ ® Any portion of'a cesspool (or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool(or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water suppi.W. well with no acceptable water quality analysis:[This system passes if the welll water analysis, performed at a DEP.certified laboratory,for fecal coliform bacteria indicates absent and the presence,° of ammonia nitrogen and nitrate nitrogen is equal to or less than 5'ppm? provided that no other faiffure criteria are triggered. A copy of the analysis and chain of custody moat be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described Nn 310 CMR 15.303, therefore the system fails. The system owner should conttact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes','or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 fetet.of a surface drinking water supply ❑ ❑ the system is within 200 feint of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E:the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. Th-e system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachm setts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Fowm Not for Voluntary Assessments 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable IAA 02632 03/04/10 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been, done. You must indicate"yes" or"no" as to each of thre followiing: Yes No ❑ ® Pumping intbrmatimn was provided by the owner, occupant, or Boarrd of Health ❑ ❑ Were any off the system components pumped out in the previous twvo weeks? ❑ ❑ Has the systtem received normal flows in the previous two week perriod? El ❑ Have large volumes of water been introduced to the system recendly or as.part of this inspection? ® El available as bumf plans of the system obtained and examined? (If they were not available nave as W/A) ® ❑ Was the fa6lity or dwelling inspected for signs of sewage back up?? ❑ ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site?- 0 ❑ Were the septic tank manholes uncovered,opened, and the interialifr of the tank inspected fi r the condition of the baffles or tees, material of constrwction, dimensions:,, depth of liquid, depth of sludge and depth of scum? ❑ ❑ Was the faefility owner(and occupants if different from owner) provided with information Eon the proper maintenance of subsurface sewage dispcosal systems? The size arud location of the Soil Absorption System '(SAS) on tthe site has been determined based on: ® ❑ Existing infcamatiorn. For example, a plan at the Board of Health. ❑ ❑ Determined iin the field (if any of the failure criteria related to Part C.. is at issue approximatin of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 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 l5ins•09/08 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal SSystem•Pag}e 6 of 17 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessrments a 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA , 02632 103/041110 every page. City/Town State Zip Code Date of IMspection D. System Information Description: Septic tank, distrbition box and soil absorpion system. Number of current residents: 0 Does residence have a garbage grinder? Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection re quiredE ❑ Yes ® No Laundry system inspected? E Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if availaible(last 2 years usage (gpd)): Detail: Not available Sump pump? ❑ Yes ❑ No Last date of occupancy: May 1, 2009 Mate Commercial/industrial Flow(Conditions: Type of Establishment: Design flow(based on 310 C W, 15.203): Gallons per clay(gpd)) Basis of design flow(sea ts/per-sons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged)to the Title 5 system? ❑ Yes ❑ No Water meter readings, if availafble: t5ins-09/08 Title 5 Official Inspection Form:Suhe-irface Seeevage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection: dorm Subsurface Sewage Disposal System Form-Not for Voll-untary Assessments a 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632: 03/04/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General lnformaftion .Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: — Type of System: ® Septic tank, distribution box, soil absorlplon system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attacth previous inspection records, if any) ❑ Innovative/Alternative technology. Attadh a copy of the current operation and maintenance contract(to be obtained frcan system owner)and a copy of latest inspection of the I/A system by system (operator under contract ❑ Tight tank. Attach a copy of the'DEP aWoval. ❑ Other(describe): l5ins•09/08 Title 5 OfF.fioal Inspecti®o Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form _ 8 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ¢t 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632 03/04/10 every page. City/Town State Zip Code Date of Inspedtion D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 23 years Were sewage odors detected when arriving at the site? ❑ Yes ❑ Nn Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5.5'x11' Sludge depth: 36" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pa¢ge 9 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632 03/04/1CO every page. City/Town State Zip Code Date of Imspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Above bottorm of tee Scum thickness N/A Distance from top of scum to torn of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet iinvert, evidence of leakage, etc.): Liquid levels in the thank were.approximately 12" below the outlet invert which,its evidence of leakage. Evidence of sewage backup was present above both the inlet and oubJet pipes. Grease Trap(locate on site plain): Depth below grade: feet 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 um in p p g: mate t5ins•09/08 Title 5 Official Inspection Formr.Subsurface Sewacge Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632 03/04/10 every page. City/Town State Zip Code- (Date of Itnspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee(or baffle:condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc:)): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on, site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑polyethylene: ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons perdy Alarm present: ❑ Yes ❑ No Alarm level: Alarm in wo►Wng order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required)_ Is copy attbched?' ❑ Yes ❑ No t5ins-09/08 Title 5 Official InspectiornForm:Sulascurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Nodfor Voluntary Assessments 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MAC 02632 03/04/10 every page. City/Town Statte Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(Iaoeate on site plan): Depth of liquid level above outlet invert none Comments(note if box is level and distribution t(o outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Heavy black staining and paper present in the c0istribution box as evidence of solids carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances;etc.): •1 Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Offidial Inspecti©n Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts i_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �j 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632 03/04/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: ❑ leaching chambers number: -- ❑ leaching galleries. number: — ❑ leaching trenches number, length: - ❑ leaching fields number, dimensions: ❑ overflow cesspool number: — ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil;,(:conditimn of vegetation, etc.): Staining was present on the leach pit walls. Cesspools(cesspool 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 I Indication of groundwater inflow ❑ Yes ❑ "No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal S}gstem•Page:13 of 17 i Commonwealth of Massachusetts W Title 5 Official` Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments aV< 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632 03/04/10 every page. City/Town State Zip Code ®ate of Inspection D. System Information (cont.) Comments (note condition of sdil, signs of hydraulic failure, level of<pon(ditng, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soul, signs of hydraulic failure,revel of pon(ding,.condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsum-liace Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA f02632 03/04/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one, of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately I � M�I o, 'V t5ins•09/08 Title 5 Offi6zal Inspection:Form:Subsurface Sewage Disposal System•Page 15 of TV r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Foram Not for Voluntary Assessments /r 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632 03/04/10 every page. City/Town Stag Zip Code Date of Inspect5on D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 15 feet Please indicate all methods used to detearmine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design pron reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of'IFlealth -explaiiin: ❑ Checked with local excavatoxrs, instaillers- (attach documentation) ❑ Accessed USGS database—explain;- You must describe how you establishedAhe high ground water elevation: Swamp/Bog 140' From SAS Before filing this Inspection Report,pltease see Report Completeness Checklisd on next pza.ge'. t5ins-09/08 Title 5 Offricial Inspection Form:Subsurface Sewage Dispomal System-Page,+6 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form =x Subsurface Sewage Disposal System Form Not for Voluntary Assessments 429 Elliott Road Property Address Carole R. Bloom Owner Owner's Name information is required for Centerville, Barnstable MA 02632 03/04/10 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage(Disposal System•Page 17 of 17 iA4 ELLIS 6 THULIN, INC. LAND SURVEYORS & CIVIL ENGINEERS 478 ROUTE 6A-P.O. BOX 159 DAVID C.THULIN, PE EAST SANDWICH: MASS. 02537 JOHN R.ELLIS, RLS TELEPHONE (617) 888-2345 I . SEPTEMBER 17, 19£37 BARNSTABLE BOARD OF HEALTH 397 MAIN STREET HYANNIS, MASS a , 02601 RE: SEPTIC SYSTEM AS—BUILT , LOT 7 , ELLIOT ROAD t CENTERV:IL.LE DEAR SIR: PLEASE BE ADVISED THE SEPTIC SYSTEM WAS INSTALLED ON THE ABOVE REFERENCED LOT IN SUBSTANTIAL COMPLIANCE WITH THE PROPOSED PLOT FLAN PREPARED BY THIS OFFICE. PROPOSED/AS-BUILT LOCATIONS HAVE-- BEEN DEFINED ON THE ATTACHED CERTIFIED PLOT PLAN (REVISION DATE: 9717•-87) o _.. SHOULD YOU HAVE ANY QUESTIONS DO NOT HESITATE TO CALL. VERY TRULY YOURS, 1p J i-IN Ra ELLIS , PLS LLIS A THULIN, INC. ENCLOSURES I TOWN OF BARNSTABLE ' LOCATION 1—bT �7 F 1_ _. � h""C" iZ L> SEWAGE"# 3 VILLAGE. C K T H�Z� lAi ASSESSOR'S MAP tSz LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY I ; 6 O G A\\o 0 LEACHING FACILITY:(tppe) CZ'�� Cis �,T (size)�c NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER ARE n Q Lk ��n t'Y1 DATE PERMIT ISSUED: "7- DATE •COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No i9 a � �Sc0 5cVY�c�hwk wl�cry p%T w(3' SZ c we 0 SioX i ELLIS �r THULIN, INC. LAND SURVEYORS & CIVIL ENGINEERS 478 ROUTE 6A—P.O. BOX 159 DAVID C.THULIN. PE EAST SANDWICH. MASS. 02537 JOHN R.ELLIS, RLS TELEPHONE (617) 888-2345 SEPTEMBER :17, 1987 BARNSTABLE BOARD OF HEALTH 397 MAIN STREET HYANNIS, MASS. , 02601 RE: SEPTIC SYSTEM AS—BUILT, LOT 7, ELLIOT ROAD, CENTERV:IL.L.E DEAR SIR: PLEASE BE ADVISED THE: SEPTIC SYSTEM WAS INSTALLED ON THE ABOVE— REFERENCED LOT IN SUBSTANTIAL COMPLIANCE WITH THE PROPOSED F'I_O.-f. PLAN PREPARED BY THIS OFFICE. PROPOSED/AS:. BU:1::1._T LOCATIONS HAVE BEEN DEFINED ON THE ATTACHED CERTIFIED PLOT PLAN (REVISION DATE: %17•-87) . SHOULD YOU HAVE ANY QUESTIONS DO NOT HESITATE TO CAI—L. VERY TRULY YOURS , • C)JIZINR". ELLI:S , PLS LTS K TI.4I.JL.Ti'4' Ti�(a. ENCLOSURES TOWN OF BARNSTABLE LOCATION (_,bT 7 F_L� . � (fT EWAGE. VILLAGE. Cj- Kz H 9.y Ai ASSESSOR'S MAP & LOT a7 OCt INSTALLER'S NAME & PHONE NO. o b E�2 -SEPTIC TANK CAPACITY S b O G A\\0 0 -71 LEACHING FACILITY:(tppe) -NO. OF BEDROOMS 'J PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER --2 �--(�n ►� DATE PERMIT ISSUED: -7- S 3~"S 7 DATE .COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No i i9 i , t4 ab � I S r a S e p}'1G TY�w k l o c a11cr, f"T D TS oK �� �ssE��oeS �n pP �.�� �`� z No._ .�... F>ls........ ..._............._ THE COMMONWEALTH OF.MASSACHUSETTS BOAR® OF HEALTH Tom -- ----------------OF...........`kA � Appfira#ion for Uhipos al Works Tumtrartinn Frrmit 4 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .............. ........ 1 o fj .............. ------------•----- ----------------------------------•---••------ Location-Address or Lot No. -------------- •••••....Pic, .-----...------------------.... 1_Chi...S:T..-------k1,.YAS��M1 Owner Address Installer Address Type of Building Size Lot.53Y.8(?y......Sq. feet U Dwelling—No. of Bedrooms.................—•S......................Expansion Attic (N/A) Garbage Grinder (✓f 04 Other—Type of Building ...... )A.............. No. of persons............N f A__.__.. Showers (Wf� — Cafeteria NA.) dOther fixtures ----N��-------•--••-----••-••••-----------------•-•----•••-•---•---••-•-----•-•------••------------------•-•••------•---••----------------••--. w Design Flow...............IQ......................gallons per person per day. Total daily flow.............�3®._.___ _ gal •--------•--- loos. WSeptic Tank—Liquid capacity _gallons Length._0C 4P.__ Width.'$____. Diameter-_.NIA.... Depth...5:n " x Disposal Trench—No. ....... ll..... Width.......NIA.... Total Length........N]A..... Total leaching area......N/A......sq. ft. Seepage Pit No...........0----------- Diameter......... .....: Depth below inlet.......&......... Total leaching area._3_'M.....sq. ft. Z Other Distribution box (✓} Dosing tank (N/A) aPercolation Test Results Performed by-__ -!S-�_.. -►4 ..._. ...__.... Date....J..-!`-�..Z_j- ----- Test Pit No. 1_...Z___minutes per inch Depth of Test Pit.,.._1 Z�.._.�._ Depth to ground water_---N_�ti____---____. LT4 Test Pit No. 2................ per inch Depth of Test Pit...... ......... Depth to ground water____NIA........._.. 04 ...................................... ...........•---••-----------........_-••-•--•---...------•---......................................................... O Description of Soil-tPJ----•.1')-ML2 A14--- c.� .....................................-••-•--------... w x -------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable--------- JA___-_____--•-_-__-•______________•-_-__________________-_-____---•---.----:-. -----------------------------------••---------------------------------------------........-•-------------------------------=-----------------------------------------................................... Agreement: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i r ance it the provisions of:ITIZ 5 of the State Sanitary Code—The undersigned further agrees no o ace he sy p p operation until a Certificate of Compliance has be sued 7bjthe board of ealth. -•-•- ------------•---• 1.11 .A. ....------- Application Approved By............ C�.......... .................... :: ...... ,1-l-Z Date Application Disapproved for the following reasons---------------------•----------•---------------------.......................................................... .................•-••--•......-•-••••----....._..••••••••----•••••--•••••-----•----•-•--------•-...-•-•-•-----•--------....-------•-------•-----•-----••--••-•--••••-••-•-----------•••••-•----....-•--- Date Permit No....... .�{�.` ... Issued-------------------------------••......--•- ate......- Date f 'S THE COMMONWEALTH OF MASSACHUSETTS y. BOARD OF HEALTH ---.....0 F.......................................................................................... Appliration for Disposal Works Tonstrurtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 21 ............. £ (__l t J;'r - >----•••-•.....-•-••-•-- -•-•••....------......--•-•••••---•-------M •..... •----------•--•-......------_.... Location.Address or Lot No. •-•••--••-•----...--•-•-•--- _Z=''�'---ivy o�..ay--.�T: i:`� �: I j<:1. �::�... Z„(%�7 Owner Address W Installer Address Type of Building Size Lot��-'-_��-_._-�" y� yp g Sq. feet U Dwelling—No. of Bedrooms............................................� Expansion Attic (NIA) Garbage Grinder (✓S p.I Other—Type of Building ____I'_) .............. No. of persons............ -a---------- Showers (VA) — Cafeteria P-4 Other fixtures .._? ...._...____ W Design Flow..........................................gallons per person per day. Total daily lflow..............�-�__�d.._..__._.........._gallons. Q; Septic Tank—Liquid capacityt:-.?'__gallons Length.0'(10". Width.!_ ±.I�----- Diameter__N_Ijj.... Depth................ Disposal Trench—No. ......''.t?...... Width....... ! ..... Total Length......P�1t...... Total leaching area-----N) ____.sq. ft. Seepage Pit No--------- ...._...... Diameter.........._.__.___. Depth below inlet....._&........... Total leaching area.. Al......sq. ft. Z Other Distribution box (-1) Dosing tank (,A) ~' Percolation Test Results Performed by... __---•-l=?- -_._ t .. .. _�__. ..... Date_... W Test Pit No. 1.. .Z-....minutes per inch Depth of Test Pit-----f_:�__....... Depth to ground water-__N f' _-_________- 44 Test Pit No. 2.4.L.....minutes per inch Depth of Test Pit------ _�___ Depth to ground water----- ............ a ............................................................ ......................................................... O .Description of Soil.'`._E A._..`.... = .at 1,�?- z f 1 c7 t i----•--•--- _ -••--............................................. ►�i _T F'-r f r":._.`?L W ------------------------------------------•----------------------------------------•---•--------------•-----------------------...--................... .............................................. V Nature of Repairs or Alterations—Answer when applicable--------v ---------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i r ance i the provisions of TIT!L- 5 of the State Sanitary Code—The undersigned further agrees no face he s e n operation until a Certificate of Compliance has beerV i ued b the board of 1 alth. _ .. _. .Signed -.u .t._ �•f4 d f --=�-- l/ _.. ______rf _____..____� ___f ...._ Application Approved By.............. = =-................................................._ ................tet, Date Application Disapproved for the following reasons:..................... ....-----•--------------------•-•-.........._._....•••-•-----------•.......---••--•-----••-•-•---•--------•--•-•-•-••-•-••-•------•------••-•---•••---•--------•-••----•--••••------••-••-•--•....._.._. Permit No..........` '-'-----------/-• n,--¢ te Issued a__. - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTiTrSIG'11ING ENGINEER MUST SUPS. INS i L 'L w R. 'kI:'D CERTIFY IN WRITIls., .'` 1—M p��1.OF...........`�:.........V, �G;► - ."i l~LLED IN STRICT .............................. (9rdifiratr of Bunt rliaurr �` � i;. ��. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X) or Repaired ( ) by.................................................................................................................................................................................................... Installer at.---••G ............�-----• �. ai l`V'�i-! (_�C'oil t v 11�C -------------- --••----------------------------------------------------••--------------------------- has been installed in accordance with the provisions of TITLE 5 of The St to Sanitary Code a�s described in the application for Disposal Works Construction Permit No.....`. --_�-�....`... - _... dated........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRl9 ® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. CC _ 0..................................... . DATE................... ' ....lI-... ................... Inspector.................. ........ PERVISE a►� I THE COMMONWEALTH of MA!ttSESIGNING ENGINEER MUST r' "-'"'Ib& AND CERTIFY IN WRITING T�-• YvTEIItI BOARD OF HEAIU�F1 WAS INSTALLED IN STRICT p (a. j.. .....OF--------------`, ` DANCE TO PLAN. No.�_°'_ 1a tf ( FEE..... _�r.... Disposal Work ons rnrtinat Pamit Permission is hereby granted -----` ...ber to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. �-=-------•••--'-7 �.l_l i t� �......_..��-�-:�--..... �_�tV."a-�-:`-�/i t•��r �9 St /� 4 Z q a• _ _ 7._.-Street t" (, -s-..Dated--- - --- ------ --- ....... as shown on the application for Disposal Works Construction Permit No.e :....._,d.` r7 �; Bpa fa of Health DATE------. = Fr ° y FORM 1255 HOBBS & WARREN, MC., PUBLISHERS 7f r ' Y r ELLIS 6? THULIN, INC. LAND SURVEYORS & CIVIL ENGINEERS 478 ROUTE 6A-P.O. BOX 159 DAVID C.THULIN, PE EAST SANDWICH, MASS. 02537 JOHN R.ELLIS, RLS TELEPHONE (617) 888-2345 February 6 , 1986 Mr . Frank Mezzacappa DEQE Southeast Region Lakeville Hospital Lakeville , Mass . 03246 re . 85-069 , Lot 7 Elliot Road , Centerville , Ma . Mr . Mezzacappa : Enclosed please find three sets of prints describing a proposed residence to be constructed on the the ref . lot . Because ' of the .limited space available for construction .of a septic system , we have proposed that the effluent from a basement level bathroom be pumped to the septic tank. A description of the remaining water using fixtures and their. floor level is on the plan . The project was just approved at a wetlands hearing in Barnstable , your file no SE3-1384 . Prior to application for a Disposal Works Permit your approval of the pumping arrangement is required . We will be pleased to assist you with any additional information you require. Very truly yours , Ellis & Thulin , Inc. David C. Thulin , P.E cc Mr . Fred Bloom, Owner y A � d a y �v ���e�a��i2l�Cs�czl2h2.Er� C��G�i�ree«i2� S. Russell Sylva Commissioner Paul T. Anderson �, 0,2.y46 Regional Environmental Engineer March 10, 1986 Ellis & Thulin, Inc. RE: BARNSTABLE--Subsurface Sewage 478 Route 6A Disposal , Pumping Prior to the P.O. Box 159 Septic Tank for Lot 7, Elliot Road, East Sandwich, Massachusetts 02537 Centerville. ATTENTION: David C. Thulin, P.E. Gentlemen: In accordance with 310 CMR 15.09(1) of Title 5 of The State Environmental Code, the Department of Environmental Quality Engineering has had an engineer review your request for prior approval to install a sewage ejector at the subject location. The Department does not recommend pumping into the septic tank, but whereas the sewage flow being pumped is a small percentage of the total daily flow and should not cause a major. disturbance, the Department hereby approves the proposal with the following provisions: 1. The installation meets the requirements of all .other. State and local agencies. 2. The sewage ejector shall be a low flow (15-25 gallons per minute) , non- grinding pump. Please be advised that the installation of a sewage ejector constitutes an alteration to your subsurface sewage disposal system, and, therefore, the appropriate permits for such .an alteration must be obtained from the Barnstable Board of Health in accordance with 310 CMR-.15.02 of Title 5. If you have any questions or need additional information, .please contact Joseph Shepherd at the above telephone number. Very truly yours, A Philip S. Ripa, Chi f Water Pollution Control Section R/JS/lm Q i J114el S. Russell Sylva / CQ Commissioner J amae�l' M Paul T. Anderson �� �h; L �� � 02316 Regional Environmental Engineer 9h7="S/, &e 680=6-(Y4 March 10, 1986 Ellis & T.hulin, Inc. RE: BARNSTABLE--Subsurface Sewage 478 Route 6A Disposal , Pumpi_ng_Prio_r to the P.O. Box 159 Septic Tank for-TLot=7_,_E11=iot-Road, East Sandwich, Massachusetts 02537 Centerville. ATTENTION: David C. Thulin, P.E. Gentlemen: In accordance with 310 CMR 15.09(1) of Title 5 of The State Environmental Code, the Department of Environmental Quality Engineering has had an engineer review your request for prior approval to install a sewage ejector at the subject location. The Department does not recommend pumping into the septic tank, but whereas the sewage flow being pumped is a small percentage of the total daily flow and should not cause a major. disturbance, the Department hereby approves the proposal with the following provisions: 1. The installation meets the requirements of all other State and local agencies. 2. The sewage ejector shall be a low flow (15-25 gallons per minute) , non- grinding pump. Please be advised that the installation of a sewage ejector constitutes an alteration to your subsurface sewage disposal system, and, therefore, the appropriate permits for such an alteration must be obtained from the Barnstable Board of Health in accordance with 310 CMR 15.02 of Title 5. If you. have any questions or need additional information, please contact Joseph Shepherd at the above telephone number. Very truly yours, Philip S. Ripa, Chi f Water Pollution Control Section R/JS/lm -2- e c 'Barnstable Bar� ---Health Town Hal'"1: I South Street Hyannis; MA=02601 Barnstable Plumbing Inspector Town Hall South Street Hyannis, MA 02601 ^� Permit Runber: Date: pleted b C om Y HIGH GROUND-WATER LEVEL COMPUTATION Site Location: L O -1 E7I110-+ Lot No. —I Owner: �fz D Coors Address: Sf S-f , y.1 , yAR • Contractor: Address: Notes: t , O STEP 1 Measure depth to water table 7 a ' ' . �, to nearest 1/10 ft. . . . . . . . .:. . . . . . . .. . . . . .. . . . . . . _ / / date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: A) Appropriate index well B) Water-level. range zone -201, STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well . .. . . . 7/ gjC� mo yr STEP 4 Using Table .of Water-level Adjustments for index well STEP 2A , current depth to water level for index well (STEP 3) , and water-level zone (STEP 28) determine 3 6 a water-level adjustment .. . . .. ..... . . .. . . . . . . . . . . . .. . . ... .. . . . . STEP 5 Estinate depth to high water by subtracting the water- ; level adjustment (STEP 4) , from measured depth to water 7�q Level at site (STEP 1) . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . jEl q, 4 -"-Al V5 0 e t'\.( A)twd I I -.s 15�-­S,V V 'I tv 2-OMP �� ... �� }-�,n c� e X�'C� � Zvi v-� U" y L �, s?> ��_� y j�,,k � �r{ ^.'[�'}.r c�rF.t 4Sr����N� � •. �I _ 1 �� �® \' `' w ♦ 5�r,'!� 4�3 ✓[rS}fit, � - i �.hi t't ty F�( •♦'1\ �. _ ie• I�j�ww�///// 11 t,";v'k'^l�°7;k^� � le�y,,.,.its tY^s��' :SCu � � ♦ � ; y�, - y ��,,� r• �,�� ,�Y►1p �%-� � ice\� � F •�n•.� �, ,Q��iT, ���,�'• J � � 7};�3 �rw' r'I�a[.j'F� .`a�n���4R�w .11f. ��� 'ti' 1 ®� ! J ��J �� _ �• 'f�r�r.... %f, k��: � r��.�SF Ih�'� �['� r�IM-ISM � ' °� ` ' � Srti•�' ��r ,,,dr � ,4 WIN. .n '' �`�. `S�+,^2'Vjk�1�.ti`7"{�. � ,2y^t' a� f�� ��Y •� �� 1� 'v,�;ei� `'l �� � -•��t,.r3t� ��" 4... y .:c ,� ; ;Sr •y5. F}rA , '6T ^ • a qvt ''♦ ` j7,f ytireb+ R �rE.t'n'' J i rS ,"� 'uY [1 �, U. 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'xL at 4`r;� `'Y a ��'At�xs ,7a'��: g1�,' ?.��,�°tt,^>S3 4!��.ry�[t�+_�t"'VB,� .. 3 d _ u(•j� .!' ,ti� 3 e. `i. �et a -b��"-.n l' :nj „�>�t>N a y � �5r 't i$.• -�.�yet-� yi,�,.[, RAP V,�pa4lvl�'Ys[° � ''�r� ���* /•/�� ');'� ! i tq• 8r+ `il.l ` f 7Ri �yv;F o �Y Yf ♦ i'•� e � g p� •g�}��M��S ( .�F�. r e' "' i.�, t � v� y?�',� ��jy,"'�4 4•ySfh�a�T, A' "i e 5 �S J 1 �: , (� ��f, y, t' �o1i t .I.,V� t '•, r ?,7y��+��'��• �� ,�'Y.``+91 � 3 io�,� i. �5 t�1,. ..J s.r 44, o.�s*F2,�lu A^ 1 K�s: �� � s j• �r t c � 4..��,.J� �fir'('3�,f'' �?�� �, '�h$ '_ �,r, ?.l ,-[ ''4�i'a �i�'.. ® e� x ���(''•l.�i. ,yyam♦�{l J � ^r 6 �3• K I �t, ELLIS & THULIN, INC. LAND SURVEYORS & CIVIL ENGINEERS 478 ROUTE 6A-P.O. BOX 159 DAVID C.THULIN, PE EAST SANDWICH. MASS. 02537 JOHN R.ELLIS, RLS TELEPHONE (617) 888-2345 SEPTEMBER 17, 1987 BARNSTABLE BOARD OF HEALTH 397 MAIN STREET HYANNIS, MASS. , 02601 RE: SEPTIC SYSTEM AS-BUILT, LOT 7, ELLIOT ROADt* CENTL RV:IL.LE DEAR SIR: PLEASE BE ADVISED THE SEPTIC SYSTEM WAS INSTALLED ON THIS ABOVE REFERENCED LOT IN SUBSTANTIAL COMPLIANCE WITH THE PROPOSED PLOT PLAN PREPARED BY THIS OFFICE. PROP02:ED/AS"BUILT LOCATIONS NS HAVE: BEEN DEFINED ON THE ATTACHED CERTIFIED PLOT FLAN (REVISION DATE: 9717•-87) . SHOULD YOU HAVE ANY QUESTIONS DO NOT HESITATE TO CALL.. VERY TRULY YOURS, J HN I,. ELLIS, PLS LLIS £: THUL.INt INC. ENCLOSURES TOWN OF BARNSTABLE LOCATION L,O-T' �' F_1.1 . � (TT R D, SEWAGE I VILLAGE. C N T H`E N'tkW ASSESSOR'S MAP 6z LOT tea' -�O� INSTALLER'S NAME & PHONE NO. :SEPTIC TANK CAPACITY S b O G A\\. r,) LEACHING FACILITY:(tppe) t?9,' 0 5l (71T (size) -;tO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER R S> �Z Lk �. 6 ►'Yl DATE PERMIT ISSUED: `7- k 3"'S 7 DATE .COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No r9 a � i 1$C O 5 c p11G TYiw k loot. �w1�oh, P"r e 0 ticX i /,C TOWN OF BARNSTABLE LONTION I o--V- -7 E L\-'` C57 7j,� Z, SEWAGE VII:LAGE e..P-lXT!`9,\ -\W ASSESSOR'S MAP & LOT a�Zµ 10,q INSTALLER'S NAME & PHONE NO. .SEPTIC TANK CAPACIT LEACHING FACILITY:(type) Rj CW-5rT p "I- (size) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER 1 LV, 12A- 6 ft"l DATE PERMIT ISSUED: DATE . COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No 0 i$00 5-6PT1G.TWwk loon et w 1pi 3' 5'V Q we 0 15OX r KIh+-IT!i Ig• of WA'-e !� oJ,�i 3�O 0 / a - of�SED GSM PaU 1=h►T L �'r�c�+J I N STA LLFM SYSTEM as if=-PrLLC rm S E:"n(= ��✓� �� '�� ��C6 k �' LEPCJ-1 P1 T W ITN D O t �ta i •O Za.� Q_ O O. r 0 L6 AREA _3_1 sF t 15ygL5� 1*d Ler 9 LoT 6 i p.,/ER PLAN REr co co SIC rw. t N 0 O CQ E N• Z/ Z rr \� OF 29874 ' \• ��^ fCISIE����crJ�c c L L. S A47.29 A-20.oo A=G8.5s R- 285 'TA- �ss.e� tea• A=31.43 A=20.oc R=g�.•=�=21�_.. 2gy is j�j TA= 26° ------- D CEF�TI�IF-,D PL.�T PLa.N SEPTIC SYSTEM AS L)UI LT PLAt\1 L-oT 7 C--L L 1 aT' lip. • 1N LCXP�TI�!mil 1�1 EASU 2EN1 EN-T B`/ 1 N S 1 IaLL�.[Z F�L>1��Z Rr]6E2TS G.s 'NTERvr� -�rr,N S tin.. I RP-✓Isc-D 9 -I1- g7 I"-3o pA-C : 12 24.86 ZWOM T H E2--a--( CX---27r F! "1 t_l AT -n-(G E.LL.1S � T1--1.U1_._IN 1Nc. �ot3 No:sS•�9 �'CIs„� r�,�,DA„or_I o1-l-n-Jl"',.� 44"18 ROUTe loA-.. IS LrxA•rED I" ar--L tJ To DFZ,ey; �7' �e �ctsn�l /�r�MeuTS �t-bwt.J EA�,`T SA�1T��t 11Gt--1�N`L�:tO253'1 GH ay: !L . ���' 3,t2 0� . � � A % I N STAL ' SYSTEVA r=PcLLLD l SE'TIG I AIL �w y .A - DIST216u-rrr�nr �x o �� 3.0 _V _ Zb' (6 X 6' LEACH P 1 T W IT I-1 if:)F S.i[7NE D .o Ib•O �� /q'y i Wp c 1 6' t)• •� 2"A O LP" p \° O Q: O CoNnG.uPeAlves 4 L_-�-6 r p�/E2 e-6 FLAN REr 0 Q FILE No co .. sea-I3a9 A° rr o J cH 29874 0 ECISTE4���QJ� ,�•- 4(41. L&hoS A,G7.21 A=G8.55 �. .. R- 285 L L TAR=�gp O �"" 2b7.4(a O D C:E:R >=1t✓� PLAT PLL�JV SEPTIC. SYSTEJ-t AS E�)ulLT• PLAN! LET 7 L-::.LL107— RP. - LUCP�Tto l�l r'1EASu 2EN1 E.N.T BY 1NSJaL1�.� � l tJ 2o6E12TS GFNrERvtua- - F-k"S-rqISL,e K#,A. R>=V ISED 9 -I - B7 �C-,&L I 3Q pe,-��: 12 Zq-86 Ca-�E1v-C: BLOT T WaCe-13--,( e-r=2TrP-e -n4AT M-ic- E.L-1-.1 soC3 c.�o:$5-�9 �Is„1�, r�,UflA„�.., �,�-r>•-a I's A 4 7 e> RCOI_ITe: (oL�. Lf=rr IS L�xA'T�D IN 101-1 To 17R,1EN: h 7 -ME �ClSTIU /V�pc.JC�ME►-tTS �v r1.l El�.>T S4t�1��,�l1G1--t��15.,�O2S3'1 GH ay: Jf-'e Q_I 24�e� m 9 u, . at DESIGN DATA STRUCTUREF+ rp I DESIGN FLOW 1 19 � + SEPTIC TANK 99 _ �► ' ' LEACHING RATES : SIDE AREA GPD/SF BOTTOM AREA GPD/SF \ LEACHING FACILITY CA:, (21 3 • . .i V / ^A/ 4` � - � L.Q ff r1 Jf/ �^'" .• _ F 1 f, l t WT /\, ' .' /� f+ (o l -- "d PLAN REFERENCE f ) fi - _ - ASSESS ORS LOT NO. _.- p ,�• f trt t 1; � , .. NOTE- A ' y -^ '�_�=,"(, a 1,5p i i-' r rZ `'y i +f '• ,� � ' ".. -- '.""' ''.,...'.,''ti.1 ! ti ALL MATERIALS AND CONSTRUCTION METHODS W _ k * c4 `.;� 'AA � S'� -, � , �" ._..r �. y �' ,T TO CONFORM WITH COMM. OF MASS TITLE SL ENVIRONMENTAL CODE t\ 1 ; i� Sri."rLr f �i ' T►.rZ `, P ��a t\ 1 ' to G7 Sri �� PLAN -= - / -- SCALE TEST PIT NO. TEST PIT NO, SOIL OBSERVATION PITS - .. ELEV ELEV s� e74L _ ES _ I ENGINEER DATE OF t -.AtJ4 _ - 1 i 4 B 0 H AGENT t t! N EXCAVATOR : , i C INTPNO T. IN I PER RATE �AT F M : 111 �f 'r g,k-- �' . ' _...-+__..._.-....._ ��„ x' t war V. • ..4� Gfrr. LS� J� f ��'��.V .., ...R:� 4--• F — . I I , LAND ENGINEERS t r :• r , �w+�.� ` i + �� it c.;.•iJ - .. ; t SURVEYORS AND CIVIL. � EAST SANDWICH MASS. ia SECTION TH R U SEPTIC SYSTEM -� SCALE HORIZ. VERY i ' DESIGN CALCULATIONS Inc` ILOT 6 / f'�� CAPACITY REQUIRED - RESIDENTIAL USE: #423 ELLIOT ROAD ,'fl$t''` DESIGN FLOW: �� ?e CP0 MAP 227 PARCEL 108 / ,,� ,, ff 3 BEDROOMS 0 110 Gal/Day 01 -a N F / � #415 330 Gal/Day REQUIRED DAVID A. SANDELL / �, v f CAPACITY PROVIDED: wc,ii/� �l I� "�s �! SEPTIC TANK: (SEE NOTE) \ {\ \ PROPOSED DESIGN FLOW = 330 Gal/Day 1 #423 /�� If i `�„� „III"`�� o\ RESERVE AREA ,i REQUIRED SIZE X 660%Gal/Day f LOT 6 SIZE PROVIDED: 1,500 Gal/Day 1N ,, �,, " #423 ELLIOT ROAD LEACHING FACILITY: '! ,3 p lw ,,p{1 g, /.. 1, Blfi CONc i f,+ MAP 227 PARCEL 108 DESIGN PERCOLATION RATE: < 2 MPI SF SOIL TEXTURAL CLASS: CLASS I N LONG TERM ACCEPTANCE RATE (LTAR): 0.74 GPD/SF -' S5740'00"E DAVID A. SANDELL ` BOTTOM AREA: 31'-6" x 1V-10" = 341 SF 168.81 SIDE AREA: 2[2(31 6 )+2(10 10 )] = 169 SF 'e TOTAL AREA: = 510 SF (LTAR): X 0.74 Gal/Day/SF LOCUS MAP Z s < rem k 1 GAS DECK TOTAL CAPACITY PROVIDEp = 377 Gal/Day N.T.S SYSTEM IS NOT DESIGNED FOR A GARBAGE GRINDER a NOTES INSPECTION w � PORT ' "� - LOCUS: 429 ELLIOT ROAD ` 106• 3 „ � � GRASS .R6 / F'�'+ •so I�,CONC, MAP 227 PARCEL 109 t { !I.- / I 0 EXISTING 1os o OWNER: CAROLE R. BLOOM o / ',. ' � ' slif,�a.I� ''R , • EXISTING SINGLE .., 3 _ 5$nNKA` FAMILY _F77 � , . - f coNc WALK _ DWELLING DECK429 ELLIOT#429 s��• ADDRESS: CENTERVILLER MA 02632 O 3 BEDROOM �8 I10,00' LOT 8 D-eox� % a°,�ii,=: �, o �• , � TOF=27.43 8��-��' r DEED REF: BOOK 14125 .PAGE 111 #435 ELLIOT ROAD LIMIT of ,, BIT Iq MAP 227 PARCEL 110 / WORK CONIC„, _ ; 0 A 2� 4 PLAN REF: BOOK 305 PAGE 43 N/F �I, �� 9 Ifi a EXISTING ....., MARY J. QUICKEL 4 , f N $. GARAGE / i ,os. I BIT. FLOOD ZONE bNc s h, o T LOCATED STRUCTURES ARE LOCA W _ IN FLOOD ZONE "X" 1 GARAGE FLR. m _ \ t�{ , a GRASS ELEV=26.05 �' ; f�� �f,; / / ON FLOOD MAP 250001 0008 D EFFECTIVE DATE: JULY 2, 1992 PROPOSED S.A.S. ! °,I �;;� ,, _ LOT 7 G�\ (3) 500 GALLON H-20 LEACHING CHAMBERS w/ 3' WASHED STONE AROUND 20 'I rII`P +� �'is ( `�K' I S5740'00"E WETLAND LOCATION FROM Lu I ��z _ MAP 227 O� EFFECTIVE AREA: 31'-6" x 1V-10" �� 110.00 CERTIFIED PLOT PLAN, LOT PARCEL 09 BENCHMARK ;': ,�.��'�,�,r - 7 ELLIOT RD" DATED �' c INSTALL 40 MIL POLY BARRIER WHERE �. SAS Is WITHIN 10' OF STRUCTi� BY ELLIS & GARAGE FLOOR �'-/ 12-24-86, t1� To BE INSTALLED W AWAY FROM SAS 33,863 SF± ti\ PROPOSED EXCEPT WHERE ADJACENT To CONCRETE v THULIN, INC. ELEVATION = 26.05 (NGVD 29) SYSTEM VENT APRON WHERE IT SHALL BE INSTALLED AT THE EDGE OF THE CONCRETE APRON. I 1 K po LEGEND TP \ s DEEP OBSERVATION HOLE TOP OF COASTAL BANK 100 Buffer to BVW ��?o '-"-"'- i �8 Soy Q PERCOLATION TEST HOLE �1/2' HANDLE 4�SANITARY ` � ` SRO' � 4 (Entire site is within the buffer ��� 25xo EXISTING SPOT GRADE \ zone of the Coastal Bank) 1s` FILTER �� oo Q� 25 EXISTING CONTOUR /7CARTRIDGE Q1� / �4. SEWER � �i �� --fin/-°--- EXISTING WATER SERVICE PIPE 1 • ►X&AA OF Mgss� WSO WATER SHUTOFF FILTER ' #439 ��� TIMOTHY `- BENNETT " GAS PROPOSED GAS LINE 9\-GAS BAFFLE No.3685 OF AUM ZABEL A1800 RESIDENTIAL SEPTIC TANK EFFLUENT FILTER FOR SINGLE FAMILY HOMES. ` . .�d RI NARI)M (800) 221-5742 ''� �f s -+ / SITE PLAN 00@IILI_ ► "� q Ta; `� FLOW RATE: 800 GPD. F 0 10 20 30 �o� " Flo. 96 INSTALLATION: FITS ANY 4" SANITARY TEE LOCAL UPGRADE APPROVAL REQUEST: METERS y�� AND SEWAGE PIPE USED AS A '� IONAt- SEPTIC TANK OUTLET BAFFLE. (1) 310 CMR 15.405(1(B)) A reduction in the FEET 7 ��Iv setback distance from a slab foundation 0 20 40 60 80 THIS MAPPING IS MADE FOR THE EXTEND SEWAGE PIPE AT LEAST " , ONE INCH BELOW BOTTOM of required by 310 CMR 15.211 , from 10 to 6.4 . GRAPHIC SCALE 1 = 20 PARTY NAMED HEREON, HIS OR HER FILTER CARTRIDGE GASKET. ' MORTGAGEE AND .GUARANTOR, TEST PIT'INF INFORMATION EXCLUSIVELY: NO FURTHER EXISTING . LIABILITY TO FINISHED 1.All users to be waterti ht. L T IS ASSU. ED. _v T.O.F. RISER INSTALL RISERS TO CHARCOAL 9 FINISHED GRADE ;, PERFORATED INSPECTION - DEEP,OBSERVATION HOLE LOG 1 DEEP OBSERVATION HOLE LOG 2 27.43 GRADE W LOCKING ' WITHIN 6 OF PORT WITH SCREW CAP To VENT 2.All joints to be watertight.. ,,. / .; All i to be h O 1H ERW SOIL DEM FROM SOIL FINISHED GRADE DEVICE ON COVER FINISHED GRADE BE BROUGHT WITHIN 3 OF 3 pipes t Schedule 40. sura ICE SOIL TEX�'TULRE caaR �L mlal(sTallcTull: SURFACE saL SOIL OVER c51R11CTIlAL © 201 O BEN N ETT ENGINEERING, INC. COLOR SOIL 26.0 FINISHED GRADE. 4.The system will be aggregate free. : HORIZON (USDA) (MUNSELL) MOTTLING FEET INCHES HORIZON (USDA) UNSEW MOTTLING S TM�11°� 40 MIL POL 5.All components to have a minimum of 9"and a maximum of 36 of cover. :1M� TOP EL-2s.e oalstgalc�r,TCTIu� REVISIONS BARRIER 6. Contractor to verify all elevations-and utility locations prior to construction. Any differences shall be ' IRRIGATION 1 1 FINISHED GRADE Box COVER brought to the attention of the engineer. a•-24• 8� L.S. TOYR s/s a•-2r e1 L.S. oYR e/s TOP OF SEPTIC TANK 24„ 24.0-26.3 TO GRADE 7.All septic system components to be marked with magnetic marking tape. 2 2 22•-26• A8 sL 1oYR 2/� ELEV=25.08 9" Min. IF 24•-27" AS 10YR 2 1 BSMT. 8.There are no known conflicts with Title 5, Section 15.220(4)(k) 3 27•-36• 82 LS 10YR 6 3 26-34 82 LS IOYR 6 FLR. (location of public and private water supplies) 1 g g 9.There are no known sources of water supply, streams or drains within 100'of the premises. 4 PERC ® 36 TOP 23 75 . 4 - 3" MIN. 3" MIN. 3'Max. 10.There are no known wetlands within 100'of the proposed system. -- ---� 5 5 10 ADD POLY BARRIER, MOVE VENT TRB 12„ TOP OF CHAMBER 0" 9"Min. 11.The existingleaching system is to be removed in accordance with Title 5. 5 -� 5 -roP�23.75 USE EXISTING 6" " L= 2.0' FT. 4" SCH 40 ELEV=23.75 23.75 g Y INVERT 2s oo .,I "'I 4 6 10 MOVE SAS ETC. TRB 3 9 S= 0.06 FT/FT PVC PIPE FILTER FABRIC �-,I,� 12 Disposal facilities shall be at least 18 inches below water supply lines. Wherever sewer lines must cross water supply 6 SYSTEM`'::.I 6 INVERT=23.0o DATE DESCRIPTION INIT.. 4" SCH 40 - 2" lines, both pipes shall be constructed of class 150 pressure pipe and shall be pressure tested to assure watertightness. LOCATION 1, PVC PIPE 4 SCH 40 13.A Zabel Filter is to be installed at the outlet the of the septic tank. � _ I I SYSTEM, .I 12" INSTAL t-�._ PVC PIPE ^°O 0000❑❑❑ 4.83'x 8.5' L ACHING CHAMBERS 0000❑❑❑ ° o •-12o c Cs IOYR 6/3 10%GRAVEL LOCATION .I ON - SITE SEWAGE DISPOSAL ZABEL * 6" 2 •o°° ° ❑❑❑❑❑❑❑ ❑❑❑❑❑❑❑ ' 0 14.The Zabel Filter is to beg leaned on an annual basis. :1 14" % 0 °° ❑0000❑❑ (3 REQ'D.) (SEE SECTION) ❑❑❑0000 e e ° 15. Use 3 500 al. leaching chambers,with 3'of washed stone all around. 8 8 FILTER MIN. `-120 c cs oYR 6/3 4'0" MIN. .,. 16. Components not to be backfilled or concealed without inspection by BOH and permission obtained from BOH. SYSTEM UPGRADE PLAN EXIST. HOUSE LIQUID DEPTH (SEE DETAIL) DB INLET INV. 21 OO 17.The utility information shown on this plan has been compiled from surface evidence and record plans. before 9 9 INVERT 23.63 construction,the appropriate utility company and dig-safe 888-dig-safe should be contacted. 10 10 CORROSION RESISTANT-- 31.5' 18. Stock piling of materials, parking or vehicular traffic prohibited at all times over the leaching area. 11 1 MAP 227 PARCEL 109 GAS BAFFLE 19. System area to be stake and flagged until a certificate of compliance is issued 0 IN 20 The t' sensitive a as defined on Title section 15 215 DB OUTLET V. a locus is no in nitrogen sens a are ed 5,s 429 ELLIOT ROAD PROPOSED :;..;;...,::.:�•.•...•,:.�: �;:;: �' •:• ' -. ;;. .,.�.: ... . 23.46 BOTTOM CHAMBERS 12 12 .. - 21.00 21. Designer As built is required TANK INLET INV .�';".',` _ ': •.:•• PROPOSED 22. System components to be install on a stable compacted base according to Title 5 13 24.00 TANK OUT INV. y P p g 14 CENTERVILLE, *INSTALL PVC TEES IN 13 ACCORDANCE WITH TITLE 5. 23.75 5.0, 23.All Materials use shall conform with Title 5. INVERT ELEV. 24. Existing Grades to be reestablished after construction. 3/4" TO 1-1/2" 23 00 g BARNSTABLE MASS. 6" CRUSHED STONE INVERT ELEV. NO GROUNDWATER ENCOUNTERED TO ELEV=16.6' * DOUBLE WASHED Compacted Earth Fill (2� Min.) Finish Grade ALL INVERTS TO BE VERIFIED SET LABEL 23.00 STONE. P _ Iju SOIL EXAMINATION PERFORMED BY: TIMOTHY R. BENNETT, PLS BY CONTRACTOR PRIOR 3' Max. SOIL EVALUATOR LICENSE SE2748 TO CONSTRUCTION. EXISTING TANK TO BE PUMPED DATE: 03/24/2010 AND INSPECTED FOR /---�' °000000 0000 ___,._,_ O o 0000 0 g Min. 0000000 O 0 0000 00 9» STRUCTURAL INTEGRITY, AND FILTER FABRIC 0" °000 00 00 40000,00 00000 REPLACED IF UNSOUND OR NO GROUNDWATER ENCOUNTERED TO ELEV. = 16.0 °° oo Q Q ° o0o PERCOLATION TEST DATA LEAKING. CONCRETE BAFFLES TO o o „ BE REPLACED WITH PVC TEES O 00 O o° Q °o0 00° 24 NO. DATE ELEV. RATE NOTES BEN NETT YE 1 1 ENGINEERING. llEERIl llG 0000 000 0$ 0 0 0000 000 0$ LAND SURVEYING,ENGINEERING,&DEVELOPMENT SERVICES EXISTING 1,500 GALLON PRECAST CONC. SOIL ABSORPTION SYSTEM 1 3/24/10 23.0' <2MP1 PRECAST CONC. SEPTIC TANK DISTRIBUTION BOX (3) 500 GALLON H-20 LEACHING CHAMBERS W/ 3/4" To 1-1/2" 3' 4.8' 3' Po Box 297 TEL.(508)88$-4868 H-20 3' WASHED STONE AROUND EFFECTIVE AREA: DOUBLE WASHED a SAGAMORE BEACH,MA02562 FAX.(508)888-4867 BY WIGGIN PRECAST CORPORATION 31'-6" x 10'-10" STONE. 10.8' OR EQUIVALENT DRAWN BY: JDP DATE:03/25/2010 SYSTEM PROFILE (not to scale SECTION (not to scale) WITNESSED BY: David W. Stanton, R.S. JOB # 061.1 RMC SHEET: NO. 100F 1