HomeMy WebLinkAbout0027 KALMIA WAY - Health 27 Kalmia Way
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Oct 02 2016 21:49 Jim The Inspector Man 5085349919 page 18
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Commonwealth of Massachusetts ��g�6 7/
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Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Kalmia Way _
Property Address
Carole Kaplan
Owner Owner's Name =�
information is required for every Centrville MA 02632 9-29-16 00
page, City/Town state ZIp Code Date of Inspection
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:Whenfilling Out forms A. General Information
on the computer, t ! //66 jH OF
r�
use onlythe tab ° .
1. Inspector: r�
• key to move your '�? 'DAMES ':m
cursor-do not ,James D.Sears a�` '"
use the return Name of Inspector =1=
key. SEARSco
Capewide Enterprises, LLC =* ' *;
—IC=V Company Name --- %�l� .RTIF\ ..`�p _
153 Commercial Street %,,F,S I N SPEG�p``��
Company Address rrmimiThl� f
Mashpee _ MA 02649 /
Cityfrown State Zip Code
508-477-8877 S1623 t '
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. I 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
�9Zaa� 10-1-16
nspector's Signature Date €
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority.
""This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
l5ins.doc•rev.6/16 Title 5 Official Inspection Fortis Subsurface Sewage Disposal Syslem•Page 1 or 17
Oct 02 2016 21:50 Jim The Inspector Man 5085349919 page 19
t
Commonwealth of Massachusetts
- Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Kalmia Way
Property Address
Carole Kaplan €
Owner Owners Name
information is required for every Centrville MA 02632 9-29-16
page. Cilyrrown 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.
t
Comments:
The system is a 1500 Gal. Tank D Box and three 500 Gal. chamber's.Note: outlet tee has a Zable
Filter.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
f.
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):
F
t5ins.doc•rev.6/15 Title 5 Official Inspection Form:Subsurface Sewage Olsposel System•Page 2 of 17
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Oct 02 2016 21:50 Jim The Inspector Man 5085349919 page 20
B
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M, r 27 Kalmia Way
Property Address
Carole Kaplan
Owner Owner's Name
information is required for every CentfVllle MA 02632 9-29-16 e
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.) E
❑ 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):
e
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
E
❑ b ostruction is removed 7 Y ❑ N K
. ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
e
E
E
❑ 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):
t
i
C) Further Evaluation is Required by the Board of Health: i
❑ 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
t5irts.doc•rev 6/16 Title 5 Official Inspe-ion Form:Subsurface Sewage Disposal System•Page 3 of 17
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Oct 02 2016 21:51 Jim The Inspector Man 5085349919 page 21
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
27 Kalmia Way
Property Address
Carole Kaplan
Owner Owner's Name
information is
required for every Centrville _ MA 02632 9-29-16
page. City/Town State Zip Code Date of Inspection
B. Certification (cont) i
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 r
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or E
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 111111111111millm is less than 6" below invert or available volume is less r
than '/z day flow j,€AC'//i�vG
t5ins.doc-rev.6116 Title 5 Offlciat Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Oct 02 2016 21:51 Jim The Inspector Man 5085349919 page 22
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Kalmia Way
rroperty Address
Carole Kaplan
Owner Owner's Name
information is
required for every Centryille MA 02632 9-29-16
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4'times in the last year NOTdue 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- t
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 15,000 gpd. €
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the r
questions in Section D.
Yes No t
❑ ❑ 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 I I 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 i
system in accordance with 310 CMR 15.304. The system owner should contact..the appropriate
regional office of the Department.
15 ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
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Oct 02 2016 21:52 Jim The Inspector Man 5085349919 page 23
r
Commonwealth of Massachusetts
Title 5 Offici
al Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
_27 Kalmia Way
Property Address
Carole Kaplan
Owner Owners Name
tion isrequired for every
Centryllle MA 02632 9-29-16
page. City/Town 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?
E
i
® . ❑ 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)
9 ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected
cted 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. r
❑ ® 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)]
r
D. System
y m Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t
15ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 or 17
Oct 02 2016 21:52 Jim The Inspector Man 5085349919 page 24 E
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
' 27 Kalmia Way I
Property Address
Carole Kaplan
Owner Owners Name €
information is
required for every Centrville MA 02632 9-29-16
page. City/Town State Zip Code Date of Inspection
D. System Information
DescriP tion:
The system is al500 Gal. Tank D Box and three 500 Gal. chamber's. Note: outlet tee has a
Zable Filter.
E
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.) ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use?
❑ Yes ® No
Water meter readings, if available(last 2 years usage (gpd)): 2014-190,000Gal
Detail:
2015-276,000Gal's
t
Sump pump?
• ❑ Yes ® No E
Last date of occupancy: Present
Date
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CM 15.203):
Gallons per day(gpd)
Basis of design flow (seats/persons/sq.f,, etc.):
Grease trap present?
❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No 3
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
15ins.doc•rev.6/16 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 7 of 17
Oct 02 2016 21:52 Jim The Inspector Man 5085349919 page 25
' F
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
' 27 Kalmia Way
Property Address
Carole Kaplan
Owner Owner's Name
information is r
required for every Centrville MA 02632 9-29-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
P
Other(describe below):
)
6
General Information
Pumping Records:
Source of information: NA
F
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 r
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
r
t5ins.doe-rev 6/16 Title 5 Official Inspeclion Form:Subsurface Sewage Disposal System•Page 6 of 17
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Oct 02 2016 21:53 Jim The Inspector Man 5085349919 page 26 I
(
(
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
27 Kalmia Way
Property Address
Carole Kaplan
Owner Owner's Name
Information is
required for every Centryille MA 02632 9-29-16
page. Cltyrrown State Zip Code Date of Inspection t
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
2004 Permit # 2004 - 593. I
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 18"
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain): t
Distance from private water supply well or suction line:
feet
i
Comments (on condition of joints, venting, evidence of leakage, etc.):
Pipeing is 4" PVC SCH 40.
Septic Tank(locate on site plan):
e
Depth below grade: 6
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene
❑ other(explain)
t'
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes I❑ No
Dimensions: 1500 Gal. Precast H-10
Sludge depth:
1'
E
5ins.doc•rev.6/16 Title 5 Official Inspection Form-Subsurface Sewage Disposal System Page 9 of 17
r
Oct 02 2016 21:53 Jim The Inspector Man 5085349919 page 27
Commonwealth of Massachusetts t
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Kalmia Way
Property Address
Carole Kaplan f
Owner Owners Name f
information is entrville MA 02632 9-29-16
required for every C _
page. Cilyrrown State Zip Code Date of Inspection
D. System Information (cont.) E
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
29"
Scum thickness
0" r
Distance from top of scum to top of outlet tee or baffle
8"
i
Distance from bottom of scum to bottom of outlet tee or baffle 181, �.
How were dimensions determined? Asbuilt- Plan-Tape
Sludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank at working level. Tank and covers at 6" below grade. In and outlet tee's. No sign of
leakage or over loading.
f
E
t
Grease Trap (locate on site plan):
Depth below grade:
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain):
t
Dimensions:
Scum thickness f
Distance from top of scum to top of outlet tee or baffle E
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Dace
t5ins.dod-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systen-Page 10 of 17
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Oct 02 2016 21:53 Jim The Inspector Man 5085349919 page 28
e
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments }
G
y 27 Kalmia Way
Property Address
Carole Kaplan
Owner Owner's Name
information is
required for every Centrville MA 02632 9-29-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
z
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglasspolyethylene
9 ❑ ❑ other(explain):
Dimensions:
Capacity:
F
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.):
r
`Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
}
t&ns.doc•rov.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
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Oct 02 2016 21:54 Jim The Inspector Man 5085349919 page 29
Commonwealth of Massachusetts
Title 5 official Inspection Form e
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M '- 27 Kalmia Way
Property Address —
Carole Kaplan
Owner Owners Name
information is required for every Centrville MA 02632 9-29-16
page. CityFrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D Box is 16"x1T-13 Below Grade. Box is clean and solid w/three line's out. No sign of over loading
or solid carry over.
f
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:
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Oct 02 2016 21:54 Jim The Inspector Man 5085349919 page 30
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal system Form-Not for Voluntary Assessments
r
27 Kalmia Way
Property Address
l•
Carole Kaplan
Owner t.
Owner's Name r
information is Centrville
required for every. MA 02632 9-29-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number
® leaching galleries number: 3
❑ 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.):
Leaching is three 500 Gal. Dry well Chamber.s w/4'stone. Chamber's and cover at 14" below
grade. Wet bottom clean wall's, like new.
E
F
F
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert f
Depth of solids layer
Depth of scum layer E
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
15ins.Aoc••e•.3116
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page 13 of 17
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Oct 02 2016 21:54 Jim The Inspector Man 5085349919 page 31
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Kalmia Way
i '
Property Address
Carole Kaplan
Owner Owner's Name
information is
required for every Centrville MA 02632 9-29-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
E
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
i .
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.):
s
. r
r
E
15ins.doc•rev.8/18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Oct 02 .2016 21:54 Jim The Inspector Man 5085349919 page 32
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
' 27 Kalmia Way
Property Address
Carole Kaplan
Owner information is Owner's Name
required for every Centrville _ MA 02632 9-29-16
page. City/Town 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:
i
® hand-sketch in the area below
❑ drawing attached separately
/3' .
i y
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ISins.Ooc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Oct 02 2016 21:55 Jim The Inspector Man 5085349919 page 33
Commonwealth of Massachusetts
t
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Kalmia Way
Property Address
Carole Kaplan
Owner 6
Information is Owner s Name
required for every Centrville _ MA 02632 _ 9-29-16
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.) 4
S
Site Exam:
t
❑ Check Slope
❑ Surface water
t
❑ Check cellar
❑ Shallow wells
N�
Estimated depth torgh ground water: 10+
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 9-23-04 f
Date
❑ Observed site (abutting propertylobservation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
t
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database- explain: t
You must describe how you established the high ground water elevation:
T.H.on design plan 9-23-04 10'+ no G.W.. Bottom of chamber's at 4' below grade. Bottom of t
chamber's at 6'+ above T.H. Depth t
F'
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc-rev.6116 - Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Oct 02 2016 21:55 Jim The Inspector Man 5085349919 page 34
Commonwealth of Massachusetts
Title 5 Official Inspection Form F
f
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Kalmia Way
Property Address
Carole Kaplan
Owner Owner's Name
information is
required for every Centrville MA 02632 9-29-16
page. City[Town 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
E
t
:
E
E
3
F
l5ins.doc•rev.6/16 Title 5 Official Inspection form;Subsurface Sewage Disposal System•Page 17 of 17
01110.06 09:21 FAX 15084289386 FAINTLY CHOICE MORTGAGE Z001
"Town of Barnstable
Regulatory Services
p
I Thomas Ceiler,Direct®r
Public Health Division
Thomas McKean,:Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 509-790-6304
Installer& Ilesianer Certification Form
Date; aG
Designer:
Address: —7, Sr� Address: / ,g���Jo,�Zrc. /7,,q
On was issued a permit to install a
(inst1 er)
septic system at '�2 4m"-
/9 mv19
Y - based on a design drawn by
1ALC—Z—
�oeslgwrf--4j
address}dated /i; ,�
I certify that the septic system referenced above was installed substantially according to
the design.,which may include minor approved chat-1ges such as lateral relocation of the
distributiori box and/or septic tanL
y/ 1 certify that the septic system referenced above was installed with major changes (x,e.
greater than l 0' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State&Local Replations. Plan revision or
certified as-built by designer to follow.
0 OF,p��B
(Installer's Sign TOW A.
Lasarge
CIVk
- 39201
esign ignattire)
(Affix e Vie- p Here)
EL.EME RETURN "Tt) HARNSTAHLE 'PTTIRLIC HEALTH DIVISI®N. CERT ICA
OF L CE IO" H ISSUED H1TH S .FQ AS-
>� C ARE CE VED D la LE PU LIC N;
Q;Health/SepUc/Designer Certification Form
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sa. °p : s i tau
P0 BOX.MY4 : .
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SEPTI
c M-ASW D NS
DAB Inm
BEN
c ARK.DESc. TOPOYlAGBOLTHYDRAW a G
p arr s : TO W ,
PLUS SHOT
haqU&S TQP E ;DEPTH of PJPE' RW-MT AM DIFF
FOUNDATION 27.96. M04
25
THIN 31113
25AWZs0.17
TANKM
TANK
DRIN 43,1 25 f}3 -, 2 24
DBD T 4,.46 24.65 ..
5
DBOUT
DBOUF
SRS,;II 4S 250.3524f 24Q' d
SASIN #3
SASEI
SASEND :
.0TMER§ RC0flffdENTR
a:ENC I 32.75iNL .
ET'TEE 1
U='TEE R5am5`
Ctti�`S �`®t of'� £g it#fe as�.a�. # s�ste�.is�•
TOWN OF BARNSTABLE '
LOCATION SEWAGE #
VILLAGE !g c of fJ'L its;/�t ASSESSOR'S MAP & LOT f 6Ly
INSTALLER'S NAME&PHONE NO. _.S41v111")XL 4� k . O�n �=�-6 gF
SEPTIC TANK CAPACITY / 6
LEACHING FACILITY: (type) !!�z o (s � 3 t O 6 6�G.,
NO.OF BEDROOMS
BUILDER OR OWNER. VF�it/r�L 1-a0GP4 Ai ogvy,,O /,�'Z
PERMTTDATE: f �� y COMPLIANCE DATE: l I
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
&Rr2 o t=
- e
Feecl4
r
te
d
D y®
3-1
t3
No.
D Fee
r 1 p THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
V� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MA SACHU
6 fa
ation for Mig ooar gtem Conetrurtion Vermit
pllcation for to Construct( , )Repair( )Upgrade( )Abandon( ) Complete System ❑Individu
09
Location Address or Lot No. Owner's Name,Address and Tel.No.
G��lr�av/c1cs ��. a�3� 3��7/�y�✓ C/izc�E C�iV�riiu c=
Assessor's Map/Parcel
/Ov� 9.2 43
Installer's Name,Address,and Tel.No. � Designer's Name,Address and Tel.No.
G�i✓l/N�'E"�n/! ll7ArN S?1�9N-�'/cy h'riA-
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
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
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
r
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage dispo'. ;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 issu Vthisoard Health. o
Signe P Date D
Application Approved by Date
Application Disapproved or the following reas
1
r
Permit No. Date Issued
Jiro • .��.: h w. i , '
• � No. LJ Fee
THE COMMONWEALTH OF MASSit - ACHUSETTS _ Entered in computer:
HUSET es
'PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHU/SYEJ)TT
I
- 4 Ation for ;Mt o ar* gtettt Cor�gtructAon ermtt
Application,fora errnf to Construct( )Repair( )Upgrade( M)Abandon( ) Complete System ❑Individu •ot" `ionen
Location Address or Lot'No. L6T 7�� �/`/�'�//'9 U//9r/ Owner's Name,Address and Tel.No. N 4445'40
Assessor's Map/Pazcelarcel ,rP
JK
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
, fylA1N Sly .twic y sr�i0.
Type of Building:
Dwelling No.of Bedrooms `7 Lot Size sq.ft. Garbage Grinder( ),Ala
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
Size of Septic Tank Type of S.A.S.
Description of Soil
y.
Nature of Repairs or Alterations(Answer when applicable)'
t � Lr
Date last inspected:
0
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on;site sewage dii`, :•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�,_i,s_suP d-15 this oard f Health.
Signed' VAlp Date D 05
' Application Approved by Date Cl/
Application Disapproved fVthe"fobowing reass 0
4.
Permit No. 'Yf Date Issued my U
-- -----r----—————;-------- ----------
THE COMMONWEALTH1OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS ,
Certificate Of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(� )Repaired ( )Upgraded( )
Abandoned( } )by :r- f/`'
at d'-Z 4 V_. I M---j aAA has een constructed in accordance
with the provisions Aide 5 and the for Disposal Sy-seem Construction Permit N�° mated u �^ (4
Installer . Am x a V Designer 'c
The issuance of this pehnit shall not be construed as a guarantee that the yste. will fJlinctio a\designed.
Date_ 17 1 d< Inspector �Vt'� i . 1 y !�
Z��o a .-5p
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS
lwig;pO al *pgtem COtt!6trUCtion Permit
Permission is hereby granted to Construct )Re air( )Upgade( )Abandon( ) //
System located at_ o 0 �C .� �t1./°17r_1 2
M
i I
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to 1f
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction ust be completed within three years of the daQ
Zei'�
Dater Approved ---
TOWN OF BARNSTABLE
LOCATION -7 SEWAGE # 4
VILLAGE--Z—C/V�� 4b 97 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. -5kfVll;�L� 6406
SEPTIC TANK CAPACITY /f$"�� 410a//0im
LEACHING FACILITY: (type) 's2Gilinvy C �(s ) 3 c' S t2 h ��1
NO.OF BEDROOMS
BUILDER OR OWNER. �i�/✓�FL Lt,/6l�dd� II "J ZIIWVA /G'f /V
PERMITDATE: , �I �I COMPLIANCE DATE: I `
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
If an wetlands exist
Edge of Wetland and Leaching Facility( y
g
within 300 feet of leaching facility) Feet
Furnished by
I>
�C R►'d. �r �-�,�s�' -
0
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0
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Town of Barnstable P# YQ6
Department of Regulatory Services
Public Health Division Date °1 o
�afF.��e$ 200 Main Street,Hyannis MA 02601
Date Scheduled 13 0`1 Time Fee Pd.
Soil Suitability Assessment or Sewage Disposal
Performed By: Witnessed By: �✓f/t J �l`�:. J Dn
.:
LOCATION &GENERAL INFORMATION
Location Address 1�.1 Owner's
t Address
114?
Assessor'sMap/Parcel: I „lu Engineer I Name 1„v uAeC-d 'ri✓G ( ` II
NEW CONSTRUCTION REPAIR Telephone# .S O — Z` G b t
Land Use ��il lirQ Slopes(90). L 3 Surface Stoaes N�
Distances from: Open Water Body Possible Wet Area Drinking Water Well >/- ft
Drainage Way 7 ft Property tine. ft Other IVA ft
SKETCH:(Street name,dimensions o, xact locations of test holes&perc tests,locate wetlands in proximity to holes)
s'
Qt L�G
ti 1
AO,1 �w
Parent material(geologic)1:?4.- 0, �wMJ >ZiSfSDepth to Bedrock
Depth to Groundwater. Standing Water in Hole: Nzj Weeping from PIE Face N n J
Estimated Seasonal High Groundwater CL �r b Z Sifd ./,ram/Q�o�k'✓✓I� /3O G vL t/AT/6/V
DETERNIINATIO,N FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole. 1 � /OS In, Depth to soil mettles: NA in.
Depth to weeping from side of obs.hole: NA _in, Groundwater Mustment��ft.
Index Well# Reading Date: Index Well level".s:,:d,..,. Adj.fttior, .,, Adj,droundwater Level �l
PERCOLATION VEST ngte y .,Time//o
Observation ;Z
Hole# `� Time at 9" LZ
3 J
Depth of Pere zu p 3 a N S Z�-G y rl Time at 6" Sr''O/6 -3I J Z
Start Pre-soak Time @ O!00 C) 'Time(0-6-9) 6?'
End Pre-soak 3 yv 3
Rate Min./Inch
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-------
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:ISEPTICIPERCFORM.DOC
?,
DEEP:OBSERVATION HOLE LOG Hole
Depth from Soil Horizon Soil Texture Soil Color Soil Other ,?
Surface(in.) (USDA) (Munsell)_ Mottling,. (Stricture,Stones,Boulders.
Con istencyAGravel) ,
41,
) 0. . M�tJI've :
L,OAw��!' SA.✓o /o yr, -2/.o,Q</Cs �4
v Sirv��o CoR/4i�iJ t}
DEEP OBSERVATION HOLE LOG Hole# 7/
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
istency. o Gravel)
.vslrw, v�y
q03�
/v 4 2/v /V 2,A07L-
��.. 6,o y A /0 yn 10/ 2 dA.Me /0.yp- 6/ s/NALo GL�'�'
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con i to c 4'a Gravel
DEEP OBSERVATION HOLE LOG Hole# _
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (structure,Stones,Boulders.
it I
Flood Insurance Rate Man: Z S`OUv/ vc�/•6 ���Q Z
Above 500 year flood boundary No_ Yes ....
Within 500 year boundary No Ye-'—,;,—
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? y�3S
If not,what is the depth of naturally occurring pervious material? &
Certification
I certify that on �"��"qS (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,expertise and a erie,nce described in 310 CMR 15.017.
Signature Date LiL�/
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ALTERNATE BENCHMARK NORTH 28
TOP OF FOUNDATION SEPTIC SYSTEM PROFILE
NAIL TO BE SET NOT TO SCALE FZ�
ELEV 28.00 6" MAX z
1.00' MIN, 3.00' MAX
RISER REQ'D 9" MIN, 36" MAX LEVEL 2' MIN -
0.17 wMPs R��
1.25 3 SEEDED TOPSOIL, 2% SLOPE 2
26 " PEASTONE
.55 MIN 0.93 <c �`
25.50 - 28.55 MAX
1.17 25.55
25.30 0.25 25.05 ':: r------- --- -------- a
0.83 4.00 24,65 c „= 'ry; ,®® r. ® ® ®;
i®® ®® C3 o ®1 3/4" TO 1-1/2" DOUBLE WASHED STONE
22.62
24.62
OF 1500 GALLON SEPTIC TANK DISTRIBUTION BOX
15.70 AS FOUND ST-1500-H-10 24.75' x 4.83' 5.00 LOCUS MAP
=-10 DB-3 OR DB5 H-10 4,00
EDGE 36 + ON LOT #2; WATER TEST TO 3-500 GAL LEACHING CHAMBERS
NOT TO SCALE
BOG EL 17.62 6" GRAVEL ON NATIVE SOIL OR PROVE EQUAL FLOW PROBABLE HIGH GROUND WATER: GENERAL NOTES
r
MECHANICALLY COMPACTED BASE, TYP EW �� ELEVATION OF BOG 17.62 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM
ZO 7A 7 , TO 310CMR15.00 THE STATE ENVIRONMENTAL CODE TITLE
E0 O 2.75 x 12.83 x V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE
DISPOSAL OF SANITARY SEWAGE, AVAILABLE FROM STATE
CO 7 HOUSE BOOKSTORE 1-617-727-2834, AND TOWN OF
1P1 58 BARNSTABLE RULES AND REGULATIONS FOR THE
SUBSURFACE DISPOSAL OF SANITARY SEWAGE.
BOG ELEV 17.62 2) CONTRACTOR SHALL VERIFY LOCATION OF EXISTING
WATER ELEV 15.69 UTILITIES. CONTACT DIG-SAFE AND LOCAL WATER
11-03-04 0 DEPARTMENT 3 BUSINESS DAYS BEFORE BEGINNING
CONSTRUCTION.
3) CONTRACTOR RESPONSIBLE FOR OBTAINING
7 ADEQUATE HORIZONTAL AND VERTICAL CONTROL.
1Q SOIL TEST P# 10806 4) CONTRACTOR SHALL VERIFY ALL PLUMBING FLOWS TO
DATE OF SOIL TEST 09-23-04 PROPOSED SEPTIC TANK, AND SHALL LOCATE ALL OTHER
WITNESSED BY DAVE STANTON EXISTING SANITARY FACILITIES ON PREMISES NO LONGER
SOIL EVALUATOR BERNIE YOUNG USED AND PUMP, AND FILL OR REMOVE SAME IN
p PERCOLATION RATE <2 MIN. INCH. ACCORDANCE WITH LOCAL REQUIREMENTS.
5) ALL COVERS OF SANITARY UNITS SHALL BE BROUGHT
TO WITHIN 6" OF FINISHED GRADE. ALL MASONRY UNITS
TO BE MORTARED
.1�0 OBSERVATION HOLE 1 SOLVENT WELDED IN PLACE. ALL PVC PIPE TO BE
ELEV.= 25.90 6) UNLESS OTHERWISE SPECIFIED, EXISTING AND FINAL
GRADES SHALL REMAIN ESSENTIALLY UNCHANGED.
ELEV. DEPTH HORIZ SOIL TEXTURE COLOR MOTTLING 7) NO DETERMINATION HAS BEEN MADE AS TO
25.73 0-2 A LOAMY SAND 10YR2/2 N COMPLIANCE WITH DEEDED OR ZONING RESTRICTIONS
24,73 2-14 Bw LOAMY SAND 10YR4/4 0 AND/OR REGULATIONS. OWNER/APPLICANT MUST OBTAIN
15.57 14-124 C COARSE SAND 1OYR6/6 N SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
E 8) EXCAVATE AND REMOVE UNSUITABLE MATERIAL
0 BELOW THE LEACHING INVERT ELEVATION FOR 5' AROUND
LEACHING SYSTEM AND REPLACE WITH CLEAN SAND.
00, 9) IF ANY DETAIL OF THIS PLAN IS NOT UNDERSTOOD,
CONTACT DESIGN ENGINEER AT 432-6360.
10) 48 HOUR NOTICE IS REQUIRED FOR ANY INSPECTION
OR CERTIFICATION REQUIRED.
11.22 11) SITE LIES WITHIN FLOOD ZONE C AS SHOWN ON MAP
10.00 250001 0016 D DATED 07-02-92.
24 PERCOLATION TEST DONE AT A DEPTH OF 20"-32"
2 WATER ENCOUNTERED ® 117", EL 16.15
2,2 8 100' FROM ISOLATED WETLAND
CBF AND WORK LIMIT 22 32 75 OBSERVATION HOLE 2
20.00
24.75 ELEV.= 25.30
ELEV. DEPTH HORIZ SOIL TEXTURE- COLOR MOTTLING
100 FROM TOP OF ANK 2
ADJ� TO BOG AN WORK LIMIT 2 � 10.00 25.13 0-2 A LOAMY SAND 10YR2/2 N
PROPOSE G5� 24.46 2-10 Bw LOAMY SAND 1OYR4/4 0
DWELLING 15.05 10-123 C COARSE SAND 1OYR6/6 N
NTOF 28.0 0 12.83 E
F TURE N 0
PO L �-
G \ 10.00
LOT 1 � 4.°°
-- \ 4.00� RESERVE
24 1 .34 AC.+
PERCOLATION TEST DONE AT A DEPTH OF 52"-64"
� U�JATER ENCOUNTERED Q 108", EL 16.30
2 I
!L LIMITS OF 5' REMOVAL N
Cb
26 \ OF UNSUITABLE
MATERIAL WHERE
ENCOUNTERED
DRIVEWAY �
F` ST#2 ! 2\ 16,3 4gyp' /
W 160
, m
t
ST#1 T A.
45.90 HIV a
11.50 GW 16.15 BENCHMA '. . p
TOP TAG BOL ON
HYDRANT a `
EL=33.99 APPROVAL ENGI EER AMP
\ APPROX. NGVD 11/03/04 HOUSE SITING AND SEPTIC DESIG BJY
DESIGN CALCULATIONS Date DESCRIPTION Drawn Checked
28
NUMBER OF BEDROOMS 4 \ 0 R E V I S 1 0 N S
GARBAGE DISPOSAL UNIT NOT ALLOWED
DRIVEWAY \ O`
DESIGN FLOW �`° PROPOSED SITE P-.L.AN & SEPTIC
4 BEDROOMS x 110 GAL/(BR-DA)=440 GPD.
REQUIRED SEPTIC TANK CAPACITY 1500 GAL (MIN),
ACTUAL SEPTIC TANK CAPACITY 1500 GAL \
LEACHING AREA REQUIREMENTS LOT 1 KALMIA WAYS
--BOTTOM 0.74 GAL/(SF-DA
IN
--SIDE 0.74 GAL/(sF-DA) CENTERVILLE
LEACHING CAPACITY
((32.75'x12.83') + 2x(32.75'+12.83')x2') NOTE' TOPOGRAPHIC
xO.74 GAL/(SF-DAY)= 445 GPD �j�' INFORMATION TAKEN FROM SCALE: NOTED DATE: OCT 26, 2004
RESERVE 445 GPD 6 0 TOWN OF BARN STABLE LA BARGE
CA \ BASE MAPS AS ENGINEERING & CONTRACTING, INC.
SUPPLEMENTED BY ON THE 237 MAIN ST. - ROUTE 28
SITE PLAN GROUND SURVEY. WEST HARWICH, MA 02671
" = NOTES :
3
1 20' Gpg 5 � (508) 432-6360
1 . LOCUS REF: D.B. 2114/239 ; P.B. 568/68 LOT 1 Y�
10 0 10 20 30 2. ASSESSOR'S MAP: 188 PARCEL 49 DRAWN BY: BJY
CHECKED BY: TAIL SHEET 1 OF 1
ALTERNATE BENCHMARK
TOP OF FOUNDATION SEPTIC SYSTEM PROFILE
NORTH
NAIL TO BE SET NOT TO SCALE
ELEV 28.00 6" MAX z
27.96
cn
1.00' MIN, 3.00' MAX
RISER REQ'D 9" MIN, 36" MAX LEVEL 2' MIN
0.17 3" SEEDED TOPSOIL, 2% SLOPE gvM
1.25 26.55 MIN 093 2" PEASTONE
28.55 MAX
25.50 - 1.17
c
25.72 25.30 0.25 =-=---- -- ----- , 25.55 q� Q
25.47 25.05 q r ��®® ® ® n
0.83 4.00 25.27 24.82 24.65 ,...,q , � ® ®®®i ;.,
24.83 24.71 ��®®� ®®i <: 3/4" TO 1-1/2" DOUBLE WASHED STONE
22.62
24.62
1500 GALLON SEPTIC TANK 24.65
pF�� �r 15:70 AS FOUND ST-1500-H-10 DISTRIBUTION BOX
24.75' x 4.83' 5.00 LOCUS MAP
_-.�-- DB-3 OR DB5 H-10 4.00
EDGE 3 - ON LOT #2; WATER TEST TO 3-500 GAL LEACHING CHAMBERS NOT TO SCALE
BOG EL 17.62 6" GRAVEL ON NATIVE SOIL OR PROVE EQUAL FLOW PROBABLE HIGH GROUND WATER:
GENERAL NOTES
MECHANICALLY COMPACTED BASE, TYP ELEVATION OF BOG 17.62 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM
�O TO 310CMR1500 THE STATE ENVIRONMENTAL CODE TITLE
0 275' x 12.83' x V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE
g 7 DISPOSAL OF I SANITARY SEWAGE, AVAILABLE FROM STATE
HOUSE BOOKSTORE 1 617-727-2834, AND TOWN OF
5� BARNSTABLE RULES AND REGULATIONS FOR THE
SUBSURFACE DISPOSAL OF SANITARY SEWAGE.
BUG ELEV 17.62 --N `� 2) CONTRAC%TOR SHALL VERIFY LOCATION OF EXISTING
WATER ELEV 15.69 `� UTILITIES. CONTACT DIG-SAFE AND LOCAL WATER
11�-03-04 ��� DEPARTMENT 3 BUSINESS DAYS BEFORE BEGINNING
CONSTRUCTION.
3) CONTRACTOR RESPONSIBLE FOR OBTAINING
7 � q ADEQUATE HORIZONTAL AND VERTICAL CONTROL.
#TO A SOIL TEST f 1 0806 4) CONTRACTOR SHALL VERIFY ALL PLUMBING FLOWS TO
DATE OF SOIL TEST 09-23-04 PROPOSED SEPTIC TANK, AND SHALL LOCATE ALL OTHER
WITNESSED BY DAVE STANTON EXISTING SANITARY FACILITIES ON PREMISES NO LONGER
SOIL EVALUATOR BERNIE YOUNG USED AND PUMP, AND FILL OR REMOVE SAME IN
PERCOLATION RATE E2 MIN./INCH. ACCORDANCE WITH LOCAL REQUIREMENTS.
5) ALL COVERS OF SANITARY UNITS SHALL BE BROUGHT
TO WITHIN 6" OF FINISHED GRADE. ALL MASONRY UNITS
TO BE MORTARED IN PLACE. ALL PVC PIPE TO BE
-Po OBSERVATION HOLE > SOLVENT WELDED.
ELEV.= 25.90 6) UNLESS OTHERWISE SPECIFIED, EXISTING AND FINAL
GRADES SHALL REMAIN ESSENTIALLY UNCHANGED.
ELEV. DEPTH HORIZ SOIL TEXTURE COLOR MOTTLING 7) NO DETERMINATION HAS BEEN MADE AS TO
�U 25.73 0-2 A LOAMY SAND
10YR2/2CMPLIANCE WTH DEED OR ZONING
24.73 2-14 Bw LOAMY SAND O AND/OR REGULIATIONS.pE RESTRICTIONS
10YR 4/4 OWNER/APPLICANT MUST OBTAIN
N 00' 15.57 14-124 C COARSE SAND 10YR6 6 N SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
8) EXCAVATE AND REMOVE UNSUITABLE MATERIAL
E BELOW THE LEACHING INVERT ELEVATION FOR 5' AROUND
LEACHING SYSTEM AND REPLACE WITH CLEAN SAND.
i 9) IF ANY DETAIL OF THIS PLAN IS NOT UNDERSTOOD;
CONTACT DESIGN ENGINEER AT 432-6360.
10) 48 HOUR NOTICE IS REQUIRED FOR ANY INSPECTION
OR CERTIFICATION REQUIRED,
11) SITE LIES WITHIN FLOOD ZONE C AS SHOWN ON MAP
250001 0016 D DATED 07-02-92.
10.00 4 PERCOLATION TEST DONE AT A DEPTH OF 20"-32"
26 WATER ENCOUNTERED Q 117'°_ EL 16.15-
2 a 100' FROM ISOLATED WETLAND
AND WORK LIMIT 22 p OBSERVATION HOLE 2
23.54 ELEV. 25.30
_--- e _ ELEV:
DEPTH HORIZ SOIL TEXTURE COLOR MOTTLING
100' FROM TOP OF ANK 10.00 32.7 25.13 0-2 A LOAMY SAND 10YR2/2 N
ADJ TO BOG AN WORK LIMIT 24.46 2-10 Bw LOAMY SAND 0
PROPOSE 22.00 24.75 10YR4/4
DWELLING 15.05 10-123 C COARSE SAND 10YR6/6 N
TO
28. o E
F TUBE N
PO L
\ 12.
LC 1
24 .3 4.0N PERCOLATION TEST DONE AT A DEPTH OF 52"-64"
\ 4.00 ATER ENCOUNTERED Q 108", EL.16.30
.24 ESER V T
E �
6
00
\ LIMITS 0 5' REMOVAL
OF UNSUI BLE AS BUILT ELEVATIONS IN BOLD RED 8 12 05
MATERIAL HERE
ENCOUNTE ED d
SN2
ST#1
Ic
�d
25.90
F` GW 16.15 BENCHMAI
-A
13.88 \ � -
DFR"ANT APPROVAL ENGtN R �TAMP
\ ,=3 oz. 11/15/04 HOUSE AND SEPTIC SITING I E4Y
AP . NG D 11/03/04 HOUSE SITING AND SEPTIC DESIGN BJY
DESIGN CALCULATIONS \ Ddte DESCRIPTION Drawn Checked
NUMBER OF BEDROOMS 4 OO 2 R E V I S 1 0 N S
GARBAGE DISPOSAL UNIT NOT ALLOWED DRIVEWAY
DESIGN FLOW PROPOSED SITE PLAN & SEPTIC
4 BEDROOMS x 110 GAL/(BR-DA)=440 GPD.
REQUIRED SEPTIC TANK CAPACITY 1500 GAL (MIN), \ SYSTEM
ACTUAL SEPTIC TANK CAPACITY 1500 GAL
LEACHING AREA REQUIREMENTS LOT 1 KALMIA WAY
--BOTTOM 0.74 GAL/(SF-DA) �
IN
--SIDE 0- GAL/(sF-DA)
LEACHING CAPAA CITY �,t ,,� i r CENTERVILLE
((32.75'x12.83') + 2x(32.75'+12.83')x2') NOTE'_'
( �I � r0i I
xO.74 GAL/(SF-DAY)= 44 5 GP D 'J INFORMATION TAKEN ��f'R t��� SCALE: NOTED DATE: OCT 26, 2004
RESERVE 445 GPD 3 6 TOWN (rv') BAR r�,I STAB fin.E LA BARGE.
CP d \ BASE m M A P 7 AS ENGINEERING & CONTRACTING,INC.
A 'S,IJ F'Imp[._EM E N l" D BY ON T H F_ 237 MAIN ST. - ROUTE 28
SITE PLAN . \/4%q
GROUND S����VE'(. WEST HARWICH, MA 02671
1 20 I �1 ���� CAg 5 (508) 432-6360
ry,
10 a 10 20 30 ', `� a p:.m > a r',P'w. ��a.AP: a I e i .. 4. DRAWN BY: BJY
]CHECKED BY: TAL SHEET 1 OF 1
TOP OF ALTERNATE
AFOUNDATION BENCHMARK
SEPTIC SYSTEM PROFILE
NAIL TO BE SET NOT TO SCALE NORTH R� 2g
ELEV 28.00 6" MAX >
27.96
z
1.00' MIN, 3.00' MAX
RISER REQ'D 9" MIN, 36" MAX LEVEL 2' MIN
1 25 0.17 3" SEEDED TOPSOIL, 2% SLOPE 2" PEASTONE wM
26.55 MIN 0.93 ? q
25.50 - 28.55 MAX
1:17 �
25.72 25.30 0.25 ------- --- --------� T25.55 �� IIZC
25.47 25.05 µ . . ;r.. ®® ® ® .
0.83 A4.00 25.27 24:82 24.65 -` z i® ® ®i
�pCa C7 24.66 z4.71 r ��®® ®®®i -" ` 3/4" TO 1-1/2" DOUBLE WASHED STONE
y.
b I®®C3 ® 'fit'.:
22.62
24.62
1500 GALLON SEPTIC TANK 24.65
DISTRIBUTION BOX 15.70 AS FOUND ST-1500-H-10 24.75' x 4.83'
EDGE 0 LOT #2; DB-3 OR DB5 H-10 4.00 5.00 LOCUS MAP
WATER TEST TO 3-500 GAL LEACHING CHAMBERS NOT TO SCALE
BOG EL 17.62 6" GRAVEL ON NATIVE SOIL OR PROVE EQUAL FLOW PROBABLE HIGH GROUND WATER: GENERAL NOTE
MECHANICALLY COMPACTED BASE, TYP
� � E`N 1� � � ELEVATION OF BOG 17.62 1} ALL WORKMANSHIP AND MATERIALS SHALL CONFORM
---
2.75 x 12.83 x , TO 310CMR15.00 THE STATE ENVIRONMENTAL CODE TITLE
V; MINIMUM REQUIREMENTS FOR THE SUBSURFACE
DISPOSAL OF SANITARY SEWAGE, AVAILABLE FROM STATE
HOUSE BOOKSTORE 1-617-727-2834, AND TOWN OF
58 BARNSTABLE RULES AND REGULATIONS FOR THE
SUBSURFACE DISPOSAL OF SANITARY SEWAGE.
BOG ELEV 17.62 `� 2) CONTRACTOR SHALL VERIFY LOCATION OF EXISTING
WATER ELEV 15.69 UTILITIES. CONTACT DIG-SAFE AND LOCAL WATER
11-03-04 OQ DEPARTMENT 3 BUSINESS DAYS BEFORE BEGINNING
CONSTRUCTION,
3) CONTRACTOR RESPONSIBLE FOR OBTAINING
� ADUATE HORIZONTAL
o SOIL TEST P 10806 4) E(CONTRACTOR SHALLAND VERIFYRCAL AILL PLUMBINGGLFLOWS TO
DATE OF SOIL TEST 09-23-04 PROPOSED SEPTIC TANK, AND SHALL LOCATE ALL OTHER
WITNESSED BY DAVE STANTON EXISTING SANITARY FACILITIES ON PREMISES NO LONGER
SOIL EVALUATOR BERNIE YOUNG USED AND PUMP, AND FILL" OR REMOVE SAME IN
p
ACCORDANCE WITH LOCAL REQUIREMENTS.PERCOLATION RATE <2 MIN./INCH. 5) ALL COVERS OF SANITARY UNITS SHALL BE BROUGHT
TO WITHIN 6" OF FINISHED GRADE. ALL MASONRY UNITS
TO BE MORTARED IN PLACE. ALL PVC PIPE TO BE
<)a OBSERVATION HOLE ' SOLVENT WELDED.
ELEV.= 25.90 6) UNLESS OTHERWISE SPECIFIED, EXISTING AND FINAL
GRADES SHALL REMAIN ESSENTIALLY UNCHANGED.
ELEV. DEPTH HORIZ SOIL TEXTURE COLOR MOTTLING 7) NO DETERMINATION HAS BEEN MADE AS TO
25.73 24.73 0-2 A LOAMY SAND-14 Bw LOAMY SAND 10YR2/2 O COMPLIAAND/OR CE REGULATIONS.EGULITH ATIONS�ED OR ZONING RESTRICTIONS
10YR4/4
OWNER/APPLICANT MUST OBTAIN N OO' 15,57 14-124 C COARSE SAND 10YR6/6 N
SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
N E 8) EXCAVATE AND REMOVE UNSUITABLE MATERIAL
BELOW THE LEACHING INVERT ELEVATION FOR 5' AROUND
LEACHING SYSTEM AND REPLACE WITH CLEAN SAND.
9) IF ANY DETAIL OF THIS PLAN IS NOT UNDERSTOOD,
CONTACT DESIGN ENGINEER AT 432-6360.
10) 48 HOUR NOTICE IS REQUIRED FOR ANY INSPECTION
OR CERTIFICATION REQUIRED.
11) SITE LIES WITHIN FLOOD ZONE C AS SHOWN ON MAP
----�"'�10.00 4 PERCOLATION TEST DONE AT A DEPTH OF 20"-32" 250001 0016 D DATED 07-02-92,
2 100' FROM ISOLATED WETLAND 26 WATER ENCOUNTERED @ 117", EL 16.15
_cep a AND WORK LIMIT 22 4,, OBSERVATION HOLE 2
23.54 ELEV.= 25.30
ELEV. DEPTH HORIZ SOIL TEXTURE COLOR MOTTLING
100 FROM TOP OF ANK :2 10 00 327 25.13 0-2 A LOAMY SAND 10YR2/2 N
ADJ TO BOG AN - WORK LIMIT
PROPOSE 22.00 24.75 24.46 2-10 Bw LOAMY SAND 10YR4/4 0
DWELLING 15.05 10-123 C COARSE SAND 10YR6/6 N
�TOF 28. 0 E
F TURE N
12.
LOT 1
24 \ 354 4.00 4 0� PERCOLATION TEST DONE AT A DEPTH OF 52"-64"
-- T- �, ATER ENCOUNTERED @ 108", EL 16.30
24 � \ ESER v
6 CO
\
LIMITS 0 5' REMOVAL
OF UNSUI BILE , AS BUILT ELEVATIONS IN BOLD RED 8 12 05
MATERIAL HERE
\ ENCOUNTE ED
250 4
W 16.Z0 tP / Todd A.
ST#1 -�� ��
4 2
25.90
f GW 16.15 BEN H A. �
TOP TAG1
13.88 HYDRikNT
6 APPROVAL EN , ERA S4 eMP
1 EL 3, 9' 11/15/04 HOUSE AND SEPTIC SITING
APPROX. NGVD 11/03/04 HOUSE SITING AND SEPTIC DESIGN BJY
DESIGN CALCULATIONS \ O Date DESCRIPTION Drawn Checked
NUMBER OF BEDROOMS 4 � 28 R E V I S I O N S
GARBAGE DISPOSAL UNIT NOT ALLOWED DRIVEWAY
DESIGN FLOW PROPOSED SITE PLAN & SEPTIC
4 BEDROOMS x 110 GAL/(BR-DA)=440 GPD.
REQUIRED SEPTIC TANK CAPACITY 1500 GAL (MIN), \ \ SYSTEM
ACTUAL SEPTIC TANK CAPACITY 1500 GAL
LEACHING AREA REQUIREMENTS LOT 1 KALMIA WAY
--BOTTOM 0.74 GAL/(SF-DA) \
--SIDE 0.74 GAL SF-DA !Y IN
LEACHING CAPACITY CENTERVILLE
((32.75'x12.83') + 2x(32.75'+12.83')x2') NOTE- T 0 P 0 G RAP I l(Nt
xO.74 GAL/(SF-DAY)= 445 GPD INFORMATION TAKEN FROM SCALE: NOTED DATE: OCT 26, 2004
RESERVE 445 GPD
3 TOWN Orr- BAFJ\,lS-T,IABLE LA BARGE
BA S17 M A F -' S ENGINEERING & CONTRACTING,INC.
Q `�� .) '� '�._ �� .. I -. w �'� I� 23 7 MAIN ST. - ROUTE 28
SITE (CLAN nn II T . 3 �5 I � _)r, � S l..1,I: s�'E)/.. WEST HARWICH, MA 02671
1 " = 20' NOTES -�� . CPS 5 ��
10 0 10 20 30 2, ���.°�.,�;�S...s�_.�I�.r`..� t f�, ,r�,T.`N ( ���`y I�'; . rF ..Ir._ ..�;�� t C� DRAWN BY: BJY
[CHECKED BY: TAIL SHEET 1 OF 1
_ i
Bernard J.Young,P.E. LOCUS: LOT I KALMIA WAY
P.0 Buz 15" CE t1EIIY I.I E
Demmi vt�lA •5539
SEPTIC 5Y M AS BUILT ELEVATIONS
BATE S/125'
BENCHMARK DESC: TOP OF TAG BOLT HYDRANT
ELEVATION ;3399' 1.97 -8.66 27-V�ELEV TO WALL
PLUS<SH€T 22IIT.IN;STI�IIIENTS
ACNUS SHOTS TOP OF PIPE DEPT 4 OF PIPE INVERT PI AN DIFF
FOUNDATION 1-56 27.96 28:fl0 -0.t)4
SEW 3.45 26 i7 035 , _72 25-10 0.22
TANK IN 3,70` 25-32 U5. 25.47' 2530 a17
TANK OUT 3.9@' 25A2 0.3, 25.27 25.05 t)�
"TAN
TANK OUT
DB I 431 25.21 t135 24.96 24.82 F04
DBOUT 4 46 25�- 0.35 24.71 24.65 OJD6,
DBOUT 4.46 25-tom,- t335 24-71. 24.65 C06',
'DBC 4 25_06 0.35 24.71 24.65 .II:fl6
DBOUT
DBCKJT
SAS IN 4 52' 25.00 Q35 24.65 24-62 &03
SAS IN 0.35
SAS END
SAS END 0.3'51
OTHER MASURKMIMS AND CO&MENTS
LENGTH 32.75
WIDTH 12.93
INLET TEE Ib INCHES
OUTLETTEE 14INC.HES
COMMENTS To the best of my knowIcdM,infornm im and befiefthesystem is in substantial
q)Hmwe with 31OCNMI5 and the approved plan: