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0379 LAKESIDE DRIVE WEST - Health
379 Lakeside Drive West Centerville A= 232 - 048 THE Barnstable PROF Tp�� y� Town of Barnstable edcaC► nAaySrASLE. MASS. a Board of Health I. 9�0 i 63 9 `gym HIED MAC A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Paul I Canniff,D.M.D. FAX: 508-790-6304 Junichi Sawayanagi Donald A.Guadagnoli,M.D. September 12, 2016 Mr. Peter McEntee, P.E. 12 West Crossfield Road Forestdale, MA 02644 RE: 379 Lakeside Drive West, Centerville A = 232-048 Dear Mr. McEntee, You are granted variances, on behalf of your clients, Theodore and Jane Gravel, to construct an onsite sewage disposal system at 379 Lakeside Drive West, Centerville. The variances granted are as follows: 310 CMR 15.405: To construct a soil absorption system five feet away from the property line, in lieu of the ten feet minimum required. Section 360-1, Town of Barnstable Code: To construct a soil absorption system 70 feet away from a wetland, in lieu of the minimum 100 feet separation distance required. Section 360-1, Town of Barnstable Code: To construct a soil absorption system 59 feet away from an inland coastal bank, in lieu of the minimum 100 feet separation distance required. The variances are granted with the following conditions: (1) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of.Deeds restricting the property to three (3) bedrooms maximum. A copy of the Q:\WPFILES\McEntee 379 Lakeside Drive West Variances.docx 1 Y recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The system shall be installed in strict accordance with the revised engineered plans. (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised plans. This variance is granted because physical constraints at the site severely restrict the location of a soil absorption system due to its close proximity to wetlands. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sincerely yours, auI C A ni , Chairman, Board of Health Q: WP/McEntee 379 Lakeside Drive West Variances.docx d l� (ol 6� �tr+e tlp,, 1'\ " DATE: 'off' �I'� FEE: MASS1639. C� a g4.p�aio REC. BY ` `Town of Barnstable SCHED. DATE: Board of Health aa. 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION L Property Address: 3 7 q Q f de- Assessor's Map and Parcel Number: 2w_—®'4 s Size of Lot: 4� ZO +/ Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: 17e4-cf MC,6I4-,P_e Phone 5-0 ' -/1-7-7' s31 Did the owner of the property authorize you to represent him or her? Yes 'X No PROPERTY OWNER'S NAME CONTACT PERSON Name: � e �Q�R. G"-0.Uk i Name: e�e� M LC-7,,.}_e e IOC-7 1 r , , lz!j , Crb5_v*f lCj A-4 Address: l.�Z 0.uQ� t� �� ��S r Address: Phone: 4 '7— Phone: t VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) 31a C1Ai2 15-;LtoS" CC, G tigp A- 3 C-0 AT--ir-. ( -' Coot-S Aso.', ✓1 to It ' q (,-- NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC v v Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 Tel/Fax (508) 477-5313 August 5, 2015 Re: 379 Lakeside Drive West, Centerville, MA (Assessors Map 232, Parcel 048) Construction Title 5 Septic System Dear Sir/Mam: Please be advised that an application for variances from the Massachusetts Department of Environmental Protection, Title 5, and Local Regulations have been submitted to the Barnstable Health Department for approval. The following variances are being requested: • 310 CMR 15.405(a) —CONTENTS OF LOCAL UPGRADE APPROVAL 1. A 5' variance, S.A.S. to property line (side), for a 5' setback. • LOCAL REGULATION, Chapter 360, Article 1 — Setback Requirements 1. A 30' variance, S.A.S. to bordering vegetated wetland, for a 70' setback. 2. A 41' variance, S.A.S. to inland bank, for a 59' setback. The application and plans are available for review at the Barnstable Health Department, 200 Main Street, Hyannis, MA, Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30 p.m. A public hearing will be held, to discuss the proposed work, on Tuesday, August 23, 2016, at 3:00 p.m. The hearing will be held at the following location: Town Hall Hearing Room Second Floor 367 Main Street Hyannis, MA Sincerely, C ^1 L-L� Peter T. McEntee P.E. Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 Tel/Fax (508) 477-5313 July 28, 2016 Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Re: 379 Lakeside Drive West, Centerville, MA, Title 5 Septic System Upgrade Representation Authorization Dear Board members: I hereby authorize Peter McEntee PE to represent my interests for the subject.project. Theodore Grauel 8/4/2016 AbutterReport Board of Health Abutter List for Map & Parcel(s): '232048' c4ect abutters (no set distance) and the properties located across the street. Total Count: 5 rR �� Close Map& Parcel Ownerl Owner2 Addressl Address 2 Mailing Country Deed CityStateZip 232021 CHENG,PETER H & 393 LAKESIDE CENTERVILLE, C171320 SHANG YEE DRIVE WEST MA 02632 WEISS,BERNARD & C/O FIRST ESCROW MAIL 1 FIRST 'WESTLAKE TX 232023 AMERICAN RE TAX AMERICAN C202803 LISA SERV CODE DFW 4-3 WAY 76262 GRAUEL, 379 LAKESIDE CENTERVILLE, 232048 THEODORE A JR& DRIVE WEST MA 02632 C208372 JANE H TARSY,DANIEL & LTARSY REALTY 16 DAVIS BROOK NATICK, MA 232049 C151009 LOUISE TRS TRUST DRIVE 01760 232076 FALKSON,SUSAN 329 LAKESIDE DR CENTERVILLE, C155998 WEST MA 02632 This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters. If a certified list of abutters is required,contact the Assessing Division to have this list certified. The owner and address data on this list isfrom the Town of Barnstable Assessor's database as of 8/4/2016 . http://maps.townofbarnstable.us/arcims/appgeoapp/AbutterReport.aspPbA),-BOH 1/1 T••own of Barnstable Geographic Information System August 4,2016 232075 #346 iE i#366 i iQ:;:{:,:jii c:•`?rC;::::i ii�•:•:.. 232050 232049 #357 6 123202 0 #339 232048 '':::':':: ;•i'i:: ':':::..:'.:':'.::'::::: ...:::.::.:':: 37# 9 :;�`••232023 #400 232021 #393:;::::::::':' 231031 231029 #417 #481 1003 0 40 Feet #429 DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:232 Parcel:048 Board of Health boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1^=100'may not meet established map accuracy standards. The parcel lines on this map Abutter List Type-Direct abutters(no set distance)and the properties located are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters boundaries and do not represent accurate relationships to physical features on the map1 such as building locations. Buffer 1�'f� Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 026" TeVFax(508)477-5313 August 5, 2015 Re: 379 Lakeside Drive West, Centerville, MA (Assessors Map 232, Parcel 048) Construction Title 5 Septic System Dear Sir/Mam: Please be advised that an application for variances from the Massachusetts Department of Environmental Protection,Title 5, and Local Regulations have been submitted to the Barnstable Health Department for approval. The following variances are being requested: • 310 CMR 15.405(a)—CONTENTS OF LOCAL UPGRADE APPROVAL 1. A 5' variance, S.A.S.to property line (side), for a 5' setback. • LOCAL REGULATION, Chapter 360, Article 1 —Setback Requirements 1. A 30' variance, S.A.S. to bordering vegetated wetland, for a 70' setback. 2. A 41' variance, S.A.S. to inland bank, for a 59' setback. The application and plans are available for review at the Barnstable Health Department, 200 Main Street, Hyannis, MA, Monday through Friday (excluding holidays)from 8:30 a.m. to 4:30 p.m. A public hearing will be held,to discuss the proposed work, on Tuesday, August 23, 2016, at 3:00 p.m. The hearing will be held at the following location: Town Hall Hearing Room Second Floor 367 Main Street Hyannis, MA Sincerely, Peter-T. McEntee P.E. c SUN PORCH w DECK 0 SLIDERS SITTING [KITCHEN ROOM w LIVING RM 0 ENTR HALL MASTER BEDROOM BEDROOM BATH PORCH BATH 200 s.f. 142 s.f. ENTRY PRIMARY FLOOR ENTRY SLIDERS J a BEDROOM GARAGE = FAMILY RM 180 s.f. HALL BASEMENT BASEMENT LOWER LEVEL FLOOR PLAN 379 LAKESIDE DRIVE WEST, CENTERVILLE, MA TOWN OF BARNSTABLE LOCATION 37Cj X5ic)e'Dr-( V SEWAGE# aO VI.LLAGE (fC_09�of ASSESSOR'S MAP&PARCEL`o1:�5.-Q-C ;2� INSTALLER'S NAME&PHONE NO.��(_% 2&ChAro J:�c_ SEPTIC TANK CAPACITY PXlt tL4C LEACHING FACILITY. (type) ,,L(, = C�,�ICcMK.C'f (size) E5 KA 3 NO.OF BEDROOMS OWNER 6r0C2P\ PERMIT DATE: t 0 —I COMPLIANCE DATE: Separation Distance Between the: 1 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 6e �� U of. F(O,Dy' n M1 recap r �V :31 Wide or, v '� A No �` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plitation for jOisposAl 6pstrut Construction Perini Application for a Permit to Construct( ) Repair(�pgrade( ) Abandon( ) ❑Complete System Individual Components Location Address oy Lot No. 3 7� G��eS/r)� l�r(,c�( b� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a)�L— &co Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size // ) sq.ft. Garbage Grinder( ) Other Type of Building N No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `3 'I(7 gpd Design flow provided "3 3Q gpd Plan Date (1 Number of sheets e:2_ Revision Date Title 1 Size of Septic Tank 0kjS�Ir-�x Type of S.A.S. [_C_ C, C Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1ZS 01 ) knY Sc;�f(('��)N(�1°C 7 c t3 tt tOmra 0.S S"C'3 n� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date e. 7 Application Disapproved by Date for the following reasons Permit No. �� Date Issued . D No y Fee /G9 THE,COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y_\ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppiication for Mispos it 0pstrm Construction Verm Application for a Permit to Construct( ) Repair(Upgrade( ); Abandon( ) ❑Complete System '0 Individual Components Location Address qr Lot No.3 7 j 44�/df Dr Gt�°St Owner's Name,Address,and Tel.No. .; CeN)k-,tvl1lr `Assessor's Map/Parcel Z-3 2_Q43 &(uCt e' Installer's Name,Address,and Tel.No, Designer's Name,Address,and Tel.No. � � C',is (rF1,�-�Jc 5C3-y�-7/ �v,tNtrrt�t lS ' Type of Building: .. Dwelling No.of Bedrooms Lot Size j � �O sq.ft. Garbage Grinder( ) Other Type of Building ►,ptV No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided "?S 3Q gpd Plan Date 4 a'�c, Number of sheets Revision Date Title Size of Septic Tank tXI-�Au\1 Type of S-A.S. Description of Soil / tt Nature of Repairs or Alterations(Answer when applicable) ►�5� u ar n cl�tr�mlgo IV Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 1 _ Application Approved by _ Date 4. Application Disapproved by Date for the following reasons _ r __. . Permit No. �� Date Issued -_ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by at __ 2)l c1 L�f CP S ICY? -0 Est- has been constructed in accordance f / with the provisions of Title 5 and the for Disposal System Construction Permit No,cQated � / Installer'T.))o 1c S A ((LJr Designer E.NSN,,w?Prink wo d�(r� J - #bedrooms, �_ Approved dea,gnu owl"? (a gpd The issuance oft s permit shall not be construed as a guarantee that the system will funct'o as desigkned. 'Date ! • ��. Inspectors ------------------------------------- - - ----------------------------- Fee /�� , No. �� {. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Nsposal *pstp onstruttion Permit '3 Permission is hereby granted to Construct( \) Repair( � Upgrade( ) bandon( ) System located at 379 9 i•-Gc 1 5 I(� 1� ( to*S�' �\t ✓�)t���° 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 co pleted Within three years of the date of this pe r 'Date Approved bye s `u Town of Barnstable Regulatory Services �nsrnat.�, t Richard V. Scali,Interim Director � '0 ,0� Public .Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 installer&Designer Certification Form Date: In 't <<L Sewage Permit# C)1(, -2)70 Assessor's Map\Parcel 2 3 2 -019' Designer: l n�?;,_� €oc;Uj& j,. Installer: DI A • 6—,,VA Ito C Address: i Z i u, C c s r-�.� t�c=� Address: P 0- i3Q X .1 S a e y ",���,-LI~�i �M t� �t< - -e✓i �✓ 1 l� M 4 0 2 6 32 On 10-17—I G b - Q rv-N 4 1 c was issued a permit to install a (date) (installer) septic system at 37 1 LC.Vt S?J ().r V%�-ka I— based on a design drawn by (address) 1�'e SY1 L i✓A t-k.e. ?t5� dated Z. t �1 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the e septic system referenced above was installed with mayor changes greater than10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. 1 certify that the system referenced above was constructed in co Hance with the terms of the I1A approval letters(if applicable) o PETER T. G� NTEE Installers Signature) o Mc CIVIL civet No. 35109 AfGISAE%61 (Designer's Signature) (Affix Desi Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE .ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC IIIEALTH DIVMSION. THANK YOU. QASepticlnesignerCertification Form Rev 8-14-13.doe r Doc=1s304s847 09-30-2016 10327 BARNSTABLE LAND COURT REGISTRY DEED RESTRICTION or WHEREAS,Theodore A. Grauel Jr. and Jane Grauel of 379 Lakeside Drive West, ti NW-A I M46 It GrAt,,L, located in Centerville, MA, are the owners of 379 Lakeview Drive West, Centerville, MA and being shown as Lot 7 on Land Court Plan 20239-C (Sheet 2)dated February, 1958, drawn by Gerald A. Mercer and Co., Inc., Engineers, and duly recorded at the Barnstable County Registry of Deeds. WHEREAS,Theodore A. Grauel Jr. and Jane Grauel as owners of said lot have agreed with the Town of Barnstable, Board of Health to a restriction as to the number of bedrooms which can be included on any home built on said lot as a pre-condition of obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code,Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. WHEREAS, the Town of Barnstable, Board of Health, as a pre-condition to granting a Disposal Works Construction Permit for a septic system in compliance with 310 CMR 15.000, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on said lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW THEREFORE, Theodore A. Grauel Jr. and Jane Grauel do hereby place the following restriction on their above referenced land in accordance with their agreement with the Town of Barnstable Board of Health,which restriction shall run with the land and be binding upon all successors in title: 1. 379 Lakeside Drive West may have constructed upon it a house containing no more than three (3) bedrooms. Theodore A. Grauel Jr. and Jane Grauel,agree that this shall be a permanent Deed Restriction affecting the dwelling located at 379 Lakeside Drive West, Centerville, MA being shown as Lot 7 on Land Court Plan Number 20239-C (Sheet 2). TENNA&7&EWER,P,t~ THE CHATHAM CENTER :9 CRAFTS STREET SU1TE SL, ►1`r170tj 4r U' 'T Page 1 1 i i For title of Theodore A. Grauel Jr. and Jane Grauel,see the following Land Court Certificate Number 208372. Executed as a sealed instrument this Uffl day of �te�fUr✓i+, 20t6, Owner's signature is signature COMMONWEALTH OF MASSACHUSETTS ss Date 20 1( ,2807 Then personally appeared the above named 1AWDOP-G- A 6"VU, known to me to be the person/s who executed the following instrument and acknowledged the same to be their free act and deed, before me. Notary Public My commission expires: 1 2A (date) ,LSN1ttl rltiq, Page 2 _ � n( BARNSTABLE REGISTRY OF DEEDS I s`,. 2 John F. Meade, Register TV+fI�I G aTB1Liw VILLA ASSE5�^s4}i�'S M�41?&LOT 1NSTFZURR'S DIAM Ist`I?t•IOIktE I+i6. Li GI IthIG +ACILI'T Y:.t �) �` .�_,.._.(size):.1 } ��fU31..I".fl~Id�GDkL©Wi'+11'✓lt ..:.,. ' P iV[gT' da'X N. CaWLwit i`ATE.�.�..w Snpt�ratiori�dsix�a�e I3atve�n tfre.':. m of Z�;s�htn�l7fciUt!/ �.���ecMmAd w atto ' 1'ilv�g�; Tas.�i �;u�iply Jell` �cl I»et s l4ing ' rlity If 04y Wel,s dib oil,ast real let9and "d lLoac1u'mg rv*6:lity tYF�u�y arctpand5 exist aitci30{1 fc et`A 60 ins fu Ili } P c Lk , Town of Barnstable Barnstable .�. Regulatory Services Department •� Q p anxrrsrnsLe, 16 Public Health Division • 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1520 0001 2273 2640 February 18, 2016 Theodore A. Grauel Jr. 379 Lakeside Dr. West Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located 379 Lakeside Drive West, Centerville,MA, was last inspected on 1/17/2016,by Shawn Mcelroy certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet(per Town Code 360-0.1). • Distribution-box in poor condition; in need of replacement. You are ordered to repair or replace the septic system within two (2)years days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO OF HEALTH as cKean, .5.;CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\379 Lakeside Dr Cent Feb 2016.doc Town of Barnstable M" a Regulatory Services Department Public Health Division 200 Main Street; Hyannis MA 02601 Office: 508-862-4644 Richard Scab,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6,'2007 - Rev. 7/6/15 DEADLINES TO REPAIR-FAMED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA. ❑Discharge or ponding of effluent to the surface of the ground ❑.Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Stafic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS of cesspool ❑Any portion of the SAS, cesspool, or privy, below high groundwater elevation ❑Any portion of the cesspool within*a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water.quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components; etc) . 01 Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) B � OTHER �'✓D�' I J� a Y o r' d y� n PJQ 0'1—f P ti GF'/yr-1"? Repair deadline: a n� 4-7'M P Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc a3.2 - ()//"/9 t Commonwealth of Massachusetts / o W .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name Qj information is required for every Centerville ✓ MA 02632 1-17-16 . page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in an p p Y Y way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 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 Z Fails ❑ Needs Furthe Evaluation by the Local Approving Authority 1-17-16 1 spector'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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 379 Lakeside Dr W. ;el Property Address Louisa Grauel Owner Owner's Name information is required for e ry Centerville MA 02632 1-17-16 � page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a yeardue to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh L55ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well: ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 IL Commonwealth of Massachusetts v .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of'a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ 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 questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G'M 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 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? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 for example: 110 d x#of bedrooms 330 ( P 9P ) t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Lakeside DrW. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. City/Town State Zip Code Date of Inspection D. System Information Description. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 1-2016 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatstpersons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , M 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped within last 2 yrs Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1978 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 14"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 10" t5ins•3M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , M , 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 22" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15 How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ''p 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y�< 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is in poor condition with concrete giving way to erosion. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page_ City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leach pit was filled to the inlet invert at inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, �I etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 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: ® hand-sketch in the area below ❑ drawing attached separately A-D- l � t5ins•3M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12' 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 I c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 379 Lakeside Dr W. Property Address Louisa Grauel Owner Owner's Name information is required for every Centerville MA 02632 1-17-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Z Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Town of Barnstable P# Department of Regulatory Services e,ruvaT,,a� Public Health Division Date 200 Main Street,Hyannis MA 02601 �f0 AtA'�A F+ Date Scheduled_ Time U t Fee Pd. Go � Soil Suitability Assessment for Sew e a►%posal Performed By: ���W .0� -2� S� � Witnessed By: �f��_ �.,, PS Owner's Name LOCATION & GENERAL INFORMATION ^� Location Address 37q L�[(eStr .D,� w es4—. � �oac (rr,w�� Address 37`j LALCes''�cjx. Q,,- v/,)v,— Assessor's Map/Parcel: ce.v�E-t-,rl Ak M I-A C3 z C4 `Z�vZ- -� Engineer's Name kV\een j VQt! l NEW CONSTRUCTION REPAIR Telephone# SQ \-( Land Use �td��a-�q`l Slopes(30) Y— _ Surface Stones Distances from: Open Water Body ft Possible Wet Area <"Q-01 ft Drinking Water Well ft Drainage Ways ft Property Line E _,__ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) ... .........47- Parent material(geologic) C(J_LVVQ.-y Y1 -7-10-% -2 Depth to Bedrock A/ Depth to Groundwater. Standing Water in Hole- Weeping from Pit}once Estimated Seasonal High Groundwater `c?L `�'y'e � Ai,&V_V , <s DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: _ Depth Observed standing in obs.hole: In, Depth to still mottles; ,_,_ Depth to weeping from side of obs,hole: , in, Clroundwater Adjustment ft. Index Wcll# Reading Date:_ _ Index.Well!evc! - Aqi,factor— Adj,uroundwater Leyel , - PERCOLATION TEST Date Time.-- Observation Hole# "- z - _ Time at 0" Depth of Pere � 9 cL t�0E^� Time at 6" Start Pre-soak Time @ l Time(9"-6") End Pre-soak Rate Min,/Inch. Z_ Site Suitability Assessment: Site Passed D�__ Site Failed: Additional Testing Needed(Y/N)_ Original: Public Health Division Observiftion 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:\SI3PTICVERCFORM.DOC f DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in'.) (USDA) (Munsell) Mottling (Structure,Stones,-Boulders, Cot i istencv.%Gravel) ►2 b�l� C- Lei :DEEP OBSERVATION HOLE LOG Hole#_2-- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o Consistency.%Graven _ ]DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG . Hole#r Depth fronm Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. -Consistency.%OraXW)_____,� Flood Insurance Rate Man: Above 500 year flood boundary No— Yes X ^Wit.Wn 500 year boundary No Yes Within 100 year flood boundary No Death of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervious,ma'terial exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on �� (date)I have passed i:he soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai.nin peruse and experience described in 10 CMR 15.017. Signature _ Date QASBP'1 ICTERCFORM.DOC LOCATION SEWAGE ,PERMIT NO. �v r Z6k9 ,f� p' Dan � 70 • VILLAGE Ile INSTA LLER'S NAME & ADDRESS l B U I'L D E R OR OWNER Ul G'c e DATE ' PERMIT ISSUED <w— DATE COMPLIANCE ISSUED /l�.cL ,lr�'r d�l t vr� S=/•� 7F ,. � ,^- � t _,;ti f „�. � � ,. � . . . 17 l ,� .. _ � �� __ ,,,o � , ��,� ��,.,i5_�" _--- t�"" .;� � ,. No.......... ............ Flzs.... ....... THE COMMONWEALTH OF-MAS9ACHUSETTS BOARD OF HEALTH .......... ................OF..... i9l�ilJ :?.A.� �.--------------............_.....-- E Appliration for Disposal Works Tonstrurtion Prrmit plication is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: �qif st ------------- ---------------------------•. -7------------ -- ...........----- Location.Address or Lot No. . ....r�.t�..�.r�.r ....�,�9.�[P ..--..... --��jj�� --- ��-•� e'•Ow r •-----•-Address a ....U— Alga J_ .---. .z._ _ ........... -•----•............................ ................_.......................... � Insta ler � Address Type of Building Size Lot..Le/,..S'Ql0.......Sq. feet Dwelling—No. of Bedrooms.................3..._...._•......__.._..Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures --------------•--•------------•• . W Design Flow........._�Q........................gallons per person per day. Total daily flow........ ,00..._•....................pl lops. WSeptic Tank—Liquid capacity./--TAQ.gallons Length ._..... Width....4S_-_-_--- Diameter................ Depth.40-3...... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./........... Diameter./D.`l0._ _.. Depth below inle __..: .�, __'�.... Total leachin area.1.3.4A.....sq. ft. Z Other Distribution box (i�) Dosing tank ( ) —did`�01 . ' �� aPercolation Test Results Performed by---AIVA14,9A I...j&_'54AjM1............... Date..A/0.1/.....%.�1 ........ a Test Pit No. ..minutes per inch Depth of Test Pit--- ..... Depth to ground water___________________•,__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil....... Pi{ ll/,S_. .__ _:'..... .:.. ... ......... . W ----.•-----------------------•--••--.-•-••-•..•..-•-•-••-•••-......•------•---•-- ---•--•-- c ----'--.---------------------------------------.---.-----::_:::::::-- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescr' d Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary od T under ' ed further agrees of to place the system in operation until a Certificate of Compliance has b i s d by e b r of health. ned . ...... . ------- --- ----- -- ------ Date Application Approved By................ .... .. •--- ' 1 •••. .......... Date Application Disapproved for the f ollowin reosons: -•-•-----•-------•---•--••-•---------•--------•-•---•--•---••••-••-•--•-•-•----••-••............. ..................••-----•---•-•---•--•-•-•--•--••••-•---••--•--••-------••------•-----••--•--......•--•-••---•----••----•-•----••-•-------••---••--••--•-••••----•••-•------....._ -•••-••-•---. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ....a,�.......OF..........�.... ... .. . . .. ....................... % Carr ifirtt#le of Tomplianrr T IS TO RTIFY, Thanttli I_n�aidual Sewage Disposal System constructed ( ) or Repaired by-- --- w. Gl:. - L&_ --- ...... nstill has been installed in accordance with the provisions of T 7 ` of The State Sanitary Code as esc�in the application for Disposal Works Construction Per No. __ .._... _�.&._..__...... dated_..._7_"..7.'_Z1'................... 2.THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WIL FUNCTI N SATISFACTORY. ;..., . ��. Inspector c /DATE...... ... C��-------••-----------------------•----------- No..•.. .J-----_ , '� FICE.....V................... THE COMMONWEALTH ,C F MASSACHUSETTS BOARD OF HEALTH W ��Z7K , ApplirFation for Disposal Works Cnnntrnrtiun ramit Application is hereby made for a Permit to Construct. ) or `Repair ( ) an Individual Sewage Disposal System at: ..... Location-Address 1 or Lot No. N},.r-� fi 1 Gr�J �/!f^/r.h'f•-� 6 �a?��.s�-t'.���'.4�._ ���� .i ::� f .... .. ._ ..................... ........................ .... .-....... O Address ►� ...........1 A. _ ...------•------- Installer Address Type of Building _ Size Lot_��r`f,_•�_<=".......Sq. feet . U Dwelling—No. of Bedrooms______________ ........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building p., yp g -------------•----•---__--._ No. of persons............................ Showers ( ) — Cafeteria ( ) Other_fixtures ...4................................................. W Design Flow............ ._.._____________:_:_._____._gallons per person W , pday. Total daily flo w____._ .......................... _gallons. —Liquid ca acity� V allons Len th lW ----_•Se tic Tank .__.____ idth._. :__:_____ ---------------- p x Disposal Trench—No_ .................... Width.................... Total Length..................... Total leaching area_____.__________....sq. ft. 3 Seepage Pit 'No. I. _.___0_._._.___:___ Diameter.� _.:I!?_.____. Depth below inlet___. .� .. .._. Total leachin areas ' ?_::_sq. ft. Z Other Distribution box (��) Dosing tank �` Percolation Test Results Performed by._2.?�Q!?!!�A•L�•--• i4'i'.`:_ r;....-_- a --------- Date_ r���---..f..2"/..�.------- a Test Pit No. 1. _:�'-� _..minutes per inch Depth of Test Pit _` :___ Depth to ground water_____________________ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Rir1 ------- D Description of Soil----•�. r�' r~'1ttl - : _//" ' e "til`�j� ............................................... ----------------------- w .............••- x .. U Nature of Repairs or Alterations—Answer when applicable................................................................................._.............. --------••-------------•--------.._..--•------------------•-----------------------------..__....._..------------------------------------------------------------------------------._.._..---•-•.....-•-- Agreement: The undersigned agrees to install the aforedesc ibed Individual Sewage Disposal System in accordance with the provisions of 1 1 4 5 of the State SanitaryCo T yQ under>si ed further agrees, of to place the system in operation until a Certificate of Compliance has beEn ' s ed by Ythe boar of health. / B �• A .Date. Application Approved By----- f i e -.._, ,� t - ---------------------------- Date 7 % .... Application Disapproved for the following reasons:•--------------------------------------------------------------------------•--------------••----------------- i Date PermitNo......................................................... Issued--------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS �p.. BOARD ;OF HEALT ....... ��3�• .........OF....... .% ;.l'6.' ..`.. ................... Trrtifa de of f�, mptiFattrie TgIS %S TO C ORTIFY,, T de Incidual Sewage Disposal Sy . stem constructed or Repaired by Y. --N :... ��nstalle� f`-f //!! / d _. = "' �t t. has been installed in accordance with the provisions of T�'=k -E `of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ;;, ___ _____________ dated----- "-. _". .................... THE 'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WIL4 FUNCTION SATISFACTORY. DATE... :777 Inspector------------------------------------••-•---••---•-••-•-.... • . THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEAL (791 ............. No......................... FEE._/��t �rnr�uan Permission is hereby granted_' ----- ------- .. --t-----------•----------------------------------------------------------------------- s�t to Con (I-) or Re�air / Individual .w e Dispo S stem- at No.,k.,,.,.. �Y✓ ......,1 fGff.�!� ` p` 7.__ A.......64. ............................... Street as shown on the application for Disposal Works Construction pqmit Dated____7`--__��_�.._�.......... G. 1. /t /� --------•--------------•-• Board of Heal DATE.' -- '- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - � n 6339/y wM J . Z � � c0 7 7- 70 (D LU N A-4 �= LJJ > Co Q G i g�, ll 2,-Fla 2,-Fla b 3,2^ iII cC r LL�� S',�y,���A.JWb'd-1 o� � � 1� 06 111 LH AW:CX245 AW:C 245 AW:RV2127 Casement) / Casems t ICI 1Oi�t3 06 W .J Roof Windows,manual / I r/) \ operation with - - - - .'�= � r�. long-reach pole �1ULLED UNIT I MULLED UNIT /' Z O W �y operators and screens. = LL 2 4 — \\ / cj O 0QLU I—�-0F JKYLIG —�- AW:CX245 O J F— ��tIWIN OWS Casement w 7 L _ J \ L—� L Casement ��— \ r I I,. AW:RV2127 Uj M E- /'jUk b 0 M -�� Roof Windows,manual EXISTG DECK - v _ — — b operation with _.._. _:._ \ operators pole \ TITLE: __ `LINE OF CATHEDRAL / / operators and screens. Casement CEILING / (// \ -O-4KYLI 'r RELOCATED: L 8 DOJOR / Relocated existing slider and storm slider to West wall of new I� 1ST FLOOR St.nroom— _ PLAN i NEW CASED OPNG @ .5a— Kitchen Counters.rain —�- - RELOCATED SLIDER Green granite as selected and i LOCATION reserved by owner.Note& - AW:FW031611 a t` confirm areas to have c Frenchwood Outswin I backs lashes or ledges.Provide Yn Patio Door - dra Inge for approval prior to c� 6-54s" I, _ I fabrication. E a,t k-• @i New Kitchen Flooring: Naturoor -r ELEG I I Kitchen Cabinets:IKEA Akurum 2 m I __ Natural Splendor collection;color: KIT_C1'_�_v_N__ I system rases with Cartagena,Install per mfr's "ID ! Door and Drawer Fonts.See 3 specs and recommendations. r - itemized list provided by owner. Raise level of subfioor as NEW BOXED 4x4 F. required I install level with SUPPORT ON FL �.)�1I�I� i FRAMING BELOW Kitchen Appliances:Existing W L si refrigerator,000ktop,trash AW:C245 ?, - 2.6 rl a'- compacotr,oven and microwave to 1 Casementw/ be salvaged for reinstallation in new J AW:AR41 awning --------- kitchen casework!iayoul.New above ------ sink and dishwasher to be selected [� by owner. I . N CD � -�- New shower unit:Linea Aqua Demo existing plumbing wall and �X� �C7 ALL Davenport 48 x 32 semici cular run supply from below loft ex'g hall -._.__.-__...__ _ glass shower enclosure and wall to new shower unit. N tray.Corian or equal side well material.Fittings to be m iD r= selected by owner. Master Bath:Demo ez'g ceiling, U N New sink in new granite I I lighting,remove ex'g plumbing v counter&vanily cabinet. fixtures.Install new fixtures and ) o (2)wall cabinets with ,, fittings,new blue board at walls& '^ 1L mirrored medicine cabinet I I s _. ceiling,new trim,window, r v . (� Guest Bath:Install new fixtures and between at wall above. '\ 1 �` 1 S I G venting,new tile Floors and new � B U. I - `- -- solid core door. fittings as selected by owner,and �'�FiST r D t ,,.T. �., new solid core doors.Remove s -.- R E2 ,y E r° ISTG GUEST ' +�� wallpaper andFrepwalls,irim& NewTotocomfortheight �� BATH U � BEDR, calling for new paint.New lighting,, toilet at ex' location wl ._ ....._ _..-. _ mirror cabinets and venting. oft heated seat.. �•�"� Providesani information bb� ----- I for owner approval. '.y = J Q La L AW:AX251 Awning window-cut .dw - new rough opening in existing wall File No. g and install new window. - Date 05/30/07 Sheet No ~ FIRST FLOOR PLAN SCALE:114"=1'-0" Y J W I- O W N Z � � (D O O w CV o Y iT•1De" ui Q � < ui NEW 3.50.5 HHS STL COL.W/ —LINE OF SUNROOM N 3.5x3.5 HHS STL COL.W/,/ I I J W W BASE PL TOP 8 BOTTOM,BOLT B SEPL�fOfj&B�OTt06^B LT ABOVE p TO FTG AND BEAM—, j' / Tb FfG AND BEAM I W J r __ - - � LIJ1L -%�u � Lu L -- - - - - - �, � U) zz -�-, -- - = = -_- -=� ; I> � �� Z O � � I Y LINE OF STEEL BEAM `} O Q I W 3D"'BIGFC DT CC FTG,4,10"\� ABOVE I�30"'BIGFOOT CONC FTG,4'.0" Q MIN.BELOW FIN I GRADE MiW-BELOW-FINL GRADE —PORTION OF EXISTG I �—EXISTG DECK 8 DECK AND COLUMNS / FRAMING TO REMAIN TO BE REMOVED ! I \ = F_ M C) TITLE: h _ FOOTING & LINEOFS I EEL bt&W BASEMENT ABOVE — _ PLAN LINE OF N W DE CK ABOVE / 8 d NEW 3.54.5 HH$STL COL I I d BASE PL SOP 8 BOTTOM,81)LT TO FTGAlJDBEl�M 30"BIGFCt,OT CONC I I FTG, W 4'0" MIN.BELOW FIN!GRADE I \ 7 E II —13 V o I d y \ (� W y U � ~ R U CD U CD File No. .dwg Date 05/30/07 Sheet No BASEMENT FLOOR PLAN SCALE:1/4"=1'-0" A�2 A / N LEGEND - - 10 -- EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE �� OVERHEAD WIRES �0 BVW-12 W EXISTING WATER SVC. I-02 0 TOP OF INLAND BANK 3 - / BVW-10 BVW.9 6.98� WETLAND FLAG � us �, � a t N -1k WETLAND SYMBOL I iy N TEST PIT Wequaquet Lake 1 � BVW-09 LOCUS MAP NOT TO SCALE Wequaquet Lake , BVW-08 WA TER SURFACE EL.=33.8 (NGVD) DUNE-2016 ,I� / VEGETATED f B V W-0 7 / WETLAND / EXISTING LEACH PITS TO BE PUMPED, FILLED WITH BENCHMARK SAND & ABANDONED / 39.83 TOP CONC. BOUND � EL.=42.46 EXISTING SEPTIC TANK Ilk- ,BV -06 01 39.8 ��\ (TO REMAIN) INV.(0UT)=45.7t(F/EL•D VERIFY) - _ / ) 0.5 2 _ INSTALL 40 MIL POLY LINER /�0 `A( v 40,47" TP- TOP OF LINER, EL.=41.5 / vV 'D BOTT. OF LINER, EL.39.8 CID 40.52 BV -04 / TP-1 t �. � 41 ° e� .8 / 45.49 � Jed /� � , / _ BVW-03 p i \ 4310 / ��� , 41.12 ��Op' Opp • 48.29� 46.4 `` i x o 42.59 i 48,30 p i 49.43 45.5 \ �' 41,45 -y�D� 6 / /� 48. .85 +� 8 �Q� ` VENT L16T 114,820±SF 44 46. _ .B i#0 0.34�Acre q 43.2.9 PK 0 RE 4 315' 0 / .62 x �'� / / x 48.84 0 4 :PAVED:::.;: ;'y. 'DRIVE Y WA00., O � 41,72 / M-1 /y �Et 0 v 42,8 ' x 42, cb/ 5 �.. = ': 42,35 J 4 2.7 0 i s 49.55 - �- 41,10) G�ye��o< 42,4r �1 EXISTING yo / - 4$- �' HOUSE(#379) 00 _ \ � 9.54 TOF=50.4f I� fie° 1 'X 4 2.j0� /�� -38� eoye 000 �42 17 � " 36.30�w'00 DECK i x / c 36.33�4 f (ab o ve) i�-: 0 7 00/ x 35A9 "06 00`_ / X 41.88-' �� x 36.94 735.03 �,� i M \6�0 0 / -F 42.67i i , / r�35 24 gP �B.F05 0 F ASJ9c \ p., - - / � x 3+4 5/ x ��,F /�6.84 �/ ���/'IB-04 o PETER T. �G� 0 o McENTEE ---` / /35 26,SOP!� \ oL' CIVIL "' 6.86 IB^02 i -03 i No. 35109 // Wequaquet Lake • of SA- WATER SURFACE EL.=33.8 NGVO JUNE 2016 �F'SSlpOPI�L/ '�� /35.30 ed9 ( ) i x ♦/* PLAN REVISION 8/23/16 IB-01•' 1) DESIGN CALCS FOR 43' LONG S.A.S. 2) ADD BREAKOUT BARRIER PARCEL ID: 232-048 FEMA FLOOD DESIGNATION PROPOSED SEPTIC SYSTEM UPGRADE PLAN MAP EFFECTIVE NUMBER: DATE:5 ULY 016622014 379 LAKESIDE DRIVE WEST, CENTERVILLE, MA NON HAZARD & 0.2 % ANNUAL CHANCE Prepared for: Theodore Grauel, 379 Lakeside Dr. West, Centerville, MA 02632 WETLAND CONSULTANT OWNER OF RECORD MARSH MATTERS ENVIRONMENTAL GRUAEL, THEODORE A JR Engineering by: SCALE DRAWN JOB.1"=20' P.T.M. 174-1 s P.O. Box 554 & JANE H Engineering Works, Inc. FORESTDALE, MA 02644 379 LAKESIDE DRIVE WEST 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. 978-434-1228 CENTERVILLE, MA 02632 (508) 477-5313 8/2/16 P.T.M. 1 of 2 NOTE: TO PREVENT BREAKOUT INSTALL 40 MIL POLY LINER TOP OF LINER, EL.=41.5 SEPTIC TANK BOTT. OF LINER, EL.39.8 INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE INSTALL WATERTIGHT H-20 INSTALL WATERTIGHT H-20 RISER & COVER OVER ONE RISER AND COVER SET TO CHAMBER (MIN.) AND SET TO FINISH GRADE TO SERVE T.O.F.=50.4t FINISH GRADE AS AN INSPECTION MANHOLE. - EXISTING F.G. EL.=43.2t F.G. EL.=47.9t F.G. EL.=43.5t CHARCOAL VENT S L = 52' L = 17'(MAX) S=1% (MIN.) @ S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 6" 2" LAYER OF 1/8" 1o"I ®�E3 TO 1/2 DOUBLE 14" 6 12" WASHED STONE EXISTING 48" LIQUID INV.=45.7f OR APPROVED FILTER FABRIC) LEVEL VERIFY PROPOSED INV.=42.00 GAS 1 . ( ) 2.5' 3' 2.5' 3/4"-1 1/2" INV.=42.17 D BOX INV.=40.80 EFFECTIVE WIDTH = 8 DOUBLE WASHED H-20 RATED STONE EXISTING SEPTIC TANK USE 6 LC-6 LEACHING CHAMBERS IN SERIES WITH 2.5' OF DOUBLE WASHED STONE-ALL SIDES NOTES: 4' OF DOUBLE WASHED, STONE-ON BOTH ENDS 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS, PRIOR TO INSTALLATION. H-20 RATED TOP CONC. ELEV.= 41.6 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE -- -- -BREAKOUT ON A MECHANICALLY COMPACTED SI XINCH CRUSHED INV. ELEV.=40.80 E3 E3 EM O EM E3 E3 ELEV.=41.3 STONE BASE, AS SPECIFIED IN 310 CMR 15.221(20. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM ELEV.=39.80 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 4' OF NATURALLY OCCURRING 3.5' 6 x 6' = 36' 3.5' AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. PERVIOUS MATERIAL EFFECTIVE LENGTH = 43' 5' (MIN.) ABOVE G.W. ESTABLISHED HIGH G.W., EL=34.80 - LEACHING SYSTEM SECTION SEPTIC SYSTEM PROFILE N.T.S. GENERAL NOTES: SOIL LOG 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: JULY 5, 2016 (REF#15,092) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL EVALUATOR: PETER McENTEE PE(SE#1542) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE WITNESS: DAVID STANTON R.S. HEALTH AGENT LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH -310 CMR 15.405(1)(a)&(b): 1) A 5' variance, S.A.S. to property line (side), for a 5' setback. 43.5 A 0 42.8 A 0" -LOCAL REGULATION Chapter 360. Article 1 - Setback Requirements LOAMY SAND LOAMY SAND 2) A 30' variance, S.A.S. to vegetated wetland, for a 70' setback.' 42.2 10YR 4/2 16 42.1 10YR 4/2 3) A 41' variance, S.A.S. to inland bank, for a 59' setback. B B 8 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR LOAMY SAND LOAMY SAND TO-INSPECTION-AND APPROVAL BY THE BOARD OF HEALTH ,AND THE 10YR 5/6 10YR 5/6 - - --- DESIGN ENGINEER. 41.0 30" 40.8 24" C C 4.' ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING PERC FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN M-C SAND M-C SAND 30"/48" ENGINEER BEFORE CONSTRUCTION CONTINUES. 2.5Y 6/6 2.5Y 6/6 5. ALL ELEVATIONS BASED ON NGVD±. COBBLES & COBBLES & 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF `� BOULDERS BOULDERS THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 34.8 HIGH G.W. = 34.8 HIGH G.W. _ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 33.8 STG. G.W. - 108" 33.8 STG. G.W. = 116" 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 32.5 132" 32.8 120" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS PERC RATE <2 MIN/IN., "C" HORIZON AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE STANDING G.W. AT EL.=33.8 DIRECTED BY THE APPROVING AUTHORITIES. ESTABLISH MAX. HIGH G.W. FOR LAKE WEQUAQUET, EL.=34.8 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 1 CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS I 20'KMk COVER THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). I 1 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 4•KNOCKOUT 4"KNOCKOUT INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. I 1 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND I I IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. L------ 4•KNOCKOUT 72' PLAN VIEW DESIGN CRITERIA NUMBER OF BEDROOMS: 3 BEDROOMS Ea EEA E?I 0 E3 a E3T SOIL TEXTURAL CLASS: CLASS I 22' TE3 ® DESIGN PERCOLATION RATE: <2 MIN/IN 11122 I ® ® ® ® ® ® ® I I I DAILY FLOW: 330 GPD I I I DESIGN FLOW: 330 GPD 72" 1 E 36" 1 GARBAGE GRINDER: NO-AND NOT PERMITTED WITH THIS DESIGN SIDE VIEW END VIEW EXISTING SEPTIC TANK: 1500 GALLON CAPACITY WIGGIN LC-6, H-20 LOADING PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS H-20 RATED LEACHING CHAMBER LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF .74 GPD/SF N.T.S. USE 6 LC-6 LEACHING CHAMBERS IN SERIES WITH 2.5' OF DOUBLE WASHED STONE-ALL SIDES PROPOSED SEPTIC SYSTEM UPGRADE PLAN 4' OF DOUBLE WASHED STONE-ON BOTH ENDS 379 LAKESIDE DRIVE WEST, CENTERVILLE, MA SIDEWALL AREA: (8.0' + 43.0') x 2 x 1' = 102.0 SF Prepared for: Theodore Grouel, 379 Lakeside Dr. West, Centerville, MA 02632 BOTTOM AREA: 8.0' x 43.0' = 344.0 SF Engineering by: SCALE DRAWN TOTAL AREA:........................................................... 446.0 SF Engineering Works, Inc. 1"=20' P.T.M. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED DESIGN FLOW PROVIDED: 0.74 GPD/SF(446.0 SF) = 330.0 GPD (508) 477-5313 8/2/16 P.T.M. �r. a N LEGEND 10 -- EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE k"ft D, � s -aH. -- OVERHEAD WIRES BVW-12 W EXISTING WATER SVC. \\ J �� 16 98 0 TOP OF INLAND BANK m / BVW-10 BVW-0� V 6.98 WETLAND FLAG ( �, a • N WETLAND SYMBOL Wequaquet Lake 1 ✓� N TEST PIT �� � BVW-09 LNOT OCUO SCALE o` � Ci � J AL / Wequaquet Lake Bvw-08 WATER SURFACE EL.=33.8 (NGVD) JUNE 2016 VEGETATED ;BVW-0 7 / WETLAND EXISTING LEACH PITS _& / BENCHMARK TO BE PUMPED, FILLED WITH TOP OF CONC. BOUND SAND & ABANDONED /39.83 EL.=42.46 EXISTING SEPTIC TANK A& ,BV -06 SO' 39.. , (TO REMAIN) . /z.'. INV.(OUT)=45.7t(FIEL•D VERIFY) (C CB l -;�O' 40,08 0.52� \2,46 (1 .J (1!� I!J` 0 Y/ 40=4 7 TP-2 BV -04 Z r n / L � 41,86 4 5.4 9 ' l BVW-03 / P°Je / i� 1� :A' ® °k �� i� / 45.35 41.12 00 - / OQ . 4 8.2 9- 46.4 O �, i 42.59 i 61 48.30 :. e. ..... . 49.43 \ 45.5 O 0' 48.0 .85 41,45-/i � �/ VENT LOT F . i .44 Q y �JF 11 14,820•±SF 46. B 0.3Acre 0 ��.7. .43.29 :' PK S gP� ,62 j '` / x 48,84 � o a - ORlVEWAY ,i'p 1� 41.72 x 42.2- . M-13 QOFtO000 G2��� 42,P., � 42.35 J i �/ 5 , ✓� �i� !y i - �9. 4100 1.10� 49.55 oOo � < 42.4f� ,J EXISTING °o cep • �' HOUSE(#379) / / \ �' 9,54 TOF=50.4f �e�`t 42,&f0.00 �µ°° 4217 / / 36.30 /- - DECK 42,1100, x �{� (above) ? � ,� �' -1 i�07 i� ♦ r2r 36.33�i� �!. ice/ ,� ,� /� x 35.19 ♦� 06 S f �/ /X 41.88-'/ x 36.94 / 35.03 �x�,♦�V' i 761. + 42.67,- , / <,35 24 �P ♦ kE-05 / � x36.45/ , 6,84 J/ 1 \,♦ IB-04 0 F MS _ �3�� //3 26LOP O A x Af -03 P s9�y 36.86 I�02 ♦♦ �f o PETER T. o� / i ° Wequaquet Lake McENTEE � CIVIL "' /35.30 ♦l edge WATER SURFACE EL-=33.8 (NGVD) DUNE 2016 No. 35109 x 4, /S1E� �� & /0 N� I -01•' <� PARCEL ID: 232-048 FEMA FLOOD DESIGNATION PROPOSED SEPTIC SYSTEM UPGRADE PLAN MAP J EF ECTIVEBDATE:5 ULY 016?2014 379 LAKESIDE DRIVE WEST, CENTERVILLE, MA NON HAZARD & 0.2 % ANNUAL CHANCE Prepared for: Theodore Grauel, 379 Lakeside Dr. West, Centerville, MA 02632 WETLAND CONSULTANT OWNER OF RECORD MARSH MATTERS ENVIRONMENTAL GRUAEL, THEODORE A JR Engineering by: SCALE DRAWN JOB.1"=20' P.T.M. 174-1 P.O. BOX 554 & JANE H Engineering Works, Inc. 6 FORESTDALE, MA 02644 379 LAKESIDE DRIVE WEST 12 West Crossfield Road, Forestdale, MA 02644 SATE CHECKED SHEET N0. 978-434-1228 CENTERVILLE, MA 02632 (508) 477-5313 8/2/16 P.T.M. 1 Of 2 7 i �V, rr l p �a N E: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 41.3 FOR A DISTANCE OF 15' AROUND THE ERIMETER OF THE S.A.S. SEPTIC TANK �. INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE INSTALL WATERTIGHT H-20 INSTALL WATERTIGHT H-20 ER RISER AND COVER SET TO CHAMBER (MIN.) AND SET TO FINISH GRADE TO SERVE T.O.F.=50.4t FINISH GRADE AS AN INSPECTION MANHOLE. EXISTING F.G. EL.=47.9t F.G. EL.=43.5t F.G. EL.=43.2t CHARCOAL VENT L = 52' L = 17'(MAX) S=1% (MIN.) ® S=1% (MIN.) 4"SCH40 PVC 4'SCH40 PVC s 2" LAY_R OF 1/8" io"I ®O® 6 TO 1/2 DOUBLE WASHED STONE EXISTING 48" UQUID INV.=45.7t (OR APPROVED FILTER FABRIC) LEVEL INV.=42.00 W BAFFLE (VERIFY) PROPOSED 2.5' 3' 2.5' 3/4"-1 1/2" INV.=42.17 D-BOX EFFECTIVE WIDTH = 8' DOUBLE WASHED H-20 RATED INV.=40.80 STONE EXISTING SEPTIC TANK USE 6 LC-6 LEACHING CHAMBERS IN SERIES WITH 2.5' OF DOUBLE WASHED STONE-ALL SIDES NOTES: 4' OF DOUBLE WASHED STONE-ON BOTH ENDS 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS, PRIOR TO INSTALLATION. H-20 RATED 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE TOP CONC. ELEV.= 41.6 -- -- -BREAKOUT ON A MECHANICALLY COMPACTED SI XINCH CRUSHED INV. ELEV.=40.80 ®®®O®®® ELEV.=41.3 STONE BASE, AS SPECIFIED IN 310 CMR 15.221(20. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM ELEV.=39.80 o ' am 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 4' OF NATURALLY OCCURRING 4 6 x 6' = 36' 4' AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. PERVIOUS MATERIAL EFFECTIVE LENGTH 44' 5' (MIN.) ABOVE G.W. ESTABLISHED HIGH G.W., EL=34.80 = LEACHING SYSTEM SECTION SEPTIC SYSTEM PROFILE N.T.S. GENERAL NOTES: SOIL LOG 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: JULY 5, 2016 (REF#15,092) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL EVALUATOR: PETER McENTEE PE(SE#1542) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE WITNESS: DAVID STANTON R.S. HEALTH AGENT LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: ELEv. TP-1 DEPTH ELEv. TP-2 DEPTH -310 CMR 15.405(1)(o)&(b): 1) A 5' variance, S.A.S. to property line (side), for a 5' setback. 43.5 A O 42.8 A 0" -LOCAL REGULATION Chapter 360. Article 1 - Setback Requirements LOAMY SAND LOAMY SAND 2) A 30' variance, S.A.S. to vegetated wetland, for a 70' setback. 42.2 10YR 4/2 42 1 10YR 4/2 3) A 41' variance, S.A.S. to inland bank, for a 59' setback. B 16 B g 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR LOAMY SAND LOAMY SAND -`JTO 'INSPECTION-AND APPROVAL BY THE BOARD OF HEALTH AND THE 10YR 5/6 ` " 10YR 5/6 - ` "- DESIGN ENGINEER. 41.0 C 30" 40.8 C 24" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING PERC FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN M-C SAND M-C SAND 30"/48" ENGINEER BEFORE CONSTRUCTION CONTINUES. 2.5Y 6/6 2.5Y 6/6 5. ALL ELEVATIONS BASED ON NGVD±. COBBLES & COBBLES & 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF BOULDERS BOULDERS THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 34.8 HIGH G.W. - 34.8 HIGH G.W. - HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. _ - 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 33.8 STG. G.W. = 108" 33.8 STG. G.W. = 116" 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 32.5 132" 32.8 120" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS PERC RATE <2 MIN/IN., "C" HORIZON AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE STANDING G.W. AT EL.=33.8 DIRECTED BY THE APPROVING AUTHORITIES. ESTABLISH MAX. HIGH G.W. FOR LAKE WEQUAQUET, EL.=34.8 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. r--4. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS I 20.DIX COVER IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). I 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 4. -KNOCKOUT 4. n KNOCKOUT INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. I 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND I I IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. L------ t KNOCKOUT 1 I 72" � PLAN VIEW DESIGN CRITERIA 17-1 NUMBER OF BEDROOMS: 3 BEDROOMS ® ® ® 0 SOIL .TEXTURAL CLASS: CLASS I 22" ® ® Ea DESIGN PERCOLATION RATE: <2 MIN/IN IN�Rr ® ® ® ® ® ® ® I I I DAILY FLOW: 330 GPD DESIGN FLOW: 330 GPD L` 72' 1 36" 'I GARBAGE GRINDER: NO-AND NOT PERMITTED WITH THIS DESIGN SIDE VIEW END VIEW EXISTING SEPTIC TANK: 1500 GALLON CAPACITY WIGGIN LC-6, H-20 LOADING PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS H-20 RATED LEACHING CHAMBER LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF .74 GPD/SF r ' N.T.S. USE 6 L -6 LEACHING CHAMBERS IN SE 31 WITH 2.5COF DOUBLE WASHED STONE-ALLI SIDES 1 u^ PROPOSED SEPTIC SYSTEM UPGRADE PLAN 4' OF DOUBLE WASHED STONE--ON BOTH ENDS 379 LAKESIDE DRIVE WEST, CENTERVILLE, MA SIDEWALL AREA: (8.0' + 2 1' = 104.0 SF Prepared for: Theodore Grouel, 379 Lakeside Dr. West, Centerville, MA 02632 BOTTOM AREA: 8.0' 44.0' = 352.0 SF Engineering by: SCALE DRAWN TOTAL AREA:.................................. 456.0 SF Engineering Works, Inc. 1"=20' P.T.M. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED DESIGN FLOW PROVIDED: 0.74 GPD/SF(456.0 SF) - 337.4 GPD (508) 477-5313 8/2/16 P.T.M. , T - �,. . ,, - ..+a. N,NHAt4'•.... r4.a-rew..,-..- ,.:wsr'bv:,<:w:..xwnws'rmw-Nr s.., Ys+ =n.s,wz„nws+.—..-. . �.•u9k.mi,•. ..:n,:____Y tt�.-m.I:, .mma,w�a•.m.,.., ua„v....a_„ '.-.o,.u,y11W, , ww,..Al.--v «srw ..wzv.•r:w„ . ,r,+,s•.,c,wtwMMw:.er,v,:, ..e.».mM r'r•::«,b•:• .' ,tiY� amYlWlrrR+M:r,..,w,.••::-.w•,. `:*' 1+N+eN.g{Y++W. 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