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HomeMy WebLinkAbout0043 JACKSON AVENUE - Health 43 JACKSON AVENUE Centerville A = 226 - 130 _. ups M No. 143 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.LA; IZ CtScl X--L %1AA0 Owner's Name,A dress,and Tel.No." If Assessor's Map/Parcel �b ��O L50 f Installer's Name Address and Tel.N Designer's Name,Addres ,and Tel.No. %Attds. M.Z" -Z,Qi .a /J�.u, 1,s7�ULc VL '4.v5k 645k 'k zIS Qxv, N-, v r-^ V,441 771f-2a7 73Bo Type of Building: Dwelling No.of Bedrooms Lot Size 3 2Z sq.ft. Garbage Grinder( ) Other Type of Building IC'gCX4--r l c,\ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required 33o gpd Design flow provided 3 S 5� gpd Plan Date LA \ Number of sheets Revision Date Title Size of Septic Tank Sd0 cgs Aur, Type of S.A.S.I Z1%4d WM k Szl`to PV4 �•��'- �s Description of Soil 0 o k-2, VL—X(4 W oo v San \G—24( ) , Qe^h SyA — YLO C Ae ivn Sow Nature of Repairs or Alterations(Answer when applicable) �0 t.W MI. ar-A n.�!Lvv 6ne,ti ce- 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 542-15 Application Approved by Date S—t is Application Disapproved by Date for the following reasons Permit No. Date Issued 1 �. + ,r 1`r -No. �o 1 5� ' 1 Fee 160 _ THE COMMONWEALTH OF MASSACHUSETTS Entered,in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSFTTS Yes .' } Z*licatiou for Disposal 4pstem Construction Ver'mit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.LJ3 S c,c.1CS, X- •Vo V\U Owner's Name,Address,and Tel.No.e\/ Assessor's Map/Parcel h — V - (3C7 ' 1 Installer's Name,Address,and Tel.No. �� ,• Designer's Name,Address,and Tel.No. �gt';v�E!t,y dJICy,fin -� \7 ,wc5k c�os 02 Sc��v �� � `ld�� �- 4<< ?+S Uaat.. T�nnx 'ajl! xrs .L Md 4Z(MS 77,f %t7-7 'Cx ! .4 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building'Kct)44 .1r I�A No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd' Design flow provided 3��, gpd Plan Date '-1\VI\ 2cj\< Number of sheets Revision Date ~ r Title 0 Size of Septic Tank r4cAut'. Type of S.A.S. Z�X��j� �.�1�1 W k Sc-`%io nVL Description of Soil (j-�Z �`\� 12-14 �a,ti.� Sc.AA !o-2�i� � ©ckrn� SSA `�� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviromnental Code and not to place the system in operation until a Certificate of 1 Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons r j Permit No. 6 ( 5 ' 114 Date Issued �" b --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS,IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by &,A 4 STck.. LL C at Lj� St,c V.S[n. Av c r-e-.k t,l& A A has been constructed in accordance {� with the provisions of Title 5 and the for Disposal System Construction Permit No.A 15%1 11 dated Installer Ec,r tl, ( 5 .t L(L Designer_fin � ,�, W�,rICf ;N( i #bedrooms Approved design flow 3 ej gpd The issuance!of this permit shall not be construed as a guarantee that the system will fu}c'on ja designed. Date C !7 f(1 r i Inspector t (,( ---------------------------------------------------------------------------------------------------------------------------------------- No. O l L Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Vermit Permission is hereby granted to Construct( ) n Repair( ) Upgrade( ) Abandon( ) System located at ( (-2- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. + Provided:Construction must be completed within three years of the date of this permit. c 2 Date 8 Approved by r - Town of Barnstable oZVE rO°�� Regulatory Services Richard V. Scali,Interim Director + RARNSUELS, 1 : ��� Public Health Division 0>Fo►nA�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Offi e: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form „ 5 i �81�s Z��+�- ►30 -a v � Dai Sewage Permitl# 143 Assessor's Map\Parcel 'Pe�-•e� M c.�n�-ems �•� ' � _ — 4 D goer: rr, vi e�r_n��� o rAy a.1a, Installer; skow Ad ress: IZ W, Cros�`t",-eta( 2cA Address: Le M A Z ,q Ma��wS M:11�_ Mfg Va4K 1 S°�- LL C o u 4 On Ob was issued a permit to install a (date) (installer) sep�'c system at 4 3 ZaIzAA so A A ,-t �'^+4,"'11e based on a design drawn by Q�e �`ttilCrr'�e� P (address) !ft,(1 ¢�t W0AU 10,C dated 12"7' 1 J� (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 were found satisfactory. I certify that the septic system referenced.above was installed with major changes (Le, greater than 10' lateral-relocation of the SAS or any vertical relocation of any component of the septic sys ier_a but in acaordainc with State & Local Regulations. :Plain revision or certified as-built by desiper to follow. Ship out(if required)was inspected.and the soils were found satisfactory. 1,certify that tMhe systern referenced above was constructed ccznpd>c'n4e'vvrth Affic terms of the IAA approval letters(ifapplicable) ! v l ly 3 V i f 3J (1nStaller's Signature) 4� � n 1Ju• ���Q �. (Designer's Signature) (Affix Designer's Stamp Here) Pl.i,ASE RETURN TO BARNSTABLE PUBLIC '13EA TI-T. DnrTS10-N. CK TIFICA TE -OF COfvLPLJA-NCE WILLh?OT BE ISSUED UNTIL BOTH TEES FORM ,k-ND AS- BRI {'WED BY I-E T3A.1bNSTAPL:'+ PUBLIC BEE. LTki; III"1TISION. TIL4t1K YOU. Q:1c''epiicTesigner Ceitification Form Rev 8-14-13.doc TOWN OF BARNSTABLE LO ATION H3 ,5aC&n Nut SEWAGE# G d 5 VILLAGE L_e,4ery--J1 . ASSESSOR'S MAP&PARCELZW"' 130'"06 INSTALLER'S NAME&PHONE NO. r 4'i_JV C L L L i SEPTIC TANK CAPACITY J5)0 5 f L,,1 i �G►r ���� �� `I Un LEACHING FACILITY:(type)L(J4'6_ `,KS Stiff g�+ (size) I`Z )(�® NO.OF BEDROOMS OWNER L'2V V'P_rn0V&4 PERMIT DATE: S e 1 - ZG 1 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 facili Feet FURNISHED BY ��z2 r rt 3 ° y 3 T Lkt�� Town of Barnstable P#IKE 5 c Department of Regulatory Services BARNSTABLE,� Public Health Division Date y MASS. ' 019. �0� 11,Main Street,Hyannis MA 02601 AlFO MAC A ,1 g � t©-O CJ?J a� Date ScheduledY r ��} Time Fee Pd: � , Soil Suitability Assessment for ST!e fis gsal I ` Performed By: � 1 S�� —Witnessed By: ` N- ^, LOCATION & GENERAL INFORMATION ILocation Address �p� �^ Owner's Name Lev v..q�wv�Vs y Address TV-0w0-k C f-� Assessor's Ma /Parcel: Q 4"f tM t k Z_ `Q p `L ��1 Tj��dQ 1 Engineer's Name 0,1U5 tY� 1 ` I NEW CCN;T-.ETC"TION 3ERA-1. �jTelephone# r V Land Use Slopes(%) Z 1 Surface Stones PI)o^L Distances from: Open Water Body 7��p / / fftPossible Wet Area ��� ft Drinking Water Well 7 1 Drainage Way J R Property Line /ML�a ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) i i - I s1 — t r Z� Y y I ' r�soy,r A�.� Parent material(geologic) Depth to Bedrock W Depth to Groundwater: Standing Water in Hole: [ 1 l Weeping from Pit FFaace Estimated Seasonal High Groundwater V // ( I l0 j DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. i . Dq !,to, frog,sde;of ubs,bolt: irt. Groundwater Adjustment ft. Index Well it Reading Date: Index Well level Adj.factor Adj.Groundwater Level— PERCOLATION TEST Date Time k Observation Hole# �fi f Time at 9" Depth of Percy Time at 6" °� Start Pre-soak Time @ ` t P Time(9"-6") End Pre-soak \ (� Rate Min./Inch Site Suitability Assessment: Site Passed_� Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- i ***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. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLD LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other urface(in.) (USDA) J(Munsell) Mottling (Structure.Stones,'Boulders. Consistency, vl �1C-L (,_j Zv C iM . Sa h0 DEEP OBSERVATION HOLE LOG Hole# Z r�epth from Soil Horizon Soil Texture oil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,So- rave 2 U t0 ?, -3a t✓S �`� (145 2�s- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sail Color Soil Other Surface(in.) (USDA) ;(Munsell) Mottling (Structure,Stones,Boulders. ' Consistency,%Gravel) �l I I „ i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, 1 Flood Insurance Rate Map: i Above 500 year flood boundary No_ Yes . _ Within 500 year boundary No 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 a ea proposed for the soil absorption system? .� I not,what is the depth of naturally occurring pervious material? erhfication certify that on A �a (date)I have passed the soil evaluator.examinatio In approved by epartment of Environmental Protection and that the above analysis was performed by me consistent with . `i e required trttini expertise and experience described in 3 10 CMR 15.017. c Signature.� Date �. \SBpT1C.1PERCPORM.DOC -� C0_M-10NT EALT 11-I0 ATASSACHL-SETTS - --, ? - Ex'ECL i nT OFFICE ( TT_ .. r T-D DEPARTMENT OF EN ,TROTQMENT_A_L PROTECTIOZ TITLE OFFICIAL nSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORT u Wlhj9 PART A CERTIFICATION Property Add�ss:' J a ekxv14 G2v� rvi ©oZ 6.�02 0�wner"s.N'a:ne: _ rllqel" />owlei kIS4-'� Owner's address: 29 -S7,V_/1n .1 /71 oa Q/ Date of Inspection. Name of inspector: (please print) /zoIe Companv Narne: V/O— TFC hailing Address:. PD pX 1) Telephone-Number: .5tg-,-? r� CERTIFICATION STATEANIENT =r� I certify that I have personally inspected the selvage disposal system at this address and that the�i 1�=a`c re-te below is true, accurate and complete as of the time of the inspection. The inspection was perfo=a, asea training and experience in the proper function and maintenance of on site set age disposal syste :,O T am a IMP ca f approved system inspector pursuant to Section 15.340 of Title 5(310 CIN1R 15.000). ice s� , , '� �� vj y Passes �.`. �•�r Conditionally Passes c7 r-- Needs Further Evaluation by the Local Approving Au- on n7 Fails - Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving AU,"_' :(Beard c,I"H ea_th DLP)within 30 days of completing this inspection.If the system is a shared system or has a desie . gpd or sreater, the inspector and the system owner shall submit the report to the appronr ate re�i�--a! of=ce o-- - DEP. The original should be sent to the system o«per and copies sent to the hove-. ;`a. ,li ate. �_r, -- ai r_ - m� cat- -_ r - .ithority. Notes and Comments *""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. Tide ;Inspection Form 6115112000 page 1 Page 2 of 11 OFFICI_AL INSPECTION FOR-NI-NOT FOR tiOLU'NT CRY" ASSESS-MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertvAddress: �G1G41�_ro� Ce h er4-1/. /V14 OdG&111- 0-omer: Date of Inspection: Inspection Summary-: Check A.B.C,D or E/ALNVAYS complete all of Section D A.A°stemasses: not .found any information which indicates.that anv of tine failure crrer:a descr e i n C`,:R 15.3013 or in 310 CNIR 15.304 exist.Any failure criteria rot evaluated are indicated belo-�-,-. Comments: B. Sy em Conditionally Passes: One or more system components as described in the`:Conditional Pass"section reed to be ten?aced or repaired.The system.upon completion of the replacement or repair,as approN ed by the Beard of Heath. -.:ill puss. : f' '1 a c r -n -n - e 'r-ri .-ins«er yes. no or not determined(Y;�;��D)m the_for the:oLoazn__ta�e:�.e.:a. L'"net d._tv___..�_e` p I..___ explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is unsound. exhibits substant,.al infiltration or exfiltration or tart:failure is irnrninent. Sv:t I: 11 pass uspectior:if t". 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,net leaking and if a Cent `care of C 0=fiance indicating that the tank is less than 20 years old is available. N-D. explain: Observation of sewage backup or break out or bigh static,eater level in the dis:r b'dt_on box due tc^reken or obstructed pipes) or due to a broken, settled or uneven distribution box. System ; .1 pass in-;-ecti approval of Board of Health.): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced \-L explain: The system required pumping more than 4 times a v_ear due to broken or ob=: acted ian_'s;. pass inspection.if(with approval of the Board of Healfn): broken pipes)are replaced obstruction is removed \�D explain: Tula � incnari�n.,. Win.-,,.. �/1 Ci'�nnn 7 Page ; of 11 OFFICIAL. ItiSPECTION FORNI-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SE«'AGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATIO!' (continued) Property Address: �-�� ✓ G�''J o� ��� e ry, Owner: Date of Inspection: C. Fu ther Evaluation is Required by the Board of Health: �7Conditions exist Nyhich require further evaluation by the Board of Health'in order.o deter1. re if s_-s-e= is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 0IR 155.303(l)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or-onvv is ,within 50 feet of a surface water Cesspool or privy is v,,thin 0 feet ofa bordering vegetated wetland or a sail~harsh Z. Svstem 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 SyStern.has a septic tank and soil absorption system(SAS)and the SAC ': vvith= l 00 c surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is«-:thin a Zone i ofa public,k-ater The system has a septic tank and SAS and the SAS is within 50 feet of a Dr vale rater su n:., The system has a septic tangy and SAS and the SAS is less than 100 feel but 5Q feet or core _-o:M a private water supply well'".Method used to determine distance "This system passes if the-y ell water analysis.performed at a DEP certi and laborato_ for ccli c= bacteria and volatile organic compounds indicares that the«-ell is free fiom poll_u-ion=crn. ftc. the presence of arnrrionia nitrogen and nitrate nitrogen is equal.c or less than.f.pprr -. mviced tha-uo of_;- failure criteria.are traQered:A copy of the anal,:sis must be attached to this for~. 3. Other: Page 4 of l 1 OFFICIAL I\`SPECTIO\ FORM—NOT FOR 1.OLti\TARP ASSESSMENTS SUBSURFACE SELVAGE DISPOSAL SYSTEILI I-"SPECTIOo FORM FART A CERTIFICATION(continued) Property Address: ✓ Ge G�f Oh 4vz'- �, trlii .� Do16 �oL Owner: Ok 7 Oki Date of Inspection: ,, D. System,Failure Criteria applicable to all systems: You must indicate "yes" or"no"to each ofthe following for all inspections: Yes \70 _ ackup of sewage into facility or system component due to overloaded or clogaec S_�S or ces=poe_ _ _� Discharge or pondina of effluent to the Surface of the grotnd or surface-,-ate-_ due to an e er±czce c- aced SAS or cesspool l/ Static liquid ltvei in the distribution box above outlet invert due to an overloaded cr cicgge S_-kS o- �c spool v L. tid depth in cesspool is less than.6"below inert or available-,ol=e is i,ss th_n i'_ day e_• Required pumping more than 4 times in the last year NOT due to clogged or cbsmucted 1D„ �f times pumped portion of the SAS;cesspool or privy is below h gh ground—ater elevation. portion of cesspool or privy is within 100 feet o:r a Su-face eater suppl,-c- �_b rz- tea :wrfzc rater supply. _ Any portion of a cesspool or privy is within a Zone i of a public well. _ (--An;,- portion of a cesspool or privy is within 50 feet of a private water sup-cle Vvell. _ �An;v portion of a cesspool or privy is less than 100 feet but greater hap 50 feet from:a pr ovate water supply well with no acceptable water quality analysis. f This system passes if the well water analysis. performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility-and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. (Yesi\o) The system fails.IT have determined that one or more of the above failure criteria exist aS described in 310 CM- R 15.303,therefore the system fails.The system owner sho�id contact t'-:e Board o_ Health to determine what will be necessar.-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 ;pd to 15.000 gpd. You must indicate either`eyes"or"no"to each of the following: The following criteria apply to large systems in addition to the criteria above) les o the system is within 400 feet of a surface drinking water suppl-, the system is within 200 feet of a tributary to a surface drinking water suppi the system is located in a nitrogen sensitive area(Interi?r Wellhead protec on Ar.ez— ?_-. Zone II of a public water supph,well if you h ave answered"yes"to any question in Section E the system is considered a -ea:. ".es" in Section D above the large system has failed.The ovner or operator of anv large sT:Stems oa_i_er a sigtlificant threat under Section E or failed under Section D shall upgrade the s-,stp-m_n accor"a-ce 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of I I OFFICIAL INSPECTION FOR-11-NOT FOR VOLUNTARY' ASSESSMENTS SUBSURFACE SE`VAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �J� GV 4✓1017 /4-(- rn Owner: ��wlGdls ti Date of Inspection: Check if the following have been done.You must indicate"yes'or"no"as to each of the follo<.j-g: 1 es \o/ v Pumping information was provided by the owner,occupant_ or Board of Heal:c C, Were any of the system components pumped out inn the previous two weeks ? Has the system received normal flows in the previous t�o week period /t,�Have large volumes of water been introduced to the system recently or as ran:ofthis nspec-=, were as built plans of the system obtained and examined?(If they were not available note as N. _�) Was the facility or dwelling inspected for signs of sewage'back up VVas the site.inspected for signs of break out`? f Were all system components,excluding the SAS, located on site? Were the septic tank.manholes uncovered; opened;and the interior of the rank nsrected for ro-d=or_ of the baffles or tees. material of construction;dimensior_s,depth of liquid.. depth of sludge and de-pt'h of scum _ Was the facility owner(and occupants if different from owner)provided-•fh nfor razor_on proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been deterr~-ned based o :: Yes no / _T Existing information. For example,a plan at the Board.of Health. v . Determined in the field(if any of the failure criteria related to Part C is at iss.te a=c. a or o= is unacceptable) (310 CNIR 1-5.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY"ASSESS:TENTS SUBSURFACE SEWAGE DISPOSAL SYSTE'NT INSPECTION FOR-�Z PART C SYSTEM INFORNIATIO Property Address: �� JGial✓To+'1 �v� �P ✓yi ,G. f� Oot 6 �v� O.vner: Date of Inspection: FLOW CO\TITIOi�S RESIDENTIAL7 E� Number of bedrooms(design): 3 Number of bedrooms.(actual): DESIGN flow based on 3'_0 CMR 15.203(for example: ll 0 gpd x_of bedrooms): \umber of current residents: 0 � Does residence have a?arbaae grinder(yes or no):V ?s laundry on a separate se`�-age system(yes or no):, if yes separate inspection required Laundry system inspected(ves no): Seasonal use: (yes or no): Water meter readings- if available(last 2 years usage(gpd)): Sump pump(yes or no): /Od T aSt Gale Of occupancy: _ CO�"i-NTERCIAL/'I\N-D STRIAI Type of establishment: Design flew(based on 310 CMR 15.%0 ): gpd Basis of design flow(seatsipersonsisgft.etc.): Grease trap present(yes or no): _ Industrial waste holding tank present(yes or no): N on-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings. if available: Last date of occupancy/use: OTHER(describe): GENER INFORRNTATTON Pumping Records Source of information: Was system pumped as part of the inspe on(ves or no 1 If ves,.volume pumped: gallons=-How was quantity pumped determined? Reason for pumping: y T F S_N _Septic tank, distribution box, soil absorption system _Single cesspool _Overflow cesspool Pricy _Shared system(yes or no) (if yes, attach previous inspection records; if any-) Innovative.%Alternative technology.Attach a copy of the current operation and btairled from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate aze of all components;date installed(if ho«n)and source of information: <<'ere se«-age odors detected when arriving at the site A I Pa,e 7 of 11 0FFICLAJY_ INS PECTI0 N FORINI—NOT FORVOLU TA-RY SSESSATENTS SUBSURFACE SENVAGE DISPOSAL. SYSTEM 1-N-SPECTION FORM PART C SYSTEM I r ORXI ATIO__N_' (continued) Property Address: 1-7 r � P, /lei¢ Ci�3oL Gs*fner: V'9G tiI� Bate of Inspection: BUILDING SE«ER(locate on site plan) Depth below-,rade: Materials of construction: mast iron 40 PVC_other(explain): Distance fi•om private ,eater supply well or suction line: Comments (on condition of joints,venting,evidence of leakage,etc.): SEPTIC TA:'+TK: _(ifocate on site plan) Depth oelo,v grade: �� n: Material of constructio _concrete_metal—fiberglass_polyethylene other(explain) if tank is metal list age:_ is age confirmed by a Certificate of Compliance(yes or no): _(a-�a,h a cou_:e- Gercat i fie) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: g Scum thickness: 4;; Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom f outlet e or baffler „Ho ,,°ere dimensions determined: 1 O e G 2 vi G-C--' Comments (on pu_mping recommendations.inlet an outlet tee or baffle condition, Szruc Ural in---, as- ated to outlet irvei+t.//evidence of le//aka_g/e. etc.): / / N✓"! i✓1 /2O 7`- ngo CG cZ r" T�it /d'9?. 7 cs v�lii Ci H�L o off r _ GREASE TRAP:/1/(locate on site plan) Depth belo,v grade:_ Maierial of construction:_concrete_metal fiberglass nolvethylene_07 e- Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ Distance from bo tom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations; inlet and outlet tee or baffle condito-L slac -a' i - as related to outlet invert, evidence of leakage,etc.): Page Q of 11 OFFICIAL INSPECTION FOR NOT FOR VOLUNTARY' ASSESS_N S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORA r-4 ART C SYSTEM INFORMATION(continued, Propert- Address: 4'. 'o`i Owner: O v"1 G'✓1,,e Date of Inspection: TIGHT or HOLDI\G TANK: /y (tank-must be pumped at time of inspection)(locat_on sire pia-) Depth below grade: Material of construction: concrete metal nberalass poivet v ene "-ye7 e c a r!: Dimensions: Capacity: Gallons Desi--r:Flow: Gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBU TION BOY: (y if present must be opened)(loca e on site plan) Depth of liquid level above outlet invert: Comments (note ifbox is level and distribution to outlets equal,ar_y evidence of solids cart-over, an,:evidence of leakage into out of boa_ c.): 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. T;tl. Tncrartinr T yr 1�/^nnn Pasze 9 of 11 OFFICIAL I\'SPECTIO\FORM-NOT FOR VOLLITAR1-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE'Nl I�-SPECTTOti FOR-AT P.XH r C r SYSTEM INFORIIATIO (continued) Property-address: /J CLJov, Owner: 6124pvlctr+Sk-S Date of inspection: Z-? SOIL ABSORPTION SYSTEM(SAS): (locate on site plan.exca-vation not required) If SAS not located explain why: Type leaching pits. number: leaching chambers, number: leachinz galleries, number: leaching trenches; number, length: leaching fields, nnu-nber, dimensions. overflow cesspool; number: irnovarve/alternative system Type name of technolo?y: Comments(note condition of soil, s'.Qns of hvdraulic 'failure, r_p level of ponding,da soil, condinon of eg- -ion: Sv c-Z,, Cy/,- _ —Lv S D lGw��C FG�r 144/C� — — 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 laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition, of soil signs ofhvdraulic failure,level ofponding, condition of eye Gticn. e:_. PRIVY: L/(Iocate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs ofhvdraulic fail-.:re,level of pond nr, conditio_o-of c»Ann 9 Page 10 of 11 A OFFICIAL I TSPECTION FORM—NOT FOR VOLL1"TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO\ FORM PART C SYSTEM INFORMATION(continued) Property Address:_ J G`vr0 t �` Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM rovide a sketch of the se-wage disposal system includitia ties to at least tu>o pertnanent reference lap`: _arks er enchmarks- Locate all «ells -xithin 100 feet. Locate where public vrater supply enters the b41c Q i i T;-to :Tncr rrnr r, 4.!i:!�nnn i0 Pa--e I! of 11 OFFICIAL INSPECTION FORM-NOT FORVOLI,'NTARY A-SSESSMENTS SUBSURFACE SENVAGE DISPOSAL SYSTEM NSPECTION FOF AI P_ KT C SYSTEM INFORMATION(continued) Property Address: Is Ta6kvrOP7 H ✓vs Qot 6'oZ Date of Inspection: 0 6 SITE EXAM Slope Surface�;ater Check cellar Shallow«-ells Estimated depth to --round ,ater 1/Sfeet Please indicate(check) all methods used to determine the high around rater elegy-ation:. Obtained from s_ysrem design plans on record-if checked,date of design_plan Observed site (abutting prop ertyiobservation hole-within 1 50 feet of SAS; Checked'with local Board of Health-explain: Checked«:th local excavators, installers-(attach docurnentatio ) Accessed T SGS database-explain: You must ribe how<Io established the high gr and water elevation: w i o/f o 7;t— C,,-- — �—� n f < r c- (t,9 G✓ _ �� CT- 4i! .� Type of Building: Dwelling No. of Bedrooms 3 Garbage Grinder(no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures • Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil sand Nature of Repairs or Alterations(Answer when applicable)) Septic repair Install 3 heavy duty stonepac7ce infiltrators and D-Box Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oar f Health. Signed i Date � 1< Application Approved b '� _ s z� Date � � Application Disapproved for the following reasons Permit No_-Z '—� Date Issued THE COMMONWEALTH OF MASSACHUSETTS f BARNSTABLE, MASSACHUSETTS Domanska Certifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/rep]aced on ( � by Installer . tam. E•. Robinson Sr. , Septic Srv. at_ 15 Jn nk s on Ay __ . Centerville has been constructed in accordance with the provisions of Title 5 and thq for Disposal System Construction Permit No. ated Date P s j f' _e;: 4�. �►--- ,. -r Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. —F THE COMMONWEALTH QF iMASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS " Doraanska i� oar i?p�tem Con-5truction permit Permission is hereby granted to wn R E obissQn Sr. , Septic Szv. to construct( )repair( an On-site Sewage System located at No.# 15 Jackson AVUn. ue Centerville, _IA Sum and as described in the above Application for Disposal System Construction Permit. 4 No. Date r The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. _IZ1 _ "_-- 1 Date: Approvedby - `F Board of Health 46 Search for Ma /Parcel 226180 p �, Town of Barnstable For Parcel Number:226180 $� Rental Property(Y/N): Business Name:j r Zone of Contribution(Y/N): Ir1 0 OOOOO ri Area -' TT--_ ContaminantRel(YIN). ll Phone: 000 6 r I� Fuel Storage Tank Permit: # _ O Card n File: Disposal Works Perc Test Well Permit Construction i File/Permit No: F _ 96"562_�� Issuance Date: _ �� 11/04/19961 Completion Date: 11/06/1996a Size of Septic Type/Size of Tank: SAS ! --__�_ _-------- -._� _..__------_- ---_- ii Comments: �i mappar: i 226180 owner: BOWEN,BRUCE M&LOYCE C TRS {�proploc: 15 JACKSON AVENUE i Innovative/Alternative Technology Septic Systems Single or Clustered I/A Type: I/A Service Type: add delete records? F0 {� E 0 Pj-"- /�y 130 1 Parcel Detail Page 1 of 2 LIE >� V " II b ll.�iA�{�A�rrl����..._ n. '�" {�'� i �e•n� w �.a ' vel"� Logged in As: Parcel Detail Friday, Novemb. Parcel Lookup Parcel Info Parcel ID 226-180 I Developer(LOTS 6 & 513 Lo Location 94 CENTERVILLE AVENUE ( Pri Frontage'75 Sec Road JACKSON AVENUE I Sec 160 Frontage village CENTERVILLE I Fire District ^C-O-MM Sewer Acct I Road Index 10274 Interactive i Map I V, 101 - Owner Info owner BOWEN, BRUCE M & LOYCE C TRS I Co-owner-BOWEN FAMILY TRUST Streets 1313 GRESHAM RD I Street2 City SILVER SPRING I State!MD Zip;20907 Country - Land Info Acres 0.25 Use IrPot Dev Ld I Zoning RB I Nghbd;0109 Topography I Road Utilities I Location - Construction Info - Permit History Issue Date iPurpose Permit# Amount Insp Date Comments - Visit History Date IWho Purpose Sales History Line Sale Date Owner Book/Page Sale P http://issql/intranet/propdata/ParcelDetail.aspx?ID=15775 11/17/2006 Parcel Detail Page 2 of 2 1 4/12/2001 BOWEN, BRUCE M & LOYCE C TRS 13721/050 2 6/26/1981 BOWEN, BRUCE M & LOYCE C 3313/098 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcf 1 2006 $0 $0 $0 $85,800 2 2005 $0 $0 $0 $77,600 3 2004 $0 $0 $0 $64,700 4 2003 $0 $0 $0 $42,300 5 2002 $0 $0 $0 $42,300 6 2001 $0 $0 $0 $42,300 7 2000 $0 $0 $0 $34,500 8 1999 $0 $0 $0 $34,500 9 1998 $0 $0 $0 $34,500 10 1997 $0 $0 $0 $31,400 11 1996 $0 $0 $0 $31,400 12 1995 $0 $0 $0 $31,400 13 1994 $0 $0 $0 $33,900 14 1993 $0 $0 $0 $33,900 15 1992 $0 $0 $0 $37,700 16 1991 $0 $0 $0 $50,200 17 1990 $0 $0 $0 $50,200 18 1989 $0 $0 $0 $50,200 19 1988 $0 $0 $0 $17,700 20 1987 $0 $0 $0 $17,700 21 1986 $0 $0 $0 $17,700 Photos http://issql/intranet/propdata/ParcelDetail.aspx?ID=15775 11/17/2006 �- • Jj,'7 j,TOWN OF BARNS TABLE LOCATION Al 10,' SEWAGE# VILLAGE 14:�IV 727k La/1-1-4 ASSESSOR'S MAP & LOT-,1 INSTALLER'S,NAME&PHONE SEPTIC TANK CAPACITY /. LEACHING FACILITY: (type) ®L 7,:e k (size) NO.OF BEDROOMS 3 L BUILDER OR OWNER PERMITDATE: ' /V Z COMPLIANCE DATE: Zf Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 11,0000 0 v � � 05 IbH o .� r, No. �—��. )�6 Fee 5 0 .0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HE TH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS - ZIppric tion for Migool *pgtetn Conztruction Permit Appli tion is hereby ma a for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: Locati 4Add ss r Lot No. Jackson Avenue Owner's Name,Address and Tel.No. 7 7 5—9 0 9 6 33r, Centerville Maria Domanska Assesso /P cel 15 Jackson Ave. , Centerville Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. �9m.E. Robinson Sr. , Septic Srv. P.O. Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil sand re Septic air Nature of Repairs or Alterations(Answer when ap licable) p p Install 3 heavy duty stor�epaCKe infiltrators and D-Box Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oaz f Health. l Signed E Date �! m Application Approved b Date Application Disapproved for the following reasons Permit No. Date Issued � 2� b 50•00 .. _ No. Fee i r �— THE COMMONWEALTH OF MASSACHUSETTS y. } 140 PUBLIC HE TH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS - ric ton for Mood 6pgtem Construction,Vermit Applic on is hereby ma a for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: Locatio Addressor Lot No. Jackson Avenue Owner's Name,Address and Tel.No. 7 7 5—9 0 9 6 3 Tenterville Maria DomanskaAssessor's IGflap/RP cel . 15 Jackson Ave. , Centerville I; Installer's Name,Address,and Tel.No. 7 7 5—8 7 7( Designer's Name,Address and Tel.No. Wm.E. Robinson Ste,, Septic Srv. , P.O. Box 1089, Centerville _ Type of Building: r Dwelling No.of Bedrooms 3 Garbage Grinder(nq -h. Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures Desig n Flow �gallons per day. Calculated daily flow '� �.�� (� .gallons. ` 1 Plan Date Number of sheets Revision Date Title s Description of Soil sand I Nature of Repairs or Alterations(Answer when applicable) Septic repair ' Install 3 heavy duty stonepacke iinfiltrators and D-Box Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this jBjpardof Health. Signed Date Application Approved by Date ! Application Disapproved for the following reasons Permit No. .._ .ZIP lD�e Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Domanska Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( X)on by Installer Wm. E. Robinson Sr. , Septic Srv. at 1 S .Tar_kson Ave. . Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. C ated N' Date =La Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. No. � ..•�+ G7 s -------------------------Fee $,5.0.00 _. r,. THE COMMONWEALTH OF MASSACHUSETTS 4` PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Domanska Mi5pozat *pgtem Construction Permit Permission is hereby granted to Wm.E. Robinson Sr. . Septic Srv. to construct( )repair( :�O an On-site Sewage System located at No.# 15 Jackson Avenue Centerville, MA Street and as described in the above Application for Disposal System Construction Permit. No Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. �--� '' 9�'Date: < Approved by Boar of Health ^ TOWN OF BARNSTABLE LOCATION ,4�,1 AGA-J'® Al Al/,�' SEWAGE # la®S O �-130-00 VILLAGE -�"'�T 'fi 1,144Z e ASSESSOR'S a( & LOT INSTALLER'S NAME&PHONE NO. /dl Z, A')B 7 7 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ®L ro!f A- (size) NO. OF BEDROOMS_ 3 BUILDER OR OWNER Q d OAA4�01 PERMITDATE: �P COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 o e v vo5 J Q bk '�s y CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I,William E. Robinson, Sr.,hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 15 Jackson Avenue, Centerville meets all of the following criteria: * There are no wetlands within 300 feet of the proposed septic system. * There are no private wells within 150 feet of the proposed septic system. t * The obseved groundwater table is 14 feet or greater below the bottom of the leaching facility. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. SIGNED:AV 1 DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER Al (Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification plot plan,this plan should be submitted). r _ , f t ;_ __ � �� r ,1,�1:, � . ,. j , -_ _ T ' .r-- rune � � - �-�� r / . �l LEGEND N EXISTING CONTOUR (C x 100.98 EXISTING SPOT GRADE Lake Elizabeth `a�y G EXISTING GAS SERVICE LOCUS / 1 / W EXISTING WATER SERVICE IP FND I 1 / Q!) TEST PIT 6 Q. °a o �� 18,45 1 / Q? BENCHMARK o ►1 (( `��`° ° °s 9 S 02'25 30 W 1 13,47 N v o$ + < VENT 40:04'ed9�. '�6,54 14.22 \ co Y ge°°" o y \ 40' 0f�6 - + . . . . Crai villa `� c\--- --'�117,43 01' 15.44 ;\ ° y �r ----``------------------- 1 TP-2 \ cruiGVILW eFAcn NI P� OSED S.A.S. ( \ f_ ------ ____-- TP-1 EXISTING S.A.S. LOCUS MAP i�_�o \ �+ +14.91 � TO BE ABANDONED GENERAL NOTES: NOT TO SCALE SPIKE 15,9 x 14 15,49\\ \ } DISTURBED PARTS TO 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL P� NQ9 I BE REMOVED BOARD OF HEALTH AND THE DESIGN ENGINEER. 0 \ 17.88 PORCH \ f N, 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS \ ON BLOCKS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE _ 18.29 TBM2 DECK 1 1 00 LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 7BM.-2 18.93 xl 1 1 co •- / -310 CMR 15.405(1)(b): CONTENTS OF LOCAL UPGRADE APPROVAL CORNER/STOOP i ,21 1 1 go / 1) A 3' variance, pump chamber to cellar wall, for a 7' setback. EL. 18.93 18,45,' x 2 A 1' variance to the 3' maximum cover requirement, for 4' of = 1 -• cn'� ) WALK + O cover over the pump chamber. 8,50 . SEXIST/NG 15.17 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE \ x 19,38'- HOUSE(#43) x 15,5 / EXISTING SEPTIC TANK DESIGN ENGINEER. GARAGE ` ,TOF=18.96 87 / TOP OF TANK, EL.=1 1.54 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION .DIFFERING CELLAR FL=12.04 / INV.(OUT), EL.=10.21.E FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN C))', ! ENGINEER BEFORE CONSTRUCTION CONTINUES. BM- 5. ALL ELEVATIONS BASED BARNSTABLE G.I.S. DATUM±. '7 .2 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF r( O� 18,19: �j�IPI K �' 1 1t THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF .°:,'18,30 "' ',.' ..'. :• 11 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 18,43 x\ PROPOSED 13,8 7• WATER SUPPLY PROVIDED BY PRIVATE WELL.:• 17.81 \ 8. THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE PROPOSED S.A.S.. PUMP CHAMBER 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 18,36 , t / DIRECTED BY THE APPROVING AUTHORITIES. .._r. �:::: :•Oft�l1!EtNAY:�•�: 1 LOT 10� / �x 11,81 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 1 MBLU 226-1 30-00 CONSTRUCT OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 1 + 12. 1 13,422tSF 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 1 •�' / G) x 12,39 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND' 16,96 REPLACE E LACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 1 17,39, 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE •;; x 611 1 .:.\•., ::;. �c�Q' 13.33 INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. N 15 13. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED EXISTING 1 07 13,95\ SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. ,18.33•, 17,36 overnent _ 14. CONTRACTOR SHALL TAKE ALL NECESSARY PRECAUTIONS TO MAINTAIN THE �. P TDB s o OP THE STABILITY OF ADJACENT STRUCTURES AND RETAINING WALLS. • 18,1 edge 1 jrj TOP CTR..�STOOP 15. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND O F Mq ,, T U Y 16.83 ) ICI EL.=15.72 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY, PETER T. AV 1 18,69 0 N PROPOSED SEPTIC SYSTEM UPGRADE PLAN � McENTEE � �� CIVIL 19.02 C 43 JACKSON AVENUE, CENTERVILLE, MA No. 35109 '( /, �'£GISZER�`� ��� �J P Prepared for: Lev Vernovsky, 20 Temple Street, Newton, MA 02465 F t E \� OWNER OF RECORD Engineering by: SCALE DRAWN B. No. ten/ FLOOD ZONE DESIGNATION VERNOVSKY, LEV & INNA Engineering Works, Inc. 1"=20' P.T.M. 130-15 z 1\ o NON-HAZARD 20 TEMPLE STREET 12 West Crossfield Road, Forestdale, MA 02644 DATE NEWTON, MA 02465 CHECKED SHEET N0. (508) 477-5313 4/27/15 P.T.M. 1 Of 3 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 15.5 FOR A DISTANCE OF 15' AROUND THE PROPOSED PUMP CHAMBER PERIMETER OF THE S.A.S. PROVIDE RISERS WITH FRAMES & COVERS OVER PROPOSED D-BOX PROPOSED S.A.S. EACH ACCESS MANHOLE AND SET TO FINISH GRADE. INSTALL WATERTIGHT RISER, AND INSTALL A 4" DIAM. INSPECTION PORT„ PERFORATED IN MANHOLES BROUGHT TO GRADE SHALL BE SECURED COVER SET TO WITHIN 6" OF S.A.S., SOLID ABOVE THE S.A.S. WITH SCREW CAP WITHIN TO PREVENT UNAUTHORIZED ACCESS. RISER OVER FINISH GRADE. 3" OF FINISH GRADE CHARCOAL VENT PUMP SHALL BE 4' DIAMETER WITH AN ACCESS F.G. EL.=17.2 TO 18.2t LADDER. F.G. EL.=17.2f MAINTAIN 2% GRADE MIN. OVER S.A.S. F.G. EL.-15.8t F.G. EL.=11.5t PROVIDE ENOUGH WIRE (EXISTING) SLACK TO REMOVE PUMP L - 8'(MAX.) 12' x 40' LEACHING FIELD W/2-4" ® S=1 , (MIN.) SCH 40 PERF. PVC DISTRIBUTION LINES 2" SCH 40 PVC 4"SCH40 PVC C 0 S=1% (MIN.) TOP, EL.=12.00; THRUST BLOCKS 8' 6" EFF.DEPTIIMSLMOPFOF SOIL LOG 4"SCH40 PVC AT ALL BENDS s PERF. PIPE = 0.5% I INV. EL. t0., INV.=15.45 INV.=15.28 40' EFFECTIVE LENGTH =(END) DATE: APRIL 9, 2015 (REF P#14654) WA 5:: PROPOSED (END) SOIL EVALUATOR: PETER McENTEE PE(SE#1542) D-BOX INV.=15.20 SOIL ABSORPTION SYSTEM OFILE) WITNESS: DAVID STANTON RS HEALTH AGENT INV•=10.00 LOAM & SEED AREAS OUTSIDE DRIVEWAY FOOTPRINT ELEv. TP- 1 DEPTH ELEV. TP-2 DEPTH RESTORE STONE DRIVEWAY TO ORIGINAL CONDITION2 FLOATS t4.9 011 15.4 0XIS NATIVE FILL OVER S.A.S. 13 9 FILL 12„ 14.1 FILL 16" BOT., EL.=5.92 FINISH GRADE INV.=10.21 t ALOAMY SAND ALOAMY SAND EXISTING 500 GALLON PUMP CHAMBER EL.=10.6t 10YR 4/2 10YR 4/2 (FIELD VERIFY) (H-20 RATED) 13• 16 20" ACME-SHOREY PRECAST (PCR55) <"` " .�'•• ":.: .•"•r s " 13•7 B B NOTES: (See Pump Detail, Sheet 3) BREAKOUT ELEV.=15.70 LOAMY SAND LOAMY SAND 10YR 5/8 10YR 5/8 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BOTTOM ELEV.=14.50 12.7 C 26" 12.9 C 30" INVERTS, PRIOR TO INSTALLATION. PERC 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING 3 6 3' ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL MED. SAND MED. SAND 22"/40" STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5 (MIN.) ABOVE G.W. 12 EFFECTIVE WIDTH 2.5Y 6/6 2.5Y 6/6 3) INSTALL INLET & OUTLET TEES AS REQUIRED, BOTTOM OF TP., EL.=4.9 SOIL ABSORPTION SYSTEM (SECTION) 4) CONTRACTOR SHALL INSPECT EFFLUENT FILTER ON ESTIMATED HIGH GROUNDWATER N.T.S. 7.0 ADJ. G.W. 7.0 ADJ. G.W. OUTLET TEE AND REPLACE IF NECESSARY, LIES BELOW EL.=7.0 3/4"-1 1/2" DOUBLE WASHED STONE 5.4 STG. G.W. 4 114" 5.4 STG. G.W. 114" SEPTIC SYSTEM PROFILE NOTE: "C" HORIZON IS ESTIMATED 2" LAYER OF 1/8"-1/2" 4.9 120" 4.9 126" AT EL.=15.0 AT LOCATION DOUBLE WASHED STONE STANDING G.W. AT EL.=5.4, USE INDEX WELL MIW-29, ZONE B N.T.S. OF PROPOSED S.A.S. (OR APPROVED FILTER FABRIC) WATER LEVEL=7.3 (MARCH 2O15), ADJUSTMENT=1.6' ESTIMATED HIGH G.W., EL.=7.0 DESIGN CRITERIA � ' _ PERC RATE 2 MIN/IN. ("C" HORIZON) NUMBER OF BEDROOMS: 3 BEDROOMS C'4 1 PROPOSED S.A.S. I 2> SOIL TEXTURAL CLASS: CLASS I 1 I ________ I R, NOTE: "C" HORIZON IS ESTIMATED DESIGN PERCOLATION RATE: <2 MIN/IN (0.74 GPD/SF) 22.6' AT EL.=15.0 AT LOCATION OF DAILY FLOW: 330 GPD � � PROPOSED S.A.S. (VERIFY). DESIGN FLOW: 330 GPD ' 3S �o PORCH GARBAGE GRINDER: NO 6'• ON BLOCKS EXISTING SEPTIC TANK: 1500 GALLON CAPACITY Q, DECK PROPOSED PUMP CHAMBER: 1000 GALLON CAPACITY (H-20) PROPOSED D-BOX: 1 INLET, 3 OUTLETS, (H-20) LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF.74 GPD/SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN ��i 12' X 40' LEACHING FIELD W/2 DISTRIBUTION LINES OUSE(#4 43 JACKSON AVENUE, CENTERVILLE MA TOF=18.96 RAG ��'ELLAR,FL=12.0 Prepared for: Lev Vernovsky, 20 Temple Street, Newton, MA 02465 SIDEWALL AREA: (NOT APPLICABLE) /GA BOTTOM AREA: 12' x 40' = 480 SF Engineering by: SCALE DRAWN JOB. N0. TOTAL AREA:................................................ .480 SF Engineering Works, Inc. N.T.S. P.T.M. 130-15 DESIGN FLOW PROVIDED: 0.74 GPD/SF(480 SF) = 355.2 GPD S.A.S. LAYOUT 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 4/27/15 P.T.M. 2 Of 3 NEMA 4 JUNCTION BOX CORROSION RESISTANT & LIQUID—TIGHT CABLE CONNECTORS SUPPORTED PROVIDE WATERTIGHT CONCRETE RISER WITH BY 1-1/4" PVC CONDUIT. JOINTS TO BE MADE SECURED FRAME & COVER TO GRADE WATERTIGHT. USE SJE RHOMBUS—JB PLUGGER OR EQUAL. PROVIDE ENOUGH WIRE SLACK TO REMOVE PUMP INSTALL 1' PVC CONDUIT TO HOUSE FOR WIRING 61 HOISTING CABLE 7x19 STAINLESS STEEL WITH WATERTIGHT JOINTS. WIRE HIGH WATER ALARM 1/8" DIAMETER. / 1,760 LB. STRENGTH. FLOAT TO SJE RHOMBUS TANK ALERT XT ALARM PANEL �L ON CIRCUIT SEPARATE FROM CIRCUIT TO THE PUMP. i INV. IN =10.00 2" BALL VALVE (FIELD ADJUST FOR 20 GPM RATE) (INSTALL QUICK DISCONNECT FOR EASY REMOVAL) \ 2"SCH. 40 DISCHARGE (THROUGH RISER—SEE PROFILE) -1 1-- ALARM ON EL: 8.59 -- 2" 90' ELBOW W/ 1/4" WEEP HOLE t r- PUMP ON EL: 7.75 FOR SELF—DRAINING FORCE MAIN \ PUMP OFF EL: 7.25 24" 2" SWING CHECK VALVE BOTTOM OF 14" -1-7 24" DIAM. OFFSET OPENING 8„ PUMP CHAMBER 2 SCH. 40 PVC DISCHARGE 'PIPE ELEV.= 5.92 ADDITIONAL 3/16" VENT HOLE (MIN.) ABOVE PUMP FLANGE PROVIDE 2 FLOATS: 8 (TO PREVENT PREMATURE PUMP BURNOUT) FLOAT NO.1: PUMP ON/OFF—POLYLOCK FLOAT PROVIDED WITH PUMP POLOO FLOAT NO.2: ALARM ACTIVATION FLOAT—PROVIDED WITH ALARM PANEL WITH 2 CK CHARL—EF 05W PUMP .5 H.P. 115 V (ON SEPARATE CIRCUIT FROM PUMP SPECIFIED) WITH 2" DISCHARGE, OR EQUAL I I I PUMP CHAMBER, PUMP & ACCESSORIES AVAILABLE AS A UNIT ACME—SHOREY PRECAST CO., HARWICH, MA. (508) 548-9607 ^ I I NOTE: APPROVED ALTERNATE MAY BE SUBSTITUTED. I I PUMP DETAIL I I I I a J-------J 00. -6'� r OUTLET(TYP �F4" BUOYANCY CALCULATIONS 4" TYP. —�-I �— H-20 MONOLITHIC 1000 GALLON PUMP CHAMBER ITEM # PCR55 BOTTOM OF UNIT EL.= 5.92 SPECIFIED WEIGHT=11,795 LBS. FORCED INLET O 1122.5" HIGH GROUNDWATER EL.=7.0 (ADJUSTED) H-20 22' CAL TEE ?: BUOYANCY FORCE PER FOOT OF DEPTH: 9,5" 11.5 3.1415' x 3.0' x 3.0' x 1' x 62.4 lbs./cu.ft. = 1764.3 lbs. NOTES: • ' MAX. DISPLACEMENT= 7.0 — 5.92 = 1.08' MAX. UPLIFT PRESSURE = 1.08' X 1764.3 Ibs/ft = 1905.4 lbs. 1. PUMP CHAMBER SHOWN IS AS MANUFACTURED BY ACME—SHOREY 4' PRECAST CO„ 36 GREAT WESTERN RD, HARWICH, MA 02645 WEIGHT OF UNIT EMPTY= 11,795 Ibs. (INCLUDING TOP) 4" GRAVITY OUTLET(TYP.) 11,795 Ibs > 1905 Ibs O.K. PLAN SE TTION DOSING & STORAGE. REQUIREMENTS H-20 PRECAST 500 GALLON PUMP CHAMBER N.T.S. NOTE: BOTTOM OF TEE SHALL NOT DESIGN FLOW: 330 GPD EXTEND BELOW FLOW LINE. DOSING REQUIRED: 4 CYCLES/DAY (SAND) 330 _ 4 = 82.5 GALLONS/CYCLE BETWEED—BOX SHALL HAVE H-20 RATING ONT AND EPU PUIRED OFFF FLOATS: PUMP PROPOSED SEPTIC SYSTEM UPGRADE PLAN DISTRIBUTION BOX 82.5 GAL/CYCLE - 147 GAL/FT = 0.56 FT/CYCLE (SAY 6") 43 JACKSON AVENUE, CENTERVILLE, MA STORAGE REQUIRED ABOVE WORKING LEVEL: 330 GALLONS STORAGE PROVIDED: Prepared for: Lev Vernovsky, 20 Temple Street, Newton, MA 02465 INV.(IN) EL: 10.00 — PUMP ON EL: 7.75 = 2.25' Engineering by: SCALE DRAWN JOB. NO. STORAGE PROVIDED = 2.25' x 147 GAL/FT = 330.8 GALLONS N.T.S. P.T.M. 130-15 Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 4/27/15 P.T.M. 3 of 3