HomeMy WebLinkAbout0009 EVSUN DRIVE - Health 9 Evsun Drive
Centerville P
A = 168 081
No. 4210 1/3 ORA
10%4 o
0 0 0 0
a
` No. '� °� ' 03 Fee too
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ll-W
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppfication for ]Disposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade X Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. q Wun t ri Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel - i
Qi Wo Uma. q EVSUn 7Dr• Ctn�'crYi ILc
�jg
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
OUlW EACAva'� 074)3120g9 Fqiwxi Wtyg o?)f-71-5313
Type of Building:
Dwelling No.of Bedrooms � Lot Size g�gP'D sq.ft. Garbage Grinder( )
Other Type of Building' &/r C 6 k k No.of Persons Showers( ) Cafeteria( )
Other Fixtures �^
Design Flow(min.required) 330 gpd Design flow provided g4,3.4 gp V-g
Plan Date 11 M 1 y� n Number of sheets pp Revision Date � 7i�
Title l;G� � 74L dlJCt" �{�� �- f��A EyJdn �r Gnt�rytl
Size of Septic Tank �1 , Type of S.A.S. ( ) LC _I (,{,(A_,j t rS S�oltL
Description of Soil
Nature of Repairs or Alterations(A
n
swer 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 f e nvironmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Bo d o ealth.
Signed Date 1 ZI
Application Approved by Date Z
Application Disapproved by Date
for the following reasons
Permit No. ?�� '-�� Date Issued Z Z
31
No:`"�'�1 d ( T o Sd Fee AI(1l
-W' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:i�-'1�
,•, Dr, .f t A Yes
PUBLIC HEALTH DIVISION - TOWN OF�BA�RNSTABLE, MASSACHUSETTS
21 tpl Catigh for',Misposat �pstetn �OYY tt`L1LtI0n erYnit
Application for a Permit to Construct,( :4Repa( ) Upgrad O Aba don( ) ❑Complete System �D�Individual Components
_ 1 E SUi
Location Address or Lot No. i briye pp(: � Owner's Name,Address?and Tel.rNo:' -
Assessor'sMap/Parcel l�t? t7 1 /I -D a'�t4 aP *`ifJ 6 {tY+(,1 N1?1(.Yl Dr• C,htef.Vi ILL
Installer's Name,Address,and Tel.No., , j j Designer's Name,Address,and Tel.No.
(�llint►'� ,�X U 7�t 3��`AAel enninerrltq WbrKS (Spy) 7-5313
Type of Building: `r
Dwelling No.of Bedrooms Lot Size 19.,, 'I) sq.ft. Garbage Grinder( )
Other Type of Building An k,4 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided _243.4 gpd x�
Plan Date 1) 1 W 21 Number of sheets Revision Date �J(A WWI
i 1
Title Dr-hw<,eA ,01't_ `1ti4�"ro Uwir.4t�d V1c,n 61 r-y< t, IAf . tpf`ti�,,V 0111 �
r 1
y Size of Septic Tank { rd)h Af* .I . Type of S.A.S. I C,) LC - la (Ll 1'h 1,-t r( otrLL
Description of Soil
Nayt�u,,re of Repairs or Alterations(Answer when applicable)
�t } Date last inspected:
`w Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in A`
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 ooffHealth.
Signed (\ ,ail_ - Date 1
.Application Approved by I , Date
Application Disapproved by� ( Date ¢1
for the following reasons
Permit No: �,� ( �' �� Date Issued
THE COMMONWEALTH OFrMASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certifirate'of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(/k)
Abandoned( )by f'�, i,n r�l C7�'Gf.✓/rLy/tip_
at { \J�1 l YX 1 J I V t has been constructed in accordance f
with the provisions of Title 5 and the for Disposal System Construction Permit No. ?,k2-('JA'7 dated 7 f Z,
Installer ')l 111 yt h< ytj V a 11i�h Designer F r11�1 K d 0 yl,-" L� A
% :.. , - -
#bedrooms .- ! Approved design�flow 1 '2 god
The issuance of this permit shall not be construed as a guarantee that the system will function,as designed.
Date l/� Inspector
n _ - . - - _--. --- - - -- --.-- -- ------- -- ----
No. � f — (i��_ Fee 1 6-b
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstrm ConstrUrtion Vermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade Abandon( )
System located at
6
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date �✓{ "l •�� Approved by
i �
Town of Barnstable
Regulatory Services
sata� $ Richard V.Sca11,Interim Director
KAM
Public Health Division
Thomas McKean,Director
200 Main Street;Hyanftls,NIA.02601
Of m. 508-962-4644 Fax 508-740-6304
Installer&Designer Certification Form
Date: V Sewa e Permit# 76L 7 Assessor's MaplParcel
Fg;+C r N C-�t�e
Designer: In i ,,�c_ ems; Wa'd i c Inc installer: vyA'S e�Cc4V 4-4i A9 � -�fP(;C
Address: JZJ Address: 301 Tt&„., /
ea•�r Fclet le.MA d Ziy y 1AA- o 7,<b y 9
On .Z 2� Q U�•Vnvt 5 ,t ct Gl was issued a permit to install a
(date) (installer)
septic system at 9 S\!SIU x —Os 6&—tt�C\t, based on,a design drawn by
(address).
L/►9 i�t eer ii NG,.,14x 1 k( dated y f.5d J411 21
(designer)
certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
Were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system}but in accordance with State&..Loral Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if.required,)was inspected and the soils
were:found satisfactory.
I certify that the system referenced above was constructed in with.the terms
of e 11A approval letters(if applicable)
(Installer's Signature
L q �
esiFper!s Signature). (Affix eslgr► g)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION C3:RTIFICATE
,OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
°BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION e
TRANK YOU.
Q:'S91Ydv1)esigner Certification Form Rev&14-13.doc
Engineers note:I'M certfioation to limited to an as-btritt inspection of system components as Installed prior to bacK&The
engineer did not supervise construction of the system.The installer assumes responsibi ty for all materlats,workmanship,backeiAng
to specified grades with propor compaction and setting rioemcovers es she"on the design ptan.
TOWN OF BARNSTABLE `
LOCATION q 1 V� _ Y)Y�. SEWAGE# 2I'— 03 7 '
VILLAGE C ttM �� _ASSESSOR'S MAP&PARCEL`
ITT W
INSTALLER'S NAME&PHONE NO. �' 1
+ gg V{L
SEPTIC TANK CAPACITY
LEACHING FACILITY.(type) . ei� .(size) IT��i ��„qo(�t�F
NO.OF BEDROOMS `3
OWNER
PERMIT DATE: N COMPLIANCE DATE: 2
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 lea hi cili - Feet
FURNISHED BY x
17�q" 91201 ,
<* K q'5`
- A4
z Q ;becK
i
Town of Barnstable PTO ?9 z®
Department of Inspectional Services
Public Health Division
►�� 200 Main Street,Hyannis MA 02601
Office: 508-862 4644
Date Scheduled t 3! Z Time I i 4 v"'
Soil Suitability Assessment for Sewage Disposal
— V�b� JYC`'A
Performed By. CE'17' L- Witnessed B Y
LOCATION A.GENERAL.INFOR. ATION
Location Address: S V' ✓1 v 2 Owner's Name: CA 0 VA e1
CLn /V,*I Z �JSiJYl r7f
te
Owner's Address: [ e r A Q 2 c'✓Z
Assessor's Map/Parcel: 8"ID 5 1
Certified Soil Evaluators Name: R4—t.'11/1 t«
P L•1--e i,vwe K't G47—
Certified Soil Evaluators Email: , i t co W►
het r Certified Soil Evaluators Telephone#1j(7 - 3
3— 7
New Construction or Repair: (3
i Surface Stones N 0 V14
Land Use �.$l�P�"t�1` Slopes(%) Z-'
Distances from: Open Water Body 410 0 ft Possible Wet Area!t0 U ft Drinking Water Well I d ft
Drainage Way / rA ft Property Line (P f"L— ft Other ft
Parent material(geologic) O V I LA;9`5" Depth to Bedrock /J d'
Water in Hole: 117 ti Weeping from Pit Face 117
Depth to Groundwater Standing t r
Estimated Seasonal High Groundwater t o Y!t
f
DETERMINATION FO.R.SEASONAL HIGH WATER, LE
Method Used: id y t r in.
Depth Observed standing in obs.hole: in. Depth to soil mottles:
in. Groundwater Adjus ent
Depth to weeping from side of obs.hole:
tm ft•
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date Time
FPPcrc
lac rc Time at 9"
}
(Uj- Time at 6"
Startre-soaQ Z 2 apt a `..c k Time(9"-6")
(VL Sc%
End Pre-soak 4e,-s t5*vt�
Rate M.inAtnch
Site.Suitability Assessment: Site Passed.__
Site Failed: Additional Testing Needed(YIN)
Deep'Observation:Hole Log Hole#:
Other
Depth from Surface Soil Horizon Soil Texture SoiluColl)r Soil Mottling (Structure,stones,Boulders,
(in) (USDA) (M Consistene %Gravel
LL
(Z-iL A %nctr.,y 5a.,
C Z i�lttt. $Gtw� Z,5`� -7 Oeaofe 7.5`t s�, Co a b-e—
Deep Observation Hole Log' Hole,#: Z
Depth from Surface Soil Horizon Soil Texture Sail Color Soil Mottling Other
unsell (Structure,Stones,Boulders,
(in) (USDA) iT l ) Consistency,%Gravel
d (o Y(i• /z
(a '7 Z: CI 41piRf•@. Sctrc�l 2d l �°'U r �tk E'3-t.
C eeaal 7/'j fZeJOf-7,5r''"(1L� � s('k
IC+f a
Deep Observation Holle Log : Hole#r
Other
Depth from Surface Soli Horizon Soil Texture Soil Color Soil Mottling Structure,Stones,Boulders,
(in) (USDA) (Munsell) ( Consistent %Gravel
'Observation Hole Log Hole#
Deep. Other
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling (Stricture,Stones,Boulders,
(in) (USDA) (Munsell) Consistency,%Gravel
a
Flood Insurance Rate Mai):
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Death 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?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the Department of
Environmental Prote tion and that the above analysis was performed by me consistent with the required training,expertise
and experience described in 310 CMR 15.017.
Signature
�, C� - Date
T
SKETCH: (Or you can attach a separate sheet)
(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
i
2�
5 �\
Win �
c_
0
COMMONWEALTH OF MASSACHUSETTS
z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
a d DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A (o a
CERTIFICATION MAP
PARCEL • o B 1
Property Address: #9 Evsun Head- l>Rl'NA LOT 3
Centerville,MA
Owner's Name: Charles&Marie Warren
Owner's Address: 72 Hayward Street
Milford,MA 01757 RECEIVED
Date of Inspection: 04/5/02
Name of Inspector: (please print) Mr. Carmen E. Shay APR 10 2002
Company Name: Shay Environmental Services,Inc.
Address: 34 Thatchers Lane TOWN OF BART
ABLE
Mailing HEALTH DEPT.
East Falmouth,MA 02536
Telephone Number: (508)-548-0796
y
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
XX Passes
Conditionally Passes :=
Needs Further Evaluation by the Local Approving Authority
Fails c' �•
Inspector's Signature: Date: 4/5/02 v SHAY
c
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
Fc`
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of e
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
No liquid found in SAS and surrounding stone area.
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: #9 Evsun Road
Centerville,MA
Owner: Charles& Marie Warren
Date of Inspection: 4/5/02
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
XX I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined" please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
. Page 3 of 1 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: #9 Evsun Road
Centerville,MA
Owner: Charles& Marie Warren
Date of Inspection: 4/5/02
C. 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 public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,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 any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
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 laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: #9 Evsun Road
Centerville,MA
Owner: Charles&Marie Warren
Date of Inspection: 4/5/02
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
XX Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow
XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
XX Any portion of the SAS, cesspool or privy is below high ground water elevation.
XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
XX Any portion of a cesspool or privy is within a Zone 1 of a public well.
XX Any portion of a cesspool or privy is within 50 feet of a private water supply well.
XX Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.1
NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 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. The system owner should contact the appropriate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: #9 Evsun Road
Centerville,MA
Owner: Charles& Marie Warren
Date of Inspection: 4/5/02
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
XX Pumping information was provided by the owner, occupant,or Board of Health
XX Were any of the system components pumped out in the previous two weeks `?
XX _ Has the system received normal flows in the previous two week period?
XX Have large volumes of water been introduced to the system recently or as part of this inspection '?
XX _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
XX _ Was the facility or dwelling inspected for signs of sewage back up`?
XX _ Was the site inspected for signs of break out?
XX _ Were all system components,excluding the SAS, located on site ?
XX _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition
of t he baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge and depth of scum ?
XX _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
XX _ Existing information. For example, a plan at the Board of Health.
XX _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b))
Page 6 of l 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: #9 Evsun Road
Centerville,MA
Owner: Charles&Marie Warren
Date of Inspection: 4/5/02
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: Unk.
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use: (yes or no): Yes
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump(yes or no): No
Last date of occupancy: Currently Unoccupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: None on File
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: gallons-- How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
XX Septic tank, distribution box, soil absorption system
Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
1985- per Board of Health & Owner Records
Were sewage odors detected when arriving at the site(yes or no): No
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #9 Evsun Road
Centerville,MA
Owner: Charles&Marie Warren
Date of Inspection: 4/5/02
BUILDING SEWER(locate on site plan)
Depth below grade: 24"
Materials of construction: XX cast iron XX 40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints, venting, evidence of leakage,etc.):
SEPTIC TANK: XX (locate on site plan)
Depth below grade: 1411
Material of construction: XX concrete_metal_fiberglass__polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 5' deep x 5'wide by 8' long (1000 gallon)
Sludge depth: 4. 75'
Distance from top of sludge to bottom of outlet tee or baffle: 3.00'
Scum thickness: No Significant Scum Laver Noted
Distance from top of scum to top of outlet tee or baffle: 8
Distance from bottom of scum to bottom of outlet tee or baffle: 16
How were dimensions determined: Measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Structural integrity of tank was ok No evidence of cracks leaks or water infiltration/exfiltration. 4" PVC Tee present and
in good condition Outlet Tee also in good condition Liquid level equal with outlet invert
GREASE TRAP:_(locate on site plan)
Depth below grade: _
Material of construction:_concrete_metal_fiberglass polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #9 Evsun Road
Centerville,MA
Owner: Charles& Marie Warren
Date of Inspection: 4/5/02
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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: Present (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.): One outlet to leaching chambers. D-Box in good condition.
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):_
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.)-
Page 9 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 49 Evsun Road
Centerville,MA
Owner: Charles&Marie Warren
Date of Inspection: 4/5/02
SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries, number:
XX leaching trenches, number, length: 1 Trench—13' wide by 25 feet long,2' deep. 2-500 gal chambers
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, condition of vegetation,
etc.): No evidence of hydraulic failure, ponding damp soil or stressed vegetation. Excavated access cover of
chamber and noted no liquid in chamber.
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:
Indication of groundwater inflow(yes or no):
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:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #9 Evsun Road
Centerville,MA
Owner: Charles&Marie Warren
Date of Inspection: 4/5/02
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
D-Box
r0
Leach Trench
Septic
A B
3 Br
House Swine Ties:
A-Tank Out—2 P
B-Tank Out—21'
A—D-Box—31'
B—D-Box—35'
A—Leach Trench Cover—54'
B—Leach Trench Cover—35'
Evsun Road
T ,,. 10
i
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #9 Evsun Road
Centerville,MA
Owner: Charles&Marie Warren
Date of Inspection: 4/5/02
SITE EXAM
Slope
Surface water -None
Check cellar -Yes
Shallow wells—None
Estimated depth to ground water 14 feet below grade.
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
XX Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation)
XX Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Checked with Ouadranele of USGS Map
Per Barnstable GIS:
Elev. of Ground=22 Feet
Elev. Of Groundwater=8 Feet
Elev. Of Bottom of Leach Trench=18 Feet
Therefore: 18—8= 10 feet separation between Bottom of Leach Trench and Groundwater.
Groundwater Adjustment using Index Well AIW230: 7.2 feet
Adjusted Groundwater Separation= 10'—7.2' =2.8 feet
(Refer to attached work sheet)
Grade=Elev.22 feet
Leach Trench
D-Box
Septic Tank
Bottom of Leach Trench=Elev. 18 feet
Adj.Groundwater=Elev. 15.20
.. -
Permit Number: Date:
Completed by:
HIGH GROUNDWATER LEVEL COMPUTATION
Site Location: - q p,)*"t Lot No. I(D —8 1
Owner: �{q�� � (0PreQ•VA Address:
Contractor: Address:
Notes:
STEP 1 Measure depth to water table -
tonearest 1/10 It. .............................................................................. Date t ,
m nth/tloy/year
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
site and determine:
OAppropriate index well.................................................... �W
OBWater-level range zone.....................................................
STEP 3 Using monthly report"Current
Water Resources Conditions"
determine current depth to 2 A
water level for index well........................... J a 5•'{
m th year
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 water-level adjustment .......................................................................................... �'a
STEP 5 Estimate depth to high water
by subtracting the water•
level adjustment (STEP 4)
from measured depth to water
levelat site(STEP 1) ............................................................................................................. �Ie�) (�
THE COMMONWEALTH OF MASSACHU,SETTS
< , . BOAR® OF HEALTH
------.. .....::.........................0F.........................------•-•"---------------------------------•--------------------
ApplirFation for Uhip sal Works Toustrnrtiun - .ermi#
Application is hereby made for a Permit to Construct OO or Repair'( ') an Individual Sewage Disposal
System at
3 �!Vey C o'Z
y;�cation ddres _p or Lot No.
..--
O er — (�" �6•' p;A Address P
Installer Address
d Type of Building Size Lot_____/JoM6.....Sq. feet
U Dwelling—No. of Bed rooms............ ..............................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building No, of persons____________________________ Showers — Cafeteria
Pa Oth r fixtures ................•------------------•-----••_-----
Design Flow..... P P Y Y .......................................
W ��_________________________._gallons per person per day. Total dail flow____._._.____._______.._.._..______________. loos.
WSeptic Tank—Liquid ca.pacitylQs?Q__gallons Length._. ...... Width---L ..... Diameter.............:_. Depth................
x Disposal Trench—No_____________________ Width.... Total Length.....................Total leaching area___:_______.___....sq. ft.
Seepage Pit No................. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by........................................................................... Date........................................
Test Pit No. I........;3.-...minutes per inch Depth of Test Pit____________________ Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
....................................................r ...._._....•-----•--••--•----•-•-----•______----......--•-_._.......---=...........................
0 Description of Soil_._..IQATO. A �6 kS—d.....�� ...................................................................... s
x ......___.l , : r!S�. -------•-------42
U
--------------------------------------------------------`--------------------------------------------__----------------------------------------•---- ------•----------------------------------
U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
••----------------------------------------•------------..:..__..._...---•------------•-••••-.....-•------------------------------------------•-------------------------•----------------••-----•--------
Agreement:
The undersigned agrees to install the scribed Ind• 'dual Sewage Disposal System in accordance with
fthheovistons of T1`11Z 5 of the State Sa itary Co e—The ersigned further agrees not to place the system in
i ntil ertificate of Compliance ha b sue h board of health. _ �t
Sied----- .............. ................................................ .....
Dat
Application Approved By............ . . . . ....... . ...... ..... --_. .. - '".... -•------
Dat
Application Disapproved for the o lowing reasons:________________________________________________________________________________________________________________
Date
PermitNo......................................................... Issued........................................................
Date
No.... .......... -L
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Appliration f aax Dispaaiittl Work.5 Cfnntritrtiaan rtnit
Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal
}
System at:
........................................................... --- .....
IQcationt5ddresi or Lot No.
.. ...........•._........--------•--........... --••--...... .... ------..................--•-•-
----- --
ddres f�
a ---------- ----•- .. ...
Installer Address
UType of Building Size Lot...._1.f t1_4.....Sq. feet
�-, Dwelling—No. of Bedrooms........... ..............................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type T e of Building No. of persons............................ Showers
� YP g -------------•-•--•-- ------ ---• -( ---)--- Cafeteria ( )
Other fixtures --------------•-••......-•---•--•--------- ------------------------
------
w DesignFlow....... -.i. p p y y ............................................+ gallons.
1 _________________________gallons per person per day. Total daily flow
WSeptic Tank—Liquid capacity./ 9:tl.gallons Length...__._ ..... Width---1 A...._ Diameter................ Depth................
x Disposal Trench—No..................... Width....'....._:........ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.................... Diameter.................... Depth below inlet.................... Total leaching area.':...............sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
�_' Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1........;2-..minutes per inch Depth of Test Pit.................... Depth to ground water--------_---_-_-_-___--.
fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�+ ------------------------ -----------------•-----
D Description of Soil...... 1 t3.rY'P.. .... v - � r - -- -- - - -
-
cx, -A ......................../ .!
w
U Nature of Repairs or Alterations-Answer when applicable---------------------------------------------------.__--.......................................
..................--.............................------....---•-----------------------------.......----•---------------------------------------==------------------•--•----------------....:.......
Agreement:
The undersigned agrees to install the aforedescribed Indiv•duaI Sewage Disposal System in accordance with
t rovisious o TIT?,;�. 5 of the State Sa itary Code—The ersigned further agrees not to place the system in
ati�cnti a Certificat of Compliance ha een issued h�board of health.
-._/-- _..�_ i ned ---�1 .�.-�--•-----•----------------•- .....
-- `�-�Af�
Application Approved B t r /.IDat
Dat
Application Disapproved for the f lowing reasons:--.--•--------•--•- s:::---------------------------•------•-----------------------. ------ ..-------.-
.........................................................--------------•----------
--------•-----------------------------------------------------------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Tutifiratr of Taantplianrae
THIRS�("Tg CEI WIF�Y,, Tbat the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by -•......� .................. =
Ins,alley
at -741•----......--••------------------------- 3 ...._ 'dsa°� i C v 1 1 1 tE
- ----- . -- ----------------------•-------......--------....-------------------
has been installed in accordance with the provisions-of TIT r' r of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.' 46LIO............. dated__... _ _ g
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRUE AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIO SATISFACTORY.
DATE............. $ ......................................... Inspector.....
x- THE COMMONWEALTH OF MASSACHUSETTS -`
IV
tBQARD OF HEALTH
Cv ._•_ _"
No......................... FEZ. Q............
Diipaasal 1ULrhp ion ra'rmit
Permission s hereby granted............. ----- `= .wl ' a
. ................................................:.
to Construct ). or Re it ( Lan Individu ewage Di osal ys
at No.. :.. -.---. . t ....
4 .........
t• Street
as shown on the application for Disposal Works Construction Permit No................... ate . _s�lv�' � ard 0ed lr -•-------------------- -----? . '
DATE--------------------------------------------------------------------------------
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS „�L.,t...�.,iy• - .
^-�'' ' L��S%G/V .l�QTA •. SfleeT'1 of.Z
IR
/O GA �l,2B GE G.e/"o,ov
�i 2
AYG. v.4/Ly.��OG✓ =3X//o'=330G.P. O.
r-TO
U•s'E /000 Al-,
,GE4Cy F/E,w USE 3---�GoW,O/FFU.So,25
S eEA
.B O 7 7-0/9 AeE.4
2 0 Goo,
TOTAL OES/GN = -17Z/2
7 O- 7A.G .3'o G.
Sr �Z &i'aZ .'. ..
.FLOW � '� ,` � � �•• v�� �. �: �\t;.o n .�'2 �p
O�FFUSG��S •'I
n fi •�
N,.
a 0
/.CE.2T/�Y 7;ZIA7 Tf1,C- T:�-Jj:;�
S.yOc%v�E.�EO�c/ Co�IP.L YS lsi/r. ,��., Aso
r wIU A!� ti •C'o.2 Th!E S/oE.G/.UE A.No
�ir-JE.c/"fS OF Th�FTZ»'s�i(/ '�•`" N Y t fi
.C�/V.$T.LiB�-�• , I93 Kti��� j ..SGQLE:. �'_� f„' , O,g7-E.•4 �j ..
OATS_•' ' �U•8� a s '
AXTE.e
.2EG�ST�,2Ev L.�Lvv SU,2 t/EY0/-
Tc,�J lvaz/er/0 6e 1,07sla//el. GSTE.21//L.CE M.4S5;
•i���cb/a�ior/?atc L Zi�h .
i .CUifi/esSed.13Y r
/028
ScdSo//P_»7T. �' �. ,•P oisT. /G4 /NV
=lo
,V✓• IAIV
30" 9B•o . : 99•0 c3ak SEPr1c �9�3
Fled 3 -Xl'.rB �,CGYt/O/FF!/SO�S `39�9
.Samoa/ W 44'rawE,vr z(a.v,silaEs�
Ta /%z"W,,4"6ZO sTnN6
ALA -4.e,= Z:)O. L -
�
72 C,tC✓. ,o/Q._SC.QLE- ... . .
PP .
I
14 �.
Oo:o exIsr SAoTELc 1/
� . . UP .
0o Prc
P l'�fovr8 ®3
10 .
MAN. PF.vo� ,L
�S'ovse• . r
Pl-7107
�ar�sfa,6/e �Ce��ervil/e,/�as5.
30
doe.
N MARTIN ru,ki
Sim E
MOPAN
y�
.o 7 1234I
�c f `
e
LOC.AT ION 9 ��lsr� r;v � S E W A G E,PE RMIT N0.
V I L.L A G E
I N S T LLER'S NAME i ADDRESS
R U I:L D E R OR OWNER
C..l
DATE PERMIT ISSUED
D'AT' E COMPLIANCE ISSUED � � ��'
m etl
i
ii
--100 -- EXISTING CONTOUR �D oo'
x 100.98 EXISTING SPOT GRADE tomb
W EXISTING WATER SERVICE en ��� Rv
Rd
G EXISTING GAS SERVICE jorom�`
---UGW - UNDERGROUND WIRES
Route 28 F`s�
TEST PIT
Westminster Rd LOCUS
v
BENCHMARK �a
LEGEND
J
J
LOCUS MAP
NOT TO SCALE
N.
99.30 99.22
OL 8
I � � 98.77
rn
N
99.53 ®99.17 H
ca
Q_ O o'jement 98.05
R P -
R,30
99.71 01 L� sue::.....
C B
0 97.60
po W DRIVEIN,4Y.'r::,.
BENCHMARK .,''.
100.12
S 08�0 00 \ S O N O/B M
103.33 ''` HED 97.50
\
9 8:5\\ � 1
2-
7 ()()
D0� SHED >`;.`. '';
loo.so
LOT 3 � .+ � + .32
18,880 fSF 100.32x Ioo. 6 _ =00.32
$ --i Ol-�
101.22
l o"
STRIPOUT BOUNDARY / 2� 9a.2s
"B" HORIZON & UNSUITABLE pL 1012
SOILS OF EXISTING S.A.S. SHED + f:.`;.o `. Z 3.25\
(SEE NOTE 1 1) X 02.3TP
102.29 0�
101.42+ \ ` 1 > O 96,65
TP-1 \\ 1 No EXISTING x 103.N
- PROPOSED S.A.S. SS828�S �,\ \ \ HOUSE(#9 -
103.37
5-LC6 PRECAST CHAMBERS 1R2D2, 03. 7 �, T.O.F.=104.9E 103:9
SURROUNDED W%3.5' OF STONE F to .as z
101.82 +
EXISTING S.A.S. S NE:'.
DECK
(APPROXIMATE) x +103. 9
3 FLOW DIFFUSORS W/STONE 102.08 02.91 99.71
TO BE REMOVED-SEE NOTE 11 DECK
x P TI x 103.13 1 :26 101. 0
EXISTING SEPTIC TANK 1o2.40 +
a 03.09 02.13 100.27
TOP OF TANK, EL.=102.09 c 1 .04
INV.(OUT)=100.75E + \ - \ •-
GENERAL NOTES: 102V. •� �" •
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL \ +102.49
\\
BOARD OF HEALTH AND THE DESIGN ENGINEER. �P SPIKE
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS + 101.77
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS + 101.83
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
TO INSPECTION- AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 0 M4ss9cyG
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF o PETER T.
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. g McENTEE
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. v CIVIL
S. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
No. 35109
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
DIRECTED BY THE APPROVING AUTHORITIES.
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY A ( `�Z�
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING �1
CONSTRUCTION. PLAN REVISED 2/12/21
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS MISC. TYPO CORRECTIONS
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE PARCEL ID: 168-081
INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND PROPOSED SEPTIC SYSTEM UPGRADE PLAN
NOT CONSIDERED TO BE A PROPERTY LINE SURVEY.
14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 9 EVSUN DRIVE, CENTERVILLE, MA
SYSTEM COMPONENTS NOT SHOWN ON THE PLAN
Prepared for: Rildo Lima, 9 Evsun Drive, Centerville, MA 02632
OWNER OF RECORD Engineering by: SCALE DRAWN- JOB: NO:
LIMA, RILDO, E & BRUSTOLIN, GEVAINE DEBOR Engineering Works, Inc. 1"=30' P.T.M. 335-20
9 EVSUN DRIVE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
CENTERVILLE, MA 02632 (508) 477-5313 1/16/21 P.T.M. 1 of 2
I
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL: 99:5
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER AND COVER INSTALL RISER & COVER OVER ONE CHAMBER(MIN.)
OUTLET AND SET TO 6" OF FINISH GRADE SET TO WITHIN 6" OF FINISH AND SET TO WITHIN 3" OF FINISH GRADE TO SERVE
T.O.F.=104.9t GRADE AS AN INSPECTION MANHOLE.
•.�F.G. IEL.=104.0t F.G. EL.=103.0t F.G. EL.=102.3t F.G. EL.=101.2f to 102.5t
EXISTING
L - 20' L - 28'
@ S=1% (MIN.) @ S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC
10 2" LAYER OF 1/8"
�o I s ®O® TO 1/2 DOUBLE
•. 14" 12" I I WASHED STONE
EXISTING 48' LIQUID INV.=100.75 OR APPROVED FILTER FABRIC)
LEVEL (VERIFY) PROPOSED INV.=99.50 5' 3' 3.5' _ //
• INV.=99.67 D-BOX EFFECTIVE WIDTH = 10' DOUBLE 1WASHED
cns eAF .. INV.=99:00 /
H-10 RATED STONE
EXISTING SEPTIC TANK USE 5 LC-6 LEACHING CHAMBERS IN SERIES WITH
3.5' OF DOUBLE WASHED STONE ON ALL SIDES
H-10 RATED
NOTES:
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP CONC. ELEV.=99.83 -BREAKOUT
INVERTS, PRIOR TO INSTALLATION. --- ---
2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE INV. ELEV.=99.00 EA laE3 O®®E3 ELEV.=99.5
GRADE ON A MECHANICALLY COMPACTED STABLE BASE ®®®®®�®
OR 6" CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=98.00
310 CMR 15.221(2). 1 . 3.5' 5 x 6' = 30' 3.5'
3) INSTALL INLET & OUTLET TEES AS REQUIRED. 4' OF NATURALLY OCCURRING PERVIOUS MATERIAL EFFECTIVE LENGTH = 37'
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W.
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION
EST. HIGH GROUNDWATER, EL=92.7 = '
SEPTIC SYSTEM PROFILE
N.T.S.
SOIL LOG
EXISTING
DATE JANUARY 1.3, 2021 . REF.#T.PT-20-.290 HOUSE(#9,
SOIL EVALUATOR: PETER M(ENTEE SE#1542 ) T.O:F.-to :9
WITNESS: DAVID STANTON R.S. HEALTH AGENT
ELEv. TP- 1 DEPTH ELEV. T P-2 DEPTH SHED ONOTUBE FNDN.
101.4 0" 101.4 0" �}�• ,
FILL FILL p, 36-7Ila �� cK
100.4 12" 100.1 14"
Ab Ab o w T
LOAMY SAND. . LOAMY SAND. __________,��_
100.1 10YR 4/2 10YR 4/2 If--37'--=;
B 16 B" 99 9 18>'
LOAMY SAND LOAMY SAND
10YR 5/8 10YR 5/8 PROPOSED S.A.S.
98 4 C1 36 98 4 C1 36 SHED 5-LC6 PRECAST CHAMBERS
COARSE SAND COARSE SAND SURROUNDED W/3.5' OF STONE
2.5Y 6/4 2.5Y 6/4
95.4 _.. � 72" 95.4 72' -C2M-C SAND C2M-C SAND PERC SEPTIC LAYOUT
2.5Y 7/4 2.5Y 7/4
92.7 HIGH G.W. = 104" 92.7 HIGH G.W. = 104"
REDOX - REDOX -
91.6 STG. G.W. - 1 17" 91.6 STG. G.W. = 1 17" ---- a' KNOCKOUT
91.4 120" 91.4 120" i 20' MA COVER
. PERC RATE <2 MIN/IN. "C" HORIZON _ 1 ,
ESTIMATED HIGH GROUNDWATER, EL.=92.7 (REDOX) e-KNOCKOUT 4-KNOCKOUT "�'
PERC REFERENCE: 7/9/84 BAXTER & NYE
4'KNOCKOUT-----
I I
r 72' '1
DESIGN CRITERIA PLAN VIEW
NUMBER OF BEDROOMS: 3 BEDROOMS
SOIL TEXTURAL CLASS: CLASS I r Ea EA ® 0 ® ® ® 22' r ® 0 ® ,
Ir
DESIGN PERCOLATION RATE: <2 MIN/IN I"2RT I
I I � I
DAILY FLOW: 330 GPD
DESIGN FLOW: 330 GPD 72' I 36'
GARBAGE GRINDER: NO-AND NOT PERMITTED WITH THIS DESIGN SIDE VIEW END VIEW
LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF WIGGIN LC-6, H-10 LOADING
.74 GPD/SF LEACHING CHAMBER
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY
PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS, H-10 RATED N.T.S.
USE 5 LC-6 LEACHING CHAMBERS IN SERIES WITH PROPOSED SEPTIC SYSTEM UPGRADE PLAN
3.5' of DOUBLE WASHED STONE ON ALL SIDES 9 EVSUN DRIVE, CENTERVILLE, MA
SIDEWALL AREA: (10.0' + 37.0') x 2 x 1' = 94.0 SF Prepared for: Rildo Lima, 9 Evsun Drive, Centerville, MA 02632
BOTTOM AREA: 1.0.0' x 37.0' = 370.0 SF Engineering by: SCALE - .DRAWN JOB.-NO. - -
TOTAL AREA:.................................................. ........ 464.0 SF Engineering Works, Inc. N.T.S. P.T.M. 335-20
12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(464.0 SF) = 343.4 GPD (508) 477-5313 1/16/21 P.T.M. 2 of 2