Loading...
HomeMy WebLinkAbout0259 GREAT MARSH ROAD - Health 259 GREAT MARSH RD., CENTERVILLE A= 210 136 1 �I UPC 12534 No. 2153LOR It co HASTINGS. MN Commonwealth of Massachusetts Title 5 Official- Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 0825/12 page. Cityrrown 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. Important:When A. General Information filling out forms i on the computes, I use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett - - use the return - - -- — - — key. Name of Inspector --— -- - - - - T Aardvark Environmental Inspections "�11 Company Name PO Box 896 Company Address r East Dennis MA 02641 Citylrown State Zip Code 508-385-7608 SI 3742 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage deposal 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 15A00).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority No�zko-el 0826/12 Inspector's Signature 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 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 DEP.The original should be sent to the system owner and copies sent to the buyer,tf 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. I t5ins-1 WO Title 5 Official11nmnrm:Subsurface Sewage Disposal System-Page 1 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is Centerville MA 02632 0825112 required for every page. Cttyrrown 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: ® A 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 efiltration 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): t51ns•11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Flame information is required for every Centerville MA 02632 0825/12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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—El N—❑-ND(Explain below):__.--4-.- ❑ 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 ❑ N ❑ ND(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 mannerwhich 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 w7TS• I%V 1 a J 1J kia1 I Iwectl rin Form.Siobsiuiiaoe Svwage Uspwal&f.Aa2m•Page 3 ai 117 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 08f25/12 page City/Town 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 El ® 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'/z day flow t5ins•11/10 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 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is Centerville MA 02632 0825/12 required for every page. City/Town 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 a private water supply well with no acceptable water quality analysis.[This from p pp y P q �Y Y 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 e)dst 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 Deparfinent, t5ins•11/10 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 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 08/25/12 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"non 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? El ® 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-11110 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 08/25/12 page. City/Town State Zip Code Date of Inspection D. System Information Description: 3 Number of current residents: Does residence have a garbage grinder? ❑ Yes E No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings,if available (last 2 years usage (gpd)): Detail: 2011 15,000 gals 2012 63,000gals Sump pump? ❑ Yes ® No Current Last date of occupancy: Date Commerciallindustrial 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: t51ns•11/10 Title 5 Official Inspedion Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts . Title- 5 Official Inspection Form K Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 08/25/12 page. City/Town 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: 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5Offclal 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 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is Centerville MA 02632 08/25/12 required for every page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 04/28/06 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ED No Building Sewer(locate on site plan):- Depth below grade: 3.6 p g feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: eet Material of construction: ® concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,500 gal 4" Sludge depth: t5ins-11/10 Tdle 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 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is Centerville MA 02632 08/25/12 required for every page. Cityrrown 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 ZS" Scum thickness 4" - --- - - - - - 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 15" 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.): The tank was sound and tight with tees in place and liquid at outlet invert. 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•11110 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection_Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 08/25/12 page. Cityrrown state Zip Code Date of Inspection D. System Information (cant.) 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title-5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is Centerville MA 02632 0825112 required for every page. Citylrown 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 even 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.): The box was level and tight with tees in place and liquid at outlet invert. 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.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 08/25/12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 - ---- - 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.): This system has 5 infiltrators in a 37'X10' stone field.There was no sign of ponding or failure in the stones. 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•11/10 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 '< 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 08/25/12 page. City/Town 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.): t5lns-11/10 Me 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 08/25/12 page. City/Town 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts . Title .5-Official Inspection Form "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner - Owner's Name information is Centerville MA 02632 08/25/12 required for every page. City(rown 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: 20.0 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: Date ❑ Observed site (abutting properlylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20.0 feet Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5lns•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 259 Great Marsh Road Property Address Donna Wilson Owner Owner's Name information is required for every Centerville MA 02632 08/25/12 page. Cityrrown 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 1 1 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i n ,�^ TOWN F BARNST ALE LOCATION oS 7 ��, T S� r SEWAGE#;;r VILLAGE.(� e�ffU�1�� ASSESSOR'S (MAP&PARCEL _ / INSTALLERS NAME&PHONE NO.7:D�? SEPTIC TANK CAPACITY 4157t5-- TS '^JA= `07fT} LEACHING FACILITY: yy pp a �f�� f size 2 (type) 1`1_C.� (size) -����8� NO.OF BEDROOMS 3 OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �I . . �.c� � A 1� _.: �/�1� � /� � �-�� � �r l �� �, PiNo. r +F Fee A/Q THE COMMONWEALTH OF MASSACHUSET�S Entered in computer: V PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for � gpogal *pgtem Con5truction joermit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑ Complete System)Qjndividual Components Location Address or Lot No. p�,j 9 7-eq-i- 4d Owner's Name,Address,and Tel.No. t / Assessor's Map/Parcel --21Q-- /-34 &I �/�-t/ �✓ ��d Installer's Name,Address,and 11. o. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -33 0 gpd Design flow provided 73 1 1 `i gpd Plan Date 'f ­ 'aurl- Number of sheets Revision Date Title Size of Septic Tank l StV k 60 b Type of S.A.S. {-� , t � w(mil[,-'(�`/ C�-t-g Description of Soil Q-.90 ice vvk-- s S Nature of Repairs or Alterations(Answer when applicable) V 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;e�d_ Date :Application Approved by Date � :Application Disapproved by: Date for.the following reasons Permit No. � Q��? l C Date Issued No. r C W l L a -f— 'i' �K� r ylr NNN `Y Fee,-,* 00 THE COMMONWEALTH OF MASSACHUSETM Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for Migogal 4bp9;tem Congtruction permit Application for a Permit to Construct O Repair O Upgrade(4-1 Abandon O ❑ Complete System Y2,I dividual Components Location�Address or Lot No. p�J / �f/&q-f #GacS Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 1'3(l, 44101 j"24 v,� /X Installer's Name,Address,andP, A o. Designer's Name,Address and Tel.No. 1 S �� vvr S�J 14-7/ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Design flow provided gpd Plan Date '( `- acej I Number of sheets Revision Date Title q `\-/ Size of Septic Tank � 60 b Type of S.A.S. H i w(g t L_-T_ r Description of Soil vwe Q S YA Nature of Repairs or Alterations(Answer when applicable) iV '-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 'e Date Application Approved by� \ Date Application Disapproved by: Date for the following reasons sE Permit No. C._l 1 & tl c Date Issued U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,t at the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( L_)�. Abandoned( )by M n e r�S SIA; at Q q C9^rect-f- /,/Q , , h Z AY9 CG_,N7'i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ."400� �` ( dated Installer d Y ,5; ' 5 Designer -5744 A zn/ #bedrooms _� Approved design flow 330 gpd The issuance of this permit sha of bbe�cobstrued as a guarantee that the system will f�nc n s sssig ed. Date ' `'1 Yl Inspector l � ) No. & 9 (-P Fee-� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS -Migpogal *pgtem Congtruction Vermit Permission is hereby granted to Construct ( ) ((Repair ( ) Upja�de (./)Abandon ( ) System located at,, lc,��aT � u,S ICL and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.r� Provided: Construcfon must be completed within three years of the dat• of this perms . Date �7 �`� f� `P Approved b i Town of Barnstable �F1HE lq�, Regulatory Services ~O Thomas F. Geiler,Director snaxseas i 9� 1639. � Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: \C�— (� Designer: Shay Environmental Services, Inc. Installer: "C Address: P.O. Box 627 Address: � East Falmouth, MA 02536 �CCmn���� k46 OngC was issued a permit to install a (date) (installer) septic system at 259 &.0"c "RZ5 u based on a design drawn by (address) Shay Environmental Services, Inc. dated �Yr©Co-dQ (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or J certified as-built by designer to follow. 4 , OF M ,189 CARMEN (Installer's ignature) o E. � Y S{-iAY No. 1181 0 'PS P (Designer's Signature) (Affix Desi p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM s n I, OPP-M1f C,` �:)iAAq,hereby certify that the engineered plan signed by me dated Z(4 10 Ie concerning the property located at A,,,D = L 25q &c-t%:k Vky-,5 W� % !> cii1'Icmeets. all ofthe. following criteria: • This failed system is connected to a residential dwelling only,..There are no.commercial or business uses.associated with the.dwelling. • The.soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests.at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information). 1o,00 B) G.W.Elevation 2-5 +adjustment for high G.W. Z = 27,06 DIFFERENCE B TWEEN A and 9,CCd SIGNED : DATE: NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexernp.doc I SUBSU ACE SEWAGE DISPOSAL SYSTEM- INSPECTION .FORM- Address of prop ty - Owner's name V =--- - -- - Date of Inspection 6 f ���.� PART A � oU l3 ce, CHECKLIST Check if the following have been done: Pumping information was re P 9 quested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. f/ As built plans have been obtained and examined. Note if they are not available with N/A. C/ The facility or dwelling was inspected for signs of sewage back-up. c�The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. C/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 SAS on the site has been determined based /on existing information or approximated by non-intrusive methods. y The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. FPR VED 1995 DEPT. TOWN OF BARNSTABLE i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms_ number of current residents NJ garbage grinder, yes or no e5 laundry connected to system, yes or no Avd seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: oc C u�i Last date of occupancy GENERAL INFORMATION Pumping records and ourc i formation:_ i lZQ System pumped as part of inspection, yes or no if yes, volume pumped y o� Reason for pumping: Type of system peptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) ' Other (explain) Approximate age of all components. Date installed, if known. S.ource .of information* Sewage odors detected when arriving at the site, yes or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK:. SR/ (locate on site plan) depth below grade:-9_._ material of construction: 6,ncrete metal FRP other explain) dimensions• tC ti X S sludge depth distance from top of sludge to bottom of outlet tee or baffle 3" scum thickness _ distance from top of scum to top of outlet tee or baffle I.V distance from bottom of scum to bottom of outleL tee or baffle Comments: ation for pumping, condition of inlet and outlet tees or baffles, ton outlet invert, structural integrity, depth of liquid level in relation t evidence of leakage, recommendatio�rl� r r pairs, etc. ) . DISTRIBUTION BOX: (locate on site plan) [j depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence o leaka a 'nto or out of ox, recommendation for repairs, a c.) PUMP CH BER• (locate o site plan) pumps 1 orking order, yes or no _ Comments: urtenances, (note condition of pump c r, ndition of pumps and app rec ommendations for m tenance or r irs,etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued j1 I t/ SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) J If not determined to be present, explain: t I Type. _ o leaching pits and number i leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recoiDmenda, ions fo maintenance r 9pairs,etc. ) 4SSX0LS (lo e n site plan) : number and configurati depth-top of liquid to in invert _ depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must a pumped as part of inspectio Comments: (note dition of soil, signs of hydraulic failure, level of ponding, condi ion of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY: (locate on 'te plan) materials of co ruction dimensions depth of solids Comments: (no ition of soil, signs of by ulic failure, level of ponding, condition of vegetation,- recommendations for maintenance or repairs,etc. ) . 1 /r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE 7-=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' 0 6 ' 'D `(l ' DEPTH TO GROUNDWATER depth to groundwater method of determination or a x ma on: r . J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Q� Backup of sewage into facility? /1/0 Discharge or ponding of effluent to the surface. of the gro d or surface waters? �Z Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool �of <6" below invert" or available volume< 1/2 de flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? � 1�� Is any portion of the SAS, cesspool or_privy: L!� below the high groundwater elevation? within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? Al within a Zone I of a public well? „ within 50 feet of a bordering vegetated wetland or" salt marsh- I1 (cesspools and privies only, not the SAS) ? I within 50 feet of a private water supply well? less than_ 100 feet but greater than 50 feet from a private water j supply well with no acceptable water quality analysis? If the -well has been analyzed to be acceptable, attach copy of well water ana.- for coliform bacteria, volatile organic compounds, ammonia nitrog and nitrate nitrogen. i i i . 1 J.' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Uzi Company Name � � • Company Address Certification Statement I- certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maiitenance of on-site sewage disposal systems. Check e: have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector' s Signature � ' /���` .C✓ Date 141�;�,Z6 _ ly. Original to system owner Copies to: Buyer (if applicable) Approving authority i No.__.5-c,__` -- Fis......7.,:5-.---._ THE COMMONWEALTH OF MASSACRUSETTS BOARD OF HEALTH ...... --- ... ....OF........ Ze 43 ----------- tj Application for UhipaaFal Works Teat lrurtion Famit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal ystem at: .ic ---------•---------•- .............. .�a .... ------------- --------------------•-------------------- Location-Address or Lot No. 3-c3 _. ram CSC/.........' C���/f f ���1C`i2s/ ! Leo1� - y Owner Address a -••• ` -------------------------------------•----- Installer Address d Type of Building Size Lot.....!;.l._Q_fa...Sq. feet V Dwelling—No. of Bedrooms......TW..ca..........................Expansion Attic (✓) Garbage Grinder 0,6) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ................................. . . ..... W Design Flow...................................5 __gallons per person per day. Total daily flow.............................2L4....gallons. R; Septic Tank—Liquid*capacity.U9.9Rgallons Length./O.1_L.". Width4F��;g�"... Diameter................ Depth`............ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__5;.!�ts?-......... Diameter....z.c.......... Depth below inlet..s. ........ Total leaching area_!?7_...sq. ft. Z Other Distribution box (x) Dosing tank ( ) Percolation Test Results Performed by._5.t��;.lSw►.--- raxn 3 ... 4-9............ Date__ -V_I' ... .p.l.`?...t..... 1 Test Pit No. 1.....oz-------minutes per inch Depth of Test Pit.__44 `...... Depth to ground water_________________•._.__. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa __'W.QF __. •---•---------------------------------- ................................................................................ ------- O Description of Soil----. a `4 T® Qf.l_ _ !t�s�� l -----------------------------------------............... ------------------- (4 _6'-_.:Z__..S_ ti Q•._iY�1cc01a1m ems' Q `�! s.Vs ----•----------------•-•-------•--- X ALLYN---- W - '7�"-14.5 • 1.alai.kr-_..M.scfi+lm__. n.&................................. MLSON ----------- UNature of Repairs or Alterations—Answer when applicable._-__-_•_________-------------------------------------------- �A.o.30216 -------------------------------- •-•--------------- •------------------------ --------------•-•-•-------•-•---•--------••-•---•---•-•--------•--------------.-•-•- - G/ST�� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sys e i accor a ce with 7ro/B>r the provisions of i i: .~.p 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. P $ Signed--- 1M -.... .�..,.—�.t�-_,._r........................ •--•-- Date , Ii Application Approved B �Iell�.. ................................ ----------r�. �6__T CS .sr Date Application Disapproved for the following reasons--------------------------------------------------------•------•---------•---------------------------------•----- ---•--•---•---------------•-••••-•.........•••-•----•----•-•-••--••-•------•-----•-------•-•--•--•--••--•-•-•----•--•-•--•----•-•••----•-•----•-•-•-•---•--•-----•-------•---••-----•--•-----•-••------- Date Permit No.••• _ .-...•'........-7 su --•--....----•--_.._. Date Permit Dsu y. Ore No...... :3 % FEs...._..7.6'�..--- THE COMMONWEALTH OF MASSACH'USETTS BOARD OF HEALTH ............/.n c,r.-J..............OF....... �� �s1:2!)r L.L--- ApplirFation for Di-qVuiiFal Workii Tontrnrtion runfit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: ...............................................................................•------------------ ........ ..----•-•-•-----------•-..._...--------------...-------------....._...•-•- Location-Address or Lot No. ---•-- -�... ---Lei nr•---••-----------•--•----••--•----------------- ........ . T--• ----------------------------------- 112:c��.Cs-hY GEi ?-_________------------------------- y. Owner Address aWr--............................................. ....... _______--------•-------___________-_-__---------------- Installer Address Q Type of Building Size Lot......d �_L?p__�__Sq. feet U Dwelling—No. of Bedrooms-----___!__ t_sa..............._.........Expansion Attic ( ✓S Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q, Other QW fixtures -------------------------------------------------------------•--------------------_._._..-----__.------------•---------------- ------------------:- Deign Flow____._.__ ._.__.____ _--:- --- 5-- per person per day. daily flow .............................. � ns 1:4 SePtic Tank—Liquid caPacity - cogallons Length.l.D � W Diameter___ _ Depti�� - W Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No.... t --------- Diameter.__.. a......... Depth below inlet__.::,.7_........ Total leaching area_._;L.�.7_...sq. ft. Z Other Distribution box ( x) Dosing tank ( ) aPercolation Test Results Performed by.__�:_QLJ .`Yk..... tQ-Y.ta........... Date-__Jt„az__2 a Test Pit No. 1......a_------minutes per inch Depth of Test Pit..../.4_q_.''_____ Depth to ground water_-,-�.-----,________-. " Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w �t�_ }� # �, qs 0 Description of Soil..... ........................................-..................--........ STEP. EK..•� (xj ALLYN r, . r?aLrL --- WILSON W 7Z'•-.1 `�'" LJln.tc._.!r]�c(htrr, .r��t ----- - v' U Nature of Repairs or Alterations—Answer when applicable.............._............................................. yn A Qj Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i ccor ance withQiri� �'1 T r'1 s-�+ the provisions of :.i: 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. -----•---••---- Date Application Approved By_____________ _ �—� 7 ate to Application Disapproved for the following reasons----------------------------------------•----------------------•---------------------------...•-•••---•••--••---- ..------•-•---•--•------------------------------------------•-----•--------------•-......--•--------•-•---••--•-•--•••--•-•----••••--•--••-•••-•••-•------••-•-----••--••---•--•--•---•••-••--••-••----- Date PermitNo.......Y•—------`........................................ Issued-------------------- ............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH cT.L:U�ij..............OF........ &0,1.................................. 01rdif irFatr of TontpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................... .......... -----------------•-•--------•-----------•--•-----•-••••--••---•--•-•-...._.._..------•--------.......----•---•-----•-•------- /� ,4 nstaller (� at. r'� C:� ,d!V!--C... . _..-------F�------------ 2 ;n-c. -------------_-------== ....__ has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the - application for Disposal Works Construction Permit •To.___.r�, ----_. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... --.---/-.............................. Inspector............... .................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT/fH' r? OF...... _L [....._................_......._....... N O.9 2...��3S///' . ............._ FEE . ,.. Riipos al Morkii TDonotr ion rrntit Permission is hereby granted.................V ---------- I ••-----..._..----..__...-----•------.._.........••-••...•••••.._........_.._. to Construct ) or Re •r ( ) an Individual Sewage Disposal System at No. ff'� �� rt�C�� .. �..-ems •��--•--------�Y s2��- ------•-•---•--- street �� as shown on the application for Disposal Works Construction Permit NO &`T�Dat _________________________________________ - -- -----------•••-••-••------------- ..� ---•-------•---•-------------- Boar f Health DATE--- -- -------•---••---•---- FORM 1255 HOB S & WARREN• INC., PUBLISHERS • I DESIGN DATA TEST PIT DttTA Sn91c Family Z f3cc4roorng , No Gar6a9C G(-ind'cr Date.; _Sunc. 2'M,-19 Sj_.-_- . Des tts o F I o w I. Z_ ZC 11.0_= 220.G P p Tess- L'Sd SePt,tc. Tar\l< i ZZ-0 X S30 Gc-llo�i5 U)I+Y\csta J --- U S E :150p G A L.uo N TANK =.�T__.2:_�_--_ 1 oT� LGar--1 Pit C d1�Z x S.7�cf{,ccfive. el.apHi w e t ti t 8 S�dcw411 ; 1'76 SF X Z.SG of SF 7o ro. F P. / = 44S G P iD 13oNorr+ 7--( S -K 1,O Gpd / SF = 74 G fD D Su63o./ sobsei 25-7 SP S2a GPD S+,,t��«Q rYlccQ�rv9 Sated � )I'Ncdivrn Gravtl 5�nd } 72"- rgof I — 54•$ - r. r � STEPHEN \7- fir, '� WILLIAM P' nlcdwM ALLYN ,{ra WILSON e x ; 4�k Y E y No.30216 QR "' No. 14:; SUR•" I�f<I`_ t'/J. W a kr o�f jus+ inlet cover Fo"'z. on i'o one 400i- below Z" Pcaslanc finish � ISop luv loz.o r itao,o Qox I►w__ 101,4 Gz//o., InN VI 101:2 .Se/offe 101,7 It — 10 ----------- cJ`>'STEM PRO F'I LE (K6T +d SC.A Le) . L CE-RTIFY THAT THC }7ROPoSED HooSe SEPTIC SYSTEM DESIGN SHOWN HERE-01.1 corAPt_YS VVITW THE LO�r�rso/✓: L:ate- 2. SIDHLIIJE i4ND SETLACI-( G"z 4- Of- THE '1mWN <3 ARtJSTAr3La 4\1D IS No oca"re,D wIT IN A t=Loo�ar�u41�V J / ' �c.4n/ REFEREII/CE: P�: Zo;PG 7Z pATL T'HI5 1?t-iAki Is No sI`FX) ON An1 aAXTE'R NYE , ZNC, I►JSTRuri�ENT SUFyG `� ANl7 THE Ot=t=SETs �Qa�i�Jreer/ Aan.r .Svevecfoola SHOWN! HEREON StlovL-p NOT' Off USED �n17 i7rzi-a TLC ESTAaLISH L.AT L I NLS . ds r--aVIA-Lf&- /J.}SS , svr io�a 87Z4 p• ��n?; .6.E'Cs�T /YJn'�Z.SN /ZOy p J�' s'=."� ,rn• �� :�. 0 \ �loZ i ya'{ L o T l�rczko�+ Gzlc. ` 103�IDZ \.3. o = 191 l01 too STEPHEN n ALLYN cs WILSON h .o No.30216�Q awl s'- 73Z I 90��G/$TES 0 L Gidlt- L.aT 1 62E/3 r 1"I51/Z5H .R040 CCN71 I—RV/LL C Sckbacics; Fror,'t.— ZO� ' Rca.r — 1 O SHEET 2 of i SECTION A -A ALL OUTLET PIPES Frtaw THE *NOTE ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. DisTRleultDN Box SHAu BE Nn / �h,.seto min. from PROFILE VIEW OF ADDITION TO LEACHING SYSTEM s1:T LEVMT FDRAT LEAST 2 FT• t2" s } , � » p to septic tank D-BOX cover must be a, Existing Foundation mrithtn 6 in. of finished de ��-: • c�'-' c 3 p o T.O.F. elev. = 100.00 Septic tank coven must be gm de 1 8• - 1 2• Washed Peaston KNOdr OUTLET ' �� •: " �,p r, tom^ f�y b, within 6 In. of finished grade / / ' ' Gnode over Septic Tank- 96.00 Grade over D-Box- 90.00 over SAS- 90.00 3/4• to 1 1/2 " Washed Crushed Stone \: 1 ,//NA�� S.S• OUIIET •, f ,r WLET 4'PVC(CAPPED)fNSPECTION PORT TO BE <�'. orr►f M,rf,py S = 0.02 3 HOLE Tap OF System- Elev. m87.75 E4STAUM AND To BE N11HIN 6.OF GRADE _ J' kloximmwrn Cover - -• .r ' _ Ad __ _ S-0.01 or (H-10) D,ST. Box �"EMeetM f A greats Depth 1S 5• 1.75• �NiA�j i i ti e j Exlsr. PIPE N 12 EXIST. 1,500 GA 65 0010• foot rRON FOUNDATION '� SEPTIC TANK H-to N 0.63' to inches) PLAN SECTION ' CROSS-SECTION J I o.•... 0 5 Units @ 6.25 = 30' CONGREIE F,n.L Founon 6 n I n 3'so 7 31.25 3' - 3 HOLE H-10 DISTRIBUTION BOX , ",1�4q, °;4 P1 11-1 i i I • CO ,Ip•, SYSTEM PROFILE I _ - I 12 Not to Scats - • 0 v 3.5' I '-3- 3.5' aa p Effect e2length NOT TO SCALE Bpi tstayiLa+}tny�2E0.NAVfEO f Rd= Qr r - s o Effective vwm 0 SOT.ABSORPTION SYSTEM (SAS) GENERAL NOTES 6 In of 3ed stone e o NOTE ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE com ted st o INFILTA)ROR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN 1. Contractor is responsible for Digsafe notification, Verification of Utilities pac w Bottom of Test Hole I aev.-79.00 m (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. Groundwater Observed - NONE OBSERVED NOTE: 'OVERALL.HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10" 2. The septic"tank and distribution box shall be set level on 6 of 3/4"-1 1/2 stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. PERCOLATION TEST 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance Date of Percolation Test: APRIL 22, 2006 with Title V of the Massachusetts state code, the approved plan Test Performed By. CARMEN E. SHAY, R.S., C.S.E. TEST HOLE #2 and Local Regulations. Results Witnessed By. WAIVER (Per Barnstable B.O.H.) EXCAVATOR: Shay Env. Svcs. ELEV.= 90.00 6. If, during installation the contractor encounters any soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI ® 30" O from those shown on the soil log or in our design Test Hole Test Hole 9�•43 do' ® installation must halt immediate notification be \ made to Carmen E. Shay - Environmental Services, Inc. No. 1 No. 2 2 \ 7. No vehicle or heavy machinery shall drive over the DEPTH saLs 0.00 DEPTH SOILS ELEV. TEST HOLE #1 septic system unless noted as H-20 septic components. 0 so.00 0 s0.00 z ELEV.= 90.00 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Sand Loom 37.,25 g' y sandy Loom 0 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. ,o YR 3 _ D-B,`tx ::�.=.;:�„,' r _ }- 9 10. All solid piping, tees do fittings shall be 4" diameter 0"-6• Ae 89.50 0•_g• Ae 89.50 1 • • • , • / Schedule 40 NSF PVC pipes with water tight joints. Sandy Sandy 9 l W d t ALL OF-�� \ } �` 2 11. Municipal is Connected The Residence and Abutting�� � � ` �-•--" . �� g Loam Loom /� Properties Within 150 Feet.' 10 YR 5/6 10 YR 5/6 EXIST94 6•- 30• Be 87.50 6•- 30' Be87.50 / RETANING - - THE PROPERTY LINES•ARE APPROXIMATE AND Medium/Coarse Medium/Course /� i � COMPILED FROM THE SURVEY PLAN GENERATED BY Sand Sand / i �� BAXTER dt NYE. of OSTERVILLE, MA 2.5 Y 7/4 z r 7/4 / / ; Failed �� ENTITLED "CERTIFIED PLOT PLAN OF LOT #1 GREAT MARSH ROAD, ao"- tat h ao"- 732 / ` CENTERVILLE, MA, DATED AUGUST 10, 1989 G Leach Pit \\ AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN Cl �� IT SHOULD BE USED FOR NO PURPOSE OTHER THAN I ;EXIST. 1,500 GAL. THE SEPTIC SYSTEM INSTALLATION. PROJECT BENCH MARK �/ i SEPTIC TANK 43.5' `�� 96 EXISTING ICM W .711'TO BE PUMPED OUT AND FILLED IN PLACE TOP OF FOUNDATION t_ ELEV. = 100.00 (Assumed) ; NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE i �,---_-- 8 FROM THE EXISTING 'Lt~t}CL;?' TO BE DISpf1SFn --- ,-:9_ a - OF AS PER BOARD OF HEALTH SPECIFICATIONS. i - _ .,..-- -- Perc #1 / THERE ARE NO WETLANDS ARE PRESENT ,WITHIN 200' OF THE PROPERTY Depth to Perc: 32" to 50" Perc Rate= 2 MPI Groundwater Not Observed i j cp ASSESSORS MAP 210 PARCEL 136/001 No Observed ESHWT l 1259 EXIST. _----- LEGEND ADJUSTED H2O Elev. = None f EXISTIVG GARAGE i 3 9EDR003f \ � 1 SOUSE i 104X1 DENOTES PROPOSED 3-24'DIAM. ACCESS MANHOLES i \�� F SPOT GRADE DENOTES EXISTING • -_�� t _���;• -:=�;-::�-. �-- IF ----,----�� x 104.46 SPOT GRADE i ( ---- PL PROPERTY LINE INLET 1 1 ► � �. ,_' - I - ---_ NET ``/ `/ ;� 105 _ 9 ` THE ACCESS COVERS FOR THE SEPTIC TANK. I 96P PROPOSED CONTOUR DISTRIBUTION BOX AND LEACHING COMPONENT EXIST. " ,-.,_,T._,, •.r T.- SHALL BE RAISED TO WITHIN 6" OF I DRIVEWAY I ,. _ fix-; _-z�_'a:•�::-„ . FINISHED GRADE _- ----,,--' I - - - -- -97 EXISTING CONTOUR STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITS GAS BAFFLES OR EQUALS -------- --- PLAN VIEW ON ALL OUTLET TEE ENDS LOT #1 DEEP TEST HOLE & �- 3-24•REMOVABLE Cow 15,000 Square Feet +/- ' ,�I H I PERCOLATION TEST LOCATION _ _ t _•�,_�_ _ - 4• _ .er•, __ _ � •-� 6 FOOT STOCKADE FENCE 3"min. learance 94-- NLET e'min.T- rm,n, wet to outkd e•mhT -----------' f 13.31' I - OUTLET td rnYm u -, Eg e.•w. UWb��, _ PLOT PLAN ' b� OF PROPOSED SEPTIC SYSTEM UPGRADE T:- ,_�_..� _ -_• -f GR.E'A T MIA R S7" R 0-4 D PREPARED FOR CROSS SECTION END-SECTION (40 FOOT ;,RIGHT OF WAY) MR . DAVID REILLY TYPICAL (H-10 LOADING) 1500 GALLON SEPTIC TANK AT NOT TO SALE #259 G R EAT MARSH ROAD FutureCENTERVILLE, MA Design Calculations Bath Bedroom Bath Kitchen Number of Bedrooms: 3 Bedroom EXISTING Bedroom Bedroom < EPARED BY: Garbage Grinder No R' ' ea G7 CARA AT E. ,SHA Y Leaching Capacity Required: 330 Gal./Day (MIN. PER TITLE V) Dining . Living Room ' Septic Tank : - 2 x 330 Gal./Day = 660 USE EXIST. 1,500 GAL. Septic Tank. Storage Storage (-�,+ 1 , NVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons 0 1 Sidewall Area: 0.74 gal./sq. ft. x 78 sq. ft. 58 gallons -p o P.O. BOX 627 Providing: = 331.80 gallons 0 20 40 50 2nd Floor 1st Floor }sT� EAST FALMOUTH, MA 02536 '41VITAR TEL FAX : 508-539-7966 Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEP TO BE USED NTH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE 3 BR HOUSE FLOOR SCHEMATIC SCALE1"=20' DRAWN BY: CES DATE: APRIL 26, 2006 ON THE ENDS. NO STONE UNDER. SCALE: 1„=20' PROJECT#SD905 FILENAME: SD905PP.DWG SHEET 1 OF 1 f ASSESSOR'S MAP NO. PARCEL LOCATION #' SEWAGE PERMIT NO. Ld 1 evict F VILLAGE e�l-a"., -/e ,_ ,, <lc INSTALLER'S NAME L ADDRESS 3 ///, ✓C eP Pre roc; Sc 1� ri'r�ia r! r SUIL' DER OR OWNER �< f B DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 9k "-�