HomeMy WebLinkAbout0063 HARBOR HILLS ROAD - Health f3 Harbor Hills Road
Centerville
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Commonwealth of Massachusetts
; Title 5 Official Inspection Form
-li Subsurface Sewage Disposal System Form -Not for Voluntary Assessments }
63 Harbor Hills Rd r D
J
Property Address +»7
raw
Lynn Tabor -°
Owner Owner's Name
information is ✓ i
required for every Centerville MA 02632 4-26-18
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.
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
P.O. Box 73
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
1-508-495-0905 S 13971
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ .Needs Further Evaluatio y the Local Approving,Authority
4-26-18
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 has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins.doc•rev.6/16 Title 5'Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts r
If'
Title 5 Official Inspection Form
w
i"l Subsurface Sewage Disposal:System Form -Not for Voluntary Assessments
%_ 0
� 63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
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:
System is in good working order with no sign of failure.
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 El !❑ ND (Explain below):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
V /
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18 .
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage`backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑Y ❑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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-1.8
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the-well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes"or"No"to each of the following for all inspections:
Yes No `
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid:depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
,ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
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
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure:criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure..
E) Large Systems:To be considered a large system the system must serve a facility with a design
flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins.doc•rev.6116 Title 5'Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i�i Subsurface Sewage Disposal System Form -Not for Vol untary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
®' ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Wasthe 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): 2 Number of bedrooms (actual): 2
DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
,w Title 5 Official Inspection Form
! bl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 p Y ry
. . /
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage:(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 4-2018
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system?' ❑ Yes ❑ No
Water meter readings, if available:
t5ins.doc•rev.6/16 Title 5'Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
C�,i Subsurface Sewage Disposal:System Form -Not for Voluntary Assessments
r r.✓ ;Y 63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
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: Owner--pumped 4yrs ago
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping: Maintenance
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
r Commonwealth of Massachusetts
3� Title 5 Official Inspection Form
t N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
x\ '" 63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
2006
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 18"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.):
Good condition.
Septic Tank (locate on site plan):
Depth below grade: 12"feet
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: 1500 gal
Sludge depth:
12"
t5ins.doc•rev.6/16 Title 5'Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
-I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
page. City/Town 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
20"
Scum thickness
1"
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? Tape
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 is in good condition with baffles installed and no sign of leakage.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
hl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc:):
Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
3 Title 5 Official Inspection Form
0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
page. City/Town 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 0
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.):
Good condition with water at working level and no sign of back-up from field.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located explain why:
P Y
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
r Commonwealth of Massachusetts
Title 5 Official Inspection Form
! N Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type.
❑ leaching pits number:
® leaching chambers number: Infiltrators
❑ 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.):
Infiltrator field in good working order with no sign of back-up into d-box or surrounding stone.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
r► Subsurface Sewage Disposal:System Form -Not for Voluntary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
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.):
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
c Commonwealth of Massachusetts
Title 5 Official� Inspection .Form
i�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is Centerville MA 02632 4-26-18
required for every
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
R
Uf
I I .f R -fRRl1 IRcs
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
�-r
Title 5 Official Inspection Form
w:•
Cl Subsurface Sewage Disposal:System Form -Not for Voluntary Assessments
63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name
information is required for every Centerville MA 02632 4-26-18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
El Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12
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
I
® Observed site (abutting property/observation 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:
Original design plans show no groundwater at 12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
r
` Commonwealth of Massachusetts
Title 5 Official Inspection Form
? M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 p Y rY
-r �.:,•;> 63 Harbor Hills Rd
Property Address
Lynn Tabor
Owner Owner's Name A
information is required for every Centerville MA 02632 4-26-18
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page:17 of 17
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates [cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: 1 S Fill in please:
:.'
APPLICANT'S YOUR NAME/S: 1 AA U�tc(lc
BUSINESS YOUR HOME ADDRESS: f, 3 N c�c l
Cv�{ evil S e Op33
Sc,�s-36`7 336f , 2
TELEPHONE # Home Telephone Number _ 5OR -S —33 6
NAME OF CORPORATION:
NAME OF NEW.BUSINESS � cs� S COL TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? t/ E5 NO ��"
ADDRESS OF BU51NE55 (� r,j \ouV (� �I (°�ci ���st'e�iwC �(� MAP/PARCEL NUMBER (Assessing]
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
2. BOARD OF HEALTH
This individual has lbeer,�fgr_ y�jsd of the permit requirements that pertain to this type of business;=
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Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of.the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
1 -
r
MORTGAGE INSPECTION PLAN 5 DB LAuRIERS
ADDRESS: 63 HARBOR"HILLS ROAD, BARNSTABLE, MA _.. &ASSOCIATES, INC.
101 CONSTITUTION BLVD, SUITE D, FRANKLIN, MA 02038
LENDER: TEL.:(800)287-8800 FAX.:(W8)528-4011
ATTORNEY: GILL, DEVINE & WHITE UNREGISTERED LAND FILE NO.: 158302
OWNER: MONIAC NOMINEE TRUST DEED BOOK: 20433 PAGE: 111
APPLICANT: JAMES TABOR & LYNN HURLEY PLAN BOOK: 103 PAGE: 127 LOT(S): 51
DATE: 12L3012005 SCALE: 1"=20' PLAN NUMBER: OF 1951
FLOOD HAZARD INFORMATION COMMUNITY No.:250001
ZONE: C PANEL: 0008D DATED: 07/02/1992 REGISTERED LAND CERTIFICATE OF TITLE:
REGISTRATION BOOK: PAGE:
ASSESSORS MAP: BLOCK: LOT: PLAN NUMBER: T(S):
LOT 40 LOT 39
'c)7
7_v
7500'
LOT: 51
7,50O S F
M w _
0 0
LOT 50 0 ;o LOT 52
p OWWELLING ,
i
75 O__
HARBOR HILLS ROAD
MORTGAGE LENDER
USE ONLY
r �r ' THIS IS THE RESULT OF TAPE MEASUREMENT, NOT www■plotplans.com
.�r,,.f + 't, 1 THE RESULT OF AN INSTRUMENT SURVEY AND IS
OWN OF P-ARNS,TABLE E'L i
LOCATION 1/sZ al /� SEWAGE # a002- a I z/
iVr-LAGE (f ` P ASSESSOR'S MAP & LOT Y7- 1�53
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS,-
BUILDER OR OWNER
PERMITDATE: a0 O Z 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
Doe
No. �J"`-�J ��l 1 r FEE J
COMMONWEALTH OF MASSAC14USETTS
Board of Health, k , MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) xComplete System ❑Individual Components
Location 0 Owner's Name V
Map/Parcel# P S AddressV`
Lot# Telephone#
Installer's Name �5 Designer's Name tQ
Address Address A
Telephone# _ Telephone#
Type of Building �� / Lot Size sq.ft.
Dwelling-No.of Bedrooms \ r11�YS�, l.�J. Garbage grinder (416
Other-Type of Building No.of persons Showers (*�Cafeteria
Other Fixtures
Design Flow (min.required) ?)o gpd Calculated design flow_ � Design flow provided A 4D. gpd
Plan: Date ��LQ Number of sheets Revision Date .--�
Title
Description of Soil(s) C c e Sy S( J
Soil Evaluator Form No. �� Name of Soil Evaluator PFR.!'1� ikAYDate of Evaluation_ T/Sa�
DESCRIPTION OF REPAIRS OR ALTERATIONS G ��knn.
DESIGMNG
INSTALLATION AND CERTIFY IN WRITING
The und' signed agrees to inst the above described Individual Sewage Disposal System in acT ccQaV9I;A WApr i L') T
further a ees t not to plac a tem' ation until a Certificate of Comp'ance has b&(MQued !eTEo of Health.
Signed Date
�• �D r
t' i
No., / , —C�1 ; %. �q `..� FEE J
COMMONWEALTH OF MASSAC14USETIS
Board of Health, �D!5 MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair° Upgrade( ) Abandon( ) -XComplete System ❑Individual Components
f
Location (02)
Owner's Name'7 ���
Map/Parcel# AP 4771 �->C Ei 5,2) Address
Lot# -4-- Telephone#
Installer's Name � .� \C Designer's Name
Address ' k\ Cl,1Cl\S Address''
Telephone# s - Telephone# S LAB_
Type of Building .•-r'iQ'-•,I AQ_C�, \GA Lot Size sq.ft.
Dwelling-No.of Bedrooms Garbage grinder
'1 "'''� Other-Type of Building No.of persons Showers ( ►Cafeteria ( a�
,,y_Other Fixtures �F l`.A C Cc Cl� L ytlC�1
'- Design Flow (min.required) b gpd Calculated design flow'
!')OD)o I esign flow provided gpd
Plan: Date 5 t 1 L 02- Number of sheets Revision Date
Title �C}7�C�C]� ZC� `��,(��IC .� "��eQ�`� urx-xa& r �r ( l W
Description of Soil(s) C C 1CDG C ���CIC� ,C,1 �C P� � G" 1C11�
Soil Evaluator Form No. , ,� �� Name of Soil Evaluator �Azy1Ft �JiAF1`rDate of Evaluation `> /`) C)Q �'uf
DESCRIPTION OF REPAIRS OR ALTERATIONS "^Cb
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to plac a stem In -cration until a Certificate of omp'ance has been issued by the Board of Health.
Signe Date d
V }
No. ��-Y�t`J-�I�'� ,{` W 14 Of ,('' U FEE
SETTS
Board of Health, _ a
CERTIFICATE OF COMPLIANCE
Description of Work: .❑Individual Component(s) omplete System
The undersigned here y certify t at the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ,Abandoned ( )
at 53 ak- nr 4,115 bad, r -&,qTiA ydle--
has been install .d in accordance with the provision of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. " 31�� date- C�k) Approved Design Flow (gpd)
Installer A L i tr
Designer: Inspector: Date:
,
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. FEE "
COMMONWEALTH OF MASSACHUSETTS
r 'n r �;I,/
Board ofHealt&,, 00 7-dG i— , MADESIGN:;SC ENGINEER P.9UST SUPERVISE
INSTA��RPTION AND CERTIFY IN WRITING
DISPOSAL SYSTEM CONSTRUCTION PM p'J�TEM WAS INSTALLED IN STRICT
,. ACCORDA.---E TO PLAN.
Permissionpa
hereby graM)s
to; Co•struc i ) Repair( ) Upgrade( Abandon( ) an individual sewage disposal system
at �3 )olf 0 rt ri�—IA ))6 as described in the application for
Disposal System Construction Permit (L-dated S ('DUI� .
Provided: Construction shall be completed within three years of the date of this pe mit. All local conditions must be et.
T
Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date SAC)(-) board of Health 1 - )-- `^�JU�� \ L t,
a
9
OWN OF DARNSTABLE F7L
LOCATION SEWAGE # �002-21 L�
VILLAGE i1n`f/# ASS SSOR'S MAP& LOT a - 053
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 'S
LEACHING FACILITY: (type)' . /ir' T / (size)
NO. OF BEDROOMS,.
.K, BUILDER OR OWNER 1 ram`
PERMITDATE: aU o 2, COMPLIANCE DATE: b�
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
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CARMEN E. SHAY (508)-548-0796
ENVIRONMENTAL SERVICES, INC. P.O.Box 627,East Falmouth,MA 02536
May 24, 2002
RE: Certification of'Title V Septic System Installation:
Residential Property—63 Harbor Hills Road,Hyannis, MA
Dear Sir or Madam:
On May 23, 2002, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at
63 Harbor Hills Road, Hyannis, MA, based on a design drawn by Shay Environmental Services, Inc,
dated, May 18, 2002.
XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan
I Certify That the Referenced Above Septic System Was Installed With Changes but in
Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow.
The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is
Required.
If you have any questions, please do not hesitate to call the undersigned at(508)-548-0796.
Sincerely,
CARMEN E. SHAY
ENVIRONMENTAL SERVICES,INC.
IH OF Mgss9c
�a CARMEN y�N
E.
0 NA SHAY
Carmen E. Shay, R.S., C. E. 0. 1181
President �F0/S T Sa'
SJIVITAR\P'
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Sep- 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 P . 02
52S%O1
'NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. r_---.
PERCOLATION TEST AIND SOIL EVALUATION EXEMPTION
FORM
1, CA R-My,*,S hereby certify that the engineered pian signed by me
dated A I Lo OQ concerning the property located at
V�X*5 meets all of the
following criteria:
• This failed system is connected to a residential dwelling onl,v. There are no
commercial or business uses associated with the dwelling.
The soil is ciassiEed as.CLASS I and the percolation rate i
s less than or equal to 5
I,
m.inutes per inch. The applicant may use histonca] data to conclude this fac; or may
conduct preliminary tests at the site without a health agent present.
• There is no increase in flow and/or change in use proposed
• There are no vanances requested or needed.
• The bottom of the proposed leaching facility will not be located less than fourteen
-(14) feet above the maximum adjusted groundwater table elevation. (Adjust the
groundwater table using the Erimptor method when applicable)
Please complete the following:
r
A) Top of Ground .Surface Elevation (using GIS information)
B) G.W. Elevation + adjustment for nigh G.W. 4•1 _ 1(P• 30
U EFFERENCF. B ETWEEN and B s f
SiG?,�ED : DATE: �lnloa
�— ._... NOTICE
l Based upon the above information, a repair permit will be issued for bedrooms
maximum. No additional bedrooms are authorized in the future without engineered
septic system plans. °'
q:h;=11h loldcr.pciccxmp
Permit Number: Date:
Completed by:
HIGH GROUNDWATER LEVEL COMPUTATION
Site Location: R(a!C)pCf�7 Gt\ 1lS 1�� ��7t f� Lot No. SI
Owner ,1 som it) kc-AS0_\k Address: �� Q
Contractor: S\CIQ&N qnQ$X c11Address: b• +6c1C,
I ,,,, 11
i Notes: IVOMQ
STEP 1 Measure depth to water table ��
to nearest 1/10 h. .............................................................................. Date 1 Is
Ia•O
monthlday/year
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
site and determine:
OA Appropriate index well....................................................
I ('
I O Water-level range zone.r.r.................................................
i
STEP 3 Using monthly report"Current
Water Resources Conditions"
determine current depth to oa
water level for index well ...........................
monthifyear
i
STEP 4 Using Table of Water level Adjustments
for index well (STEP 2A),current depth
to water level for index well (STEP 3),
and water level zone (STEP 28)
determine water-level adjustment ...................................................................................
i t
STEP 5 Estimate depth to high water
iby subtracting the water•
level adjustment (STEP 4)
from measured depth to water
levelat site (STEP 1) ......r..............r........r.rr....r......................................................................
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Cape Cod Commission: USGS Well Data - April 2002 Page 1 of 2
United States Geological Survey
Observation Wells
As a service to Cape officials, engineers and other interested parties, the Cape Cod Commission
publishes monthly groundwater data gathered by its Water Resources Office.
The water level measurements shown below are taken monthly from United States Geological Survey
(USGS) observation wells and compiled during the last week of each month. They are published as soon
as possible thereafter.
Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water
Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to
predict high groundwater levels.
For your convenience, we've also provided links to USGS national and state data. See the last column in
the table and the footnotes below.
For further information, please contact Hydrologist Gabrielle Belfit at the Commission offices (508-362-
3828).
April 2002
UISGS Site
WaterDeparture from Number
Level
Location Well No. Level* Record Record Average** (links to I. SGS
High Low* Overall national water-level
database)
Barnstable 230 25.1 20.5 26.6 -2.4 -1.4 41395607.01.64301
Barnstable 24w 26.6 20.5 28.6 -2.8 -2.1 414154070165001
Brewster BMW 21 12.8 6.9 13.3 -3.0 -2.6 41451807002030.1�
Chatham CGW138 24.8 20.9 26.6 -1.6 -0.8 41410007001.1101_
Mashpee MIW 29 8.9 5.6 10.0 -1.2 -0.4 4135250702.91.904
Sandwich ZI52 47.8 45.9 48.2 -0.9 -0.5 41441.8.07024.1.601
Sandwich 2DW 53.6 45.8 55.1 -4.0 -3.6 414124070265901.
Truro TSW 89 12.5*** 10.2 13.0 -0.9 -0.5 420206070045901
I!ff1E
9*** E][:1
I==
415353069585401
i
http://www.capecodcommission.org/wells.htm 5/18/2002
` FORM 11 SOIL EVALUATOR FORIN
Page 1 of
No.: Date: 5/15/02
COMMONWEALTH OF MASSACHUSETTS
Barnstable , Massachusetts
Performed By: Carmen E. Shay Date: 5/15/02
Witnessed By: Waiver
Location Address or#63 Harbor Hills Road Owners Name: Mr. David Birdsall
Centerville,MA Address and #63 Harbor Hills Road, Centerville, MA
Lot 4 (Map—247,Parcel 053) Telephone Number: (508)-
New Construction : X Repair :
OFFICE REVIEW:
Published Soil Survey Available: No ❑ Yes ❑
Year Published: Publication Scale: Soil Map Unit:
Drainage Class: Soil Limitations:
Surficial Geologic Report Available: No
9 p ❑ Yes
Year Published: Publication Scale:
Geologic Material: (Map Unit):
Landform: Glacial Outwash
Flood Insurance Rate Map:
Above 500 Year Flood Boundary: No ❑ Yes
Within 500 Year Flood Boundary: No F 7x Yes ❑
Within 100 Year Flood Boundary: No FX I Yes ❑
Wetland Area: None
National Wetland Inventory Map (map Unit):
Wetlands Conservancy Program Map (map unit):
Current Water Resource Conditions (USGS): Month
Range: Above Normal ❑ Normal a Below Normal ❑
Other References Reviewed: USGS Topographic Map
DEP APPROVED FORM 12/7/95
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot No.: #63 Harbor Hills Road, Centerville, MA
On -Site Review
Deep Hole Number: #1 Date: 5/15/02 Time: 10:00 AM Weather: Sunny, Cool
Location (identify on site plan): Refer to Sketch
Landform: Outwash Plane
Position on Landscape (sketch on back): Refer to Sketch
Distances From:
Open Water Body N/A feet Drainage Way N/A feet
Possible Wet Area N/A feet Property Line 25' feet
Drinking Water Well N/A feet Other
DEEP OBSERVATION HOLE LOG
Depth From Soil Soil Soil Soil Other
Surface Horizon Texture Color Mottling Structure, Stones,
(inches) (USDA) (Munsel) Boulders, Consistency,
% Gravel
0" — 10" AB Loamy 10 YR 3/2 None <5% Gravel, Friable
Sand Friable
10" — 34" Bw Loamy 10 Y/R None <5% Gravel, Friable
Sand 5/6 Friable
34" — 168" C1 Medium 2.5 Y 7/4 None Medium Sand, 10%
Sand gravel, Loose
Parent Material (Geologic): Glacial Outwash Depth to Bedrock:None encountered
Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: None
Estimated Seasonal High Water Table 168" Assumed — No groundwater Observed
DEP APPROVED FORM 12/7/95
,
FORM 11 = SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No.: #63 Harbor Hills Road, Centerville MA
Determination of Seasonal High Water Table
Method Used:
❑ Depth observed standing in Observation Hole: N/A inches
❑ Depth weeping from side of Observation Hole: 168 inches (assumed)
❑ Depth to Soil Mottles: None inches
❑ Groundwater Adjustment: None feet
Index Well Number: Reading Date: Index Well Level:
Adjustment Factor: Adjusted Groundwater Level: N/A
DEPTH OF NATURALLY OCCURING 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: Yes
CERTIFICATION:
I CertifyThat on September 17 2000 date I have passed the soil evaluators
p ), p at s examination
approved by the Department of Environmental Protection and that the above analysis was
performed by me consistent with the required training, expertise and experience described in
310 CMR 15.017.
Signature: Date: 5 0
FORM 12 - PERCOLATION TEST
Location Address or Lot No.: #63 Harbor Hills Road
COMMONWEALTH OF MASSACHUSETTS
Centerville , Massachusetts
Percolation Test
Date: 5/15/02 Time: 10:30 AM
Observation Hole #: #1
Depth of Perc 38" — 54"
Start Pre-soak 10:28 AM
End Pre-soak 10:38 AM
Time at 12" Would Not Hold 24 Gallon
Presoak
Time at 9
Time at 6"
Time (9-6")
Rate Min./inch < 2MPI
* Minimum of 1 percolation test must be performed in both the primary area AND.reserve
area.
Performed By: Carmen E. Shay
Witnessed By: Waiver
Comments: Would Not Hold 24 Gallon Presoak - <2 MPI
Site Passed X Site Failed
DEP APPROVED FORM 12/7/95
SKETCH OF PERC TEST & DEEP HOLE LOCATION
Property Address: #63 Harbor Hills Rd
Centerville,MA
Owner: David Birdsall
Date of Perc Test: 5/15/02
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rVENT PIPE (®Least 24 inches toll) SECTION A -A 1' = 2000'
Schedule 40 PVC w/Chorcool Odor Filter
ll
�--1 D' min. from A OUTLET PIPES FROM THE
r, t house to septic tank 'NOTE. ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. PROFILE VIEW OF ADDITION TO LEACHING SYSTEM DISTRe„TM eox SHALL BE 12 fn
Existing Foundation SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER -
t I Septic tank covers must be 3" of t/8" - t/2" Washed Pension SITE 13
within 6 in. of linished grade »'• �.r"' "S'
Grade over Septic Tonk - 98.50 /-Grade ow D-So. - 98.50 z—(`,rode over SAS - 98.50 3/4' tot t/2 Washed Crushed Slone NN S�CTTLET ry ' 2' �q HARBOR , ILLS RD
1ZL '
s a 0.02 — -15.5" OUTLET t2 MET H N 6 P�
_ 't.' i _ ' ✓ p a
i r 10' NEW g-0-0t 3 DISE f30X� 3' Ma.imum Cover \ "/ 6 � 8 � �
Top of SAS Elev. -95.00 r a Vr Opp
Ex,sT. PIPE �^ t,500 GAL. sm 0.010' per root . 15.5
r FRO+ EXIST. FOUNDATION Ixj SEPTIC TANK CN 7 2' Effective Deptn 4' - SCH. 40 7
! 1 rl rn H-10 ,ri c1 �b v O d
owl/ ,,„ a o PLAN SECTION CROSS—SECTION tiT one Rd
CONCRETE FULL FOUNDATI
t �Q1 Or
1 w 0 11 r` n 4 Units @ 6' _ 24" G F
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SYSTEM PROFILE 6 n.ol 3/4'-1 1J2- V n rn t' � 3. i" STONE UNDER CHAMBERS . 3, 3 HOLE H-10 DISTRIBUTION BOX
ccompacted stone i y
Not to Scale - c y fl , N 24' NOT TO SCALE
i
LOCUS MAP
� „ 4' 4, � 30,
I c w �2.5 Effective Length
6 in of 3/4'-1 1/2' c -10'-
compacted stone Effective nndth m SOIL ABSORPTION SYSTEM (SAS)
@QLts _----_-. CULTEC MODEL 125 (H-20 LOADING)/ SHOREY PRECASTE GENERAL NOTES
(OR EOUIVALENT) Not.to Scale 1. Contractor is responsible for Oigsofe notification
NOTE. OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 12" and protection of oil underground utilities and pipes.
2, The septic„tank onq distribution box shall be set
level on 6 of 3/4 -1 1/2 stone.
3. Backfill should be clean sand or grovel with no
stones over 3" in size.
4. This system is subject to inspection during installation
3-24' NAM. ACCESS MANHOLES
by Carmen E. Shay Environmental Services, Inc.
5. The contractor shall install this System in accordance
with Title V of the Massachusetts state code, the approved plan
and Local Regulations.
'f 6. If, during installation the contractor encounters any
n soil conditions or site conditions that are different
INLET ( � 1 r ' LOT #41 from those shown on the soil log or in our design
INLET �` ou ET LOT #40 LOT #39 installation must halt & immediate notification be
THE ACCESS COVERS FOR THE SEPTIC TANK,DISTRIBUTION BOX AND LEACHING COMPONENT made to Carmen E. Shay - Environmental Services, Inc.
•
. T �,�.• SHALL BE RAISED TO WITHIN 6" OF 7. No vehicle or heavy machinery shall drive over the
^' : FINISHED GRADE. septic system unless noted as H-20 septic components.
{ STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EOUALS 8. Install Tuf-Tite gas baffles or equals on oil outlet tee ends.
ON ALL OUTLET TEE ENDS
PLAN VIEW 9, All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
i 3-24' REMOVABLE CovERs 10. All solid piping, tees & fittings shall be 4" diameter
_ Schedule 40 NSF PVC pipes with water tight joints.
11. Municipal Water is Connected to The Residence and Abutting
3 min cleoronce
INLET 8'min_r min. inlet to outlet 6-mn 1S .rA.Et't-
N 17d 36' 30" E Properties within 150 Feet.
-- �' OUTLET
INLE ter'm 'J"
in. `
' { l.pued IevN
,r
75.00' NOTE:
THE PROPERTY LINES ARE APPROXIMATE AND
-.1 E t am. - iW depth >6'
o$ COMPILED FROM THE SURVEY PLAN GENERATED BY
e = 17' 40' BEARSE & KELLOG, SURVEYORS. OF CENTERVILLE, MA
�. . .,.;.. � .�. •. ,.. .. ENTITLED PLA 0 GV L MA
N OF LOTS IN CRAI ILLE, BARNSTAB E
10'-0' 5' _8- 1` :, r , :-;p. .1-.rs�w`s'. O DATED AUG. 24, 1951, PLAN BOOK 103 PAGE 127
AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
a CROSS SECTION END^SECTION TEST HOLE #1 CS IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
ELEV.= 98.48 w
O � THE SEPTIC SYSTEM INSTALLATION.
_ TYPICAL 1500 - GALLON SEPTIC TANK_— ..._
NOT TO SCALE \ Foiled ` Faded
p �
(H- 10 LOADING) 00 Cesspool Cesspool LEGEND
LOT #50
f 0'
1 NEW 1500 gal-� -
PERCOLATION TEST Septic Tank LOT #52 DENOTES PROPOSED
PROJECT BENCH MARK 104x1 SPOT GRADE
Date of Percolation Test: MAY 15, 2002 TOP OF FOUNDATION
Test Performed B CARMEN E. SHAY, R.S., C_S.E EXISTING DENOTES 'EXISTING
Results Witnessed By: WAIVER ( per Barnstable B O H ) ELEV. = 100.00 (Assumed) a L� X 104.46 SPOT GRADE
Excavator: Roberts Septic Services 3 BEDROOM w
Percolation Rate: Less Than 2 MPl `p HOUSE a CD
98 -- #63 LN 98 PL PROPERTY LINE
----- ------ ------ o
96P PROPOSED CONTOUR
97— — — — — —97 EXISTING CONTOUR
Test Hole LOT ##51 t`No. 1 �
DEPTH SOILS ELEV. 7.500 Square Feet +/- DEEP TEST HOLE &
0 98,48 97 __ _______o----------------- ----- ------- --97 PERCOLATION TEST LOCATION
Loamy Sond
10 YR 3/2 �- 75.00'
Pb
o -to" A• ooI S 17d 36' 20" W f---� 6 FOOT STOCKADE FENCE
96---------- ---------------- ---------------- 96
Loamy
Sand !
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10 Y5/6
10-- j4" a. 95-50'
Coorse
SandP LOT PA
2.5 Y 7/4 IL____ I \Vf
34"-168" C, 84.50I (40 FOOT RIGHT OF WAY)
OF PROPOSED SEPTIC SYSTEM UPGRADE
PREPARED FOR
Perc #1 Tv1R . DAVID BIRDSALL
Depth to Perc: 38" to 56"
Perc Rote= Less Tho 2 MPI
Groundwater Not Observed z AT
No Observed Elev
HWT
ADJUSTED H2O lev = None 6J HARBOR HILLS ROAD
EL
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Design Calcul i ns 0 20 40 50 CENTr RUII E ' MA
Number of Bedrooms: 3 Equivalent to 330 Gal /Doy (330 Gal. Do Title V/ y Min. per ) I I I I NOF As PREPARED BY:
Garbage Grinder: No E77 �
Leaching Capacity Proposed. 330 Gcl./Doy Minimum (Min. Per Title V) T CAR F�1 R 7
Septic Tank : - 3 x 330 Col./Day = 660 USE 1,500 GAL Septic Tank SCALE: 1 "=20' E. A- NEY E. SIZA 1
SOIL ABSORPTION AREA: Using percolation rate of <2 min-/inch ENVIRONMENTAL SERVICES, INC.
Bottom Area: 0.74 gal/sq. ft. x 300 sq. ft. = 222 gollons Rlo. 1181
Sidewall Area: 0.74 gal./sq. ft. x 160 sq. ft. = 11840 gollons EXISTING CESSPOOLS TO BE PUMPED & REMOVED TO 4'F �10 P.O. BOX 627
Providing: = 340.40 gallons FACILITATE INSTALLATION OF NEW TANK AND SAS S��ISAR L EAST FALMOUTH, MA 02536
Use: (4) CULTEC MODEL 135 UNITS, HAVING A 1' EFFECTIVE DEPTH, TEL/FAX : 508-548-0796
TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, 3' OF WASHED STONE NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE SCALE: 1 "=20' DRAWN BY: CES DATE: MAY 16, 2002
ON THE ENDS AND 1' OF WASHED STONE BENEATH THE ENTIRE SAS. FROM THE EXISTING LEACH PIT TO BE DISPOSED
I OF AS PER BOARD OF HEALTH SPECIFICATIONS. PROJECT#SD317 FILENAME: SD317PP.DWG SHEET 1 OF 1
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