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HomeMy WebLinkAbout0176 FIVE CORNERS ROAD - Health 176 FIVE CORNERS RD., CENTERVILLE A= 168 112 I i �RECYtfFOr UPC 12543 �4 N0.63M HASTIHOS, MN �.w TOWN OF BARNSTABLE LOCATION 17 G I—. V r, Col--VtIO SEWAGE#, VILLAGE Gtllk' ASSESSOR'S MAP&PARCEL �( 2 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l LEACHING FACILITY: (type) _���o"D lc (size) NO.OF BEDROOMS Wi OWNER a 1 C 1,A.S PERMIT DATE: 1 —l — " 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 ho 17� F'V,e (OrAeo Z No. o Fee oa THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Misposaf 6pstem Construction VPrmit Application for a Permit to Construct( ) Repair(I<U�pgrade( ) Abandon( ) ❑Complete System QIndividual Components Location Address or Lot No. Lor`f-67 Owner's Name,Address,and Tel.No. StLvv kq`0%J VW e,�„�'cCt'✓.y\�... �7 F3 �iV� l.af'�n�.;� jl,�c�b- l.Cm+r'lr":M'`� Assessor's Map/Parcel 1 Installer's Narfie,Address,and Tel.No. 770'I1L Designer's Name,Address,and Tel.No. Atkk UV G-9) -°d�i.�°�`1`� J �r�l� ��t`A'F�✓ `�" 3►n <�t y. Qytj j r�c fr' SrCLf°iT Type of Building: n,dw,( vlIom� Dwelling No.of Bedrooms Ox r -7�-V Lt Size 78 -2- sq.ft. Garbage Grinder( ) Other Type of Building P4, No.of Persons Showers( ) Cafeteria( ) Other Fixtures qhfib Design Flow(min.required) gpd Design flow provided 3 4q gpd Plan Date -31 2.$'I l(e Number of sheets a- Revision Date Title Size of Septic Tank Type of S.A.S. (ke A 6,• f" Description of Soil see Ns 21 Nature of Repairs or Alterations(Answer when applicable) ��c.(,('� A. ... V� (./4A_ Date last inspected: Agreement: i The undersigned agrees to ensure a constructioFandm ntenance of the afore described on-site sewage disposal system in accordance with the provisions of Title :the Environmeand not to place the system in operation until a Certificate of 1 Compliance has been issued by this Boar f ea x Signe I. Date 0,41061(` Application Approved by _ Date Ll Application Disapproved by VVVDate for the following reasons Permit No. 2-ri L, o Date Issued rr.. .. gr �( Fee' No. a Entered computer: THE COMMONWEALTH OF,MASSACHUSETTS f Yes t PUBLIC HEALTH DIVISION -_TOWN OF BARNSTABLE, MASSACHUSETTS 2pplicatlon for 13isposal 6pstem CIdustrUctlon Permit Application for a Permit to Construct( ) Repair(1<1U_pgrade( ) Abandon( ) D Complete System aIndividual Components Location Address or Lot No. L or'wtS _Owner's Na te,dAddress and Tel.No. St/C-e- k4 I e C �.t�r,.;e\f� 4 . O ( `6� or..c�S` �eA� �C MCP..►.�J Assessor's Map/Parcel { 3 . Installer's Name,Address,and Tel.No."Toy L(. � Designer's Name,Address,and Tel.No. Rkl C-,4C St -};_ P/fi-.,,� (gyp&') �'2Y'`t,�'�'1'Z ( jg wr+L Z$ V. ya'(AoVR'{\,J fi k OL643 a �V K- ,S.Y CLC 4' P�a.r S'�+^S /ti.c 1lS SO :731 -- Z.•O Type of Building: Dwelling No.of Bedrooms t r '19- 7 tot Size 7a Z- sq.ft. Garbage Grinder( ) Other Type of Building i PA No.of Persons Showers( ) Cafeteria( ) Other Fixtures �4/1 b Design Flow(min.required) i' 1 gpd Design flow provided 3 41 gpd Plan Date 3I 2S I lie Number of sheets Revision Date Title —Size of Septic Tank e �n� ' goo Type of S.A.S. i'1 a ��dlC�.'r4 �-h6A� Lry Description of Soil _ Nature of Repairs or Alterations(Answer when applicable) be.Q`c.Lt- 'e CI& — 414 No moo 64 j%.jN 1e�c1,. �► ` C� r Date last inspected: Agreement: t r 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 o: the Environmental ode and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of ea . x Signed f, Date P\i o6l Application Approved by (-� (�( Date / Application Disapproved by V V� Date / for the following reasons Permit No. ,f i/ h - l o[.^ Date Issued t � ------------------------------------------------------------ -------------------------------------------------------------------------- TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by 0�j V-, �C4 N t_S,A t N. 12n(a C_1 at s been constructed in accordance / with the provisiont of e 5 and the for Disposal System Construction Permit No. - 6(o dated XInstaller Designer , C01 _ Sq LC- VV #bedrooms Approved design flo�V� d gpd The issuance of thi permit shall not be construed as a guarantee that the system will funtti+on as designed. ?j Date Inspector /' No. - 6 Fee % THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstrm Construction Permit Permission is hereby granted to Construct( ) Repair(J) Upgrade( ) Abandon( ) System located at /..� / t"� „ 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. Q Date /� ;/ Approved by / l PQfC. fM M�,,� C �� �/ �Pa , h �' df 1U ( U � � rr I Town of Barnstable ° Regulatory Services Richard V. Scali, Interim Director e w►acaus. 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: 19 if I& Sewage Permit# ° 1 _ 0� Assessor's Map\Parcel E3S Z9 3 Designer: �e tr M c 6A ry J Installer: Address: (nf 13 IQa Zf Address: On was issued a perrrA to install a (date) (installer) 1 P septic system at 1-7 tO->,.V GO d 'S,�h��� 1�� based on a design drawn by (address) L), C,4 �Z--L 1A4 &4f:�JV ratd --3 ISS-4 I �. (designer) `� I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. cert' that the system referenced above was constructed. in compliance with the terms f th I1A approval letters (if applicable) k-44 nstal is Si ture) No 1224 (Designer' S'g ture) (Affix Designer''s-S m ere) d PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc A Town of Barnstable P#_l� 60 Department of Regulatory Services ar►rwaren+�a F Public Health Division Date MA8.4. 1e7A 200 Main Street,Hyannis MA 02601 • lft►�� Date Scheduled l h ' Tfine Fee Pd. 01) W Soil Suitability Assessment for Sew e Disposal ' Performed By: Witnessed By: v� �• n � LOCATION&.GENERAL INFORMATION Location Address Owner's Name /•%Gs F1Vt: Gar er-5 /2za . fGalt�/� _ Address /7fv _r—itJe- C.Gr�/c%frj Assessor's Map/Parcel: r t/i t Engineer's Name ,CGS f Mc-60, n rt NEWCONSTRUCTION ,_ I REPAIR Telephone# (3 3 Land Uso' RQP, ,Aom,iC5_1 Slopes(96) Surface Stones Distancea from: Open Water Body ft Possible Wet Area ft Drinking Witter Well ft Dmthage Way i ft Property Lino ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands-in proximity to holes) ®T CZ .IT/ _T, . : 5C�1`ti2rs Parent material(geologic) L Depth to Bedroalt Depth to Groundwater. Standing Water In Hole: 1 V l)!VC"�.. tc7O Weeping from Pit Fnea Estimated Seasonal High Groundwater DETERMINATION FOR SEAS ONALMIGH'WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to still mottles: In,' Depth to weeping from side of obs.hole: _ ___ hi. Groundwater Adjustment tr. Index Well-0 Rending Date: Index Well level ,._„ Adj4hotor, ,r Adj.draundwater_Le,val. _, PERCOLATION TEST l]Nie I� inu. .h' Observation —t�l Hole# Tlme at 9" Depth of Pero n�� Tima at 6" I b Start Pro-soak Time @ 14 Time(9"•6") A I�IJ End Pro-soak 1 Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observdtlon Hole Data To Be Completed on Back--- - ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conseli'vation Division at least one (1)week prior to beginning. Q:\SEPTIC\PBRCFORM.DOC rn �� DEEP.OBSERVATION HOLE LOG Hole#� Depth from Soil Horizon Soil Texture Shcl Color Soil. Other Surface(in.) (USDA) (Mansell) Mottling (Stnucture,Stones;Boulders. Consistency,%'(]rival) w F'Aj. �a Rya Kwza � JUaNF, 6oSi� r wa DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Soli Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistflay.-WOMyell _3Z b N 5 ? 4 LLN DEEP OBSERVATION HOLE LOG Hole# --- . Depth from Soil Horizon Sall Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders, Flood Insurance Rate Map: Above 500 year flood boundary No— Yes _ ",Vithir.500 year boundary _ No--I- Yes-*.. . Within 100 year flood boundary No., Yds Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? �2S If not,what is the depth of naturally occurring pe ious material? ._..._. Certification I certify that on Q714 (date)I have passed the soil evaluator examination approved by the Department of Environment Protection and that the above analysis was performed by me consistent with . the required tralnln exper s and experience described in�1 10 Cl IIM 15.017. Signature Date 3ia�_lao , Q:\aEFrrlC\PSACPORM.DOC L O AT.�O (7�O S E G E PE RM1T N0. i VIL GE I N STjj L R'S NAME & ADDRESS 03 ill rz_lJL BUILDER 0 ER z22 DATE PERMIT ISSUED ® e� DATE COMPLIANCE. _ ISSUED 7�- G��2 ` 4 U\ No.. �....X 7® _ FEs... :`S..1�.... THE COMMONWEALTH O� MASSACHUSETTS BOAR® OF - HEALTH. , Appliration for Disposal Works Tonstrnr#iun ramit l�v Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal �► System at: /'1 C � /�/Ve u f`y �G Tz e A j1,GLe___ /��' , L ion-Address (► o Lot No.,�/� /r/� ..............lJ O.S.� .1?_.... � _ �Gt.....e of!?t.6?.... Owner Address a .......... ' Installer Address yy Type of Building Size Lot.!_.......�� ......Sq. fee U Dwelling—No. of Bedrooms..... .......................... pGrinder _. ._ ._.__.. Expansion Attic ) Garbage Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................ Design Flow........... ..........gallons per person-per day. Total dail flow........ .... WSeptic Tank—Liquid capacity � .gallons Length!l.!_e Width___O.--------- Diameter________________ Depth...A........... x Disposal Trench—No...................:. Width....'.............. Total Length.......... Total leaching area_._.`.._._.__..._._sq. ft. Seepage Pit No.---./------------- Diameter..... :..._ Depth below inlet................ Total leaching area®Z.....sq. ft. Z Other Distribution box (®) Dosing tank 9 '~ Percolation Test Results Performed by.... _ + �' .............f---..------..-.----- Date....�f � ...._..._,. Test Pit No. I..__£--_..._..minutes per inch Depth of Test �it.................... Depth to ground water.-/--p____-__-: (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............ �4.j./.�.�...... ........................................ .. #....... .... Description of Soil.................. -----•••--•--•.....-- .......... ._.....-----�" .2— � V ..............................................---•---•------••--.......•----•-••••-•-•...-•••---•••--••------•••-•--••--••-••--•--•---•--•---•----•--••-•-••-•--•••••-------------...-----•--•----•---•. 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 TITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued y e and of health. LSig a Z, T -... - --- -.----- - --•• --•--•--------•-•--•-•-•-- Date Application Approved By-.... •---------•------------------- C = �� Date Application Disapproved for the following reasons---------------••----•--•----•---------------•-------------------------------•-----=•...........-•••---••--•---•- ......••-----•.......................•••..............-••......---•-•-•---------------...............----•----------•---.....---....--•-•----•-•-----•-•-•-••---•••-••••••-----••••---•••••---•----•---- Date PermitNo......................................................... Issued... ...... .... •• ==............... Date 1 • � F/l r ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD,#OF HEA��THYA ...............OF.......A ............. .........................•. " Applirttiinn for Disposal Works Tlinstrnr#inn Prrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ."1 /.../�......./V �/ iD..Y..'..r...j..e."...�.*...S.. ../... C2` �10-1YI�/-CY L/+f�/�.f�,�' No........... ....................aa.•- ----------------------------- -•----------- •----•---------• S "/ � s" E tYf CjP Owner .._.•Address W Installer Address �� �� Type of Building Size Lot............................Sq. fee; U Dwelling—No. of Bedrooms-------------............................ _Expansion Attic/ ) Garbage Grinder # �4 Other—Type T e of Building No. of persons............................ Showers — A4 YP g ---------•-----•-----------• P � ( ) Cafeteria ( ) d + ;Other fix ures .--•----•--•-----------•-------•---•---•-------•-----•-------•----............-•-•-•....................Z -- W Design F1'ow.1....... ` ....... . ......gallons per person er day:: Total daili flow.......�:_.� _....___.._.___. kris. W Septic Tank f Liquid capacity �>qgallons Length Width_._ ?,.._.' Diameter................ Depth.....__......... x Disposal Trench—No. .................... Width." ;; .... Total Length y Total leaching area sq. ft. ... Diameter.....6.._.__._._. De tl below inlet__''.. Total leaching area?9.�....Seepage Pit No......___._•__-_-- p g sq. ft. z Other Distribution box (f) Dosing tpk WPercolation Test Result Performed by....1 .....:................ ..•-_._. ...r.................... Date___.._. ___.....1.._. _.._... , r Test Pit No. 1.... _......minutes per inch Depth of Test I it.................... Depth io ground water__............. r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. a .......... :-------•----------•--- ------------•--••--.... ...J... -..... D Description of Soil................. .. _ """`:._.... .`."�1.....'�.�....`......�-`--!' ....... - G - - x 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not,to place the system in operation until a Certificate of Compliance has b n issue b t e and of health:: Sig ed-• .......................••-•-•--•-- .: 7T ... y Date ,r-Application Approved BY l. -t - -4_4.4 .."._ Date Application Disapproved for the following reasons:................'................_..................._..___.._.......__ .. •-•--•-•-•-•--------•-------•-------•---------------------------------------•--------------.........---•••--------------•-•--•-•-----•----•---...-•------••--•--•-•---•--•---••-•------•--•--....-•--- Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH' t° .......... t.........o F.......... G - .................... Trrtifiratr of Tout�'fiFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (� or' Repaired ( ) by 6 ... .... ---• r...... ..... h •�`at 4 • _. ._._. has been-installed in accordance with the provisions of T r 5 of The State Sanitary de as describ d in the application for,Disposal Works Construction Permit No. �_.. ._ �� dated---�"'.�__7_.-.T THE. ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Inspector.... i DATE.....--•.�--�4.. ..---•-•�- -••-•---......-•-• -------- ------•--- -------•--- -------•-------.........------- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH �... ........ ..........OF...... �G? 1! ,....... ..2�- No. ............... M w FEE......................... Disposal Workii WInntrurtinn rranii PermissioVishn eby granted:.... • .....---•--• ----•to Construct Reps'( ) an vidual Sewage posaltat No... -•- ' P(--�----•--•-----•-- .... ---••= .............. Street-- ........................ ------- Y - ----- • Street y/J s � !i�, ,`��• . as shown on the application for Disposal Works Construction P it No��. Dated.__--�-_._-... i� `► - Board of He f1^i DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - - A , COMMON«TALTH OF IvMaSSACkSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR-4 DEPARTNIEN'T OF EN-VIRONMEITAL PROT� TION ONE WINTER STREET. BOSTON. MA 02109 bl y`9�>E9n 1999 f yO Tae1F. TR,vDl CG>� Vt1LL1AM F.WELD Gavcnc ARGEO PAUL CELLUCCI g LS D�4--'B S i _-RUF Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION p Scir,n� d�� Property Address; 11(v �i�i -�� '�'� t��- `�='titi1� Address of Owner: i Date of Inspection: -3k i%15� of difiere ) Name of Inspector: H,,l 'o 1 am a DEP ap ved system inspector pursuant to Section 15.340 of Title S (310 CMR 15.000) Oii-i 2tS Company Name: 17.royr -,-e ge7ir P-I*efl N 0" P ^4---/ Mailing Address: 2Q /;o,c e_3?-P!�f f/0'7Sd4eL H /T o 2_C4- Telephone Number: . rS'C4z CERTIFICATION STATE.IEIT ce.^.if) that I have pe•sonally inspected the sewage d!srosal system a: this address and tha: the information reported be!ow is true. accurate and comolete as o:the time of inspec:oo-.. The inspecion was pe^crmed base--* on my training anc experience in the proper funcicn and nnamtenance o;on-sae sewage disposa: systems. The . •s:err:: XPasses _ Concit-onai:\ Passes 11.eecs Furthe- Eva!uanor, S the Local Approvtng Authonn Fa Inspector's Signatur A Date: T:ie Svs:em Ins ?_o• sha!' s.tbmi. a cope of this inspection reocr, to the Aporoving Authority within thirty (301 days of completing this inspe:ion. If the system is a share_ Svstem o- has a des-gn flow of 10.000 gx or greater, the inspector and the sys:e•n owner shall submit the redo- to the aporopnate regional office of the Deparment of Envirenmenta' Frotection. The crigtna! should be sent to the system, owner and copes : in to the buyer, ii applicable. and the aparoving authorir\ INSPECTION SUMMARY: Check A, B, C, or D AI SYSTEM PA55ES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 13.303. Any faiiure.criteria not evaluated are indicate✓ below. COMMENTS: BJ SYSTEM CO-NDITIONALLY 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. Indicate yes, no, or not determined (Y, N. or NDi. Describe basis of determination in all instances. If'not determined-, explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; Or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspe :ion if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B] SYSTEM CONDITIONALLY PASSES tcont,n,�'d Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken. settled or uneven distribution box. The system will pass inspection if(with approval of the ._ PPe . Board of Health). Describe observations: _ broken pipe(s) are replaced . . obstruction is removed distribution box is levelled or replaced The system requirea 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 pipets; are replace--' obstruction is removed C] FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require furthe•evaluation by the Board of Health in order to determine if the system is failing to protect the public health. sale:)•and the environment. - 1) SYSTEM WILL PA55 UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or prn1 is within 50 fee, of a surface water _ Cesspoc! or pr.- is vn ithin 50 feet o;a bordering vegetated wetland or a sait marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIO-41-Nt N A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAF"t:TY AND THE ENVIRONMENT: or _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 fee: to a surface water supply tributan- to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water sup��y well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system, has a septic tank and soil absorption system and the SAS is less thar 100 feet but S0 fee: or more from a private water supply well, uniess a we!I water analysis for coliform bacteria and volatile organic compounds indicates than 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. Method used to determine distance (approximation not valid). 3) _ OTHER (revised 04.125/9-1 Page 2 of 10 .3 SUBSURFACE SEWAGE DISPOSAL Sy STEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D] SYSTEM FAILS: You must indicate either "Yes" or "No' as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The oasts for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No 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 bo). above outlet invert due to an overloaded or clogged SAS or cesspoo!. Liquid depth to cesspool is less than 6" below invert or available volume is less than 1/2 day floe. Recuired pumping more thar, 4 times in the last year NOT due to clogged or obstructea pipes . Number of times pumped _. An%- portion o'the Sod Adsorption System, cesspool or privy is below the high groundwate• eievatior. Am por.on o'a cesspool or privy is within 100 feet of a surface water supply or tributar to a surface water supply. Any pomon of a cesspoo' or privy is N rthir a Zone I of a public well. Am pc! io- o*-a cesspool or pm1 is within 50 feet of a private water supply well Anv por•,or. o,a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water qualir, analvsis. If the well has been analyzed to be acceptable. anach copy of well water analysis.for colnorm bacteria volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either 'Yes' or "No" as to each of the following: The iolioww:rg criteria aop;. to large systems in addition to the criteria above: The system serves a facilit% with a design flows of 10,000 gpd or greater (Large System; and the system is a significant threat to public hea!th and safes and the environment because one or more of the following conditions exist: Yes No . the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well) 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 04/25/97) page 3 of 10 c SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTS CHECKLIST Property AddEess: Owner: CZ4."Nec�w► Date of Inspection:3I%4 9 1 6 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or 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. . As bull: plans have been omamed and examined. Note if they are not available with N/A. S( The fac:li­� or d%%elling was inspected for signs o-*sewage back-up. The system does not receive non-sanitam• or industrial waste flow. The site vi as inspected for signs of breakout. All systerr. components. excluding the Scid Aosorption System, have been located on the site. The septic tank manholes \&ere uncovered, opened. and the interior of the septic tank was inspected for condition of baffies or tees. materia; o- construction, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption Svstem on the site has been determined based on. The facda% ok%ne• ,ano occupants. if d,rteren; from owners were provided with information on the proper maintenance of Sub-Surface Disposal Svstem. Existing information. Ex. Plan at B.O.H. _ De:ermined in the field of am of the failure criteria related to Part C is at issue, approximation of distance is unacceptable (15.3013itil (revised 04/25/57) Page 4 of 10 r\ A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR-M PART C SYSTEM INFORMATION r� Properts Address: L Five coetjtez,�, Owner: .�1Nt_L-4— Date of Ihspection3111h, 11 1 h `, FLOW CONDITIONS RESIDENTIAL: Design floes B30 e o.d./bedroom for S.A.S Number of becrooms Number o'current residents- Garbage g•, der (yes or no,-AP Laundry cor•^ected to syste (yes or no! Seasonal use Ives or no!: Water meter readings, if av ilable (last two i2: year usage igpdi: — . • Sump Pump Ives or noa Lai: date o;occupant,, COMMERC i 4L'INDL`STRIAL: Type of establishment Design fio%% ea!ionsrtla\ Grease trap present. Ives or no' Indus;ria! \%aste Holding Tani; present. eves or no_ :on-sanitan Haste dscnargeo to the T!tie 5 system ,ves or no_ \later meter readings. if availabie Las:pa;e o; o cLpanc. OTHER: .De;cribe Last pate of occucanc. GENERAL INFORMATION PUMPING RECORDS and s urce of information System pumped as par, of inspection: (ves or no. If yes, volume pumped eallons Reason for pumping TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Piny Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: �SV'IP�4 Sewage odors detected when arriving at the site. (yes or no) (revised 04/25/9'7) Pag• 5 of 10 . - - A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION (continued) Property 4AIell: 1 ✓ cowlt15 Owner: Date of Inspection: I . Y BUILDING SEWER: (Locate on site plan) Depth below grade. Material of construction: _cast iron _40 PVC _other texplain) Distance from private water supply well or suction h-t Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:X� (locate on site pl n tf Depth below grade Material of construction: Aconcre.e _meta _Fioergiass _Polyethvlene _othertexplain If tank is metal. Its. aggee._ Is age confirmec o, Ce�t:fica:e of Compliance _(hes-No Dimensions � AON Sludge depth 14 it Distance from top o: sludge to bonorn of outie: tee o, ba;;e QLIQ Scum thickness Distance from top o, scum to top of outlet tee or ba^ie Distance from bottom of scurn to bo-oln 01 outie; t er bare How dimensions were determines v Comments trecommendation for pumping, condit,ol of niet an ' outl t t s or baH es. depth of h d level in r at n to u i ve stru ral i r vi4u- I Q i 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: n f n I tees r baffles, depth of liquid level in relation to outlet invert, structural (recommendation for pumping, condition o Met and outlet ee_ o p q miegrity, evidence of leakage, etc.; (rov:.s.d 04/25:97) Pag• 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propertm Address..Q 0"ner: gzNN Date of Inspection:3 � �r V 40 TIGHT OR HOLDING TANK:Tank must be pumped prior to, or at time, of inspection) (locate on site plan, Depth below grade: Material of construction. _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacin•: gallons Design floN gal)ons-da, Alarm level Alarm in %%orking order _ Yes. _ No Date of previous pumping Comments (condition of inlet tee. condition o* ala,m and float switches, etc.) DISTRIBUTION BOX: (locate on site par: Depth of Mould level aoove ouue-. ime a Comments aad d tribut or. Ic eaua' evidence of solids ryover, vidence of leakagp, into or out of box, etc.) PUMP CHAMBER: (locate on site plan. Pumps in working order: (Yes or No' Alarms in working order (tes or No Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION (continued) Property ddr-as : Owner: N Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):i 91<1 (locate on srte_plan, if possible, excaltion not required, but may be approximated by non-intrusive methods; If not determined to be present, explain: Type: � leaching pits. number.141. leaching chambers, number:_ leaching galleries, number. leaching trenches. number length: leaching fields, number, dirnensjon.s overflow cesspool, number Alternative system Name of Techno(og,. Comments. (note condition of soil. V s of hydraulic failure, level of pon ingnln4ition eg tion, etc.) f AA� CESSPOOLS: (locate on site plan Number and configura:,on Depth-top of liquid to inlet rover, Depth of solids layer Depth of scum layer. Dimensions of cesspoo: Materials of construction Indication of groundwate- inflow• (cesspool must oe pumpec as par, 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: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page a of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR:k1 PART C SYSTEM INFORMATION (continued Propert,. Address Date of In,pection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate.where public water supply comes into house) �sh��zt e+ A Z- A-3 . 37 b3_ (revise'_ 04'75!5") Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addres-• �1(.a �1 V?-C�LSD Owner:Sc-UtIrL Date of Inspeciion:A 1`\ Depth to Groundwat P e. , �� Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained irom Design Plans on record Observation of Site (Abunmg property. obsenation hole, basement sump etc.) Determine it from local conditions Cnec*N %yRh loca! Board o• nea:tr Chec'K FE.MA Maps Check pumping records Check local excavators irs;allers L se I-SCS Da:a r• Describe in your o\.- %••oras r.o,.% .oL; es:ab!ahed the H ¢h Groundwater Elevation. (Must be completed: fill trav_aad 0�:2'_'9- Page 10 of 10 i TOWN OF BARNSTABLE LOCATION C 11�1� ��UP�� `�.0 SEWAGE # VILLAGE CQJ& ASSESSOR'S MAP& LOT M INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER LZZPJC,1 PEf<MITDATE: 51 1 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) I Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fit gl;leac ' g facility) Feet Furnished by 4 ® Q 1 �31- (t3. 437 l33- a7 q Centerville,MA' / INSPECTION NOTE: f PRIOR TO FINAL INSPECTION BY THE ENGINEER,SYSTEM Rte 28 / Falltto Rd NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. WW N►estminste`Rd LOCUS 0 1 \ Ix �� Locus Map Lot 6 Corner Bulkhead — 1 6,782± Sq. Ft. TBM EL=50.0 1.)Assessor's Map 88 Parcel 293 2.)Book 12268 Page 2 �9 492 3.)Plan Book 312 Page 56 _ House#�17b �, 4.)This property is in the Saltwater Estuary _._.. � , �-, D/W �,� �� Protection Zone. 2 Bedrooms � '� TOF El=50.6 5.)This property is not in a Flood Zone \ Existing 1,�0 a Gaiinn SrptrcTank LEGEND Gravel Full Cellar ST To Remain \ Panting Garage Q Deck 49.7 Edge f 13 EXISTING SPOT GRADE First Floor Slab Law24x5 PROPOSED SPOT GRADE 24 — PROPOSED CONTOUR Bed 1 [l3ath Dining ro�o� See Note#19 a9.z aa9 o OVERHEAD UTILITY LINES Room Kitchen 50.1 ,. 4", 49,6 Wooded v UNDERGROUND UTILITY LINES �,r �� x4 {m t a Area GAS SERVICE LINE Bede R, �� �, s :, � EDGE OF CLEARING FENCE .. o � TEST HOLE LOCATION . .-_49s --. ST SEPTIC TANK Bath Family 49x4 - Q � -4 :` DB DISTRIBUTION BOX WftorkRooral ` .0 o so" f` "— Area open, 1y SAS SOIL ABSORPTION SYSTEM 50.15 Sewing Storage y ; Prepared for: u. sM .a 50.1 , ' Wooded �. Steve Kalinyak Basement Area 4%9 176 Five Corners Road Centerville, MA 432 �, Proposed Sewage Disposal System I CERTIFY THAT I AM CURRENTLY APPR BY THE DEPARTMENT OF °< w OF 176 Five Corners Road Centerville, MA ENVIRONMENTAL PROTECTION PURSU MT O 310 CMR 15.017 TO CONDUCT SOIL EVALUATIONS AND THIATTHE ABO LYSIS HAS BEEN PERFORMED s BY ME CONSISTENT WITH THE REQUIREDTRAINING,EXPEPTISE,AND EXPERIENCE Kl Prepared by: DESCRIBED IN 310 CMR 15.017.1 FURTHER CERTIFYTHATTHE RESULTS OF MY 5 MoGAi ! SOIL EVALUATION,AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, �'' ` 1` Via•1.224 �J-a All Ca pe Septic LLC ARE ACCURATE AND IN CCORDANCEW11TH 310 CMR 15.100 THROUGH 15.107. d �' 618 Route 28 Pas t� West Yarmouth, MA 02673 SCOTT MCGANN,CERTIFIED SOIL EVALUATOR 0 20 40 60 (508) 771-4200 Email:ailcapeseptic@gmail.com SCALE 1"=20' Date:03/25/16 Sheet 1 of 2 if MA Check SM Project No.AC-50 'i TOP OF FOUNDATION MINIMUM 2("DIAMETER CONCRETE CONSTRUCTION NOTES EL=SO.ft CO SRAISEDTOWISNOT OF FINISH GRADE(OR A5 NOTED) EL=49.6t E1�9.4t 1.)ALL WORK SHALL CONFORM TOTHE STATE ENVIRONMENTAL CODE,TIRE 5(MO CMI8115.000): STANDARD REQUIREMENTS FOR THE SITING,CONSTRUCTION,INSPECTION,UPGRADE,AND rLjl EXPANSION OF ON-SITE SEWAGETREATMENT AND DISPOSAL SYSTEMS AND FORTHETRANSPORTAND DISPOSAL OF SEPTAGE,ANDTHE LOCAL BOARD OF HEALTH REGULATIONS. E 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED iN A LOCATION WHERETHERE 15 OTENTIAL FOR 4sof VEHICLES OR HEAVY EQUIPMENTTO PASSOVER II SHALL BE DESIGNED TOWITHSTAND AN H-20 GEOTEXTILE FABRIC 46A GE PLACE OF 1 BRI /2"PEASTONE) LOADING. IF UNDER AN IMPERVIOUS SURFACE,SYSTEM SHALL BE VENTED TOTHE ATMOSPHERE 3.)TO MINIMIZE UNEVEN SETTLING,SEPTIC TANKS SHALL BE INSTALLED ON A STABLE MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. 47.5t 4635 46.2 46A3 ) x q 3/4"to 46.7 45.9 ,. y 1-1/2 STONE 4.)COVERS OVER THE INLET AND OUTLETTEES OF THE SEPTiCTANK,THEDISTRIBUTION BOX,AND OB�-3 (Double wash) THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN 6'OF FINAL GRADE. LEACHING GAS BAFFLE H-20 Rated HAFIELDS,VEE ATRENCHES, LEEW ONE(1 INSPECTION PORT CONSISTING OF PERFORATED RATED a PVC MANHOLES OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS E PLACED SHALL LEACH-1CHAMBERS WITH V OF STO PRECAST E CONCRETE „ 43.9 D-BOX VERTICALLYTO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAR TIED WITH MAGNETIC L ENDS AND 4'ON SIDES 5 4 NARKING TAPE,ACCESSIBLETO WITHIN 3'OF FINAL GRADE " EXISTING 1,000GALLON - Longest RIM LEACH CHAMBERS 5.)PIPING SHALL CONSIST OF 4-SCHEDULE 40 PVC OR EQUIVALENT.PIPE SHALL BE LAID ON A (TO REMAIN) MINIMUM CONTINUOUS GRADEOF NOTLESSTHAN 2 %FROMTHEBUI DMTOTHESEPTICTANK, SEPTICTANK FLOW PROFILE (ENDVIEW) EL=385Bottom Test Hole ANDNOTLESSTHAN1 %OTHERWISE. 6.)DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4-'DIAMETER SCHEDULE 40 25.0' NOTTO SCALE PVC(OR EQUIVALENT)LAID AT 0.005 FT/FT.UNLESS OTHERWISE NOTED.LINES SHALL BE CAPPED BS' 8.5' AT END OR AS NOTED. f SYSTEM DESIGN CALCULATIONS 7.)LINES FROMTHE DISTRIBUTION BOXTO BE LEVEL FORTHE FIRSTTWO(2)FEETBEFORE PITCHING TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATERTESTED TO SEWAGE DESIGN FLOW REQUIRED:2 BEDROOM DWELLING @ 110 GPD/BEDROOM=220 GPD ASSURE EVEN DISTRIBUTION.'' REQUIRED 8.)GROUTTO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL '� SEWAGE DESIGN FLOW PROVIDED:TWO(2)500 GALLON LEACH CHAMBERS WITH 4'STONE ON THE ENDS AND 4'STONE ON THE SIDES 9.)HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE -t a _ , Vt=R25.0 x 12.83)+2(25.0+12.83)(2)x.74=349 GPD PROVIDED DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. �i 349 GPD PROMDED>220 GPD REQUIRED 10.)IN ACCORDANCE WITH 310 CMR 15.221,ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING TAPE. SEPTICTANKCAPACIT 'REQUIRED:220 GPD X 200%=440 GPD REQUIRED 11.)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED SOIL ABSORPTION SYSTEM. SEPTIC TANK CAPACITY PROVIDEI)t 1,000 GALLON PROVIDED(EXISTING) 12.)FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL(RECEIPT OF D-Box A GARBAGE DISPOSAL IS NOT PERMITTED WM4 THIS DESIGN FLOW THE CERTIFICATE OF COMPLIANCE,THE'PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT TEST HOLE LOGS USE OFTHE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. Test Hole#1 (EL=50.0t) 13.)THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS Layer Soil Class Soil Color Y+ CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BYTHE Depth Elev. Comments DESIGNER. 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT of THE 0"-12" 49.0 A Loamy Sand 10YR 3/2 BOARD OF HEALTH AND THE DESIGNER.THE DESIGNER SHALL CERTIFY IN WRITING THAT THE a SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT 12"-36" 46.0 B Loamy Sand 10YR 5/6 MC•�A AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE IS REQUESTED. 1Z.S 224 Pa► 36"-1.38" 38.5 C Medium Sand 2.5Y 7/4 15.)LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ANY WORK.THIS INCLUDES,BUT IS NOT LIMITED TO,REQUESTS TO DIGSAFE, Test Hole#1 (EL=50.Ot) ANY PRIVATE UTILITY COMPANIES,AND THE LOCAL WATER DEPARTMENT. Depth Elev. Layer Soil Class Soil Color Comments 16.)CONTRACTOR SHALL VERIFYTHAT ALL WASTELINES ARE CONNECTED BY WATER TESTING P WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. Proposed Sewage Disposal System 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY 0"-10-- 49.1 A Loamy Sand 1 OYR 3/2 SEPTIC SYSTEM COMPONENTS. 10"-34". 46.2 B Loamy Sand 10YR 5/6 176 Five Corners Road Centerville, MA 18.)TEST HOLES COMPLETED PER STATE ENVIRONMENTAL CODE,TITLE 5. SOILS CAN BE Prepared for: Prepared by: VARIABLE AND TEST HOLE DATA IS NO GUARANTEE OF SOIL CONDITIONS IN OTHER AREAS. IF 34"-138" 38.5 C Medium Sand 2.5Y 7/4 P SOILS DIFFER FROM THOSE SHOWN IN THE SOILS LOGS,DESIGN ENGINEER IS TO INSPECTTHE j Steve KalinyalC All Cape Septic LLC SOILS PRIOR TO PROCEEDING WITH INSTALLATION OF ANY SEPTIC COMPONENTS. 618 Route 28 DATE OF TESTING: 3l23/16 176 Five Corners Road 19.)EXISTING SEPTIC COMPONENTS TO BE LOCATED,PUMPED DRY,FILLED WITH CLEAN SAND AND SOIL EVALUATOR: SCOTT MCGANN Centerville,MA West Yarmouth,MA 02673 ABANDONED IN PLACE OR REMOVED AS REQUIRED.AREA TO BE COMPACTED TO MINIMIZE SETTLING. BOARD OF HEALTH AGENT:DAVE STANTON (508)77.1-4200 PERCOLATION RATE:. LESS THAN 2 MIN/INCH IN"C"LAYER AT 50" alicapeseptic@gmail.com NO GROUNDWATER ENCOUNTERED Date:03/25/16 Sheet 2 of 2 By-MA Chedc SM Project No.AC-50-Sht2 ..-.�...� ..�..�...----,....,......._-........._..-.......�....._.._.�-...-_____.-._._._._....,�-._.__..,m_,�...____._.._......_���_�_._�_.�.- � Co✓y .�?"��Cl c�/T f ra��„_._.,..___---..._.._...__. -' /��j�1Y o!✓/ram •� G t/ sq v 77 S IV ia�pf /G 7e .z c!'t A4 ,SC' 77 r )",Zoo x //,a x /. �� ��''r`� �e � fd � Pc�C�t ��3! 1'C rbt ��7 ` .3Z o�-► c tj /o f f 1X y s, z PLAN .of LAN® � a m _ Ce r/T',g5 v 14 t e MASS, OF'hf4-r tM OF y ©WNEU BY FRANK je>S C^��/7� A A � 4C C019ERY o CONERY y No: 6573 0 " Na ER FRANK CONERY 5 TRENTON iT. A��F �� � '�F 4.° HYANNIS. MASS. 0201 ,47/ v �. (.. b AL /v� � S �L � 4ss ONA��16\� (1 � �H�/G��'I�A0 r�snncweo�o�t�re ♦ uu+v suw�vow 1� s