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HomeMy WebLinkAbout0253 GLENEAGLE DRIVE - Health r,"2!53 Gleneagle Drive Cterville P - A = 192 142 --.._______ UPC 12534 No.2-153LOR HASTINGS.MN r t� �'"� G d �. No. � 4 FEE C®MMONWLA T14 OF MA SACHU SETT Board of Health, aMSko-bye. ,MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct Repair Upgrade( ) Abandon( - ❑Complete SystemxIndividual Components ( Location 'J� Owner's Name Map/Parcel# `q a Address ZS i%, 4 Lot# C C Telephone# ado Installer's Name C J; Designer's Name Address —7Siry Address�D� A Telephone# — _ _ 5 Telephone# Type of BuildingS'tdQnQ� Lot Size /S l D09 sq.ft. Dwelling-No.of Bedrooms �"trY� Garbage grinder W/k Other-Type of Building No.of persons Showers (ir'S Cafeteria (P/ Other Fixtures L-A-4 WT 6?k�k�� r—WrT 4 U►n1��A� Design Flow (min.required) 3";,),b gpd Calculated design flow 330 Design flow provided &'jj•$ gpd Plan: Date 1`D 2) Number of sheects--` Revision Date Title �SpDO �Ph1C c U� � oa mMAO�t Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator AAV Date of Evaluation G DESCRIPTION OF REPAIRS OR ALTERATIONS �A�CR�1pr•���y��1 19���y �t ' 11CA 1 MUST OB A A SE YY..... ,,ui,iAEUTIOA E f IZ 1VI T!i- :.T CTWERING DIVISION PRJOR Tf: Q5 nUCTION The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further not to ce the em' operation until a Certificate of Compliance has been issued by the Board of Health. Sig Date - Inspections f...:�N"1- „-'ti,��^.,...+-.,, r"^.-� +t",.'"�'""���;i,Y--:��,z^r;,`.h-�,3�•-a�w'G-:..rt..�,r•�:..��--+'1..J'�.r�.erg•-rn.:..l�r"""'"".k,�.,c _ �{47'��-r'r`�-�n.a...,r•.�..,-..�-_- No. J� 3 FEE r COMMONWEALTH Of MASSACHUSETTS r r. j Board of Health, cn s4 ab\e MA. t t. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT r Application for a Permit to Construct( ) RepaiX Upgrade( ) Abandon( ) - ❑Complete SystemXIndividual Components .t. Location `� ?� G�e n Q �� t ,�2 Owner's Name Ge.D c��m it n Map/Parcel# `C� 4 Address Z Lot# a.4 Telephone# �� a ` Installer's Name tC CU�CP Designer's Name S nv� ont�n�c\ Address S �. Address (7 tJ o�� t . ri�G Telephone# 5 a _ A-6 _ 5 Telephone# d a 53b Type of Building .S IG\�1�1 iG� Lot Size S 1 sq.ft. Dwelling-No.of Bedrooms -Ti.�h Garbage grindg (A/q, Other-Type of Building (Q\i>(12 No.of persons Showers (✓S,Cafeteria (tj Other Fixtures L4�10AI P WY ,T �-i Z`r✓ >�nl� LGt�� Design Flow (min.required) gpd Calculated design flow 3�a v Design flow provided ��J gpd Plan: Date \a aAA -n - Number of sheets Revision Date TitleE �?V:)D0']OX Description of Soil(s) A;20 '7n�Ct� Soil Evaluator Form No. Name of Soil Evaluator ( �2rH CJ 1 S a�Y Date of Evaluation ( q 0 3 DESCRIPTION OF REPAIRS OR ALTERATIONS '--Z'n ;RZC Ar, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furtheees:16'not to lace the- , tf�* operation until a Certificate of Compliance has been issued by the Board of Health. Sig efl Date Inspections y� �I� FEE y`,' ' Board of Health,a A ChI k 0-0e— , MA. CERTIFICATE OF COMPLIANCE Description of Work: 1611ndividual Component(s) ❑Complete System - The undersigned herPbqcfify that the Sewage Diissposal System; Constructed ( ) Repaired ( ) Upgraded /Abandonedby: e As at N -T r.VX.a1 �il has been installed in accordance with the pisi 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. Ut) � 3 , dated 1 ?3 Approved Desi n Flow (\ (gpd) 9� Installer �� /V A Designer: Inspector: \ ! Date: , d The issuance of this permit shall not be construed as a guarantevthat the system will function as designed. No. C.�;, —6 3 If FEE Board of Health, �11ic, IQ_ MA. ➢ ISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Co struct( ) Repair(L4--t p�'grade( ) Abandon( ) an individual sewage disposal system at _�� �y�w G a 1.2 t �,�o�wT� as described in the application for ` Disposal System Construction Permit No. r,_')—b L4, dated Provided: Construction shall be completed within three years of the date of this-per ..i . Alfilocal conditions must be met. t Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date f �.� Board of Health TOWN OF BARNSTABLE C- 1 LOCATION ��N --�rt SEWAGE # U� ^ VILLAGE C 4�-A ASSE FUS MAP &LOT INSTALLER'S NAME&PHONE NO. Lflr SEPTIC TANK CAPACITY 5T�/� lDOU a- LEACHING FACILITY: (type) di ziEw L77--irive-((size) 416 , 1C l6rr NO. OF BEDROOMS BUILDER OR OWNE PERMIT DATE: 1'P-L93LO COMPLIANCE DATE:� 6�" 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 �i t. F Y � f ' TOWN OF BARNSTABLE C LOCATION OI�,3 6 ��r"' �-�-�rf V---e- SEWAGE # VILLAGE � ��`�- ASSE R'S MAP & LOT INSTALLER'S NAME&PHONE NO. �•� SEPTIC TANK.CAPACITY 15TN� 1/000 LEACHING.FACILITY: (type)C, fv%L L77AV U(size) l NO. OF BEDROOMS BUILDER OR OWNER0,5 PERMITDATE: COMPLIANCE DATE: 6�" Separation Distance Between the: Maximum Adjusted Groundwater le 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 I i i �o Sep - 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 N . UL SR-5;01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify chat the engineered pian signet by r .e uetec 1a_j'gVjo3 concerning gtthe � property located at meets all of the • This failed system is connected to a residential dwelling only. There are no :ommercia! or business uses associated with the dwelling, • T? e soil is class: zd as CLASS l and the percolation rime is less than or equal !o -rt:r,utes per inch. The applicant may use historical data to conclude th)s f3c: or may ;onduce .ore!imi;mar; tests at the site without a health agent present • T her: :s no increase in flow and/or change in use proposed • i here are rto variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen fee: aoove the maximum adjusted groundwater table elevagon. (Adjust the nunt:.Yater cable using the Frimptor method when applicabicl Please complete the following; "fop of Ground Surface Elevation (using GIS information) g C.Vr' Elevacon ad;uscmenc for high 0.VJ.. t. ... = .._.. BETWEEN and B S:(,.dED _ - DATE: ...------------- ._.._., NOTICE 335CC J-OR (,ne above sr.formation, a ceoair permit will be issued for -)edroorr.s ,ddiuonal bedrooms are authorized to c�e future without encincerec :epe.. s_+sce^t plans. �_ s 1c.IN:q:Oci �cicc.�m� 1 / ' Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: aS1) CIene��`e Ql.l�,P_ r��c� 'yi t�1 Akot No, Owner:_ l 1 � Address: Q Contractor:_! A 9n1.* w o CSAddress: 2'-V Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map.locate site and determiner OAppropriate index well.................................................... 3 © Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... 11 -5 •I;t mohth/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) IRdetermine water-level adjustment ..............................................:............................... STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ......................................... . 1; Figure 13.--Reproducible computation form, 15 CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL SERVICES, INC. P.O.Box 627,East Falmouth,MA 02536 February 2, 2004 RE: Certification of Title V Septic System Installation: Residential Property—253 Glen Eagle Drive, Centerville, MA Dear Sir or Madam: On January 7, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 253 Glenn Eagle Drive, Centerville, MA based on a design drawn by Shay Environmental Services on January 6, 2004. XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions, please do not hesitate to call the undersigned at (508)-548-0796. Sincerely, CARMEN E. SHAY ENVIRONMENTAL SERVICES,INC. C MEN E. SHAY en E. Shay, R.S., C.S. No. 1181 President S41VITAR�a � r00"R 3 2000 COMMONWEALTH OF MASACHUSETTS P. EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108.(617)292-3500 TRUDY COXE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Address of Owner: 263 GLENN EAGLE DR.CENTERVILLE,MA 02632 Date of Inspection: 3/16/00 Name of Inspector: JOHN GRACI I am a DEP approved system Inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608d84-6813 FAX 608-664-7270 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: X Passes _ Conditionally Passes _ Needs Further Evaluatio the Local Approving Authority Fails Inspector's Signature: Date:3/17/00 The System Inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined In Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY ONE TO TWO YEARS FOR PROPER MAINTENANCE. revised 9/2198 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Date of Inspection: 3116/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa 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 complying septic tank as approved by the Board of Health. n1a Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n1a 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 revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Date of Inspection: 3/16/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health In order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and 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 n&(approximation not valid). 3) OTHER n/a revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Date of Inspection: 3/16/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described 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 - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool Is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Q. _ X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. - X Any portion of a cesspool or privy is within 50 feet of a private water supply well, - X 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"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 - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner: BRUNO MARKELIUNAS Date of Inspection: 3/16/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ 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 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. X _ The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X - The site was Inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X - 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: X - Existing information,For example,Plan at B4O,H, X - Determined in the field(if any of the failure criteria related to Part C Is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) X - The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Date of Inspection: 3116100 FLOW CONDITIONS RES113ENTIAI: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual): Total DESIGN flow: 220 gpd Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system Inspected(yes or no): NO Seasonal use(yes or no): NO ,Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n1a COM M ERCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X 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.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1981 Sewage odors detected when arriving at the site:(yes or no). NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: . 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Date of Inspection: 3/16/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 12" Material of construction: _ cast Iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 4" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 6'6"H 6'7"W 4'10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY ONE TO TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: Na Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Date of Inspection: 3/16/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet Invert: n/a Comments: . (note if level and distribution Is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Date of Inspection: 3/16/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site.plan,If possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Aftemative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 8"OF LEACHING LEFT AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n1a PRIVY: (locate on site plan) Materials of construction: Na Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 253 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Date of Inspection: 3/16100 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) P�a�k Qcrk.- 0 revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 263 GLENN EAGLE DR. CENTERVILLE, MA 02632 M192 P142 L24 Name of Owner BRUNO MARKELIUNAS Date of Inspection: 3/16/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet n/a Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET ,r revised 9/2198 Page 11 of 11 LO CAT ION SEw PERMIT, NO. ,At-- VI-LtAGE INSTA LLER'S NAME i ADDRESS . . DSy"' _ S B U I l D E OR OWN ER DAT- E PERMIT ISSUED DAT E COMPLIA' N-C-E ISSUED So yy i 1 ` /�' Inc M No.. a a-�.. . Fss..__3..��.. .. •' ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratiou for Bhyj`ii al Workii Tonstrurtanat rrmtt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �r .......... Z r ......_.. �.�--------•------------------•--------.._...-------....------------ Crkon-Ad ress A, or IAt No. wner Address Wt! /�.�.�.S........�ezzelll.A.............................. ........_..-•---------------•-• Installer Address Type of Building Size Lot__/_�t_ ....... feet U Dwelling—No. of Bedrooms.......... ____________________________Expansion Attic ( ) GhAage Grinder (1I0) aP4 Other—T e of Building No. of ersons____________________________ Showers Other—Type g ------•--------------------- P ( ) — Cafeteria ( ) A4Other fixtures ......................... •--•••••-••--•--•-•--•••••----•-•-••••••••-••--••-------------•-•--•••-••••--•••••••••••••-•••--•-••••-••••--•-•-----•-•-•- WDesign Flow............. ____________ _____gallons per person per day. Total daily flow_____°_. �a_._______._.___________gallons. Septic Tank-A Liquid capacity./COO gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........./--------- Diameter....A. . ...._. Depth below inlet... Total leaching area;2/v. __....sq. ft. Z �wOther Distribution box Dosing tank ( ) Percolation Test Results Performed by___________________________________________________ Test Pit No. 1.__._�......minutes per inch Depth of Test Pit____________________ Depth,to ground water_______-_______________- : . '.fr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................�5. . •••-•----•••--------•--•---- •----•••-•-----•-•-••---•••••-•-- ••....•-•..........................r�;-•------•-...----•••-•-•--•--•--•-...--•-•-__-•- Descriptionof Soil................................................................................................. x I U -•-••---•-••-•-•------•--•••----••-••••--...•------•--•-•••-•-•••--••-••••--•..._..••••---••---•-••••-•••---•--••-•••-•••••-•------•••---••••••---•••-••••-••-•---- -•-•••-•----•---•-••-•--•••-•-•••••- 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 T TLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in { operation until a Certificate of Compliance hajbbe issued by the bo iea Signed (_n�.t�---------- • Date A lication A roved B _._______ �_ _ /... PP PP y ---e/'�-f••2.•-••-- Date Application Disapproved for the following reasons---------------------------------------------------- ........................................................ - ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date i No.......00)�4Z4 FEs....3.�r................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................_OF........................................ ...........I........... ................. Appliratiou for Uiipu, al Mirka (foustruriion "trio# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..........Q. ri L :...............b.r................... ......----....... "c ........... -t -No -.. . ---------. . . ..---... c on-Ad ress ...I,0 k� - b . 4................ -------••--._ .............................. _ - Owner s�� Y Address Wr Installer • ' Address Typeg Size Lot.. O.............Sq. feet of Building sr- �-'� �. Dwelling—No. of Bedrooms........... ............................Expansion Attic ( ) Gage Grinder (//A Other—T e of Building .._.... No. of persons............................ Showers a YP g ------•-•------•----- P ( ). — Cafeteria ( ) dOther fixtures .. ••-•••......----••-••••-•.---•-•-••--••-•••----•--••-•••-••--•--••-•-•---••--........ •--•--•--- W Design Flow.......... :4..........................gallons per person per day. Total daily flow...... LAD......__............_._gallons. C4 Septic Tank-/.Liquid capacity-,/ ' 'gallons Length................ Width.._._........... Diameter.__.....-:...._. Depth................. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........./--------- Diameter....1'<<:_ ...... Depth below inlet_1. ............. Total leaching area.vV/rA^z.....sq. ft. z Other Distribution box (&60t Dosing tank ( ) 1 .-4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1......j......minutes per inch Depth of Test Pit.................... Depth`'tQground water........................ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ... ----------------------------------------------------- ---............... :................................................................................... 0 Description of Soil................•-------------------........--••--•---•------------•----•-•---------•-----------•--•----------...------..........---•---•----------------••----•-••--••- x U W 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 ILTL y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has be issued by the bo hea ! Signed-.... �=�A.A........--•-- ' �� 1�s.,...,..:.-- i 1 pate Application Approved By........_.....--- .!...f,/ _.._...__... -- . /_4? ----- Date Application Disapproved for the following reasons:-•-------------------------•-----------...--•---....-------------------•-------••-••--•---• ----••-•--•........ Date PermitNo.......................................................- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALTH .........:/ !tr►"r,............OF....... L.................................................. Trr#if irtttr of Toutplitturr THIS TO CERTIFY at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------- '" ...................................¢............................................................ .. stiller has been installed in accordance with the provisions of TITL w ' f The State Sanita Code as described in the application for Disposal Works Construction Permit No. ...............I............:_.. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL:NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................. -,cz .s ---------------- Inspector..............1-4��--�.__ _/V THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH .C.��".G J r.►...........OF...... N .. _........ FEE... ? ...------ DisposVhy orks Ton ilanrnti Permission is ereby granted.. - to Construct or Repair ( an, idual Sewage Diss osal System x atNo C .. .''•✓'r'j. 1., .... ................................................... Street as shown on the application for Disposal Works Construction Permit No.,.................... Dated.......................................... J Boar ealth DATE................. -• -$ -aloL•-•••-•••-•---•-----------••--- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ik r �y FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA T J1 OF........ . ... ........................... ApplirFation for Dispoiml Workii Tonotrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . ............__. ------.._.................... ............ Locati on_Address or Lot 13q. !3 Nj ... �� ?_Q_S - ..._�� .�. .... ................................... . -•• - ............. Owner Address W Installer Address Type of Building Size Lot vU ..•.--_..Sq. feet U Dwelling—No. of Bedrooms............a..........................Expansion Attic ( ) Garbage Grinder (Ab) Other—T e of Building 77---------- No. of persons............................ Showers — Cafeteria a Other fixtures ------------•• =` W Design Flow...............�-5----••-____•••••-••--gatlons per person per day. Total daily flow.............'2.;7-9...................gallons. WSeptic Tank-L Liquid capacity,00.0_gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No.•----•-----••...__- Width.................... Total Length....... .......... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter./Q..X......... Depth below inlet................... Total leachin area.i2.6.(?----sq. ft. Z Other Distribution box (X) Dosing to k ( ) —4,6- G Percolation Test Results Performed b ................... Date....�_�2>�_s7 "....... aTest Pit No. 1___. --..minutes per inch Depth of Test Pit....... ........... Depth to ground water........................ PL4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 ............ ............................. --------------..,.... _ Desc�iption of Soil lad •�. ! `�-a.--J �i '_ Z ---------------------------------------------------------------------------------------••----•---------••----•----------•-•-----------•-----•-•---•-•-••-•......•-•••-•---•-•--....................... 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 TIT L E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign . ....... ••.... •--•--•-••••........ ............ Application Approved By.._..•• •. .... --•--•------ • •. -•- =�`� 1 ............. Date Application Disapproved for the following reasons:................................................................................................................ -----•---•---•-•---------------------------•-------------------••---------------••--........---•--•----•-••••••••-•--------------------••-•-•-••-------•-••-••----•---••••---------- .................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ....OF........... .... ..... ............................................. Tntifiratr of Tompliatarr l/ THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-•.--•-------••---•--•--•-------•---------•-•------•............................•-------------:.-....--- --- . ...-----•-- pp ,oC� _Q Installer h n at...4eu.p�f d.� �t�1 . "+ a /Y'�' f- ' �/ .....` --------------- has been installed in accordance with the provisions of 5 of The State Sanitary Code as describ d in the application for Disposal Works Construction Permit No._......_ _�_•__-••-....... dated--... ---�'_7�:............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ` ...:.....OF....... . .. 1 ..r................................................. No._...._.s7_�_ 2 S- •-- FEE........................ � �io�o��tl or�o �on�#ruatt rrmi� Permiss'on�ts�ereby granted-----------------------------------------•---.---------------------------------- ----------------- -•-•-•----------------•-•--•-••--•---•--- to Cons r �/ or Rep 'r ) an, Indivi�al Se is osal Sy ` at No.... _ / \ ------ - -----=----- - -- - -- - ----- ------ Street as shown on the application for Disposal Works Construction P No.-. __ .._ _,_ ated.. _'_f `. •------------- ----....----•......... Board of Health DATE....................................................................-........... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS E 00 NP ` z °.... Fps...... ........ THE COMMONWEALTH OF,MASSACHUSETTS BOARD 9F H EA Tno 'Ole aLj , . . ........OF....... ....................... Appliration for Diipaa*gal Works Tnnstrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -- -- --------------------------------------------- ...................... 1Loca'on-Address or Lot p .5.......................•. Owner Address W Installer Address / 't d Type of Building Size Lot._..;r._...--•-__-•-------.Sq. feet aDwelling—No. of Bedrooms............ ..........................Expansion Attic ( ) Garbage Grinder (A&) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ..--• ---•- -•--•---------• . W Design Flowx...............5` .__ ``.........gallons per person per day. Total daily flow....... „;xa9.............._..._gallons. WSeptic Tank-L-Liquid capacity,MQ-gallons Length................ Width................ Diameter -;-____.._- Depth................ x Disposal Trench—Nq_ ____________________ Width..._ _...._.... Total Length .._. _ Total leaching area--:.. ``_ sq. ft: Seepage Pit No..................... Diameter.��__X Depth below inlet.._: _________. Total leachiri. area_. :SA__..sq. ft. z Other Distribution box ( Dosing t k ) '-' Percolation Test Results Performed by.... __: _. .,, __..,................ Date.._ ' "� `_:_.... aTest Pit No. I.... ___minutes per inch Depth of Test.Pit....... ::......... Depth to ground water________________________ (� Test Pit No. 2................minutes per inch Depth of Test Pit....._.............. Depth to ground water........................ O Des iption of Soil...n------ b'� = - 11._ � 6'` - "" -.._.... x "+ ," W -------•--•----------•-----•-----------•------•-•---------••-•-•------------------------•--••-.------------:---...------------------------•---------------------------------.--.•-•------•..........•--- UNature of Repairs or Alterations—Answer when applicable.-.: ................................................::....................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign- . -- -------------•-----•--•-•-••---••-------• •--•-------•---•............... D.�s� Application Approved By........ . • --- -----------• • ... ...... ��. -------- --- !._ ............. Date Application Disapproved for the following'reasons:---•----•-----•---------------------------------------------•-......---- -•....---•--•------------••-•--•---._.....••-•-••-------••--•-•-------------------------••-•--•••-....--•--...---•-••--------------------•----------•------••-------------------...---•••---•-----•---- Date PermitNo......................................................... Issued--•------•-•---------................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................. (Intifiratr ,af Toutplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.. ._.. --- Installer at_..:�e1-rv_ _..___, �_, _1 .<r__w_ _�►'_�_._ _!F_ _� __t°._., r 4--_. .__.__...__�__ has been installed in accordance with the provisions of r 5 of The State Sanitary Coe as des-}'b in the application for Disposal Works Construction Permit No.-:.......�_f.:L............... da.ted-.... .�..,...... ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................•--•-•--•----•-------------.............._••---• Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS A BOARD F HEALTH No.__..... ._ ..........�''.:d..41,4 . OF.. ._................................................... �C ----- '' FEE......................... Permiss•on s reby granted................................................................... ........................................................................ to Cons ep an i osal Sy6 at No... - Street s v as shown on the application for Disposal Works Construction P No.._ ated_._ `_1 .._��.......... r, 3. Board of Health DATE................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i EZ-41.Z — — . i P,evposcrD .SEv�/AGE 2/'t' \� SYsr��y �o" EZ �7 y�sr SE�T)C O 43iT / �1 � P,tv sN.►7D I A.� / .d vT Z,3 4zey o,F , a Lc�7' �oU .ap9 �, Fr. Iz1 . I�,eJV. mac_as,Z Csn/E'AGLE' D,ely �t, T: 4n'w�a�- . Nam-f+tEY�9TicwS 6,4516D ON.ASSu�fE�D A A"V.*I CERTIFIED PLOT PLAN LOCATION N � SCALE . .1. .=30. : . . DATE / 7� EDWARD E. KELLEY PLAN REFERENCE Ct3MA�,AC7@jl#:.:., MASS, 02837 ED,ARU a I CERTIFY THAT T ....... .. .. .... �'015TO`{o@ SHOWN ON T 1 LOCATED ON THE GROUND 0 su�y AS SHOW AND THAT IT CONFORMS TO THE SET MENTS OF THE TOWN OF C�,NST,el�C7/0 A/ Co/7I' . . . . . . WHEN CONSTRUCTED. 6)094 A 2or9t� DATE . . . . . .. : . . . . . . PETITIONER: I-1,/,4NAyiS MASS, 02GO/ REGISTERED LAND SURVEYOR L. . 47 O 4. . ... . TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 4' CAST IRON 12"MAX. � 12"MAX. PIPE (OR 4"ORANGEBURG(OR EQUIV.) EQUIV)— MIN. PIPE- MIN. LEACH 'I PITCH I/4"PER, PITCH I/4 PER.FT PIT PRECAST NVERT a LEACHING fL. ! INV INVERL ce w �.� PIT OR SEPTIC TANK �E�,TB DIST. 3 474, EQUIV. EL..J.7� . .Z BOX EL.: r. : >x a IN ER /pap .. GAL. INV T V 0a Q: � o' EL...q• .. E , . :+. 3/4,0TO I V2' EL...,7Q a V INVERT , � w� o. :�. EL39.z. ti �: WASHED w STONE AD ., /6 -- —6'DIA. —}I ivoNE �---/o DIA.--►-, PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE PRELIM ARY SOIL LOG WITNESSED BY : DATE/.cy!!4 ',97&TIME: .9'3o,y, Pfiv L �'I!i,P� BOARD. OF HEALTH TEST HOLE 3 TEST HOLE 2 T�/oy� �. 1• P,�.. ENGINEER ELEV. . ¢Z..4. . . . ELEV. .. .. . . . DESIGN DATA NUMBER OF BEDROOMS TOTAL ESTIMATED FLOW GALLONS/DAY Co�.st S�a.l> 78 s►p BOTTOM LEACHING AREA SO.FT. /PIT -- �" SIDE LEACHING AREA SO-.FT./ PIT ME.Dd�7 GARBAGE DISPOSAL .Nv^!� . .(50%. AREA INCREASE) S.4avD. TOTAL LEACHING AREA 7:OU SQ.FT PERCOLATION RATE ZZ . -. . . MIN/INCH LEACHING AREA PER PERCOLATION°- RATE �r��?. . SQ.FT. .N9.WATER ENCOUNTERED NUMBER OF LEACHING PITS . . �T SKI THOMAS'E. EL EY CO. APPROVED . . . . BOARD OF HEALTH rwo •r� T aF .5'TONEEMMI . -SURVEYORS aAl es}L G. S`/Dt'$ 346 LONG POND DRIVE 'SO'UTH'YA MOUTH,MASS. DATE . . . . . 02664 AGENT OR INSPECTOR EDWARD, E KrIa.EY t"`.UMVAQUID, 1` C3 a OFlygss THOMA 9°yo �fsS/pWAL PETITIONER /�j ' To Date Z ,r Time / 6 WH1 �,YOU MF OUT M of Phone Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOYR CALL �42 Operator No. 2725-S CHARLBET'S, INC. Hyannis. Ma. 775-2810 Orleans, Ma. 255-3232 a 3s' s _ SNIT i of Z St•/�"lS EZ.- - � Sy-rv'1 LEsLH P,T BG 34 / ED EC.41.7 >- s4xpnc o is ZoT � Foei,�pA'rIo41 a � E-t.4Z,6 Z07-*1f 13 1 �s-oay 2 Ile,040 I � 1 i \ pe V. Ec.45,z G'LL--N, 6 a_lw-4 �z.•a�,ft No�E E+CEV.gTicviS Qi4SG� 0^1 ASScIl1D �y CERTIFIED PLOT PLAN LOCATION SCALE . .I. ..3a. . . . DATE �Xe Z/ lf7.$ EDWARD E. KELLEY � C„UMMAWD, MASS. 02637 PLAN �wN oN A.�A�✓ b� C�k �� . Wuf -. �/NSo A/.:4.rp. &_ Qp� . . . . . ... . . .. . . . EO`pk/ARU .r E. �✓} a I CERTIFY THAT THE SHOWN ON THI CATED ON THE GROUND t4 su �{ AS SHOWN D THAT IT CONFORMS TO THE SETS ENTS OF THE TOWN OF � WHEN CONSTRUCTED. sPi,evs Gv�s7-,Fi,,cr/v DATE . . . . . .. . . . . . . PETITIONER: � �Nn/i�r /VfA55= o26p/ REGISTERED LAND SURVEYOR ' SNE T 2 aF 2 SAMTrs TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS e; 4'�CAST IRON 12"MAX. • PIPE (OR 4 12"MAX. "ORANGEBURG(OR EQUIV.) EQUIV.)— MIN. PIPE- MIN. LEACH PITCH I/4"PER. PITCH 1/4"PER.FT PIT PRECAST NVERT o J LEACHING Q INVE T INV R PIT'OR SEPTIC TANK j, 8Z DIST. 3 • . W EQUIV. e INVER EL..,�.7� . . . . BOX EL..7... .. _>_ .•: 3 . .. GAL. INVER-T V Ua o; EL...`/: ... INVERT '•' :::� 3/4"TO I I/2 D EL.......7.4 EL3Z: �o WASHED STONE PROFi LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE PREL1MINARN SOIL LOG WITNESSED BY : DATE!`Pie�4'•s'978 TIME. .9'30 fMf. /�Hv L /`'I(��.2 . . . . . . . . . . . . . . . ?�. ,� . . BOARD OF HEALTH TEST HOLE 3 TEST HOLE 2 T/ti�y!95 - /1• P, _ ENGINEER ¢z ELEV. . . . . . . . . . . ELEV. .. .. . . . . . . wp t. ut7 ' DESIGN DATA S�&SviG. NUMBER OF BEDROOMS . . TOTAL ESTIMATED FLOW . '?!? . GALLONS/DAY Pe G y BOTTOM LEACHING AREA SO.FT. /PIT r 5-0 SIDE LEACHING AREA . . . i88' SQ.FT./ PIT GARBAGE DISPOSAL .NvA� (50%c AREA INCREASE) S.gtivp TOTAL LEACHING AREA 7+. 00 SO.FT PERCOLATION RATE ZZ . -. . . MIN/INCH N° LEACHING AREA PER PERCOLATION RATE .. SQ.FT. .WATER ENCOUNTERED 1 NUMBER OF LEACHING PITSiOMA1H �' APPROVED . . . . . . TWD � T of 'tea GINEERS--SURVEYORS BOARD OF HEALTH 346 LO O/V C.. S/,Dt��$ NG PONDPOND�g� �L- ASS. . . . . . . . . . . . . . . . . .SOUTH YARMOU'TH., A . DATE . . . . . . . . . . AGENT OR INSPECTOR �v//{r11'�', ( ' ;��qq++(LFy j-4k.• Of 7 '• THCIST OMAS E. •�.S � Li'Q C p k� { �. �Fss/ONAL�Nw PETITIONER-ti,fs/S ��� Imim,Irom ALL PIPES ARE -SC ED LE: Kv.U. In house to H U VENT PIPE AO Least 24 AL.L U I UJUT FWTS FIM IW 0 TEM ots ROFrr�F tF PVC w/Ch Filter ADIJ17 Afth orik ," :" "I I Schopdule'4 i4,o6vent,Imust 0" 5 WL of I!irl" gode uEW 2 FT,tic To* 99.75 bw US-99.75 Id Cinus,he.d -4 W76 Foo�' Eu sop 'Stone C,PVC(CAPPM) '4 Y�T 002 OWAL=AM 0 BE DIST a 3.Ille3dillb -0&45 2 CAL, 10.01 Tn FQ*EmsT.n1#0A P44 C" 5 Units PLAN RO ' 'SE ON top"M"FULL fi Ln 083 (10 inches) 3,1 3,collipa.td stone 25' 3 H I E H 10 blsll�t6 ��nON BO'$IrLof 314C-1 4/2*S)t TEM PROFILE Effectlove LenQ-Cn Not to Scale NOT TO SCALE 4 SOIL ABSORPTION SYSTEM"(SAS)6 In.of ,V 'CA A6ITY :'-(H,' rS INFILfATPOR HIGH P GENERAL NOT compacted stone Effecilve WW*h A,LOADING)/ GEORGE O'BRIEN MPONENTS MUST HAW.RISERS V WITHIN 6' BELOW G RA D=E ' (OR EQUIVALENT)',,,Not,to'Scale 7 1 Con ractor.js :T DigSOfe"'nott ication Bottom'of 'rest Hd*I Elov.=87.25 co on NOTE. OvERALL HEIGHT OF INF1LTRAi0k Is 18"'/EFFECTIVE HEIGHT IS 10" ,and pr6tedtiOh Of 11 :Underground uttivis: -O d n pipes.T Obs. Groundwater Test Hole 1 Elev. NONE OBSERVED tOnk an4 disitri 2.' The septic tion box _Sh011 be set'level �on .6*j of:3/4�-1�,1 2 Istone.3. 'Backfill'should�be. tlean� sond or gri '*th ovel *I no stones o"r in SiZe.L"'is 'Subject toAnOoection unng installati 4�' This',:$'yttem ion by 'Carmen' E.-.,Shay Environmental, Services, Inc d 5. The �controct � �shall`install t "i PERCOLATION �-TEST 0 is sy3 em in occor once hi t with; t V�iof.jhe-,Massachusetts state,code, the'approved, Ion_:Tj le,, p and Local Regulat Date of Percolation est:- DECEMBER 19, 2003'T -if, during ins allation the'Test performed By.��CARWEN E.,SHAY, R.S., ; C.S. t c6ritrottor E, ounters any Reiijits Witri ridlitioni that ore different essed By� WAIVER (per:BARNSTABLE B.O.H.)'� soil conditions or',site,�6c,TEST,,HOLE 1, .111, �----------- rom osd s wn',,,,6n�1! oq,�of-,in,�;bur design f 6 'ho he','SHAY,ENVIRONMENTAL SERVICES, INC. ,soi ate- Less',Thon. <2 MPI lIolt,& i m diate notification be.ELEV,ii,6 99.75 118 04'Percolation R I& , Ust m e:i�m6de`fo 'Carmen E" Shay Environmental.Services,,Inc.6 in h rive 7, vehic a or ji" .over t e�,A 0.septic -components.est 4- 10,0C sep ic,system ,unles noted 'as �H�2 T' e.gas' ffles`�'6r iOn''611�outlet tee'end 8. Itistdfl.,16f it O s Ho e Fa I ed NO. 1 Ve,nt Pip frib, joh`Lines'-�bho 1:be�4 <iornater Schedule 40 NSF'PV p pe 9. Alt, ILeac h Pit -10. AJF I*d' " ho'll be 47 iometer PROJECT:�BENCH iMARK ,so I piping, t t-99, 5�ch `40", F �,pipes with-es fgs75 OTING edule� PVC waiter tight oin s y Sand 1 Muriidipbl'Watee, n A F,Th e is� a noc: e LL 0 e es dence -and Abutting Lom ELEV. 00.00 �(As'sum d)— R i EXIST. 1000 10ATt 3/2 thin 150': t 0 Septic Tank A, , 99.25 0 0 Loo THE PROPERIYAJN�ES�-ARE APPROXIMATEAND"I y Sand 'COMPILED FROM THE,�'SURVEY PLAN,�'GENERA70) BY EDWARD of I 0 YR 5/8 CUMMAQUID 'MA"CERTIFIED.,,PLOT PLAN OF: GLE DRIVE,ENTITLED 36* �EC 6' 96.75 _MA".�DATED JULY,21':CENTERVILILE,CV 0) AND INTENDED:T0 BE A SURVEY, PLOT,,IPLAN 2.5 Y 7/4 IT SHOULD BE USED FORs,N0' PURPOSE OTHER THAN 36'- 60" 94J5 THE SEPT1C.SYSTEM INSTALLATION.Mad.Som EXISTING'EXIS TISC GARACE LLACH �PrT'To BE pu�is y 8,11 OV PED''OUT,AND REMOVED' TO,FACILITATE.NEW'SASAW;TALLATION.81.25 2 'BEDRO UOUSN ANY-STRIPPW-OUT,S OIL-�CONWNiNG­LEACHATE 10 , FROM 'THEtXISTIING LEACH ""$)IT TO 43E'DISPOSED.................. OF AS PER BOARD OF,%HEALTH-SPECIFICATIONS.NO�' WITHIN �00' F THE PROPERTY S Pere #1 9 2,'PARCEL 1 42,ASSESSORS MAP Depth to Pere: 60" to 78"n ASPHALT I Pere Rote--.,Less 'Tha 2 MPI LEGEND 1,DRIVEWAY,Observed ESHW10 NONE OBS.��'l 50' A e'd LOT #24 ssum ADJUSTED H20 Elev.:- NONE OBS'.' - 150", Assumed f5,009, Squaie Feet NOPROPOSED,SPOT,. GRADE DENOTES EXISTING X 104.46 SPOT GRADE;IPL ,I:4 18.00 PROPOSED CONTOUR PF -97 EXISTING:,CONTOUR--- --- - I�GALLON SEPTIC TAN TYPICAL I 000 K DEEP EST HOLE PERCOLATION:,JEST LOCATION CCESS MANHOLES 'V 2-18 61AM.A" I 6 FOOT STOCKADE F'I�N CE(40 FOOT 'RIGHT OF WAY)INLET LO T P LA' IN OLITT 0 F PRO[ OSED,, SEPTIC ' SYSTEM,,, UPGR IHE ACCESS COM3M FOR IME SEPTIC TAW, ADE DISTRIBUTION BOX,AND LEACHING COMPONENT' ,SET DEEPER THAN 6 INCHES BELOW FINISHED OR PREPARED GRADE SMALL BE RAISED TO VATHIN Oft OF STEEL,REINrORCM 'PRECAST CONCRETE FINISHED GRADE. GEORGE�11 CUMMING—N V1 P EW INSTALL TLIF-IE GAS BAFFLES OR EQUALS AT-2 VERS REMOVABLE CO #�53 DRIVE 4' A clearance -� , I q,.. CENTERVI LLE, :�M NLET !t min. 2" min.'inlet to Qe§:ign_Calculations outiet OUTLET'rTtl-q 6 o7T e"F lul mirL PREPARED By�14' Number of Bedrooms: 2 Equivalent to 220 GdL,Day '(330 Col./Day"Min. per T e L 5' -7 ift V)Garbage'Grinder.: No E g CA l'-0, mih� Leaching Capacity Propb Liquid depth MA Septic ank x 330 RJfE)V- E. ' SHA Y sed:,,,330'Gol./Doy Minimum�(Min. Per ritle V)660 USE EXIST. -1,000 GAL Septie:'Tahk, 0 20 .40 5o Gol./Oay SOIL ABSORPTION AREA: �Using percolotl �'ENVIRONMENTAL: SERVICES, INC.on rate of <2 min./inch'-T:. 7.V Bottom Area: 0.74 got/sq. ft. k 70 sq.,ft. 27.3.8 gallons 0 0, BO ar-o- ------ _41� -10- 'Sidewall Area:' 0.74 gal./sq. ft. 78 sq. ft. 5 62T' E'gallons AST FALMOUTH MA ,02536 Providing, 331.80 gallon CROSS SEQ-TION END-LSECTION I T AIR TE se: (5) INFILTRATOR HIGH,U CAPACIT H-10 UNITS HAVING:A 0.83',(10 INCHES) :EFFEC-nVE E)EkH, SCALE: :1 20' L/FAX 508 548 07�6 SCALE: 1"=26, DRAWN BY:TO BE USE0 WITH 4,'O* OF'WASHED STONE ON THE.SIDES,`AND OF WASHED tT'ONE CES �DATE':,'DEC. 22 2003 ON__THE;ENDS, NO STONE UNDER.arcool Odor Jim! iPF 'PROJECT#SD5! 1;:,, ,,,.: FILENAME,, SD51 1 PP.DING SHEET OF`