Loading...
HomeMy WebLinkAbout0095 HUCKINS NECK ROAD - Health 95 HUCKINS NECK ROAD °Centerville ° A = 252 - 015 S M EAD No. 2-153LOR == UPC 12534 amead.com • Made in USA J��cvct� 4 i =p 06 2016 09:40 Jim The Inspector Man 5085349919' page 1 i r " 6 67 Commonwealth of Massachusetts L Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Huckins Neck Road Iv Property Address David Jackson cr Owner Owner's Name information is ✓ required for every Centerville MA 02632 9-1-16 .� page. City/Town State Zip Code Date of InspectionCA Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. fm :When gng out A. General Information out forms uNntt�nrrgin 0 the computer, use only the tab `�-w -IN OF I gS.,11�2�yi key to move your 1. Inspector: a�`+�►.. '. c, cursor-do not ' James D.Sears � JAMES •N use the return rn m key. Name of Inspector t.>'7 : A Capewide Enterprises, LLC *�:, o o :?*c Company Name TI*:IQ. Ada 153 Commercial Street Company Address Mashpee _ MA 02649 Cltyrrown State Zip Cade 508-477-8877 _ . S1623 Telephone Number License Number B. Certification 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. 1 am a DEP.approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® passes ❑ Conditionally Passes ❑ Failp ❑ Needs Further Evaluation by the Local Approving Authority 9-2-16 �n�smeecltorls Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector,and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform In the future under the same or different conditions of use. tsins.doc•rev-6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Sep 06 2016 09:40 Jim The Inspector Man 5085349919 page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E!always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a H-20 1500 Gal. Tank. H-20 1000 Gal.Pump Chamber D Box and 27 Chambers. Note: Outlet tee has a zable filter. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank (whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. " A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Sep 06 2016 09:40 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments FY w 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16' page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): i ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins.doc•rev.6/16 Title 5 Official Inspeclion Form:subsurface Sewage Disposal Syslem•Page 3 of 17 Sep 06 2016 09:40 Jim The Inspector Man 5085349919 page 4 r , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than Y day flow F,�C,#/Ae& t5ins.doc•rev.6/16 Title 5 Oftlual Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ISep 06 2016 09:40 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts Title 5 Official '4 facial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a' 95 Huckins Neck Road Properl Address - David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or,less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.. For large systems, you must indicate either"yes" or"no" to each.of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.6116 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 5 of 17 Sep 06 2016 09:40 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts s Title 5 official Inspection Form A Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 4 r 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16 page. CitylTown Stale Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of Scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue. approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 15ins.doo•rev,6116 Title 5 Official Inspection Fong Subsurface Sewage Disposal System-Page 6 01`17 Sep 06 2016 09:40 Jim The Inspector Man 5085349919 page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information isequired for every Centerville MA 02632 9-1-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a H-20 1500 Gal. Tank with zable filter. 1000 Gal. H-20 pump chamber. D Box and 27 chamber's. Number of current residents: .0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection Yes ® No information in this report.) Laundry system inspected? El Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2014-9,000 gals Detail: 2015--5,000 gals Sump pump? ❑ Yes ® No Last date of occupancy: na Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203).- Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6116 Title 5 Officlal Inspection Form:subsurface sewage Disposal System•Page 7 of 17 Sep 06 2016 09:41 Jim The Inspector Man 5085349919 page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: ., Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): ISins.doc-rev.6/16 Title 5 Otficial Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Sep 06 2016 09:41 Jim The Inspector Man 5085349919 page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2013 Permit # 2013-33 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth.below grade: 28 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-20 Sludge depth: t5ins.tloc•rev.6116 Title 5 Official Irspectlon Form:Subsurface Sewage Disposal System•Page 9 of 17 Sep 06 2016 09:41 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is Centerville MA 02632 9-1-16 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of Scum to bottom of outlet tee or baffle 1 7 How were dimensions determined? Asbuilt- Plan -Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 18" below grade. Cement inlet cover, steel outlet cover, both at grade. Outlet tee wlzable filter. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene, ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage bisposal systen•Page to of 17 ISep 06 2016 09:41 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts _ Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16 page. City/Town State Zip Code Date of.Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions.- Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5lns.doc-rev 6116 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 11 of 17 ISep 06 2016 09:41 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name - information is Centerville MA 02632 9-1-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x 16"-3' below grade w/three lines out. Box is clean and solid w/2" inlet w/A 90. Cover at 4" below grade. No sign of over loading or solid carry over. Pump Chamber (locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is a H-20 1000 Gal. Precast Tank w/steel oulet cover. Chamber clean, pump and alarm working. If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required):• If SAS.not located, explain why: t5ins.doc rev.6116 THIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Sep 06 2016 09:41 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts u Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C ' 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is -Centerville required for every MA 02632 9-1-16 page. CilylTown Slate Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 27 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: C • omments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 27 ARC 36 H1 cap Biodiffusers stone less. Ck D Box and camera out lines. Clean and dry like new. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins.cloc•rev.6/16 - Title 5 Official Inspeclion Form:Subsurface Sewage Disposal Systen•Page 13 of 17 Sep 06 2016 09:41 Jim The Inspector Man 5085349919 page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is Centerville required for every MA 02632 9-1-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure: level of ponding, condition of vegetation, etc.): Privy (locate on site plan): ` Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev,6/15 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 0117 Sep 06 2016 09:42 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville _ MA 02632 9-1-16 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System; Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Q 4 • t5ins.doc rev.6/16 'Title 5 Official Inspection Form:Subsurface Sewage Disposal Systam•Page 15 of 17 ISep 06 2016 09:42 Jim The Inspector Man 5085349919 page 16 Aug. 25. 2016 3:24PM No, 2191• P• 11 TOWN OF BARNSTABLE I.ocnTloN 45,H okirs Ne�� ► r4 sswnccA 2�r3-33 VILLAGE<r,C,n*k,V lie ASSESSOR'S MAP&PARCEL /1!61.5 WSTALLPA'SNAME&PHONE NO. ) r d'N1`bi7 SUPTIC TANK CAPACITY LEACHING FACILM.(type) RG (size) fs'.G, X •6►rr. N-Jh Al4 No.OF BEDROOMS _ OWNER PBRMTP DATE: a o l3- 1.1 -13 COMPLIANCE DATG: Sryvatloo Note ce Rewwn die: Wd4V'4EW-CLAPR14 Maximum Adjaaled Ckoundwauer Tabi'a to the Burero uri,eaehing Peciliry a t U K' _Fcct Privalo Walw Supply Well Lld Loathing Facility of any wells exits m �l silo olwilhin200fietofleuhingfacility) Nr'1 Pcct Edge of Wetland and Lathing facility(If any well ands exin within 300 foci o(leecl, ig ricility) ��• Feet FURN13HBDBY dolowi'k Lsh�e )ti LAG A-I-d4! 7 i A-3=a4r 4 13 3-AO, A_6 w;6 13-6=583' ; IS-8=S3" A f)el.J; a u� Sep 06 2016 09:42 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont_) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells No Estimated depth to high ground water: 10'-6" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9-13-12 Date El Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 9-13-12 no G.W. at 10'-6 Chambers at 5'+ above T H• Depth Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins.doc•rev.6/16 - Tille 6 official Inspection Form:Subsurfaos Sewage Disposal System.Page 16 of 17 Sep 06 2016 09:42 Jim The Inspector Man 5085349919 page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Huckins Neck Road Property Address David Jackson Owner Owner's Name information is required for every Centerville MA 02632 9-1-16 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System•Page 17 of 17 No. J/ •V 0 1 Fee U U THE 9�`M`MONWEALTH OF MASSACHUSETTS Entered in computer: Yes �� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpIitation for Misposal 6pstem Construrtion Permit Application for a Permit to Construct( ) Repair( .). Upgrade(q Abandon MComplete System ❑Individual Components Location Address or Lot No. q i5 N ucA4�n S IV e-(tL Il a-q4 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 7_5'2 / "Y.4 es C ;1 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. C �cw�r.(Q ��r�P •sus ace- LY77-Fr?-7-7 3 .c. Egg, ,.,h 5-og-2,37 Type of Building: Dwelling No.of Bedrooms ` Lot Size ,O'Z `( sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) y o gpd Design flow provided Ll Z<1 gpd Plan Date t 0— t`:b - ?�1 i�— Number of sheets Revision Date t 0^1"7 7A I L Title dl J `W � r Q eJ� 4 Size of Septic Tank 1 5Up 4 d�-1 Type of S.A.S. Description of Soil �� D l Nature of Repairs or Alterations(Answer when applicable) 0-LO I'i-o 14-Zd 1 d 0a /y!e loc. 42) A- �i''c�.111 p F �2-7 3�,, 2F; Gon Date last inspected: 7iU l?� 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. Si n Date 2 qi 2©1.3 Application Approved by 14Date 0 9 Application Disapproved by Date for the following reasons Permit No. (3 3 Date Issued 0 I (1 4 ' No. � 33 A- �� �� �V £� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes apilitation for aisposaY-6pBtem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade K Abandon( ) Complete System ❑Individual Components x, Location Address or Lot No. 0195 14 o ut;„5 N e(,tc a,),)d Owner's Name,Address,and Tel.No. '�wlckcscn -/yk4lk�c�n ilsys-�r7 r2vs'I"" Assessor's Map/Parcel Z S 2. Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. � /�6w,'a. l=s�ieiP 1�5 6Gc W77-k-"'Z7-7 T-C- i:n51 So£5 - 23-7 - 6�-►7 Type of Building: r,i1r"44 Dwelling No.of Bedrooms Lot Size 2 2 O$ `( ± sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 00 gpd Design flow provided t-( -7 cl a gpd Plan Date 9 0- 1'b - 2D 0- Number of sheets 1 Revision Date (0 ^1 7 ?.-►L Title of ) L L-,t--, r\,Qj aA)-cie) Size of Septic Tank (5'C)0 G/-1 I Type of S.A.S. i Description of Soil D l.o-h Nature of Repairs or Alterations(Answyr.when tppliolable) O-Z o 0011 �4/ 5. r . T c� l�' L o /t)0 O 5ee PC Date last inspected: 7il) 1 Z t k j Agreement: The undersigned agrees to ensure the construction and� aintenance 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 V Compliance has been issued by this Board of Health. Sin Date 1 2 r9 2 011 Application Approved by j �� Date t 2 D/3 Application Disapproved by Date for the following reasons Permit No. (3 3 3 Date Issued o ( -_ - - - _---- - _ - - y...-r. _r . - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS. ,— Certificate of Compliance µ THIS IS TO CERTIFY,that the On-site Sewage Disposal,system Constructed( ) Repaired( ) Upgraded(X) Abandoned( )by zw,-a. at (35 77V,1C,h S 9,1,4 14,,ea has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.t)a 17-33 dated !Id �1 1 Installer 416,aeW,d e d R',a,) e) I-L<- Designer .1 •(..• cliv #bedrooms t"r f-o J rZ,. Approved design flow t/u gpd �y The issuance of this permit sh tl not a construed as a guarantee that the system will t'o as des gned. Date Inspector ? 7 No. 1 3- J l Fee /c)y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposar *pstrtft (Construction 2"Iefinit Permission is hereby granted to Construct( ) Repair( ) Upgrade( �K) Abandon( ) 9 S 1-� 5 /I e c k Ito A d �.�/�., � I-- ? System located at c.l C,:rn l i liand as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with .I. Title 5 and the following local provisions or special conditions. Provided:Construction trust be completed within three years of the date of this permit.Date 1 2 aJ // Approved by / le k TOWN OF BAR/NSTABLE LOCATION qT 14ock y ti3 ICI*,-k KUl SEWAGE# VILLAGEC ASSESSOR'S MAP&PARCEL �pZ INSTALLER'S NAME&PHONE NO. 1c�C� fer[s�ise� g �08 �8�77 SEPTIC TANK CAPACITY 1 `00 f /0W Come,I pi►rnp 01,40im- LEACHING FACILITY.(type) 366� IBC 36NCH-orb (size) ka (,ra�X 4T NO.OF BEDROOMS J z OWNER D! ® W. S PERMIT DATE: 01 COMPLIANCE DATE: r Separation Distance Between the: U/a'feo- exJidel`4 Maximum Adjuste&Groundwater Table io the Bottom of Leaching Facility g f f pZ 6 �' Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) �IVA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within r 300 feet of leaching facility) ®. / Feet 3 FURNISHED BY L�hd�l J-e-5 A-1-dt( t3--1-7 ' ) 3=aa' so 3 _. elf' A-6=l+.6 A-7=71 A—a 7�rr �3�7-7q' a o ' L.J� 3/14/2013 22:58 5082730367 91829 P. 001/001 Town of Barnstable Regulatory Services Thomas F. Geiler,Director • °°RNMBLE. Public Health Division HAS9 6. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: .508-862.4644 Fax: 508-790-6304 Date: 3-15- 13 Sewage Permit# 2013- 33 Assessor's Map/Parcel 2-5 Installer &Designer Certification Form Designer: SG Egot t0eeci0 T0C, _ Installer: Ga(2ewide_ Eif ecec(s e_ LI-C Address: 285y Ccon%oeccy lii�hWQy Address: t 3 C° m*�� S EOS1 oz538 a-c fi" P'Z(O On �'2 �7 Z��3 �Wwilde was issued a permit to install a (date) (install Er) Septic system at 93 Huckf,ns Ne-ok (Load based on a design drawn by (address) TV)C. dated 9-18-12. OLcu, ib-(7-fz) (designer) ✓" 1 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. Stripout (if required) was inspected and the soils were found satisfactory. _ 1gc _tify that the septic s stem referenced above was installed with major changes (i.e. reater 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. Stripout (if req . .nspected and the soils were found satisfactory. �noF 4� UR C l.. M OLL -P— tilfe—r 's Signs e) Na�e�iaa7 w- / esigner's Signatur (Affix esi e s mp Here) P—L' I:ASE 1tETURN O BARNSTAI3LE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE .RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK VOL]. �'.of'firr I'unnaWesigncr«nificalion I'nnn.du� - B k 271 185 Fs 64 �6334 a 01-29-2013 11 = 29U tE DEED RESTRICTION Whereas,David W.Jackson,Trustee of Provident Realty Trust,formerly.,known as Jackson-Malden Realty Trust(see name change recorded with the Barnstable County Registry of Deeds in Book 1912,Page 242),under declaration of trust dated August 22, 1.962,and recorded with said Registry of Deeds in Book 1.462,Page 451.,of 87.Broadway,-Malden,Massachusetts 02148,is the owner of Lot 49, as shown on a plan of land recorded with said Registry of Deeds in Plan Book 21, Page 93, located at 95 Huckins Neck Road, Centerville,Massachusetts (hereinafter,the"Lot"); and Whereas;David W. Jackson,Trustee of Provident Realty-Trust,.as the owner of the Lot, has agreed with.the Town of Barnstable Board of Health to a restriction as to the number of bedrooms-which,can.be included in any home built on the Lot as a pre-condition.to obtaining a disposal:works construction permit in;compliance with 310.CMR 1.5,000,State Environmental Code,Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage;and Whereas,the Town of Barnstable Board of Health, as a pre-condition to granting•a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, is requiring that the:agreement°for tfie restriction on the number of bedrooms in any house constructed on the Lot be put on recorded with the Barnstable County Registry of Deeds and/or the Barnstable Registry District of the Land Court,as applicable, by recording this document. Now,therefore,David W. Jackson,Trustee of Provident Realty Trust,does hereby place and impose the following restriction upon the Lot in accordance'with his agreement With the. Town of Barnstable Board of Health, which said restriction shall run with the land and be binding upon all successors in title: The dwelling constructed upon the Lot shall contain no more than four(4)bedrooms unless and until it is connected to the municipal sewer or the Board of Health of the Town of Barnstable permits otherwise. Property Address: 95 Huckins Neck Road, Centerville,Massachusetts For title, see deed recorded with said Registry of Deeds in Book 1462,Page 449. � 1 Executed as a sealed instrument this day of 2013. Provident Realty.Trust By: David W..Jackson,.Trustee COMMONWEALTH OF MASSACHUSETTS. Barnstable,ss. On this *Z3 RD day of 2013,before me,the undersigned notary public,personally.appeared David W. Jackson,proved to me through satisfactory evidence of identification;-which was PZRS0AJ4—Gy KkiCahl ,to be the person:whose name is signed on the,,preceding or attached document,and acknowledged to-me that..he.s fined it , voluntarily for-.its stated purpose,as Trustee of Provident Realty Trust. Notaty`.'1't�blic .�,_ My Comm ssio {xpires MARYELLEN SHEEHAN " * Notary Public Commonwealth of Massachusetts' My commission Expires July 20, 2018 , Town of Barnstable Barnstable p SF1E1°�y °�, Board of Health �miwicaC M I . ► Il li*11 nAnNSTAULE,l I - �IASS. ,m 200 Main-Street, Hyannis MA 02601 �O\aibgq. a` 2007 Bp I Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi October 31, 2012 Mr. Michael Pimentel, E.I.T. JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538 RE: 85-95•Huckins Neck Road, Centerville A = 252 — 014 and -015 Dear Mr. Pimentel, You are granted a conditional variance on behalf of your client, David W. Jackson, Trustee of Jackson-Malden Realty Trust, to construct an onsite sewage disposal system at 85-95 Huckins Neck Road, Centerville. The variances granted are as follows: 310 CM 15. 221 (7): To install the pump chamber with 4.5 feet of coverage, a waiver of 1.5 feet from the maximum allowable coverage of three (3.0) feet. 310 CMR 15. 221 (7): To install the soil absorption system with 6.0 feet of coverage, a waiver of 3.0 feet from the maximum allowable coverage of three (3.0) feet. Section 360-1 of the Town of Barnstable Code: To install the H-20 monolithic septic tank 66.1 feet away from a bordering vegetative wetlands, in lieu of the minimum 100 feet separation distance required. Section 360-1 of the Town of Barnstable Code: To install the.H-20 monolithic pump chamber 55.1 feet.away from a bordering vegetative wetlands, in lieu of the minimum 100 feet separation distance required. Section 360-1 of the Town of Barnstable Code: To install a soil absorption system 19.9 feet away from a bordering vegetative wetlands, in lieu of the minimum 100 feet separation distance required. Q:\WPFILES\85-95 HuckinsNeckRdCentSeptcVarOct2012.doc y e, This variance is granted with the following conditions: (1) No more than four (4) bedrooms are authorized at this property. Dens,. study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health .Agent prior to obtaining a disposal works construction permit. (3) The septic system shall be installed in strict accordance with the j engineered plans dated September 18, 2012 with the H-20 pump chamber and the revision to the plan of using an H-20 septic tank. (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the plans dated September 18, 2012 with the H-20 pump chamber and the revision to the plan of using an H-20 septic tank This variance is granted because the proposed plan appears to meet the design standards contained within the State Environmental Code, Title 5 and local Health Regulations. Sinc ely yours,. ayn Miller, M.D. Chair an i Q:\WPFILES\85-95 HuckinsNeckRdCentSeptcVaroct2012.doc I EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES 10/09/12: A. Michael Pimentel, JC Engineering, and Richard Capen, Capewide Enterprises, representing David Jackson, Trustee of Jackson-Malden Realty Trust, owner— 85 and 95 Huckins Neck Road, Centerville, Map/Parcel 252- 014 and -015, 2 lots totals 22,084 square feet. 'Mike Pimentel presented his plan dated 9/18/12. Due to the steep incline, they also need approval on variances of the groundcover for the septic and the leaching. The pump chamber is H2O because there is more than three feet of soil resting on it due to I the incline. The septic is under the paved walkway (not the driveway, itself). The walkway will have to be dug up. To eliminate any issues with driving over the system, the septic tank will also be H2O. Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to approve the septic plan dated 9/18/12 with the following conditions: 1) the septic tank will be H2O, 2) a four-bedroom deed restriction will be recorded at the Barnstable County Registry of Deeds, and 3) a proper copy of the deed restriction will be submitted to the Barnstable Public Health Division. (Unanimously, voted in favor.) Q-\MINUTES\EXCERPT OF MINUTES\Excerpt BOH Oct 2012 85-95 Huckins Neck Rd Cent.doc - ,���,Sibml��iy.Etnall DATE: 9" FEE: ��- BARN se&et e 16.19. REC. BY / Town of Barnstable SCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 JunichiSawayanagi Paul J.Canniff,D.M.D. LOCATION VARIANCE REQUEST FORM � Property Address:—95 Huckins Neck Road Centerville MA Assessor's Map and Parcel Number: _Map 252,Parcels 14& 15 Size of Lot: 22 084 s.f. Wetlands Within 300 Ft. Yes X Business Name: N/A No Subdivision Name: N/A APPLICANT'S NAME: JC Engineering,Inc. Phone 508-273-0377 Did the owner of the property authorize you to represent him or her? Yes X_ No PROPERTY OWNER'S NAME CONTACT PERSON Name:David W.Jackson,Trustee of Jackson-Malden Realty Trust Name: Michael Pimentel.E.I.T.(JC Engineering.Inc.) Address:_387 Broadway,Malden,MA 02148 Address:2854 Cranberry Highway,East Wareham,MA (/ Phone: Phone: 508-273-0377 VARIANCE FROM REGULATION (List Reg.) REASON FOR VARIANCE (May attach if more space needed) _See attached Appendix A NATURE OF WORK House Addition 0 House Renovation 0 Repair of Failed Septic System 0 -4 Checklist(to be completed by office staff-person receiving variance request application) ' W v Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four 4 copies of labeled dimensional floor plans submitted e. house plans or restaurant kitchen plans) O P P ( g• P P ) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense'l(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) h? Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], - ;i ate$ outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\\Users\\decollik\\AppData\\Local\\Microsoft\\Windows\\Temporary Internet Files\\Content.0uticok\\BAJ9P9B7\\VF Town of Barnstable P# l Departinnent of Regulatory Services ! Public Health Di ' ' MAB& V1S10II Date 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sew ' is osal G P Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address _ o 5 'In,S /J'2,C,L, (t,e r� Owner's Name �At-l(,$c y) Address C: Assessor's Map/Parcel: 2 2/e)t 5 Engineer's Name NEW CONSTRUCTION REPAIR Telephone# S�g Land Use S(n`l� `Omt t �('�� Slopes Surface Stones Distances from: Body Water Open r �d P Y I�7U � ft Possible Wet-Area � ft Drinking Water Well ft Drainage Way ft Property Line > I b ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to holes) See ac4tr�r� ouktuasLn u Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: — tJ Weeping from Pit FQoe Estimated Seasonal High Groundwater - era/•��t 11(r�� 2`� (eer loc..( &H Q6iv,y DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: I-OGr-I li0tA 90 (c y d Fj6u17 Depth Observed standing in obs.hole: r�� 3/L'�� In. Depth to soil mottles: In. Dcpth to weeping from side of obs.hole: In, Groundwater Adjustment Index Well# Reading Date: — Index Well level Adj.thCtdr. Adj.Groundwater level - _ _.__PERCOLATION—TESTS_ beep 9--13-12 xhtt� AR Observation _ ._ _ - Hole# I Time at 4" Depth of Pero 30 Y O ` Time at 6" Start Pre-soak Time @ Time(9'.'-6") _ End Pre-soak Rate Min./Inch 4 Z ^ Site Suitability Assessment: Site Passed Ye-.s Site Failed: — Additional Testing Needed(Y/N) A) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 1.00' of wetland,you must First notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# 1+2. Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. onsistency,%%ravel) id Y(3/i 26- 30 t; L S ! ', .s/b 36 C. 1'1_CS 2.5 26 30 r-C6�0 �3 • �'{C�'�1�1e� Sa S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. - onsis en %Crave DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) . 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stotte9:Boulders, Cositn Flood Insurance Rate Map: Above 500 year flood boundary No— Ye;; Within 500 year boundary No t/ 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? U5 If not,what is the depth.of naturally occurring pervious material? Certification I certifythat on �d" date I have a sed the soil evaluator examination approved b the (date) P �� PP Y Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise a d experi described in 10 CMR 15.017. Signature Datb QAS..EPTIC�PERCPORM.DOC • t I t TOF = 47.5'± PROVIDE H.D.P.E. RISER WITH COVER TO WITHIN PROVIDE H.D.P.E. RISER WITH REMOVABLE, FINISH GRADE OVER D-BOX= 60.2 ± GENERAL NOTES PROP.4"VENT WITH CHARCOAL FINISH GRADE 6"OF F.G. (TYP OF 3) SECURED, WATER-TIGHT COVER TO F.G. o FILTER TO ABOVE GRADE 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION REMOVABLE WATERTIGHT RISER 4 SCHEDULE 40 PVC MIN. SLOPE 1 /o - METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE @ FND. EL.= 2"SCH. 40 FINISHED GRADE OVER BIODIFFUSERS= rj9,0 - 62.9 44,9'± F.G. OVER TANK EL.= 44.2'± F.G. OVER P.C. EL.= 46.1'± (max) TO D-BOX TO WITHIN 6"OF FINISHED GRADE SLOPE @ 2% MIN. - ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. _ - 5" DIA. OUTLET(S) INSPECTION PORT WITH 20"MIN. 9"MIN. EL.=41.6' ACCESS BOX TO WITHIN 3"OF 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD EL.=42.03' (TYP) 9" MAX. 20"MIN. 4.5'(max) F.G. (ONE PER OUTER ROW) OF HEALTH AND THE DESIGN ENGINEER. TYP 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL PROPOSED 9"MIN. BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 4 SCH. 40 PVC PROP. �� 2" DROP MAX. 3° 4"SCH. 36"MAX. 6.00' MAX. SLOPE 2%min. 3 3" DROP MAX. g" 40 PVC SEE VARIANCE ' 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN 40 14" @ ! TOP OF SAS/B.O. _ rj6,90 SLOPE %min. NOTE 2 ELEVATION = 56.90' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 48" INV. OUT= � ALARM ON 2"PVC TEE 4"SCH.40 PVC THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 41 .U'-- LIQUID 40.65' 40.50 OUT TO SAS VTEE LEVEL PUMP ON 1 33' 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 10.7'TO FND. TEE VTEE UMP (TYP.) (SAND LEAN 16 OFF1 0.90' 10.75"(TYP) 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 12" MIN. 6" EL.=36.4' 22"ZABEL FILTER 56.80' 56.63' I 7- LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN MODEL#A1801 4x22 56.47' 55.57' (laid flat) 2.876(34.5")--I SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO 6"CRUSHED STONE (GAS BAFFLE ON BOTTOM) EL.=36.0 6"CRUSHED STONE 40.25' 6"CRUSHED STONE (TYP.) BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. OVER MECHANICALLY OVER MECHANICALLY �6 OVER MECHANICALLY M� 5.0 COMPACTED BASE COMPACTED BASE COMPACTED BASE (TYP.) 5'MIN. 8 625' 8. ELEVATIONS BASED ON N.G.V.D 1929 DATUM. BENCHMARK ELEVATION OF 60.40, REQ'D ESTABLISHED ON TOP OF A NAIL SET IN A UTILITY POLE AS SHOWN ON PLAN. LENGTH 10'-2.5" WIDTH 6'-0.5" HEIGHT 6-7.5" LENGTH V-3.5" WIDTH V-5.5" HEIGHT 6-7.5" 45.0' 1 ,500 GAL. H-20 MONOLITHIC SEPTIC TANK 1 ,000 GAL. H-20 MONOLITHIC PUMP CHAMBER 5 OUTLET DISTRIBUTION BOX (TYP.) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= * 34.80' BIODIFFUSERS END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE BASE. FIRST TWO FEET OF OUTLET ) AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY TANKS SHALL BE INSTALLED ON A LEVEL STABLE BASE PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) DISCREPANCIES TO THE DESIGN ENGINEER. 1 ,500 GALLON H-20 MONOLITHIC SEPTIC TANK & CROSS SECTION VIEW (BY INFILTRATOR SYSTEMS, INC.) *EL. OF WEQUAQUET LAKE PER B.O.H. 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE 1 ,000 GALLON H-20 MONOLITHIC PUMP CHAMBER DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) H-20 BIODIFFUSERS WATERTIGHT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH MAP 252TEST PIT DATA DETERMINATION FROM APPROPRIATE AUTHORITY. PARCEL 16 `�- \ �� �'`�SnS� - DESIGN DATA , ._,. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-1 (#107 HUCKINS NECK RD) �j -"C S \ PERC NO. 13731 0 LOADING UNLESS ion INSPECTOR: David W. Stanton, R.S. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE #107 \ \ �\ \ I NUMBER OF BEDROOMS (DESIGN) 4 THEY SHALL WITHSTAND H-20 LOADING. � 1 DWELLING G S , P1 I I DESIGN FLOW 110 GAUDAY/BEDROOM 'Q EVALUATOR: Michael Pimentel, EIT, CSE i 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE F l � � Benchmark O ALL DIRT, DUST AND FINES. l + . C.S.E.APPROVAL DATE: Oct. 27, 1999 \ GPS ` \ I \ I I Nail in U.P. TOTAL DESIGN FLOW 440 GAUDAY + ,Qr 1 \ N Elev.=60.40' o _ DATE OF TEST PIT: Sept. 13, 2012 j 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND cr �n DESIGN FLOW x 200/o - 880 GAUDAY - N85°26'43"W �rn �„�� �' ( N.G.V.D. 29 • • k TEST PIT#: 1 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF Q , rT o0 0� a, rn USE PROPOSED 1,500 GALLON SEPTIC TANK LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN , M `3 137± oNnrn � / -S` `o ELEV TOP= 62.00' COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN o, I ACCORDANCE WITH 310 CMR 15.255(3). I O INSTALL 27 ARC 36HC (#3616BD) H-20 BIODIFFUSERS . ELEV WATER= 34.80 (see above) 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN O.H.CORNER ` ` , ,�`, I i / *' ` - PERC RATE < 2 Min./In. SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. �� WET-11 � o\, , , I�� � I , ,���� = SYSTEM CAPACITY - #g5 -a N Oti, (TOTAL L.F. OF BIO'S& COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)_ • • • 60 a DEPTH OF PERC 30"-48" 16. PROPOSED PROJECT IS LOCATED WITHIN: X,S-t1NG ti �` 1 U) C? C7 V (135)(4.8 SF/LF)(0.74 GAUSQ.FT.)= 479.5 GAL. LEACHING/DAY • i • a . TEXTURAL CLASS:_ 1 ASSESSORS MAP 252 PARCELS 14& 15 eEORO°� ��� m � Gooseberry � \N war MET R PI I 0 v M a •aaa 17. OWNER OF RECORD: DAVID W. JACKSON m m o TOTALS: cAslan r a 0" 62.00 ADDRESS: TRUSTEE OF JACKSON-MALDEN REALTY TRUST OCK z O 10 ;Ag 5 IHiW ❑i W U.P. r 10 C TOTAL NUMBER OF BIODIFFUSERS: 27 Fi GD ►� o FFE ,i Z 87 BROADWAY i U 11$r Fill E�US��N ` a IDW fTl TOTAL NUMBER OF COUPLINGS: 0 LOCUS MALDEN, MA 02148 O.H.CORNER w ■ < -0 0 N TOTAL LEACHING AREA: 648.0 « + a18" 60.50' VE t o m � 4 • a a A Loamy Sand FEMA FLOOD ZONE C o � '�I `I i� _ m V '� 10YR 3/1 EXISTING CESSPOOL TO BE PUMPED m ` o K TOTAL LEACHING CAPACITY: 479.5 AND FILLED WITH CLEAN SAND -- \ ' I o I z 0 a • :N 20" 60.33' AS SHOWN ON COMMUNITY PANEL# 250001 0005 C p P OP ( c N a • • • a 1 18. PLAN REFERENCES: TP + ♦ a a Loamy Sand tt 1EPSNCj t , ° ° s4 0' S DOSING & STORAGE REQUIREMENTS ' • ; ' B 1oYR5/6 1.) L.C. PLAN 20239-C S�RVEY�o- �EH • • 2.)P.B. 21, PG. 93 WET-10 J PR.C/O X O ( I X k rn I I DESIGN FLOW: 440 GPD • a * • 30" 59.50 19. DEED REFERENCES: � 31 a Pere PROPOSED 1,500 GALLON H-20 ' 4 O �+ t) PROPOSED TOTAL 27 ARC DOSING REQUIRED: 4 CYCLES /DAY . • ZONE 2 I( 1.)BOOK 1462, PAGE 443 2 i O i �` 36HC (#3616BD) BIODIFFUSERS 440 GPD/4= 110 GAUCYCLE �xc. * 48 58.00 2.)L.C.C.#47794 MONOLITHIC SEPTIC TANK PARCEL 15 I � i ` IN A FIELD CONFIGURATION WET '' PARCEL 14 ® n' "' `O t DISTANCE REQUIRED BETWEEN PUMP • + . a j 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. t\ 4.9 PROPOSED IN P I TI P ON AND PUMP OFF FLOATS: R ,. , ` a Med. -Coarse Sand o O S EC ON PORT '`,,..' a P a , 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY y� r [ . _ a 2.5Y 6/6 w o ~` I WITH ACCESS BOX (TYP OF 2) 110 GAUCYCLE - 250 GAUFT = 0.44 FT/CYCLE C 20-30% ravel & FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY PROPOSED 1,000 GALLON H-20 0' MONOLITHIC PUMP CHAMBER (USE 0.50 TO PROVIDE FOR BACKFLOW) cobbles; stratified( g FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ` t f I � , STORAGE REQUIRED ABOVE WORKING LEVEL:440 GAL. sands) 22. CONTRACTOR TO PROVIDE THRUST BLOCKING AT ALL ANGLES, BENDS, BRANCHES, PLUGS x ( I STORAGE PROVIDED ABOVE WORKING LEVEL: 625 GAL. AND WHEREVER ELSE NECESSARY TO PREVENT DISRUPTION OF PROPER FUNCTIONING OF SILT FENCE (TYP) I I ` BIT. DRIVEWAY I 1 LOCUS PLAN THE FORCE MAIN. r rn ESTIMATED LIMIT OF SCALE: 1"= 1000'WEQUAQUET LAKE I WET-8I I ` 0.1' � I PROPOSED WORK 126" 51.50, I TOWN DESIGNATED EL.= 34.8'± (N,G.V.D. 29) m + I PROPOSED 4" PVC I VENT; - - No standing, weeping, or mottling observed LEGEND 0 ACTUAL SURVEY EL. = 33.4'± (N.G.V.D. 29) G) '` 1 I + I EXACT LOCATION PER OWNER -- --- -- -- R (TAKEN ON SEPTEMBER 6, 2012) N TEST PIT DATA 50 EXISTING CONTOUR n I I I I x I I PROPOSED 40 MIL. IMPERVIOUS NOTE: PUMP MUST BE EQUIPPED WITH A HIGH PERC NO. 13731 * I o m I I �� GEOMEMBRANE LINER LEVEL ALARM LOCATED IN THE HOUSE SERVED 50 PROPOSED SPOT GRADES I I ' �` I I I I ( INSTALL 1-1/4 PVC TO HOUSE. JOINTS TO BE MADE WHICH IS POWERED BY A CIRCUIT SEPARATE INSPECTOR: David W. Stanton, R.S. TOP I 5 EL. = 56.90' I i WET-7 m I I i I I WATERTIGHT. WIRE PUMP AND FLOATS TO SIMPLEX FROM THE CIRCUIT TO THE PUMP. EVALUATOR: Michael Pimentel, EIT, CSE 50 PROPOSED CONTOUR ,� U, CONTROL PANEL No. 1-CC2 NEMA-1 MFG. HOOVER C.S.E. APPROVAL DATE: Oct. 27, 1999 ELEC PROPOSED UNDERGROUND ELECTRIC� I SWING TIES SCALE: 1" =20' INSTRUMENTS. �/ r / a`O,. r / I i 6, NEMA 4 JUNCTION BOX CORROSION RESISTANT& HOISTING CABLE 7 x 19 STAINLESS STEEL DATE OF TEST PIT: Sept. 13, 2012 p�H��/ EXISTING OVERHEAD UTILITIES �` �` ( `� \ /5 ' ) i m DESCRIPTION HC-1 HC-2 WSO LIQUID-TIGHT CABLE CONNECTORS SUPPORTED 1/8" DIA./ 1,760 LB. STRENGTH TEST PIT#: 2 64 4 �' ) � CONNECTORS SUPPORTED BY 1-1/4"PVC CONDUIT, ELEV TOP - 62.00' W W EXISTING WATERLINE Co 1 SEPTIC COVER IN (1) 12.5' 25.2' -- JOINTS TO BE MADE WATERTIGHT 2"BALL VALVE w/ UNIONS SCH. 80 PVC rn ELEV WATER= 34.80 see above TEST PIT LOCATION a� I GEORGE FISHER CO. MODEL NO. '( ) < , SEPTIC COVER OUT(2) 19.4' 29.3' -- - \ i io 3' 2"SCH. 40 TO D-BOX PERC RATE = O O O PROPOSED 1,500 GALLON H-20 MONOLITHIC SEPTIC TANK I WET-6 i PUMP COVER IN (3) 25.9' 27.9' -- _ i � I _ � DEPTH OF PERC= o PUMP COVER OUT(4) 27.8' 26.1' -- ti ALARM oN 2 SCH. 40 TEE w/CLEAN-OUT CAP O O PROPOSED 1,000 GALLON H-20 MONOLITHIC PUMP CHAMBER o co TEXTURAL CLASS: 1 MAP 252 I N BIODIFFUSER CORNER 5 56.5' 40.4' 25.5' 1/4"WEEP HOLE IN DISCHARGE PIPE co ( ) - UMP ON - ❑ PROPOSED DISTRIBUTION BOX �1/gs° PARCELS 14& 15 „ A ��Op., 22,084 S.F.± BIODIFFUSER CORNER(6) 64.9' 48.2' 17.3' PUMP 2" BALL CHECK VALVE SCH. 80 PVC 100 0�� 62.00' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE WET-5 1�2 OFF P.S.I. FLOWMATIC MODEL No. 208S Fil' BIODIFFUSER CORNER(7) 85.9' 77.7' 54.0' 18" 60.50' FM FM PROPOSED 2"SOLID SCHEDULE 40 PVC FORCEMAIN SPECIAL NOTES: Loam Sand BIODIFFUSER CORNER(8) 79.7' 73.1' 57.1' (2)WIDE ANGLE CONTROL FLOATS a o 1/4"WEEP HOLE IN DISCHARGE PIPE A 10YR 3/1 PROPOSED ARC 36HC(#3616BD)H-20 BIODIFFUSER EACH AGNETIC SEPTIC SYSTEM COMPONENTKING TAPE . BE PLACED ALONG THE TOP EDGE OF PMAP 252ARCEL 8 / ey\\s ���, I 1BAPUMP ONIOFF)120 ACTIVATION 2"SCH. 40 PVC DISCHARGE PIPE 20" 60.33' 1 10-17-12 MCP JLC CHANGED 1,500 GAL. H-10 SEPTIC TANK TO H-20 #61 B PARCEL OD RDC-2 2: ALARM ACTIVATION BARNES SE774L PUMP 0.75 H.P., B Loamy Sand REV. DATE BY APP'D. DESCRIPTION 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE ( ) O.H.o.H.CORNER `�\ 10YR 5/6 - HC-1 �� 200/240 V, 2 DISCHARGE PASSING PROPOSED LEACHING SYSTEM TO ENSURE CONSISTENCY WITH TEST PIT w 2"SOLIDS OR APPROVED EQUAL 30" 5950' PROPOSED SEPTIC SYSTEM UPGRADE . DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF DECK \`�w.,r WS0 I PREPARED FOR: HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. O N 4p�, T I 1 000 GALLON H-20 MONOLITHIC PUMP CHAMBER CAPEWIDE ENTERPRISES 3.) ALL PROPOSED WORK IS LOCATED OUTSIDE THE LIMITS OF ANY AQUIFER ' PROTECTION AREAS OR ESTUARINE WATERSHEDS. (1 10.0' I O 4) (5 19.6J RESERVED FOR BOARD OF HEALTH USE Med. -Coarse Sand LOCATED AT (2 6) 2.5Y6/6 95 HUCKINS NECK ROAD VARIANCE REQUESTS (3 ° (20-30%gravel& cobbles; stratified C E N TE RV I L L E, MA 02632 1. THE FOLLOWING LOCAL VARIANCES ARE REQUESTED FROM ARTICLE 1,SECTION 360-1: m sands) (1.) A 66.V VARIANCE (100.0'-33.9') FOR THE SETBACK FROM THE PROPOSED 1,500 b Io GALLON H-20 MONOLITHIC SEPTIC TANK TO THE BORDERING VEGETATIVE WETLANDS. L6 m SCALE: 1 INCH = 20 FT. DATE: SEPTEMBER 18, 2012 (2.) A 55.1'VARIANCE (100.0'-44.9') FOR THE SETBACK FROM THE PROPOSED 1,500 I0 %\f � �!h o �0 20 ao so FEET GALLON H-20 MONOLITHIC PUMP CHAMBER TO THE BORDERING VEGETATIVE WETLANDS. 0 126" 51.50' ! s, --- -_ (3.) A 19.9'VARIANCE(100.0'-80.1') FOR THE SETBACK FROM THE PROPOSED LEACHING SYSTEM D JOHN L. PREPARED BY: TO THE BORDERING VEGETATIVE WETLANDS. M No standing,weeping, or mottling observed CHURCHILL.JR. s, P 9, 9 CIviL « JC ENGINEERING, INC. m $' No �� 2854 CRANBERRY HIGHWAY 2. IN ACCORDANCE WITH 310 CMR 15.401 - 15.405, THE FOLLOWING LOCAL UPGRADE I-zi EAST WAREHAM MA 02538 APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7): SITE PLAN (8 .6' 10.0' �� :S sT , (1.) A 1.5 WAIVER(3.0 -4.5) FOR THE MAXIMUM COVER OVER THE PUMP CHAMBER. 7) y. 508-273-0377 (2.) A 3.0'WAIVER(3.0'-6.0') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. 19.2' -- -- -- - SCALE: 1"=20' Drawn By: MCP F Designed By: MCP Checked By:JLC Job No.:2296