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HomeMy WebLinkAbout0107 GLENEAGLE DRIVE - Health 107 GLENEAGLE DR. CENTERVILLE A = 191 141 010 No. 42101/3 ORA 1 0% ; ® 4� O 0 Town of Barnstable P# Department of Health,Safety,"and Environmental Services �IHE Public Health Division Date a� 367 Main Street,Hyannis MA 02601 nwruvsTesrE Date Scheduled 7A2o/7 Time w� Fee Pd. I r-A Soil Suitability Assessment for Sewage Disposal s Performed By: Witnessed By: ����� W _.-. .- .. .. . _ _.... ... ....._.__........_._......-...__...._...... ._........:...__._......... ........._-. ...... ....................... ..._--.....__......................._.............................................. ................................... ._........ .. ... LOCATION & GENERAL INFORMATION,;; . . Location Address 9 �G�,� �.4z--- ..,ye-rv6 Owner's Name �p /O 7 C. p2 C-7 _.._ Address,' Assessor's Map/Parcel: j / Engineer's Name` j 7 NEW CONSTRUCTION REPAIR Telephone# 5bo 3loZ / 3 t Land Use Slopes(%) Z Surface Stones �zs Distances from: Open Water Body t-- It Possible Wet Area ft Drinking Water Well ft Drainage Way zS It Property Line 70-01 ft Other SKETCH: (Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) } I n J aIN V� I Parent material(geologic) Z>` 05 Depth to Bedrock Depth to Groundwater: Standing Water in Hole: ) J Weeping from Pit Face E-stimaied Seasonal High Groundwater DETER1�IIlYATION FO.R SEASONAL TCI IATEiZ TT.E . . Method Used . :: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side.of obs,hole: in. Groundwater Adjustment ft. Index Well#_ Reading Date: Index Well level.;._.__ Adj.factor_ Adj.Groundwater Level PERCOLATION 'PEST Date Time Observation Hole# Time at 9" 3 /S Depth of Perc Time at 6" Start Pre-soak Time @ d' Time(9"-6") End Pre-soak 'G'e Rate Min./Inch Z_ Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant.' '! DEEP OBSERVATION HOLE LOG < Hole'# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface in. ( ) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) 3 DEEP OBSERVATION HOZ)�,L:OG Hale __ .. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° ravel L ��- 2- L 5 >6 Y.L. 3�2 �Z L 5 DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulderes. Consistenc %Gravel DEED' OBSERVATION HOLE LOG JEI0 e#< Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel I � Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on l/ IY S,(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,exp rtise and experience described in 310 CM.R 15.017. / ?Signature _ Date� r�� Town of Barnstable Regulatory Services Richard V. Scali, Interim Director • sn[uvsrnaLE, Public Health Division �Ep►��s Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# ; 6/4 —JeQ,) Assessor's Map\Parcel 14 Designer: STC-�Htv-� k N�1•S , (�c Installer: Address: P.o.�o,� 1S Address: !a 'U�•E� rP On /�2_-�2-7-jG //�,,& was issued a permit to install a (date) (installer) ' septic system at I D'1 4L 60 4=A-4 LC_ 0,-r V based on a design drawn by ` (address) 1�> dated (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed.with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I\A approval letters (if applicable) ^md_ OF 1 nstaller's Signature) G �`' iSlf4 (Designer's Signature) (Affix Desigiier'cs1'St p ere) 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:\Septic\Designer Certification Form Rev 8-14-13.doc AsBuilt Page 1 of 2 TOWN OF BARNSTABLE LOCATION r SEWAGE '" VILLAGE ,y ` ASSESSOR'S`-MAP&PARCEL.I IV LNSTALLER'S NAME&PHONE N0. TPI j ) . SEPTIC TANK CAPACITY LEACHING FACILITY:`( e) NO,OF BEDROOMS / OWNER t(?L�,`t �r)G PERMIT DATE; /,�:�27 26 A, COMPLIANCE DATE: Id -JJ -4 , 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 leach ing.fac il ity) Feet Edge of Wetland and Leaching.Facility(If any wetlands exist within f 300 feet of leaching facility.) Feet i FURNISHED BY r�7HPG. j _Z7 I I http://issgl2/intranet/propdata/prebuilt.aspx?mappar=191141&seq=1 5/9/2017 1 No. ll/ l Fee ©� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: y" PUBLIC HEALTH DIVISION - 'tOWN'OF BARNSTABLE, MASSACHUSETTS Yes Zipphtation for M' al 6pstem Cunstruttion permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Individual Components LocatioijAddress or Lot No.A � � 3/.0 Owner's Name,Address,and Tel.No. Assessor ..r Installer's Name,Address,and Tel.No. Designer's Name,A dre sand Tel.No. Type of Building: Dwelling No.of Bedrooms _ Lot Size ��, 7/," sq.ft. Garbage Grinder( ) Other Type of Building g' 3 ? No.of Persons Showers( ) Cafeteria( ) Other Fixtures �� Design Flow(min.required) j ✓ gpd Design flow provided ,r? gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank IOCC> /1,C1— Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site Y sewage disposal system in P 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 t . Signed r Date f l� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued c7� Fee- !4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: tr-- I' PUBLIC HEALTH DIVISION -t OWN°OF-BARNSTABLE, MASSACHUSETTS YeS f ih q'• b•. G' application for Vsposar *pstem Construrtion j3ermit V Application for a Permit to Construct( ) Repair grade( ) Abandon( ) ❑Complete System R Individual Components Location Address Lot No/ Can �� Owner's Name,Address,and Tel.No. Assess cel M Installer's Name,,Address,and Tel.No. Designer's Name,Address,and Tel. Type of Building: `Dwelling No.of Bedrooms Lot Size f�. ?/.? sq.ft. Garbage Grinder( ) Other Type of Building , No.of Persons Showers( ) Cafeteria( ) Other Fixtures " Design Flow(min.hrequired) 9157 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Y ,. Title Size of Septic Tank /Oc> Type of S.A.S. Description of Soil � Nature of Repairs or Alterations(Answer when applicable)&.,�?' to) Dafe 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 Re altU. ` Signed _ Date /,Z ' � �•Ea Application Approved by Date Application Disapproved by Date for the following reasons Permit No. r�/(o �1 / Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(a() Upgraded( ) / Abandoned by Joh a �l> V at !0J 6/P v Q�,4 q/L6, VIP 6 (_,`/has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No h 4 / dated Installer %z• %p/V ,,/1) Designer ��tlP , #bedrooms "Z r Approved design flow „ D gpd The issuance of his, ermit shall not be construed as a guarantee that the system will DasdesiDate (� �C1 Inspector - - - - - = = - -- ----------------------------- ----------------- Fee `0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construrtion permit Permission is hereby granted to Construct( ) Repair ,./ - ,Upgrade( ) Abandon( ) System located at / '�.� QJ-e 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 co letted within three years of the date of this pe it. DateXqq Approved by �— TOWN OF BARNSTABLE LOCATION /0 7 640—AJSEWAGE# VILLAGE 4Je ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f �3 LEACHING FACILITY: ( e) e V (size) , NO.OF BEDROOMS OWNER L�`�G.�4 be U,!�,,S6 PERMIT DATE: A2. 7_,26 14 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 -S^ - 300 feet of leaching facility) Feet FURNISHED BY r 2 - cl =z7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Mi0pogal Opotem Conotruction 3permit Application for a Permit to Construct( )Repair( )Upgrade,O Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f a-7 le V/f%�i-�i 'D1 Owner's Name,Address and Tel.No. �{-c v L L� 2e,SS Assessor's Map/Parcel 0(— Ile f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �P /'►�ta2 t eC? ��. �..e ��o Type 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 33 Q gallons per day. Calculated daily flow gallons. Plan Date /!w< I_L3 �" Number of sheets Revision Date Title Size of Septic Tank /U cj Type of S.A.S. 1 F Description of Soil Nature of Repairs or Alterations(Answer when applicable) S+� l� /Ve—'4/ E?h C 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 f i e 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu �bysd Heg4h. Signed � Date A � a-� Application Approved by C` Date ai Application Disapproved for the following reasons Permit No. 2 rf-) — 0 L-)C) Date Issued 3lol y a . Fee - Z 4� / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yest` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS , Application for 30i5pogal &pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade )Abandon( ) 0 Complete System O Individual Components Location Address or Lot No. l 0 7 G le N`o,4.5 -e 'D2 Owner's,Name,Address and Tel.No. Assessor's MapTarcel (bl j_ ' ( 4_V �O Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. _'P M62 C:et lt4 1. o Type of Building: i Dwelling---No.of Bedrooms 4144 Lot Size I67sq.ft. Garbage Grinder( ) -Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow 3 3 \ gallons per day. Calculated daily flow gallons. Plan Date Number of sheets —Revision Date Title i Size of Septic Tank /U y d Type of S.A.S. T n 'f 1 �(a,kctiVf I�X � Description of Soil Nature of Repairs or Alterations(Answer when applicable) Lti 5��} l/ AM- h 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 ofTft�e 5 of the Environmental Code and not to place the system in operation until_a Certifi- cate of Compliance has been issu d by t s oardof Heoh. Signed n Date 4 ° 2- Application Approved by Date 1 Application Disapproved for the following reasons -41 Permit No. C C) - o C'(1 Date Issued 31 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(G-)Upgraded( ) Abandoned( )by J e /or,A-Ity at 10 -7 6124l e<4 le 222 �'e / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.aQ-U(I) dated (11 IU 1 Installer A4,.,e/,C, Designer ��✓ The issuance of this permit shall not be construed as a guarantee that the sy temnvill func 1 n as esigned. Date `� Inspector Q � � � —----------------------------- — -- ——— -- . No. .�, "'�'mil Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migoar *pztem Con6truction Permit Permission is hereby granted to Construct( )Repair( `>)Up rade( )Abandon System located at ( y to AI f 4 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. ,Q Date: <; 'y "` Approved by -- . 5/25101 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated 0v6 ?� Zv a 1 , concerning the property located at 167 meets" all of the following criteia: Co This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. C 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 preliminary tests at the site without a health agent present. C 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 not"be located less than fourteen (14) 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) 1 .3 B) G.W. Elevationn_+ adjustment for high G.W. 3 = 3 DIFFERENCE BETWEEN A and B SIGNED : s DATE: NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health Folder:percexmp o F TOP OF FOUNDATION ' �.� CONCRETE COVERS I 30•,_' ..`• 4"CAS; IRON 9�n / ....._ , . ...1 .., ... .F�' C.2/aflG� ` LZ. 30 '. OR SCHEDULE 40 - ULE � 4 SCH_DUL;, 40 P.V.C. (ONLY) 9"MIN. LEACHING TRENCH ( �)REQ. � P.VC PIPE MIN. - � PIPE-MlN. 24" - 1/8"- i/Z" WASHED STONE _ 3+"M.4JC. °,' PITCH 1/4"P�.FL PITCH !1V$.Ri GAS BAFFLE—s �Gev: ----------------- ;•• Li'- SEPTIC 1C 7P1NIK INV�T 'STD E iNV=.-ii �•• iNVrrT s„L•?/30, iV- .� /oao GAL.. INVERTDIST . INVc ��--==s_�c�=��c� �I• BOX ., _93 HANCOR ENVIRO 4 -1 2 6 cRusxED sro�E I CHAMBER(orequal) wrsxED STONE ��, • � 33 •:.�•. PROF]LE Or r !.:-�!• GROUND WATa..� iA3'a SOIL LOG SEYYAGE DISPOSAL SYSTEM i IM_ ........ . .. . . NO, SCALE TES Ho°l I TEST HOLE Z ELEV. :oa.. .. =may. _, . . •e • ... DESIGN DATA : ate- Co/�•r I n S�d.g3 off � TOTAL ESTIASAT-ED FLOW •330. . . GALLONS/DAY But i M LZAc::I;vG AREA SI D E L ACH 1 N G AR=A , , 1G 2.t3:- . . SO.:i-/i r.=NCH 1 ' 1 34' GARBAGE DISPOSAL . lY't%% .(50 co AREA INCREASE) ive>E �vy/i�ts-Cs/q.�B� �/g2gLr TOTAL L=nCHiNG AREA �`J. f. .9.`�.... s►'..:i, = to NA✓E 48"0I4 ,Sg1tD No.vN S1a�/C a."/acc_ .SIDBT Pr-RCOLAT10N RATE : ;;►! L."�i!S!/r=R.INC:i toA/7&M � LEA04ING AREA PER PE-RCOLATION rP ,-E / GZ./o.eo ® 0 0 APPROVED .. . . . . . . . . .._ BOARD OF KEAL.T'rl " ......WATER ENCOUNTERED - DATE ....... WITNESSED BY : AGENT o.� .r1sP= T - - � 0� Mgsf4 o��f),Ofl OF o EDWARD � o . .. 4.4 • v2R . . . .. 30^.r`�.D Or HsaL'e it LoT /o E. �� KELLEY N P G/l/tyG '2. •��2?. p ENGINEER • /v7.G'�N�✓E/-IEEE. D . . . No. 26100 . . C6.v��✓/LEG MA. s�®SAL LAQ1U`'� 8T�P� / ' j_; . • - PETI;lON a .T•�. rlo2/A/ s+nrtea�*'� ! . . . . . I A LOCATION , CL-7VTtViGLG M/� . SCALE . ��= 30.�. . . BATE !�c•G; 2�, Zip,/, PLAN nErEf?F1VCr , :q4-7/YG. . .47-.IvIa. Zee;, . .P�: 7/ /I Ss&-ss0/1—s M'lp /9/ 1- — N ti N - / 77 I 20�� 7�l.'r/CN J /o b'3 y33' ra --..r,-i Girl i r �♦1 Tj � a OAK � O pT tJ N Norte- �Zis�in/C- .�isrYe��3urio.v .Bax 73 C36� 4!5FW/ NG L ev P17- 7V Au kip ev G7 -D �� OF LV/77/ C� -S/Y��, o�' . EDWAR KLE" N o. 26100 Q ►STER`�0 `�obgL LAND S TOWN OF BARNSTABLE 6C_ L0CA21ON `J e SEWAGE # VILLAGE_' ��✓ � r�,`�+ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. T P 9 -710 SEPTIC TANK CAPACITY -- if® LEACHING FACILITY:.(type) 1 l X 3 -3 eA c (size) 66- GeOV J-PUT';' ,,NO.OF BEDROOMS ' T ~� �t/e BUILDER OR OWNER) PERMITDATE: / � COMPLIANCE DATE C� 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 r on site or within 200 feet of leaching facility) mod' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ��/ Feet Furnished by t :. � . 13 -y: LEGEND s = NEW CONSTRUCTION EXISTING CONSTRUCTION 'U �^ w 24 D �� ✓ � 3 r,.-e'ooPu[P L[nc,n it -J VL ,/ _ e-+o' I rr ---------------- a 1/r,u 1/i U Mq ITI (n 21110 tl l0 Aw ST Dwc.5—A]nuc w ATM ]0 1 8•[19 I/i 10 1/8•119 1/i «+SnE CCO1�A]00N Sucn _ ' ' AS PMI[P u100-0 S1M n[MPOOu PLOUIPCUEMS so . OFT COMPUTER AREA I nou: 11 i LM„wn � _7E•x 19 T i,9e] II ovra�oPEn I� awL EXISTING BALCONY(' iA ,m !CUPPED CEILWG 111E( 1 1YP KxI�« 11` eJ CIIS1inG DwELLwG - CASED OPEW1- - MASTER BEDROOM -e- r-e- ' 1,901,1.1,1 VWX I —� �— — O I R 1 I I /CDPPC0 count LINE MP..)J I - - 1 / ,I Q 1, I D. " AIIO I 1 1 I I I I 9.9/S 00,.1/[IS11 - J LL I r O w SCALE: DATE: PROD. # J �� II�L._ t/4"=1'-0" 13-JULY-2001 1317 E��' � D E L 1 A P R 0 P 0 S E D 2 N D F LO 0 R PLAN ADDITIONS & RENOVATIONS SHEET M F R Y A 0 LIVING DESIGNS 2001 Z JE F E A. B RNABY, CPBD COLARUSSO RESIDENCE A— 3 CERTIFIED PROFESSIONAL BUILDING DESIGNER D- ua�LW[ o...uu a co' aao nG1 131 QUAKER MEETINGHOUSE ROAD. E AST'SANDVICH, MA. 107 Gleneogle Drive, ,„,[PPGNPS�OF�pSCPIPwt[][D�Pe Gn,K:< TEL. 508-888-2747 IAn9.P[*D a ePouun w n,[+n[.nK.+or Centerville,, Ma. 02xxx OF 5 f r M Fo i 3y LI) n b-e-Dluvu 1 bt Z Z COMMONWEALTH OF MASSACHUSETTS EaECt'TIVE OFFICE OF E?�-IRONMENTAL AFFAIRS DEPARTMENT OF ENVIRON;IE\TAL PROTECTION ONE WINTER STREET. BOSTON. N1A O:IOS Fl :9:•S:OG 11ILL1A�t F.WELD ?: TRI-•DY CO?ZE GOve-.nc' - .. ARGEO P.4L1 CELLLCCI _ _ DAVID B STRL:1-_ Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ..--, Comrnissio= PART A CERTIFICATION Property Address; 1 p Address of Owner: I�H�w P m' -I �atr►Qa�lc. l��t,(,aTt�:v►��-�.�3 :(If Date of Inspection. gjiltj nn -� 2, -- -� Name of Inspector: N.�� / a Y 11 E D, �C�� am a DEP ap roved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 13.000) Company Name: o Mailing Address: p O /;enx H,K&4f. _ / 5-c7 2C4-q . Telephone Number: rSG2T C /Lf a CERTIFICATION STATEMENT I ce.^-rf� that I have pe•sonalb. inspected the sewage disposal s}stern at this address and that the information reported be!oN is true. accurate and comole!e as of the time of inspec-oo ct The inspe ,on was pe-iormed base--' on my training and experience in the proper tuncien and maintenance of on-sae sewage d;sposa: systems. The wsterr.: Passes _ Concioonaii% Passes _ Neecs Funhe- E%-a!uat;on Sy the Local Approving Authority Fa•-s _ Inspector's Signature: Date: 1 1 T;ie Svste^ Insc-e:o• sha!! submit a copy of this inspection reper, to the Approving Authority within thin (30) days of completing this inspection. li the system is a shared system o• has a des,gn flow of 10,000 gpd or greater, the inspector and the system owner shall submit the repo tc the appropriate regional onice of the Deparment of Erivirenmenta� Protection. The orig:na! should be sent to the syste r+ owner and copies t-nt to the buver, if applicable. and the approving authorin. INSPECTION SUMMARY. Check A, B, C, or D: Al SYSTEM PASSES: X1 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: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The systern, 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 inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. trev.zod 04125!9') Page 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART A CERTIFICATION (continued) .- • -- ''' "-` Property Address: . Owner: _ . _.. . ... . ..:. _.. . �{ Date of Inspection: =-V=��'�''r MC 61 SYSTEM CONDITIONALLY PASSES (contin j,d broken r •obstructed x i u o o e -o o ucted r high static ware. level observed in the distributionbox s d t b . _ Sewage backup or'breakout o g pipets) or due to a broken, settled or uneven distribution box. The system will pass inspe ion if(with approval of the Board of Healthi. 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 ob ucted pipe!s).•The system will pass inspection if twith approval of the Board of Health): - - broken pipe!si are replaces -_ obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health n order to determine if the system is failing to proteZ the public health, safe-,.-and the environment. 1) SYSTEM WILL PASS UNLE55 BOARD OF HEALTH DETERMINES AT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY A D THE ENVIRONMENT: Cesspool or prn, is within SO ieet of a surface wat Cesspool or prn,- is within 50 feet of a bordering egetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH. ND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER TH PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: r _ The system has a septic tank and sail sorption system (SAS) and the SAS is within 100 fee/, to a surface ware. supply Gr tributary to a surface water supply. _ The system has a septic tank and s it absorption system and the SAS is within a Zone I of a public water supply we!l. 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 fee! but 50 feet or more from a private water supply well, u iess a we!I water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollu 'on from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Meth used to determine distance (approximation not valid). 3) _ OTHER - -- - (revised 04;25/91) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM 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 defin to 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to deter ne what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or ogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface w ers due to an overloaded or clogged SAS or cesspool. Static hquid level in the distribution box above outlet invert due to a overloaded or clogged SAS or cesspool. liquid depth in cesspool is less than 6" below invert or available olume is less than 1/2 day floe. Reouired pumping more than 4 times in the last year NOT du to clogged or obstructed pipes:. Number o;times pumped _. Anv portion of the So!l Absorption System, cesspool or pr • is below the high groundwater eievation Ar.y portion o'a cesspool or privy is within 100 feet o a surface water suppiv or tributary to a surface water supply. Any portion of a cesspoo' or pricy is within a Zone of a public well. Am po^lo-. o;a cesspool or pri,.ti is within 50 f t of a private water supply well Any por,.or: o'a cesspool or prey is less tha 100 feet but greater than 50 feet from a private water suppiv well with no acceptable water qualir� analysis. If the w• I has been analyzed to be acceptabie, anach cope of well water analysis for coliform bacteria. volatile organic eompo nds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes' or "No" as to each of the following: The foho�A.rg criteria apply to large systems in addition to the criteria above: i The system serves a facilit% with a design flow of 10,000 god 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: i 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 04/7/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 107 4(714AJ4-11 L'O&, Owner.-? wT:irZs Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes NoYe _ Pumping information was provided by the owner, occupant, or Board of Health. x _ None of the system components have been pumped for at least two weeks and the system has been receiving normal r1 flow rates during that period. large volumes of water have not been introduced into the system recentl% or as pan of this inspection. As built plans have beert obtained and examined. Note if they are not available with N/A. The facilin or d%%ellrrtg was inspected for signs o�sewage back-up. --r _ The s•stem does not receive non-sanitary or industrial waste flow. _ The site %%as inspected for signs of breakout. _ All stem components. excluding the So![ .Aosorption System, have been located on the site. The septic tank manholes mere 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 Svstern on the site has been determined based on: x _ The facdit� 0%%ne• iano occupants. if difteren: trom owners were provided with information on the proper maintenance of —t Sub-Surface Disposal System. N A Existing information. Ex. Plan at B.O.H. _ De-,ermined in the field +r•,'am of the failure criteria related to Part C is at issue, approximation of distance is unacceptable (15.302:3t;blj (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.tit PART C SYSTEM INFORMATION Property Address: 161 4kii v'7�k p� Owner: ?&k4k Date of Ihspection: `2/1 I FLOW CONDITIONS RESIDENTIAL: Design floN 0 e.p.dA)edroom for S.g15 Number of bedrooms 02 Number of current residents Oz, Garbage g,.,der (yes or no}:_JJ Laundry connected to system (yes or no!4- Seasonal use ryes or no!:_LJ Water meter readings. if available (last two Qi year usage tgpo): N Sump Pump Ives or no): fU Lai: date o'occupanc1 Seruer--- COMMERC i AL'INDUSTRIAL: Type of establishment Design fiov, _gahons/da-, Grease trap present. rues or no_ Industna! %Haste Holding Tani; present. Ives or no ':on-sanitan Haste discnargeo to the Tate 5 system. ;yes or no X%ater meter readings, if availabie Las:pate of o .;.pane. OTHER: .De:cribe Last care of occueanc. GENERAL INFORMATION PUMPING RECORDS and source of inform�tio u NtS !]?14 De►o tt System pumped as par, of inspection: ryes or no. If yes, volume pumped ttallons Reason for pumping TYPE OF SYSTEM _ Septic tank/distribution box/sod 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: 2h4._c Sewage odors detected when arriving at the site: (yes or no) 1.7� (revised 04/25/91) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �" SYSTEM INFORMATION (continued) Property Address: 107 G6401 Owner:�A Co¢ Date of Inspection: fLIt,1�, 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 li-t Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site p n Depth below grader �l Material of construction: __Voncre:e _meta _Fiberglass _Polyethylene _othertexplam' If tank is metal, lis: age _ Is age con:irmec o% Cen;fica:e of Compttance _(Nes.-No Dimensions JUlbG1Y�S Sludge depth -4N y Disiance from top of sludge to bonorn of out;e: tee o, ba^;e L Scum thickness 0-1 Distance from top of scum to top of outle: tee or ba^te to r� Distance from bottom of scurn to bo-o-n o;outlet tee e• bane 1� How dimensions were determined ftagivatyl Comments. trecommendation for pumping. condition of role and outlet tees or baffles. depth of liquid leve in relation to out invert, structural integrity, evidence of leakage. etc.t Al 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: (recommendation for pumping, condition of islet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.; (revised 04/35.171 Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1e1:� tc ,, OM ner: 124" Date of Inspection: �Llll'GJ� c TIGHT OR HOLDING TANK: lank must be pumped prior to, or at time, of inspections (locate on site plan, Depth below grade: Material of construction. _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacm•. gallons Deng^ flov, galions`da. Alarm level Alarm in working order_ Yes. _ No Date of previous pumping Comments (condition of inlet tee. condition o- a!a,m and float switches. etc.) DISTRIBUTION BOX: 5 docate on site p a- Depth of liquid !e%'el a00%'e ouue: ime,: w�o�l�itT-�y'k'� Comments' mote r.• leve! and distributor is eaua' evidence of solids tarn ver, evidence of leaks a into or out of box, etc.) /g co< < S Vols♦ 1 S Q1 hUQ7QIc.�^�/f SQ�r O Js bDU1�G2- 161 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.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION (continued) Property Addr-ss: Owner:TA4:�Z x Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): oki (locate on site.plan, if possible: exca,.ation not required, but may be approximated by non-intrusive methodsi If not determined to be present, explain: Type: leaching pits. number. leaching chambers, number:_ leaching galleries, number: leaching trenches, number,)ength: leaching fields, number, dirnension.s overflow cesspool, number Alternative system name of Tecnno)og\ Comments. mote condition of soii, signs of hydraulic failure, level: of ponding, condition of vegetation, etc.) l p CESSPOOLS: „ (locate on site play. Number and configura:,or Depth-top of liquid to inlet Inver, Depth of solids layer Depth of scum layer. Dimensions of cesspool Materials of constructior 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:�d (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 04/2S/97) page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property (Address: 167�A 4( I I_ Owner: f , `IK-- 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) izE ( 0, 1�- 3 D yd (revised 04!25/97) Page 9 of 10 -a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propertv Address• f67 Gla, L Owner: (rfy *, Date of Inspection: l 1 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation o'. Site (Abutting property-. observation hole, basement sump etc.) Determine it from local conditions Cnec'K %+ah loca! Board o• nea!tn Chec:. FEMA Maps Check pumping records Check local excavators. installers nxM T L-se L SCS Da:a r Describe in voir o�%-• %.oros no•.% %o:: es:ab!!shed the 6+ig6i Groundwater Elevation. (Must be completed: 3 r e✓ Col osrc,YNV� /J.S .!�-. L _ 5'�— q � lz•y_•••d P•q• 10of 10 No.8o- ... Fps. .. .... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ...... D 'N----------OF.....�J ?'te✓57Y� ..... -E. Appliration for Diipngal Workii Tomotrnrtion Frrutit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: EN'F_F}6 ...�..................... .....................��-/� /® - ..........._ Location-Address or Lot No. . ........•..... /Z f�-r / .f-:1`P..:NLF.4 ............................ ---------------------.._...._......-• ---.....-----------•------------•----•......•---•- Owner Address t a -••••-••-�� T-•••-- °�^^. ------------------------------------------- _._. Installer Address U Type of Building 3 Size Lot_._16713 . .........Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (n/o) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ____________________________ _ W Design Flow......................5........_..........__gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity 0? _gallons Length_S-_.Ea...._.. Width_'4..14.._ Diameter_4__6...... Depth..-5_._8..... x ,Disposal Trench—No..................... Width---I___--_-______-- Total Length.............f...... Total leaching area....................sq. ft. Seepage Pit No....___.-f----------- Diameter------`�-_.......... Depth below inlet.......6........... Total leaching area..2050...sq. ft. Z Other Distribution box ( 9 ) Dosing tank ( ) '-' Percolation Test Results Performed by....C..' .._.��?.?.!'�........._ 6_ 4 - $®Date ----- Test Pit No. 1..".."-_..minutes per inch Depth of Test Pit____!2......... Depth to ground water-_NC-'-"/E Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground•wateie45W a ---------•• - ODescription of Soil--- -�---------------- -- -------- -------------------------------- -----------------------------•------•------------- vEL v ..•••-••......--•-----•--••-----... f 2'..-.I2'....91 ............................> .�► G' �-►-i 5 ._ .. ... iZA' ? 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'T`:I_ p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has`been�ued. the b and of ha h. Signed... -[- -------- --------ii( -•--•-----•----------•- Date Application Approved BY l C�a__.��� J?y /Q�J y D....... Date Application Disapproved for the following reasons---- -----------------------------------------------------------------------------------------=----------------•- ..---•--.......-•................•-------------------------------••••••••....•----•----......--------••--•••---•----••-••----•----•--•••-•••-•••-•----------•--------••--•-----•---••----••........... Date PermitNo......................................................... Issued_... =t -••---•-•--------------- Date l Fizs.,S 0..:::..."...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1rtfM OF:_.:. ^ .......�........ ...►....-=. ................................. Appliration for Diipniial Works Tnnitrnrtinn ramit Application is hereby made for a Permit to Construct (V) or Repair ( )' an Individual Sewage Disposal System at: ...•--------�•c.�:;✓ % hG.. .��t� ..................... ------------------'------�-.---f ------------------------------------------- Location-Address J— or Lot No. .............•J�/c! //G...- '�-�--"VLFC...----.....----•--•------•--- ..........---------...--- ---••----------........-•------------............--- Owner Address .5............::............................. .................................................................................................. a Installer, Address UType of Building Size Lot__161 ....... feet a Dwelling—No. of Bedrooms...:.........................................Expansion Attic ( ) Garbage Grinder (vo) a Other—Type of Building"......................... No. of persons___-•__--___--_-__-__----_ Showers ( ) — Cafeteria ( ) P-+ Other fixtures --------------- --•-------•---`----------------••-•-.•-•--------- . . 3`. W Design Flow..................-_�_...............--..gallons per person per day. Total daily flow_-_--__«'�___--�_ ............................gal Ions. 1:4 Septic Tank—Liquid capacity3�?ad_.gal•Yons Length_g�__ 6e".._.. Width.4_1 - -_4-- Diameter_ _��6_..___. Depth__�� .&'.'_.. Disposal Trench—No..................... Width.................... Total Length..__.._..._.F...... Total leaching area.........._....._...sq. ft. Seepage Pit No.___..-.�---._-__-_- Diameter_:__._-_.______. Depth below inlet:__.........._.. Total leaching area..�'�....ep.sq. ft. Z Other Distribution box (t ) Dosing tanl ( ) ''" Percolation Test Results Performed by �`� �.�.. ........................... Date-____�'_ .....�.-_..��......... ..1 Test Pit No. I_G-----":____minutes per inch Depth of Test Pit___/Z_.......... Depth to ground water.61!!_".6-..-_-. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wateF'..nf<'Q4t'!_7;r_,ZCT.) ... --- --- --- ... -------------------------......................................... Description of Soil.... O b�rv? E.+ a cam/L.. U ?._�_'_ ..---- ( ..E.f�+'!_ U.............�. -"�--�--.--_-�.........t�rrl Gr.-------------••-•------------ 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 TITI-" p o,� 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has gbeen,issued.b the board of liea th. Signed.. . . ............................ ................................ Date, Application Approve By - _ m,, ' Date Application Disapproved for the following reasons-----------------------------•--------------------...----------•----------------•-----------...--•---------•----- ------•.........................•--------•-----•---•-------...------•-----•----•-------------•----•. .... Date PermitNo............................................................ Issued-..............................-........................ Date THE COMMONWEALTH OF MASSACHUSETTS 1 I BOARD OF HEALTH ...... ®: !\/............OF....... ?' N .....�................. Trrtifiratr aaf �nrnt r� rr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (`� or Repaired ( ) by--------../ .....2 n ---------------------------------------------------- ---------------------------------- .................................................... �.p�_,,�. Installer_,,, -,. at---------.: 7...Win . .Zir._ ---'-',� M s ------------------------------------------------------------------------------ has been installed in accordance with the provisions of TITL; ` of The State Sanitary Code as described in the application foisposal Works Construction Permit No._ GJ_". _lt ________________ dated---.._--..-..-_----__.____._____.______ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. ..._._.:.(_-.. ...... =x; Inspector.... ....... i�7-------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.. .•r0/ `7�7�1.J ...�....................... .......................................... No4�.................. FEE. :...... �i��rr,s�1 nrk� ����#rtmrn rrntt� Permission is hereby granted.......lit----- .. SR ------------------------------------------------------•----------..............---•--. to Construct (I-) or Repair ) an Individual Sewage Disposal System atNo.......... ........ -- , _ ..... =........... L-------------------------------------------------------------------- aStreet as shown on the application for Disposal Works Construction Permit-No..................... Dated.......................................... ......................................... - Bo . . .' le a DATE.....7..zc3r?► 1--------- .......................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS r. T✓rS7 ' 34 L"2S CA 4�1 T /Q IS/ , P2Q I�O SED f .. .� •E3�.DT200M5' SE P T I C 5 y5 T;eM CONS 7-)2 UC T/ON SHA[.�. CONF02M To MASS' L7ESiGN FLOvt/ G� GAL./1?.AY kr --�,rG -} � '� /� r •. k'EQU/I/ZG-D LE�iCs.CArr' �'Ldr � �Y 7-4P OF NEALJ'f,r TZE 6 fJLA TiONS io2O/�E7S E r,-� Z-F-AiCA/ MANHOLE Gor�E,2 TO �XTEnlD TO 7A'IpC2✓1oe/5' CoVE/2 TC� ,a2E VENT r--/A/ES 1 W/ 7-f-1/A/' 1 .pF F!/\// �/�D C71ZA D i E IC 2or1 /A/c 2.a 7-/A/6 tr,T f,o tr�5 r` _ 'I D/S T. t f S TOn�E rv�1V11-1 eJAij u j \` I �/ Co✓ z% G,2A� ;aox Pr7- 4 CAST/20n/ —� -— - x 3„Mry � / ..... �.. 3"'"tiAJ 4„ A. A7FA2 >/7GA/ FA-OW LINE NI/N diTCt/ -�- _ e - t/ �2., n7rni _,_._ -� P/T Ai"DoT tT.cAt _Y_ MiIU WA S N E O 5 T-0 AJE GAL.LO� /A/V e7 /iv VF,.2T C A,;*FAA G / T y f_L EV. i A/2 O Ui-10 SE 1-7-1 G TA�/ C)710A-f (OF CWATG TIG/�T) I'NVEZ7T. r L . �C � 1 =/Z-{ ,fl/T / /rVVE.Lr fir# w/norC✓ns f �� �' f / o GA,e,5A6E G,21AJZ) SITE hLA AJ r s y , . R.T/C TANK 4/ST'2/L9UT/ON 8QX r� CS OuT�E7'3) .41,/,Z> L�.4C�✓/.�/G �/T GO.VCI�ET� - CRAIG RIcYt�ON ONG'!2E T-E, S TL�G•c%GT�/ 3000 r f 20000 LOB'' �S /O L A ZD i.vG YA. i r"li"'�+!, T J 0✓,�&' Sy5T n�J lJn1LE 55 f/- C? _ I ZDE S/L�Aj: LOL, L7/Nt� /J CJS�J. 7`: tit Qf' r _ 47�f9 A >) 0 V is L.- ACCESS COVERS MUST BE WITHIN 9" MINIMUM. INVERT 'ELEVATIONS : DES I GN CR I TER I A : GENERAL NO TES : 6" OF FINISH GRADE 3' MAXIMUM COVER INVERT OUT SEPTIC TANK: 2/.5 DESIGN FLOW: BM, TOF-24.5 FIRST 2' TO MlN 2" OF PEA STONE INVERT 1N DIST. BOX: 19.97 3 BEDROOMS AT 110 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION BE LEVELG.P.D. 22.s OR FILTER FABRIC ''INVERT OUT DIST. BOX: 19.8 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 4" NAM PIPE TEE 20.5 3/4- 1 1/2. DIA. INVERT IN LEACH CHAMBER: 19.5 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS ° DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 17.5 NO GARBAGE GRINDER � 21.50 l9.8 � 2' �° SET. SEE S/TE PLAN. OAS ° ° 2, I7.5 ADJUSTED GROUND WATER: -„f /9.97 ��� 19.5 N/A SEPTIC TANK REQUIRED: BAFFLE OBSERVED GROUND WA TER: N/A J. ALL CONS TRUCT I ON METHODS AND MA TER I AL S AND 3 OUTLET 3-500 GAL LEACHING CHAMBERS 330 G.P.D. X 200% - 660 GAL. + + BOTTOM OF TEST HOLE #I: 10.0 MAINTENANCE OF THE SEPTIC SYSTEM SHALL EXISTING D-BOX W/2'- STONE SIDES. 3'- ENDS. 9'w x 32'1 x 2'd SEPTIC TANK PROVIDED: 1000 GAL. EXISTING CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL 1000 GAL H-20 SEPTIC TANK 6" CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DESIGN PERC RATE ( 5 M1 N/1 NCH SOIL TEXTURAL CLASS - l 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER PROFILE : NOT TO SCALE EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPD / 0.74 GPD/SF 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH STANDING H-20 WHEEL LOADS. I\I PROVIDED: 3-500 GAL LEACHING CHAMBERS L V W/2'' STONE SIDES. 3'+ ENDS. A 452 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 452 S.F. x 0.74 - 334 G.P.D. APPROVED EQUAL. 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED SOIL TEST PIT DA TA PRECAST CONCRETE OR APPROVED POLYETHYLENE. BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER INDICATES v INDICATES TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE _PERCOLATION OBSERBSERVEDED TEST GROUNDWATER OUTLET. TPs/ 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE". 0 taAM 22.0 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. SUBSOIL - FOR LOCATION OF UNDERGROUND UTILITIES. 3-500 GALLON ° LEACHING CHAMBERS /65 7, p- W12•= STONE SIDES. 3 = ENDS 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE 30--- - - - - - - - - - - - - - - - - 19.5 DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION MEDIUM-COARSE OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE SAND BM. TOP of FOUND ti CONS TRUCT I ON l NSPECT I ON$. EL-24.50 CATCH BASIN h 9. EXISTING LEACHING AREA TO BE PUMPED DRY. 0. Q 25 REMOVED ALONG WITH ALL CONTAMINATED SOIL AND Exl TING I6 20 BACKFILLED WITH CLEAN SAND. o 1 I O EX/S SE TIC TANK EXISTING LOT NO WATER �b LEACHING AREA T/JVG r4 - 10.0 I0. EXISTING SEPTIC TANK TO BE PUMPED AND CLEANED. 0 16. 713+ S.F. Dti'ELt/JVG -- INSPECT AND REPLACE INLET TEE IF REQUIRED. r*' DATE: JUNE 4. 1980 TEST SY: CRAIG SHORT. PE D-BOX WITNESSED 8Y: PAUL MURRAY PERC RATE: ( 2 MIN/INCH 20.3 TP a2 TP s3 0 HORIZON TEXTURE COLOR 22.5 0' HORIZON TEXTURE COLOR 22.5 y TP.2 TP�3 FILL FILL - � . O 16' - - - - - - - - - - - - - - - 21.2 l2" - - - - - - - - - - - - - - - 21.5 LOAMY IOYR LOAMY IOYR p M A SAND 3/2 A SAND 3/2 TPs! 20' - - - - - - - - - - - - - - - 20.8 24 - - - - - - - - - - - - - - - 20.5 O� �( LOAMY IOYR LOAMY IOYR GgRgGE B SAND 5/6 B SAND 5/6 ` 36' - - - - - - - - - - - - - - - 19.5 32' - - - - - - - - - - - - - - - 19.8 fX/STJNG D (�If� C MED-COARSE IOYR Cl MED-COARSE IOYR RJVEO SAND 6/6 SAND 6/6 y 60 F 168 '8/°3/ . NO WATER NO WATER 40 O. � I20" 12.5 12 12.5 � DATE: DECEMBER 27. 2016 TEST BY: STEPHEN HAASM WITNESSED BY: DONALD DESMARAIS PERC RATE: ( 2 MIN/INCH N zo.9 S EF' T 1 S YS TEM DES l ON i 107 GLENEAGLE OR I VE . MAP 19 I PARCEL 1 4 1 BARNS TABLE CCENTERVILLE ) MA o q PREPARE© FOR q LEGEND S T v N �c S A N © /� A C O L- A R U S S O u N CB CONCRETE BOUND g -w WATER LINE SCALE l a 20 DECEMBER 22 2016 N n <O HYDRANT OCs -G GAS LINE STEPHEN A . HAAS OHW- OVER HEAD WIRES A>F LIGHT POST ENGINEERING , INC ---E- UNDERGROUND ELECTRIC L l NE -� � P . 0 . Box 16 .-�� S© e uth 0nn i s , MA 02660 -T- UNDERGROUND TELEPHONE L 1 NE //, ��. -CTV- UNDERGROUND CABLEVISION LINE j���'��\ 508 � 362-8 'I 32 / +40.4 SPOT ELEVATION .­­-40--- EXISTING CONTOUR LOCUS MAP 0 /0 20 40 �_ PROPOSED CONTOUR REVISED: JANUAR Y 24. 2017 (ADD TEST HOLES) JOB NO: /6-065