HomeMy WebLinkAbout0008 LESTER CIRCLE - Health 8 Lester Circle, Centerville
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No. t7-D Fee Q
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Rpplir&an for MisposaY *pstrm Construction 3PPrmit
Application for a Permit to Construct( ) Repair(Upgrade(Gy'Abandon( ) []Complete System ❑Individual Components
Location Address or Lot No. YLr,S'�'F/"C//'�r'i^ Owner's Yyne,Address,and Tel.No.
Assessor's Map/Parcel /72_
I7taller's Name,Address,and Tel.No.,-49-g2$-Q'722 Designer's Name,Address,and Tel.No.3 4'$-3G2- z�2
oscph ,17c C3�H�dS ��rH� �!�-yc�
C'>�iril�7T`20�`1�lgNsrG`/s )am,!/�
Type of Building:
t
Dwelling No.of Bedrooms 'j Lot Size t . v — sq.ft. Garbage Grinder( )
Other Type of Building S ILG; No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) �j gpd Design flow provided ?] 512_ gpd
Plan Date Number of sheets Revision Date
Title p
Size of Septic Tank �a)0 6w Type of S.A.S. 14. 15 x ;�-Q,D r �U
Description of Soil
Nature of Repairs or Alterations
//(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed V,=g ,j � Date
Application Approved by �'� Y `-"" �/�'�Z i -(f ��,.5 Date V
Application Disapproved by Date
for the following reasons
Permit No. 0 d j Date Issued to—
/ TOWN OF BARNSTABLE
LOCATION L �,ST;�/' �i�"G,� SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL
p / n
INSTALLER'S NAME&PHONE�NO. j dF''4�/20-77,38 J0S<1! 4 &,Ar 0S
SEPTIC TANK CAPACITY /OOD
y-2o
LEACHING FACILITY: (type) '-1-RouJ 0?- f�f C 3 (size) 2e X /Y,/S'
NO.OF BEDROOMS
OWNER
PERMIT DATE: /0— `Y—// COMPLIANCE DATE:10
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) /J Feet
FURNISHED BY l. v� ✓�� tyQ/LG��
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No. �� . .i (I/ s+ � .,,..'^.k• Fee
THE COMMONWEALTH OF MASS'ONUSETTS Entered in computer: Y
es
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
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{ ` ap#huvadftum for Misposal *psteut Construction Perron
Application for a Permit to Construct( ) Repair(1,)—Upgrade(l)--Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. L _S re., C/YG//: Owner's Name,Address,and Tel.No.
!Assessor's Map/Parcel 2_
Installer's Name,Address,and Tel.No. 6/2 S-y/F,° Designer's Name,Address,and Tel.No._5-0? 3G 1- 19 22
Joseph U� (3�rvo� ,(�i�rvN vr.�/=yG�
% 77-
Type of Building:
f
Dwelling No.of Bedrooms '3 Lot Size d sq.ft. Garbage Grinder( )
Other Type of Building vac, �� No.of Persons r Showers( ) Cafeteria( )
i
Other Fixtures
Design Flow(min.required) 3: gpd Design flow provided _� 512. C'4-)-- gpd
Plan Date Number of sheets Revision Date
Title
i
Size of Septic Tank X_ j j)Z)0 6— i Type of S.A.S. (' 151 0, 0 , Tj f
f\�
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
�i Ll/l�c
j 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 y- f
Application Approved by �� L ��/V� L �. �� Date "� f
Application Disapproved by Date
for the following reasons
i
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�7( — �3 1
Permit No. ( Date Issued i<
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
f THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded(c)-_
r Abandoned( )by
at 7 has been constructed in accordance ti .
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer hK zz/pl/ Designer
#bedrooms '3 Approved design flow gpd
The issuance of this permit sha 1 not be c nstrued as a guarantee that the systerh wil� io a es fined.
Date ZO Inspector
----------------------------------------------------------------------------------------------------------------------------------------
No. ' 1 1 Fee t U oL
. THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair Upgrade(Ga-- Abandon( )
System located at
V/
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.
?I
Provided:Construction must be completed within three years of the date of this permit. l
Date 1 u'' Approved by z
Town of Barnstalble,
'"E' i.� Regulatory Services
Thomas F. Geiler,Director
• t�nrwsrnscE,
9�a IMAX �,S Public Health Division
%639. Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 503-362-4644 Fax: 503-790-6304
Installer & Desi2ner Certification Form
Date: �5 11 Sewage Permit# ,,)o Assessor's Map\Parcel l�
Designer: 4 /Q
g installer:
Address: BOX 9,4 Address:
. 5AWQ�cat kA�
On c _e /�/��� �,.�s was issued a permit to install a
(date) (Installer)
P Y beo i
septic stem.at rZ based on a design drawn by
i (address)
I il� 0 AA IAI dated f/- 19y— 11
(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 andlor septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation,of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
OF Mq
s`09c
o DARREN
�u%G2GQ� MEYER
(Installer's Signature) " No. 1140
I � �NITAR\Pa
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BA STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU..
Q:Health/Septic/Designer Certification Form 3-26-adoc
I
Town of,Bai-ns-table P it ZJ 9-
° � Department of Regulatory Services )
' Public Health Division Date
: �� = I.
ibs!> tea$ 200 Main Street;Hyannis MA 02601
-
)j`� I
Date Scheduled f r Time 10 Fee Pd.
: oil' ,5uitab4 ity Assessment fog- S e Disposal
Performed By.—. 1,JA '✓ t ' Witnessed By
I
L_O CATION & GENERAL iNFORMA�:TION
Location Address Les 1 E12•• C 1 RGLi—:; Owner's Name'` W.I S E M
' po BOX,
•CC-NJ-M\/t u.E Mk I Address GoTu rr KA d 2�035
Assessor's Map/P4rcel: (rI 2 {4' I Engineer's Name D k RAN 14 6Y 60L
NEW CONSIR&ON REPAIR Telephone#, �v� Z-2-9 ZZ
Land Use y ► , , Slopes(�'o) ' �� 4` Surface Stones
Distances from: Open Water Body � ZOO ft Possible Wet Area ����ft Drinking Water Well��� ft
i
j)tainage Way - -ft. 4 ft Other fit Property Line —
• 1
SKETCH:($treet name,dimemiods'of lot,exact locations of tc§t holes&pere tests,locate wetlands in proxitnity to holes)
I
/ 546'46'17"E 152.00
64J
0'
$,
L? h dCD
DECK o
Q - -.-.-- - 00
v�,—:iL' :J� '•VI w .
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DRIVE . d l6Ob rY
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548- 11—E _______"I" Qat
LESTER CIRCLE
Parent material(gcologic)
�J lit •�J-t �1 Depth to Bedrock
Depth to Crroundwa(:dr. Standing Water in Hole: • 1��� i weeping from Pit Face
Estimated Seasonal;Fiigh Groundwater WA i
DtTERMWATION FOR SEASONAL HIGH WATr"ADLE
Method Used: I in. Depth td Sall Mottles; Jn.
Depth Cibperved standing in obs.hole: I in; Groundwater Adjustment
Depth tolweeping from side of obs.hole: i _ Adj.fsetor..,.._ Adj.Proundwateri evel.,,�,e,
Index Well# Reading Date: Index Well leviil —
i
PERCOLATION TEST . Date
Observation I Time at 9" -
Hole# t}� i
Depth of Perc
32 .. Time at
C) O rime me(V-6") :t
Start Pre-soak Time.@ --
tol� I
End Pre-soak
Rate l injlnch i
_
Site Failed: Additional Testing Needed(YIN)
Site Suitability Ass0sment: Site Passed
Original,Public k e$ith Division Observation Hole Data To Be Completed on Back
us
***If P ercolajitin test is to be conducted within 100' of wetland,;you must first notify the
Barnstable C c�.>4servation Di�zsion at least one(1)week pilot to beg g
DEEP OBSERVATION HOLE LOG Hole# '�
Depth from Soil Horizon Soil:Texture Soil Color, Soil ' Other
Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulders.
Consistent %Gravel
°
®star Fill ` -� p rd .4
lof t art S' Z," 7I
DEEP.OBSERVATION HOLE LOG 'Hole# Z
Depth from Soil Horizon Sail Texture Soil Color Soil Other
Surface rn.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders.
Consistent %Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from' Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.%Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders.
ConsistenGravel)
Flood Insurance'Rate Map:
Above'500 year flood boundary No Yes
.within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervio s material exist.in all areas observed throughout the
area proposed for the soil absorptiori system?
If not,what is the depth of naturally occurring pervious material?
Certification
I"certify that on (date)I have passed the soil evaluator examination approved by the
Department of Enviro ental Protection and that the above analysis was performed by me consistent with
' the required t ' ng,expert i and experience described in3.10 CUR 15.017.
SignatureE't� : ,-— Date `� °1
Q:\.SEPTICVERCFORM.DOC
a
Conunonwealth of Massachusetts
Executive Office of Envirotunental Affairs
Dept. of Environmental Protection
.Jol
One winter Street, Boston,Ma. 02108
y � D.E.P. Titlee V Septic hlrspector
P.O. Box 2119
Teaticket;AA 0,2536
WILLIAM F.WELD 508) 564-6 b--
Governor
ARGEO PAUL CELLUCCI
i
Lt.Governor / W�a S
SUBSURFACE SEWAGE DISPOSAL
ART ASYSTEM INSPECTION FORM cP
S
CERTIFICATION TQ oF2 2 1997
W
NfA(H p pr
Property Address: 8 Lester Circle Centerville Lot 24A Address of Owner:
Date of Inspection:9/11/97 (If different) ,p 4
Name of Inspector:John Graci Mahoney:36 Oxford St.Arlington Ma. Y7
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) L 9
Company Name,Address and Telephone Number:
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X Passes This inspection is based on criteria defined in Title V
— Conditionally P, Sses code 310 CMR 15.303.My findings are of how the system is
Needs F h Evaluation 8 the Local A rovin Authori performing at the time ofthe inspection.My inspection does
— Y PP 9 tY not imply any warranty or guarantee of the longevity of the
Falls septic system and any of its components useful life.
Inspector's Signature: / Date: 9120197
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B,C, or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair, passes inspection.
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/27/97)
One Winter Street 9 Boston,Massachusetts 02108 • FAX(617)556-1049 9 Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 8 Lester Circle Centerville Lot 24A
Owner: Mahoney;36 Oxford St.Arlington Ms.02174
Date of Inspection:9/11/97
Sewaae backup or.breakout.or. hiah.static water level observed.in.the distrihution b.ox is due to a broken.
or obstructed pipe(s)or due to broken, settled or uneven distribution box.The system will pass inspection if
(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private watersupply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must Indicate elther"Yes"or"No"as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 8 Lester Circle Centerville Lot 24A
Owner: Mahoney;36 Oxford St.Arlington Ma.02174
Date of Inspection:9/11197
D] SYSTEM FAILS(continued)
Yes No
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 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/27197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 8 Lester Circle Centerville Lot24A
Owner: Mahoney;36 Oxford St.Arlington Me.02174
Date of Inspection:9/11/97
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
_y_ — Pumping information was requested of the owner,occupant, and Board of Health.
x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
— flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
x — As built plans have been obtained and examined. Note if they are not available with N/A.
x — The facility or dwelling was inspected for signs of sewage back-up.
x — The system does not receive non-sanitary or industrial waste flow.
x — The site was inspected for signs of breakout.
x All system components,excluding the Soil Absorption System,have been located on the site.
x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected
for condition of baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge, depth of scum.
x _ The size and location of the Soil Absorption System on the site has been determined based on
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal Systens.
x Existing information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is
unacceptable)115.302(3)(b)j
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 8 Lester Circle Centerville Lot 24A
Owner: Mahoney;36 Oxford St.Arlington Me.02174
Date of Inspection:9/11/97
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 g•p•d./bedroom for S.A.S.
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available:(last two(2)year usage(gpd):
n/a
Sump Pump(yes or no): No
Last date of occupancy: 6 Months ago
COMMERCIAL/INDUSTRIAL:
Type of establishment: nla
Design flow:0 gallons/day
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: We
Last date of occupancy: n/a
OTHER:(Describe) We
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped in the last year.
System pumped as part of inspection: (yes or no)No
If yes,volume pumped: 0 gallons
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
I/A Technology etc. Copy of up to date contract?
Other:
APPROXIMATE AGE of all components,date installed(if known)and source information:
1974
Sewage odors detected when arriving at the site:(yes or no) No
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 8 Lester Circle Centerville Lot 24A
Owner: Mahoney;36 Oxford St.Arlington Me.02174
Date of Inspection:9/11/97
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 1'
Material of construction:X concreate_metal_FRP_Polyethylene_other(explain)
If tank is metal, list age 0 . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions: L B'6'H 5'7' W 4'10'8'
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle: 24"
Scum thickness:t"
Distance from top of scum to top of outlet tee or baffle:6"
Distance form bottom of scum to bottom of outlet tee or baffle: 17"
How dimensions were determined: Measured
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Septic tank and all components are structurally sound.Recommend pumping septic system every two years for maintenance.
GREASE TRAP:_
(locate on site plan)
Depth below grade: n/a ( p lain Polyethylene_other ex
Material of construction: _concrete_metai_FRP_ )
Dimensions: We
Scum thickness:n/a
Distance from top of scum to top of outlet tee or baffle:We r
Distance from bottom of scum to bottom of outlet tee or baffle: No
Date of last pumping,v
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
n/a
BUILDING SEWER:
(Locate on site plan)
Depth below grade:.to'
Material of construction:_cast iron_40 PVC_other(explain)
Distance from private water supply well or suction line'town
Diameter: 4'_
t;ramments:(conditions of joints,venting, evidence of leakage,etc.)
(revised 04127/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 8 Lester Circle Centerville Lot 24A
Owner: Mahoney;36 Oxford St.Arlington Me.02174
Date of Inspection:9/11/97
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: n/a
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm level:—n/a Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
n/a
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: nfa
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
We
r
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)No
Alarms in working order(yes or no)_Yes
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
n/a
(revised 04127/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 8 Lester Circle Centerville Lot24A
Owner: Mahoney;36 Oxford St.Arlington Ma.02174
Date of Inspection:9/11/97
SOIL ABSORPTION SYSTEM (SAS):X
(locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
n1a
Type:
leaching pits,number: 1,000 gallon leach pit
leaching chambers,number:n/a
leaching galleries,number: n/a
leaching trenches,number, length: n/a
leaching fields,number,dimensions:n/a
overflow cesspool,number:n/a
Alternate system: n/a Name of Technology:_n/a
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
The leach pit is structurally sound and functioning propery.It was empty at the time of the inspection There has not been more than V of water in it.
CESSPOOLS:_
(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: n/a
inflow(cesspool must be pumped as part of inspection)
n/a
Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) '
We
PRIVY:_
(locate on site plan)
Materials of construction: nla 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
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
8 Lester Circle Centerville Lot 24A
Mahoney;36 Oxford St.Arlington Me.02174
9/11197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
��A
no
All y
0
(revised 04/27/97)
gage 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
8 Lester Circle Centerville Lot 24A
Mahoney:36 Oxford St.Arlington Ma.02174
9/11/97
Depth of groundwater 12+
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting property,observation hole,,basement sump etc.)
Determine it from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators, installers
x Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS Maps and Charts
page 10 0[ 10
(revised 04127/97)
; 7- L O C_ _T_1 O-N SEW_ii s:�.E P ERMCT Q O..
--;-1�i`►-- T AL l:.E -- ---1J�,tJl-E—=��A=D D R E S-S
D ACE P E-R 1T 1_SSI)E-D� / —_—
•1082 Old Stage Road
— ---eCwttirville;Maas-
IP - - - t
All
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........OF... = ..-.-.....
Applira$ion for Disposal Iforks ( onti#rur#inn run fit
Application ishereby made for a Permit to Construct ( ) or Repair ( ) an:Individual Sewage Disposal
Systemat..... ......... ........ . ...... .................. .......
.................................. ..�Address sd�Y ... ..Q................. .........................S::..........rA4
or Lot No.....0`'' .....,..........,......
Owner n'
........................................ Installer... �C .... .- a•�-a .......................Type of Building t...../_ .YR:P........Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garage Grinder ( )
aOther—Type of Building ----- No. of persons...........k.............. Showers ( ) — Cafeteria ( )
QOther fixtures .....................................................................................................................................................
Design Flow..................... °..................gallons per person per day. Total daily flow...... ............................gallons.
WSeptic Tank—Liquid capacity-C _gallons Length................ Width.-__.__...'`_... Diameter................ Depth................
x Disposal Trench—No..................... Width................... Total Length....................
Total leaching area....................sq. ft.
Seepage Pit No. Diameter_ '` Depth below inlet------............. Total leachin area_';"�--•-•.sq. ft.
z Other Distribution box ( ) Dosing tank ( ) d�j �G�i's - S 72�/'7 `- -
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
;3� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
ODescription of Soil. 4 ...----------•-------------------------------------------------------- - - --- -- -------------
W
----------------•-••-•--•------------•----------•-----•--•-----------•-•-----•------•-••--•-•••-•••-----------------------------------•--••-•-••---•-------------------••-----•--••--••--••-••---•-•---
U Nature of Repairs or Alterations—Answer when applicable...........:....................................................................................
-----------------------------------•-•-••----.---•-•
Agreement
The undersigned agrees to install the aforedescribe ndividual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code - undersigned fu r agrees not to place the system in
operation until a Certificate of Compliance has been issue the boo�XF Ith.
Siged ,,..:.... ............ ................ -•-•-•- ... ... ..
C•
—X
ate
Application Approved By..... ...: ... -----• /i/j... -=--•----------------- ......
Application Disapproved for the following reasons: -----------------------------------------------••-•,---•----.-•-•--ate--------......
......................:..........................................................................•-••••-
-:-
Date
/
0/
Permit No......................................................... Issued... / --. ---••-•-•-• -----
�`-- ------- - ----------------------------------------------------- --- (------_Date--------------------------------
No.---- ........ FFz..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................ OF... ri.: M
Appliration for Ui,ipooal Marks Toustrudion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: 9' J
....................... 8 ....... ..........6pa;e" ': .. # .. ......... ...............'.`....✓ ri tf; .........................................................
Location Address „ or Lot No #
N '7:'a`trc':: ... .I..::'Y�7".:'...� k:..................... .............................t........'.'. s ...,..,1. '#............ .....,.......
Owner address I
........................................ ...:.e '. ... .. '....... ......_ c�% .^'.mac d"'
f Installer T`Address
UType of Building rSize Lot...... *:_ °. _r.......Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ��
a yp g .....:..:. .............. No. of persons.............C.............. Showers ( ) — Cafeteria ( )
Other fixtures - --------------------------•------------------------
W Design Flow...................... ?..............._..gallons per person per day. Total daily flow------ . ............................gallons.
WSeptic Tank—Liquid capacity O..gallons Length................ Width................ Diameter................ Depth............__..
x Disposal Trench—No..................... Width................,... Total Length.................... Total leaching area....................sq. ft.
____. Diameter..: Depth below inlet.................... Total leaching area._.,::.� Seepage Pit No--------------------- �`�`'' � p a "+�. �:......sq. ft.
Z Other Distribution box ( ) Do inTtank ( )
aPercolation Test Results Performed by------------------------•----......--------.--•---•---•--••-----------•--- Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-__-__.-__-_-_.-_-._-..
f3 ? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ........4•----------------------------------------------------------------------------------------------------------------------------------
r�...rDescription of Soil............. '�_.. ........ �.; �= •-----------------------------------------------------------------------------------------------------•-----------
._____ ,�
_ ------------- ----------------------------------------------------- -----------------------------------
.-------------
•-----------------------------
------------
-................
V ature of Repairs or Alterations—Answer when applicable................................................................................................
------- ----------------...........................................
Agreement:
The undersigned agrees to install the aforedescribe&Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code undersigned fultkier agrees not to place the system in
operation until a Certificate of Compliance has been issu y the boa,,.,IY�<h:'�..
Sig ed E .n -------------
.�
y` r _.(. _ ate
Application Approved By--- ---- . :....A14.1.. a. ------
Application Disapproved for the following reasons:--------------••---••--•-----------•----•--------------------•-------••-......-•---•---••-----ate..................
'^ .. . `4.................................................................................................................................
a f
Date
PermitNo....."C'-f__---------•-•. . ........................ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 'OF HEALTH
E n.__.... !€ •,i r f �"
(Irrtif irate of Tontplianrr
THIS IS TO C RTIFY, That the,Individual Sewage Disposal System constructed ( ) or Repaired ( )
b . �
tnstalle
---------•-•---------•------------------------------•---•--------•-•-•-•-•-•--.....-----
has been installed in accordance with the provisions of Article XI Qj The State Sanitary Cod as desc*'bed in the
application for Disposal Works Construction Permit iNo............I...9.3....._... dated.._;Se_ .. .........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................................................•----------------•------•-•_._.. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
` �-�'f P
�-. I:sa ..... OF._
:+.., .: ................................
No......................... FEE........................
�on�tr,�r�io�t rruti#
-nr, !v s,a`.r t,v
Permission ts�hereby granted...---- ----- � ..................� .._ ... ...._....._.._..... ................_ .....................
to Construct ( ) or Repair ( )man Inc h ual SeK ge Disposal Systeniv,
-)AZ NO. ....... ...'Street
Street...... ................./_ x .....�4!.✓.i.................
as shown on the application for Disposal Works Construction Per N ... D d._.....3�'",//.?, ?..��...
00
Board of F ea th
DATE-------i--- ---------- ----------- ...................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
r
Psler
GENERAL NOTES: CENTERVILLE
1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ti� OP
BOARD OF HEALTH AND THE DESIGN ENGINEER.`" RACE LANE
r 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS. `CT
OY 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR p qCF
P PARCEL ID: TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE ��
172 143 DESIGN ENGINEER. \V
/ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING �� yes
��. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN �� C'jR
ENGINEER BEFORE CONSTRUCTION CONTINUES.
PARCEL ID: LOCUS
\\J 172/144 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF O
AREA=I5,000f S.F. S THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF Q �Z
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.� _��
LO
N C/ Tls; 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 14
�`/ y 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED Z 2
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION. LOCUS MAP
_- - -_ 10. EXISTING LEACHING TO BE PUMPED AND FILLED PER TITLE 5.
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION LOCUS
CB = 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY L O C U S INFORMATION
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING PLAN REF: 257/94TITLE REF: 21294/318
14. ALL PIPE TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) PARCEL 10: MAP 172 PAR. 144
- - ,s� 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW ZONE II
�16"OAK 00 FOR THE USE OF A GARBAGE GRINDER FLOOD ZONE: "C"
0, 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING COMMUNITY PANEL: 250001-0015-C DATED:08/19/85
' '0 _ #8 =_ SEPTIC SYSTEM
3-BEDROOM = i REPAIR PLAN
\ _
NG
_ - Do E LII ss LOCATED AT:
CATCH% \ s W - _BASIN
63.0
\ \\ TBM: - PIPE OUT = `Sy 8 LESTER CIRCLE
CB �, \ COR STEP - INV.=66.13 - , Fo �' CEN TER VI LLE, MA.
\ - f
\ \ \ EL-68.5 _ _ __ -� PREPARED FOR
\ - DAVID WISEMAN
EX15T. 1 ,000G v v _-_-- `� �
SEPTIC TANK Is,
\\ \\ ?� SEPTEMBER 15, 2011
\ 0
L`\.I Inap. Porte
EXIST. LEACH PIT \ \ \ - 00 DA Ma G
see note 1 O \ 18 '( OA YER
,`� PINEW 8" 4 No. 1140
�� PINE _ p0 .�-
.�\ \\ \ _ O. O II I
Pi E O I � SANI TA
% /
�' Q� = CLUSTER "�
PARCEL ID:
172/153
.e
MEYER & SONS INC.
, � GRAPHIC SCALE P.O. BOX 981
20 0 '° 20 °° 80 EAST SANDWICH, MA. 02537
.,UPOLE (508)362-2922
( IN FEET )
1 inch = 20 ft.
SHEET 1 OF 2 J#1372
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:65.03
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED• D-BOX PROPOSED S.A.S.
T.O.F. EL.=68.88 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER ��� 0F MgsS
OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. �c�� 9�y
' F.G. EL.=67.5t F.G. EL.=67.25t F.G. EL: 67.50t F.G. EL: 67.5(MAX.) 1 DA EN f
4 0.�Y11�k0
L = 10't g�MMCCOVER L = 50' L = 10'(MAX INSTALL TWO INSPECTION PORTS (MIN.)
0 S=1% (MIN.) ® S=1% (MIN.) 0 S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC-14 '�FG/SiER�
NITLLiAR���
,a.
'•\INV.=65.89 14" 6" 11.2" TO
ae- L/WID INV.=65.64 INVERT alp</�
��L INV.=64.94
GAS BAFFLE PROPOSED 5 ROWS OF 5 UNITS AT 4'/UNIT = 20'/ROW
• "' ' ' " INV.=65.14 DB-5 INV.=64.70 SOIL ABSORPTION SYSTEM (PROFILE)
EXISTING 1,000 GALLON SEPTIC TANK
EXISTING SEWER OUTLET RESTORE VEGETATIVE COVER
BACKFILL WITH CLEAN PERC SAND 47"
TO TOP OF CHAMBERS
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.=65.03 ;.
2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 64.7
GRADE ON A MECHANICALL COMPACTED SIX BOTTOM ELEV.= 64.03
INCH CRUSHED STONE BASE, AS SPECIFIED IN EXISTING SUITABLE
310 CMR 15.221(2) 2.83' MATERIAL
3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF 1 _
TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 5 x 2.83 = 14.15 48"
IF FAILED, DAMAGED, OR UNDERSIZED. (7.78' PROVIDED) USE 5 ROWS OF 5-INFILTRATOR QUICK 4 PROFILE
4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL.=56.25 -_ STANDARD UNITS-NO STONE
GAS BAFFLE AS REQUIRED
SEPTIC SYSTEM PROFILE TYPICAL SECTION
N.T.S. e.rs. 8 12"
P'::-) AN
DESIGN CRITERIA SOIL LOG P#: 13395
I
NUMBER OF BEDROOMS: 3 BEDROOM DESIGN DATE: SEPTEMBER 8, 2011 I�---34" -�
SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. SECTION END CAP
DESIGN PERCOLATION RATE: <2 MIN/IN
WITNESS: DON DESMARAIS, BARNSTABLE BOH DAILY FLOW: 330 G.P.D. Elev. TP-1 Depth Elev. TP-2 Depth _INFILTRATOR QUICK 4 STANDARD UNIT
DESIGN FLOW: 330 G.P.D. 67.50 0" 67.50 0" MODEL QUICK 4 STD
GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) FILL
67.08 5" 67.0 6" LENGTH 48" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY A A EFFECTIVE LENGTH 48 TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
L0� 4/1 D „ LOAMY SAND „ DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
LEACHING AREA REQUIRED: (330) = 445.94 S.F. 66.83 B 8 66.75 B 9" SIDE WALL HEIGHT 8"
•74 SANDY LOAM SANDY LOAM OVERALL HEIGHT 12"
DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) 64.83 10YR 5/8 32" 64.83 1oYR 5/8 32"
Cl Cl OVERALL WIDTH 34"
PRIMARY S.A.S. MEDI M SAND MEDIUM SAND
USE 5 ROWS OF 5 - INFILTRATOR QUICK 4 STANDARD UNITS NO STONE PERC ® EL. 63.32 2.5Y 7/4 2.5Y 7/4 CAPACITY (43.5 GAL)
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) 58.50 2 108" 515.42 2 109"
- (QUICK 4 UNIT) 25 UNITS x 4.0 LF x 4.73 SF/LF = 473.0 SF MEDIUM SAND MEDIUM SAND PROPOSED SEPTIC SYSTEM/SITE PLAN
DESIGN FLOW PROVIDED: 0.74(473 GPD/SF) = 350.02 GPD > 330 GPD req'd 56.25 2.5Y 7/3 135„ 56.25 2.5Y 7/3 1
135„ 8 LESTER CIRCLE CENTERVILLE MA
PERC RATE <2 MIN/IN. ("C1" HORIZON) Prepared for: Wiseman
NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB. NO.
Meyer&Sons,Inc. A•faCDou al SurveyNTS D.M.M.
• I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pO BOX 981 g
to conduct soil evaluations and that the above analysis has been performed by me consistent with the EgSTSANDW/CH,MA 02537 DATE CHECKED SHEET N0.
requirements of 310 CMR 15.017. 1 further certify that I hove passed the Soil Eval. Exam in October, 1999. (508) 419-1086
508-362-2922 09/15/1 1 D.M.M. 2 of 2