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HomeMy WebLinkAbout0145 HIGHLAND DRIVE - Health 145 Highland Dr. Centerville A = 190 - 058 A/ SMEAD Na 24=R UPC 12834 WOGWL a+'n • Nub In NM e i TOWN OF BARNSTABLE LOCATION ) ® SEWAGE# $0/5-•atgJ VILLAGE , ( ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. . bft!A.cWZ C SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS OWNER MajJ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY DAO, 13 QrX0!-,j A cm -2.y c 14 � -0-���s �- V,q our,-)g:s 'D ' JI No.� � Fee Q V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLation for 33ispo9Af.6psttm Construction Permit Application for a Permit to Construct( ) Repair(ol/pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address Pf Lot No. /'ITfdi q &--rt Dr Owner's Name,Address,and Tel.No. Co—Kf u, le- l AX Assessor's Map/Parcel o — C5 5 gj Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. a)-vst�s A 3r-C,"J,4 tic ` -flog - !� C—,., 5��� ���NS VJvr[cS Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building r P5(34r a-}i CL No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 Lf6 ,'( gpd Plan Date —LO — / Number of sheets _�k_ Revision Date Title Size of Septic Tank �i�•�Yr�c Type of S.A.S. 2 sDo �C)CA" c Description of Soil Nature of Repairs or Alterations(Answer when applicable) cL a ti.J �0Z3 C7J c.N Z 11 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed , Date Application Approved by ® Date Application Disapproved by Date for the following reasons Permit No. �J Date Issued 8-5 1 No. Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ltlYication foristlosafip_ IP;tlt Construction Permit NJ Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandori( ) ❑Complete System ❑Individual Components Location Address or Lot No. yS //, i ,,,J Dr Owner's Name,Address,and Tel.No. C�..Itrfu' II P /%-k�5 Assessor's Map/Parcel d - 6 5 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ,,Jc - L OO - f5 (^ �S nor �t , Worlc S Type of Building: Dwelling No.of Bedrooms 3 Lot Size /Al 1 7 S sq.ft. Garbage Grinder( ) Other Type of Building' t kws r 3 r ct No.of Persons ItShowers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ?,'" C� gpd Design flow provided _31-/,6 gpd Plan Date 2- _-7 cD — / Number of sheets 1) Revision Date Title Size of Septic Tank X, 1 ,,, Type of S.A.S. e- A"—"),rr S Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 rJ�t-c,)) r;. 2 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date 'j �2_ '5_ - ram+ Application Approved by _ Date — Application Disapproved by Date for the following reasons Permit No. G S -- Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V<" Upgraded( ) Abandoned( )by, _,,/ f at 11,e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NeG dated Installer,/,)_ Ids A Designer /-,A. 5 #bedrooms - Approved design now : gpd The issuance of this�ermit shall not be construed as a guarantee that the system wil cti n�as designed. f Date J a 1 �� Inspector U1 -- ------------ ------- - _ --------------- ------------- - -- ------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Disposal Opste onstruction J)ermit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at �f S y /�,t L, �c.�{J �/ P^✓r^!/�/. t and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with j I Title 5 and the following local provisions or special conditions. Provided:Construction must e comple ed within three years of the date of this pe it. Date ��j Approved by TRANS. NO.: CIT /TOWN: l APPLICANT: 1�< ADDRESS: t'1 S 1A I�k \c,,.k 7r` DESIGN FLOW: gpd RE EWED BY: DATE: Y 1 N/A OK NO Lega boundaries denoted [310 CMR 15.220(4)(a)] Streek, Lot, tax parcel number and lot number noted on plan [3.10 CMR115.220(4)(u)] _ Locu 3 Provided [310 CMR 15,2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easeipents shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) ✓ [310 CMR 15.220(4)(d)] Loca ion all buildings existing and proposed 310 CMR ✓ 15.2 0(4)(c)] Loca ion and dimensions of system components and reserve ✓ areas [310 CMR 15.220(4)(e)] §Zstem Calculations [310 CMR 15.220(4)(f)] daily flow se tic tank ca aci (required and provided) ✓ ___ soil absorption system (required and provided) hether system designed for garbage grinder Leach arrow 310 CMR 15.220(4)(g)] ✓ _�__ g and ro osed contours [310 CMR 15.220(4)( )] ✓ ___ ion and log of deep observation holes (existing grade el. on est) [310 CMR 15.220(4)(h)] _ Names of soil evaluator and BOH representative [310 CMR 15.2 0(4)(h and i Location and date of percolation tests (performed at proper —^- eleva ion?) [310 CMR 15.220(4)(i)] _ Perco ation test results match loading rate? [310 CMR 15.242] Cer !cation statement by Soil Evaluator [310 CMR 15.220(4)0)] Obse ed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.22)(4)(n)] Addre s Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] ✓t within 400 feet of the proposed system location in the case of su•face water supplies and gravel packed public water§Rpply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of pAvate water supply wells Location of all surface waters and wetlands located up to 100 ft. beyo d setbacks listed in 310 CMR 15.211 and any catch basins locat d within 50 ft. [310 CMR 15.220(4)(1)] Wat r lines and other subsurface utilities located [310 CMR 15.2 0(4)(m)] (if water line cross see 310 CMR 15.211 1 1] Prof e of system showing invert elevations of all system com:onents and the bottom of the SAS [310 CMR15.220(4)(o)] ✓ ___ Sta of designer [310 CMR 15.220 1 and 310 CMR 15.220(2)] ✓ ___ Stam p of Registered Land Surveyor (required if construction activ ties within 5 ft. of lot line) [310 CMR 15.220(3)] Test oles adequate (two in each of the primary and reserve unle s trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(l) Test iole adequate to demonstrate four feet of suitable material? [310 CMR 15.103 4 ] Test oles adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benc imark within 50-75' of system [310 CMR 15.220(4)(9)] Mate 'als specifications noted? [various sections of 31.0 CMR ✓ 15.0(0] System components not> 36" deep (unless Local Upgrade A r� val or LUA requested) [310 CMR 15.405(1(b)] Addre s Sheet 2 of 7 N/A OK NO .. _ Size OK? [310 CMR 15,223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.2 7 6 ] Outl t tee with gas baffle or approved filter [310 CMR 15.227(4)] ✓ Note regarding installation on stable compacted base [310 CMR 15.228(l)] "L5-1Pj-C-- Separation between inlet and outlet tees (no less than liquid t/ depth) [310 CMR 15.227(2)] _ Inle Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for L/ upgr ides under LUA [310 CMR 15.405(1)(k)] _ Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CM9 15.232(3)(f)] Thre access covers (inlet and outlet must be 20" or greater) - _ mid le access at least 8" (by 7/07) [310 CMR 15.228(2)] 1 �y Ace s to within 6 " of grade - one port for systems<1000gpd, twolors stems >1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.2 8 2 ] > 10 ft from building foundation [310 CMR 15.211(1)] ✓ __ BuoN ancy calculation Required/Done [310 CMR 15.221(8)] ✓ ___ H-201 Where appropriate? 310 CMR 15.226(3)] ✓ ___ Setb cks from resources [310 CMR 15.211] lul' .P'atmtsTanks� 1 d . ,.D1�.�' Req iced when other than single-family dwelling or flow>1000 d r010 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% U/A- dail flow [310 CMR 15.224 2 and 3 ] "U" pipe through or over baffle, outlet of each compartment with gas b iffle or approved filter [310 CMR 15.224(4)] Addre 3s Sheet 3 of 7 N/A OK NO Loc ted at least ten feet from any water line? [310 CMR 15.212 2 ✓ _ ___ Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211 1 1 Cleafiouts required/provided ? [310 CMR 15.222(8)] _e Thrust blocks specified in force mains? 310 CMR 15.221 6 c ] ✓ _~_ Slop of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Prop r pitch on all runs? (.005 within gravity-distributed trenches and eds) 310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Si h nproblem/ leachfield below pump chamber) Endc a s or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than /8" not larger than 5/8") [310 CMR 15.251(8) and 310 CM 15.252(2)(h)] Mate rials specified (310 CMR 15.251(5) specifies various pipe type,, allowed) _ fDIS6 sR�IrBU��ION`�BOX' ' - _ Stab e compacted base [310 CMR 15.221(2) and 310 CMR / 15.2 2 2 (a)] ✓ ___ Spla h plate or baffle tee required on inlet/provided? (when / pres re sewer to d-box or steep pitch of gravity sewer) [310 ✓ CMR 15.323(3)(a)] Risei if deeper than 9" 310 CMR 15.232(3)(f)] Insid,b minimum dimension 12" [310 CMR 15.232(2)(b)] Mininum sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d Capacity (emergency storage above working=design flow)? [310 CM 1231 2 ] Prop r setbacks 310 CMR 15.211 same as septic tanks Wate ight 20-in miniurn access manhole at least 20" MUST BE TO RADE f 310 CMR 15.231(5)] Serv•Zects components accessible (not too deep with piping, ` disco accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mod . [310 CMR 15.231.(6) and (8)] Stabl Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ? Provided? [310 CMR. 15.221 8 Address Sheet 4 of 7 N/A OIK NO Calc ilations correct? 4 fe t of naturally occurring material demonstrated? [310 CMR 15.2 0 1 ✓� _ Req iced separation to oundwater? [310 CMR 15.212)] LZ- Agglegate specified as double washed [310 CMR 15.247(2)] System Venting required/provided. (system under driveway or >36" deep) 310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15,210(13)] Brea out requirements met? (No violation of breakout elevation with n 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guic ance Document] Cha T hers and Gal. in trench configuration supplied with inlet _ every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be tograde) 310 CMR 15.253(2)] AggieEate I' minimum- 4' maximum. [310 CMR 15.253 1 (b)] 2' sid ewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet eve 40 s . ft. [310 CMR 15.253(6)] Widb a 2'minimum 3' maximum [310 CMR 15.251(1)(b)] 100 1 eet-maximum length [310 CMR 15.251(1)(a)] Mini um separation 2x effective depth or width whichever eater Qx if reserve between trenches [310 CMR 251 1 (d)] Situ ed along contours [310 CMR 15.251(2)] Brea out OK? [310 CMR 15.211(1)[4] and Guidance Document] or ,!.k7� Bl?D Chumsofbed `ed500gPd� r , r s ; min' um 2 distribution lines [310 CMR 15.252(2)( Maximum sg aration between lines 6' [310 CM R15.2.52 2 d ] 7Z— Maximum separation between lines and outside of bed 4' [310 CMF. 15.252(2)(e)] Aggr gate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252(2)( Se pa:ation between beds 10' minimum. 310 CMR 15.252(2)(t)] Bott m area used in calculations only [310 CMR 15,252(2)(i)] Address Sheet 5 of 7 i N/A OK NO A', t --- Pre ure Dosed System ? Provided pump and piping; calculations as required [310 CMR 15.220(4)(r)] _ Pres ure dosing required on all systems >2000gpd or alternative syst ms under remedial approval [310 CMR 15.254(2) and I/A Re edial Use Approvals] If us d in gravelless system -make sure jet is directed as not to scou soil interface Guidance Document Inspections once per year(systems<2000 gpd) or quarterly - (>2000 dgood to note on plan [310 CMR 15.254(2)(d)] _ Con truction in fill -Did the plan specify that the fill shall meet the s ecification of 310 CMR 15.255(3)? Impc rvious barrier and/or retaining watt? [Guidance Document] pervious barrier installation must be supervised by desi ner [310 CMR 15.255(2)(b)] G — Retaining wall must be designed by Registered Professional Engi eer 310 CMR 15.255(2)(a)] Side slo e not exceed 3:1 ? [310 CMR 15.255(2)] reakout requirements met? [310 CMR 15.252(2) and Gui ance Document] t least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) 310 CMR 15.255 2 e f4 ra elressSys*tem�' PPr lLetters]r Check DEP Approval letters for credits and design conditions f used with pressure dosing do not allow pressure discharge l/ to scour soil interface Alte natvve�_eptcc5ys temAAppr�ovalL�etters] .....,,,., >... ,s. .x.... J Y. Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? G Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copXf a maintenance a �- ,Ya�l re the variances listed on the plan ? [310 CMR 15.220 �- (4 i V S Stamp necessary on plan if a component is within five — feet f property line [310 CMR 15.412(4)] _ ew construction or increased flow proposed - [Refer to 310 --% CMR 15.414] Address Sheet 6 of 7 4 N/A OK NO VIA.,S! sative.4 eus x � a a „ram o..,:, §� aln` t!`,'n4�',:3n.Rrti� 4�krui Is th system in a Designated Nitrogen Sensitive Area(Zone II for r a pu Aic supply well)? [310 CMR 15.214, 310 CMR 15.215 and �S „ 310 MR 15.216 - also refer to Policy regarding upgrades of such J .existingsystems] _ Is the system proposed on the same lot as served by private well [310 CMR 15.214(2)] _ Are he nitrogen loads proposed in compliance? [310 CMR �.. 15.2 6(1 �£"t %Fx. 4`z .' "f 1V1�V e��a�ieous,, r }> a", .. .. N o.w,. 3,3��1,r,.. .r,�.3n �.,.'..,.Pr.....n,i Pum in to se tic tank ? [ 310 CMR 15.229 Shar d System [310 CMR 15.290] �- Addre s Sheet 7 of 7 Page 2 of 2 i Town of Barnstable i IHI rO`' Regulato>fy Services Richard V. Scali,Interim Director 0 FIN ABLE, Public Health Division t6g9. Aje0Ma�p Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 0!fiice: 508-862-4644 Pax: 508-790-6304 Installer &Designer Certification,Form D to.: ?.l i Sewage Permit:# v22S--2!71 Assessor's Map\.Parcel Dj,signer: moo ;rte.e -.ncy W0HA s IBC Installer: 1� P\-, 7dress: I W , Cross-Pi'va (2a1 Address: 19�d , 30'< lares l4 0z 4k4 (fo_,�-eryAU MA_ CZGTZ 0 was issued a permit to install l:t (date) (installer) s tic system at I`{S H;c h 14t-iJ PrCep ltiv�l(.e, _ based on a design drawn by ��eFer MLCN+1-e e 6 (address) tr�rar VL-N IYvc, dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils J were found satisfactory. I certify that the septic stem referenced above was installed with. ma'p Y for change., (l.e, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations, Plan.revision or certified as-built by designer to follow, Strip out(if required) was inspected anal the:soils were found satisfactory. I certify that the system referenced above was constructed in con fiance with. the terms of the I\A approval letters (if'applicable) !L _ o PETER T. � st r' S Signatuz° o McENTEK CIVIL ,y No, 35109 RfCfSi��LSv 4� (Designer's Signature) (Affix Des1_g '_i Here)_ a P 4 EASE RETURN TO BARNSTABLE .PUBLIC HEALTH DIVISI0h. CER:ICNFICATE C C7 COMPLIANCE_WILL NO]' BE ISSUED UNTIL BOTH THIS FORM. AND AS- B ILT CARD ARE RECIEIVED BY THE BARNSTABLE PUBLIC HEALTH-Ir)Mc;:CON. T IANK YOU. — — _s�.. Q: eptic\Designer Certification Form Rev 8-14-l3.doc https://rolb.santanderbank.com/IRSVCDS ENS/s.ssobto?dse_contextRoot=true& 9/21/2015 ��� �'0 �6 ea�3� A McKean, Thomas From: McKean, Thomas on behalf of Health Sent: Monday, December 01, 2014 12:22 PM To: 'Wilson & Cassie' Subject: RE: Inquiry about a septic plan Good Afternoon, According to the assessor's database, there are two bedrooms existing there. There is insufficient information available in the official Health Division permit paperwork. The 1979 septic system repair permit #79-355 does not list the number of bedrooms on it. The number of bedrooms was left blank by the applicant, Joseph P. Macomber. There was some septic system repair work completed in 1979 which consisted of the following: a 1, 000 gallon septic tank the (smallest tank available at that time) and a 1, 000 gallon leaching pit. Back then, this was adequate for either two or three bedrooms. There was a 1999 septic system inspection conducted by an independent inspector who noted three bedrooms on page six of the report. This 15 year old report would need to be updated (system needs to be reinspected) to evaluate whether or not this older septic system is functioning properly today. Sincerely, Thomas McKean -----Original Message----- From: Wilson & Cassie [mailto:griscruf@comcast.net] Sent: Monday, December 01, 2014 11:51 AM To: Health Subject: Inquiry about a septic plan Hello, i would like to find out if 145 Highland Dr, Centerville has a 3 bedroom septic. Could you let me know what it is rated for? Thanks, wilson 1 t "A7 iJ�l _'� �" - -- SEWAGE # VULLAGE (pwFvtUi1L,,,- ASSESSOR'S MAP & L0'r-A0Jm---.- NAME&PHONE NO. SEPnC TANK CAPACITY LEACFMqG FACILITY: (type) (size) NO. OF BEDROOMS A BUILDER OR CIY-ffr--R thL,,) PERN171 DATE: III 61'rl COtvTLJ-AN,-CE DATE: Separation Distaricc Between dhe: B F=1 Maximum Adjusted Ground-water Taburo the'Bonorr of 1--aching Facd,.Aty Private WaterSup'n,Well and Leachin FaciLt", (If a— wens c:,ust or site or within 2(P, fcc:of Icacn-ing F Edge of Wed.md and Leac�-ing Faciliq (If any wetlands within 300 feet of lc3c,.6nv facil-im, C, Furnished by P Z �I P30 oF� Town of Barnstable P# 'Department of Regulatory Services Public Health Division Date 200 Main Street,Hyannis MA 02601 ' �f0 MA't A Date Scheduled 1 3PL Time Fee Pd. �- c)cJ Soil Suitability Assessment for Se ge isposal Performed By: ) 2S Witnessed ,By: G✓ �✓_ t„ LOCATION& GENERAL INFORMATION Location Address Owner's Name M,G I �_e j Cer'L�ervr �IQ� Address lq-5 6,tki f Assessor's Map/Parcel: I 0,- Engineer's Name fl-t CL j-1 NEW CONSTRUCTION REP AIIt ( j Telephone# �O� - ?7 5313 Land Use JSier.\ 30 Slopes ~ ��� P ( ) Surface Stones Distances from: Open Water Body Z� ft Possible Wet Area ft Drinking Water Well?f_S_b ft Drainage Way ft Property Line I S— ft Other ft SKETCH:(Street name,dimensions of xact locations of test holes&perc tests,locate wetlands in proximity to holes) - L A < Parent material(geologic) 0`jam Depth to Bedrock ,C� pA Depth to Groundwater. Standing Water in Hole: ✓TO YXQ Weeping from Pit Race Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles; in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor.,....mom_ Adj.Groundwater Level PERCOLATION TEST bate, ';<ime, Observation/ y Hole# Time at 9" 1© Z Depth of Perc 3Z( Time at 6" Start Pre-soak Time @ Q +� _ _ Time(9"•6") End Pre-soak l� RateMin./Inch. Site'Suitabilit�ssmenC Site Passed--,/= _ Site railed: Additional Testing Needed(YIN) 07, al: Publ\Health Division Observation Hole Data To Be Completed on Back----------- ** If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. C Q:\SEPTIC\PERCFORM.DOC /�✓ f; DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. Gravel) DEEP OBSERVATION HOLE LOG Hole# 'Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in,) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% rave C-- 2,5 Y l DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. o Gravel) -4 DEEP OBSERVATION HOLE'LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soot Other (Structure,Stones,Bould Surface(in.) (USDA) (Munsell) Mottling e rs. o si to ° Flood Insurance Rate Map: OLAbove 500 year flood boundary No_ Y Within 500 year boundary No A- Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? eS ; If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trainin ,expertise and experience described in 3 10 CMR 15.017. Signature �— Date Q;\.SEPTIC\PERCFORM.DOC _ R -_ COMMONWE.A .TH OF 1 LkSSACHUSETTS =- _ - -_ EhECL'TIVE OFFICE OF E�'VIRONA4E:�TAI. FA1RS,- DEPARTMENT OF ENVIRONMENTAL PROTECTIO -• 0\E R'INTER STREET. BOSTO\ NLa 021UF (617) 292•5:iUu � OCT 2 8 TRU OX 1999 F:ar-. t01�F N AQ`ID ARGEO PAUL CELLUCCI IHOpj C• s:_r,er Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �f pp_ ,�O PART A 8 f,�� ��� CERTIFICATION T 1 W f Property Address: l� t-�( "j of Name of Owner { S , W t Address of Owner: S ^9 Date of Inspection:. kOl lZ��� / ��l O� Name of kupector:(Please Print) •�-�*a_�_� �� EL U 15.340 of Title 5(310 CMR 15.000) 1 am a DEP approved system inspector pursuant to Section Company Name: 1q .,_10< PLC L...AC4 . 29% C Ni9 oL -4-c1 Mailing Address:..'r,r) A14 Z:3 74 N r4 ZZIE Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address end 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: Passes _ Conditionally Passes _ Needs Further Evalu the Local Approving Authority Fails_ n Inspector's Signature: _J1 Date: �4 The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. It 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 Department of Environmental Protection. The original should be sent to ttre system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Pbacetoru , h C J Pnnied on R"6d Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A C l n CERTIFICATION (continued) +roperty.Address: Owner: Date of Inspection: �{ INSPECTION SUMMARY. Check A, B,. C, or D: A. SYSTEM PASSES: ' I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure ` criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass`section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is 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 complying septic tank as approved by the Board of Health. _ 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 revised 9/2/98 r..,{s>� Page 2of11 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: 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 IN ACCORDANCE�WITH 310 CMR 15.303 (1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEAL AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland r a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND P LIC WATER SUPPLIER, IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC LTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption s stem (SAS) and the SAS is within 100 feet of a surface water supply c: tributary to a surface water supply. _ The system has a septic tank and soil absorptio system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorpti system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorpt' n system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well wate analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility nd the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine di once (approximation not valid). 3) OTHER °revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) property Address: Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: have determined that o e or more of the following failure conditions exist as described in Sat CMR 15.303. The basis for this d to determine what will be necessary to correct the failure determination is identified elow. The Board of Health should be contacte Yes No _ Backup of sewage i to facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding f effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS cc cesspool. _ Static liquid level in the 'stribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ Liquid depth in cesspool is ess than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than times in the last year NOT due to clogged or obstructed pipets). Number of times pumped_. _ Any portion of the Soil Absorpti n System, cesspool or privy is below the high groundwater elevation. feet of a surface water supply or tributary to a surface water supply Any portion of a cesspool or privy is within 100 _ Any portion of a cesspool or privy is within a Zone I of a public well. _ Any portion of a cesspool or privy is 'thin 50 feet of a private water supply well. _ Any portion of a cesspool or privy is les than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the ell has been analyzed to be acceptable, attach copy of well water analysis for cofiform bacteria, volatile organic compoun s. ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: you must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to he criteria above: The system serves a facility with a design flow of 10,000 gp or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more o the following conditions exist: Yes No the system is within 400 feet of a surface drinking water\upply 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 Well ead Protection Area-IWPA) or a mapped Zone It of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. \\ 1 t revised 9/2/98 e'F`a°r11 1 � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST hoperty Address: S Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No NoPumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow TC rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. x _ As built plans have been obtained and examined. Note if they are not available with N:A. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. 1l The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles -/� or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)1 The facility owner (and occupants,if different from owner) were provided with information on the propermaintenanr.s-0f 4, SubSurface Disposal Systems. revised 9/2/98 rage sorn d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK. PART C SYSTEM INFORMATION 'roperty Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: -Ueg.p•d./bedro m. Number of bedrooms (design):O Number of bedrooms (actual): Total DESIGN flow30 Number of current residents:z>—Z Garbage grinder(yes or no):—L—_3 Laundry(separate system) Ls or no): If yes, separate inspection required Laundry system inspected es or no) Seasonal use (yes or no):_ Water meter readings, if available (last two year's usage (gpd): Sump Pump (yes or no): D �' Lest date of occupancy:I����``,���'''''' p```���� COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow 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) Lest date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of inform tion: System pumped as part of inspe tion: (yes or not ' If yes, volume pumped: gallons .Reason for pumping: F SYSTEM Septic tank/ oil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes. attach previous inspection records,if any) 1/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date Installed(if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) ^� revised 9/2/98 Pagc6(of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (corrtinued) 'roperty Address: Owner: Date of Inspection: BUILDING SEINER: (Locate on site plan) Depth below grade:_ Material of construction: _cast iron_40 PVC_ other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site pi n) 4 Depth below grade: Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: l 00Q� Sludge depth Q outlet tee or baffler Distance from top of sludgeto bottom of Scum thickness:_ 't Distance from top of scum to top of outlet tee or baffle:_ zt Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: omments: (recommendation for pumpin eonditionsf i t and outlet taw r baffles, depth of liq�id level in relation to outlet in er , struc al integrity. e ' ante of akage etc.) O6 GREASE TRAP: (locate on site plan) Depth below grade: 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: 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.) revised 9/2/98 Page 7of11 r SUB URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address: Owner: Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be umped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal _Fi rglass_Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switch , etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, vidence of leakage into or out of box, etc.) 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, condition of pumps and appurtenances, a c.) revised 9/2/98 Pagc8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (corlb"A) 4opefty Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):W/ (locate on site plan, if possible: excav tion not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:L ok(e leaching chambers, number:_ leaching galleries. number:_ leaching trenches. number, length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs t hydr lic failure, level o ponding, amp soil, ondition of eget "on, etc.) i CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: 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:=v (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 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Address: Jwner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Zfa 03 Vkl - 3G` l�3' revised 9/2/98 Pap.10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ( CC r,�[ �Gt� SYSTEM INFORMATION (continued) ropertyAddress: 6�'�,J tit"��`� Owner: Date of Inspection: NRCS Report name v L — -- Soil Type_ _ —�— Typical depth to groundwater _ USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope +1, Surface watery-0 Check Cellar Qq 1 Shallow wells�0 I Estimated Depth to Groundwater yI Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property. observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps I Checked pumping records Checked local excavators. installers Used USGS Data Describe how you established the Hi h Groundwater Elevation. (Must be completed) revised 9/2/98 page 11oflt FFA:�� No............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ��. App iration for Diipniitti Warkii Cnoutitrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (/_-�^an Individual Sewage Disposal System at: ....1 .., ,� . .................. ....... ..........- �g / --- Locatio •Address 61`-'61� t Lo No. Ow r �• t/ AdC ..... Installer Address Q Type of Building Size Lot............................Sq. feet UDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ') = Cafeteria ( ) p-' Other fixtures .......................... ............................. Design Flow..............-7--------------------------- per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter.............._. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by-•--------•----•-------------•----------••------•---•--•---•------••--•-• Date........................................ Test Pit No. 1...:............minutes per inch Depth of Test Pit.................... Depth to ground water_-________.._-__.-..___. Test Pit No. 2................minutes per inch Depth of Test Pit____-___--._____-__: Depth to ground water........................ P4 •--•---- ........... 0 Description of Soil.........c x U -•••----•----••-•-----•--•-•-••-••-•-••-••••-•---•-•-•••-•••.........................•-•---••---•-•--•-••-••---•-----•-••--•-------•----•-•--•......................................................... ----------------------....................................... .......--------------•--------------- -----•--• ------------------------ ..................................................... U Nature of Repairs or Alterations—Answer when applicable..___l ;----------------------- .......................................................)-')Abe . :I.A ...act........................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI:'1% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance habbDn sued by the rd of health. S' edSDate Application Approved By..... _._. ' .. ........ .. ..�.__......... Date Application Disapproved for the.following reasons:----•-•-----------•-•--•--•-•---------•-------------•---------------••-•------•------•--------•---........_..... .....................................................----------•-•-•-•--•------•-------••-----------......••----•---••--•-------•----------•----••-•.............................................. / Date . Issued-..- /_l Permit No.......:...:.:. � 7� < - ... "----------------- ---Date -----._......._....._.... NO. .._.. FEB.. ......2..-.1. THE COMMONWEALTH OF MASSACHUSETTS V f ;.. BOARD OF HEALTH fi i ....0F....6}.0.) :'� r -, d'-Z.------•--•--...--------- . 1, Application is hereby made for a Permit to Construct ( ) or Repair (4,-�""an Individual Sewage Disposal System at a�' 3 f ----------------- Locations . • 4 ' Address_ o � p o +Lot No.•-- .............................. :,, 4 g 1 ;f� 9s._..... •... ................... .. Own r H Add}e's nm Installer B Address Type of Building Size Lot----_........................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _____________________ ...... No. of persons............................ Showers ( ) — Cafeteria ( ) P' Other fixtures ..........------•---------•----- -•- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.............gallons Length................ Width................ Diameter________________ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter______..____-_______ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date______________.......________________... Test Pit No. I..............__minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2.............___minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-•- -•- -- -----------------------------•----.........-----•... •------------------------- > ........_------------- DDescription of Soil----•- y. �6�° : `-- ----------------------------------------------------•----------------------------•------------- x fi W°y ...................-------------------- ------------------------------------------------ - U Nature of Repairs or Alterations—Answer when applicable r_ b'evz'I r` >`3r' `- rjr �11 Zr _____________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT.f-Z' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has been issued by the board of health. P + A. sp Date "Application Approved ...... ....... ...•---- '- -•-•..._..._..._-------- -••••---•-•----•--- -------•-•------•-- t: Date Application Disapproved for the following reasons:....................... s....................................................................................... SA Date PermitNo......................................................... *Issued_....................................................... Date i ---THE COMMONWEALTH OF MASSACHU SETTS _ a BOARD c OF HEALTH Y J ....._ Tntifira tle of flu �rli�a�trr THIS I TO CERTIFY That the Inu vi�ual Sew zjjie Disposal Sy stem const ucted ( ) or Repaired 'A A nstall ......... .................•----- •-- --- at .__/.A �s s�. ..��_�_tr> �_�` ____.................x _...._. has been installed in accordance with the provisions of F ` of T e State Sanitary Code as described in the application for Disposal Works Construction Permit i ........... .� ............... dated- ___-_.�/'._�_� ___________________ THE ISSUANCE OF THIS CERTIFICATESHALL NOT BE CONS UED AS A GUARANTEE THAT TIME SYSTEM WILt FUNCTLOX.SATISFACTORY. aXa $iZkA "�. 'trt ;•;S Sat attl + r� t Inys�pt�o ._ ................ __ .............................� THE COMMONWEALTH OF MASSACHUSETTSf' �A. BOARD F HEALTH s . Vy/ 4-:'.'.�f. .e".::'�.......OF ........................ E� ......................... �.�.. FE �y :. 1...... TPermissi"on is hereby granted__°,,_r__ ...... -.................................... to Construct ) or Repair (1,4,jaji Indiyi4ual�L.Sewage Disposal System r Street as shown on the application for Dispos Works Construction r~ // r� No Bo & -- '- 77 w_ ealth DATE_ a•r} FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS �• �;_-,� L`O C A T 10 _ SEWAGE PERMIT NO. � i z VIL-LA E �/,>7C/P INSTALLER'S NAME i ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �`� 0 k F r LEGEND N Woo&o10 Ln °(teton 'S0" W �ti/-2 EXISTING LEACH PIT - 44 -= EXISTING CONTOUR o `n c 6'15 N CONCRETE BOUN x 100.98 EXISTING SPOT'GRADE' °�eto� ' EL.=50.94 TO BE PUMPED, FILLED WITH °a i 21.00 SAND & ABANDONED. W EXISTING WATER SERVICE X i G EXISTING GAS SERVICE Great Marsh Rd 11 EXISTING SEPTIC TANK -g/-/,-y�- OVERHEAD WIRES LOCUS TOP OF TANK, EL.=52.2 INV.(OUT), EL.=50.87± TEST PIT I a0, O, Tam-1 { d CORNER OF STEP EL.=52.90 6' r C B � ' 50,92. fence line N 6'45'40" W SHED Ro O 1 h p' PK 59.00 SET ute + 50.97' S60 LOCUS MAP M&50.37 n r �;•.�� •� �\ shrubs NOT TO SCALE 10.70� TP-15�^,h�/ O .;}:// , 51.7 + 5 +." 3,58. . . 58.15 50.50 u ;' 50, a ��O 1.16 ; 1 �� \LOT 3 l. . ^ ^ GENERAL NOTES: /Q +'52•,24 shrubs MBL�190L-058 N 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL cn ��� : . / 14 975fS ,� 58.22Q� BOARD OF HEALTH AND THE DESIGN ENGINEER, W 15 �`J``' � •' x 1• 9 If 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS + 52.47 LA + 52.89 ` :1 �IT � OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE (0 cD LOCAL RULES AND REGULATIONS. t' Oo0 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR (_1 1 58.69 �, TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE a x 53,231 DESIGN ENGINEER. `L Q S� ® DECK I ' \ 5 7.5 5 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ° 3.52I x 57.00 ENGINEER BEFORE CONSTRUCTION CONTINUES. 51.83 Z 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. I I c 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF ° I I THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF I N HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. EX/STIN 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. i 50.95 HOUSE( . OUSE#145) / 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. / T.O.F.( .3f I I o ° 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 53 r lx 56.33 m AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 3,65 ` DIRECTED BY THE APPROVING AUTHORITIES. x 5176 5 m3':..':.. I 0 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 5 •50 - ':5�:.9"°:''': I 7 THE LOCATIONOF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING shrubs \� 7/ 11 NOTHERR UI ED, ON RA TOR SHALL L REMO ALL VE ALLES UNSUITABLE NSUI ABLLESSOII SS .' 3,29 x 53• DRIVEWAY-:: ' 6'2 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). \ x 52.32 I 55.23 x 5L32 � l 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE , \ O INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. _ � x 54.8 13, THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 50,90 G� 106.0 NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. S 49*34'40" F` :: : ;;' `• 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC ".:,,`.."•.. SYSTEM COMPONENTS NOT SHOWN ON THE PLAN `-- 54.13 of MASsq�ti 50,32 edge o pavement PK SET 53.11 PROPOSED SEPTIC SYSTEM UPGRADE PLAN PETER T.=ye G 52.60 M ENTEE 145 HIGHLAND DRIVE, CENTERVILLE, MA CIVIL N TUIGHLAND DRIVE -Prepared for: D.A. Brown, Inc, P.O. Box 145, Centerville, MA 02632 35109 En ineerin b SCALE DRAWN JOB. NO. A £GISTE��� F� OHW OWNER OE RECORD 9 9 Y• 1„=20' P.T.M. 168-15 MAGNER, MICHAEL S Engineering Works, Inc. F10,00 7 145 HIHLAND DRIVE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. J UP CENTERVILLE, MA 02632 (508) 477-5313 7/20/15 P.T.M. 1 Of 2 ti , L , NOTE: TO PREVENTBREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=48.0 50.9 FOR A DISTANCE OF 15' FROM THE EDGE SEPTIC TANK PROPOSED D—BOX OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED S.A.S. € " SET TO 6" OF GRADE INSTALL RISER & COVER OVER EACH CHAMBER AND T.O.F.=53.3t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT M �y F.G. EL.=52.0t F.G. EL.=52.0t F.G. EL.=51.2t F.G. EL.=51.2t MAINTAIN 2% SLOPE OVER S.A.S. N� L = 18' L = 5' Q 9 4 ® S=1% (MIN.) ® S=1% (MIN.) t 2" LAYER OF 1/8" TO 1/2" In ^ 4"SCH40 PVC 4"SCH40 PVC DOUBLE WASHED STONE �� -P. to"I *2M�� aa®8aae (OR APPROVED FILTER FABRIC) (A_J-60 4ta'EXISTING 49" LIQUID ----3/4" TO 1-1/2" DOUBLE 48.1 LEVEL WASHED STONEAo0 INV.=49.57 4' 5.2' 4' 6' GAS BAFFLE _ INV.=49.40 19•�s INV.=50.87t D BOX EFFECTIVE WIDTH 12.8' (VERIFY) 3 OUTLETS INV.=47.50 DECK EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBER SURROUNDED WITH STONE AS SHOWN H-10 RATED lllEX/STING TOP CONIC. ELEV.=48.3f MOUSE(#145) BREAKOUT ELEV.=48.00 INV. ELEV.=47.50 aea®® NOTES: aaoaa®®oeeo 3WO 30BBB SEPTIC LAYOUT 86 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.=45.50 INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. 4' 2 x 8.5' = 17.0' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED 310 CMR 15.405(2). 4' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=38.9 Q 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE I- ®®®®®® ® ® ®®® 33" AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. W EO z ®Q2F®®®® ® ®0®® SEPTIC SYSTEM PROFILE - 102" DESIGN CRITERIA SOIL LOG 4" KNOCKOUT DATE: JUNE 30, 2015 (REF#14 734) 20" DIA. COVER NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) WITNESS: DAVID STANTON R.S. HEALTH AGENT 4" KNOCKOUT / 4" KNOCKOUT 58" ELEV. TP— � DEPTH ELEV. TP-2 DEPTH DESIGN PERCOLATION RATE: 5 MIN/IN 0" 0" 50.5 q 50.7� A DAILY FLOW: 330 GPD SANDY LOAM SANDY LOAM DESIGN FLOW: 330 GPD 49.8 10YR 4/2 10YR 4/2 4" KNOCKOUT B 8" 50.0 B 8„ GARBAGE GRINDER: NO—not allowed with design SANDY LOAM SANDY LOAM 10YR 5/6 7 10YR 5/6 500 GALLON CAPACITY, H-10 LOADING LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 47.5 36" 47.7. 36" CHAMBERS .74 GPD/SF C PERC C EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 32'/50" N.T.S. PROPOSED D—BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED F-C SAND F-C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 2.5Y s/s z.SY s/s SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 145 HIGHLAND DRIVE, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. ? Prepared for: D.A. Brown, Inc, P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:......................................... .. 39.0 138" 39.2 138' . .................. 471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 168-15 PERC RATE 3 MIN/IN °C' HORIZON 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 7/20/15 P.T.M. 2 of 2 ,