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HomeMy WebLinkAbout0051 LARCH LANE - Health 51 Larch Lane Centerville P A = 189 006010 d f FROM FAX NO. May 25 2016 03:47PM P1 kVWf M,Cp PAVED DRAG OVWJ pUS11NG DMWNG • TOF � 3f.0' 8VW4 J kvW5 O O t*.6• OM OVW/ y0, SHED ED s� ovws AS BUILT SEPTIC PLAN DCE #16--109 LOCATION. 51 LARCH LANE PREPARED FOR: CENTERVILLE,MASS. B&B EXCAVATION SCALE 1" 30' DATE MAY 25, 2016 �+of nt�,� "or: guns n?, DANIELA. DANIEL x OJALA A. a ' 0JALA 6bd2 o No.4098 ^�().`\. I °IFS 16 �G��'wq lyN Qi8T ess �oQ own cape engln®errng, Inc. �f-Z�•�(,� s�pN �N v -�-� 01 NL ENGINEERS LAND SURWYORS DATE REG. LAND SURVEYOR 9J9 Mohr YARMIWTHPORT, MASS TOWN OF BARNSTABLE TION :5) Larck LtJ SEWAGE# ZOI4G ' 1G VILLAGE CsJc ru►J 1 c. ASSESSOR'S MAP&PARCEL 1994t!01 O INSTALLER'S NAME&PHONE NO. _R* .R FXccL%Jc_4 i on y%77- OGS3 SEPTIC TANK CAPACITY J000 cqt;► LEACHING FACILITY: (type) 4=Q Cqz ) (size) 13.a 2$A Z NO.OF BEDROOMS OWNER PERMIT DATE: S-J y7.f G COMPLIANCE DATE: �f Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al- 33'10 " �3 - Z 2 s •, Fcon-I A T A2 '.39-s (32' A3's2 13*# �3.35 S 2 Ay' 60' REAP., 13LI• 4s's ' �t►ne, S o No. a (,e Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplitation for MispoSal *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.5) L 4 rci Owner's Address,and Tel.No. i h 05e } UClri4Ues 1-78_jZ) yl1 Assessor's Map/Parcel Mapg _ Installer's N me,Address,and Tel.No. Designer's Nam Address,an Tel.No. tQxcCt�a.�ron soy• �-�7 a653 �ov�ne 50�•3�2-'+541 Type of Building: ? Dwelling No.of Bedrooms V Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date Jr (D I Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Zb d,b H �-��rnbea's 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:BoQofealth. Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No._�,�. — 6 Date Issued t - r! r No. (X IN Fee 6 C:J THE COMMONWELTHIbFjMASSACHUSETTS Entered in computer: Yeses PUBLIC HEALTH DIVISION - TOI OF BARNSTABLE, MASSACHUSETTS application for Bisposal 6pstem (Construction Permit Application for a Permit to Construct(Repair(.) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.5! L Cl Owner's Nameq Address,and Tel.No. Assessor's Map/Parcel AA CL10 �(� �C I 1( Installer's Name,Address,and Tel.No. t, Designer's Name,Address,and Tel.No. _I LxtC1 �Cc 17 -U�53 �awt �5y1 Type of Building: Dwelling No.of Bedrooms Lot Size s .ft. Garbage Grinder � q g ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) (J gpd Design flow provided gpd Plan .Date ra �! (r Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil - Nature of Repairs or Alterations(Answer when applicable) G d b 2, {) ►U ) -I a 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 ealth. , Signe Date .5�✓I Application Approved by Date J �7 Application Disapproved by Date for the following reasons Permit No. ��� -^ 6 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( 11)by I j`� k ( ��\J N` [ (1 I at l_ri(r; \ L rI has been constructed in accordance with the provis ons Iof Title 5 and the forDisposal System Construction Permit N /(�r dated Installer () 4 j ( I I (f(�\i Designer #bedrooms �3 Approved desi ow 0 gpd The issuance of thi permit all not be construed as a guarantee that the system wil functi as designed Date �� l// Inspector �/ / ---- -'--------- ---------------------------------------------------- No. / Fee I<C7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at `j M L (.I' r E 1 r a p rl ( q 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 Qby Date Approved P town of Barnstable P# De afttnenV Health Safety,xan'dFEnvtronmen,ta'l'Services?. ( �p• rt 'it � a rrt .4 Pmblic�H°ea'lth Di�isl'o,n Date. ��/,�.x 367 Main`1Street,Ilyr.inis MA�02601) "Y` areas. �.� � 6 Q•0• Q(, 7�p rFn�tn�d� Date Scheduled Time to hAl Fee Pd. Soil Suitability Assessment for ASewa =osal Performed By: ` Witnessed BYV r16✓I��Jw t- :: I�I�� I( T1 X. I > :»> <:>;:::;::;:::;:.:;:.::..:...... Location Address ^^,w i p ,� Owner's Name _ JI Assessor's Map/Parcel: rr! 0 4/0`0 � � y' �0 En O1vt1'^--` e NEW CONSTRUCTION REPAIR t/`" - Telephone# J Ad-" Land Use 'V)6S tl( `O, ! _ Slopes C/o) 0'� Surface-Stones Distances from: Open Water Body ft Possible Wet Area_IQO ft Drinking Water Well i ft - Drainage Way ft Property Line _R Other ft - ns of lest holes& erc tests locate wetlands in proximity to holes) SKETCH:(Street name,dimensions of Lot,exact locations p _ _ C - 1A Ile, r ,\ I je& Zi _r?06rT& Z Parent material(geologic) s _1ret Depth.to Bedrock Depth to Groundwater: Standing Water in Hole: N6106 Weeping.from Pit Face Estimated Seasonal High,Groundwater.• yy/�C1 R ........ Method Used: OV �:•:• .:.:•;:::;;::•;:::::.r::::::::........................ Depth Observed standing in obs:hole: in. Depth to>soiVmottles: in. Depth to weeping from side of obs.hole: in. Groundwater AdjustmentY �• index Weil#___•_._ •Reading Dale:_•_=_ Index Well level-__`' A(]J factor ''Adj.-Groundwater Level_ hie...... .........................................................................................................................:.. _ Observation Tim at Hole# r r. Depth of Perc Time at"6 "�' ` "" Start Pre-soak Time® s a TimeO'.'011) } ± 0 End Pre-soak Rate Min./Inch ��- _ Site Suitability Assessment: Site Passed Xeo -Site Falled:**,*,u. . Additionai.Testing•Needed(Y"TMA$ -+r» Original: Public Health Division Observation Hole Data'!0 13e Oompleted on d3ack Copy: Applicant � i • i;•isi.i;isi::i�siin:.i::o:::::::::. . {..�.. iii. RR. .`y... 1. .: iJ�ljJ:: .V..::w:.ii'.iii:::::isi::^?'::: •.:::::::.:::................;:is<Ji:::.i:.ii:viiii:::.:::::;.i: :•::::.�::::::::.:.i::•: � 1:1�.:�YW�..:�:::•:�:::::::.iii:•i:p'r;i:.::•::::.:::•:::::: :::<.iii:•iii:'rS:.�•.�:::::•::::::::::::::::::.�:.�.�.�............................................ Depth from Soil Horizon SoilTextu eft # 11#iSoil`6olor'E4 is " Soil Other Surface(in.) (.USDA),� ,, (Munsell) Mottling (Structure,Stones,Boulderes. '11 <�.,pi� ;°�•e .� i ''2 t3 X. ;��',��', *x t ���#�r L�����J d� 7 c .�;Z��e' S .-AkAe d 9 2a - i+mi EF:.:ClB.SERA.:T.:.IQN.:HCI►.LE;:�!.;:::.::.::::::::.;::.;:.;;;:.;:.;:.;:.:<.;:.;;>;:.::::::::::::.�.�..�..,,.:;:;:.;:.;:.>::::;:.;;:.:::..;.:::.;<::::: .6epth from Soil IIorizon- Soil Texture Soil Color Soil Ot er Surface from (USDA)' (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°oGravel) -G bq .............................:..:.:.::::.:::..:::..:::.: ::.::.::.:::.; :.:::.::::::::: ::::: ::::;:::::::::::::: : : :: «<: »::>::> :.: :.:.:.:..::... . ( .C.::::::::::..:...:::dole:#.:::::...:......................:::::.::::: ;:.:: ::.::.::.::.::.;:<.:;10 .::::.:::.:::<.>::.;:.;:.: ..::.::.::::.::.::.::.:;:.>:;:.:::::.::::::::::::::..::::............................... Depth from Soil Horizon Soil Texture Soil Color Soil tier Surface(in.) (USDr►) (Munsell) Mottling (Structure,Stones,Boulderes. o i nc °o Gravel) .......... ATxC ;:H.1Q;L :.L(7!G<:>::»:<:;:.;:<.::.:::.::.;:.::::::::.::::;:.::.::�::.>:. De-pth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°o Gravel) - - as r z+,-,..t f 4,...•. ';lal'o°oilj'nsuranc'e Raf"a,ri� +' m _ ,`• - , Above 500 year flood,boundary,.,No= Yes - .. ._ �; ,ilk...t .... .,_• t•--• 'Within,500:year�boundary No Yes Wiihih-l.00'yeaP flood«undary'No11-- -, Yes: f Mpth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi u terial exist in all areas observed throughout the area proposed for the soil absorption system? IT not,what is the depth of"naturally occurring pervious material? Certification I certify-that on ��(date)I fiave passed the soil evaluator examination approved by the `D'epartment ofEiivirbt mental=Protection_and,that,the above analysis was.performed bytme consistent with the required training,ex pert'se and experience described in 310 CMR 15.017. Signature ` geeDate. �� _ FROM FAX NO. May 25 2016 03:47PM P2 �01 Town of"Barustecole Ro egi&tm services, : a " pumas McKean,Dirocior 9tb�19�aim�Street,Wamb,WA026O1 Q,�ne. 509-862-4644 t�aic 4OJ�790-6304 tOar sir Des gDa e- �. Szcap Permit# 20/6 � Asseumd,4 Ma-pWarrel 4011� a9rffx� — u 93 ' 0140A OD. was.1sstmed A peamit-to iustaB.a septia�.Yste at L410-L _based Qu a.design dr1'wn by �a.cir3ress ds* .. Q, ed Y aertifp the the;segio^ystm zefexanced above wax insWled gabatDntz illy fcamdiug to the desip,which may 1nol:xde minor appxovrd chmgeF such,as .l,exal relocation d tbr; diffh*ation.box audlw sepdo tanks. I certify ibat ft segdc syst=,z<krojn.Eed above was an:�t Wed with:i Ajor cl ttg, (1.e. greater tip,lo' latmal relaratlon of t1w SAS or aver vulitical,relocation.of Wly couypileut of&,septic System)bat in accaxdance,"NitStzte&,:Goal hegulataozua. Plan.xc�r�sia ox carii'ded,as-Wit by&sipa to follow qi gFM,gs r DANIEL V 5�td 3°S IguQtuYo) CIVIL No.46502 ` �Ss/ONAI ®ei 'sSi �Atiu�sIrT?ceiaor.'s `I�►.znp -iris) - its . T O, NMI 'i7N`�f� BOTH F ,At jjWl],X,T C B�,,,�'['�.�tiff_Axi L,XC JE 'xH9lld�i�; AZT. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a d DEPARTMENT OF ENVIRONMENTAL PROTECTION r r � d ti �e TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Ot v Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Lo� Owner's Name: CHUAN HWA PAN Owner's Address: 7 HIALEAH LANE FRAMINGHAM MA.01701 Date of Inspection:2/12/01 --�_ RECEIVED Name of Inspector: (please print) , JOHN GRACI Company Name: SEPTIC INSPECTIONS FEB 1 6 Mailing Address: `P*b.BOX 2119 TEATICKET,MA.02536 2001 Telephone Number: 508-564-6813 FAX 508-564-7270 TOWN OF BARNS i P HEALTH DEPT.. CERTIFICATION STATEMENT 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: X Passes _ Conditionally Passes _ Needs Furtheir Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 2/12/01 i opy of this inspection report to the Approving Authority(Board of Health or DEP)within The system inspector shall submi t rci 30 days of completing this inspection. If the system is a shared system or has a design now 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. r�. Notes and Comments ;t THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. RECOMMEND REPLACING COVER ON TANK-RECOMMEND MOVING SPRINKLER LINT;NEAR PIT, ****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. TitIP S TwznPrtlnn Frn•m F/i s/?nnn Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 51 LARCH LANE CEN;TERVILLE,MA 02632 t. Owner: CHUAN HWA PAN Date of Inspection: 2/12/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.RECOMMEND REPLACING COVER ON TANK-RECOMMEND MOVING SPRINKLER LINE NEAR PIT. 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. } Answer yes,no or not determined(Y,N,ND),in the for the following statements. If"not determined"please explain. n/a 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. t *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. ND explain: n/a n/a 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): It . _ Broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ' _broken pipe(s)arereplaced _obstruction,is'xemoved ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A c. CERTIFICATION(continued) Property Address: 51 LARCH-LANE'CENTERVILLE,MA 02632 Owner: CHUAN HWA PAN Date of Inspection: 2/12/01 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 A 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: . r _ 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia ` nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. a 3. Other: n/a ,! . ti z f Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: CHUAN HWA PAN Date of Inspection: 2/12/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to'each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged , SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool r. _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times s pumped nLa. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia.nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/No)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 µ. necessary to correct the failure. i ,.F 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a,surface drinking water supply _ X the system is within 200 feet of a'tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any_question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner . should contact the appropriate regional office of the Department. l' � 4 d Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: CHUAN HWA PAN Date of Inspection: 2/12/01 Check if the following have been done.You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? I X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? ; k X _ Were all system components,excluding the SAS, located on site? X _ 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? X _ 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: Yes no X Existing information. For example,a plan at the Board of Health. X _ 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(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: CHUAN HWA PAN , Date of Inspection: 2/12/01 FLOW CONDITIONS i RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO a Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIALANDUSTRIAL Type of establishment: n/a ; 3 Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soiP'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) ` _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1987 Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: CHUAN HWA PAN Date of Inspection: 2/12/01 BUILDING SEWER(locate on site plan) 9 Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7" W 4' 10 1' Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness:3" 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: n/a Now were dimensions determined: MEASURED 4 ' Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): a SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,.inlet and outlet tee or baffle condition,structural integrity,liquid levels as related c to outlet invert,evidence of leakage,etc.)` , 4.� n/a : x 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: CHUAN HWA PAN Date of Inspection: 2/12/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a { Dimensions: n/a h Capacity: n/a gallons f Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO ; Date of last pumping: n/a I Comments(condition of alarm and float switches,etc.): n/a I DISTRIBUTION BOX:X(if presentpust be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a t. t R Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART C SYSTEM INFORMATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: CHUAN HWA PAN Date of Inspection: 2/12/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 6' X 4' LEACH PIT leaching pits, number: 1 n/a leaching chambers, number: n/a i n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system ,Type/name of technology: n/a i I Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT 1 HAD I' OF WATER IN IT AT THE TIME OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN 1' OF WATER IN IT. CESSPOOLS: (cesspool must be'pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a x Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: CHUAN HWA PAN Date of Inspection: 2/12/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. L IR 0 � 11 Q*7 QA 3-a �g 3y BA 3� 3 s 6g . j in Page 11 of 11 , c A OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1 Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: CHUAN HWA PAN Date of Inspection: 2/12/01 SITE EXAM _Slope i _Surface water _Check cellar Shallow wells ' _ s c Estimated depth to ground water 12+feet E Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a j NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain; n/a I You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET II YOU.VVISH TO OPEN A BUSINESS" For Your Information: Business certificates (cost $40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR 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., 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate'that is required by law. DATE: a l �� Fill in please: APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: 54 LAOC !! LA/V ['�iv 2� ��' ,,,� .�L rear" 979)'�0s 41 15 TELEPHONE #k Home Telephone Number � Ct NAME OF CORPORATION: NAME OF NEW BUSINESS SPh i2 KL C ('1A(In`S TYPE OF BUSINESS C L A/1 .� 5 VI ' IS THIS A HOME OCCUPATION? � YES NO ` J /I 1� c9�i ADDRESS OF BUSINESS 5 L A C( Aa - 2 Cei T 2u(ec i Oa63 MAP/PARCEL NUMBER �[� Vv� —vl [gssees(ng] When starting a'new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended 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 this town. 1. BUILDING COMMISSIONER'VDF �This individual has been 1d of any e it requirements that pertain to this type of business. oriz d ignature** • COMMENTS: 2. BOARD OF HEALTH MUST COMPLY WITH ALL This Individual has.baen inf et1 of the permit requirements that pertain to this type of business,,WARp�jUS-COMPNATERIALS WITH ALL TIONS Authorized Signature** COMMENTS: -------------- 3. CONSUMER AFFAIRS [LICENSING AUTHORITY] This Individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE Date:09/ o 1 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: 5 PAQ j g BUSINESS LOCATION: 5 ( LAP-CH /APje- INVENTORY MAILING ADDRESS: 5 { L A P—C LI LA I - C TOTAL AMOUNT: TELEPHONE NUMBER: j 46'. 505 y 1 (� � CONTACT PERSON: 7/a Lc''rA CSC(I & A-0 MAgArPA Ie fik9���c3 EMERGENCY CONTACT TELEPHONE NUMBER: � �((( �5 MSDS ON SITE? TYPE OF BUSINESS: C C ��NC N� 3e120I' INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): X Metal polishes Laundry soil &stain removers >c (including bleach) Spot removers &cleaning fluids (dry cleaners) ,Z Other cleaning solvents Bug and tar removers J Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS App ant' igna ure Staff's Initials ` YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR 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, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. �� rn DATE: Fill in please: f APPLICANT'S YOUR NAME/S: �-Pe-71 BUSINESS YOUR HOME ADDRESS: "-1A 02., r(2e).So 1-d-&% 54/ ! ° TELEPHONE # Home Telephone Number NAME OF CORPORATION: n NAME OF NEW BUSINESS Ile TYPE:O.F BUSINESS IS THIS A HOME OCCUPATION? YES NO , 0 ADDRESS OF BUSINESS SJ ffZ Cif Liv CCwfc- Vi//6% ,0 . MAP/PARCEL NUMB o ER �� I � Od�0 l (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended 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 this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. .Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has been ' c�i ch�permit requirements that pertain to this type of business. (•t -r(( VA MUST COMPLY WITH ALL Authorized Signature** HAZARDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: { l '} TOWN OF BARNSTABLE Date: 7/ TOXIC AND HAZARDOUS MATERIALS NAME OF BUSINESS: 66�vA�2g lle � rav�i�1� C-os i7 d BUSINESS LOCATION: I-/ Z666/ `v 0,4 oZd�Z- INVENTORY MAILING ADDRESS: S9mC TOTAL AMOUNT: TELEPHONE NUMBER: (�)Sa 6 —6'1,04 CONTACT PERSON: A✓rc-4y 2G S,*loe21o^) EMERGENCY CONTACT TELEPHONE NUMBER: 1S06&of MSDS ON SITE? TYPE OF BUSINESS: ,r�e3is✓fii.�q INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ap icant's ignature Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost A 2-00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.- it does not give you permission L'o 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, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. / DATE: O a N' l� Fill in please: e APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: A/ F ' r TELEPHONE # Home Telephone Number 5 NAME OF CORPORATION: - NAME OF NEW BUSINESS QZ-Vri/9 ( 71 C' TYPE OF BUSINESS IS THIS A HOME OCCUPATION? X YE NO ADDRESS OF BUSINESS C �r 2 V l MAP/PARCEL NUMBER /gy 006 J 0/10 (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended 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 this town. 1. BUILDING COMMISSIONER'S OFFICE / This individual has bee nformed of permit requirements that pertain to this type of business. T COMPLY WITH HOME OCCUPATION rn�cc�n j�L's 16 4 thori ed Sign 'ure** RULES AND REGULATIONS. FAILURE TO U Oe ( ,jAI J COMME TS: J Q�W 1 i 2. BOARD OF HEA TH•. This individual has ee informed fthe itrequipements that pertain to this type of business. Aut orized ignature** " " MUST";OMPLY.WITH ALL COMMENTS: P�'WRDO"S MATERIALS RE8UtA1rqj . 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b inf, d of theltipensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: IL r Hzardous Materials Inventory Sheet Checklist - l� I Date _... Physical Street Add ress-Check,database-to ensure it exists Workin`g'Phone Number Actual Amounts--,( ie. gas being used Ito fuel machines,'thinner to clean brushes all count as hazardous=materials=no.blanks) Storage Information-location of storage;how,long is storage for? . If none, note that: ;} Disposal Information,-where and°who? If none,tnote"that. Applicant Signature -understand what.is.listed and,noted Staff Initial -:any questions, knowwho!to ask Vehicle.Washing/Rinsing? -,give a:vehicle-washing policy and explain it; F Attach the Business Certificate'with=your"`sign off and comments �• *"The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them_ y. } Date�p //�/ 20� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: a L i U l As - BUSINESS LOCATION: S INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: 1Q — 22?Z1 — ,S CONTACT PERSON: EMERGENCY CONTACT T LEPH NE NUMBER: 56&-080 - J S 4,3 MSDS ON SITE? TYPE OF BUSINESS: ` INFORMATION/RECOMMENDATION Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive Antifreeze ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants i L(Motor Oils Pesticides 4NEW ❑ USED (insecticides, herbicides, rodenticides) I �L Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) �f q lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout ,l (f� Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's L (, Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, G,LLacquer thinners (including carbon tetrachloride) �I'NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, __- Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes I Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS w DEPARTMENT OF ENVIRONMENTAL PROTECTION KXDVED d 1vIAP � NOV 2 9 2004 PARCEL o ®® of Q. WN OF BARNSTABLE -•��. <. �.�, 'EALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ' Property Address: 51 LARCH LANE CENTERVILLE'MA 02632 e� � .4 Owner's Name: ALTY Owner's Address: 51 LARCH LANE CENTERVILLE,MA 02632 Date of Inspection: 11/1/04 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT -Vz 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 mainte ance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Ti le 5(310 CMR 15.000). The system: �� r1 X Passes _ Conditionall P sses _ Needs Furt aluation by the Local Approving Authority Fails Inspector's Signature: Date: 11/1/04 The system inspector shall submit a py of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspectio 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. Notes and Comments SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING NOW AND THEN EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE.THE LEACH PIT HAD 1'OF EFFECTIVE LEACHING LEFT AT THE TIME OF THE INSPECTION. ****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. Titles 5 In-mertinn Fnrm 6/151')000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:. 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING NOW AND THEN EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE.THE LEACH PIT HAD P OF EFFECTIVE LEACHING LEFT AT THE TIME OF THE INSPECTION. 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a 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. ND explain: n/a n/a 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 _ obstruction is removed _ distribution box is leveled or replaced ' ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 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 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a 2 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/Z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NOT IN THE LAST YEAR PER OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. a Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 Check if the following have been done.You must indicate "yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period`? _ X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site X _ 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? X _ 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: Yes no X Existing information.For example,a plan at the Board of Health. X _ 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(3)(b)] i 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): NO r Last date of occupancy: n/a 1,29000 021- COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NOT 1N THE LAST YEAR PER OWNER Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X 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) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1987 PER OWNER Were sewage odors detected when arriving at the site es or no : NO g g (y ) Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6"H 5' 7" W 4' 1011" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness:3" 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: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING NOW AND THEN EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page 8.of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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 STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a I R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 6' X 4' LEACH PIT leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE AT THE TIME OF THE INSPECTION.PIT HAS 1' OF EFFECTIVE LEACHING LEFT IN IT. BOTTOM IS AT 10'- CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 Page 1Q of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. �Csq(.1 W in Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 LARCH LANE CENTERVILLE,MA 02632 Owner: ALTY Date of Inspection: 11/1/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER DETERMINED BY HAND AUGER- 12+FT. it TOWN OF BARNSTABLE LOCATION S 1 � SEW I� GE# Ni�►PCO����'"�l V&� ,.AGE_�� �Al�o ASSESSOR'S & L INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C ' LEACHING FACILITY: (ty ) C���' (size) l �1 NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachi acility)�� � Feet Furnished by l SA AAA �c s� sS � e No........... .. �� � Fim...... ...�......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH T v✓.........'oF._.3... ..... ' '�..._. .....-- __ Aplitir�ation for llhipos a1 irks Mies*trurtinn umit Application is hereby made for a Permit to Construct ( 0)or Repair ( ) an Individual Sewage Disposal System at: �t ... .... ...... Location-Address i t O Address r �. t .a.. - Installers �ti� p L Address Type of Building Size.Lot....3:_1�,_L_ .I.Sq. feet Dwelling'-No. of Bedrooms__('I:___�,.: _-..___ _____.____Expansiol .,Attic (, *)- Garbage Grinder( -) pa, Other—Type of Building. _. }2,tc :.___ No of persons.__'_:�_________________ Showers-�� — Cafeteri )� Other fixtures q'.,r' W Design Flow..............____�`-r __________gallons per person peg day. Total d''lywflow__�r.� __�_.___.__. ............gallons. Septic Tank—Liquid capacityp�gallons Length__:V____��.:__ Width._ ( Diameter________________ Depth__.r..__.V Disposal Trench—No_.................... Width...... Total Length..................... Total leaching area___________.________sq. ft. Seepage Pit No.......:P..........1Diameter - ._...... Depth below inlet____________________ Total leaching area.ZP_S__sq. ft. z Other Distribution box Dosing.ta� a Percolation Test Results Performed by.___��._..1 -_ _ _ `4_ .s_______________ Date__._L t, t___ __ 6 Test Pit No. 1....`_4---mmutes per inch Depth of"Test Pit.:__ ___ Depth to ground water....__ ; /! (i, Test Pit No. 2________... _minutes pereh..\Dep of Test Pit Depth to ground water.._9 m w _ O •t"Z V r= A� Description of Soiil-/--Cn= �"`�1p �� L SST �J�L-'�'�c � r W !l._�ar�.!` .:JC—E'✓.�SCIf— .. v •• ..l+t Dxw% I S1�-•----•-•---'----------------------------- �_ Z.1�'_Ffi'%: "-� -------- :- emir S Al--1_A l®4!4 f3-ZE l - ---------_-- U Nature of Repairs or Alterations—Answer when applicable.--;*,k4r--__"y.,,-T.EM__WAS__lt4STA LF-D__tU-.3 .hi_S________________ ...................... - -----•---•--------•--------•------•-•-•-------- ___---------•----------------•-•----•-••---•--_. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'L 11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ed y he b d of health. Application Approved ::• AD ate Application Disapproved for the following reasons-----------------------•--------------------------------•-----------••-------------=----•--•-•-----•---•-•••-••-- ......................................................-.................................................................................................................. •-------•--•-•----------------- Date PermitNo. ----- Issued-....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA ) 1 d t No ... 0, it I+ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......:.........:�. .........------..OF..1'........---..................... .............................................. Appliration for Bhipasal Workri Tomitror#ioo rrmff Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: \ ................_............................................................................... --•-•-------••-•----•---....••----•-------•----••-•--------•----...............•.................. Location-Address or Lot No. Al �•--.-••••--•--- ----•........... -----•-•••--•-•-----•-----•-• •--...... -- -•-- ••---•-- -- . ....................... -. ..... .. Owner ..._Address 57 a ....._..... :.... -----------------------•-----.------ --•---...---•••••---.....••.-•----•---�...-................................................. Installer Address Type of Building Size Lot_.__=.�__L---Z._:_ .f._Sq. feet Dwelling—No. of Bedrooms............... ........._.............Expansion Attic (.--) Garbage Grinder-(— ) `4 Other—Type e of Building � _..____ �_....__... No. of persons .................. Showers`P.I yP g �------ P (—) — Cafeteria-(- ) 04 Other fixtures .................................----------------------------------------------------------------- .................................... Design Flow.................. ................gallons per person per day. Total daily flow----- c...................................gallons. WSeptic Tank—Liquid capacityL_'......gallons Length_..".......... Width_`....!?__- Diameter................ Depth-_=......_.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage PitNNo..................... Diameter....!___ ......... Depth below inlet.................... Total leaching area...?....._5-..sq. ft. z Other Distribution box ( ✓) Dosing tank-(--) ~' Percolation Test Results Performed by....C------------_-}_........:j...`..... ----_----_.---_---- Date_._...._:... � �• - - ' -•••• le Test Pit No. 1 ----minutes per inch Depth of Test Pit.... ..... Depth to ground water... ...:..�. fT4 Test Pit No. 2..._.`....4..niinutes per inch Depth of Test Pit.... _.. Depth to ground water--- L..!__....__- x r D Description of Soil .............�---•f-----•......... ......=.- ...... . `'----'� -D ------••�.-----i r - ---- - . - -•• •••- V = --•-------------------------------------------- x ---------------- ------------ -• •. -----------------------------------------------------•------------------------------•--•-----••--•--•••-- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------7--, ---•--•.-----------------•--.------.--..-----•---•----------•-----------------------.-.-------------------------------•------------------.------- Agreement: \"- I., The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..................... -------------------------------------------•---•-------------- ------------Da........---..... Dat Application Approved BY__:` � a Y E fbr /14` ` ==-----•......-•-...------•-•-- r` ? ' ate Application Disapproved for the following reasons---------------------------------------------------------------•-----------------••--•--•---••----•.._...._...._ ---•-----•-----•--•--------------------------------------------------------------------------•--------------•---•---•-•---•-•••--•--•-------•---••-••-•-•--------••--•••-•-----•••-••------•••••-----•-- _ Date PermitNo. :_? ------ ----------- Issued....................................................... Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L ,r - Trr#ifiratr of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (V)or Repaired ( ) ............................... --------------............. ............................................... ......................... _ Installer at.-•---- - J .-) G= =- 7 ? ; 1-I / � .. (-_ , L/ :.C- Z ✓/ -••--•-• ••-------------- - . -----•--•-•----•-.......................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___ _%_ z..__I_;_-?!_ ...... dated--------- ._:_>__a.....__:_r' _.____..__. ... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .......... ...... Inspector ector.......P ---------------------------------------•----------------•-_•---- IIESIGNING ENGINEER MUST SUPFRVISF THE COMMONWEALTH OF ►vIASSAC1KQLSE;,T1rj!DN AND CERTIFY IN WRITING Tw1z SYSTEM WAS INSTALLED IN STRIC.I BOARD OF HEAL�� -�-- ��. LVC RDA, CE TO PLAN. Nola!" � }Z/c / � vt/- /. OF ...��L . FEE :: ...... ... ......................... ..--- :..._. Disposal Vorko Tomitrortion amit Permission is hereby granted..... . . - \� ...-.-.-c ................................ ............. .••--------- to Construct ( �) or Repair ( ) an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit N_oZ�7..f' -__ Dated....... ......... DA Q1 H / ( )(�` � �+ �'" Board of Health a TE. �/ . V l D 4iCJ FORM 1255 A. M. SULKIN. INC., BOSTON t. No.'` ................... Fns.............................. THE COMMONWEALTH OF MASSACHUSETTS IL73®ARD OF HEALTH T d.V.I.V....OF...�"3 -..✓ .:T�.. ..... . '........... pVfirafijau. for Dinjai Works (91ingtrurtion 11nnift , Application is hereby made for`a Permit to Construct ( <or Repair ( ). an Individual Sewage Disposal System at ........................... Location_Address t No. or Lo .......................................................... L7- ✓' L �a e' 3 `=Jr, �'" ' O ner Address .................... .................... ........................ a Installer Address U Type of Building Size Lot....:3__1,./._FJ_Sq. feet Dwelling—No. of Bedrooms .............. -__. -___Expansion Attic (rr Garbage Grinder,-( •-) Other—Type of Buildin ___._._._�T... No. of persons.............. _. Shower a YP g/� �°� P � -- --- Showers-—(—"—) — Cafeterias� A. Other fixtures .....4../-- ^''. ........................................•---. ........... ----------------------------------------------------- Design Flow...................`.- ..........gallons per person pey day. Total daily flow 01 � 3 c>---.-.-.-_.__ -..._gallons. a WSeptic Tank—Liquid capacity t®p_galIons Length_.:®_._`.__ Width__' ..4®.. Diameter.-. -..-:_._..:Depth_...T_`_..1.3 x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area............. -------sq. ft. Seepage Pit No--------I........... Diameter....J..1--- Depth below inlet................... Total leaching area.3......�..sq. ft. Z Other Distribution box ( ✓f Dosing to ) `-` Percolation Test Results Performed by.... _n .H ®�- Date_-_-�. ® �� t-1 ----- 1 rI / -•-•----- ----••r9--•- / H Test Pit No. 1.__:'4_ __:minutes per inch Depth of Test Pit__:.�: �._._ Depth to ground water-.. --- /- (-T Test Pit No. 2•-•--c•_ �.... . C_:.. y nunutes per Inch Depth of Test Pit._.__. Y Depth to ground water.... - I ._..�� o -®-. -•-tin/ sIZ---� /C ®v �/ TIZ Description of Soil............................... B.U 7^ . ...:'___ .f9P t. 7 !>_..:0.07 ----------------- rJ f _ _..,c �_ /, . --••- • ... •-----•. --......------ UNature of Repairs or Alterations-Answer when applicable._.__._-..----..._..__. ._..--_-- ......................:....... ..:.__,. .. -•--•---------:--•---•-----------------------•-------•••-•....._---- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in.accordance with the provisions of TITLE 5 of the State Salutary Code— The undersigned further agrees not to place the system in operation until a Certificate of.Compliance has been issued by the board of health. Signed...................................................................................... Date Application Approved BY---------- .....................................-•----•--•-- Datc Application Disapproved for the following reasons:......................................................... .............................................................-------------------------------------------'--------------------- ----------------------------------------........------- ._... Date PermitNo........................................................ Issued_...................... -•-------------- -•-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ✓...oF..... 3, 2 /s Tip} 4.! ........... Tr if iratr of Tomplian THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (VI or Repaired ( ) by ,.''----- ' ®_.......�7^......•----- ---- ----••--•--•....---- Installer�2c-�- L 1/ _at.... : T ------ ------- ------ has been installed in accordance with the provisions of 'TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------------- -. ._:-.__--_-_-____ dated._..... ..................__._.-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................................... ......................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. ✓ ✓ 'OF .. :B I' /® .................................................. No.......................... FEE........................ Permission is hereby granted -�-� �� �' T to Constr>�ct ( �or Repair � ) an Individual Sewage Disposal stem at No:-. 1 !°�✓2 :.0 l _.... _./� -�/ ' � .r �'?-✓ r�- 1. Street f as shown on.the application for Disposal l orks Construction Permit No...............:.......Datcd.......................................... ............................................. ---------------.-.------------------------ ............... .. , Board of Health DATE............................................................ FORM 1255 A. M. SULKIN, INC., BOS'rON �;+. . , l rcr mr l Number :---- —Date Completed .by _—C S J-J0JZ-7 HIGH GROUND-WATER LEVEL COMPUTATION V / L (Site t e Location: � S W 4�4. / r L R C t-1 t /"1 L o t NO. Owner: l /3/= Z_/_5o 1..�. o � ,S Address 13 j2. 7-IF t 3 'z... Contractor: Address : � Notes: STEP 1 Measure depth to water table / 10 ft . ... . . . . . . . . . . . . . . . . . . . . . . /2//G/8,T to .nearest 1/ _ date STEP 2 Using Water-Level Range Zone and Index Well. Map locate site and determine: \/V � A) .Appropriate index well . . . . . . . . . . . . B) Water-level range `Zone . . . STEP 3 Using monthly report,'.'Current Water Resources Conditions" determine current depth to water level for index well / mo yr STEP . 4 Using Table of Water level Adjustments for index well STEP 2A , current depth. to water level for index well (STEP 3) , and water-level zone (STEP 2B) determine ftf: water-level adjustment . STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to .water I evel at site (STEP 1 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V, Z 7 , 7 �. 2 /-� Z) T. VV-1)Z 2 2.2. �a r r ei'n;r'.t Nunber :--- UalQ Completed by C .2 , S .C�1�7 HIGH GROUND-WATER LEVEL COMPUTATION Si to Locat ion: /-)- = . S W L,9i�.0 �-1 �"i°"✓E" Lot No. S Address: 0 L 12 7 7 I a '?._ /�. �/ 9 �Vsvr/-s Contractor: Address: � Notes: STEP 1 Measure depth to water table to nearest 1/10 ft . . . . . . . . . . .. . . . date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: A) Appropriate index well B) Water-level range zone . . . �'. sM?!V r. � STEP 3 Using monthly. report"Current Water Resources Conditions" determine current depth to , water level for index .well . . . • . .ref /� � mo yr STEP Using Table of Water-level Adjustments for index well STEP 2A , current dLpth. to water level for index well (STEP 3) , and water-level zone (STEP 2B) determine water-level adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STEP 5 Estinate depth to high water by subtracting the water- level adjustment (STEf? 4) from measured depth to water level at site (STEP 1 ) . . . . . . . . . . . . . . . ... . . . . . . .. . . . . . . . . . . . . . . . V. i. vv,,) 2'2,2- December 11, 1986 John Kelly Health Department Director Barnstable Town Hall Hyannis, MA 02601 Re: Lot 10, Larch Lane, Centerville Project #1-519, D.E.Q.E. S.E.-3-1442 Dear John: This is to certify that I have inspected the installation of the subject septic system and that it agrees with the intent of my approved design and complies with Title V and Barnstable Board of Health regulations. -pA Sincerely, oy,I CRAlGcti SHORT o r=i CtViL N Cra' R. Short No. 27483/STE Professional Engineer o�o��SpNALE��'\���� cat/CRS cc: Barnstable Conservation Commission TOWN OF BARNSTAB_L$ J,iL_ C'A. N ot \-o-- c~..sr.\� `. SEWAGE # �'6 ' \CJ�� VILLAGE ASSESSOR'S MAP LOTn=!Ej�� �r- INSTALLER'S NAME & PHONE NO. c-\L SEPTIC TANK CAPACITY ', LEACHING FACILITY:(type) �'� (size) (,C?Ucj Fj p> NO. OF BEDROOMS 6 PRIVATE WELL OR P BLIC WATER BUILDER OR OWNER L e�L,\ _ c�A DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � R r� � �l TO(WNA OF BARNSTABLE PFAN LJ� `� I } �V�.�. SEWAGE # v {LAGE �1� ASSESSOR'S MAP & LOT ' Orb INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) k. NO. OF BEDROOMS BUILDER OR OWNER ��111�-/ol PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by AB C IJA AA T7 a a cuR Ag 35 6 �ra►� Ac 51 EA 3 7 3 Af/PPLICATION FOR //PERCOLATION TEST AND OBSERVATION PITS , ;CATION 1,�JT �n A�,g2C --� 'v NO. Ls23L .CLLAGE - L DATE -/6 .,PPLICANT Z , FEEdz� hDDRESS G 3j- y/vis TELEPHONE NO.&a-994/ (Non-refundable) ENGINEER" TELEPHONE NO. P3� DATE SCHEDULED (Appl-f-caYitlg signature) . . . . . . . 000000 . a . 00aoo . . aa . . . ooa . 00e . . . . . . a . . . o . . . o . . . . 000 . . . . . . , . o . o . . . aa . a . . . . . . SOIL LOG SUB-DIVISION NAME DATE 1 2-2 2 ®2e S TIME EXPANSION AREA: YES VINO _ C' 2 At� Gz Sff ® /Z 7- ENGINEER TOWN WATER ✓PRIVATE WELL C U n/1©A/BOARD OF HEALTH Fo (3� i�3i LL 4SSESSOR'S MAP & LOT NO: / /r F EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: 41 J 2 �I o/ � i 19 J � � y2. rr� Z ✓ © rN 7-1 fz Y J J •, @ 9 / SM, v/ Tz- TE `Z PERCOLATION RATE: U SC " i'' "/�/�✓ TEST HOLE NO: ELEVATION: TES-T HOLE NO: 2- ELEVATION: 1. G a A= .e-, vLL26�_ P._ �.. SU2t .5vI L- 2 3 M E 1 t/M ;� 4 4 7 8 8 9 v, A�5-A.y , Oat' 9 10 �-. .�,w 10 11 s/--i-n/v 11 12 C� o-�, e 12 I SG, 13 T1 Gy AY 7-- J. 13 - 14 - 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS t/ LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P , E . AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT W 6 c>�v�' ,: c f T --�.,•. G X,oN 4�R,z y ays ---`- SOI L LOG �C;I R " �� • . Ld7 S T,`i it� • r. r` f DATE: /2 20�85 JT,,�4 ,A4 _ 43 , ©ss WITNESSED BY : oGV$ r"ono S r> ..... fir. Rer 4e •,•, ''f p(3uMP , •� � Q T,'f-�O4L `cL 30.0 0 -7— �''. - PcNp F'L 28, i loco, ) `" Q 7 ^ 47c�t3S .+L All 16 a,v,v) L H Yi'1�5 o ' I { �9 N H N 4 r+, s 7 X-? L> d 4 '� �. F_ LVV ' w 0JK L/N► / T cs ELEv TOP Of !q UANHOI_ ES AND COVER TO 8E BUILT NI rHI N �, `^q t.j i) /J ' , � jf 2 a' �' 7 T 1 0 N ,- 1 2" O F- F ! N S H E D G R A D E _._.__ b - �, - � o J l !l J � .. / J o o 4"C AST I RO ° ;PVC SCH 40 P iTC H '� /F- ( V � - ---�� ✓ a 2' E V1E ' r ��' vl 1 N. 2`r L A Y E t. to - PITCH y 1 , I/2 E A S T O N E 1/4`+/FT a✓f ,�., a C. C) p° INVERT °' S:Ct7 r, ' J iP4VERT DIST. GALLON ` INVERT' ,,INVERT r BOX ! J/4"- IA S E PT I C TA N K -+ o J < O n ` !�� tF , r+ :Q ..,.... •..•►... .,, .,►. .= NVERI" _ 7.SVim.• . wra'aN V D ST-0'NF r A N 7"ir✓Jf X .. �.... { V :+^ 't= Q i ALL AROUND . I v 0r GARBAGE ,�/ST \ MIN . -__- GRINDER _ .. . Q- -�'� ._ELE BOT OM 2 0' KA N 4 i , J i PROF : LI"_ ) r GROUND VYATER TtB; F-- -- `'- POSAL SYSTEM _ SANI1A R Y DiS vrl Q ► �:. ! / NOT TO ALE _DE S I G N DATA Ix. \ .r .C. 0 / CO R ►� 3 EFDROOMS 5,47FS7 - • CONSTR UCTION OF SAN ( TAR Y POS .4 !. S 371 vPLA1vD w.E-T . 7 c DE5 GN F LOW �` •,' y GAL . DA`!•� \ 1 ' SYSTEM SHALL CONFORM TO MA, 55 . - 3/, T'f.)(.. L E A C H RATE 4 _— MIN. /INCH `� ' ► E NVI RONME NTAL CODE TITL_ ,_ V (REVISED 7- 1 - 17� � J / F AND THE TOWN OF 7-1 -477 PROPOSED LEACH CAPACITY J / HEALTH REGULATIONS . ,� ► �i'" / 2, I 'per SEPTIC TANK, DISTRI BUT- ION BOX P Nr (_ EAr rr ( NG PIT TO BE OF REINFORCED CONCRET C1. 35 GAL. DAY 4 r •/�' VIN. CONCRETE STRENGTH 3000 PSI / ►', ' 'q D f 'DESIGNING ENGINEER MUST SUPERVISE MIN STEEL STRENGTH 20,�, _)`PS ' >> STALLATION AND CERTIFY RJ 1,�JRITINC © H 10 DESIGN LOADING .,_ W,TEM WAS INSTALLED I�! .:,e R'C N • DRIVEWAYS NOTTO BE LOCATED OVER SYSTEM ` Tr) nLp�a. UNLESS H - 20 DESIGN LOADING IS USED. • ALLPIPES AND FITTINGSTO BE WATER TIGHT' AND Q {� 1 R 7/!/ v F'L .�=)/t/ 70 BE OF CAST IRON OR SCHEDq 40 P.V. C. D SITE PLAN SHOWING PROPOSED SH '4OF _wSHS SED CONSTRUCTION LEGEND L b C A T 1 0 N 43 /V -5 T-� a Z-�- (C •E/vr-,S rz v/4 E.e) M � FOR • _ 4- _ = _ - S L �. C7 ,� L� �'v�L . �" /� p. _ A P P R. J E D . 19 SCAL E : DATE G ^ J ,( `3 �. Rr� �/2:y"V�f HJArc D OF HE A L T H BUILDING SETBACK REGULATIONS PER EXISTING CONTOUR - - -Is- -- R E F E RENC E L © T" / � .� v .5 . -+• � L✓'� / ^� BUILDING INSPECTOR OR BUILDING F, _ � ,C -4et) 3 6 COMMISSIONER PROPOSED CONTOUR — 16 -- DATE A C E N T ;,/' IN FRONT SETBACK EXISTING SPOT ELEVATION IT MIN . SIDE SETBACK � PROPOSED WATER SERVICE W OF MIN REAR SETBACK ' TEST HOLE LOCATION C . R . S !4RT, INC . No. PROFESSIONA ; LAND SURVEYORS L ENG , NEL* RS 1586 MAIM STREET `,-, rE. FAj EAST DENNPS, MASS . 02641 fSS�ONAI zz • J N. z h LEGENDSYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES opp�9v� 'c SYSTEM DESIGN. MARKED WITH MAGNETIC TAPE OR a o n COMPARABLE MEANS FOR FUTURE LOCATION. (uoT TO SCALE) 1. DATUM IS NAVD 88 99 — EXISTING CONTOUR PROVIDE MIN. 20I" DIAM. WATERTIGHT ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING o Locus .� X 99•1 EXIST. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED \ TOP FOUND. EL. 31.0 FILTER FABRIC OVER STONE 5 Vic 99 PROPOSED CONTOUR MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 30.0 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. 28 Fuller Rd. EXISTING 3 BEDROOM DWELLING 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS �98 4] PROPOSED SPOT EL PRECAST H-10JTEE , NOTE. 2" MIN. WALL BLOCKS OR TO BE AASHO H-10 Rou{e DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD THICKNESS REQUIRED TH 1 RISERS (TYP.) PRECAST RISERS USE A 330 GPD DESIGN FLOW 2'+e PIPES PVC MORTAR ALL H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. TEST HOLE s" MIN. SUMP PIPES LEVEL 1ST 2' 4' COMPONENTS 1;- MIN. INT. DIM. (TYP.) INV'S EL. 26.2 4' ENDS SIDES 27.03' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH % - 10. 000 310 CMR 15.000 TITLE 5. oSLOPE OF GROUND EE ° ( )SEPTIC TANK: 330 GPD (2) - 660 rEE "'EXISTING Q O 0��0 ���0 O ���� o 0 0 0SEPTIC TANK29.08' o 0 0 0 DODO OOOO DODO � � 0 � o 0 0 0 UTILITY POLE **USE EXISTING 1000 GAL. SEPTIC TANK °o°o°o°o°o WATERTES" D'BOX o \o aaa��a���a� ������OQ��� ;a0000000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO 1 Rood c�b GAS BAFFLE o 0 0 0^0 0 0 0 0 0 0 � 000 DODO 00 0 000000 0 0 0 o Je ,o 0 0 0 0 0 o�aoa®®DODO ��®O�DDDD�O ° ° o ° BE USED FOR LOT LINE STAKING OR ANY OTHER FOR LEVELNESS `� 0��®�000�0� �����0�0�00 °o°o Bump s �� LEACHING: °°°°°°°° °°°°°°°° 24 2' PURPOSE. 714 FIRE HYDRANT 26.47 26.30 >°°°°°°°° ' °°°°°°°° o NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. BOTTOM 25 X 12.83 (.74) = 237 GPD (2) UNITS REQUIRED WITHOU9. T INSPECTIONBY BOARDNENTS NOT TO BE HEALTLLED OH AND CONCEALED ALL AROUND PRECAST STRUCTURES sc r/7) Z, 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' PERMISSION OBTAINED FROM BOARD OF HEALTH. TOTAL: 472 S.F. 349 GPD COMPACTION. (15.221 [2]) `O 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCUS MAP LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES *THE INSTALLER SHALL VERIFY THE WITH 4' STONE ALL AROUND PRIOR TO COMMENCEMENT of WORK. NOT TO SCALE LOCATIONS OF ALL UTILITIES AND ALL 18.0' BOTTOM TH-1 BUILDING SEWER OUTLETS AND ( 20 % SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUND 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE ELEVATIONS PRIOR TO INSTALLING ANY MA EXIST LEACHING REMOVED 5' BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 189 PARCEL 6-10 PORTION OF SEPTIC SYSTEM APPROVED DATE BOARD OF HEALTH FOUNDATION SEPTIC TANK 13 D' BOX 12' FACILITY LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND **INSTALLER SHALL CONFIRM MINIMUM SEPTIC REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF NOT SUITABLE \ v �\ 1 LARC E TEST HOLE LOGS ENGINEER: CRAIG J. FERRARI, SE #13871 / WITNESS: DAVID W. STANTON RS •. ��/ � DATE: 4/28/2016 zl� - PERC. RATE _ < 2 MIN/INCH � 5 ' CLASS I SOILS P# 15020 32 G / ELEV. ELEV. v / 0„ 4 29' 0„ 4 30' FI LL • E � A 12" LS 0 A 10YR 3/2 BENCH ARK:TO ' 19 28.4 0 FRONT L V LS 11 PAVED DRIVE =31.0 N 8 10YR 3/2 V 21" 27.2' ✓BVW3 EXISTING PERC C C DWELLING TOF = 31.0' / MS MS x BV \)� 1 OYR 7/4 10YR 7/4 Ir..�, X 13 w I �'� I '• I I 132" 18' 120" 20' A- L 07-1-o NO GROUNDWATER ENCOUNTERED I 31/181 S.F H 0. OTITLE 5 SITE r I BV 6 I PLAN \ It B 7 a ' ED OF 100 N v 2 SHED #51 LARCH LANE CENTER""VILLE PREPARED FOR B 0% ell% RODRIGUES ��\ X o X 12 \ / DATE: . MAY 6, 2016 X \ Scale: 1"= 20' � 13.36 0 10 20 30 40 50 FEET off 508-362-4541 OF htuSs I fax 508-362-9880 OlJ O o� DANIIEI '�� downcape.com / DANIEI_A . A. OJALA u 01j°1 A down cape engineering Inc. Z IL r 0.465 Nb.40 300, civil engineers c \ ° � ��°�` " -, ,. land surveyors 939 Main Street ( R to 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02575 DICE # 16- 109 16-109