HomeMy WebLinkAbout0053 HIGH NOON DRIVE - Health 53 High Noon Drive
Centerville F/R
A = 193 227
an #C-fCt&D
.M y
UPC 10259 :
No.H 630R
HAMMON. ON
TOWN OF BARNSTABLE
d
LOCATIG,N 3 111 111`lGD/? SEWAGE,# 2 uox— 6G
VILLAGE //t"�/�- ASSESSOR'S MAP & LOT F �"�a�
INSTALLER'S NAME& PHONE NO. G l 1 G lKe U
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) -�t5-D0 4y"I1e?116 (size) ,G� 57
NO. OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: o t COMPLIANCE DATE: rld ilia }
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,Aof leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet y
Furnished by
t �s^6r� ���G'�•s�
'�` CO �,
1
No.
2002 — 6 0; _r, Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01oprication for �Digool bp5tem Con.5truction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /4i V(,^p o tj plf\,Q, Owner's Name,Address and Tel.No
Assessor's Map/Pazce
r 3
Installer's Name,Address,and Tel.No. , 12. Designer's Name,Address and Tel.No.
Cow Ist
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Sjo
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 33o gallons per day. Calculated daily flow '34 0 gallons.
Plan Date i Number of sheets l Revision Date Lj
Title
Size of Septic Tank -e -1 ,)oO. Type of S.A.S. `' r
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 is Board of ealth.
Signed Date Z3
Application Approved by 'V\) Date o z
Application Disapproved for the following reasons
Permit No. b a a-6 0,7 Date Issued E;taz 2
61
r No. 20 U ^r y Fee ✓ `P
g•"',"�+ � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
)Ilk
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS
ZIPPrication for 0i.5pozar *pgtem Congtruction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 5*3 14 i 3�h o o vj PrN_Q.. Owner's Name,Address and Tel.No
Assessor's Map/Parcel,
9.3 P "a 7 Sc,.,r..9__
Installer's Name,Address,and Tel.No. { - Z Designer's Name,Address and Tel.No.
Type of Building: Zi
Dwelling-,- No.of Bedrooms .3 Lot Size M L sq.ft. Garbage Grinder IOpcj { ,
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow '330 gallons per day. Calculated daily flow ray U gallons.
Plan Date i2) o-t Number of sheets k Revision Date
Title
Size of Septic Tank 1000. Type of S.A.S. W
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
R6.
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 4bisBoard of Jjealth.
Signed N no..,Is A �.1 '` Date
Application Approved by `// W. Date
Application disapproved for the following reasons
Permit No. �6 d : ~6 03 Date Issued I a ) t e 2
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
_ (Certificate of (tompliance �
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (V )Upgraded( )
Abandoned( )by \a ,e k-V ck c, \r,.,0 T uv
at St k•k %cj\_V.00 A 16r,,.n has been constructed in accordance
with the provisions of Title 5 and a for Disposal System Construction Permit No. �001 l9 dated I d b Y/d y
Installer e Qe Designer
.c \ c.,e.c F a
The issuance of this permit dhall not be construed as a guarantee that the system will function as designed.
Date 0\e I o 9` 0 Inspector
-----(----------------------------------
No. 3 0O.2 Fee Sv
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mi.5po5al *pMem Qfon!6truction Permit
Permission is hereby granted to Construct( )Repair( l�Upgrade( )Abandon
System located at 5 J 4 V u o •-. .�r e�- v j \
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date:_ �a(�Y! L'Z Approved by
TOWN OF BARNSTABLE
LOCATIONS �� l/D SEWAGE # ZUU�— ;�
VILLAGE C �D�l/Y l�� ASSESSOR'S MAP & LOT , 3",R,2—7
INSTALLER'S NAME&PHONE NO. �>r
SEPTIC TAN CAPACITY
T /
LEACHING FACILITY: (type) :��� ��' (size) ,!.�
NO. OF BEDROOMS 3
BUILDER OR OWNER F Ae,441
PERMIT DATE:---JL/ COMPL CE 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
o1s 1
I l
Q� r
,. �ROY WILLIAMS `- - I3
SEPTIC INSPECTIONS
Certified by MA Department of Environmental Protection (508) 385-1300
)9 Hummel Drive FAILED INSPECTION
South Dennis, MA 02660
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE, OFFICE OF ENVIRONMENTAI.AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
f
TITLE 5 \,
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A T 00- ®��o
CERTIFICATION
0
Proper(. Address: 53 High Noon Drive
Centerville,MA ��ATTq
Owner's Name: Glenn&Laura Hoffinan e�F
Owner's Addres.: 53 High Noon Drive
Centerville, MA 02632
Date of Inspection: October 16,2002
Name of Inspector: . 'TroyM. Williams \w<
Company Name: Troy Williams Septic Inspections
Mailing Address: 19 Hummel Drive
South Dennis,MA 02660
Telephone Number: (Sd8)385-1300
CERTIFICATION STATEMENT
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
approsed system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system
Passes
Conditionall.v ('asses
Needs further Evaluation by the Local Approving Authoni)
Fails
Inspector's Signature: ,� J,,,CL/�..,,.. Date: /0//6 /o a.
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I leal(h 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.
Notes and Comments
Although system meets the minimum requirements set forth by the Massachusetts Department of
Environmental Protection,certification is not to be construed as a guarantee of future working condition
of system,piping or components. This inspection represents the conditions of the system on the Date of
Inspection noted above.
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. phis inspection does not address how the system will perform in the future under the saute or different
conditions of use.
Title 5 Inspection Form 6/15/2000 naee 1
Page 2ofII
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
53 High Noon Drive
Owner: Centerville,N A
Date of Inspection: Glenn&Laura Hoffman
October 16,2002
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 a of the failure criteria described in 310 C.N4R
15.303 or in 310 C'MR 15.304 exist. Any failure criteria not aluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section nee to be replaced or
repaired. The system, upon completion of the replacement or repair,as approved by the oard of Ilealth, will pass.
Answer yes. no or not determined(Y,N,ND)in the for the following staten nts. if"not determined"please
explain.
The septic tank is metal and over 20 years old* or the septic tank hether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure ' imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved the Board of Health.
•A metal septic tank will pass inspection if it is structurally sou ,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break o or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled o even distribution box.System will pass inspection if(with
approval of Board of Health):
bro pipe(s)are replaced
o traction is removed
istribution box is leveled or replaced
ND explain:
The system req ' ed pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(w' approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
'Page 3 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
53 High Noon Drive
Owner: Centerville,MA
Date of lrtsPectiou: Glenn&Laura Hoffman
October 16,2002
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. S3 stem v+ill pass unless Board of Health determines in accordance with 310 CMR 15. (1)(b)that the
system is not functioning in a manner which will protect public health,safety and t e 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 s marsh
2. System will fail unless the Board of Health(and Public W r Supplier,if any)determines that the
system is functioning in a manner that protects [tic public h th,safety and environment:
_ The system has a septic tank and soil absorption stem(SAS)and the SAS is within 100 feet of a
surface %cater supply or tributary to a surface wale upply.
The system has a septic tank and SAS d the SAS is within a Zone I of a public water supply.
The sN stem has a septic tank and S and the SAS is within 50 feet of a private water supply well.
— The systern has a septic tan ' and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". ethod used to determine distance
**This system passes if a well water analysis, performed at a DEP certified laboratory,for coliform
bacteria and volatile ganic compounds indicates that the well is free from pollution from,that facility and
the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteri a triggered.A copy of the analysis must be attached to this form.
3. Other:
3 r.y .
7
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 53 High Noon Drive
Centerville,MA
Owner: Glenn&Laura Hoffman
Date of Inspection: October 16,2002
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
— Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6"below invert or available volume is less than,%:day flow
Required pumping more than 4 times in the last year 1N T due to clogged or obstructed pipe(s).Number
of tiines pumped
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
Ar /q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply. ,
.via Any portion of a cesspool or privy is within a Zone 1 of a public well.
lvtg Any portion of a cesspool or privy is within 50 feet of a private water supply well.
a Any po
rtion rtton of a cesspool 0 t p p I r 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility 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 forma
y% (Yes/No)The system fails. 1 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 esign flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the cr' ria above)
yes no
_ the system is within 400 feet of a surface drinki water supply
— the system is within 200 feet of a tribu o a surface drinking water supply
_ the system is located in a nitrogen s sitive area(interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply ell
If you have answered"yes"to any stion in Section E the system is considered a significant threat,or answered
"yes"in Section D above the lar system has failed.The owner or operator of any large system considered a
significant thcfat under Sectio or failed under Section D shall upgrade the system in eccordimce with 310 CMR
15.304.The System owner Auld contact the appropriate regional off
ce of the Department.
€ 4 i r
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
53 High Noon Drive
Owner: Centerville,MA
Date of inspection: Glenn&Laura Hoffinan
October 16,2002
Check if the following have been done.You must indicate-yes"or"no"as to each of the followinc:
Yes No
✓ _ P..;:Iping information was provided by the owner. occupant, or Board of I lealtl,
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:
Yes no
_ 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(3)(b)J
g_ ,
lg
._ tR.
5 t xq v
Page 6 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
53 High Noon Drive
Owner: Centerville,MA
Date of inspection: Glenn&Laura Hoffman
RESIDENTIAL October 16,20noW CONDITIONS
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: I I0gpd x#of bedrooms): 33 u
Number of current residents: Y
Does residence have a garbage grinder(yes or no):YL s (M-t
Is laundry on a separate sewage system(yes or no):Nu [if yes separate inspection required]
Laundry system inspected(yes or no): Ay/q
Seasonal use:(yes or no): Nv
Water meter readings,if available(last 2 yearslusage(gpd)): D_
Sump pump(yes or no): Ato
Last date of occupancy:
COMM ERCIAL/INDUSTRIA L
Type of establishment:
Design flow(based on 310 CMR 15.203):
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):—
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 sys (yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records �
Source of information:
Was system pumped as pan of the inspection(yes or no): ivo
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)
_Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components.date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no): n/0
6
Page 7 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
53 High Noon Drive
Owner: Centerville,MA
Date of Inspection: Glenn&Laura Hoflirtan
October 16,2002
BUILDING SEWER(locate on site plan)
Depth belu« grade: 2 '+
Materials of construction:_cast iron v-"40 PVC/other(explain): c.5,
Dktancr fron. private water supply well or suction line: v/,n
Comments(on condition of joints,venting,evidence of leakage,etc.):
1_.�.Lww.� 6Y./o wtA.�.c✓ It l � �'1. �-iw.-� o �, ., t n<
SEPTIC TANK:,�(locate on site plan)
Depth below grade: /8" kL'�
Material of construction: ✓concrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ is age confirmed by a Certificate of Compliance(yes or no):'_(attach a copy of
certificate)
Dimensions: _ S" 'x q 'x c ' ♦o �i�ti.
Sludge depth y'
Distance from top of sludge to bottom of outlet tee or baffle: -2'8
Scum thickness: /1'
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: go
How were dimensions determined:
Comments(on pumping recommendations, inlet and outlet tee or bate condition, structural integrity, liquid levels
ads related to outlet invert,evidence of leakage,etc.): t
_ :ss(<c,�y3...a v Ul 4 W Ne. wG.s X.—A.
t.lc�;a✓ It_.1 tTyMt� IJKS G�OUs_(_N Il }_. , UaJ4-I11...!_.h41 — 1
in)Pc��i►� w l.ii[a•nt. u�C' w�y. I .r. c u&S, ;r� +f2 r.Sc✓
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polye ene_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 outleZteeo ffle:
Date of last pumping:
Comments(on pumping recommendations,inlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leaka ,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
53 High Noon Drive
Owner: Centerville,MA
Date of Inspection: Glenn&Laura Hoffinan
October 16,2002
TIGHT or HOLDING TANK: (tank must be pumped at time of' ection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fibergla _—polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flo\�: gallons/day
Alarm present(yes or no):
Alarm level:__ Alarm in working or r(yes or no):
Date of last pumping:
Comments(condition of alarm and fl t switches,etc.):
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 carrygver, any evidence of
leakage into or out of box,etc.):
0"C TV inI'� t.✓ I i�J/w�. f JIA� YI /} L N I 14 W Gl rr✓— (L f H
. /C1 — u;//I-,,W t ,i f�_�.iSS2 V Z 1{1 ✓� =SI•a...l." '+'
'`�•Y 1,�.t J
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condid of pumps and appurtenances,etc.):
IZZ
4�
8
Page 9 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
53 High Noon Drive
Owner: Centerville,MA
Date of Inspection: Glenn&Laura Hoffman
October 16,2002
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits, number:
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,Zondition of vegetation,
etc.): -4,-j yC i i
CESSPOOLS: (cesspool must be pumped as part of inspection) ocate on site plan)
Number and configuration:— _ _
Depth—top of liquid to inlet invert: -
Depth.of solids layer: _
Depth of scum la.er
Dimensions of cesspool
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of draulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(dote condition of soil,signs of hydraul' ailure,level of ponding,condition of vegetation,etc.):
9
r
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 53 High No.on Drive
Centerville,MA
Owner: Glenn&Laura Hoffinan
Date of Inspection: October 16,2002
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
y
18 ,
1 o- 31 '
. O
IQ
-Page l l of
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
53 High Noon Drive
Owner: Centerville,MA
Date of Inspection: Glenn&Laura Hoffinan
October 16,2002
SITE EXAM
Slope
Surface water-
Check cellar ✓
Shallow wells
Estimated depth to ground water feet Adjusted high ground water elevation feel
Please indicate(check)all methods used to determine the high ground slater elevation:
Obtained from system design plans on record- if checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Ftealth-explain:
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain: S« 0,1
You must describe how you established the high ground water elevation:
u 5 S
G `U
q.U
36. 3
This report has been prttpared and the sy#ttsm inspected as of the date of inspection. This report is not a
warranty or guarantee that the system wl function properly In the future. There have been no warranties or
guarantees,either expressed,written or(tnplied, relating to the system,the inspection and/or this report.
11
(/'✓roPc�
TOWN OF BARNSTABLE
LOCATION ,'�3 IgLC�1'/ Aey-n 43 .
SEWAGE #
VILLAGE
ASSESSOR'S MAP & LOT
I
INSTALLER'S NAME & PHONE NO. ��� S //•OQi�
A
SEPTIC TANK CAPACITY
LEACHINP FACILITY:(type) /poa c �—(size)
! NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
i
BUILDER OR OWNER D/�(/I fj C,:94 a i✓
DATE PERMIT ISSUED: Z6
i
DATE COMPLIANCE ISSUED:
i VARIANCE GRANTED: Yes No
49
i
i
r71. 1.
it
Commonwealth of Massachusetts a 1�&CjV �
Executive Office of Environmental Affairs NO V ,�
Department of rt of z 199
4:
Environmental Protection N
William F.Weld S
Gcwmor
Trudy Coxe
etx s ,w EA
David 8.Struhs
Comtnasioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: Ac3OZ'"r '�` ' " Address of Owner.
Date of Inspection: %a—aG 9 Of different)
Name of Inspector:
Company Name, Address and Telephone Number:
� -'77 g_uz yS s ro/ c3- '
CERTIFICATION STATEMENT
1 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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
�sses '
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: J""'1 `�-�,� ' �� Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30) days of completing this
r n h system owner shall submit
r h inflow of t0 000 or realer, the inspector and the inspection. If the system is a shared system o as a design gpd g p Y
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the s�steni owner and copies ser: to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C, or D:
A] SYSTEM PASSES:
L II have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/15/95)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556.1049 • Telephone(611)292-5500
Printed on Recycled Paper
z .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
..�. PART A
-f CERTIFICATION (continued)
Property Address:
Owner.x
Date�of Inspection:
B] SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more than four 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
obstruction is removed
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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND 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.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a seouc tank and soii absorption system and is within i00 feel to a surface water supply or tributary to a
surface water supply.
_ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5
ppm.
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
contacted to determine what will be to correct
for this determination is identified below. The Board of Health should be co necessary
the failure.
Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or
cesspool.
(revised 8/15/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
D] SYSTEM FAILS (continued):
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 1/2 day flow.
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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis fair
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Date of Inspection:
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of Health.
Xone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rages
during that period. Large volumes of water have not been introduced into the system recently or aS part of this inspection.
Zs built plans have been obtained and examined. Note if they are not available with N/A.
Zhe facility or dwelling was inspected for signs of sewage back-up.
ZThe system does not receive non-sanitary or industrial waste flow
Zhe site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
,/The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
i"The facility o�%ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 8/15/95) 4
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 8.3 Wc,_ ' 171,-O"` °j!�
Owner:
Date of Inspection: /p_
FLOW CONDITIONS
RESIDENTIAL:
Design flow:-?' gallons
Number of bedrooms:
Number of current esidents:�
Garbage grinder Wor no):_4tja./
Laundry connected to system (yes or no):_jLkj/
Seasonal use(yes or no):—/—Vu
Water meter readings, if available: A/U
Last date of occupancy:
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow:_,gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)L✓O
If yes, volume pumped: gallons
Reason for pumping:
TYPE OfSYSTEM
,/ 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)
Other(explain)
APPROXIMATE AGE of all components, date installed (if kn wn)and source of information: ,/7 4W - ( /—��' r'�>
�.-eve-�
Sewage odors detected when arriving at the site: (yes or no) ��
(revised 8/15/9S) S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C.
SYSTEM INFORMATION (continued)
Property A,d Iress:
Owner:
Date of Inspection: 10 3'7-1-5 -
SEPTIC TANK: ✓ 1�� C '
(locate on site plan)
Depth below grader
Material of construction: concrete_metal _FRP_other(explain)
Dimensions: �' G x y d
Sludge depth: �' f
Distance from top of judge to bottom of outlet tee or baffle:
Scum thickness:0_
Distance from top of scum to top of outlet tee or baffler_
Distance from bottom of scum to bottom of outlet tee or baffler-
Comments:
I s or baffles depth of liquid(recommendation for pumping, condition of inlet and outlet tee level in relation to outlet invert, structural
p
integrity, evidence of leakage, etc.) Z ��, Jg
GREASE TRAP:_
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP —other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from'bottorn ni scum t- bottom of outlet tee of baffle:
Comments:
(recommendation for pumping• condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) nn.h t_2
6
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: / 0zov"+
Owner. -4'e'r � a P>s:�
Date of Inspection: 10_a 7-0 s'
TIGHT OR HOLDING TANK:_
(locate on site plan)
Depth below grade:
Material of construction: _concrete_metal _FRP—Other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: ✓
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribu6cr, is egca!,1/evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order.(yes or no)
Comments: ,
(note condition of pump chamber, condition of pumps and appurtenances, etc)
(revised 8/15/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: S,3 AgitA ® °'
Owner. Lt/v
Date of Inspection: �/
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type: (�.� ��� ( � � Z
leaching pits, number:_ u
leaching chambers, number:_
leaching galleries, number
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
CESSPOOLS:
(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 ground,•:a:er:
inflow (cesspool must be pumped as part of inspection)
\ 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.)
(revised 8/15/95) 8
h`
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: �3 /� V,
Owner. �� (,(J,e:eEcc •o
Date of Inspection: 0_a 7 9 5-
SKETCH OF SEWAGE DISPOSAL SYSTEM:-
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
1 i
�f� I
DEPTH TO GROUNDWATER
Depth to groundwater. al-, feet T
method of determination or approximation: �i � (�/�i�C>S " ua�cc rat Gd �s•r.�Y`
(revised 8/I5/95) 9
AF9125A/ 9 4v,'t T �°sf�A '�� o� �-az
TOWN OF BARNSTABLE
LC,CAtibN ,3 3 �Gr.�y/ /� t 3 • SEWAGE # 78- Q s8
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME 6a PHONE NO. L -� S //•dQ.�
SEPTIC TANK CAPACITY ,f`1/JC'�l
LEACHING FACILITY:(type) / pp(q C,,ae /--(size)
NO. OF BEDROOMS J PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: `7
DATE COMPLIANCE ISSUED: /—/O— 7 j
VARIANCE GRANTED: Yes No
� :�
�.�.
1
i
3� ,�
(�D
•r
LO C 4fION SEWAGE PERMIT NO.
VI L GE
INSTA LLER'S NAME & ADDRESS
L 57(/;"-
B U 11 D E R OR OWNER
DATE PERMIT ISSUED -Z/-
DATE COMPLIANCE ISSUED
,
j
1 coo 6A c'
j..
Nd........................ Fxs.... r.............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
��I �2"1 ... --......OF.......... G�i� ...-S ZI Pe—
.............................. .. .. ..............
ApplirFa#ion for Diipnoal Narks Tnnitrnrtinn Errant
Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal
System at: i
i �!a v� tj l®l / 61- 77 �;vif�Ll�... .......-- . ............................................................••---•--................
�} o tion-Address � /� or Lot No. /Y
C¢ 1// Q P '1 an 7... �� /�/ �..F� Y %.?ZiJ X L�p!'7 f' (_Cr,77
.. ....._................ - ........... ...
�O�wne�r/ Address
�..L...----- -^.v`...a-"`f-----•------------------------•----•--•-•- --•----....--•-------------.........-•---.........._...---•------...............--•---........_...
Installer Address
dType of Building Size .......Sq. fee
Dwelling—No, of Bedrooms. ........ Expansion Attic Garbage Grinder
`4 Other—Type T e of Building ............. No. of rsons...._................._._... Showers — Cafeteria
a yP g --------•------ P ( � )
114 Other fixtures --------------------------------
------------------------
W Design Flow............ ..................gallons per person sy. Total lily flow....
WSeptic Tank—Liquid*capacitye�_._......gallons Length.. ............ Width.......__._.____ Dia r__-_____._...... Depth................
Disposal Trench— ..................... Width_..4_......_....__ Total Length.......... _.V._.__ Tit lleaching ....................sq. ft.
--Seepage Pit No_____________________ Diameter.....t�__.._...... Deptl below inlet......____.....A T"otal leaching area--_------.1......sq. ft.
Z/ Other Distribution box (� ) Dosing tank }7
a 79
Percolation Test Results Performed by...�___ _ ......... :_:..�o.................. Date..... __..� ....__
a Test Pit No. 1...�Q--.......minutes per inch Depth of TesP Pit. 6...._..... Depth to ground water. .... __------
44 Test Pit No. 2................minutes per inch Depth of Test P't:.____.._...__.____. Depth to ground water........................
�-I _...---'-----'-------------------------------. - ._..a> ----•-•------•...... h _
O Description of Soil----------------0__'±_ .. ....A4 ct _..: ! `tl . l k/�l�E��i
x �..-•--
--------- -------------------•-•----------•-•----'-----•----------------•---•---•------_'-• '--•-------------•---------•--'-----------------------••---'•--'-••------••.._..............
U Nature of Repairs or Alterations—Answer when aP1i1icable..._..__.<.....................................................................................
"-
Agreement
The undersigned agrees to install the aforede�er ed Individual 10, �ySewage Disposal SysteI
ordance with
the provisions of iIT?.i. 5 of the State Sa yCo',de—Te unde�igned urther agrees not the system in
operation until a Certificate of Complianc as be.', issued y the oard , h h.
Si , ed---- --••-------- -----------------------
.._....:::---------
---------------- ---•�... _
Date
Application Approved By..... � � = ............................. f
D
Application Disapproved for the following reasons:..• ----'-' '-•---------------•--'-----•--------------••-•-•----------•-•••'---'-'-''---'----..........--
••......------•--'--•......--•••------•-•-•--•-••--.-•-..._..•-•-•'-'•'-------•...................•.........----•-----•--------------•-------•------------------------'---••---------'"'-•--••....._..--
Date
Permit No.......................................................... Issued--. I k.p
---....------------•----
_.
Nod-: - ��-5 -• ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH�/e
........... . ...........................OF.......... ...... ......................................................................
Appliration for DWIl'nsal Works Tonoiruriinn Vamit
Application is hereby made for a Permit to Construct X) or Repair ( } an Individual Sewage Disposal
System at
f���r~ poi/ J/�. �c / ee777l�v U/�t�
... .......... .......................................... ••--•-•-••-•-••'•-••--•-......••••._.....•••-•-•-_._-••-•--••-•-•-•.........•-•••..........--
o tion-Address or
97 t No.
--' .._......
owner Address
Installer Address �'
UType of Building Size A.AI.19 6/ .......Sq. fee
�-, Dwelling—No. of Bedrooms............................................Expansion Attic Mr Garbage Grinder 060
4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria
aOther fixtures .................................................................................................
Design Flow__._.......�-v!_+_._..__-_oD�_gallons per person$er ay. Total dill flow....:r�/-
Se . .___ - _* loins.
Wp Tank—Liquid capacity -----.___gallons Length__9--____.___. Width________________ Diameter__.______.__.___ Depth..*..............
x Disposal Trench—No_____________________ Width.................... Total Length.............. Total leaching area...__._,._._........sq. ft.
Seepage Pit No..................... Diameter.....C,........... Dept1q below inlet...... ..... Total leaching area s-�.__q�._....sq. ft.
z Other Distrit'ution box Dosing tank
Percolation Test Results Performed by.._.."e__.__.o_??.'......I_____________�o .. Date-___��.."�D•._.7�
1_4l
1 Test Pit No. 1...e'�-_.......minutes per inch Depth of TestPi#�__d Depth to ground water_�p..............
/i Test Pit No. 2................minutes per inch Depth of Test Pit_..--. ______. Depth to round water
Description of Soil t.._:. 7 = -------- /� '-'- ------ -
------------------------------------------------- ............................... ' `----------/-------------•--••----•----••---'------•--•-----'---•••••-'----_.---•-•-__________---
U Nature of Repairs or Alterations—Answer when applicable...
---- ------------•-•------------------•-•-----------_________-_'�_________________.
Agreement:
The undersigned agrees to install the aforedescribed Individual . wa Disposal System i ccordance with
the rovisions of T1:;. / 'i �" ,,f
p I . 5 Of the State �'anitary Code—Theunder 'fined ttrther agrees not to pla the system in
operation until..a Certificate of Complian�Ahas been4 e'd bv&the boar�rd 'qJ.he`aldt.
ign - ----_ ................�- _._... •.•--------------'.. .�. �
- W
---- Date I
Application Approved By..:..t` "vrt� 1. �1i...tom:?.........-'-"-'•'-.....:_.
/ / +" Y `! -� --�/ . Date.
Application Disapproved for the following reasons:.... ........................ __________________`-----•-------------------...._.._..---
..............................................................................................................................................................................................
Date
PermitNo...:::::.-•-'•............:::........•-•-'='---•••••--- Issued.......................................................
Date -
A
rTH.E COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
n ........ O F...... . ,?�" .<t� � .- ---`� .. ....................
't ✓' Trrfifirate of Tpmplianrr
THIS TO Cp70TIFY, That the Individual Sewage'Disposal System constructed ( ) o�Repaired ( )
by......... ' . f-� f ------:"=.--•'--•......................•-----•--------......_
s.
aat----
In er �
has beAdstalled in ac or nce wrth4the. rovisions of Tj 'f The State Sanitary Code as describe i the
application for Disposal Works Construction Permit No._ci7�
.__. �- ._________. dated_-...___.�_ _�_. __/_._�.�._...
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ..................... Inspector..............................................
y THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................. ,jJ/J�..........OF.............. ..'. . rl �. ..................
No............. . . FEE.......................
k antr iott rrntit
Permission is hereby granted -------�6------- ---- '
to Construct �ror Repair ) an dividual Sew e Dispo Syst ` k
.....
•, Street
r
as shown on the application for Disposal Works Construction Permit ____ ated....... .,%?__.__�.l/ .::............
............... _ i_ .
Board ot�Hea t� �
DATE... L�_" ........................
.................••-'•-• .:
FORM 1255 �HOBBS & WARREN. INC., PUBLISHERS ... -
,�`7V S 7: 3 7 /`_l f i7 , j r .,� / / ,7 .✓. . s«.. -. CO/•1 J` r /( 'T( v r' /, SIB"' O�j/ p�Gi`!✓1 «} �4%' G
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nn Q
v p �e ' �,z " °�►�,� � f/.2 `o x R " /-
6�7 #'f �CR` '�!
V it
jEll lot
�• �, s � ,���Lp z�. «-� Liss - 4 -.,
rn, »
- /z "s-are
OF BSI t
�K V'1•� Q�' � \� li o FRANK 1. FRANK
...-. .,. ,. . . _ _._T ._ _ 1 _ / .. -> . . ..- •-> t'- CONERY �' CONERY u
!7 L G'k Mom•1 r,, /ail/ +/ /�e a yam / f 1,' " 2 ts�',i w _-____ ._ A p�No. 65/3�O ! ,A No. 6232 p
y GISTS ��� �016T£P�pQ
Fs�ONAL.� 4�'O suR`�E
PLAN OF LAND
0 CIE 7—, it v/j j E MASS.
.
:J j OWNED BY
4
' �' 'r R4, . f . V'ya"....- .E. , - ` � ;f - \ .. .^M•.. y Sri/
- FRANK CONERY 5 TRENTON ST.
a HYANNIS, MASS. ON41
RQGtSTHRED ENGINEER Q LAND 9UllkV5V0w
SCALE 1 IN -26 FT.
CENTERVILLE N
COVERS TO BE WITHIN 9pVTE 6 I
6" OF FINISHED GRADE
TOF- 54.45' 9" MIN. COVER TYP.
0
F.G. = 53'+/- c �A
's S4CF EILPEIPO 52.65' MIN WATER TESTED FOR LEVEL pAK Sl
2
S=.02 FT/FT 2' LEVEL WEQUAQUET
3' MAX. COVER MAXd LAKE
::r` 11' +/— Lf• 4" SCHE 51 - 50.82' MIN
;r S-.01 Fr/FT 1' MIN. COVER `ram
PVC PIPE 9
85 +/- I.f. (TYP) a PEASTONE CF LOCUST
50.95'
d
10" 74"
ol�L4' GAS BAFFLE 49.83' 49.48' C3 C3 C3 C3 C3 2
PLACE SEPTIC TANK AND;"
'�•32' I 47.32'
EXISTING DIST. BOX ON 6" OF' STONE 3 , - 24 3 '—*`
OR MECHANICALLY I 3 I LOCUS MAP
BUILDING COMPACTED SOIL FUSORS H-2O 3/4" TO 1 1/2" NOT TO SCALE
EXISTING 1000 GALLON DISTRIBUTION 10 30 ' 5
SEPTIC TANK BOX 'MIN DOUBLE WASHED STONE
H-1 -- -- 4 46.00'
H-10 0 � C - ��6, C6.' m�0 OVERDIG �v� k)
BOTTOM OF TEST LE OR 39.00,
SEPTIC SYSTEM PROFILE NOTES:
NOT TO SCALE
1. SEPTIC SYSTEM SHALL BE INSTALLED ACCORDING TO
,- 310 CMR 15.00 (TITLE 5)AND THE TOWN OF CENTERVILLE
BOARD OF HEALTH REGULATIONS.
DATE: 12/3/02 HEALTH DEPT.: DAVID STANTON 2. ALL PIPES SHALL BE 4" SCHEDULE 40 PVC
TEST HOLE , GSE= 51.00' SOIL EVALUATOR: TODD LABARGE 3. THE DISTRIBUTION BOX SHALL BE WATER TESTED TO
EOP DEPTH FROM SOIL HORIZON SOILTEXTURE SOIL COLOR SOIL MOTTIJNG OTHER INSURE LEVELNESS AND EQUAL FLOW.
/ � _ �y , (INCHES) (USDA) (MUNSELL) (STONES,REfC)
SURFACE 4. THE INSTALLER IS TO VERIFY THE LOCATION OF UTILITIES
\\\ AND SEWER LINE ELEVATIONS PRIOR TO INSTALLATION.
M
0-28 FILL 5. EXCAVATION FOR AREA WHERE FILL IS REQUIRED SHALL
EXTEND 5' LATERALLY B
LOT 12 ,S, , 28-34 A SANDY 10YR 3/6 — BEYOND S.A.S.
a� LOAM6. VERTICAL DATUM — T.O.F. = 54.45
34-51 Bw FINE 10YR 4/s 7. SYSTEM IS NOT DESIGNED FOR GARBAGE GRINDER.
<` SAND 8. ALL PRE CAST UNITS ARE TO BE PLACED ON 6 MIN.
,�O ��� ✓ � `�` •� 51-60 Cl SANDY 10YR 5/8 CRUSHED STONE, OR MECHANICALLY COMPACTED SOIL.
E FINE — 9. MIN. PIPE SLOPE 1/8 IN/FT. . 1/4 IN/FT PREFERRED.
ELEV. =46.00' 60-144 C:2 MEDIUM 10YR 5/s 10. ALL CONSTRUCTION DETAILS ARE TO CONFORM TO STATE
/L APPR❑X, L❑CATI❑N OF
ti BOTTOM F
12 OF MASS. ENVIRONMENTAL CODE (TITLE 5) AND LOCAL
a ..n EXISTING ��9� SAND " � PeRC AT '73"
EXISTING CESSPOOLS CRoINID � iFO O1COUNtE�ED
o TEST HOLE AT s ELEV. 9.33 REGULATIONS.
1000 GAL TANK o, O c �---�• P� �
a 1 1 . ALL MANHOLE COVERS `ARE TO BE WITHIN 6" OF
z -owP 15 MIN PRESOAK
53.
FINISHED GRADE.
Op� �G L� 12"-9" 9 MIN. 12. SEPTIC TANK TEES SHALL CONFORM TO MASS & LOCAL
` 9*-6" 10 MIN. REGULATIO
NS.
LIVING 13. ALL STONE IS TO BE DOUBLE WASHED ACCORDING TO
H BED OR OP EOD MASS. & LOCAL REGULATIONS.
M 14. GROUND COVER OVER SYSTEM COMPONENTS SHALL NOT
+ LOT 13 TOF= EXCEED 3'.
15,616 SF+\— BATH 5 15, EXISTING LEACHING PIT, SHALL BE REMOVED
DINING ACC❑RDIING TO LOCAL REGULATI❑NS
KITCHENS' A
WD 53.13 a, g
FAMILY PAVED 50.
SUN RM 53. DRIVE CBDH D
WATER LINE 3
LOT .14 GARAGE SHALL BE
SLEEVED AT
OR (SLAB) CR❑SSING FOR APPROVAL ENGINE Ralf T P SURVEYOR STAMP
52.s \ 10' EACH SIDE, �' N DESIGN CALCULATIONS:
.9. � 3
9 TH NUMBER OF BEDROOMS: _ 3__
GARBAGE DISPOSAL UNIT: NONE Date DESCRIPTION Drawn Checked
� e
Fop c TOTAL ESTIMATED FLOWN R E V I S `ION S
BED OVERDI ; - `f'LF BASIN ( 110 GAL./BEDROOM/DAY X 3 BEDROOMS = 330 GPD)
a'• ;A REQUIRED SEPTIC,;TANK CAPACITY= (200%) 660 GAL, SEPTIC SYSTEM UPGRADE DESIGN
ACTUAL TANK SIZE: 1000 GAL. LAURA & GLENN HOFFMAN
BATH LEACHING a
AREA 14' P
AT
10' X 30'
�' LEACHING AREA REQUIRED: HIGH NOON DRIVE
,tij
O ��
BED ., O O SOIL CLASS — _i
9 �h �O �' PERC RATE K.2-- MIN/IN. IN
LTAR - IZ4-- GPD/FT CEN TER VI LLE
O 330 / 0,74 GPD/SF = _ 445,95 _SF USE _ ___ SF
f SECOND FL. LAYOUT ,� 330 _' GPp . . 446_
SCALE: 1" = 20 DATE: D ECEMBER 6, 2002
LEACHING CAPACITY: LA BARGE
3 FLOW DIFFUSERS WITH 3' OF STONE ALL AROUND & 1' UNDER
SIDES [�' x _2_'] _ _LC�O SF ENGIlVEERIlVG&CONTRACTING,INC.
BOTTOM= [_10_' x _30 _'] _ --000-- SF 22MOSSHILLRD.
TOTAL AREA __AfiQ_ SF
URWICH,MA02(4S
S ITE
P LAN TOTAL CAPACITY 460 SF * .74 GPD/SF = 340 GPD (508)432-6360
1 " — 20' DRAWN BY: SEM 0 2 ")9
CHECKED BY:. TAL SHEET 1 OF 1