HomeMy WebLinkAbout0128 ENSIGN ROAD - Health 1-28 Ensign Road,Centerville
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No. Fee— ------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application ffor Well Con0truction3permit
Application is hereby made for a permit to Construct (tom), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
Owner Address
Installer — Driller Address
Type of Building /
Dwelling
Other=r"'If
—= --------- No. of Persons---
Type of Well _ �'� _ Capacity-------------.
———-- —__—
Purpose of Well
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the Board of/Heaal'th.
Signed _l2h, Z _--
/� d e J
Application Approved By
date
Application Disapproved for the following reaso
date
Permit No. L� —_-- Issued--_- '_ -- - ___--_
date
--- ------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
(certificate Of Compliance
THIS IS TO CERTIFY, at the I dividual Well Constructed (/' ), Altered ( ), or Repaired ( )
by�4- _� /�� nl —_-- —-- ----_— —--
Instailer
at—._1 9' ,Ell/S1 C� �� `tJi/ _ --- —
has been installed in accordance with the provisions of the Town of Barnstable B r ja_-�J�f Health P 'vate Well Protection
0V Regulation as described in the application for Well Construction Permit No. -- ated----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- ---- ____ Inspector-------------_--___—_
Jy10 0_10/ k ------- ----Fee -------
BOARD OF HEALTH
TOWN OF BARNSTABLE
` zippIicat ion,lorWell Con0ruct ion Permit
Application is hereby made for a permit to Construct (�), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
-- _—.___-----------------------.- __—_.__---------
Owner Address
Type of Building
Installer — Driller // Address
V
Dwelling- KE S1cj�.J,`_!'j
Other - T e_of-Bttildi --� �__—________- No. of Persons--- _--_____--___
Type of Well 10 �4 iiv, Capacity-------------------
Purpose of Well- I O I-= ----______--
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed -
U �t / d fe
Application Approved By /� :� // As ( --TO---
/date
Application Disapproved for the following reaso
- date
Permit No. __ __ Issued---_ �-_�D_ �-_--- ---___--
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of Compliance
THIS IS TO CERTIFY, /That the Individual) Well Constructed (Altered ( ), or Repairedby it J ( )
--- / ------------_----
at
----------------------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable B rd f Health11a
'vate Well Protection
n
Regulation as described in the application for Well Construction Permit No. ----- ted------ ---------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ____ — __ _ Inspector —_----_____--
BOARD OF HEALTH
TOWN OF BARNSTABLE
Well ConoructionPer-mit '
J
No. rL
W
4 gff
Permission i hereby granted 5C -- _e - 1-1-(iff G-
to Const c ( ��;ee�r•�( ), or a air ( )�n In 'dual Well at: / d) '�I
No. _1AJ
)0 ,
Street
as shown,ol the application for a We Construction Permit
d I
No.----- � --' -- Dated �--_---
- - -----------------
oar' o I4e, la th --
DATE— _ 1 ��C /_
NOTES TO THE FILE
October 13, 2011
The Pool Man
128 Ensign Road
Centerville, MA
Cynthia Martin
Donald Desmarais
The Pool Man was visited due the concern of the use, handling and storage of
hazardous materials (i.e. pool chemicals). There was no one home at this residential
address. There was no evidence of pool chemical storage in the six out buildings.
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No. /tJ�(h . Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
application for �Dizpozat 6p9tem Con5truction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑ Complete System Nndividual Components
Location Address or Lot No. IpC �.v /) �,)I Ow C/J�s/�N/ame,Addres�/��,C Ted el.No.
Assessor's Map/Parcel —610 3
Installer's Name,Address,and Tel.No. 56�-77 9 YV Designer's Name,Address and Tel.No.
�o Z
hL 1p0' r� � � (o Ed t)Z-
53
Type of Building.
DwellingNo.of Bedrooms .J Lot Size s .ft. Garbage Grinder
q g ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures �7
Design Flow(min.required) gpd Design flow provided /r O gpd
Plan Date '0 Number of sheets Revision Date
Title
Size of Septic Tank hjq Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this oard of Health.
Signed Date —10 `Q
Application Approved by Date
Application'Disapproved by: Date
for the following reasons
Permit No. Date Issued
No. VCY O s�"..--•-•4,: 1 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yet
2pplicatton for �Dtzpoal *patent Con5tructton Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon,( ) ❑ Complete System ENfIndividual Components
Location Address or Lot No. ,p`(� S J Ic•{Ct Ow er's Name,Address and Tel.No.
✓Ctnff rvr')! _ �haul7 �r-ea.g.,,,
Assessor's Map/Parcel l q�— O o 3 Y P, f� A a f /16
Installer's Name,Address,and Tel.No. -5b 8--77 Y' 2 (O Designer's Name,Address and Tel.No. 5U� 5�j / / lOi•
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 2
Design Flow(min.required) gpd Design flow provided 3 3 1. .,gpd
Plan Date °'J J' D Number of sheets Revision Date
Title
Size of Septic Tank j4 54,hit I OW Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of 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.
Signed (f.��12 �{ � Date , [�
Application Approved by Date 7 •6(Ji'
Application Disapproved by: Date
for the following reasons I �.
Permit No.7�' r 3 9fl Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIF thhat the n-site Sewage isposal System Constructed ( ) Repaired ( ) Upgraded
t Abandoned( )by i ° •'A —r-� S ei941 L s
at i ,9 F P1 5 )'cA has been constructed in accordance
with the pro isions pp,fTitle 5 andAe for Dispos 1 -ystem Construction Permit No. �Qof} 7 39U dated / 17 0�.
Installer L_yy, yu�/W li Designer
#bedrooms � Approved desig 3_ gpd
The issuance of this permit shal°1T3jt e c n trued as a guarantee that the system�11 fu�on s desi .ned.
Date `t t � Inspector
No.200V"39 D Fee mo
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
lwigool i§pgtem Con5tructton Permit
Permission is hereby granted to Co- struct , ) Repair ( U rade ( ) Abandon ( )
.System located at 1 Z Cs l n Q. I %
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date (,6 Approved by
12/11/2016 00:42 FAX la 001/001
Town of Barnstable
. �t Regulatory Services
. Thomas F. Geiter,Director
MASK
M enexernet�, r '
05
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508.790-6304
Installer &Designer Certification Form
Date: 9-14-06
Desiper: Shay Environmental Services, Inc. Installer: Robert Septic Services.
Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street
MA 02536 Yarmouth,MA__
On 9/06/06 Robert Seotic Service was issued a permit to install a
(date) (installer)
septic system at 128 Ensign Road, Hyannis,MA based on a design drawn by
(address)
Shax Environmental Services, Inc. _ dated 9/OS��Q6_
(designer)
XX I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Focal Regulations. Plan revision or
certified as-built by designer to follow.
r�-yyT +9
taper's S1ggnature) o
U
O.
O
(Designer's Signature (A amp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BF, IS5UED UNTIL BO TH TWS FOBN AND AS-
BUILT CARD RECEI D BY THE 13ARNSTABLE7PUBLIC HEALTH D VIS ON.
THANK YOU.
Q:Health/Scptic/Desiper Cerdfication Form
,
TOWN OF B/gRNSTABLE
LOCATION � SA C,AJ - _SEWAGE'# ® 39
VILLAGE E I �SSESSOR'S MAP&P4KE
INSTALLERS NAME&PHONE_ NO. c` e
,o-SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) -���%� � (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: 1 <I-6/0 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
D �
6 2t .
t
IJ r
G[
7:� r
Town of Barnstable P#
1
�•� Department of.Regulatory Services
i BCA" °
Public Health Division Hate L
NAM $ 200 Main Street,Hyannis MA 02601
Otis¢ �e
rfD1A1��
I
Time
Date Scheduled —��s---
Fee Pd-
i
Suitability Assessment for ,�`o-waPe D' al
Nq Witnessed B
Performed By:
LOCATION & GENERAL INFORMATION
Location Address ..t �n Owner's Name AJttJ �jQ E�J
'�� Address J:� R9Ck
Assessor's Map/Parcel: (93 I Engineer's Name .CC ji�-V�Q
REPAIR I Telephone# /
NEW CONSTRUCTION ` --
_t
Slopes(%) Surface Stones
Land Use (�Y
- —`�= ----
ft Drinking Water Well _AiP�Lft
Distances from: Open Water Body ft Possible Wet Area __44�_
Drainage Way ft Property Lin; ft Other
ft
Y
SKETCH:($treat name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands in proximity to holes)
s
� ��41r� Depth to Bedrock
Parent material(gedlogic)
Weeping from Plt Face
Depth to GroundwatOr. Standing Water in Hole: I
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: in. Depth tt)snil tn0ules:
in.
in obs.hole:
Depth OWerved standing (n. Oroundwater Acjuattrtent _.
Depth to weeping from side of obs.hole: — p ,fACtor,,.._, Adj.droundwater Levi, c
Index Well# Reading Date
Index Well level
PERCOLATION TEST
Observation , ! Time at9"
Hole#
Tlme at 6"
Depth of Perc ;
Start Pre-soak Time.(
End Pre-soak O 1
Rate MinJlnch
AMP-�
Site Suitability Assessment: Site Passed
Site Failed; Additional Testing Needed(Y/N)
Observation Hole Data To Be Completed on Back
Original: Public He*lth Division ---~--_
' you must first notify the j
***If percolation test is to be conducted within 100 of we o,b ginning.
Barnstable C4#servation Division at least one(1)wedk prior
S.
DEEP OBSERVATION BOLE LOG Hole#_
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Struc re,Stones,Boulders.
Consistency, ravel
Ls lo"?e 31 A,
L 61t.
?.re I
DEEP OBSERVATION HOLE LOG. Hole#?�
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gra e
O - S Ye 3 !J/A Flickple
0fes
41 Diu L` 2-5 Y 3h L
PEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravell
'DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color 5o(i Other
Surface(in.) (USDA) (Munsell) - Mottling (Structure,Stones,Boulders.
onsi a rn i
1 �
Flood Insurantte Rate Map:
Above 5p0 year flood boundary No_ Yes
Within 500 year boundary No .es
Within 100 year flood boundary No✓ Yes
Depth of Natutaffy Occurring Pervious Materlal
Does at least f0tir feet of naturally occurring pervigy material exist in all areas observed throughout the
area proposed ter the soil absorption system?
If not,what is the depth of naturally occurring pervious material?.,
Certification
I certify that on• (date)I have passed the soil evaluator examination approved by the
Department of�nvirofunental Protection and that the above analysis was performed by tree consistent with .
the required training x se d ex p ence described in 310 CMR 15.017.
Signature Date
Q:ISEPTICIPERCFORMMOC
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
De
partntent of � �n
7 '. V
Environmental Protection 96
William F.Weld �`� T dudy�Cgze Governor � ���
Argeo Paul Celluxi avid B.Struhs
U.Governor
C=mb',ner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
n ' /� ��"' CERTIFICATION
Property Address: ;a 8 Ens iC{„ 12<1 en /1Ck'_ot +'tV Address of Owner 9.G,l6C� Ua( C,Date of Inspection: i V1 ICl!q(' (If different) �ile Z I co I69(cU
Name of Inspector. Ed Wi n C G,61'JS' SQn a `J
Compan�1y-Name,Address andT_elepbone Number.
1_4 ORi ore_Vavv_ ,Sc� w►Lh O'��4�3 Scram ofs —Sis
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site/sewage disposal systems. The system:
Y Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: f ' ,�~ ,�
� Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C,or D:
A] SYSTEM PASSES:
._� I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components,need to be replaced or repaired. The system,upon completion of the replacement or repair, passes
inspection.
Indicate yes, no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved
by the Board of Health.
(revised 11/03/95) I
One Winter Street • Boston,Massachusetts 021.08— • FAX(617)556-1049 • Telephone(617)292-5500
i1 Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner.
Date of Inspection:
B1 SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis 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.
3) OTHER
(revised 11/03/95) 2
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address; �7D nr)�� Ce�1 12
Owner. bNane. �R PQ '' J -n
Date of Inspection: J
►o1l9NO
D] SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT'due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E]LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11/03/95) 3
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner.
Date of Inspection:
Check if the following have been done:
&.mping information was requested of the owner, occupant, and Board of Health.
,None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
ZkAs built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
YThe system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
IZ/All system components,excluding the Soil Absorption System, have been located on the site.
, The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or
material of construction, dimensions,depth of liquid,depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on exist' information or
mg
'pp
by non-intrusive methods.
/The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/03/95) 4
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
+�c ( SYSTEM INFORMATION
Property Addreag I o,V i'1s.1,G))-i1`` f�G eE i l�E'►Z�J 1�l E'
Owner:
Date of Inspection:
10) I`t 19,6
RESIDENTIAL: FLOW CONDITIONS
Design flow ons
Number of bedrooms:-13—
Number of current residents:1
Garbage grinder(yes or no):I&
Laundry connected to system(yes or no):j/[�
Seasonal use(yes or no):W,2 J—
Water meter readings, if available: 1
Last date of occupancy:(fG/&941F,(; f'
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow:_gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings,if available:
Last date of occupancy:
OTHER(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)_
If yes,volume pumped gallons
Reason for pumping
TYPE OF SYSTEM
.Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes, attach previous inspection records, if any)
Other(explain)
APPPR0-2UMATE AGE of all components, date installed(if known)and source of information:
Sewage odors detected when arriving at the site: (yes or no)_
(revised 11/03/95) 6
V
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION (continued)
Property.Address:
Owner-
Date of Inspection:
SEPTIC TANK:_V
(locate on site plan)
Depth below grade: J 2
Material of construction: /concrete metal_FRP_other(explain) if
Dimensions:
Sludge depth: "' A
Distance from top of sludge to bottom of outlet tee or baf'fle�2E i
Scum thickness:
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of scum to bottom of outlet tee or baffle: A)
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
GREASE TRAP: O/t C
(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_FRP—other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
(revised 11/03/95) 6
I
'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
-SYSTEM INFORMATION(continued)
Property Addresa� )� F—Mi Y) 1`A Cevlki2..1,` e
Owner. Q�Ckna, W�y --
Date of Inspection:
l i
TIGHT OR HOLDING
(locate on site plan)
Depth below grade:
Material of constriction:_concrete_metal_FRP_other(explain)
Dimensions:
Capacity. gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:AICAI C,
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:,�oNC
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 11/03/95) 7
L
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner.
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type: leaching pits, number:
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.
CESSPOOLS:_
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
PRIVY:_
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Continents: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Addre.,, (JSI `t� eerki20 t e—
Owner. \QVLq V�Ovw-,,(\
Date of Inspection: .�01m b6
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
I
i
y,,
DEPTH TO GROUNDWATER
Depth to groundwater:_�feet
method o determination or approximation:
(revised 11/03/95) 9
KEY NUMBER <7070 >
NAME <WARBURTON, DIANA > B-C 1 B-C 2
B-C 3 B-C 4
STREET P 0 BOX 621 -
CITY SANTA YNEZ ST CA ZIP 93460-0621 REF 1 REF 2
PHONE ( ) - REF 3 REF 4
METER NO. < 6721> DATE READING CONS
STREET <ENSIGN RD NO. 128> 08/26/96 0 0
CITY CEN J L14 ST LOC 08/26/96 110 17.
PHONE ( ) - 06/30/96 93 33
12/31/95 60 36
ROUTE NUMBER O1 06/30/95 24 21
SERVICE DATE 06/10/82 12/31/94 3 32
METER DATE 08/26/96 11/04/94 0 0
CAPACITY 7 11/04/94 966 29
STYLE T10F
SIZE 1 RATE SCHEDULE
KEY PIT PLASTIC
NOTE RR RIGHT SIDE IS A RENTAL! ADDITIONAL CONS 17
ALTERNATE MIN 0
a
TOWN OF BARNSTABLE
LOCATION C-its n Rci SEWA
GE #
VILLAGE ��� �v�I I� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 7
SEPTIC TANK CAPACITY 1OC-0qCk� .
LEACHING FACILITY: (type) l' n
(size) -OC
NO.OF BEDROOMS ,3
BUILDER OR OWNED
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility (/Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any�.vetlands exist
within 300 feeso leaching f ility)
Feet
Furnished b ��
TOWN OF BARNSTABLE . 1
!,r,CATIQN �a� �l)S�G(1 6�c1 SEWAGE # _
III VILLAGE l P-611 If, ASSESSOR'S MAP & LOT/ 6J
tINSTALLER'S NAME&PHONE NOr �''"�
SEPTIC TANK CAPACITY I OCOA0J
LEACHING FACILITY: (type) �01,-- --(size) (0x(O ��l
NO.OF BEDROOMS 3
BUILDER OR OWNE j „\am ,9..a&uf8cn
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) - Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 fee o leachinprii
ity) p Feet
Furnished by
f c' W PERMIT NO•
LOCATION E AGE
r
VILLAGE ._
INSTA ER'S AME i ADDRESS
f/z
S U tL D E R OR OWNER
DATE PERMtT ISSUED (12
DATE COMPLIANCE I- SSUED
`1 �.2J
L rl ry
- d
,so
Fxs5....................
THE COMMONWEALTH OF MASSACHUSETTS
�T BOAR® iOF 6(-hE�ALT/ IH
.r�.�....OA. ...........OF.......... #,7 `�.! ':.'//�".� . .�_...._.._.
App iration for Disposal Works Toustrurtiun thrutit
Application is hereby math r a Permit to Construct (X or Repair ( ) an Individual/Sewge Disposal
System at:
ll-
-- ..... ___ _-.. Z. .... ----p= �l � .. � .. -------_...�=-------- -----.---
- -� Lo lion•Add ess or Lot o.
ner �. Address
W ..
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms......... -------------------------------Expansion Attic (41V Garbage Grinder (Vo
p,, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures -.__.._.._--•-• •-----••-••---- -
W Design Flow.................. ----------------- per person per day. Total daily flow.._.._________` i_ __ ___.__._____gallons.
WSeptic Tank—Liquid capacityl_0 00gallons 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 (�Y Dosing tank ( ).
`" Percolation Test Result Performed by..................____���_ _:�_4,c._...._I✓ _ Date........
Test Pit No. 1_____:__ .`s_�ninutes er inch De th of Test Pit__.___._p p ��_ Depth to ground wa r_.__
fs, Test Pit No. 2____ � iinutes per inch Depth of Test Pit_______ ____________ Depth to ground water_____ ,_
••--•---------------•------•---- ....................... ------0.0--..r... ..--.........................................................
Ox Description of Soil........................... Z- Q P0 +1 �o .------•--i••-...--- S
-----•-------------------------------------•._._.....-•.--.._.._..----------------•--._._..._..--•---------------•--------------••------•••-•---•----------•-----•..-------------•--•---•-------•-------
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of h Ith.
�.
Signed.............�` �"_`-- �-- ------------•---•--- •------
Date
Application Approved By-•••--•-- �f' � �j �/� �,�-L--------
-,Date
Application Disapproved for the following reasons:--••------------•-----•-•-•--•-----------•-----------------------•-•-------------•••---------•---•--........._
....-•--------•-----------------••-----•----•-•------•-------------------•---------......-•---------•-----••••-----•-•---•••---••------••--•---•-•-•---•••--•--•-------•-••••---•----•-----•-•-•-•-----
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Biipniial Workii Tomitrnrthitt Vamit
Application is hereby made for a Permit to Construct (.�.4 or Repair ( )fan Individual Sew e Disposal
System at:
AV
Location-Addresspp //� ) or Lot
t/1 ltf�s I�s4 ,6 s/i F. -�i� ��r 1 �5 �_�. �f f�.. l`��• �....
e�
�•„e Owner { � Address
� �. rr
1 .
Installer Address
Type of Building , Size Lot............................Sq. feet
Dwelling—No. of Bedrooms--------- ----------------------------------Expansion Attic (.g% Garbage Grinder (►�
'4 Other—Type of Building No. of ersons____________________________ Showers —
a YP g ------•---•--•-•--•-----•--• P (---.)...._..Cafeteria ( )
dOther fixtures ---------------------------------------------------------------------•------------____..-----------------•--• ------_...
W Design Flow................... -----.--.--_-_-gallons per person per day. Total daily flow................
.__._._.___.__�..- .t 1............gallons.
WSeptic Tank—Liquid capacity!J-)Q Jgallons 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 (,.j�" Dosing tank ( L . + — t
aPercolation Test Results Performed by.....................�:_. ��_����...... c�1 4�. Date_____._.._.!
,.-a Test Pit No. I___fir.? _`z_�minutes per inch Depth of Test Pit________._ Depth to ground wadr.._._k
(T4 Test Pit No. 2......� minutes per inch Depth of Test Pit-------(K:_--:. Depth to ground water_--__
____________________________________�. ____..,-...._.-___9___a__--.-.----------
-__-__.---------
---------------
---_-___-__»»_..---____.
O Description of Soil........................... ................c'. . Lj�r���� tom......:�•� %---....-.}�°..-•�.-----------------------..._.............---------
V -------------------------------------------------- =" ��°'q r`� {�"
W
UNature of Repairs or Alterations—Answer when applicable................................................................................................
----------------------------•--------------------------------------------------------..........-----------------------------------------------•----------------•-------------..........................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TA!TIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed............. x,:a�-n........" ``� ! ... �` r ' -,
.
f Date
Application Approved By...........- ,e 1 '' �- ------------------------- ........... .- . L=-------
Date
Application Disapproved,f or the following reasons:..............
------------- •.............
....•...............................•-------•-----------------------------....._..---------------...--------...••-------•-••----•-----•---------------------------------------------------------...-----
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....!1. ..................... .................................................
Tatifirate of Tnntp$iattre
F THIS IS TO CERTIFY, That the Individual Sewag isposal System constructed `7 or Repaired ( )
by..................................... .... ) r?t [.: .................................... d ..-..... ...
' ! // I taller r j
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----- .......... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................... ....................... InspectoAA/__.".....•.._...---------------....._...-------•---•---..•.....----••--
THE COMMONWEALTH OF MASSACHUSETTS
x. _..• - BOARD OF HEALTH �..
47 -
' e en
'
............... ............... ZOO
OF.. n
' FEE.. ................
i a a1 Worho Tom#r w rrmit
Permission kis hereby granted......................... ;ri t I. '? ........................................to Construct Construct'�V or Repair ( ):an Individual Sewage Disposal System
at No ! , >-
�. ✓
^--^---------------------------•------ Street
as shown on the application for Disposal Works Construction Permit No..................... D4ted..........................................
----------------------------
/ B a
DATE...... — ovd
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
loZ: �� V
.� �d 00'
D ,
�cb 9 \
-�
yZ
s S y / 3
29874 O
�v �
h
o� AL
G 1
fLn .
1
` �� iJ 1 1✓ 1` :
SE p� (�� .0 �I!
MIN. L" f+ /_S' a S,F
\ F D E C\ 1 IA4 i N.
o c;
iJAL t.
` 'LEGDCERTIFIED PLOT PLAN
EXISTING SPOT ELEVATION Ox0N
EXISTING CONTOUR --- O — sj °Sy o L, o T
FINISHED SPOT ELEVATION [ °E� Cc-�/Ti ✓
FINISHED CONTOUR 0 \
IN
APPROVED , BOARD OF HEALTH
DATE AGENT SCALE, /l�40 DATES
LDREDGE ENGINEERING CQ IN GR "'�gR'c2
CLIENTL I CERTIFY THAT THE PROPOSED
EGISTERE REGISTE-REO � y �3 BUILDING SHOWN ON THIS PLAN
CIVIL LAND
JOB. NO,'.' CONFORMS TO THE ZONING LAWS
�,�,
ENGINEER URVE DR.BYlil.: OF BARNSTA lE ASS.
712 MAIN. STREET. CH. By'
HYANN I S,. MASS. Z . -
SHEET_. . OF DATED. LAND SURVEYOR
NOTE /F E/TMER T//E SEPT/C TA.V k OR
EAC/•✓.ING P/T ARE MORP 7H.9:"/ /2"BELO.&V
/O f7:.1"1/N rRAOE� f� 24+�/AM ETER CONC.F'ET� COVER
SNALL BE BROUGHT To GRALaE.�,�;,ti z:,,r A
CONCRETE 4 rPVC O/PL �J,- C^S T /R 0/Y C O{i—R Sh�A L L L3E USED
M/N. P.ITCH
-v
ELEI/il gg:0' COYERS /B•PER FT IF/N DR/VEy1/i4)/
2��JJ• M/N. CO/VCRE•TE
Ra: _ C,It.�oE Cc� rER CLEAN -5,AN.O
BACKF/LL
PE /!7 (7 l� o e o • a ° C.1F //B -318`
a'-41
MIN.P/TC/v, Git'L. v � • . . . . • , .e o
%4 PCit ! TANK D/ST .. ' WA SHED 572�NE F SE?T C �'
BOX o B • • • • • � 1. •
e y 4. t O • •�
p L at � w z . - - �•- •. • •EFFECT/1e�.r _• 3�4 R- -� �2
, .� `-} i � � „ � .t° n r • . DEPTJ+/ 1 • � r ° •� o lVA3.5rE0 STO/YE
• s • o
I BB.S x 2 5 4771 C../D i a • �` • • • • • • • p o PRECAST SEEPAGE
tNYBR7 tCEY.�T/o�ra. , -r :•s x 1 a = �.6 /lb
I/VYERT AT O[/!LD/IVG 9 .a FT. R-r.cAP/�c,rY S49 v/i� 6� D/AM.
. ..INLET: .SEPTlG Ti4NK 9.S.8 FT + :- L F7 PlAm. C SEE T�4BL/L4TIO/V,
/D
GtJTLET SEPTI C.7-AN o< S 6 pT..
- � J
1,yjer ovsznzail ivw.eox _F`r sEcT-ia�/ aF -
- GROUND WELTER-TABLE
�. OtJTLETD/STR/B�J7YON BOX 9. ,Z FT --- .
DlSfJ4�S'A t .SYSTEM.
lNCE7"L"EACH/NG P/7FT-
-- .. - LEACH//VG P/T TABUCATlON
SCALE %4~ _ ../ =0� D/MENS/DN...A FT•
DFS/6N CR/TER/A o/r/ENS/4N 8 6 FT.
_ -
iVUM®ER OF BEDRaOMS' 3' ,r'
G�RBAGED/SPOSAL[/N/T NONE
i
T®TAC.EST/Mr.•tTEp FLOW 3 G.4L DAY SO/L TEST l SD/L.TFST40Z SD/L TEST
�/YUMBER OF[.EACH/NG P/TS /7ELEY. 9 - -E[FYx z/ �B
S/OE LL'ACH/NG PER P/T l8&` S ter. ` DATE OF SO/L TEST
�g �' RESULTS W171./VESSED 8Y
BOTTOM L,6•ICH//VG PER P/T S4• CT TDAScriC PCRCOLAT/Olb /tRTAe�,i!/ �Ess M/IVY/.INCH
TOT.4t. LEACH//VG AREA 2� b SQ. FT. NO LOAF•-�: ` -- - PENCOL..�►T/•sN RATE j*2 �1Y^� MIN.11NCY
'RESR'RYEdEA4CN/N6AREA �O� SQ. FT
S�OF "o. M�D/[I/�
M,fss o 5'�i-i✓D
c� w may . L1_C
? � F LB R
•' NY SE
►�o:loss p Q FL DREDGE ENG/N.E�R/NG Cc INC.
R
.
Q�BTE� p� 9o�FG/STEM �4 �L. $4,5 7/2 "A//V ST•° NY•gNN/S. ".4S.S,
S; �O.SUK�� FSs1o.NALE��'� ,NOGROVNr� yYATCR ENCOUNTERED CL/E/VT: �NBx,�� DATE:4- Z6 •2 I
'' Q GROUND YvATER ATJ06 NO.' g'/o Z3_ SHEETT ZOF Z {
2-18• DIAM. ACCESS MANHOLES � ,"
�,q. i.+.,. •�.t��•f •A•` r•.1'.•sI•.:1i�.r."�•(: i " � �_�}�"/ � _JI•`f� l ` �I•
r 'r , FJ
*NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A INLETpl;j
T •`4me'"10' min. fromExisting Foundation house to septic tankPROFILE VIE1P OF ADDITION TO LEACHING SYSTEMTOP OF FOUNDATION ELEV. 100.00 Assumed P D-Box cover must D•Se tic tank covers must b• V I
(Assumed) within 6 In. of finished grads within 6 in. of finished grade THE ACCESS COVERS FOR THE SEPTIC TANK, ; tt r
v I DISTRIBUTION BOX AND LEACHING COMPONENT
t,4od•over Septic Tank- ti3.00 Grade over D-Box- g3.00 • over SAS- p3.OG 3" of 1/8" - 1/2• Washed Peaeton t, .,., .--..ra- T►-ti�' SET DEEPER THAN 6 INCHES BELOW FINISHED
3/4• to 1 1 2 " Washed Crushed Stone ' •d-'r'••. �'r' :�` '*' r
/ GRADE SHALL BE RAISED TO WITHIN 6 OF
STEEL REINFORCED PRECAST CONCRETE FINISHED GRACE + ,
S - 0.02 3 HOLE H-10 4•PVC(CAPPED)INSPECTION PORT TO BE INSTALL TUF-TITS GAS BAFFLES OR EQUALS ! oM+
EXIST. 5-0.01 ST. BOX 3' Moxknum Cover Top OF Syst•rn- Eiw. - e0.36 INSTALLED AND TO BE WITHIN 6 OF GRADE PLAN VIEW ww y u
Q _..
EXIST. PIPE " 12 n 1,00 GAL. p or Greater S- 0,01• per. f A 3-24• REMOVABLE COVERS 'm • sires - V
FROM EXIST. FOUNDATION p, C SEPTIC TANK uI cot 0" Effective Depth
i H-10 of a S Units ! 6.25' 30' •t• c 4•
CONCRETE FULL FOUNDA o II N o 0.83' (10 inches) min. d•aanc•
"''' GENERAL NOTES
3, 3, 'f Wr Sur
in N ao , INLET 6' min 2• min. inlet to outlet Je.
SYSTEM PROFILE a k,.of 3/4•-1 i/2• y N a; $ 31,25 Lt�,T�i.wi- OUTLET 1. Contractor is responsible for Dig notification
C compacted stone > 'o p co 37.25' ,o'min. ,r and protection of all underground utilities and pipes.
Not to Scale - c e N ' s' -7• " -- +'s' -r 2. The septic tank a l distrl t{ion box shall be set
i Effective Length
c 3.5' 3.5' n � level on 6 of 3/4 -1 1i2 stone.
�; 4'-0"min.
c Ti 3' ; tt 4z' SDIL ABSDRPTIDN SYSTEM CSAS) o»s.a. ' Liquid dpth 3. Backfill should be clean sand or gravel with no
npe te/d4".tone 2• 0 Effective vwth Pn'vid•d . stones over 3' in size.
INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O BRIEN '� i 4. This system is subject to inspection during installation
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 8" BELOW GRADE °'
C m (OR EQUIVALENT) Not to Scale .+ , •• ti (' . .. 1 by Carmen E. Shay - Environmental Services, Inc. I ,I
6j Bottom of Test Hole 2 Elev.-81.0o NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" /EFIECTIVE HEIGHT I5 10" s_o- 4' -10" 5. The contractor shall install this system in accordance
Groundwater Observed- NONE OBSERVED CROSS SECTION END-SECTION awith nd Local V of Regulations.
Massachusetts state code, the approved plan
6. If, during installation the contractor encounters any
TYPICAL 1000 GALLON SEPTIC TANK soil conditions or site conditions that are different
NOT TO SCALE from those shown on the soil log or in our design
installation must halt do immediate notification be
made to Carmen E. Shay - Environmental Services, Inc.
T 7. No vehicle or heavy machinery shall drive over the
1 PERCOLATION TEST ST septic system unless noted as H-20 septic components.
P1 1399
8. Install Tuf-rite y'as baffles or equals on all outlet tee ends.
Date of Percolation Test: AUGUST; 30, 2006 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes.
Test Performed By: CARMEN E. SHAY, R.S., C.S.E. 10. All solid piping, tees do fittings shall be 4" diameter
C� Results Witnessed By. DONALD DE: MARAIS ( Bomstable B.O.H.)
EXCAVATOR: Shay Env. Svcs. , Schedule 40 NSF'PVC pipes with water tight joints.
Percolation Rate: Less Than 2 tu:'PI ® 30" 11. MUNICIPAL WATER IS `AVAILABLE TO THE SiTE and Surrounding
f QQ------------- --------- ,' �''`� FO Properties.
OT Test Hole Test Hole
EXIST. / ' R/C6, .� No. 1 No. 2
DRIVEWAY /'t \\ \��� OF 0 DEPTH SOILS ELEV. -
98---__-- / DEPTH saLs ELEV. NOM
'�� �`\ �� `� y �pO `�\\ q y� �� 0 93.00 0 93.0o THE PROPERTY LINES ARE APPROXIMATE AND
�� p, ��\ Loamy Sand Loamy Sand
COMPILED FROM THE PLAN BY BAXTER do NYE, INC.
PROJECT BENCH MARK �� ./ p, 10 Yt2 s/2 ,a YR 3/i ENTITLED " CERTIFIED PLOT PLAN OF LOT #13 ENSIGN ROAD, CENT., MA" ;
TOP OF FOUNDATION �\ �"� o•-s• As 92.50 0•_6• As 92.50 DATED MAY 07, 1982
AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
LOT #15 ELEV. = 100.00 (Assume \\ e / sandy sandy IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
`\ ------ Loam Loam
THE SEPTIC SYSTEM INSTALLATION.
10 YR a/e 10 YR a/6
\\ LOT #14 ��98 6"- 30" Be90.50 6•- 30• B 90.50
Medium Medium
Sand Sand NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
G \ 45,201 Square Feet +/- FROM THE EXISTING LEACH PIT TO BE DISPOSED
2.a Y 7/4 2.5 Y 7/4
30"- 132 c, 30'- 144 G OF AS PER BOA TH SPECIFICATIONS.
/ - -- 6 EXISTING LEACH PIT TO BE PUMPED DRY do
96 Q -_- -_ FILLED IN PLACE
#128 --
A\ �' EXISTING
�\ 3 BEDROOM ASSESSORS MAP - 147 PARCEL - 063
v ' HOUSE
n
ZONING -
ZONEECIDENTIAL
i (Walk-Out Basement) Perc #1
I � i
-------------- Depth to Perc: 30" to 48"
a A i -------J6 Perc Rate= 2 MPI
t ��\ Failed ---_ __---- ---- 94 Groundwater Not Observed WETLANDS E LJGA HIN A 200' RADIUS
---_
I � Leach Pit NO WET D ARE TED,WIT
\ I ,F No Observed ESHWT OF THE PROPERTY
�\ I O / ADJUSTED H2O Elev. None _
• x I ( --- --------9�
1:
EXIST. i
\� �, • ,•'�< TEST HOLE #1 1 DDD gal! DdSTROU71OON OUTLET BOX SHALL FROM BE 12• coNGxiETE COVER
L E C E I V LJ
'1.• Septic Tank SET LEVEL FOR AT LEAST 2 FT.
® DENOTES PROPOSED
TEST HOLE #2 0''� . t,� \ - s6• OUTLET
, 12• INLET SPOT GRADE
\ 1 ' �'• \
ELEV.= 93.00 S7. 5 r.. e
� r,.: \ DENOTES EXISTING
\ `� �''`� fl;��f� \ ,Qa• >( 104.46 SPOT GRADE
SHED
t.7s'
D-Box \ PLAN SECTION CROSS-SECTION
PL PROPERTY LINE
3 HOLE DISTRIBUTION BOX - H-10 LOADING PROPOSED CONTOUR
n NOT TO SCALE
EXIST. <' ; 97-- - - - -gq EXISTING CONTOUR
DRIVEWAY � W
Deign Calculations
PERCOLATION DEEP TEST OTEST LOCATION
r o LOT #13
►- `� �. I FENCE
Number of Bedrooms: 3 Equivalent to 330.Gal./Day (330 Gal./Day Min. per Title V)
Garbage Grinder: No
Leaching Capacity Proposed: 330 Gol./Doy Minimum (Min. Per Title V)
O ��\ Septic Tank - 2 x 330 Gal./Day - 660 USE EXIST. 1,000 GAL. Septic Tank. - PRIVATE DRINKING WATER WELL
i SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch , /
�� Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons R E V I S I 0 N S
Sidewall Area: 0.74 gal./sq. ft. x 78 sq. ft. 58 gallons
331.80 gallons NO DATE: DEFINITION
Providing:
i
Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH,
TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE
►\ ON THE ENDS. NO STONE UNDER.
PREPARED FO R :
PROPOSED
SUBSURFACE SEWAGE DISPOSAL SYSTEM. .
- ------
I OF
o�,� AU # 128 ENSIGN ROAD
SHAUN M . BRE
\ �
I _ CENTERVILLE, MA
155 BAXTER NECK ROAD
MARSTONS MILLS , MA 02648 PREPARED BY:
oS
CA)?ffEN Em SHAY
� CA N
�\ \\ 0 20 40 50
ENVIRONMENTAL SERVICES, INC.
O a
\ N H 81 N P.O. BOX 627
1 \
i \
\� f0f.29' ` EAST FALMOUTH, MA 02536
0
i \ 25.00' \I SCALE: 1"=20' S4NITAR PN
I
\ TEL/FAX : 508-539-7966
II o 9� SCALE: 1"=20' DRAWN BY: CES ATE: SEPTEMBER 5, 2006
PROJECT#SD-960 FILENAME: SD960PP.DWG SHEET 1 OF 1