HomeMy WebLinkAbout0041 KNOTTY PINE LANE - Health 41 Knotty Pine Lane
Centerville
A= 191-024
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS
NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, I" FL., 367 Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law.
�k Fill in please: Date: t
�,: �} APPLICANT'S NAME: U001414M 6g
YOUR HOME ADDRESS: 1
W. % J t,l rL YvLk o
BUSINESS TELEPHONE HOME TELELPHONE #:�6��7)/-
NAME OF CORPORATION: 05
NAME OF NEW BUSINESS 1 14Y►1 A� G T2 TYPE OF BUSINES;`J ,-,
IS THIS A HOME OCCUPATION? " Y€;S . NO
ADDRESS OF BUSINESS MAP/PARCEL NUMBER (Assessing)
When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of
Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St (corner of Yarmouth Rd.
& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
2�
Authorized Signature'
COMMENTS:
2. BOARD OF HEALTH
This individual has been inf rme of the permit requ a ents that pertain to this type of business.
;,
Authhorized Si ture**
1
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTH)af IT This individua`lifia been me of th :c s lg__2 irements that pertain to this type of business.
Authorized Signature** -
COMMENTS: �.
1. 1
No. g 10" � Fee V v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
apphLafion for 30ispo8al bpsttm ConstrUition jhrmit
Application for a Permit to Construct( ) Repair(),Y"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Ad re`ss or Lot No. 0/ /ono f� i O�net's Name, dress,and Tel.No.
Lf I /ham krzPAt N� E.
Assessor's Map/Parcel �q 1 ^ `!/ fc.to :.
Installer's Name,Address,and Tel.No., ya 8 -jo-7 B De�ner's Name,Address,and Tel.No. y 7-7- S 3 f
e t2, q„�, PJL& a�'ivy c,,�,, r
Type of Building:
Dwelling No.of Bedrooms Lot Size kS'i p oc7 sq.ft. Garbage Grinder( )
Other Type of Building ( Q $ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 n gpd Design flow provided 31 C�) gpd
Plan Date 3 — 3 t 1 Number of sheets Z. Revision Date
Title
Size of Septic Tank 100 C) xcS KQ Type of S.A.S. C,Pf, sAr )S�
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 Healt
Si ne Date .�—�^ 1C�
Application Approved by Date �1 —f C)
Application Disapproved by Date
for the following reasons
Permit No. a0l�' ffig Date Issued '1 'd'o—`®
t ( ,
No. I O" fp j Fee
». Entered in computer:
THE COMMONWEALTH O;F'MASSACHUSETTS i Yes
PUBLIC HEALTH DIVISION - TOWNfOF BARNSTABLE, MASSACHUSETTS
01pplitation for Disposal *pstrm Construrtion Permit '
Application for a Permit to Construct( ) Repair(k)/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. �// /fro fj�y �nt �a.ct Owner's Name,Address,and Tel.No.
�(c,i 44A 1,r Qc /j" U T &4- / 1)-eft]r0- \"� 0-
Assessor's Map/Parcel y/ "U L (�i"/
Installer's Name,Address,and Tel.No. . r S c�� .2 Designer's Name,Address,and Tel.No. y 7-7- S-31
Viso 2 �. z �a �� �2 ,, -.I ,l
Type of Building:
Dwelling No.of Bedrooms Lot Size \S, 0 O() sq.ft. Garbage Grinder( )
Other Type of Building e p 5 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided r� � gpd
Plan Date 3 - 3 1 l C� Number of sheets Z Revision Date t r7t �
Title / r
Size of Septic Tank On r7 i xr Type of S.A.S. 1(c t��; lS�� rJ.( (�,g-er-
Description of Soil , i ` r � ,, t ;1 !' /
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: '
1 i 1
Agreement: �
The undersigned agrees to ensure the construction and maintenance of the afore described o/-sitewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system•ii operation until a Certificate,of
Compliance has been issued by this Board of Healt !
Signed Date 4 — I
Application Approved by T5, 75 Date '1 " ;;LG I 0
Application Disapproved by V ell,
Date
for the following reasons
Permit No. , 010 I61,( Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Crrtifiratr of Compliantr
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by e"�., W p �, �A QA �,e,,p
at (.a/ k_„t 4, - dWY({i'-'
4 has been constructed in acc dance
with the provisions of Title 5 and the for Disposal.System Construction Permit No. I dated �� �'O
Installer I,,F„3 �� L, (,¢ S Designer �� �,=��{ �
#bedrooms Approved design flow _2 -zz� gpd
The issuance of thi pe it shall not be construed as a guarantee that the system i n as des gned.
Date Inspector 4" J
---------------------------------------------------------------------------------------------------= =------------------------------
No. '90 I d Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal 6pstem ConstrUttion �Prmit
Permission is hereby granted to Construct( ) Repair( H'- Upgrade( ) Abandon( )
System located at 7 JC n u i \h r �<2
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions. -
Provided:Construction must be completed within three years of the date of this permit------'
'lcl
Date q-a D—(V Approved by
04/23/2010 05:43 5084775313 ENGINEERING WORKS PAGE 01
_ Town of Barnstable
Regulatory Services
Thomas F. Geller,Director
Public Health Division
usa Thomas McKean,Director
209 Main street, Hyannis,MA 02601
O$oe: 30"62r4644 Fox: 308-790.(,304
Date: Sewage Permit# 2 010 -toy Assessor's Map/Parcel
141 -4Z'1
IngAger&Delis=CertlScatfOn FQrm
714
Designer: Vic . Installer:
Address: n tn!, Cc-e s s-�: 1 CA �Z.c?� Address:
�. ,-mot�� �� ��y ��►��-J�11e MX-
on w jA was issued a permit to install a
(date) installer) "
septic system at q 14'-YV 4V 0 1 t1V t teased on a design drawn by
( dress) i
dated 3 65 to
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of army component
of the septic system) but in accordancc with State& Local Regulations. Plan revision ar
certified as-built by designer to follow. Stripout(if required) was inspected and the soils
were found satisfactory.
N OF Mgs�y
r-_a_C $ PETER T.
(Idiltaller Sigma ) WEN TEE N
CIVIL
N0,35108
(Designer's Signature) (�A xbe 6RIVIft)
PT.EASE RETURN To BARN ABLE EMjC D
F SZ 111 L F AS—
BM HEA
N'
q;\antoe fonw\ esigoerrati$obtionfosmdoc
TOWN OF BARNSTABLE
LOCATION IC n obi h SEWAGE# Z O 10 s f 0
VILLAGE ASSESSOR'S MAP&��PARCEL i'Ci l "0 2
INSTALLER'S NAME&PHONE NO. `yob 8
SEPTIC TANK CAPACITY /®o o . . /-//b £'ut f/ice
LEACHING FACILITY: (type) kt f r3ia �oFG (size) 3 Z.
NO.OF BEDROOOMS`
OWNERS
PERMIT DATE: COMPLIANCE DATE: �" 2"®
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility a 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 BY 174 �*A-e-5
R
Al ai
AZ 23
q i 34
• � a3 s Z
35 ��
1
•
Town of Barm
�ta.ble
Department o.f Regt>�atory Services y
. F Publ><c Health Division Hate.
3` io
t63q.. � 200 Main Street.Hyannis MA 02601
Date.Scl Owed � (`� o. Tune l � Fee
Soil Suitability Assessment for Sewage Fsposal
Perforrned?By: 1•L Witnessed By 1U d -
LOCATION& GENERAL INFORMATION
L.ocahon Address Owner's Narne•
1 �C t�•t S'� ✓1 2 `
vie vvo-M-l01
�2fnk��J l�k Address ``T 1 KA '" P ✓w �.►'�
..
Assessor's:Map/Parcel: �(' / QZ Engineer's Name
t�e�Fe✓M l--ee
NEW CONSTRUCTION REPAIR Telephone#
o -7—5 7,41,
Land Use, �-uCi� Slopes(9b) 2 Surface Stones
Distances from: Open Water Body l ft Possible Wet Area 1ft Drinking Water Well t ftU
Drainage Way ft Property Line ca ft Other ft
SRETCHt'(Street name,dimensions of lot,exact Imations of test holes&perc tests,locate wetlands in proxfmity'to"holes)
cU � '
Dpi
s � Z
.._ ------- s-
Parent material(geologic) — Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: M/'� Weeping from Pit Face
Estimated Sea§onal.High Groundwater
DETERNHNATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing fn obs.hole: ?n, Depth to eBll mottles In'
Depth to weeping from side of obs.hole: in, Groundwater A,tlJustment 1h.
Index Well#' Reading Date: Index Well level Adj.fketof,,,:,. _ el►E({;drolindwater Level
7.
PERCOLATION TESL' bate�, Thus
Observation
Hole# Time at 9"
Depth of Pere . �� 2i'� (MS Time at 6"
Start Pre-soak'11me® '11me ff'- �')
Ena Pre-soak
Rate Min./Inch:.
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
S,
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' t f wetland,you must first notify.the•
Barnstable Conservation Division at least one (1)we4k prior to beginning.
Q:ISEPTICIPERCFORM.DOC
- DEEP OBSERVATION HOLE`LOG Mel,.
Depth from Soil Horizon Soii Textures •...Soil.Color, Soil x Otbea•
S .(USDA),,, (Munseli) Mottling (Structure,Stones Boulders:.
urface:(in.)..
S
��. JA
,
DEEP:UBSERV f_'HOLE)✓OG Hole# `L
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface"(inJ (USDA) (Munsell) Mottling (Structure Stones Boulders
tency
Consis
C CQ L
2 �,_ z-s y
DEEP OBSERVATION,HOLE LOG Hole# _
Depth from.. Soil Horizon Soil Texture. Soil Coloc Soil Older
3urface.(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Onsistency.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture S' I Color Soil Other
Surface(in) (USDA) (Munsell) Mottling (Structure,Stones Boulders,
Flood Insurance>Rate 1VIan: -
Above SOOyearflood boundary No Yes
Vl fdtln SDO'year boundary No Yea
Within lXI ear flood boundary No_,., Y
1
Death of Naturally Occurring_Pervious Material
Does.at ieal+t four feet of nattiialiy occurring pervious aterial'�xist�in all areas observed throughout;;the
area proposed for he soil absorption system?
If`n6t,:what is tlie'depth of naturally occurring pervio 'material?' -
Oei�tiffCation __ ,
I t:erafy that on �� (date)I have passed the soil evaluator exatninahon approved by the r
Department of Envir nmental Protection and tliat the above analysis was performed by me consistent with
the"rec}u�red tra expertise and ex perieriee'descrited in tO CivIR 15.017
Signature
Date. I� ( ( � •
Q`S. jP, bpBRCFORM:DOC
Daco9771P014 03-13-2004 3=46
RECEIPT BARNSTABLE LAND COURT REGISTRY
Printed:08-13-2004 ® 15:46:21
BARNSTABLE LAND COURT REGISTRY 6
JOHN F. MEADE, REGISTER
Trans#: 319801 Oper:KAREN . .- - - - -----
fEa►ud
Doc#: 977014
Ctl#: 1862 Rec:8-13-2004 ® 3:46:16p
BARN .."..amm of unstable
Eoning.Board.of Appeals
DOC DESCRIPTION TRANS AMT
.Decision and Notice; -
--- ----------- --------
w
. 1 Y HARTY, DEBRA L _..
NOTICE Recording fee 30.00 Appeal 2004-92-- Harty
Surcharge CPA $20.00 20:00
State Fee $20.00 20.00 (D),- Family Apartment Special Permit
Surcharge Tech $5.00 5.00
Document Copy -Man 00
_---1_
Itions
Total fees: 76.00
Centerville,MA
*** Total charges: 76.00
Dist-.ict -
Relief Requested &Background:
The property is a 0.34-acre lot located on Knotty Pine Lane,which is just west of Shootflying Hill Road in
Centerville. The lot is improved with a one-story,2-bedroom,single-family dwelling with a living area of
approximately 1,359 sq. ft. and an accessory detached 1 '/2-story garage structure. The dwelling was
-17 constructed in 1970.
The applicant requested a Special Permit for a family apartment pursuant to Section 3-1.1(3)(D)of the
Zoning Ordinance. The applicant seeks to convert 592 sq.ft.,located within the detached garage,into a one-
bedroom family apartment. The family apartment is to be occupied by the applicants' son,Jonathan Harty.
Procedural.&Hearing Summary:
6 This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on April
22,2004. A public hearing before the Zoning Board of Appeals was duly advertised and notice sent to all
abutters in accordance with MGL Chapter 40A. The hearing was opened July 07, 2004,at which time the
Board found to grant the appeal. Board Members deciding this appeal were Richard L.Boy,Jeremy
Gilmore, Gail Nightingale,Ron S.Jansson,and Chairman Daniel M. Creedon III.
1- The applicant,Ms.Debra Harty,represented herself before the Board. She stated.that the family apartment
-- was being requested for her adult son who is returning home after military service and would be continuing
his education. She noted that the space already exists within the detached garage that can be improved to
habitable area. She stated that she has reviewed the requirements for the family apartment and would abide
by those requirements and conditions.
Public comment was requested and no one spoke in favor or in opposition to the request.
Findings of Fact:
At the hearing of July 07,2004,the Board unanimously made-thefollowing findings of fact:
1. The applicant,Debra Harty has applied for a Family Apartment Special Permit in accordance with
Section 3-1.1(3)(D)to allow for a family apartment to be located in the existing detached garage located
x0ve
COMMONWEALTH OF MASSACHUSETTS ✓ �!9l ��
EXECUTIVE OFFICE OF ENVIRONMENTAL AF, 1 44,tw,3
DEPARTMENT OF.ENVIRONMENTAL
ONE WINTER STREET, BOSTON, MA 02108 617 5500
. � RfCE�� w
D40
WILLIAM F.WELD to 199T TRUDYCORE
Governor 40(Ty0 pjr��f Secretary
ARGEO PAUL CELLUCCI AVID B.STRUHS.
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM.,INSPECTION� RM. Commissioner
PART A
�.. CERTIFICATION
45�10 joy Awe.lAI . - _y
Property Address: f��f�� �f �/J� Address of Owner: .'
Date of Inspection: (If.different)
Name of Inspector: K//�/�/u� `12f/Q
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: T f a=
Mailing Address: Wie
Telephone Number: op�7y
.3'08' •�—f�o-G of
CERTIFICATION STATEMENT
I certify that 1 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 inspection."The inspection was performed based on my.training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
!/Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails p Q
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority.within thirty(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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to"the buyer, if applicable, and the approving.authority.
INSPECTION SUMMARY:" Check A, B; C, or D:
AI SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated bel w. �--
COMMENTS: � <U
404,
III SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon
completion of the replacement or repair, as approved by the Board of Health,will pass.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/25/97) Page 1 of 10
DEP on the World Wide Web: http:/t*ww.magnetstate.ma.us/dep
' Printed on Recycled Paper
SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
B] SYSTEM CONDITIONALLY PASSES (continued)
Sewage'backup or.breakout or high static water level observed in the distribution box is due to broken or obstructed
pipes) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the.
Y : Board of Health):. Describe ob'servationsc
broken pipe(s)are replaced:
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
'inspection if(with approval of the Board of Health):
r: ,-:b�okemp' sl;are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
':' :.:!:Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1). SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH.WILL PROTECT THE PUBLIC HEALTH AND 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.
2) SYSTEM WILL.FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
='THE'SYSTEM IS FUNCTIONING,IN A:MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT: . .: : .
The system has a septic tank and,soil absorption system(SAS)and the SAS is within.100 feet to a surface water supply or
tributary to a surface water supply.
The system has aseptic tank and soil absorption system and the SAS is within.a Zone I of a public water supply well..
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has,a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution.from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3),._..OTHER
(revised 04/2S/97) Page 2 of 10
-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection: ;;.;,. _•;.
Dj SYSTEM FAILS: -
rI You must indicate ei;r:er"Yes"or"No"as to each of the following:
I have determined that the system violates one or more of the following failure criteria as definW in 3.10 CMR 15.303-The basis
for this determination is identified below. The Board of Health should be.contacted�to determine;what;;willbe,;necPssary,to.•correct
the failure.
Yes No ...:: .,. w r":nib.
Backup of sewage into facility or system component due to an overloaded or,clogged SAS or cesspool. .
Discharge or ponding of effluent to the surface of the ground.or.surface:.waters due:to an.�gver loaded.or clogged SAS.or
cesspool.
Static liquid level in the distribution box above outlet invert due`:to an;overloaded:or;dogged,:SAS or cesspool.
Liquid depth in cesspool is less than 6" below.invert or available,volume:.is.Iess.than:J/2;dayfloHr ;
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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 l_of a public well..
Any portion of a cesspool or privy is within.50 feet of a private.water
- is '7_t ,.`+J.j'.•i.'^✓':�i:y,.',Rh'J: ;!ice.>i.'a"11-' ,.
Any portion of a cesspool or privy is less than 100 feet but greater than 50,feetfrorti.a,private..w4ter supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.:> .!V.i.,;•- =.t
El LARGE SYSTEM FAILS: � : ;; :.•:;�;: ,
You must indicate either"Yes" or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised O4/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART B
CHECKLIST. .
Property.Address:
Owner:
Date of Inspection:
Check'ifIhe:foltowing have'been'done.You must in- either"Yes"or.'No"as to each.of the following:
Yes ; No
_ Pumping information was provided by the owner;occupant, or Board of Health.
vool _ None of the system components'have been pumped for at least two weeks and the system has been receiving normal
flow rates "dunng that penod...Large volumes of water have,not been introduced into the system recently or
as part of this inspection.
As built plans have`been'obtained and.ezamined::. Note if they are not available with.N/A.
The facility.or-dwelling was inspected:for.signs of:sewage back-up.
Y' The system does•not recei4e..non-sanitary'or;industrial waste flow.
P The site was inspected for signs of breakout.
_,::'::r•-=:.air :,,::�::+:�•�:,: .rr_,•:•;�•':.:;i��ry.. .:. :...... :...:.:.. ... ,,., ,
'.All system'components,excluding the Soil Absorption System, have been located on the site.
_ The septic tank`manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees; material of construction;-dimensions, depth of liquid,depth of sludge, depth of scum.
/' The siie and location•of the 5oill Absorption:System on�the site has been determined based on:
f/ The facility owner(and•occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface D•isposal`System.
7.
Existing.information Ex.-:Plan at B.O.H. : .
y _ 'Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b)]
(revised 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
• PART C
SYSTEM INFORMATION
Property Address:
Owner:
Date of Inspection: ,
FLOW CONDITIONS
RESIDENTIAL:
Design.flow: p.dJbedroom for S.A.S.
Number of bedrooms: • Fr
Number of current residents: F
Garbage grinder(yes or no):•&Q
Laundry connected to system (yes or no): ,�j r r:
Seasonal use (yes or no):,d/,O -
Water meter readings, if available (lest two (2)year usage (gpd): ,{
Sump Pump (yes or no):,�
Last date of occupancy: �i 1i1 'q
A14 COMMERCIAUINDUSTRIAL:
Type of establishment: ,•�, •,
Design flow:__gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes.or no)_
Water meter readings, if available:
Last date of occupancy:.
OTHER: (Describe) :..
Last date of occupancy: „
GENERAL INFORMATION :.
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)! .$ -
If yes, volume pumped:/BUD eallons _.
Reason for pumping: _ r19.¢-ii1�.4�i►/« ye%e
TYPE OF STEM
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) .. ._... . .__.
VA Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no)
(revised 04/25/97) Page 5 of 10
• • SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of inspection:
�0
BUILDING SEWER::
(Locate on site plan).
Depth below grade:
material of construction: _cast iron_40'PVC_other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints,.venting,..evidence of leakage, etc.)
SEPTIC TANK:v .
(locate on site plan)
Depth below grade �
Material of construction: Vconcrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age Is age confirmed by.Certificate of Compliance _(Yes/No) .
Dimensions: .S X S x
Sludge depth: A07
Distante-from top of sludge,to bottom of outlet tee or baffler �f/��j�f��i�/�.$ ��/O,Q
Scum thickness:,fl -rl A .
Distance from.top of scum to top of outlet tee or baffle: i ��� �/G • .
Distance from bottom of scum to bottom.of outlet tee or baffle: /
How dimensions were determined: ?� T�1�C'it'
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth o liquids el in relation t out invert, structural
int rity;evidence of leakage, etc.) - p
GREASE TRAP:
(locate on s.ite:plan)
Depth below grade:
Material of construction: —concrete etal Fiberglass _Polyethylene other(explain)
m
Dimensions:
Scum thickness:
Distance.from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation.for pumping, condition of inlet and outlet tees or baffles,.depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
(revised 04/25/97) page. 6 of 10
v '
' r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
TIGHT OR HOLDING TANK: (Tank must be pumped prior'to,"or 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/day ,. ' ..
Alarm level: Alarm in working order_Yes;_ No -
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:_ :._._.__....... ..
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/2S/97) Page 7'of 10
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SOIL ABSORPTION. SYSTEM (SAS):—
(locate on site plan, if possible; excavation not required;but.may be approximated by non-intrusive methods)
Ifnot determined to be present, explain:' �r
Type.
Teaching pits, number:
leaching chambers; number:_
leaching galleries,number:
leaching trenches, number,length:
_leaching;fields, number, dimensions:
overflow cesspool, number:
Alternative system:.
Comments:(note condition of,.so'l, signs'of liy8'-'- 1 c'.failure,,level of ponding, condition of vegetation, etc.)
I. ll
CESSPOOL
S:
# . (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(cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.).
! PRIVY
/1 (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.)
(zeviasd 04/25/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house).
� k
0
6 F Q 0 39
0
A : 3�
t1 Ro aNFII'jhA'TOR.
OYU
p4711 'CAA 1113 [� tr 13.
P a 3-704
3�
IA, It2 l3 c
RA-ymwo DvrnAs �2
(revised 04/25/97) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
T
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
Depth to Groundwater7fAeet
Please indicate all-the methods used to determine High Groundwater.Elevation:
�./Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
✓Determine it from local conditions
Check 'with local Board of health
Check.FEMA'Maps
Check pumping'records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
02� Fill i3,�sF�s-sr�i Q,e
y
(revised 04/25/97) Pigs 10 of 10
���
y __. ,,
0,,2
No....... Finc
APPROVED
earnstabw nservation DepanOWTV COMMONWEALTH OF MASSACHUSET -STS
H
BOARD OF EALTH
co WN OF BARNSTABLE
Sign!
Appfiration for Biiymial Workii Tvastrurtion run it
Application is hereby made for a Permit to Coristruct or Repair an Individual Sewage Disposal
System at:
............... ................................ ..............
Location-Address Y Z or Lot No.
....... ............................................... --------------- ......
....Z
Owner Address
4/1,12,.......'Pic.............................
----------
Installer Address
Type of Building Size Lot............................Sq. feet
U
Dwelling— No. of Bedrooms----------7----_------------------------Expansion Attic Garbage Grinder
aOther—Type of Building ---------------------- ----- No. of persons.-.--------.-.----.---_---- Showers Cafeteria C� Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capa6tv............gallons Length.--._---_---- Width---------------- Diameter...-.-_------.- Depth----............
Disposal Trench—No. .................... Width------------.-.-.--- Total Length....----.-.---.----. Total leaching area---.................sq. f t.
Seepage Pit No--------------------- Diameter........--.......... Depth below inlet---.---.......--.... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.-.-.-.-.-.--.--.-_ Depth to ground water........................
(Xq Test Pit No. 2................minutes per inch Depth of Test Pit.-.-..-.-.---.-----. Depth to ground water......---...............
0 9 .............................................................................................................................................................
Description of Soil.........................................................................................................................................................................
W
U .........................................................................................................................................................................................................
W
x ........................................................................................................................................................................................................
U Nature of'Repairs or Alterations—Answer when applicable---------------:;27W,!�WK----- ...............
........... ........AtAl
.....�To ................................................................ ....................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environm arr�de—The undersigned further agrees not to place the
system in operation until a Certificate of(Omplian4e has en iss d b o health.
Signed -------------- -------- ........-- --------------------------------------- .................. .................................:------
Dace R ...
Application Approved By ----------------- ........ ---------------------------------------------------------- ....... ----47......
Date
Application Disapproved for the following reasons-- ----------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------
PermitNo. ........ ------------------ Issued -------------------------------------------------------------------
D
;;--T��O--WN OF BARNSTABLE
LOCATION �i�I ,'( yt, �i ', v►•..1 SEWAGE # �v" e7 L/
VILLAGE _ ? _ ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. .o f�,;�Al . L)' M
� tY
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) �J ''
�� �� < (size) .-mz r)
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: --I
DATE DATE COMPLIANCE ISSUED _
VARIANCE GRANTED: Yes
KN OTT-1 F- E LANE
P
v .. -- �� S
r
�_a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Tertifi ate of Tainjifin1TCP
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by -- Y/�`� -...1��/izhq.c. 5?...................................................Ins'all er
at .........�i�/........1�?Cf' <VF.....G CF.P�7` �Y/// f.r P6--- ------------------------------------------------------ -------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No- ----- .-.....70..1-------- dated ----_.._-----------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ............... ... ...... --� .- L.,._..----------------------- Inspector .... - - .. ._...,----
_.----------------------
-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No.la.- FEE........................
�is�n��1
Permission is hereby granted......E�` /�i�!QI�I _ -�Uiy1S.T --------------------------
to Construct ( ) or Repair (10 an Individual Sewage Disposal System
at No.=---- 'A-lv,;`V--- iNr .............. e%I
Street gg
as shown on the application for Disposal Works Construction Permit Nol _:tf_ Dated...........................................
•....................•-----•- �- , --------------------------------------------------------
Board of Health
FORM 36508 HOBBS h WARREN.INC..PUBLISHERS
No.._....Z... ��a.. FEa........ .tea....
THE COMMONWEALTH OF MASSACHUSETT�S /
p�`��BOARD OF HEALTH
OWN OF BARNSTABLE
Applirati an for UijrVn!3tt1 Markii Towitrnrtinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal
System at: ,p
-------_... _.f��l%P..71 'k.. l
---------------------------------------------- ----------------•-------------•--
-
Location..1�_-Address or Lot No.
Owner Address
M,.,9-4--`1= ----------------------------- `/ � ./1-----,5 a ------ ' .....
Installer Address
Type of Building Size Lot............................Sq. feet
., Dwelling—No. of Bedrooms---------_3--___________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. 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 inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit__.-__-_---__-___-_ Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
9 --------------------------------------------------------------------------------------------•---•-•............................................................
ODescription of Soil.....................................................................................................................................'---...............................
U ---------------•--------------------------... .........................................................................................................................................................
----------------------------------------•------------------------------------------------------------------------ ........----------------------------------------------------------------..._..._...._.
Nature of Repairs or Alterations—Answer when applicable.._..-__....__ .t/_T lL s� .Z�.F/�iJ/Tv�istT�
U PS t' --------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental-Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by-turd of health.
Signed -� '''"'
--------------------- -------- ---------------------:......
Dace
Application Approved By -----------------�.�.�.+.).'��...e �.a.�.-�7....`rz.
..................-------------------.............................. Dace
Application Disapproved for the following reasons- ---------------- --
; Dace
Permit No. --------�_Z....-.....7C�.. /�.................. Issued
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LEGEND LOCUS N
f EXISTING CONTOUR
X 100.98 EXISTING SPOT GRADE o Moon Penny
I,CP g2g98 E � 6 106.5 PROPOSED CONTOUR pia o a Ln
et ) S 11'31'40" W�Sh,g
—yy EXISTING WATER SERVICE J, a
i— 100.00' �� 105 I + 106,31 I+ —G EXISTING GAS SERVICE °9� o C
104--• -------_-_--___+�a03.86 i%_32' '� EXISTING INFILTRATORS —U EXIST. UNDERGROUND WIRES �a Mene sha Ln
it--�--- TO BE PUMPED DOWN OR REMOVED TEST PIT a
o
104,73 in -DEPENDING ON PROXIMITY TO
r' _�_ _ S_ I OP PROPOSED S.A.S.(SEE NOTE 11) BENCHMARK
ACCESSORY --- - _�_ -�" �?_
c� DWELLING ~-21 1 5 '10 EXISTING LEACH PIT
+ 105, 2 105,5. S.P S TO.BE PUMPED & FILLED WISAND ov�eton �^
SONOTUBE `L �'EX15t �� '-AR OR IF STILL ACTIVE woodvaie Ln C o
FOUNDATION , � `N,<�
EXISTING SEPTIC TANK
(To REMAIN)
105,96 � ® �0� TOP OF TANK EL.=104.71f LOCUS MAP
BIRD HOUSE INV.(IN)=103.37f NOT TO SCALE
105.32 + 105.80 G \ 1 GENERAL NOTES:
r Ben chm ark Set
10 '80 ti06 O p�°x \ 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
COR. OF BULKHEAD BOARD OF HEALTH AND THE DESIGN ENGINEER.
1 105.69 105�60 EL.=106.55 (Assumed) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
i C) c `� C ( OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
105,16 \ z + 107,26 LOCAL RULES AND REGULATIONS.
\
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
i o v TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
104,23 I to ` U' 00 DESIGN ENGINEER.
+ o EXISTING `�P rS }
w I ;� HOUSE(#41) `o 00 I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
NS
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
o j v T.O.F.=106.55" �`� 105.84+� o ENGINEER BEFORE CONSTRUCTION CONTINUES.
W a i �.__J 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
I fV CO C9 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
1 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
06.46 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
V) 105, 14 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
c 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
105, calk 8 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
AGREEc� 8 Q ��� D RECTDEDUBYN BY OWNER THE APPROVING DAUTO OR OR AS OTHERWISE
AUTHORITIES.
+ 104.43 + 105,45 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
1 aCONSTRUCTION.
- THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNIN
Qj 105.1 + Paved 105,35+ 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
< C 1` IN THE AREA BENEATH AND FOR 1' ON ALL SIDES OF THE S.A.S. AND
105,21 p I REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). THE
104 ��� ��o PROPOSED S.A.S. IS A BOTTOM AREA ONLY SYSTEM. PROPOSED STRIPOUT
104.67 ��� y BOUNDARY IS SUBJECT TO THE APPROVAL OF THE BOARD OF HEALTH.
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
�c7 LOT 4 �05-f INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
° 15,000t S.F.. � �"� �, 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
Map 191 104,97 C IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
14. THIS ENGINEER IS NOT RESPONSIBLE FOR ANY STRUCTURAL DAMAGE
g Parcel 24 OF *Sp ASSOCOATED WITH THE CONSTRUCTION OF THE SAS. THE CONTRACTOR SHALL
-- TAKE MEASURES TO PROTECT ADJACENT STRUCTURES.
�- 100.0 ' - =! ----------104 PETER T. y� PROPOSED SEPTIC SYSTEM UPGRADE PLAN
WENTEE
x-}U 3, - S 11'31'40" W 103.68 ; � CIVIL
1ro313- 102,80 ; No. 35109 41 KNOTTY PINE LANE, CENTERVILLE, . MA
c� 02,6g------163--_ 103.48 �'£G/STE�S� �`' Prepared for: Debra Harty, 41 Knotty Pine Lane, Centerville, MA 02632
101,86 102,13 102,59 edge of pavement 103.12 103,28 'POPE �`
102.39 1 E Engineering by: SCALE DRAWN JOB. NO.
,-' IFl Engineering Works, Inc. 1"=20' P.T.M. 125-10
KNOTTY PINE LANE t
C7 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
(508) 477-5313 3/31/10 P.T.M. 1 of 2
,� NOTE: TO PREVENT.BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL:102.2
FOR A DISTANCE OF 15' AROUND THE (3) 5" DIA.OUTLETS
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. i _ 15.5" �, I--16" F2"
r -1
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT
OUTLET AND SET TO 6" OF FINISH GRADE .
T.O.F. COVER SET TO 6" OF GRADE •' `
F.G. EL: 105.2(MAX.) C� 12"
EXISTING
F.G. EL.=105.8f F.G. EL: 105.6t 15.5'
6" 8"
MAINTAIN 2% GRADE (MIN.) OVER S.A.S. T}
INSPECTION 2"
' L = 19' L = 12'(MAx) PORT H-10 LOADING
S=1% (MIN.) ® S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC TOP LOAD UNITS
6"
s' D-BOX
19" TO INVERT DESIGN
EXISTING 48" LIQUID
LEVEL A00
GAS DAPPLE INV.=103.17 PROPOSED INV.=103.00
INV.=103.37t D-BOX (3 ROWS OF 5 UNITS AT 6.25'/UNIT) + 0.7' WEDGE = 32.0'
EXISTING SEPTIC TANK
EXISTING INV.=102.88 SOIL ABSORPTION SYSTEM (PROFILE)
-ESTABLISH VEGETATIVE COVER 75"
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
INV. ELEV.=102.88 c 11.3" INVERT
BREAKOUT=TOP
TOP ELEV.=102.24
NOTES:
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BOTTOM ELEV.=101.30
INVERTS, PRIOR TO INSTALLATION. II III�IIIII�II
2.83' 76"
2) D-BOX SHALL BE SET LEVEL AND TRUE TO 4' OF NATURALLY PERVIOUS MATERIAL
� -
GRADE ON A MECHANICALLY COMPACTED SIX & MORE THAN 5' TO GROUNDAWATER EFFECTIVE WIDTH=8.5'
PROFILE
INCH CRUSHED STONE BASE, AS SPECIFIED IN EXISTING SUITABLE
310 CMR 15.221(2). MATERIAL
3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W., EL=94.7
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE SEPTIC SYSTEM PROFILE WITH NO SEPARATION BETWEEN EACH ROW & NO STONE
USE 3 S I N BS
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL.
16"
N.T.S.
TYPICAL SECTION 11j 2" 7V i
�-
aas� 53.5' SOIL LOG f 34"- 0.
DESIGN CRITERIA --_---32 SECTION END CAP
"z� --------------� DATE: MARCH 17, 2010 (REF# 12,865)
NUMBER OF BEDROOMS: 2 (HSE.) + ) PROPOSED S.A.S. un SOIL EVALUATOR: PETER McENTEE (SE#1542) 16" HIGH CAPACITY(H-20) BIODIFFUSER UNIT
$ 6'
= 3 BEDROOMS TOTAL 52.- WITNESS: 'DAVID STANTON-HEALTH AGENT
SOIL TEXTURAL CLASS: CLASS I Elev. TP- 1 Depth Elev. TP-2 Depth MODEL 16" HICAP
DESIGN PERCOLATION RATE: <2 MIN/IN 105.7 A O" 105.7 0" LENGTH 76"
SANDY LOAM A SANDY LOAM NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
DAILY FLOW: 330 G.P.D. 10YR 4/2 10YR 4/2 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
105.0 8 104.7 12" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
DESIGN FLOW: 330 G.P.D. B SANDY LOAM B SANDY LOAM SIDE WALL HEIGHT 11.2"
tJ 10YR 5/4 10YR 5/4
GARBAGE GRINDER: NO �4IHOUSE(#41)
W' OVERALL HEIGHT 16"
LEACHING AREA REQUIRED: (330) = 445.9 S.F. P. j°� 103.2 C1 I 36„ 102.7 C1 36 OVERALL WIDTH 34" 4640 TRUEMAN BLVD
.74 � PERC 13.6 CF ® HILLIARD, OHIO 43026
CAPACITY
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY r 48" (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC.
N;IqE
PROPOSED D-BOX:: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATEDM-C SAND M-C SAND
2.5Y 6/4 2.5Y 6/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
USE 3 ROWS OF 5-16" (H-20) ADS BIODIFUSER UNITS
W/NO STONE AND EXTENED 0.7' W/ CONTOURED WEDGE 41 KNOTTY PINE LANE, CENTERVILLE, MA
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF UNIT) ° Prepared for: Debra Harty, 41 Knotty Pine Lane, MA 02632
(BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.70 SF/LF = 440.6 SF
EXISTING Centerville,
CONTOURED WEDGE) 3 ROWS x 0.7' x 4.70 SF LF = 9.9 SF Engineering by: SCALE DRAWN JOB. N0.
( / 94.7 132" 94.7 132" Engineering Works, Inc. NTS P.T.M. 125-10
TOTAL AREA = 450.5 SF g g
PERC RC RATE <2 MIN/IN. ("Cl" HORIZON) 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
. .
DESIGN FLOW PROVIDED: 0.74(450.5 S.F.) = 333.4 G.P.D. ?NO GROUNDWATER OBSERVED (508) 477-5313 3/31/10 P.T.M. 2 Of 2
A
1