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HomeMy WebLinkAbout0021 FOX RUN - Health 21 Fox Run, Centerville UPC 12534 No.2-153L©R "�snco HASTING*- MN No. �-� ,,Z — � , '' I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. .. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for � gpogar *pgtem Congtruction 3permit Application for a Permit to Construct( )Repair( /Upgrade( )Abandon( ) n&omplete System O Individual Components Location Address or Lot No. a 1 Owner's Name,Address and Teel..No. 00� Assessor's Map/Parcel 1 g cA 1 41 („ Ni'� Xn "Tt Ins 101 .'s Ne, dress,an T .No. � 363 4 1y Designer's Name,Address an ; 1 W � 5— 0-735 Type of Building: Dwelling No.of Bedrooms 14 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow I ID gallons per day. Calculated daily flow y© gallons. Plan Date 1 Number of sheets 1 Revision Date Title Size of Septic Tank I 1;C0 Type of S.A.S. Description of Soil txn/u Nature of Repairs or Alterations(Answer when applicable) CLQQ. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b�this Board of Flealth. Signed ` r Date Application Approved by _ _ Date Z Application Disapproved for a following reasons Permit No. 7 Date Issued I i-7 NO. .� ��Z —�� s,� ;' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS y 01p pY rat 4ott for Migoar*p5tem Con5truction Permit Application for a Permit to Construct( )Repair( v Upgrade( ' )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. F{1 mil. Owner's Name,Address and Tel.No. Assessor's Map/Parcel ' 8 + n AA!� In st is Name, dress,and T 1.No.. j 1 ��x l f Designer's Name,Address and Tel.No. r Type of Building: '' + Dwelling No.of Bedrooms W Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow L4 4 © gallons. Plan Date 11 Q'� ! Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil tSli� Nature of Repairs or Alterations(Answer when applicable) -01 4' ., Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed-M. �� Date Application Approved by �;! r� R Date P/ 7 ! 2 Application Disapproved for-following reasons t / Permit No. i 2 - 2 L 7 Date Issued -7 i .,THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance y 130,.,, THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandgned,__ )by - ,> at _ has been constructed i accordance with the provisions of Title.5 and a for Dis osal System Construction Permit N . 1? - 7 dated c4! x Installer - 0' Designer _$ ,A fi V)X2'a =ction=asdesignedThe issua a of this permi hal no be construed as a guarantee that the systerwilIC Date 1 �/ Inspector --------------------------------------- No. Fee' /00 ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1pigogar *p.5tem Congtructfon Permit Permission is hereby grant&d"fb Cons ct )Repair( Upgrade( ✓)Abandon( ) System located at S�i �vM h1l A 10.1 9 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. %(� Provided:Construction must/be completed within three years of the date of this pe hmt t? ) Date: rY/ ) 7 //7 Approved by --��/�//1,14_ _ C 4 Town of Barnstable Regulatory Services �Y Thomas F. Geiler,Director KAM Public Health Division 39. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: �- Sewage Permit# aW--o'er ? Assessor's Map/Parcel y` Installer&Designer Certification Form Designer: Installer Arlt. ��XCI Address: /moo ,C 4//2 Address: 245/ AJ o3 z 65_?2 CAS On J a cc� ,lc�,� /x;z., was issued a permit to install a (dat ) (installer)` septic system at based on a design drawn by (address) c dated designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required, spected and the soils were found satisfactory. - cF n;' ASSy N .�., ,f nstaller's Signatu (Designer's Signature) (Affix Desi J Here PLEASE RETURN TO BA STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL-BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification fonn.doc No. can to O%n V_ Fee 4.0-- `$ HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mi5po5ar 6p.5tem COttgtrurtton Verna Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑ Complete System �dividual Components Location Address or Lot No. / N d ` Owner's Name,Address,and Tel.No. C�N�i'r✓v��1-2 t} �� Assessor'sMap/Parcel Wi a.a ._ ' �O Installer's Address,and Tel.No. Designer's Name,Address and Tel.No. d�� s Po, 9o�C ISS7 � y Type of Building: / Dwelling No.of Bedrooms ell Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ` , Design Flow(min.required) 41 Lt O gpd Design flow provided V126. �o gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /S r,- !/f 00 _Type of S.A.S. O SO - �-- Description of Soil Nature of Repairs or Alterations(Answer when applicable) -� ✓ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date T�® Application Approved by Date 347 Application Disapproved by. Date for the following reasons Permit No. .��D ® Date Issued ———————— ——�—� _— - No. : l0 O� � � i �- . � Fee Ve 4HE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH`DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 1pplicatiori for nioo!gal 1p6tem Cori.5truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑ Complete System �idividual Components Location Address or Lot No: a N Owner's Name;Address,and Tel.No. Assessor's Map/Parcel �a. _ ' D Installer's Address,and Tel.No. Designer's Name,Address and Tel.No. T pe of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No,of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 41 L gpd Design flow provided 7 . �o gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank / ST/ jqj� Type of S.A.S. ` u Description of Soil s/^'e7 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o e Si ned ;Date Application Approved by �XDate ev Application Disapproved by: Date for the following reasons \ Permit No. Date Issued --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance t THIS IS TO CERTIFY I att On-site Sewa a Dis os 1 S stem Constructed Re aired U adedg P Y ( ) P ( ) P�• (Abandoned( )by pie G- � c- at 6k 1 1--0 uN C E 1Yf V/ If has been constructed in accordance / with the provisions of/Tit e 5 and the for Disposal System Construction Permit No..__,_)�o(0 "U dated Installer Designer_!�Zq /4 #bedrooms Approved design flow 7 4 gpd The issuance of this permit sh9lI no be construed as a guarantee that the system will fu c ib designed. Date YC3 Inspector V4 IV ———————————————————————————————————————————— No. - '' \ Fee /0 C) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS =igpogar 6p.5tem Construction PermYi i Permission is hereby granted to Construct ( ) pair ( ) . Upgrade ( Abandon ( ) System located at a c ✓(�i -P • � \ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special con tions. Provided: Construction must be completed within three years of th date of this ape it. Date 3/� Appro b Town of Barnstable �F tHE rp� o Regulatory Services Thomas F. Geiler, Director BARNSTABLE, 9�A MASS. ,m� Public Health Division 'E1639. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Desicner Certification Form Date: 3 Ole Designer: Shay Environmental Services, Inc. Installer: Address:. P.O. Box 627 Address: �rec�1 I East Falmouth, MA 02536 Aes>o �, � On J 30 No �� was issued a permit to install a (bate) (installer) septic system at Z v4 ` based on a design drawn by ( ddres Shay Environmental Services, Inc. dated 3f3c) 10(,a (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. 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 follower,-- o CARMEN n.y . E. = , (Insta r' Signat SHAY N No. 1181 0 SANITAR\P� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form =a 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I I, CiAl Z*J�E,.J &%fIq ,hereby certify that the engineered plan signed by me dated -�=E�j(.p ,concerning the property located at \ �-� C � v\ meets all of the following criteria: • This failed system is connected to a residential dwelling only. There.are no commercial or business.uses associated with the.dwelling. • The.soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests.at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The.bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information). �Z 0 B) G.W. Elevation 3 +adjustment for high G.W. DIFFERENCE BETWEEN A and B I o \ SIGNED : DATE: NOTICE Based upon the above information;a repair permit will be issued for bedrooms s maximum.. No additional bedroom are authorized in the future without engineered septic system plans. M �- i iw c gASeptic\percexemp.doe LQ-1� = )-J, TOWN OF BARNSTABLE ti LOCATION mill SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 52' -� INSTALLER'S NAME&PHONE NO.�„�,� f SEPTIC TANK CAPACITY LEACHING FACILITY: (type)`7osz2 2& (size) NO.OF BEDROOMS BUILDER OR OWNER �� C- �V PERMITDATE: % i'e 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 ,fir, �� p`t� _ 3 ys, I TOWN OF BARNSTABLE LOCATION _ SEWAGE # �G=�ll�(�� 9 a VILLAGE •�z" (VI <a— ASSESSOR'S MAP& LOT-2-�2 —166 INSTALLER'S NAME&PHONE NO.. f ' SEPTIC TANK CAPACITY P LEACHING.FACILITY: (type)�U5 /T (size) No.OF BEDROOMS (� BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of.eaching 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 r Vy< j63-55 A• y4 22 7 /I(�a f lo s£ L:0'�CA 'T10N SEWAGE PERMIT NO. 3 VILLAGE Li- INSTA LLER'S NAME i ADDRESS k� kC<" e U I L D E R OR OWNER s. No Ut D DATE PERMIT ISSUED i _ g _ gs DATE . COMPLIANCE ISSUED 4 - I � . 1 �l 4117 L 4--t . t � 4 No... S...�. Fss..... �`.......— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z?�wN........................O F.....�y sn,S��.$,�............................................... Appliration for Disposal Nurks Tonotrnrtiort Famit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ...................................... ..~� .........._......._................... 09 .-...._ Location-Address or Lot No. A✓�.�_.....B Ci_..�.�...I......riv..T �.. i e? C P-- vsL............................ ..... - l n Owner Address a ITiL��Y GO^Sv-r�ly'iG..� OsTE'�'vi'C ------------------•- ------•-•-----------._._..__..............---............. �d ...--•--..�---S...-••••-. Installer Address 14 Type of Building Size Lot... q. feet U Dwelling—No. of Bedrooms.............3.._............._..........Expansion Attic (.410 Garbage Grinder ('Ue aa Other—T e of Building No. of persons........_�............... Showers Other—Type g ----•----------------------- ---- --- ( ---)--- Cafeteria ( ) � gn Other fixtures ----/'eoo -............................- p ---- -------------------y---------:-------•------� � o gallons. ...---- W Desi Flow................................•....._..gallons per person per day. Total daily flow.._............. .__........_..._ WSeptic Tank—Liquid capacity.._.._...___gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area............._......sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by----- "�:._..._. ..... Date.....-3'!a_'_&.y........... ------------ Test Pit No. I......a......minutes per inch Depth of Test Pit------- Depth to ground water..'`-r_G............. r14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------------•--•-----------------.............................................................................................. O Description of Soil x Soil.......... ...............................................9c.Z a o sW;- A ------------------•--------------------------------------•-•-- ' •9'. me al�J� U ...........................................a:••-•--••-•••--.......-••---•-••--•.._.. W x ••----•------------------------------•---•-•----•-•------•---------••••--•--••-•--------•••-•-••-•••-----------•-••.......----------•-•--------••-----------•--•---•••-•--••---•--•---•--•-....._...... U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. .............................................-.............................................................................................................................:............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'J U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certifica of Compliance has been issued by the board of health. /1 Q J Signed.. - -1....... �c o- ✓- 3= - d .............................-- Date. Application Approved By......... •.•--•• . --........................... ----•-•--• ------- Date`• � Application Disapproved for th following reasons:---------------------------------------------------------------------------------------•--......------..._•••--- -•••-.....-••-••••--------••-•--•--•-•-••-•••--•....•-------•...-•-••--------••--••-------••••-------••--••---•••--••--•--••-•--•---•-•---•---•-••----•--•-•--•••-•------•---------------•----••---•---- Date Permit No......�d..c� ................... IssuecL...... .................... Date Finc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -'Gt+%a+ .:..:. > ......OF.... .�- .�Vplira ilan for Disposal Works (foustrurtiun Upumit Application is hereby made for a Permit to Construct (�-) or Repair ( ) an Individual Sewage Disposal System at: t, ................/., .......................................... ...LfA.411.-'.etnur.',t:-e-........ 1r3..:......................... Location-Address or Lot No. ... f?v,a ?.-...4�.c+:z d.A:. ----- S,- 14110....•"•--T�----�`'t............. r.. .�rr�L.1............._.......:...._ . ---•- Owner Address a .� ("A -:r:......--... ------•- .r ., Installer Address Pq VType of Building Size Lot... -----Sq. feet .-� Dwelling—No. of Bedrooms.............4............................Expansion Attic k14 Garbage Grinder (?,G,) Other—Type of Building ��' No, of persons........ ................ Showers a yP g - ----------=-------------- P - ( ) — Cafeteria ( ) dg Other fixtures ------..------- ----------- .... ---------- ---•---- ......----- y --------------..............................................o g� W P q P y� �'° gallons Length................ Width................ Diameter- ------ Depth................ Design Flow- --- . ------_. WSeptic Tank—Liquid Ll and ca aclt .._. gallons per person per day. Total dail flow................. ......................... Ions. 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 ( ) aPercolation Test Results Performed by....?ft ' ....3.girk r! ............................... Date_..a` Ga.-..&_y......_..... Test Pit No. I.....A.......minutes per inch Depth of Test Pit------es??.`..... Depth to ground water."..G.............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------•---------------------------------------•--•----•-•---------.....-•-----•-------------.......---......................------------.....-••-----•----- O Description of Soil -_a ...................�• �j "�' ------------------•---------------------------------------------•-•--..........---•-.----- (xj -••--------------------------------------�".�a......•-•--....�° ... ....- r!7P.9!!✓ W x -------------------•-•--------••--•----•-------------•--•---•----•--••-••-•-••----------------•--••-------•-••----------•------•---•-•---------•--------------•--•------•-•-••-•------•--............... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------••---------•----------------------------::...-------••---••-•---------------•-------------------------------•------------------------------------------------••_----- Agreement: s The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITA I 5 of the State:Sanitary Code—The undersigned further agrees not to place the system in operation until a Certifi to of Compliance has been issued by the board of health. Si ned _.. ------- --------------- Date Application Approved By......... ....... �_.......- Date Application Disapproved for th ollowing re ons:--•---------••-----------------•--------------------- --- = i -------------- ----------------------------------------------------------•---•--------------------------•----------------------------•-•--•----------------------------•---•--------Da......---••-•--- te Permit No...... �;,� ...-------•-•----...-•--- Issued_.-'==-=-'=---- . �----- -- "` Date -'`�-�..................... THE COMMONWEALTH,OF MASSACHUSETTS BOARD OF. HEALTH ... ......';OF.................................................................................... Tntifiratr of Tumplianrr THIS I TO CERTIFaaYJJ, Tha the Individual Sewage Disposal System constructed AA or Repaired ( ) by... .....-- 1:�- :..::::: .. ••--••--•---------------•-••----•-•-•----••---------•----••--•-•••.._......._......---- _ Installer at.......... 1 zj_....--- � + . J - r has beentinstalled in accordance with the provisions of TITLE 5 of The State Sanitary Co as escribed in the .- application for Disposal Works Construction Permit No........ dated___..__-I_ _-__q----..U.........:....... THE ISSUANCE OF THIS CERTIFICATE SHALL HOT BE CO STRUED AS A GU RA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................`T...- . ..-.. ..............--•....-• Inspector........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF..........;.......................................................................... No..... FEE•--- Si�— Disposal Works IWITP• nstrwtilan Uplerutit Permission is hereby granted,..... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit N ..................... Dated..... _-_...._......__....._........ Board eal .•: DATE �,g FORM 1255 A. M. SULKIN, INC., BOSTON -. •' ,per - \ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS z �) DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. NIA 02108 61 1-292-5500 W'ILLIAM r.WELD TRUDY COXE Governor Sectetan ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: �Z/ F4/( IPUA Address of Owner: Date of Inspection: �' �'`� 7 (If different) Name of Inspector: 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: EDcv41W C l i0'&31 QW Mailing Address: ►NOUD 4V67 tiQt4`617' /yM-4-6.25-C3 Telephone Number: Sag &'9 8 6�3�2 3 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation By the local Approving Authority _ Fails Inspector's Signature:K;S 7 / � �.� —/ Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit (lie report to the appropriate regional office of the Department of Environmental Protection. The original should be sent.to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Chec A, 8, C, or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: ,SEPTIC SYSTE/�� /S 1.v CvuR,t IitlG CO,v,0r;ftr✓ BI 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, 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 inspection if the existing septic tank is replaced with a conforming Septic tank as approved by the Board of Health. (revimod 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/I~.magnet,state.ma.us/dep 0 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: FOX RL)A) Owner: CH 12E K Date of Inspection: S),6-- J•7. eJ SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER ., . WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. T) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply, _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply 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 than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation.not valid). 3) OTHER (revised 04/25/97) Page 2. of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: a I FOX IZUAJ Owner: Date of Inspection:g�2 s_y.7 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 basis 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 box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 04/15/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ;?I FOX (QWv Owner: (f.F4 Q/—=(K Date of Inspection: 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 built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components g the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing in Ex. Plan at B.O.H. _ formation. , _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) (revised 04/25/97) Fags 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: ) Fox Ruty Owner: C f-112E K Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: V Garbage grinder (yes or p�9':/VD Laundry connected to system(92or no):y1C4C Seasonal use (yes or no):_ Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes oC D:-tV- Last date of occupancy: L/-(LQCL viol EfJ COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: HAS Ow, rCD m t/ F_ FcQ'tNRs-E yEA2S Pum l OJVC& t4gr 1167AR, System pumped as part of inspection: (yes or ►LO If yes, volume pumped: gallons Reason for pumping TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 11V 5119 UCKI y"8J Sewage odors detected when arriving at the site: (yes org Aro tzovimad 04/2S/97) Page S of 20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:;2 I Pox Rv/v Owner: C l/f'?(_K Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction hne' Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK (locate on site p an) Depth below grade: 011VcH5 Material of construction: concrete _.metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: iLg L—A'Z/1l0r�ftV Sludge depth: I iNc/ ��/NUNS Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:j/ C/ Distance from top of scum to top of outlet tee or baffle:`7//ye-tv5 Distance from bottom of scum to bottom of outlet tee or baffle: �d IrtacNS How dimensions were determined:1,4106' AlF45"ef Comments: in (recommendation for pumping, condition of inlet and outlet tees or baffles, dpth of�l+igtuidlUev� IaC�2outlet invert, structural integrity, evidence of leakage, etc.) � /S /N 004 � � P /p. 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: and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural (recornrnendation for pumping,,condition of inlet integrity, evidence of leakage, etc.) —' (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Fax RUN Owner: C�-�IZEK Date of Inspection: $.d5_97 ` 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: Capacity: gallons Design flow: gallons/daN Alarm level: Alarm in working order_ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) y DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal_, evidence of solids carryover, evidence of leakage into or out of box, etc.) otie MILE7' 01L)6 OIJTLE"j' 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.) (revioad 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I FOX 2VAJ Owner: C///2CK Date of Inspection: 9-_2 S_c?7 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: . leaching pits, number. Q&11 SIX- F007— 66'4C" /0/l' leaching chambers, number:__ leaching galleries, number: leaching trenches, number,length: _ leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetatiq�etc IQUt LEC,�L /S /C') .71) I i�ti°cN5 GEL& ✓ iti°t—ET 12cj CESSPOOLS: (locate on site plan) Number and configuration: Depth-top.of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) — PRIVY: (locate on site plan) Dimensions: Materials of construction: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Page of 10 (revised 04/25/97) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:a l FOX eUA) Owner: C HIW,�K Date of Inspection: g-,2 s-9 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) iq y' 3 y3' aN° 3`l (revived 04/2S/97) Pege 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: f0U/U Owner: C IA f ZL K Date of Inspection: Depth to Groundwater t&g Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA flaps Check pumping records Check local excavators, installers Use USG5 Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) DG 51(A/ PL61VS ©N: PIC60k D PROP Pi T L00-4 Tiow (IV4'TCR EL, (revimed 04/25/97) P&qe 10 of 10 I 2-18' DIAM. ACCESS MANHOLES e' VENT PIPE (0 Least 24 Inches tall) SECTION A -A i Schedule 40 PVC w/Charcoal Odor Filter °'' • '�'�':S`',�u� `�^'_�:.S s��' �`� � • 10' min. from 'NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. PROFILE VIEW OF LEACHING SYSTEM ; Existing Foundation house to septic tank D-Box cover must t» I �,; b " 9 Ssptic tank coven must be within 6 In. of finished groda Not t0 $COIC r, T.O.F. elev. 100.00 r n Bain. of finished grade x Grade over Septic Tank - 98.50 Grode over D-Box- 98.50 1 �--Grade over SAS - 98.50 to 99.50 INLET J " f/ a•y/fp•- f/�r• r..s.s A..saow. 31 Fox � to t 1/2 • Iea"d Crum"atone :y'i � � OU T � ✓ � ,1r" ro11k •d ti 1=1 S 0.02 3 HOLE 4•PVC CAPPED INSPECTION PORT TO BE .� �! ° Oe�ndv,evr (CAPPED) V V THE ACCESS COVERS FOR THE SEPTIC TANK, ��mac 3' Maximum Cover INSTALLED AND TO BE WITHIN 6. OF GRADE DISTRIBUTION BOX AND LEACHING COMPONENT } t d (H-10) WST. BOX To Load - Etev. a96,00 / L o 10' �0.04 1 P SET DEEPER THAN 6 INCHES BELOW FINISHED , • "C FROM FOUNDATION EXIST. 1,000 GA 10, 0• r foot d Top of SAS-€lev.�95,50 FINISHED GRADE ' GRADE SHALL BE RAISED TO WITHIN 6' OF STEEL REINFORCED PRECAST CONCRETE cJl' rn SEPTIC TANK � ff PLAN VIEW1bDf1e II H-10 or see. g N 20' EMeeflw Depth 24" Effective INSTALL TUF-TITE CAS BAFFLES OR EQUALS 6o0A `►•�_ �. p a , CONCRETEFULL FOUNDATK) II II Obi m C �S(detuall 6)2060 RandtvtH iSemyan �2DLY!NAW159 ° ai O -_ 4 p 3-24' REMOVABLE COVERS Y ' r .. II II u) y , e . C! SYSTEM PROFILE d 4 4 d 1 rn LENGTHS AS SHOWN IN PLAN VIEW Not to Scale i 1 •' 4• GENERAL NOTES ,2, j 3 min. clearance .• e e u Effective Width i INLET 8' min.- 2• mh. filet to outlet .� 1Y 6aEr t 1-__ 6•mh 1. Contractor is responsible for Digsafe notification, Verification of Utilities 6 b.of 3 4'-1 1 2' 10•min. L 'v'r- ouTLET and protection of all underground utilities and pipes. / / $ SOIL ABSORPTION SYSTEM CSAS> ,e 2. The septic tank a distrl ution box shall e compacted stone p >, � b set m° s -� , 5' --r level on 6" of 3�4�-1 1/2" stone. w e 4'-0• min. 3. Backfill should be clean sand or gravel with no NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6• BELOW GRADE Bottom of Teat Hole 1 Elev.-87.00 (OR EQUIVALENT) ,, b °"'"" `' 1�"b depth stones over 3" in size. No Groundwater observed o 132' :s 4. This system is subject to inspection Burin installation --- NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30' /EFFECTIVE HEIGHT IS 24" � y j p g :A by Carmen E. Shay - Environmental Services, Inc. ""' 5. The contractor shall install this system in 'accordance B'-a 4' -to* with Title V of the Massachusetts state code, the approved plan CROSS SECTION END-SECTION and Local Regulations. 6. If, during installation the contractor encounters any soil conditions or site conditions that are different TYPICAL 1000 GALLON SEPTIC TANK from those shown on the soil log or in our design NOT TO SCALE installation must halt & immediate notification be made to Carmen E. Shay - Environmental Services, Inc. TEST 7. No vehicle or heavy machinery shall drive over the P E R C O SAT I O N I ES I septic system unless noted as H-20 septic components. 8. Install Tuf-Tate gas baffles or equals on all outlet tee ends. \ Date of Percolation Test: FEBRUARY 27, 2006 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. Test Performed By. Carmen E. Shay, R.S., C.S.E. 10. All solid piping, tees & fittings shall be 4" diameter Witnessed By: WAIVER (per BARNSTABLE B.O.H) Schedule 40 NSF PVC pipes with water tight joints. Excavator: SHAY ENVIRONMENTAL SERVICES, INC. \ Percolation Rate: 2 min. fnch ® 0" 11. SITE and Surrounding Properties are Connected \ / 3 BELOW GRADE. to Municipal Water. Test Hole Test Hole No. 1 No. 1 DEPTH saLs ELEV..00 DEPTH solLs ELEV.8.50 THE PROPERTY LINES 'ARE APPROXIMATE AND � \ � 0 98.00 0 98.50 ' LOT #35 0\ O Sandy Loa Sandy Loam BAXTERCOMPILE& NYE MOF OSTERVI THE LLEP MA ENTILLAN TEDED BY \ 10 YR 3/2 r 10 YR 3/2 " f \ SRO 0. 10 A, s7so o'-s• a 98.0010ERTIFIED PLOT PLAN OF LOT_13 FOX RUN, CENTERVILLE, MA " 0 FQ any Sand DATED 2/08/1985 ro�'• OT barn Loamy IT SHOULD BE USED FOR NO PURPOSE OTHER THAN IQjG, �, 10 YR 5/6 10 YR 5/6 THE SEPTIC SYSTEM INSTALLATION. Failed ;� tiJ O _�1 _ s•-24" Bw 96.00 6•-30" Be 96.00 rye Leach Pit 6 �; ` v` F Medium Medium :, - �Y,gYJ Sand Sand EXISTING LEACH PIT TO BE PUMPED OUT AND zs Y 7/4 2 Y 7/4 REMOVED TO INSTALL NEW SAS. PROJECT BENCH MARK TOP OF FOUNDATION �. PVC C 1 87.00 30•-132• C/ 87.50 ELEV. = 100.00 (Assumed) ven�� ��� , L, 1,; s 6; '''z --100 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE D-Bo yI HOL/ FROM THE EXISTING LEACH PIT TO BE DISPOSED TEST HOLE �\ f-- TEST =/9 50 OF AS PER BOARD OF HEALTH SPECIFICATIONS. pp ELEV = 98.00 \\\ p> ELEV =�98.50 � \\ O E IST. 1000 GALLON a ---------------------- - �,_ L Ji S PTIC TANK -- _______j_ -� ASSESSORS MAP 227 PARCEL 160 EXISTING a ��, ----98 \ ` ,_-' / - CATCH,B DRIVEWAY __, ,,-96 `� ,�' -� ® \ R=S53.00 • ZONING RESIDENTIAL - ------ / R_-�I ��' L_ 2' \ Peptt erc: 30" D C G. p _,___----- ----- \ Pe t Rater 2 min. inch FLOOD ZONE �,r-----------__ EXISTING �' 1 0 47. \ \ Depth o P Groundwate Not LOT #34 __ __ - 4 BEDROOM 'f '�� L- � ' -_-___------ `\\ \\ \\ BOTTOM OFrTEST HOLEved k:ev. 132" µ T WETLANDS LOCATED WITHIN A 200' RADIUS ' _ 7.4T' - - _- I `\ \\ \ ADJUSTED H2O Elev. _.No Adjustment Required. OF THE PROPERTY ARE AS SHOWN. ' HOUSE - 20 / EXISTING ... � � � q 94-- ' -- ,, \ #2f GARAGE CID DISTRIUTLET BUTION UUTIONpBOX`s�' e LEGEND SET LEVEL FOR AT LEAST 2 FT. 12' CONCRETE COVER (� - DECK --' /' .. �� \\ 1 1 3- 6.OUTLET .a.+. 2 > 5 - \\ I \ i KNoaKouTs 8X0 DENOTES PROPOSED 5.5' OUTLET 12• INLET SPOT GRADE / ,- --------------- , \ I \ \o � '� °• DENOTES EXISTING \ ` SPOT GRADE �o ' / \\ \\ \\ ,66• 4• SCH.-4o'Te ,.TS• X 104.46 PLAN SECTION CROSS-SECTION `\ `\ >`\ `\ PL PROPERTY LINE ---' \� �\ I \\ i \rrl 3 HOLE DISTRIBUTION TO BO� H-10 LOADING PROPOSED CONTOUR --------------- - '� �''- ''� \ 1 �' --_-- ----- _ ��\ \1 \\\\ m\\'�I 1�1 97- - -- - -97` EXISTING CONTOUR co ------ -- - \ \\ z i ca Design Calculations ® DEEP TEST HOLE & PERCOLATION TEST LOCATION i LOT #13 Number of Bedrooms: 4 Bedroom EXISTING 10' 9 /- 5 �� \1� j LOT 12 Garbage Grinder: No �-- -� FENCE /�i� 42,456 Square Feat + / N # Leaching Capacity Required: 440 �� �L 1 i I 9 P Y q Gal./Day (MIN. PER TITLE V) QF �\ I ` I I 1 Septic Tank : - 2 x 440 Gal./Day = 880 USE EXIST. 1,000 GAL. Septic Tank. LOT #33 �e9> / / ECG �� SOIL ABSORPTION AREA: Using percolation rote of <2 min./Inch -I - PRIVATE DRINKING WATER WELL •� / O� I 1 Bottom Area: 0.74 gal/sq. ft. x 444 sq. ft. - 328.56 gallons Sidewall Area: 0.74 gal./sq. ft. x 200 sq. ft. = 148 gallons REVISIONS OF ��\ �_ � � �/ �/ I j ;Providing: = 476.56 gallons LANDS j I Use: (5) 3050 H-10 INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, NO. DATE: DEFINITION TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND 2' OF WASHED STONE ON THE ENDS. `y UNITS TO BE SEPARATELY PIPED AND PLACED AS SHOWN. I EXI ASr T. B O G ; Bed Bed i room Bed room room OPEN co FOYER // Co % co Boom BATH/ 190.93 � iw PROPOSED BATH BATH CLOSETS C PREPARED FO R . 1st FLOOR SCHEMATIC SUBSURFACE SEWAGE DISPOSAL SYSTEM OF MR. PAUL CHIZEK #21 FOX RUN LOT #3> #21 FOX RUN CENTERVILLE, MA �A�� r Living GARAGE LOT #3z CENTERVILLE MA O263 ,° Q� PREPARED BY: room FOYER 2 4 sue^ "RHEW E. SHA Y Dining . u �'NVIRON1�lENTAL SERVICES, INC.Kitchen lo. ' 131 A 1/2 Bath/Laundry P.O. BOX 627 P O 0 20 40 50 �G�sTt��` A�I7ARIP '' EAST FALMOUTH, MA 02536 2nd FLOOR SCHEMATIC 77-1 ,,, TEL/FAX : 508-539-7966 4 BR HOUSE FLOOR SCHEMATIC SCALE: 1 "=20' DRAWN BY: CES DATE: MARCH 9, 2006 PROJECT#SD-873 FILENAME: SD873PP.DWG SHEET 1 OF 1 I •' INSTALL RISERS COVERS TO PIPES TO BE LAID LEVEL FOR DEEP OB Ep ATI HOLEWITHIN 6"OF FINISH GRADE 2'OUT OF DISTRIBUTION BOX S I\V ON HOLE LOGS, (SEE PLAN VIEW FOR LOCATIONS) WATER TE5T D-BOX FOR DATE: 09 12-20 i W ! LEVELNESS�FLOW TE5T BY: M. O'LOUGIILIN, C5E EQUALIZATION WITNE55: D. DE5MARIA5, I-'EALTH AGENT OL PERC RATE: < 2 MIN./ INCH EL. 58.3 EL. 58.3 EL• 58.3 T.O.F. @ { m 5C P H 70P DEEP OBSERVATION HOLE# EL' 58.5 EL. 59.0 ao rVC @ EL 55.4 m _ 4 DEPTH o SOIL SOIL SOIL CO OR SOIL T } 56.7 56.00 55.50 BY INFILTRATOR SYSTEMS, INC. BOTTOM EL. 54.I FROM HORIZON TEXTURE OTTER :.: N5FALL GA58AF- 5.67 @ SURFACE (MUNSELI) MOTTLING Q (EXIST.) NourLe ree 55.75 `5.00 i t••- P V DB-6 8 _34" Bw SANDY LOAM I OYR5/6'' (H-2�) 34"-64" C I COARSE SAND w/GRAVEL 2.5YG/4 I ` 1 NOTE: REPLACE ANY ORAIvGEBERG INSTALL TANK*D-BOX 6.6' 84"- !32" C2 MED. COARSE SAND 2.5Y7/4 ON G"LAYER OF CRUSHED BOTTOM OF PERC: 48" Q PIPE ENCOUNTERED WITH 1 500 GALLON PRECAST STONE PRESOAK: 24 GALLONS IN 7 MINUTES 5CH 40 PVC SEPTIC TANK BOTTOM OF TEST HOLE O w @ EL. 47.5 IL LC?CUS DEEP OBSERVATION HOLE#2 EL. 56.5 a V (n DEPTH - Q p FROM SOIL SOIL SOIL CO'-OR 501E OTHER u e SEPTIC SYSTEM PROFILE SU FACE HORIZON TEXTURE (M.JN'SELL) MOTTLING l P y 2"-32" Bw SANDY LOAM I OYR5/G 32 -84" C I COARSE SAND w/GRAVEL 2.5YG/4 84" 132" C2 MED. COARSE SAND 2.5Y7/4 NOTE: NO GROUNDWATER ENCOUNTERED IN ANY 055ERVATION HOLE r -. DESIGN DATA _._-___ DAILY FLOW: (4) BEDROOMS x I 10 GPD = 440 vPD € DINING SEPTIC TANK: 440 GPD x 200% = 880 GPD RCaCUIvi USE: - 1 500 GALLON PRECAST SEPTIC TANK LIVING I DISTRIBUTION BOX: USE: DB-G (H-20) ROOM 501L ABSORPTION 5Y5TEM: +57.2 FAMILY GARAGE USE: (2) ROW5 OF (7) HIGH CAPACITY CHAMBER` BATH KITCHEN ROOM CAPACITY: (2)(43.75) x 7.79 5F/LF x 0.74 = 504.4 GPD 58 ,. _._. 58 f IRST 1=L.00R GENERAL NOTES VY _ I ;__P�>?-1r. - i5-TO D' INSTALLED IN ACt.OR[7AN(wL WITH -..ram. .,v s - !-- ----� 3I O CMR 15.00: TITLE V �\ 5EDROOm _ 5EDIIOOM 2. THIS SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL. 3. THI5 PLAN"I5 NOT TO BE USED FOR PROPERTY LINE DETERMINATION. �� ; �,� / � ' 4. CONTRACTOR SHALL PROVIDE 48 HOUR NOTICE TO DESIGN ENGINEER FOR ANY REQUIRED INSPECTIONS. ;EDROOKA 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY (.. BEDROOM BATH UTILITY, ABOVE OK UNDERGROUND, PRIOR TO ANY EXCAVATION OR CONSTRUCTION. G. EXISTING CESSPOOLS TO BE PUMPED DRY � CKU5I-IL- ) IN, • i /' Off' J•�\ l _ SECOND FLOOR BACKFILLED WITH CLEAN SAND. ' 7. REPLACE ANY ORANGEBERG PIPE FOUND WITH 4 5Cf-1 40 PVC. �G ``` O c�NSF , � tio 58.2 � co �o APPROX. LOCATION OF ♦ tiC EXISTING CESSPOOLS ti 51TE SEWAGE PLAN �2 c,� • �, 58.2 FOR INSPECTION ♦ ' 21 FOX HILL ROAD CENTERVILLE, MA O TH#1 PORT ♦♦ �`` ♦ PREPARED FOR TH#2 58.4;,,_ ESTATE OF ROBERT TIVEY sINSPECTION OO `�\ PORT ti SCALE: DATE: DRAWN BY: �3 58. 1 - I (I'= 20' TMW JOB NUMBER: REVISION: SHEET NUMBER: V o2''vl4'lE3A �1 MEYER o.35791 No. 114Q _ 55.4 S �fi WELLER ASSOCIATES �FOS N.� GISTER� " u SgNITARIPM I G45 FALMOUTH KD, SUITE IF9 - P.O. BOX 4 17 �'I Z It CENTERVILLE, MA 02G32. 1 ( TELEPHONE * FAX: (508) 775-0735 EMAIL: trisweller@comca5t.net REGISTERED LAND SURVEYORS ENVIRONMENTAL CON5ULTANTS Traver5e FG m x I L('�T . be rL ��•�MM .h*'"M�sw..yYv+a•......c...-r. "Y P ` io I ` �.� �a �p C r y. r �. -21 i TL rY � vAti SL 4.9 P7f£3 � t _!: 7-- w 3 Lo 7- / 6. 70 DAVil No. VAl D/Sri ,� fT�" I � Z/ 1 L. r _S�: T'.'G T� � 3.3G� .-�►C r� �,� - e19S 40. -A?ems. Ov /.'Ve 7E3A .�" .+Q ". .1..'.. _. fir y /ln .1..• :LA C .�a! e::l ,4/1V lotz +7",�'r✓II A4 .A/7.."' f If a ►,? a t wwi�*