HomeMy WebLinkAbout0065 HADRADA LANE - Health V.
65*drada Lane
Centerville, MA 02632
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Regulatory Services Department j e"ac j
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7,639.. Public Health Division
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ArfD MAC>, 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.GeilerLeach pit is only3f
>undwagter,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7006 0810 0000 3525 5545
June 27, 2011
Mr& Mrs Alan Johnson
65 Hadrada Lane
Centerville, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 63 Hadrada Lane, Centerville,MA. was last inspected
on 6/25/2011 by David B. Mason a certified septic inspector for the State of
Massachusetts.
According to the private septic system inspector, the system"Fails" due to the following:
• No distribution box. Primary pit acting as distribution to two additional leach pits.
• Outlet pipes to the two overflow pits have effluent half way up from pipe invert.
Indication of effluent level being above outlet pipe.
Resulting in hydraulic failure.
You are ordered to repair or replace the septic system within sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period may result in future
enforcement action
PER ORDER OF THE BOARD OF HEALTH
(ZyscKean, R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc
Commonwealth of Massachusetts
W Title 5 Official Inspection Form 0�1
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is required for every Centerville MA 02601 June 25 2011
page. 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.
Important:When filling out forms A. General Information
I
on the computer, �� I
use only the tab 1. Inspector:
key to move your
cursor-do not David B. Mason
use the return Name of Inspector
key.
David B. Mason
Company Name
4 Glacier path
Company Address
East Sandwich MA 02537
City/Town State Zip Code
508-833-2177 S1287
Telephone Number License Number
B. Certification
� t
I certify that I have personally inspected the sewage disposal system at this addresg'and that tie CO
information reported below is true, accurate and complete as of the time of the inspection. The,,�gspen
was performed based on my training and experience in the proper function and maintenance often sltet
sewage disposal systems. l am a DEP approved system inspector pursuant to Section 15.W of4
Title 5(310 CMR 15.000).The system: N
❑ Passes ❑ Conditionally Passes ® Fails rn
co
❑ Needs Further Evaluation by the Local Approving Authority
• June 25, 2011
Inspector's Signature Date
The system in 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, 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.
� ( I
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage posal System•Page 1 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is Centerville MA 02601 June 25 2011
required for every ,
page. City/Town 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-09/08 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
,M 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is required for every Centerville MA 0260:1 June 25, 2011
page. Cityrrown 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 ❑ 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 ❑ 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 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is required for every Centerville MA 02601 June 25, 2011
page. 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 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
Z. ❑ 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 '/2 day flow
t5ins•09108 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
65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is Centerville MA 0260`1 June 25 2011
required for every ,
page. Cityrrown 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-09/08 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
°M 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is required for every Centerville MA 02601 June 25, 2011
page. CitylTown 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? .
❑ 0 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.
® El 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): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�M ,•�' 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owners Name
information is Centerville MA 0260.1 June 25, 2011
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® 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 ears usage d Yes
9 ( Y 9 (gP ))�
Detail:
2009- 110,000 gallons and 2010 210,000 gallons
Sump pump? ❑ Yes ® No
Last date of occupancy: current
- 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•09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is Centerville MA 02601 June 25 2011
required for every � •
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 I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•09/08 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
�M 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is required for every Centerville MA 02601 June 25 2011
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:
June1988
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 30"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: Not Applicable
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Appears in working order
Septic Tank(locate on site plan):'
Depth below grade: 16"feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
1000 gallon tank
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
t5ins•09108 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
,M 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is Centerville MA 02601 June 25 2011
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
3211
Scum thickness
6"
Distance from top of scum to top of outlet tee or baffle level
Distance from bottom of scum to bottom of outlet tee or baffle
101.
How were dimensions determined? scour stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank appears to be in working order. Requires maintenance pumping.
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17.
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
9 p Y rY
'< 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is required for every Centerville MA 02601 June 25 2011
page. Cityrrown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is Centerville MA 02601 June 25 2011
required for every ,
page. 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
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.):
Mo distribution box:Primary pit acting as distribution to two additional leach pits. Outlet pipes to the
two overflow pits have effluent half way up from pipe invert. Indication of effluent level being above
outlet pipe.
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:
Probed area with indication of hydraulic failure due to overload as is indicated in primary pit and
effluent above outlet invert level.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
I�
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
GM , 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is required for every Centerville MA 02601 June 25 2011
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number:
2
❑ leaching chambers number:
❑ 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.):
Primary 1000 gallon leach pit acting as distribution to two 1000 gallon pits. indication of hydraulic
failure due to effluent being above outlet pipe invert and probing soil.
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•09108 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 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owners Name
information is required for every Centerville MA 02601 June 25, 2011
page. 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-09/08 Title 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
65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is required for every Centerville MA 02601 June 25, 2011
.
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•09/08 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
65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owners Name
information is required for every Centerville MA 02601 June 25, 2011
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
20 below system
Estimated depth to high ground water: 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 property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Water elevation maps
® -Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Used Town of Barnstable groundwater contour map
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•09108 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
�M 65 Hadrada Lane
Property Address
Alan and Sandra Johnson
Owner Owner's Name
information is required for every Centerville MA 02601 June 25, 2011
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
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
J a
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
fiplicatiou for Misposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair()< Upgrade( ) Abandon( ) ❑Complete,�ystem ❑Individual Components
Location Address or Lot No. #,4CY Q-,56i Lac Owner's Name,Address,and Tel.No.
CP�,irr ae A�l wv►
Assessor's Map/Parcel 1 Y� /p�
Installer's Name,Address,and Tel.No. �'Z s P z,x -j b 3 Designer's Name,Address,and Tel.No.
C4Pe_W1df 6-�,kgl)4' Gcc C,,j— L(L u77 ?Z ��'vy_v� 2B iLl C✓.a�,1 11-4 vJ. (.,�.
Type of Building:
Dwelling No.of Bedrooms Lot Size `1� (��3 sq.ft. Garbage Grinder( )
Other Type of Building S,ti j"2., No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) l ( gpd Design flow provided 1 4 3 . 3 gpd
Plan Date q'c- — 20 t( Number of sheets I Revision Date
Title Cpj IA"-Pr- )A
Size of Septic Tank Joo o 0/,,5 i —N Type of S.A.S. I I j,X 31 S 9 r,�d
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) -5 l Y<< E�tl�Csv
Date last inspected: sou
t
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 Healt
Signed Date 7-1—
Application Approved by Date 7 :7 �� C
Application Disapproved by Date
for the following reasons
Permit No. "' ` t Date Issued 6 f
`l
No. Fee vy
THE COMMONWEALTH OF MASSACHls6TN' Entered in computer:
PUBLIC HEALTH- DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ltlYltatl0l fl M" ispo8al *pstem Construction joermit
Application for a Permit to Construct( ) Re it Upgrade( ) Abandon( ") ❑Complet ystem ❑Individual Components
Location Address or Lot No. s j�q.�r��,�yd C/Yrct Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel C i t 1 f y�C /O A!bpi 5ol,..-5., 5 4
Installer's Name,Address,and Tel.No. !l 7 6 3 Designer's Name,Address,and Tel.No. Z-7�
C,gpew;� ch�'e'•ils G c t Ear, Icy ti(T�5j 7l ��- '��v,¢e-a•�� 2 Z)`I t�n,�le,. �.-
��«3. Type of Building:
Dwelling No.of Bedrooms Cl/ Lot Size I 013 sq.ft. Garbage Grinder( )
Other Type of Building 15,t ,,e �(,,1,�,L, No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided ` (3 . 3 gpd
Plan Date 20 %1 Number'of sheets f' `i Revision Date
Title (o-} 1-�0.4-A;)A ? -
Size of Septic Tank )or)a Type of S.A.S. 1 0' ) A 3,
Description of Soil
�p Zq,
( Nature of Repairs or Alterations(Answer when applicable) t✓X
Date last inspected: Zo it
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 7- 7
7' 7i0
Application Approved by s Date ! )6 t
Application Disapproved by Date
for the following reasons k
tt r
Permit No. C) f Date Issued r
_- - - - - ------ -------:---- _ `ti - - - - - - - ----- _----- - ---------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site SewageDisposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by -te`LC Q�
at 66 )-Qjy 0"n L�,.,, �,Alb.,, 1G— has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. C90lf—0 t ( dated
Installer � �,�,.p � C� C(et Designer 0, %AAA
A L
#bedrooms �-� Approved design flow 4t gpd
The issuance of this permit shall of be construed as a guarantee that the system,will ction\ es' ned.
Date /a �I ) Inspector
-----------------------------
---------------
OL 1� v-� --
No. Fee y
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal *pstem Construction i3ermit
Permission is hereby granted to Construct( ) Repair(�/) Upgrade
/( ) Abandon
(0�� 7 in
)
System located at A-,)v in r (, 7f�`,..c
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 permit
Date f Approved by '
TOWN OF BARNSTABLE
/
CATION (pS <TcY�e�a�� �cetie SEWAGE# ✓✓ �
V. LAGE L'Q„ �,�(� ASSS��ESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. Y?� P f 77
SEPTIC TANK CAPACITY /Clot) If ,u 0-KIJl.11
LEACHING FACILITY:(type) 05,J 4,- 3( ,4, (size)
NO.OF BEDROOMS y
OWNER Illen 0`i rt
PERMIT DATE: /�7 �I COMPLIANCE DATE: - ,
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility a, <i 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
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07/14/2011 07:33 FAX 5084283928 CAPEWIDE Q 001/001
Town of Barnstable
Regulatory Services
Thomas F.Geller,Director
NAM ' Public Healtb Division
�'�9'► Thomas McKean,Director
200 Maio Street, Hyannis,MA 02601
Office: 508-862.4644 Fax: 509-790.6304
Date: 7-13- i l sage Permit# Zo tl- Z 15 Assessor's Mnp/Parcel t H$ f 10 b
Installer&DgdVe>Ir Certification Form
Designer: SG En%,neew)!g , 'TnC. Installer:
Address: 2e54 crmv ocrE�f k-:•bwoy Address: � O (3.DX -7G_3
C-451 u24f6ROM tiA o2638 CZ+l4ZSi[C V7/14
zaS-273'0&77 p `s- i-_
-.�,'Lpt( P.tJi( G Ltd( vi>- )
�' was issued a permit u, insmil•a
(date) (installer)
septic system at !o 5 k adra4 a L avt t- based on a design drawn by
(ad rest)
SC En`jt�decinj =vie_ 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 aridtor septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with mzijor changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocafiun of any component
of the septic system)but in accordance with State&Local Regulatirns. Plan revision or
certified as-built by designer to follow. Stripout(if required) ' s e:ted and the soils
were found satisfactory. YrOFw
CJO HN L.
UACHL.L a
v
(In er's S gnatur -__ I L
0
esigner s Signatu A x e Wy Here
P SE RETURN TO S C HEAT. DIVISION. CE TIFICA
OF COMPLIANCE WI1, . NOT HE ISS p UNTIL BOTH INIS FDRM AND AS-
B CARD ARE RE BARNSTABLE PERLIC H ;Ai, D IdN,
THANK YOU.
0:\ofr=0 fbnW\duiVwccnir=jon rorm.doo
Town of Barnstable P# /13 3 Z) 0111�
Deipartlient of Regulatory Services
_ VARN631A8LA : Public Health Division Date 0 7111))
f039• 200 Main Street,Hyannis MA 02601
FD MK't�
Date Scheduled
Time_ ,0 Fee Pd.
Soil Suitability Assessment or S wage Disposa
Performed By: HfC�uz�A P(4M e11�1 W E^( C S l= ✓h v, �-
Y 1 Witnessed 1
L VTI N&GENERAL INFORMATION
Location Address ��) Owner's Name
Address So-kyle_
Assessor's Map/Parcel: M Engineer's Name !`a&i- 'ic cg5tYleerm5
NEW CONSTRUCTION REPAIR Telephone# SDI-2 73-0 3 77
Land Use-. S14%l e_ f avan t I y d l i o
Slopes(9b) L Surface Stones
Distances from: Open Water Body ft Possible Wet Area - ft Drinking Water Well — ft
Draihage Way ft Property Une 7 10 ft Other
---- ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands•fn proximity to holes)
See Aac.6-J ei czn
Parent material(geologic) OU lu�Gt51n
Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater 7
DETERMINATION FOR SEASONAL-HIGH WATER TABLE
Method Used: DI(ec+ 6b5ececrhoei
Depth Observed standing in obs.hole: 712,b In, Depth to loll mottles: _ In.
Depth to weeping from side of obs.hole: In, Groundwater Adjustment fr.
Weli# - Reading Date: Index Well level -Y• Adj,factor, � Adj,Groundwater Level,,
PERCOLATION TEST pate 7-6-1111 Time
Observation '
Hole# Time at 4"
Depth of Pent 2y." y2 Time at 6"
start Pre-soak Time @ /0./0 ArN lime(9"•6") '
End Pre-soak
Rate Min./Inch C 2-
Site Suitability Assessment: Site Passed ye 5 Site Failed: Additional Testing Needed(Y/N) N
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:ISEPTICIPERCFORM.DOC
DEEP-OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Shcl Color Soil Surface(in.) (USDA) Other
(Munsell) Mottling (Structure,Stones;Boulders.
o�sistencv %'OravPn
A 3/4 ^
V-2y g GS tOYrs/� — r
zy-i26 M-C S z. 6/6
/nosel. .
DEEP OBSERVATION HOLE LOG Hole# Z
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(ia.)' (USDA) Other
(Munsell) Mottling (Structure,Stones,Boulders.
on i en % Mel
�Q0jr312
-------------
_2 L 5 lQYr S/6 _
G tf-GS 2,
/00 Se—
.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil OtherSurface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
i to
DEEP OBSERVATION HOLE LOG Hole#
Depth from .Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency.
Flood Insurance Rate Mau:
Above 500 year flood boundary No— Yes ._ _
Within 500 year boundary No >l/ Yes,;
Within 100 year flood boundary No,L-, Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? YZ 5
If.not,what is the depth of naturally occurring pervious material?
Certification
I certify that on /o-27-9? (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,expertise and a erience described in 10 CMR 15.017.
Signature Date
Q.%.EPTIOPERCFORMMOC
l•' M.`i
�/F r.
N -� Fws...75................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
1Qw-ti . OF...... Q
Appliration for BiopooFal orki Tatuitrnrtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair { ) an Individual Sewage Disposal
System at:
ddr -------------------- --
� ",Location-Address or t No.
.....1.------....1�fJit!1 0y�-------•----------------•-----........ --•� 1 !� + 1�_ ..........�:N.....-------------•--------
Owner ddress
a a e......... It . . ..._....... . .....t _�...� n
Iller Address
dType of Building VVVVVV , / Size Lot............................Sq.It/
U Dwelling—No. of Bedrooms..____.__/.................................Expansion Attic ( ) Garbage Grinder (
Other—Type T e of Building No. of persons............................ Showers
� YP g --------•------•----...-•--- P (.7') — Cafeteria ( )
dOther fixtures ----------------------------------=--------------------•••--------•-••---••••-...............-••-•••-•••.....••-•...----••---•...------------•-•-•-
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________-___-_- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water____--_______-_________.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.__________-_-_--_..___.
-----------------------------------------------------------••----•-•------------•---.---•--•-------------------------------------------------------•---------
ODescription of Soil.......................................................................................................................................................................
V --•---------------------------------------•----•--------------------•----•---•---------••------•-------------•--------•------...-----------•----------------------•-------------------------------.
W
x -•-•-------------------------------------•-•--•-•••••-•----•-----------------------------••-••-•-••-----•--•------...•-----••••------•••-••--------••••••••••-----••••-•---------•---••......---•-------
V Nature of Repairs or Alterations—Answer when applicable-------A-ai_"�__.........t..___ L.______________ _------•----_____.
Tip`..K.............. ........................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i i:Li,
p 5 of the State Sanitary C9de— he un ersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu by h board of lth.
.--- ---- -•.............................. ................................
ate
Application Approved BY--•--. ••-•-••-----. -- ----•---•••••.........-•----•. :::_.... �� -------•-•-•-
D ate
Application Disapproved for the following reasons:_...---•----------•---•-------------•-----•------••----•--------•--•----------------•-••......-•--•---..........
..............................•-•....------•---••....._..--------...........---•------••--•----------•-----••--•---•-••---•--•----•-----------------•••----------•--•----------••----•--••.--•-••------.
Date
PermitNo...................................... ba_..--•-. Issued.......................................................
Date
,t
No................-....... Fss.................._.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ ....... ................OF........................................ ----......-----------...........----------
Appliration for Dispaaal Vvrks Qlantitrurtioat '"trod#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................__.............................................................................. _._._..........._._...----•--••---•••--••------•-•----••-•••-----•--•-----•••--•..........--------
Location-Address or Lot No.
...............................•...--•---_....._....__...............••. ..................................................................................................
Owner Address
W
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ......................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid'capacity............gallons Length................ Width................ Diameter....----........ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date-----------------------------------.....
Test Pit No. 1................minutes per inch Depth of Test Pit....--.............. Depth to ground water......-..-------..---...
G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...---..--------.-..---.
P4 ••--•--•-••-------••--•----•------••----------------------------------------------•-••-•••-•----...-.........................................................
0 Description of Soil.......................................................................................................................................................................
x
U ..............>..........................................................................................................................................................................................
W --------------------------------------•---------------------------------•--------------------------•----•-•...-----------------•--------- ..............................................................
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
.....................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'i'LE
p 5 of the State Sanitary C e— he undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu by h board of e�ilth.
Sign ----- -------------- --- - --- ----- ----------------------------- ..........................
Date
ApplicationApproved By.................................................................................. .............. ........................................
Date
Application Disapproved for the following reasons:-------•------------•---------••--------------•--------•----------------------------------------------------••--
....------•----------•-----------------------------------------------------------•-••••--•-------......-------•--------•-------.....-•--•-------•----------------•----------•------------•--------------
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
(Irrtifirttir of Toutph attrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by.......................................................................................................................................................................................------••--
Installer
at......................................................................................................................................................................................................
has been installed in accordance with the provisions of TIT:E 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..........................0._..' ..` ........................... Inspector...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF.....................................................................................
No......................... FEE........................
�t��n��� �rk� �uat��r�r#ilaat �erutit
Permissionis hereby granted.............................................................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo................................................................................................................................................................................................
Street
as shown on the application for Disposal W(eks Construction Permit No..................... Dated..........................................
•----...--•----•-•-------------------------------•------•---•---------•••--------•-------------•---------
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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1.- TOWN OF BARNSTABLE
LOCATION G�� SEWAGE #_,V
VILLAGEatZ, ;,ejt? , ASSESSOR'S MAP & LOT
INSTALLER'S NAME 6z PHONE NO.
- r
SEPTIC TANK CAPACITY_
LEACHING FACILITY:(type)0.1) (size) %
NO. OF BEDROOMS PRIVATE WELL OR,PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No L�
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4"SCHEDULE 40 PVC MIN. SLOPE 1 % PROP. VENT WITH CHARCOAL '
T.O.F. EL.= 56.3'± PROVIDE EXTENSION RISER WITH /--FINISH GRADE OVER D-BOX= 55.2 ± FILTER TO ABOVE GRADE FINISHED GRADE OVER BIODIFFUSERS= 55.20 - 55.63 GENERAL NOTES
SLOPE @ 2% MIN.
CONCRETE COVER TO WITHIN 6"OF INSPECTION PORT WITH
FINISH GRADE OVER INLET&OUTLET REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 1- UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISH RISER TO WITHIN 6"OF FINISHED GRADE 3 OF F.G. (ONE PER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
@ FND ELF.= 55.8'± F.G. OVER TANK EL. = 55,5'± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES.
t } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
EXISTING 4° PROPOSED 4" 9" MIN. 4.0 MAX
SEWER PIPE PVC SEWER PIPE 36"MAX. SEE NOTE 21 TOP OF SAS/B.O. = 51 .63' COUPLING W(TYP OF 4)
3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
-1 SYSTEM UNLESS OTHERWISE NOTED.
" " 3" DROP MAX " PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,
6 3 3 9 L = 40± THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
2" DROP MIN MIN.SLOPE t% JOINTS (TYP.) ELEVATION = 51.63' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
10" 4" PVC IN FROM 1.33' Q 16„ 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
14" *52.0'+ SEPTIC TANK O 4" PVC OUT TO 0.90' (TYP.) 10.75"(TYP) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
LEACHING FACILITY
I j 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
CONTRACTOR CONTRACTOR SHALL L EE 51 .50' MIN. 6" 51 .33' 51 .20' 50.30' (laid flat) 2.875'(34.5")_- 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
SHALL VERIFY SIZE 48" VERIFY CONDITION OF (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES GAS BAFFLE 5.0'
6" CRUSHED STONE (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY ( ) R MIN. 11.5' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY COMPACTED BASE REQ'D
31.2' AND DESIGN ENGINEER.
5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 56.00' ESTABLISHED
TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 44.80' BIODIFFUSERS END VIEW ON A NAIL SET IN AN OAK TREE AS SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET ( )
EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
(BY ADVANCED DRAINAGE SYSTEMS, INC.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
"CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TA L ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER.DISTRIBUTION BOX DETAIL TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONE. STRUCTURES SHALL BE MADE WATERTIGHT.
11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
I `- ' TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
o+ 7
PERC NO. 13348 APPROPRIATE AUTHORITY.
0
• ,40 . • INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
�• r EVALUATOR: Michael Pimentel E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
• ' : • • ' : + `R
-- THEY SHALL WITHSTAND H-20 LOADING.
C.S.E. APPROVAL DATE: Oct. 1999
GARAGE HC-2 * ! Z _.. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND FINES.
• DATE: July 6, 2011
#65 ! r • TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
EXISTING DECK S � 11 `"` * • • MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
4-BEDROOM 4) tl, + •` ELEV TOP= 55.30' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
DWELLING . ` • •
3) ELEV WATER= <44.80' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
TOF= 56.3'± ,`. . •
N ZONE 2 + ' • 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
ti • • PERC RATE _ < 2 min./inch
tiGK HC-1 378, g *• R * ' • SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
' 11 F ' • DEPTH OF PERC= 24"-42" 16. PROPOSED PROJECT IS LOCATED WITHIN:
N • fr TEXTURAL CLASS: 1 ASSESSOR'S MAP 148 PARCEL 106
om (1
a: f ` y `L LOCUS `' OWNER OF RECORD: ALAN B. &SANDRA A. JOHNSON
\\ r ADDRESS: 65 HADRADA LANE
�ti a il 55.30'
2 f 8 f Loamy Sand CENTERVILLE, MA 02632
r,
A
10Yr 3/2
4 54.97'
FEMA FLOOD ZONE C
SWING-TIES SCALE: 1" =20' _ {' _ ._ __ _ B Loamy Sand COMMUNITY PANEL# 250001 0015 C
N� 10Yr 5/6
�Ov(1 / DESCRIPTION HC-1 HC-2 C \(A 24" 53.30' 17. DEED REFERENCE: DEED BOOK 8239, PAGE 322
�
O '� 18. PLAN REFERENCE: P.B. 281, PG. 72
\G BIODIFFUSER CORNER 1 32.8' 38.3' f n rf Perc
11 C C3 42" 51.80'
\14\�E
A� / �6p 96 BIODIFFUSER CORNER(2) 44.1' 43.4' b8 f ° -- < fX .;
fr
_ 19. ALI, DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
l BIODIFFUSER CORNER(3) 49.2' 24.6'
20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
--52/ BIODIFFUSER CORNER(4) 39.4' 13.6' 4 23 t �` •, ' I �� Medium-Coarse Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
I' /� , `'�� r f• * ` C 2.5Y 6/6(loose) FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
VEMENS ��pi F , / . � � -`'r � �..,.� �•�„ /f.• ^' _..-�
_ W / 21. ACCORDANCE WITH 310 CMR 15.401 -15.405, THE FOLLOWING LOCAL UPGRADE
EDGE F p P, ,O tp
5� pA 5A MAP 148 APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7):
MAP 148 � PARCEL 107 LOCUS PLAN (1.) A 1.0'WAIVER(3.0'-4.0') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM.
/ £ PARCEL 106 � _ SCALE: 1"= 1000'
�Q \61 /5ti / 17,083 S.F. ± ---54 126" 1 44.80'
No Mottling, Standing or Weeping Observed
h�£ N
a
-55' DESIGN DATA TEST PIT DATA LEGEND
PERC NO. 13348 50xO EXISTING SPOT GRADE
I / INSPECTOR: David W.Stanton, R.S.
- -- EXISTING CONTOUR
/ /55 PROPOSED 1.2'WIDE H-20 COUPLING (TYP OF 4) NUMBER OF BEDROOMS (DESIGN) 4 EVALUATOR: Michael Pimentel, E.I.T. -
GARAGE PROPOSED INSPECTION PORT WITH DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 1999 50 PROPOSED SPOT GRADE
/ GAS ACCESS BOX TO GRADE (TYP OF 4) DATE: July 6, 2011 50 PROPOSED CONTOUR
/ #65 `\ TOTAL DESIGN FLOW 440 GAUDAY TEST PIT#: 2
MAP 148 / EXISTING DECK PROPOSED 4" PVC VENT PIPE; ELEV TOP 55.30'
DESIGN FLOW X 200 % = 880 GAUDAY EXISTING UNDERGROUND UTILITIES
� =
PARCEL 105 �� / 4-BEDROOM EXACT LOCATION PER OWNER USE EXISTING 1,000 GALLON SEPTIC TANK �i
/ DWELLING 3 ELEV WATER= <44.80' EXISTING WATER LINE
TOF= 56.3'± RIP
'gyp PERC RATE GAS EXISTING GAS LINE
f Q _
N oEc� o P��' I
`SN O 55.3' SYSTEM CAPACITY
INSTALL 24 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) DEPTH OF PERC -
O P 2 TEXTURAL CLASS: 1 TEST PIT LOCATION
/ �.,'
LSq TP 1 (TOTAL L.F. OF BIO'S&COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD O O O EXISTING 1,000 GALLON SEPTIC TANK
i 55.3' � � (124.8')(4.8 SF/LF)(0.74 GAL/SQ.FT.)= 443.3 GAL. LEACHING/DAY „
\ / LP PROPOSED TOTAL 24 ARC 36HC(#3616BD) W-20 0 55.30' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
LP
BIODIFFUSERS IN A FIELD CONFIGURATION A Loamy Sand
EXIST. 1,000 GAL. SEPTIC TANK SS i - - / \ / Benchmark TOTALS: 4„ 54 97'10Yr 3/2 O PROPOSED DISTRIBUTION BOX
TO BE UTILIZED IN THIS DESIGN �J` LP --55� Nail in Oak Tree TOTAL NUMBER OF BIODIFFUSERS: 24
TOTAL NUMBER OF COUPLINGS: 4 Loamy Sand PROPOSED ARC 36HC (#3616BD)BIODIFFUSER(H-20)
1 j TREE (TYP) ss Elev. =56.00' B
_ TOTAL LEACHING AREA: 599.0 10Yr 5/6
Approx. M.S.L. TOTAL LEACHING CAPACITY: 443.3 � PROPOSED ARC 36HC 1.2'WIDE H-20 COUPLING (H-20)
EXIST. LEACHING PIT(approx. loc.)TO BE
PUMPED AND FILLED w/CLEAN, COARSE a 1 PROPOSEDDISTRIBUTION BOX 24" 53.30'
/ REV. DATE BY APP'D. DESCRIPTION
SAND&ABANDONED (TYP OF 3) TREE�',NE NOTE: PROPOSED SEPTIC SYSTEM UPGRADE
h\ EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE N DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER PREPARED FOR:
1 � w� / MAP 148 "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED C Medium-Coarse Sand CAPEWIDE ENTERPRISES
6�1 PARCEL 45 DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED 2.5Y 6/6
tO m l�p0 0� JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. (loose)
LOCATED AT
65 HADRADA LANE
NOTES: CENTERVILLE, MA 02632
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF 126" 44.80' SCALE: 1 INCH = 20 FT. DATE: JULY 6, 2011
EACH SEPTIC SYSTEM COMPONENT. 0 10 20 40 80 FEET
No Mottling, Standing or Weeping Observed
o F r�ia
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF o� Ss PREPARED BY:
THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST RESERVED FOR BOARD OF HEALTH USE �:va� JOHN L. �c5v` JC ENGINEERING, INC.
PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL
cHURCHILLJR. <„ 2854 CRANBERRY HIGHWAY
BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. CIVIL
N0. 1807 EAST WAREHAM MA 02538
SITE PLAN 3.) LOCUS PROPERTY IS LOCATED WITHIN THE WELLHEAD PROTECTION `� >nF<�F �s 508.273.0377
SCALE: 1"=20' OVERLAY DISTRICT AND THE ESTUARINE WATERSHEDS. � Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.2027