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HomeMy WebLinkAbout0120 HERRING RUN DRIVE - Health 120 Herring,Run Drive Centerville - A = 229 047 No. 42101/3 ORA en FssE«E 10% (5 0 0 0 0 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i ;M 120 Herring Run Drive Property Address. Marie Salvucci Trust CP Owner Owner's Name information is Centerville �/ Ma 02632 7-25-17 required for every C -�- page. City/Town State Zip Code Date of Inspection rra. t yt r�.I 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 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation 4:1 Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 SI 13640 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 Evaluation by the Local Approving Authority 7-25-17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 pex 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 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: ® 1 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 was in working order at time of inspection. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. Cityfrown 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 isms•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts , W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: t 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 '/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. CitylTown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M ,• 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(Actual) _2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 352gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. Cityrrown 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2015- 179,000gallons 2016-6,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: 2 weeks prior Date Commercial/Industrial Flow Conditions: Type of Establishment: NA 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ,•''y 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. Citylrown 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: Date of last pump is unknown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 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: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 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 gallons Sludge depth: 4 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. Citylrown 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 32 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 16" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. Grease Trap(locate on site plan): Depth below grade: NA 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 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: NA 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•3/13 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 M 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. CitylTown 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 11 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was in working order at time of inspection with no sign of past backup or carry over. 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (2) 500 gallons ❑ 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.): Leaching was in working order at time of inspection. No high staining, damp soils or lush vegetation were present. Chambers were dry with no visible staining. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 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: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 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 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately FRONT DECK 43' 7 27' 26' 27' 24,6,# 29' 0 0 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .•'" 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is required for every Centerville Ma 02632 7-25-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar � ® Shallow wells Estimated depth to high ground water: feet GW 11' t 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: 9-23-02 Date ❑ 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: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5- Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Herring Run Drive Property Address Marie Salvucci Trust Owner Owner's Name information is Centerville Ma 02632 7-25-17 required for every 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 17 / TOWN OF BARNSTABLE LOCATION 0y a eu, o" SEWAGE # VILLAG ASSESSOR'S MAP & LOT "Q�I INSTALLER'S NAME&PHONE NO. ![ i A-6d �-- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 'Y G (size) NO.OF BEDROOMS J BUILDER OR OWNER ,CAL U%LC PERMITDATE: COMPLIANCE DATE:/0 7'-G 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 t- kX No. Fe THE COMMONWEALTH OF MASSACHUSETTS Entered in computeAI/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for 30igponl 6pgtem Congtruction Permit Application for a Permit to Construct( )Repair(Kx)Upgrade( )Abandon( ) ®Complete System ❑Individual Components Location Address or Lot No. 120 Herring Run .Rd. Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Centervillg Salvucci Installer' ame, dres n Tpl.No. Designer's Name,Address and Tel.No. m. 20 1nson Craig R. Short P.O. Box 1089 P.O. Box 1.044 Centerville, MA 02632 S. Dennis MA 02660 Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building residential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil �I Nature of Repairs or Alterations(Answer when applicable) we w i 11 install a new Title-5 septic system to the plans of Craig R. Short # 1 -933 dated 9/23/0 Date last inspected: Agreement: The undersigned agrees ro 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 Certifi- cate of Compliance has been issuedzbr�'this and Health. Q .►;/ Sign �/r Date z Application Approved by o .Date Application Disapproved for the following re_o Permit No. Date Issued N Fe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer., Yt/ PUBLIC HEALTH DIVISION -TOWN OF'BARNSTABLES MASSACHUSETT_S ; I(Mication for Miqu al *patent Construction Permit Application for a Permit to Construct( )Repair�X)Upgrade( )Abandon(\ ) ®Complete System ❑Individual Components Location Addressor Lot No. Owner 120 Herring Run.Rf11, 's Name,Address and Tel.No. Assessor'sMap/Parcel Centervlli OL Salvucci Installer's am Address and T 1.No. Designer's Name,Address and Tel.No. t 'm.e, �. Robinson Craig R. Short P.B. Box 1089 - P.O. Box 1044 Centervillp, MA 02632 S. Dennis, MA 02660 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building re ident&&1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil; Nature of Repairs or Alterations(Answer when applicable) 6A will instgAllaanew Title-5 septic system tottbb plans of eraig R. Short # 1-933 dated 9/23/0 Date last inspected: Agreement: , The undersigned agrees to,ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this RoardA Health. W.G p 9 ' Sign 006J��j22 �. Date l ` Application Approved by Date Application Disapproved for the following re od s Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Salvdcci Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (xx)Upgraded( ) Abandoned( )by William E. Robinson SEptitc Susdtce at 120 Herring Run Dr., Centerville --` has,bee'constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N dated Installer ftlliam E. Robinson Sr. —Designer "Crain . Short The issuance f this permit shall not be construed as a guarantee that the syst will ifnct'on Date 7 Inspector ' x �U No. 0 0 ` 5a ucci THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS x1i6poal *pztem Con!5truction Permit Permission is hereby granted to Construct( )Repairgx )Upgrade( )Abandon( ) Systemlocatedat 1209Herring Run Dr. Centerville ,,a•� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to -'comply with Title 5 and the folio ing local p ovisions or special conditions. Provided:Construction be o let d i 'n ee years of the date of this pe 't. ;. A/ � Date: ..PProved b Y t TOWN OF BARNSTABLE L LOCATION Ly t�,/Yt� ►". n o w 0-& SEWAGE #0-,' VILLAGE C,J^, / ,ASSESSOR'S MAP & LOT -O J. I INSTALLER'S NAME&PHONE NO. / o A— SEPTIC TANK CAPACITY t LEACHING FACILITY: (type) v —� x Z-G (size) NO.OF BEDROOMS BUILDER OR OWNER i PERMU DATE: —�c� 8 COMPLIANCE DATE:/0—7`-G :— 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 /'AGw 1 CHUM SaL TES TOP OF FOUNDATION I 20 FT. MINIMUM FROM CELLAR _ _ _ I DATE OF SOIL TEST _ L o Z_ ELEV. _ �_v_/./_ I 10 FT. MINIMUM 1 FT. MINIMUM FROM SLAB OR CRAWL SPACE SOIL TEST DONE BY (ASSUMED) CONCRETE CLEAN SAND WITNESSED BY __�_-+ L -r COVERS LOAM AND SEED OBSERVATION HOLE 1 ELEV.=__9G � 4" SCHEDULE y. PvC PPE PERCOLATION RATE � Z_ MIN./INCH AT'�2'sf NCHES 7MIN. PITCH - P -- — \ �\ I FL 99 0 1 1�8LA LAYER /2" ^cND DEPTH HORIZ TEXTURE COLOR MOTT. OTHER GE � WASHED STONE O 4, Ip 4" CAST IRON PIPE `.; Mom• VENT ExISTING SPOT ELEVATION 00„0 3 (OR EQUAL) MINIMUM u wN• NOT REQUIRED I CONTOUR _-_ .. PITCH 1/a" PER FT. r l Z FINAL SPOT ELEVATION -00---- o^�, 3/e �c FINAL CONTOUR ap y/I 1 SOIL TEST LOCATION , fi FLOW LINE UTILITY POLE �- L7� +B I I `f L •� - " TOWN WATER =W--.. W PUJAIIBMIG ELEV. _ _��� MIN. I ° ❑ C G ❑ ❑ O ❑ ❑ ❑ ❑ ❑ CATCH BASIN ��� TO BE RAISED ELEV. _ O!� 2'0" p ° ° p \ l { �'+'1 t•�l r /ol/Z �� AND RE-PIPED BY LEVEL p p ❑ ❑ ozio ❑ ❑ ❑ ❑ ❑ ❑ GAS LINE G UCEPISED PWYBFR ELEV. v� GAS ELEV. = 9S"G u6 UMZ �--ELEV. _ `_u_`- - o� o ° ° CLEAN Oi T C C v C Lt o�►�sr ��►� AS NEEDED BAFFLE DISTRIBUTION p p ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ p 2' �p CESSPOOL C.P O Js 7 ELEV 0A, 00000000 = o ° LIQUID OUTLET BOX _y_`=_ ELEVDEPTH TEE (TO BE PLACED ON FIRM BASE) 2 - $00 GALLON DRYWELLS WITH 4 FEET 14 INCHES TO BE OATEk TESTED -7 LS . 5 FEET 19 INCHES IF MORE T"A� N ONE OUTLET � Z � STONE IN AN 6 FEET 24 INCHES 1500 GALLON /✓a WATER ENCOUNTERED AT _� _ ELEV. 7 FEET 29 INCHES (TO BE PL*00 ON FIRM BASE) t_? . TRENCH FORMATION WELL N A _ v - 8 FEET 34 INCHES , SEPTIC TANK 3f4" TO 1 t/2"' CLEAN u r g ZONE______ SOIL ABSORPTION INDEX DOUBLE WASHED STONE �+ ADJUST_-- rREE OF FINES & SILT SYSTEM STEM SAS, DESIGN CALCULATIONS NUMBER OF BEDROOMS USGS PROBABLE WATER TABLE ELEV. _ 3_ GARBAGE DISPOSAL UNIT i1Jb WAGE DISPOSAL SYSTEM PROFlLE OBSERVED WATER TABLE ( / / ) ELEV. _ __ TOTAL ESTIMATED FLOW NOT TO SCALE BOTTOM OF TEST HOLE ELEV .3_3 GAL./DAY REQUIRED SEPTIC TANK CAPACITY GAL. ACTUAL SIZE OF SEPTIC TANK /_ off GAL. SOIL CLASSIFICATION r DESIGN PERCOLATION RATE �z MIN.%IN. EFFLUENT LOADING RATE , J GAL./DAY/S.F. LEACHING AREA 1�c/� r 2 / 7` � SO. FT. 3.3 \ f p LEACHING CAPACITY (AREA X RATE) GAL./DAY RESERVE LEACHING APACITY 74 GAL./DAY { DRi VG i f. • 5s.o u . �N G RN NOTES. �9d . ` 9 p \ ?. ALL WORKMANSHIP ANC MATERIALS SHALL CONFORM TO D.E.P. = TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE ONvI �/ 'Ir 96.3 1• C / \ DISPOSAL OF SEWAGE. IL • �' r + 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. 96 J //' „� ,r��-erg i ` 95�" ��. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF I ip0. �j ,Zi�� tJ-PAL£ WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN -POLE ` ;y, _ 9t3 �" \ ,6 � + 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE ` USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL ^RAIQ DIiJ►rE•aR ,� 7. ��s ' \ BE MORTARED IN PLACE. I 5 NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH /rMi''J �• - 9�4 t 64 ~` DEEDED OR ZONING REGULATIONS. OWNER / `IPPLICANT IS TO j OBTAIN SUCH DLTEr�MINATiON FROM APPROPN,^TE AUTKORITY. 97 5 \ 20• �d 00"4 p 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS 117- C ,�, BRICK PRIOR 7. CONTRAOCTORM SETOING VERIFYK ON SITE, GRADES AND ELEVATIONS AS WELL AS l O cy,,�,o�`r`''�f PA CO GARAGE 97.3 / ' �s-y�,,g ,_ SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER /r IMMEDIATELY. i / S"�,S--�► D�sr r �� Q P,eo r-<.�-a 8. PARCEL IS IN FLOOD ZONE $o a( \ 'sue/�ri� T. � 9. LOT IS SHOWN ON ASSESSORS MAP _-Q__ AS PARCEL _ 47 AA_ 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND \ DECK I __- FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, r -� ED `I AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) I 5F� iv (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT. I 11. EXISTING SEPTIC SYSTEM TO BE PUMPED AND FILLED WITH SAND ■ 3 i �''Cr T-i.0 OR REMOVED 77w ��/�� � '�' ROt3N Zh �::•� APPROVED: BOARD OF HEALTH ' C4 DATE AGENT ,or 1J PROPOSED SEPTIC DRSIGN I AREA 20,4JOf S F 232. 4 FOR LOC. LOT 13 120 HERRING RUN DR, C V-m f� I $4rAJ&Aya r < o CRHG R SXORT, A R f �,,,,,a► sr' 235 GREAT WESTERN ROAD i ,�, -----~- 508- P. 0. BOX 1044 398_831'! SOUTH DENNIS, MASS. 02660 DATE ? SCALE SEP ` ,, , 2002 � -- 20' REVISED I ,10B NO- 1_933 LOCATION NA AP I REVISED I SHEET 1 OF 1 F8 192 17 C 58'PRO,I 2J50-00 dw. 2J60-00.D►YC C 2002 CRAIG R. SHORT, P.E.