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HomeMy WebLinkAbout0049 GOFF TERRACE - Health 49 GoTerrace Centerville A=171-105 i . Ll No. 4210 1/3 ORA � K 1000 L..d o o a No. j `� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4phration for 30isposal 6psteiii Construction 3pPrmit Application for a Permit to Construct( ) Re ai ) Upgrade( ) Abandon( ) ElComplete System yndividual Components Location Address or Lot No. f tJ✓ Owner's Name,Address,and Tel.No. r AMA, Assessor'sMap/Parcel OS (S►"+� Installer's Name,Addrreess,and Tel. o. j76 I1a�r 7� Designer's Name,Address,and Tel.No. Type of Building: P-can��, t"►'1 Dwelling No.of Bedrooms tL. Lot Size U sq.ft. Garbage Grinder( ) Other Type of Building J"A., No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re uired) gpd Design flow provided K0 gpd Plan Date 11 (jl S` Number of sheets Revision Date Title , + )) Size of Septic Tank 675>l►•.' Ac Je , Type of S.A.S. Description of Soil 'A _�<c & s•°— 3 ' ,"'�rc�'✓� Sr.�/� Nature of Repairs or Alterations(Answer when applicable)911 c[n 6 1 1.1 A�4,5' SGyA 4f A S O./All,IA J !%A c O'G�S ` re, Cye. PJr1-SA$4, �sn �iwii167� / Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date C I bo Application Approved by Date Application Disapproved by Date for the following reasons Permit No.S�/ g Date Issued 'WiiYiY�Y.-y� ��d--- No. � �✓ 1 1�,,� Fee 150 THE COMMONWEALTH OF MASSACHUSETTS Entered computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye ftplication for -MispoSal 6pstem Construction joermit Application for a Permit to Construct( ) Re air ) Upgra'"i e( *`� Bandon( ) ❑Complete System Individual Components Location Address or Lot No. y/Q f` 'T'ezmt� �'-y�j) Owner's Name,Address,a d �I.No. rC re,"Al // C 1_'_ ill [ Assessor's Map/Pazcel I US (S r^� ��;�C� Installer's Name,Address,and Te1.1�o. p% L7a,* ]�` Designer's Name,Address,and Tel.No. I our -32S-6,V ..c Ate, s Yr rz r� ,�► .►,� 3 s�t..����d. Type of Building: Dwelling No.of Bedrooms rtt., Lot Size 1649 sq.ft. Garbage Grinder( ) Other Type of Building f�rt'c�r..�.4 No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required/) �?.3U gpd Design flow provided gpd Plan Date��1 /—will Number of sheets , Revision Date Title 1 / .r. Size of Septic Tank eA5L,,-. solak l� � Type of S.A.S. Description of Soil .�[ 7 3''— )3€ ' r�r�/.v.•. S�<� v �i f �^ "Op/ ' Nature of Repairs or Alterations(Answer when applicable) Rc hz,, I A g. /0 aCe. AA ' aS rn .H A41 31. cIGls �IrWG Pxl�liw�G l?n. )A r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the-provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date L It,I a0) Application Approved by Date ��f Application Disapproved by Date for the following reasons Permit No. �� -� Date Issued 4 ,/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CEERTIFY,that the On-site //Sewage ??Disposal system Constructed( ) epaired!( ) Upgraded( ) Abandoned( )by �•' � �<� C )�t.t '�► at 6[ has been constructed in accordance l 1 with the provisions of Title 5 and the for Disposal System Construction Permit No!%19"` )1-5 dated 41/J J a a Installer 7.,' Designer Swat I•-_ #bedrooms 'r Hi r` Approved design flow �j�1 gpd x The issuance of this permit shall not be construed as a guarantee that the system will funcct onlas dq?,signed . Date .� 1 Inspector •� t� i J J C. ------------- --------------------------- ------------------------------------------------------------------- No. , -P -"! 1 1 -5 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction 3permit Permission is hereby granted to Construct( ) / a; ( ) Upgrade( ) Abandon( ) ,"'•' ' 11 l System located at 7AA �+�,o,�lr► 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. r' Provided:Construction must be completed within three years of the date of rhispernmit.,� y t} Date, r`� f Approved�b _ L J TOWN OF BARNSTABLE LCvATION 2�4 )e11 acp- SEWAGE # VILLAGE C ✓SUP_ ASSESSOR'S MAP & LOT I I /0 cS •F • INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS '-�. PRIVATE WELL OR jBLIC WATER; BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Re L .-on.cT A— n L IO to Ll Terracp- ✓,r, r Town of Barnstable Regulatory Services Thomas F. Geiler,Director �s,ass. Public Health Division 9 ,'$ Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-86 -4644 c Fax: 508-790-6304 Date: Z �// Sewage Permit# Assessor's Map/Parcel (7t 116r Installer& Designer-Certification Form Designer: Installer• La.d Address: a 70 Address: �LGGo OnAgAO/4 aoll Z&1- 41) 1 ���, was issued a permit to install a (date) (installer)septic system at V 2 e�;B f /�' f /�1�Q � 1a"" based on a design drawn by (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revi$ion or certified as=built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. ti " TERENCE '"�'n (Insta er' ature HAY ES No. 979 (Designer's igna e) (Affix Designe . !t mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office formsWesignercertifcation form.doc Regulatory Services �Qq SNE Tp� o Richard V. Scah,Director H„MAB Public Health Division STM MAS9$ 1q ,0� Thomas McKean,Director ArFD"'0�a 200 Main Street,Hyannis,MA 02601 1 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property Address:. -- Assessor's Map\Parcel: Property Owners Name: r3/)Pf:>" in tUt-(UArAt j In accordance with Massachusetts DEP alternative system approval letters, the following certification information'is required by the Owner of record The Owner of record must place'af- Y' in the- applicable box next to each line certifying the information. Yes N\A ,P" ❑ I have been provided a copy of the Title 5 I/A technology Approval letters. / (15 page Standard Conditions letter and the specific technology letter) H/ ❑ I have been provided with the Owner's Manual �Q ❑ I have been provided with the Operation and Maintenance Manual Rr ❑ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval C� ❑ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) C ❑ If the design does not provide for the use of garbage grinders,the restriction is understood and accepted ❑ Whether.or not covered by a warranty,I understand the requirement.to repair,,replace, modify or take any other action as required by the Department or the LAA,if the Department or the LAA determines the System to be failing to protect public health and safety and the environment,as defined in 310 CMR 15.303 I , w ' r I& e& -'G, agree to comply with all terms and conditions above. Property 0 s p d nam Pro 7orm wners Signature Date Note: Th must be submitted long with the septic system disposal works permit application for all I\A- systems including new construction, repairs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\IA homeowner certification 2.doc TOWN OF BARNSTABLE LOCATION y� ACT rr�j� SEWAGE# 9"// VILLAGE ('e,lay,.i ASSESSOR'S MAP&PARCEL 17 10S INSTALLER'S NAME&PHONE NO. X c-, LQ„d_CA,, ,��L L,�'fP - SEPTIC TANK CAPACITY /ono , LEACHING FACILITY: (type) A '(,cP l„f,J,4 (size) NO.OF BEDROOMS OWNER t4- fflkn PERMIT DATE: COMPLIANCE DATE: Separation Distance Betwee X, . 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 LT Commonwealth of Massachusetts \ ' -1 r WC w . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Goff Terrace w y Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 4" • City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/,13/19 Inspect6K Sig Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doe•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ElN ElND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1.. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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 If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has.the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityrrown State Zip Code Date of Inspection D. System Information Description: Original septic tank, new d-box and chambers 2015 per BOH record. During inspection the original leach pit was discovered it was not filled when abandoned in 2015 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 159 GPD 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No recent pumping Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system b system operator under contract p Y Y Y p ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Original septic tank, new d-box and infiltrators 2015 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 1" t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments G M , 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3113/19 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle '12 Scum thickness • 3" Distance from top of scum to top of outlet tee or baffle >2" �2 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet 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: Date t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 5" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is flooded at this time Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Infiltrators are in a state of hydraulic failure at this time, Fail observed at inspection port Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 4� $ A- �36 S c�6 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >20 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: n/a Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4' seperation per compliance on file ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping put sit at 50'msl and nearby surface water at 22'msl You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Goff Terrace Property Address Whitley Owner information Owner's Name is required for every page. Centerville MA 02632 3/13/19 CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable -,:-`---r P# Department of Regulatory Services azernsm : Public Health Division Date August 3, :2015 �ably �� 200 MairrStreet,Hyannis MA 02601 , p NUS� .. •• s :i ta.,�� - Date Scheduled Time 1 Fee Pd. M. Soil Suitability Assessment for Sewage Disposal Z, Performed By: f�! -��o'� Witnessed By: �1 - LOCATION&_GENERAL INFORMATION Location Address ` - Owner'sName'Barbara M:gWh`iteley` 49 Goff Terrace 49 Goff Terrace Centerville Address' ' Centerville, MA 0263 ' Assessor's Map/Parcel: 171/10 5 Engineer'sNanip Robin W`.. Wilcox w . Sweetser Engineering NEW CONSTRUCTION REPAIR ._ Telephone# 5 0 8-3 8 5-6 9 0 0 Land Use Slopes(%) ' © — -- Surface Stones ! Distances from: Open Water Body ft Possible Wet Area /') V__ ft Drinking Water Well ft Drainage Way Property Line ��r ft Other ft SKETCH:(Street name,dimensions of lot,exact locator.of test holes'&perc tests,locate wetlands in proximity to holes) ID 41 cl:� Parent material(geologic) ,,Deepth to'Bedrock � 1- Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face �y j?�pN Estimated Seasonal High Groundwater T DETERIVIIN¢iTION FOR SEASONAL HIGH WATER TABLE 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_ lw _.._ , . __.. -.PERCOLATION TEST Deter ( r tine &.,Ap Observation ( _. _ .._ Hole# -" Time at 9 4 -^ Depth of Pere ti Time at 6" t Start Pre-soak Time @ Time(9;-6") s� End Pre-soak RateMin./Inch'.' Site Suitability Assessment: Site Passed Site Failed:. Additional Testing Needed(Y/N) , Original: Public Health Division , Observation Hole Data To Be Completed on Back-----------r ***If percolation test is to be conducted within 100' of wetland,you must first notify& Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC ! a F DEEP OBSERVATIONHOLE LOG Hole# Depth from Soil Horizon Soil Texture < ' Soil Color,i i t..y I Soil ,• Other'i Surface(in.) (USDA) (Munsell) { Mottling (Structure,Stones,Boulders. Consis nc -u/o Gravel) ,�.�IC Oat^ :. .:� �.�"-," '.�: • ►" ''; ,' .o r',';tE`�. `�" :_ • 5. sF l }y_*DEEP OBSERVATION HOLE LOG ' ' Hole Depth from Soil Horizon r Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistengy,%Gravel { m DEEP OBSERVATION HOLE LOGn Hole# Depth from Soil Horizon .Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION;HOLE LOG" Hole*.` Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate May: , l a •; Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No 'Yes 1 'Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? IKI�T — If not,what is the depth of naturally occurring pervious material? 1 Certification I certify that on (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 train' ' ,ex se and experience ribed in 310 CMR 15.017. Signature • Date I dt. .r,� r.?!t y. rt ,• :a I1zi' j1t'k 'eI¢ � -' e" "s" ell ! I :! i , �. .. ,` u .. a .;r, • `tip ',Ss ,.; {•,s , agit •f,: �. -. , Q:\SEPTIC\PERCFORM.DOC No. 7,6 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: tJ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricatiou for Disposal *pstem Construction hermit Application for a Permit to Construct( ) Repair+ Upgrade( ) Abandon( ) ❑Complete System Drndividual Components Location Address or Lot No.i/Y l 6(f Ter Y Owner's Name,Address,and Tel.No. o � Assessor'sMap/Parcel J-7� t kJA• e1 49 Ga �"Cz•r��e .i Installer's Jle tallerr'��s Name,Address,and Tel.No. Pr, Iwo NIP Designer's Na e,Address,and Tel.No. IKi v L4 C t.s4Acfi�,_, 5.�arr n�►h 4ijeA-a-r Type of Building: Dwelling No.of Bedrooms oe Lot Size I S,/90 ®9 sq.ft. Garbage Grinder( ) Other Type of Building 'Jew %f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ,'(] gpd Design flow provided ��, gpd Plan Date (j p,l Number of sheets i Revision Date Title Size of Septic Tank �°r� 1 Type of S.A.S. 1Vje C /go'- e In 1 sp. s Description of Soil �t� �� C ��°°w /Y#.1� �P�," -'nrA Nature of Repairs or Alterations(Answer when applicable) �j�o ®_�Q .9,c Ax -:/j �� �_ �• �� I) �1- /�,o- (��Aria L�Kd 1>f.���a�� /t II'Y.36�><14 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this d of Health. I S' ed Date ICE— A G, Application Approved by Date 5 Application Disapproved b Date for the following reasons Permit No.?oig,— Date Issued .: . No. Fee /00 i THE COMMONWEALTH OF MASSACHUSETTS Entered in compute Yes PUBLIC HEALTH DIVISION,- TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Misposal 6pstrm Construction J)Prmit Application fQr a Permit to Construct( ) Repair" Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No.f/ 9 G lf 7rrr Owner's Name,Address and Tel.No. o , Assessor's Map/Parcel 171 1 S 41 A• t k �4 �' rCVru�e. .1 Installer's Name,Address,and Tel.No. PG i56C/70 b Designer's NarKe,Address,and Tel.No. Ki Kev 1-4o Cor+S �c�lcr, $.YG/MvJ1�1 SU{e ms,- f^9iA�r•. Type of Building: Dwelling No.of Bedrooms -nee<- Lot Size I C./gd sq.ft. Garbage Grinder( ) Other Type of Building Ci 5,.de.��r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Io Design Flow(min.required) M gpd Design flow provided 3S gpd Plan Date Q_ff ���1 Number of sheets Revision Date Title Size of Septic Tank C.AS),e„r �G./4U0 pR� .. Type of S.A.S. yX A'- Cp TA A.&_Cw. S Description of Soil ,J S,e& �q C / ��?�'� l3��' rn�a�Ur► �dino� Nature of Repairs or Alterations(Answer when 1applicable) ��1 O/pU .1 A k.X IS1�/+t�a.Y, �• eX p L)� y`I. (ileALI/9 ���1✓r/I�OIS t,.• f ��lf/�nf> 1�,X36,1� 3 ti Date last inspected: `r 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 B d of Health. r S.ighe Date jg GI Application Approved by Date 6 b Zol S" Application Disapproved b Date for the following reasons Permit No. Zotq — AAW Date Issued lb ADl . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired) Upgraded( ) Abandoned( )by r.;KC•I �14N at i1 !6"*X -(•tj✓q f has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NOGG/J- 35-8 dated Installer /� ��kG+• Designer e< 4.<e� #bedrooms "rr`<C Approved de qw (l gpd The issuance of t is per.6 shall not be construed as a guarantee that the system ll fiz c 1on as design Date �. f Inspector ___________ G-_______ 2 No. J�8 Fee Z/W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal .6pstem Construction Permit Permission is hereby granted to Construcctt�( ) Repair Upgrade( ) Abandon( ) System located ate- 7 YT :T C✓f Aec and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe it. Date 20/ Approved by • Town of Barnstable Regulatory Services Thomas F. Geiler,Director. > 11 Public Health Division ��`e$ Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862 4644 / Fax: 508-790-6304 Date: 2 �i5 Sewage Permit# 1,5— ST Assessor's Map/Parcel 7 /0,5- Installer& Designer Certification Form Designer: �l.J TJ"-?t- Installer: Z Address: �osc -71; Address: FG &X 7R(a OZ66f> On (� 4\'CQ was issued a permit to install a (date) r' (installer) septic system at 5 OA4 /zf2RiK�', ����� based on a design drawn by (address) y `���^/��/r✓^��i dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution 'box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. H OF&,As y TERENCE GM1 � PA. (Instal er' a re " HAYES tn No. 979 0 �.,......-_.a.,....,:.�_�,,✓ �G►S 7 ERA i S�NfTAR\PN (Designer's igna •e) (Affix DesiofEPMamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification fonn.doc I TOWN OF BARNSTABLE LOCATION G D�F TeJ'4- e SEWAGE# VILLAGE cva XX ASSESSOR'S MAP&PARCEL 'J 1 /d INSTALLERS NAME&PHONE NO. /fie f SEPTIC TANK CAPACITY 1 U0y LEACHING FACILITkY: (type) i (size) NO.OF BEDROOMS _ OWNER � . PERMIT DATE: COMPLIANCE DATE: p Q 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 a 3 ' as , 9 1 d y , w �%14 e rs�ca- y 3 3 33 9 3 I P D fsox LI. a►7.b q S 09-05-2001 01r28P."1 CENT DST FIREDEPr 5N8'1902385 P. 76 03r 0 -280t 04 0,Te, CEM 05T FIREDEPT 1�02 Icb V. Fuv Departr+lotat raCairtal'orisinw applicatbn anti 4*1194 du~as p"mit J �7//D 6— yaasCop� c '. .—Toaa c 7uo � APPLICATION and PERMIT for StOrd"tank rOmOval and trdn&port,"on to 8pproved tank dopooW yard in oc=dwoe with 1he provisions of M.G.L C.tmpter lam.Section 3K S27 CMR 9.00.apOti Abw is heroby R by: Tank Owasr Natrte(ptrgsa prinq Urbara b_,__j&iteley..._. X 6D4 { A0d►essi..A9 Coff Terrace Centerville MA 02632 an..r ""CA• 8ear re 1 Conv"Narrra sewoal Specialists Adt4�e 63 Cevdridrp__ L4xtt. HA 01902 Addmw 63 Go®dYid8e St., Lynn. HA 01902 ..�P�. SK7nalt+R t+t tor;,8rrnitl � Sic�iAse(d ao A'stg 1vr wrt>r1U --�_ x I .� L 11:0 Carmw Other 1FG Cortiiild =LSP Jr parer Tank=Capac*y ..,69=,330 ce �CeeS�svi2la. ?SA 02632 y T'"k it -- &ftunce Lent 5toc" Tactic Owwo ona(damr w x*r qm) Ra>r+s,ecs: R.uumza4 of one 330 gallon anaergrogin aii stoke tank Fr n tr�ort%q _Removal Specialists Slow Lac.Ik.._ HARDOOO12l38 r�docrawsate manMes� rura667673 R.P.A.q HAROOOO12138 Approved tank aFpvsal yajd Turner Truck Ln /Salvage Tank yard o 002 Type of inea gas Tank yartl ad"r, g*g!2reial St. L, , HA 01902 a• CRh or Town CAntg aillc _ ��---Apops 01920 Pw1r idt _,..... . Da%ofSM Sapforchir 4. 2001 O o*f9apifdUW1 -g.Pgj@mbgS2. .ZW1 1 E i9 safn approve!mcm or. 20013SOS744 79 Sate Top Nee Tal,NUMbw.aoa ss 322.48 1 64 Siormom i T'lle of C*tw VW&V Pervrr. )A// After n rnovagil Gerd Form?-290R aiVAd by Local Fine DW,to UST Reguiatony Carnpfba"U".Ono Aghbc tton Plats. ROOM 1310.BOOM,MA 0$:0C.161S. FP.W!'*riot ww) TOTAL 02 .S3 TCTHL P.C2' oq-ate-2001 e l:28PN CENT CST F I REDEPT 508'7902385 P.02 M-64-2M1 04 02W, CEM 05T FIREDEPT it 1 e.b2 Firs C"mtt m Waim originw swiratiol,ttnd 14"'m ouoftmo as Rwe wit PJ�l�l�d�t7ll�L APPLICA"rION and PERMIT far 8t0rdP tack Mmoval arW trarlgpprtahon to approved W*&PO"Yard its=wdwoe witty the prmigions Of M.G_L Chapter 148.vvcdw 3K 527 CMR 9,00.appkation is rWgby M&;50 by: T6-4 Owner Natrte{pirsnt pnq itel X �- Address. Coff Urrace �Cent,orville MA 02632 anw cv a+a za t Co r""Name Qjz=& .5ga� ?� es Co-a ln*,i" Rftoval Specialists Nm Acs�esa 63 Gvva�rideq L Lrna. HA 01902 Addrm 63 Goadr3dje St., Lynn, HA 01902 Sionalumto fo-Qnnd) � viglit�LTe(A utgtor,wm� W a Confto o taf `IFCf Coftfied =Lsa outer f TankLg=tian .'69_�ff T�zrac�e CeAserrilis. ?IA OZ632 TaNc Capacily;gatrona} 330 Substance Lost 510(ft _ Tonk Owwa oo*(daum*r:*vgM) RomaAcs: Emova4 cf one 310 gallon undermep9N 031 Its:gAge tank IN 1 Finn ftvpoainq wam __Removal-S1ree ialists Ste*lk'd URD00012 t 38 E taa8wsssternanit � tua667673 E.P.A.V IURWO012138 A mv"tank deposal r_m Turner_Truck inASalverte Tank yard 0 002 Type of inert lu Tank yar0 aoarss>; Coaoaereial St, L, HA 01"2 ! C of low Cents i lc —_---_FOIGa pwrrriw _,._.... Dare of*We '��=aee�er (t• 7(fo 1 Wte 0)eapirati0n �.nt� �, 16�,�1 Dig sale awmVW numver. nil, 1� 3SOStb� Oi9 Sale ToU No rot.NurftW•aca322.44W"t 5fOMWM I me of Costar VwAk g pem t' After my aKr,)Send Form?-2"signed by L"Fire OW,to LIST Buie"COX*Untt.Otw Ashlh Ori Place, 900M 1310,FW00n,MA 02:00.1618. FPasn TOTAL P,02 oYU TCTRL P.C2 AFAI --T _- TOP OF FQuNDA�TION i 20 FT. MINIMUM FRPM ELLAR OR CRAVL SRACE___ _ TE 1 ELEV. r 1Q0.0 - 10 FT MINIMUM10 FT. 4INIMLIM FROM SLAB � DATE OF Sp �T ��T GL 31 20?(ASSUMED) CLEAN SAND SOIL TEST DONE BY �,-�ET R MgiN ERINNG P 1 i �QN R TE WITNEISED 13Y �$��� � QV1� INSPECTION PORT 4" 5CMEDU�E 4q PVC PIPE LOAM AND StiED ( " R A TI j MIN. PITCH 1/8" PER FT. � 2" LAYER OF F�i.+$Eft�A 110� M � -��_ f 1/8" TO 1/2" PERCOLATION RATE <_� MIN.�INCH AT 4 INCHES WASI�6D $TON£ DEP Hy HORN TEXTUR COEpR MOTT. OTHER 2V 4" CAST IRON PIPE P VENT (OR EQUAL) MINIMUM 0 MAX. OR °I� TER FABRIC T_t .75 WN. NOT REQUIRED EO�'PP LOAMY $AND 10YR6/) NO ROgYS ' _ { _ . ---- -. ---- ----- ------_ ---- _ - -- PITCH i/4" PER FT. F� {{��OW - T 110-23" LOAMY $AND 10YR7/4 ROOTS LEVELE S TEE �` 1 \ 123-138" G MEDIUM SAND 2.SY7/4 , 5% GRAV'FLS FL W LINE ELEV. 10" .O NO WATER ENCOUNTERED AT __1W_ ELEV. NflN. r _ ELEV. 3 _ � " '.�� ° .6 �B�GRY� 2 ELEV.-__�� _ ELEV. _ _�4�L_ AD GA$ E EV = 7 6 SUMP EL V a _9 _ -= - 5 EV. _ �_ _ 6FFLE L ' _.W__ - I DEPTH HORIj TEXTURE C OR MOTT. OTHER DIPTFjIBlJT1QN a 1 A LOAMY AlND 10YR6/ NO ROOTS ELEV. -- -- -- - 1--- - --- I(QUID p TLET 11 -1 4 HIGH CAPACITY INFILTRATORS OTT I 10-23" LOAMY AND 10 7 - 3__ YR /4 ROQT'S 0� ,g'+��- STONE AN - __�. - _--- ---_--_ FEEc, TO RE ' ATER TESTED 7.07 23-13 C MEDIUM SAND 2.___ 5% GRAVELS T 19 iN NES IF MORE THAN ONE OiUTLET 11' X 10� TRENCH FORMFTi�N NO WATER ENCOUNTERED AT '38 86 7 7 FEET 4 INCHES 0 GAt.I.gN (TO BE PLACED ON FIRM BASE) SQL �Bp0�P�0 'qELl _ ELE y. a SEPTIIC TANK ZONE DOLIBL,E WASHED STONE EM (W) 'NDEX N PE ON CALQVLATIONV FREE OF FINES ic SILT ADJUST NUM46R CIF BEPPOOMS _ 3 _ GARBAGE QISPQSAL UNIT S WAGE DISPOSAL S TF� PRp�I USGS PRO$ABLE WATER TABLE tLEV. - TOTAL ESTik4AT FLOW ' kZ OBSERVED WATER TABLE ( ,/ / ) ELEV. - _ _ ( 110 (i�1L,. /4y X 8R.) _ GAL./DAY ECa"` BCTTOM OF TEST HO.E ELEV. _ _ REQUIRED P C TANK CAPA ITY 1� GAL ACTUAL SIZE OF SEPTIC TANK. (�Ob'TIM6) 1 GAL rr SOIL CLASSIFICATION _Ir_ DESIGN PERCOL-ATION RATE ,5,�_ MIN./IN. EFFLUENT LOADING RATE GAL./DAY/S.F. LEACHING AREA SQ. P.T. (11 K46)4(4T)Mc10/12) LEACHING CAP.AQiTY (AREA X RATE) GALL•/DAY 474.33 X 0.74 RESERVE LEACHING EAPA�ITY GAL./DAY Q NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D �,P T'TLE 5 .AND THE TOWN'$ RQ4ES AND REGULATIONS FOR 'HE SURgURFACE DISPOSAL OF SEWAQE. F ALL COVERS TO SANITARY UNITS SHAi L BE BROUGHT TO WITH!N r3" OF FINI$HED GRADE. 3. ALL C04PONEN7S OF THE SANITARY SYSTEM SHALL DE CAPABLE OF WITHSTANDING H-10 LQADINQ UNLESS THEY ARE UNDER OR WITHN 10 FT, QF DRIVES OR RARKINC AREAS. H-20 LOADIN4 SHALL BE NC USED UNDER OR WITHIN 10 FT, OF DRIVES QR PARKING AREAS, M. - 4. ANY MASONARY UNITS USED TO BRING CCV'ERS TO GRADE SHALL }}� 0 \SHED r BE MORTARED IN PLACE. 98.8 79 5 NO DETE11MNA7104 HAI BEEN MADE AS '0 COMPLIANCE WITH r IST0'�O. DEEDED OR ZONING REGULATIONS. O"ER / APPLICANT :S TO 99.E gNITARIPN OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6 �"LITIE5 SH:)*VN ARE APPROXIMATE ONLY, �XCAYATION CONTRACTOR 9$.1 IS TC CAL "DIG-SAFE" AT 1•-88E-34A-7233 AT LEAST 72 HOURS TEST 1 PRIORO p LUMNItNv,to4o Ovid: ,r ­:'L p, 7. CONTRACTOR IS TO VERIFY GRADES AND E41VATIONS AS WkLL AS SOIL SITE CONDITIONS PR!OR TO COMMENCING WORK ON SITE. ANY VARIATION TEST 2 IS TO BE BROUGHT TO THE ATTENTION OF Tit E DESIGN ENGINEER 98.4 1NOF IMMEQ:ATELY. r, 6. PARCEL IS IN FLOOD ZONE aF, t 8. LOT IS SHGWN ON ASSESSORS MAP 171 _ A5 PARCEL 1_ _. BOX E 1 .� 1a. EXISTINi, LEACH PIT IS TO ESE PUMPED ANq B,AGKFILLFD. $ 8 X a 1i. THE !N$?ALLER IS TO GIVE THE ENGINEER 4 MINIMUM OF IS HOURS (2 WORKING DAYS) NO19CE FOR THE FINAL INSPECTION (NUMBER BELOW). 1000 GALLON F 0 L 0 r 5 g SEPTIC TANK ��V�4O�o 75, 150.0 f S.F. L 98.E APPROVED: BOARD OF HEA .1 � i DATE AGENT 93.7 `40 PTIC n#SIGN IFOR 98.0 (98 -KII:Tmy F a � �0 i 95. 7.3 r 14.' 955 LEGENO: ° 3e5-690 s©urn+ Of N►yls, 66 2 ASS. 0 Q XISTING SPOT ELEVATION 00„0 9 EXISTING CONTOUR 0---- 94 .E Q G 4Q' T SGAL i I' FINAL SPOT ELEVATI PA FINAL CONTOUR ON ( I 2 Q' SOIL TEST LOCATION UTILITY POLE -�-- �-'g 4.51,JOB-'INry0. QQ iTOWN WATER - W O f V CATCH BASIN ______ __ _ i (_ , � 1 GAS LINE GLEAN OUT � CESSPOOL C.P. 0 v ,O C A TI C�{ V A S v. ( SHEET 1 O F 1 I � ; I I C. S81A.R0✓ 7604-00 dw217604-5A5;DWG 9) 2G16 SMET$ER ryGIN ER GI