HomeMy WebLinkAbout0025 JOYCE ANNE ROAD - Health 25 Joyce Anne Road
Centerville
A= 209-113
S M E A D
No.2-153LOR
UPC 125U
smsad.com • Umb In USA
OF UE SR PROGRAM
lid IKfD N 11�l�p11CT I!E
CERTiFiED
SOURCING M WW-Fig9GRVAAW
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�a
M 25 Joyce Anne Rd p v
Property Address
Oct
Drake
Owner Owner's Name
information is Centerville MA 02632 6-20-17
required for ,^^
every page. Cityrrown State Zip Code Date of Inspection f""7
e;;yh
Uri
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: A. General Information C/
When filling out C514
forms on the
computer,use 1. Inspector:
only the tab key
to move your DOUGLAS A BROWN
cursor-do not Name of Inspector
use the return
key. D.A.BROWN INC
Company Name
P.O. BOX 145
Company Address
(( � CENTERVILLE MA 02632
I ram City/Town State Zip Code
508420-4534 S14297
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
Qwjoek C, 6-20-17
Inspector' Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority. �f
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
&nzd VS
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 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:
At time of inspection system met all passing requirements. This report can not predict the future
performance under the same or increased use.
B System Conditional) Passes:
Y Y
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,. 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,. 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. Citylrown 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 cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M y 25 Joyce Anne Rd
Property Address
Drake
Owner Owners Name
information is required for Centerville MA 02632 6-20-17
every 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-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 16,000 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
G M 25 Joyce Anne Rd
Property Address
Drake
Owner Owners Name
information is required for Centerville MA 02632 6-20-17
every page. CityrFown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
❑ ® Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. Cityfrown State Zip Code Date of Inspection
D. System Information
Description:
This system consists of a septic tank d-box and 3 bedroom s.a.s of biodiffusers
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ❑ No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ❑ No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
House has been vacant for some time ( Minimum water usage )
Sump pump? ❑ Yes ❑ No
Last date of occupancy: Date
Commercial/industrial 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every 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:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every 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:
9-23-10 per as-built
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 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.):
Septic Tank(locate on site plan):
Depth below grade: 1.5
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:
1000 gallon
Sludge depth:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M , 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. Cityrrown 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
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
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
If tank has not been pumped in the last 3 yrs I recommend pumping at time of inspection and every 2-
3 yrs there after for maintenance.Tank is under the deck(There are hatch doors for access.)
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M , 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. Citylrown 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
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. Cityrrown 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.):
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.):
*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:
15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 16 High caoBiodiffusers
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Biodiffusers were dry at time of inspection
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
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M , 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. Citylrown 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
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: greater than 5
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: 6-19-17
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Assessing As-Built Cards Page 2 of 2
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4 h t 25 Joyce Anne Rd
Property Address
Drake
Owner Owner's Name
information is required for Centerville MA 02632 6-20-17
every page. Citylrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=209113&seq=2 6/19/2017
Assessing As-Built Cards Page 1 of 2
TOWN OF BARNSTABLE
OCATION 25Joyc�il.t�se 1+2c� SEWAGE# :2010".3£i3
VILLAGE C_&4W D e+ ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. Doph 1Jf�ww3Nc
SEPTIC TANK CAPACITY I0Q0 C tstt Na
LEACHING FACILITY:(type)'3; W jAg5 Fl-20 (size) tl.3Jl 2S
NO.OF BEDROOMS
OWNER Tlfa�,°
PERMIT DATE:_y� 1 LI(�_ COMPLIANCE DATE: 23
Separation DistanceBetweeneenthe: learn Rfl-oo
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Abe 0�011r j j j 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
4 s A 1-31
z yl
�! Ow CA y 3-Y2
Q ioc�iE'4tr�rs
),eft �r9 3
?k.,a(or 7- TI17
5sty)e�i'te irk
usr
8 3-.25
Det-L �f'SI
(� 7_6q,I
http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=209113&seq=2 6/19/2017
No. rd/v � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION, - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for Oigooal 6potem Conotructton Permit
Application for a Permit to Construct( ) Repair(0--*,"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
/ Location Address or Lot No. ?5-C 0y(C-A-V V r J�� Owner's Name,Address,and Tel.No. "D(a lce
Assessor's Map/Parcel 2 O e:( - 1 11 1
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
1�i9�7$lG5 A Zfow;j Z JCy EN-yy.v�ea«v� l..�pQk� sc��3-'�77'�3i
�c5�3*�l�^'"71
Type of Building:
Dwelling No.of Bedrooms Lot Size I tiC�r 1C, sq.ft. Garbage Grinder ( )
Other Type of Building hKo j%° No.of Persons -Z_ Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.re uired) '3. '7 0 gpd Design flow provided 3 t/7 , t3 gpd
Plan Date a 7 N,,, Number of sheets '4__ Revision Date
Title
Size of Septic Tank e.N i S'Irtcye I oe3t) Type of S.A.S. 14 `2 a •3 ior)A
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Date
Application Approved by Date
Application Disapproved by: Date
for the following reasons r
Permit No. 15/V r'�4 Date Issued Q
No. O/`'" , 't t Fee 00
1
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION = TOWN OF BARNSTABL�, MASSACHUSETTS Yes
2pprtcatton for Mts;paar *p5tem Con5truction Fermat
Application for a Permit to Construct O Repair(01010`Upgrade(- Abandon( ) ❑ Complete System ❑Individual Components
/ Location Address or Lot No. S 67i:e--4�MNN Ro Owner's Name,Address,and Tel.No. Z fc i(c
Assessor's Map/Parcel cl)C? - 9 1 `�
Installer's NaaieLAddress,and Tel.No. Designer's Name,Address and Tel.No.
1fv0 C i�ivU,rj J. tic GN�j1iJP!�r DNS WcIV5 - e-06-977- 53! 3
Type 446ilding: m
Dwelling No.of Bedrooms Lot Size 1 S,2(,,S sq. ft. Garbage Grinder ( )
Other Type of Building h p J S C No.of Persons '?_ Showers( ) Cafeteria( )
h Other Fixtures „lt
Design Flow(min.required) '3.`�,® r', � gpd Design flow provided 3 '-/7 JR gpd
Plan Date 43 i ,7 4 ) i a `" Number of sheets 'L,, Revision Date
Title u
Size of Septic Tank t r ¢ 1 oexp Type of S.A.S. -2(7 1 S i n C' A `fir,rrC, 11 )(9.'s d
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) (Or,I C-1 A1ru.) d,
i"
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 tF Date f14 ill 0
Application Approved by ;_« �r- G :'h Date
Application Disapproved by: T Date
f
for the following.reasons i /"rt,:a . .
Permit No. 3 Date Issued -/ 9/ 0
- - ------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
r
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired (t''�) Upgraded ( )
Abandoned( )by 5D00.}c `, A 7�(o„t).r.) -.o C
at e 3.E,N r( <G Am—0. (� C�?61 r(tl, ?ra has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. Pom '9�_ dated / 6
InstallerJ o* A ':)to jinj I r�r Designer
#bedrooms ~` Approved design flow q 7, 8 gpd
The issuance of this permit shall not be construed as a guarantee that the system wi u do as �signed.
Date #4 t//U Inspector
I
------- Fee -------
No. �G J� v_
THE COMMONWEALTH OF MASSACHUSETTS / G/
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
�E Mi.5p gal Q praem Co`ngtructton Permit
Permission is hereby granted to Construct ( ) \Repair Upgrade ( ) Abandon ( )
System located at ? 5" JONiCr9A"iIU �(� *.1h -(�� ,P
t
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of
Date 9 `, I Approved�%y
�.�
09/24/2010 07:11 5094775313 ENGINEERING WDRKS PAGE 01
Town of Barnstable
itaWittery Services
Thomas F.Caller,Director
Public Health Dlvbion
Thomas MWear,Director
200 Main sty gam*MA aMI
Office: 508-862 4644 Fox: 508-790-6304
Date: 4 "�3 l C wage Permit# Assessor's Map/Parce! 7'09—!/'3
Designer. ��►��r+>� c�?•ovt�s �n Installer: p.A, 1 r�ru�r� ! c
Address: YL W- Crt-f S43z k cA ?-8k Address: . f3�e� !K 5
on
. rain t n c was hued a permit to install a
c) — ( er
sqmcustm at ye A n" Al 6-6%J- based an a design dream by
(address)
ficf`T: i�'1 Cr&rA E dated y��o
�
er
I certify that the septic system referenced above was installed substantiallyy according t4
the design, which may include minor approved changes such aS lateral relocation df the
distribution box and/or septic tank. Stripout (if required) was ins Mtcd and the soils
were found satisfactory.
I ceY'tify that the septic system referenced above was installed with major chaps (i.e.
Venter d= 10, lateral relocation of the SAS or any vertical relocation OfWY oompancnt
of the septic system)but in accordance with Stye&Local Regulations. Flan revision or
certified as-built by designer to follow. Stripout(if required)was i:}.spected and the soils
auad satisfactory. � 1 VFMgB
PETER r.
OfiRmer gnatWe) , McENTEE
CIVIL
No.3bi 09 9
(Desig= s Signature)- (AfftD8
PLEASE.RETURN TO T
q:bflice Rk��daetpnaestii�tiai t0emaoa
TOWN OF BARNSTABLE
LOCATION 2SJoyce A,)n5e 1Zc� SEWAGE#
VILLAGE C,ck4y,-_ 'At e ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.71):*-5 Al(ow%.N 3W_
SEPTIC TANK CAPACITY 1000 CX tstt,��)
LEACHING FACILITY: (type) ac oWo6e(5 14-20 (size)
NO.OF BEDROOMS '3
OWNER
PERMIT DATE: ClIallino COMPLIANCE DATE:
Separation Distance Between the: I�c�►t Ccz.c h 9`r3.C�
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /\)0 G,0r,*92,L 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 BYu� jlgt�
5 A 1 -31
2` l
�i Rvws ck y 7
s�8
Town of.Barnstable . P# 1
Department.of Regulatory Services
w ?, _ Public Health Division
alp,
,,, .. - D
20o Mail,Street;Hyannis.MA 02601
: '0�o•rrtal� ,
i Date Scleduled y ° Time 4 _
D Fee Pd. :
r
'Soil Suitability assessment for Sewage isposal
Performed '. c�
Witnessed By:: w
LOCATION&"GENERAL IlVFORMATION;.: ✓S
[NE
ion Address �G ,
-°CE A n I�i Owner's-Name<
Aadress 'c�/ vK
�"e.,��-ems✓ l( 1Lk �61
t
sor's Map/Parcei:
. 11�' Engineer's Names
CONSTRUCTION REPAIR
z
Telephone# Jo ^`� �-
Land Use' Slopes(`�) Surface Stones
-Distances`from: Open Water Body _R Possible We Area ZCk ft Drinking Water Well
Drainage Way l ft Property Line ��� ft Other ' ft
S TCI t(Street name,dimensions of lot,exacilocadons.of est "les&:pert t is,locate wetlands'?n proximity to doles)
2 -
l2-e-
��cr
Parent material(geologic) Depth t0 Bedrock.
sU
n /i
Depth to Groundwater. Standing Water in Hote: v/1"� Weeping from R1t Face f�1i C
a
Stimated5easonal High Groundwater c r
DETERMINATION ,FOR;SEASONAL HIGH:
Method Used: a "A
Depth Observed standing in obs.hole: in. Depth to sell mottles:
Depth to weeping from side of obs.hcle: In. Groundwater Adjustment
!ndea Well# Reading Date: Index Well level_-_, -,-Y, Adj.&ctor Adj.. routidwatei evel,,,,e,•
PERCOLATION TEST )pate�, Time
Observation
Hole# 71me at 9"
Depth of Perc Time at 6"
Start Pre-soak Time® t '15me(9".6") _
End Pre-soak
Rate MinJInch
Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Obsmation Hole Data To Be Completed on Back-----------
***If percolation test is to be,conducted within,100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1) week priorito beginning.
Q:ISEPTICIPERCFORM.DOC
DEEFOBSERVATION HOLE LOG Hole
Depth from SoiLHorizon So I Texture. Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
sA
P.
all
DEEP OBSERVATION`HOLE'LQG Hole#
Depth from Soil Horizon Soil Texture Soil Color . , Soil Other.
Surface(in) ; (USDA) (Munsell) Mottling (Structure,Stones,Boulders.'
Consistency
s
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon I Soil Texture Soil Color, Soil Other
Surface(in.) (USDA) (Munsell)% ' Mottling (Structure,Stones,Boulders.
Consiste&.t*Od*611
- t
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other:
Surface.(tq} (USDA) (Munsell) Consistency,10,13MAD
Mottling (Structure,Stones,Boulders.
Flood,,Insurance-Rate:Map:
Above 500 year flood'boundary No_. yes
Wrthin 500 year°tioimdary No Yes
Within too year flood boundau o Yes
Depth ofNaturally -C01 rine-°Perviois-Material
Does at~least four feet.of naturally occurring pervlons aterial'r~xist'in rllareas observed throughout the
area proposed for the soil absorption system?
If not„wt at.is the depth'of'naturally occurring pervi material?'
Certification
I certify that on- (date);I havepassed the soiltevaluator examinationapproved by5the
Department of thy nmental Protection and that the above analysis was performed by me consistent with
the required tra>ntng;expertise and expenerice>described in 1`0`CMR-15.017
Date
Signature
Q ISEP'I7C�I'BRCf RM.DOC
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
................�'�t ............0F.......... lkiln. ......�........................................
Appliration for Diipusal WorkB Tnnstrnr#ion ratnit
Application is hereby made for a Permit to Construct ('—or Repair ( ) an Individual Sewage Disposal
sYs h
--X-wj -'-•• ...... 3 .........................................
Locaon�ddres or Lot No.
.. .. •••-•-••-•--......................................................................................
- Owner Address
W
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling _No. of Bedrooms_______ _______�9 ...._Expansion Attic ( ) Garbage Grinder ( )
a Other Type of Building _ ,<t'd� o. of
persons____________________________ Showers ( ) — Cafeteria ( )
Otherfixtures ---------------------------------•----------------------------------------------
W Design Flow______________�-�----------------gallons per person per day. Total daily flow................/, .......-..._gallons.
WSeptic Tank Liquid capacity, -- gallons Length................ Width................ Diameter__._____-__-_-- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No------/------------ Diameter____________________ Depth Below�v 'nl�"C Total leachin area..................sq. ft.
Z Other Distribution box ( f) Dosing nk v '� y�7 '
Percolation Test Results Performed by---- ,._. t. _kl.._.................................. Date_..
a Test Pit No. L.. ...........minutes„per inch Depth of Test Pit.................... Depth to ground water........................
f, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground waiter------..................
P4 -••••-......•-••-------••-••-.................. '-/ ----•• ------
O Description of Soil----••....10-.--__•-•-/-.2....I.....?1----......Y� 9__ .- .....................................................
U
..........................................
--------------------------------------------------
__•••.........
•------------------
-----------------------------
•-•---------------------------------
•-------------------------------------------•------•--•------•---••------------•-••---•------•--•----------...------•-----......-•----•-•-----......----•------•-•---..............----.........._..---
U Nature of Repairs or Alterations—Answer when applicable..___':......................................... ..............................................
.................................................
.-•-•--•--=------ ----•---•--•-----•------•-• ........
Agreement a
The undersigned agrees to install the aforedescribed Individual Sewage Disposal-System in accordance with
the provisions of iITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signe • t;l
..... ---•.................. .......----------•-•-----•••...-•-----•••- Date
Application Approved By--_•• L -------------------
Date
Application Disapproved for the following reasons:................................................................................................................
......................................................-..................................................................................................................................................
Date
Permit No......................................................... Issued-_::__--�" �---. ........................ .
Date
No'` _ v f f ' e FEs......''4. ......." ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........".... ... ... ... .
ApplirFation for Disposal Works Tontrurtion Prrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
_
SYS" ..... ._... . --- ..........................................
Location-Addresvr
or Lot No.
.. ...:!! -- L... .............................................................----•-............................._
Owner Address
a .._...... '................................................................. ....•----•------------•--•-------•---••-••••.............. .....................................
W Installer Address
Type of Building Size Lot............................Sq. feet
aDwell* No. of Bedroom ____ _jf __`_ __.____Expansion Attic ( ) Garbage Grinder ( )
a
Other.Z--Type of Building oojo of persons____________________________ Showers ( ) — Cafeteria ( )
dOther figu es ••-•-•-•---•-•--•------•-------••-••......••-•----••••--•-•••--••--•------•--•-----------------•---••--•-•---- --•-----................
Design Flow_ ______________________:___.______:_ �gallons per person per day. Total daily flow____.___________���______'___.gallons.
WSeptic Tank Liquid capacity :-_,gallons Length.................,Width................ Diameter---------------- Depth................
x Disposal
Seepage Pit 1No.. .a-o;:'_=:___ Diamete Width____________________ Total Length.................... Total leaching area--------------------sq. ft.
P � -
r_________________`_. Depth belo nl __ tal l chi area..................s ft.
z Ot per Distribution box ( �) Dosing nk � � q
a Percolation Test Results Performed by----�_m_________.i_ _ � ?_ .__......_. Date.... ..__!...... ..
a Test Pit, No. 1.._� --- per inch` Depth of Test Pit____________________ Depth to ground water-------------------:___-
fi, Test Pit No. 2........:..::...niinutes per inch Dept of Test Pit.................... Depth to ground water........................
0 '
Descriptionof Soil---:------�.-----...---1• --.........................- •-•----- ------------ -- ----------"-------------------------••--•--•-------------
x
V ----•---------•------•---•----•------••-•--••-••••---
W -•--•-•----•---------•-•-•-•------------------•-•-•-----------•--••-•-•-----•-----•----.:-..------•------------••---------•-------•----•--••--........................................................
U Nature of Repairs or Alterations—Answer when applicable,........::......:.............:................ ..............................................
- ....................................
Agreement: "' f�« ► ''
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to,place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signe .-••-••--••--•......................................•-••---------••---•--------•••.
^: Da e
Application Approved By........ r •-- r-- ` '
Date
Application Disapproved for the following reasons:..............................
r4 ;
I
_________________________________________________________________________________________________________.._..___..._._..._______._____________.______________.____._........_...........__..._.._.......
Date
PermitNo....................................................... Issued..........................................-.........-
Date
THE COMMONWEALTH OF MASSACHUSETTS
i
BOARD r HEALTH
(Irrtifiratr of Toutplianrr
TH IS4TCEIF#+' ,That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
In 1.1er
r w :'
by ,.. ---
at.
�yy�,i� t
has been installed in accordance with the provisions of T T 5//o TI}e ate Sanitary Cpde as described in the
application for Disposal Works Construction Permit No._ {_1Q...y............ dated._ ,. ._'. _ __--j---_.1i.;T�...
THE .ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. F
DATE........................................:........................................ Inspector........................................... ........................................
THE COMMONWEALTH OFMASSACHUSETTS
BOARD OF HEALTH
1f ..........: ...OF............ ..... . .:--••--•...:............................
No...........f.. ....{.!. FEE........................
�iu�ruuttlr �uo ion "anti#
r" Permission i ,hereby granted............ S�..._ r��1""
� `
to Const 9t Re air an In di u Se aye Di al S
at No. � ( ) l 3, P d' . _ t� ...........................
Street
as shown on the application for Disposal Works Construction Permit)-No..�_tO- ..__.... Date
............................ .......... •. - '�'__..::::, ....
Board of Health
DATE............._. ...............................
FORM 1255 HOBBS.& WARREN, INC.. PUBLISHERS
Gym .
4. CATION SEWAGE PERMIT NO.
L AG E
O--Py, ler� / � �F
lINSTA LLER'S NAME & ADDRESS
/arc Ca11S' %
BUILDER OR OWNER
I 'a er S' I'd a Cate s /
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
r
�� �*
a
°L
� ro
� � . .
-�
S�
�y i
..
al
t >sao FB'7;--" Ar ;
. `6'� � k,••}}a,k.`wiy j. f f}s '� - ... ' � V�f• � .l.a A4
} ,P��hi,yy �i ��,; ♦ ''1`\'•'!aO•� , Y # ,. �t � , r a .. / S' A
Lo `
R
•I �' ' k+'' * •v A/.�'/ :
o�/A\ M� ,7'9
1,
FMIVV / k. �o• �.� _ _
r ,� s}, Ploy . %c y,,,`� ;x '�� ��w/ ., 1 f• _ •
LQ/.7 r �1
OA3 jai , �03' \ \ ♦ T/'..
4 Y��� y�'y'� •�(;FJ• t Y� i� a \ t //y / L . `�t� U L T
PEA T Oi2D5
, ex 4 ti D,-9 Tc 978
Z3 L E /AIS�? Pi9lJL M�//QiQ�Yr .
-.
M / n// r'/ U/"l, ,BOIL DI/V'G SeTBAC�! ,EE�Uc �'e ENTS ,
D R / t I.�%�1'y' , C> T T o 13.E O C T E D <. -
D V E R S E k/Ei 12 F7 ' S,Y S 7_E
N ` ,4-• 0 � D /NG %5 USED P,�Q1ooSED LEACH f�,� EA 2Oo Je
SEP? /e ,^fS"°F'E M: COn/ST72 UCT/ ON` :SHAD- pE ,�COL AT./OnJ TEST
E n/ V% O nJ M E N 7T f� - M/A/./ //V C'H
TULy 1, /97'7 .IgIVD 7-06✓/N OF
$/LL E� EV. TO 8E 7 "" F7 f380V r eD.
�-- O F l p e H �.. R ,L z �o M F/ S NF D
i TOP OF�•7QQ`�JF'OSE D G.eH DE ..A£�O vE
FoUNDc�T/Qd,G�. `/04.0 : \/ ac �9ec�
z / !`7F'c2V/GNUS "0 Vc'�
MP.NH0,C.E4 CO,VERro EXTEN o D T' 7-0 ?�2EVEn/7 O 1-7 /IVF/47,2 r9T, NG ,
/O'M/N/M U1',—l'- STONE' Z ' 0 = /g' TC -
' C'OVE25 CO vE,e'
80X `,� ��'!✓<a� AFL ,9.2o cJ�/D
Pf'7CH FFL01./ L)NE MIAJ! PIT
1�Y .-r/`F .. ""/�p,!"M/�/•04 O s � " ZM/mil PiTH ` L JOQN 31e4
- �2
D!A
FOcn ,Q.WAsNE2)/¢ Poor L Oool= M / sTo ni
"
lAl
_ E
i^!V�,er
sSEPT/42 7 t jK r 970 9G.SS
/kV R7-E e-rl6 NTI /nl VE eT (. /N V6977 L Ef�C N
%n/VE,e7-
s
< r s 'V ' .4i+ a• ZO` M/N/M U , I 4 / I / +3 p "4 7,. T'O moAX4 '
?,s Q J� -G,4?OUND WhTF,2 6Le V. �
07
L D C A ;7-' / CQ N,�:..,Y . iRN`STf�BL.�'
RONALD
$ C L E • .D� DFAARTHUR
7,E: /9�/�/L. "� �Y78 � G FFORD
' Sf-/0WN y
E F F_Fe c N C E �'E/N LOT /3 f�S• No.603
t=;' r
Off/ A PL Fq/V. - j 'C0 of;?'D "E D /N THE Bf��nl- 9FGISTER��
O F D E E D5 SgNIT gR1PN
i STABLE 'OClNTY �'.EG ISTY .
-
PT/ C TA !V K 7 23 E
O ,e U/-A UNa/1H�!—
-
/" ? N D L E F-/ 0 / T S .
9eor9Ce, C'0�AJ - � EfACH/NG P/ TS .y BE FA 1'71A.1
P R O PERT,}/
�J
'/ itj n T/C T 'T,�
l D/V:7-f( Ee( t N D� A/D
S H O ✓ N P,v'n•/,{`1`'T'f� l S L
ON THE Q F�a D Fa S S H o l�/!v' N E �On1 ', GEORGE
AND �r?`3~= %f'7T t ' ,p0�'S' G' Ql`JFO�-'/�1 � �ow• �R. DATE T/ 7-4E — — — — .
TO THE ' °L/µx D / ^/G SET;29F� CK .",�EQU/��- yt'
1-7 E_ 7-S F FQls
j H. N O F iQ STiQ'B '� �' S���E�� DATE
SU
B O..g Fe D F
E
I o N ACTH
DfATE' ' =72EG'. L F/ N, ' � VE O �
R
--98-- EXISTING CONTOUR Ra
i
x 100.98 EXISTING SPOT GRADE S 283 43r' 0- E ova PpS N y�
®44 PROPOSED CONTOUR °83.3T °
-yy EXISTING WATER SVC. , ec
v r
,
-G EXISTING GAS SVC.
m
-U UNDERGROUND WIRES i� LOCUS 6 Sf"�
19 TEST PIT !
! fO, 5ti
BENCHMARK o i II--11,3'
t
1 ! ........rT.1T.t... ,45 B,
LEGEND 1 edge of laws 102,20 ,► + 1 a
It +'1.00,89 4-� TP-1
1 ! 1 -too, 0
EXISTING LEACH PIT
\�. \�� : FLAGPOLE ;! 1 INt�/11 ��
TO BE PUMPED, FILLED W/ 1\ 100.99 !! 1 1 Ir^1 1
SAND AND ABANDONED x I: i + 1
11 LOCUS MAP
96.76 i : m ; t `1 i ' 1 NOT TO SCALE
102,47
f o ! ; : ! + ; EXISTING SEPTIC TANK
€ ,oe j 04
10 ,� 102��5 x i (INSTALL ACCESS HATCH ON DECK)
Q 102,05 N �- 102,47 TOP OF TANK, EL.=101.61 f
I ,� Ix INV.(OUT)=100.28f
� j I I
"r A
t+Z CD; o+ 100.46 DECK 102.68
_" _ BENCHMARK SET
t o�11�9 1 1 1 102.101 0 TOP OF CONCRETE/OUTSIDE
1 + t )x DEi BM + CORNER OF BULKHEAD
+ uo + i O t02,7 x 1Q2.49 EL.=102.76 (ASSUMED DATUM)
+ to t 102.55
t
x 99)2e 2.31 z
tl 1 101.39 ! cJp
11 l00,5� x EXISTING w
+ HOUSE(#25)
++ 9 7.18 t1 GARAGE T.O.F.=103.4, r''
x
I * �00,45
+ 102 3
102.11
t 1 1�1,83
WA K + 102� 6
1 'Ott li i 10 L.8 •
+
9 .4 +t 102.56 103.13 • G
+ :� + 1 + +
100. 7 101,43\
I 1 LOT 14:
APN 209'• 1-1-3--
18,269S.F.
100,70 \�\ '. 02.90
X
Nj
L MP
' 95\03 101.73 v�\
j � K `°�'.102,78
(t I 94,�3 ( 90.51
\ :+ 95,03 99.07 \
cP 0 ,42 -- --� ---
+ x 97.1 ��- 0 '
,edge 93�g2 100,69
�c \ 16 00.59
76 15\
`\ � � - 00, 100,00
�.� O 99,79x --- -Kt
9
�` \ \95, 7 96,65-- . sidewalk 99,21
nt/c
90.39 ' - `�- of Pavemeurb ^ D
94,54 edge RO
GENERAL NOTES: ANNE
�0 yCE
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF HEALTH AND THE DESIGN ENGINEER.
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS.
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES. ���` OF MASS9
5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF o PETER T.
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF WEN TEE
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. o� CIVIL "
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. No. 35109
8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. OWNER OF RECORD
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS DRAKE, SHERMAN F & DOROTHY
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 25 JOYCE ANNE ROAD
DIRECTED BY THE APPROVING AUTHORITIES. CENTERVILLE, MA 02632
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. PROPOSED SEPTIC SYSTEM UPGRADE PLAN
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 25 JOYCE ANNE ROAD, CENTERVILLE, MA
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE Prepared for: D. A. Brown, Inc., P.O. BOX 145, Centerville, MA 02632
INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. Engineering by: SCALE DRAWN JOB. NO.
13. ENGINEERING WORKS, INC. IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED Engineering "=20' P.T.M. 187-10
g Works Inc.I
SEPTIC SYSTEM COMPONENTS THAT MAY EXIST ON THE PROPERTY. nc•
14. USE OF EXISTING TANK IS SUBJECT TO AN OFFICIAL TITLE 5 INSPECTION 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
STATING THAT THE TANK IS STRUCTURALLY SOUND WITH NO LEAKAGE. (508) 477-5313 8/24/10 P.T.M. 1 Of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL:99.3
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT
T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE
EXISTING F.G. EL: 102.3(MAX.)
F.G. EL.=102.7t � F.G. EL: 102.3t
MAINTAIN 2% GRADE (MIN.) OVER S.A.S.
L = 24' L = 8'(MAX.) INSPECTION
S=1% (MIN.) ® S=1% (MIN.) PORT
4"SCH40 PVC 4"SCH40 PVC
6"
10"I a 11.3" TO
14" INVERT
EXISTING 48" LIQUID I I
LEVEL
GAS ADD
INV.=99.67 PROPOSED INV.=99.50 r4 ROWS OF 4 UNITS AT 6.25'/UNIT
,. INV.=100.28t D-BOX INV.=98.94
EXISTING 4 OUTLETS (MIN.) SOIL ABSORPTION SYSTEM (PROFILE)
EXISTING SEPTIC TANK
ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
` NOTES: BREAKOUT EL.=TOP EL.
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP ELEV.=99.33
INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=98.94
2 D-Box SHALL BE SET LEVEL AND TRUE TO GRADE
BOTTOM ELEV.=98.00
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED 2.83'
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF
T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3
3) INSTALL INLET & OUTLET TEES AS REQUIRED. '
EXISTING SUITABLE
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM OF TP, EL=92.3 -_ MATERIAL
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL.
4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS
WITH NO SEPARATION BETWEEN EACH ROW & NO STONE
SEPTIC SYSTEM PROFILE TYPICAL SECTION
N.TS
N.T.S.
SOIL LOG 21" 6-4EAL
"
2" 2" 1
DATE: AUGUST 23, 2010 (REF#13,029)
SOIL EVALUATOR: PETER McENTEE PE
WITNESS: DAVID STANTON R.S. i HEALTH AGENT <vELEV. TP- � DEPTH ELEV. TP-2 DEPTH o
00
102.3 0" 102.3 0"
A A
SANDY LOAM SANDY LOAM
10YR 4/2 10YR 4/2
102.0 B B 4" 101.8 6" N Top View D-BOX Section
SANDY LOAM SANDY LOAM
10YR 5/4 10YR 5/4
99.8 30" 99.6 32"
C1 C1
M-C SAND M-C SAND 75"
2.5Y 6/4 2.5Y 6/4
20% GRAVEL 20% GRAVEL
96.3 72" 96.3 72"
C2 C2
M-C SAND M-C SAND
2.5Y 6/4 2.5Y 6/4
5% GRAVEL 5% GRAVEL
92.3 120" 92.3 120" w 76" `I
PERC RATE <2 MIN/IN. ("C" HORIZONS) PROFILE
(TOWN RECORD)
NO GROUNDWATER ENCOUNTERED
16"
11
I► 34" ►)
DESIGN CRITERIA SECTION END CAP
NUMBER OF BEDROOMS: 3 BEDROOMS 16" HIGH CAPACITY (H-20) BIODIFFUSER UNIT
SOIL TEXTURAL CLASS: CLASS I MODEL 16" HICAP
f N /Z (.) A'
DESIGN PERCOLATION RATE: <2 MIN/IN LENGTH 76"
NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
DAILY FLOW: 330 G.P.D. EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
DESIGN FLOW: 330 G.P.D. SIDE WALL HEIGHT 11.2"
DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
GARBAGE GRINDER: NO OVERALL HEIGHT 16"
LEACHING AREA REQUIRED: (330) = 445.9 S.F. OVERALL WIDTH 34" 4640 TRUEMAN BLVD
74 13.6 CF HILLIARD, OHIO 43026
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY (SEE NOTE 14, SHEET 1) CAPACITY (101.7 GAL) ADVANCED OMNAGE SYW MS, INC.
PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED
USE 4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS PROPOSED SEPTIC SYSTEM UPGRADE PLAN
W/ NO STONE FOR AN S.A.S. WITH DIMENSIONS 11.3' x 25.0' 25 JOYCE ANNE ROAD, CENTERVILLE, MA
Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
SIDEWALL AREA: NOT APPLICABLE Engineering by: SCALE DRAWN JOB. NO.
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) Engineering Works, Inc. NTS P.T.M. 187-10
16 UNITS x 6.25 LF x 4.7 SF/LF = 470.0 SF 9 9
12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 04 x 470.0 = 347.8 GPD (508) 477-5313 8/24/10 P.T.M. 2 Of 2