HomeMy WebLinkAbout0195 LONG BEACH ROAD - Health 5 Long beacn Road
Centerville
' A 205 029
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TOWN OF BARNSTABLE Q
LOCATION IN �II/ "`�`(.f `
SEWAGE #
VILLAGE �U� ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO
.4 SEPTIC TANK CAPACITY
.� LEACHING FACILITY:(type) -15(bw (sie) 1
NO. OF BEDROOMS PRIVATE WELL OR PUBL E$s.
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: /
VARIANCE GRANTED: Yes No
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l.0 C A`T I ON r SEWAGE PERMIT NO
VILLAGE l
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INSTA LLER'S NAIVE i ADDRESS
ti' s OR OWNER
DATE PERMIT ISSUED
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DATE COMPLIANCE ISSUED
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COMMONWEALTH OF MASSACHUSETTS
A - EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 195 Long Beach Road
_ Centerville MA 02632 I 05.0
Owner's Name:, Ramsay.Crain
Owner's Address:
Date of Inspection: November 10 2011
Name of Inspector: (Please.Print) JamesM.Ford
Company Name: JaynesM. For`•d
Mailing Address: P.O.Box 49
Osterville,MA 02655-0049
Telephone Number: (508) 8624400
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:
✓ passes
Conditionally Passes
eeds Further Evaluation by the Local Approving Authority
F ils
Inspector's Signature: Date: November 14. 2011
The system`inspector shall sub t a copy of giis inspection_report to.the Approving Authority(Board of Health or
DEP)within 30 days of comple ng this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and.the system owner shall submit the report to the appropriate regional office of the
DEP,. The original should be sent to the system owner and:copies sent to the buyer,if applicable, and the approving
authority.
Notes and Comments.
****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.
Title 5 Inspection Form 6/15/2000 page 1
i
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION. (continued)
Property Address: 195 Long Beach Road
Centerville MA
Owner: Ramsay Crain
Date of Inspection: Novenzber 10 2011
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally
rtronall Y Passes:
Y
One or mores stem comp
onents
Y p s as described in the. Conditional Pass
" section need to be replaced r paced or
repaired. The system,upon completion of the replacement or repair,as approved b the Board pP Y of Health,will pass.
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined",please
explain.
The septic.tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic,tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
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:
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:
2
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 195 Long Beach Road
Centerville MA
Owner: Ranisav Crain
Date of Inspection: November 10 2011
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 environments
The system has a septic tank and soil absorption
rp system(SAS)and the SAS n's within
100 feet of a
surface water supply or tributary to a surface water supply:
The system has a septic tank,and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**. Method used to determine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory, for 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:
3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 195 Long Beach Road
Centerville MA
Owner: __Ramsay Crain
Date of Inspection: November 10 2011
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the.following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than%z day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply:
✓ Any portion of a cesspool or privy is within a Zone.1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.[This system passes if the well water analysis,
performed at a DEP certified laboratory,for 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 System:
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
— 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=lWPA)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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 195 Long Beach Road
Centerville,MA
Owner: Ramsay Crain
Date of Inspection: November 1 D 2011
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health'
_ ✓ Were any of the system components pumped out in the previous two weeks?
_✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ Were as built plans of the system obtained and examined? (If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for.signs of break out?
✓ Were all system components, excluding the.SAS,located on site?
✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,'dimensions,depth of liquid,depth of sludge and depth of scum?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
5
Page 6 of 11
4 '
OFFICIAL INSPECThON FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 195 Long Beach Road
Centerville.MA
Owner: Ramsay Crain
Date of Inspection: November 10 2011
RESIDENTIAL FLOW CONDITIONS
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
.Number of current residents: 0
Does.residence have a garbage grinder(yes or no): N/a
Is laundry on a separate sewage system(yes or no): N/a [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)): Unavailable
Sump Pump(yes or no): No
Las
t date of occupancy: Weekend/sunnier
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on,310 CMR 15.203): gpd
Basis of design flow(seats/persons/sq/ft etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/user
OTHER(describe):
GENERAL INFORMATION
Pumping Records.
Source of information: Unavailable
Was system pumped as part of the inspection.(yes or no):
If.yes,volume pumped: gallons--,How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known) and source of information:
Date of installation 3118104 Per as-built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM.- NOT.FOR VOLUNTARY ASSESSMENTS
SUB
SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
t PART C
SYSTEM INFORMATION (continued)
Property Address: 195 Long Beach Road
Centerville MA
Owner: Ranisav Crain
Date of Inspection: November 10 2011
BUILDING SEWER.(locate on site plan)
Depth below grade:
Materials of construction: cast iron _40 PVC other(explain):
Distance from private water supply.well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: _30"
Material of.construction: ✓ concrete _metal_fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 Qal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
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: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
The tees were present. The liquid level was even with the outlet invert There did not appear to be any.signs ofleakaze
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions: .
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
s ..`. Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments.(on pumping recommendations,inlet and outlet tee or.baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
7.
f
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 195 Long Beach Road
Centerville MA
Owner: Ramsay Crain
Date of Inspection: November 10 2011
TIGHT or HOLDING TANK:. None (tank must be pumped at time of inspection) (locate on site plan)
Depth below grade:
Material of construction: _concrete._metal ._fiberglass _polyethylene _other(explain):
Dimensions:
Capacity gallons
Design Flow: gallons/day
Alarm present(yes or no): .
Alarm level: Alarm in working order(yes or no):
Date of last puinping:
Comments(condition of alarm and float switches,.etc.):
DISTRIBUTION BOX: ✓ (if present must be opened) (locate on site plan)
Depth of liquid level above outlet invert: Even
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 D-Box was normal. No solids were resent: The cover was 5"below jzrade.
PUMP CHAMBER: ✓ (locate on site plan)
Pumps in working order(yes or no): N/a
Alarms in working order(yes or no) n1a
Comments(note condition of pump chamber,condition of pumps-and appurtenances,etc.):
The liquid level was norinal.could not c cle though. no one was ho»ie.
8
Page 9 of .11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 195 Long Beach Road
Centerville MA`
Owner: Ranisav Crain
Date of Inspection: November.10 2011
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: 7-infiltrators 4'x80'x2'per as-built
leaching galleries,number:
- leaching trenches,number;length:
leaching fields,.number,dimensions:
overflow cesspool,number:
- Innovative/alternative system Type/name of technology:
Comments(note.condition of soil,signs.of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):
There did not a ear to be any signs of failure...'
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:.
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments .(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation; etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic,failure,level of ponding,condition of vegetation;etc.):
i
9
Page 10 of 11
a
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 195 Lou Beach Road
Centerville MA
Owner: Ramsay Crain
Date of Inspection: November.10.2011
I
.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.
3
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1 3a6 IS'
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A- 1
10
Page 11 of 11
J
OFFICIAL INSPECTION FORM-'NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 195 Long Beach Road
Centerville,MA
Owner: Ramsay Crain
Date of Inspection: November 10, 2011
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to.ground water 12+1- feet
Please indicate (check)all methods used to determine the high groundwater elevation:
Obtained from system design plans on record - If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: Topographic and water contours maps
Checked with local.excavators,installers-(attach documentation).
Accessed USGS database-explain:
You mus
t describe how you established the high ground water elevation:
Using Barnstable topographic and water contours naps the maps were showing approximately 12'+/7 to ground water at this
site.
This report has been prepared only for the septic system and components described herein. This septic system has beers
inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the systein will
Auction properly irii the fiatire. There have been no warrawies or guarantees, either expressed, written or implied,
relating to the septic system, the inspection, this report and/or any components of the septic system which have not
been located and inspected.
11
No. lS/ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIppYicattou for �Dtgonl 6pkeiu Con0tructtou 3ermtt
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components
Locatio Address or of N g� d�t� / Owner's Name,Address,and Tel.No.
Assessor'sMap/Parcel ozQs °
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
AlZit 5!�M&
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank -� a Type of S.A.S.
Description of Soil
Nature of Repairs or Al��tt'��yms fAnswer when applicable) r.16
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 ode and not to p'lape the system in operation until a Certificate of
Compliance has been issued by this Boa of ealth.
1
Signed ate
/;3//,0
Application Approved by Date 0
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued
m �. . .�, ",.�e. X"•.,.r .,... -a.• r--...4..'a'4v*„ ,ti ,"�, ti Y .�a.
/ L' / 5 )7
No. Fee
THE COMMONWEALTH &O MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN & BARNSTABLE, MASSACHUSETTS Yes
21pprication for �Diopogal i ipg n5tructiou Permit
ry , �k, � r:
Application for a Permit to Construct( ) Repair(() Upgrade 1?O do ( :), ,i .Complete System ❑Individual Components
Location Address or Lot No. Owner's Name;•d r ssd Tel.No.
Assessor'sMap/Parcel �O ,„.�'�
—
n
Installer's Name,Address,and Tel.No. /' Desi f ner's: am Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Siz
-e, sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons* Showers( ) Cafeteria( )
Other Fixtures ..
it Design Flow(min.required) w.- gpd Design flow provided d
^'"
. :, gP
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank �rjQ® Type of S.A.S.
Description of Soil
Nature of Repairs or A-lte'ra-tio s Answer when applicable) c cl�u
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 ode and not to place the system in operation until a Certificate of
Compliance has been issued by this Boa of ealth. f' /
Signed ®�
S i Date
/i
Application Approved by j{ V�TWi Date J/08
�.
Application Disapproved by: 1/ Date
for the following reasons
Permit No. ,We Date Issued �1 .o
------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed X
Repaired ( ) Upgraded ( )
Abandoned( )by
at 17 t� plyhas been constructed in accordance
l 33 J 1 l
with the provision o 'tie 5 and the for Disposal System Construction Permit No. � A— 0 dated
Installer Designer
#bedrooms N Approved design flow ;, gpd
The issuance of this permit shall not be construed as a guarantee that the system will function as,designed±.
,I yl, .
Date tl! �" `� ; Inspector " <, ✓(_ x u
———————————————————————————————————————————
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS. -
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
�i5po.gal i§p5tem Cow5truction Permit
Permission is hereby granted to Construct (�) Repair ( ) grade ( ) Abandon ( )
System located at �,f
�r e144
t/ I r
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
ti
Provided: Clonstruction must be completed within three years of the date of this pe
Date 3� Approved by `
I
TOWN OF BARNSTABLE
LOCATION I Ct S L.0c-,a eh R6 SEWAGE#
VILLAGE Cp_i��c�`��� ASSESSOR'S MAP&PARCEL Ze),S
INSTALLERS NAME&PHONE NO. �Ou��Cb c��Np,, �T oc
SEPTIC TANK CAPACITY 15 OO QNcj\ 10M O \ i2gmp�Cgsla( zl-
LEACHING FACILITY: (type) 1r�F►t.-�(tA�¢5 (size)
NO. OF BEDROOMS
OWNER
PERMIT DATE: J_-,5 -U! COMPLIANCE DATE:-
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 3L' Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) A- Feet
Edge of Wetland and Le hi Facility(If an w tlands exist j
within 300 feet of le king facility) `� Feet
FURNISHED BY
A s yy
c,.
:b �-I Sf •I
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i s ,
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: #195 Lone Beach Road
Centerville,MA
Owner's Name: Robin Reisman
Owner's Address: #4 Rocky Ledge Road
Weston,MA 02193 f�
Date of Inspection: 08/07/06
Name of Inspector: (please print) Mr.Carmen E.Shay
Company Name: Shay Environmental Services,Inc.
Mailing Address: P.O.Box 627
East Falmouth,MA 02536
Telephone Number: (508)-548-0796
CERTIFICATION STATEMENT _ V
I certify that I have personally inspected the sewage disposal system at this address and that the in "_r.`eported:
below is true,accurate and complete as of the time of the inspection.,The inspection was.performed based o`n my t s
training and experience in the proper function and maintenance of on,site sewage disposal systems.II am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
XX Passes `
Conditionally Passes
Needs Furth ation by the Local Approving AuthorityY o CARMEN q��G
Fails r.
o SLAY 4
Inspector's Signature: Date: 08/07/06
r o
Fs rrvs��c•
The system inspector shall submit a copy of this inspection report the Approving Authority(Board of Het
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
No evidence of hydraulic failure observed in SAS. Excavated D-Box and probed stone
Pump chamber and Alarms operating properly
****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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: #195 Long Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
XX I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
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:
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:
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: #195 Long Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
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
"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:
-1 1. .„1,,,,.,.,, 3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: #195 Lone Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
XX Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
XX Any portion of the SAS,cesspool or privy is below high ground water elevation.
XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
XX Any portion of a cesspool or privy is within a Zone 1 of a public well.
XX Any portion of a cesspool or privy is within 50 feet of a private water supply well.
XX 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
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
1 r .„.,,.,.- 4
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: #195 Lone Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
XX Pumping information was provided by the owner,occupant,or Board of Health
XX Were any of the system components pumped out in the previous two weeks?
XX _ Has the system received normal flows in the previous two week period?
XX Have large volumes of water been introduced to the system recently or as part of this inspection?
XX _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
XX _ Was the facility or dwelling inspected for signs of sewage back up?
XX _ Was the site inspected for signs of break out
XX _ Were all system components,excluding the SAS, located on site?
XX _ 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?
XX _ 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
XX _ Existing information.For example,a plan at the Board of Health.
XX _ 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)]
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: #195 Long Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440
Number of current residents: Unk.
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):
Seasonal use: (yes or no): no
Water meter readings, if available(last 2 years usage(gpd)): 78,000 gallons,2005,72,000 Gallons-2004
Sump pump(yes or no): No
Last date of occupancy: Currently Occupied
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Not Pumped since installed in 2004
Was system pumped as part of the inspection(yes or no):
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
XX Septic tank,distribution box,soil absorption system (PUMP CHAMBER)
_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):
Approximate age of all components,date installed(if known)and source of information:
March 5,2004-per Owner Records&BOH Records
Were sewage odors detected when arriving at the site(yes or no): No
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #195 Long Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction: _XX cast iron XX 40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: XX (locate on site plan)
Depth below grade: 12"
Material of construction: XX concrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 5' deep x 5'wide by 10' long (1500 gallon)
Sludge depth: 4.75'
Distance from top of sludge to bottom of outlet tee or baffle: 3.00'
Scum thickness: %:"Scum Laver Noted
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: 12"
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.):
Structural integrity of tank was ok.No evidence of cracks,leaks,or water infiltration/exfiltration. 4" PVC inlet Tee present
and in good condition. Outlet Tee also in snood condition. Liquid level equal with outlet invert.
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
r .„.,. 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: #195 Long Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: Present (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
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.): No cracks noted—distribution appears to be equal. . Top of D-box is 1.5
feet deep.
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etch
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #195 Long Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
XX leaching trenches,number, length: 2 Trenchs—4'wide by 40 feet long,2'deep
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):No evidence of hydraulic failure,pondin damp soil or stressed vegetation. SAS is 3.0 feet to top.
No observation port present. Probed stone with no evidence of hydraulic failure.
CESSPOOLS: (cesspool must be pumped as part of ins ection)(locate on siteplan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions.
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
.„. 9
Page 10 of 11
• OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #195 Lone Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
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.
• ? cis � cd� � � � �� c6 c6
i
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #195 Lone Beach Road
Centerville,MA
Owner: Robin Reisman
Date of Inspection: 08/07/06
SITE EXAM
Slope
Surface water -None
Check cellar -Yes
Shallow wells—None
Estimated depth to ground water 20 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
XX Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
XX Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Observed from site conditions relative to the site and nearby Little Sandy Pond Also checked with
Quadrangle of USGS Man. 4' Separation from water table to bottom of SAS from nerc info.
Per USGS MAP PLATE 2:
Elev.of Ground=12 Feet
Elev.Of Groundwater=1.25 Feet
Elev.Of Bottom of Trench= 8.67 Feet
Therefore: 1.25—8.67=7.42 feet separation between Bottom of Leach Pit and Groundwater.
Groundwater Adjustment using Index Well MIW-29(A): 0.5 feet
Adjusted Groundwater Separation=8.67— 1.75=6.92 feet between bottom of SAS and ad a. groundwater
Grade=Elev. 12eet
Septic Tank
Bottom of Trench=Elev. 8.67feet
Adj.Groundwater=Elev. 1.75
• TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE 1 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.h%-VA(C
SEPTIC TANK CAPACITY �� low
LEACHING FACILITY:(type)` '1v (size) 2vX�
NO.OF BEDROOMS_
BUILDER OR OWNER
PERMIT DATE:-. 315)qt COMPLIANCE-DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Fable 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
6..
i
t
1
1 �
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r
No.
3 " S�q L.1 Fee dt
�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS
Zipplication for Mi p5tem Conotruction Permit
Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /9vold 0kjX0rl t.#_ ...Owner's Name,Address and Tel.No.
���' /CD�ji/V K�Ssrt A�
Assessor's Map/Parcelmrf o?QT P hae L- �9 fc1S /v(� j
UU Cdov =ttf-
Ins aller's ame,Address,and Tel.No. 6-0s-`f&-9300 Designer's Name,Address and Tel.No.
,vAP,eo � ca�v��°o� C. E1 Cr4 ,e ,4v& hive_ J73 e377
2es c f M 0 Oc)6 t/tf Z 1&,*Z �34F
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building SAS No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 1V O gallons per day. Calculated daily flow 'I"Y4 gallons.
Plan Date i o `d!do U 3 Number of sheets Revision Date
Title sED -6
Size of Septic Tank / o 64 2_0.0,1PU S— Tyne of S.A.S.
Description of Soil, SA+V 0 y ok ,) Type
Nature of repaj'rs or Alterations(Answer when applicable) AIw / (,'1n Q 4ti b
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 Certifi-
cate of Compliance has been issued b ' Bo H alth.
Signed Date /0_c�770 3
Application Approved b Date!R V )
Application Disapproved for the following reasons
Permit No. Date Issued
77
No. , Fee '�_�/J
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH.DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
jltlfiration for Mizpo Y fps rem Conztrurtion Permit
Application for a Permit to Construct( )Repair( �)///Upgrade( )Abandon( ) O Complete System O Individual Components
,.Location Address or Lot No. / 5[pyV(gy p} �p�Ct1Jpt.ru.E Owner's Name,,Address and Tel.No.
' '' ROAN I[ESSM 19I�1
Assessor's Ma /Pazcel` n_ GC /�1S (Oti(a
s �PD
P M! o9Qs I'f�R L Cbl Cj C r�n.7�C�Q
k�stt�uuer's ame,Address,and Tel.No. 6-a- 4a&r'9300 Designer's Name,Address and Tel.No.
f�As of 6ee-A.,^ fioti .1 C. ��6�,�-c €�e,,,(, � '"c� ��cr,�7 .
o /d&Cf. ass c,e ey y, ,
2es f t �1 vd y E C�iorr ,r..r �� �3f-
' Type 6f'Building:4 1
Dwelling No.of Bedrooms Lot Size/.� 1 l.sq.ft. Garbage Grinder
Other Type of Building fe1_S�+VGL No.of Persons ... .. Showers( ) Cafeteria( )
'Other Fixtures
Design Flow yS/O gallons per day.�Calculatedddaily flow r10�yo - gallons.
Plan Date /O -d/d o 0 3 Number of sheets #/ /' Revision Date -
Title s� -E 6e_ S S��r�► lJ .fa�'►� `�.. '
Size of Septic Tank 66C Type of S�A.S.
,,;
Description of Soil, SA tiO L
1 N
V
Nature of Rep ' or Alterations(Answer when applicable)_AI&V " /P(II+A C/4^n� /Z _ /9A,b
i' r
Date last inspected: .
Agreement:
The undersigned agrees to ensure the construction aridmdintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to plice the system in operation until a Certifi-
cate of Compliance has been issued b thi Bo He lth. ^
Signed ` Date �� "2703
Application Approved by-7Date313
Application Disapproved for the following reasons ;
. y f
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
r BARNSTABLE,,MASSACHUSETTS
Certif irate of-tomoliance
ti t• �
THISJS TO CE�T]FY, that the On-site Sewage Disposal.Systefn Constructed( )Repaired( )Upgraded( )
Abandoned( )by V�.��C�r V i r
at I od P, ,,I- has been constructed in accordance
with the provisions of� itle 5 and the for Disposal System Construction Permit No. (l�l Z- Xt� dated H I��l u
Installer Designer
rN The issuance of this permit s-aloot be construed as a guarantee that the system, will�fu/nction as d sign,d.
Date 2r /O Inspector wyf/ j tl �.
.---------------------- _ _ _
No.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Zigoaf bp$tem Cow5truction Permit
Permission is hereby granted to Construct( )Repair(V Up rade( )Abandon( )
System located at �?S Lc�n� c�
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Constructio must be completed within three years of the date of�eit.
Date: /) Approved by
MAR-12-2004 10 :41 AM JCENGINEERING 508 273 0367 P. 02
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Health Complaints
21-Jul-03
Time: 1:30:00 PM Date: 7/18/2003 .Complaint Number: 4178
Referred To: SAM WHITE Taken By: SAM WHITE
Complaint Type: TITLE V SEWAGE
Article X Detail: UNSANITARY CONDITIONS
Business Name:
Number: 195 Street: Long Beach Rd. ,
Village: CENTERVILLE Assessors Map_Parcel:
Complaint Description: Complaint of leaking septic system at above
address.
Actions Taken/Results: SW observed badly leaking septic tank into
groundwater. All H-10 components under
driveway. Cape Land Septic (Rodger Roberts)
installed system 9/14/90. Permit# 90-408.
Pastore Excavation was in process of installing
new system. Pictures in file for Rodger Roberts.
Investigation Date: 7/18/2003 Investigation Time: 2:30:00 PM
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SEWAGE #
VILLAGE ► ASSESSOR'S MAP& LOT r
INSTALLER'S NAME&PHONE�10. �1i✓C ?C fLQ VQ l(M Ti1'1(_
SEPTIC TANK CAPACITY ISM CkCA11,J2A\C «
LEACHING FACILITY: (type) (size) X
NO.OF BEDROOMS��J,,
,-BUILDER OR OWNER "I'n �e�S► A,VI
PERMITDATE: 315M 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 ��
PC
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
,Apure#ion for Uiopoiial Works Tatuitrurtion Jkrutit
Application is hereby made for a Permit to Construct ( ) or Repair (Lan Individual Sewage Disposal
System at:
.........� �-!� -_.t ....V ----'.........=----------------- ---------------r—e-3pY`- !2 ..........................................
,!X Add ss or Lot No.
Owner dress
a ........... :"`� - ...... P ` .�"...` ! r ... " N"`
Installer Address
Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms_________ __ _Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( )
P., Other fixtures -----------•-••---•-•-•--•-••••-
W Design Flow____..'_________________________gallons per person per day. Total daily flow....... .d_.......................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__:_____________ Depth................
x Disposal Trench—No._4j_A . Width....!_.......... Total Length....L.6`_____.____ Total leaching area____________________sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-•--•---•--------•---•--••---------••••----•--•••-•-••--•-•••••--••-••--- Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�i, Test Pit No. 2................minutes per inch Depth of Test Pit............_....... Depth to ground water........................
Q+' ------------------------------------------
••--•..... ---------------•--•••••------------------••••----••--------------------------------------------•----
ODescription of Soil........................................................................................................................................................................
x
V
---------------------------•------•-••-•------•-------•--•-•---•-•----------•---....----------•--•------------------------------------------------•-----------------••-•-----•--•--•-----------•••---•--
U Nature of Repairs or Alterations—Answer when ap licable-••-' -U`e.__._ G�e�..J�-•---- `'��'` ......._.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the b and of health.
Signe -------- ------ - --- g" .1- ------
Date
Application Approved By -----...--CU .�f/
Date
Application Disapproved for the following reasons• ------------------ ------------------------------------------------------------ ---- --------------------------------------
-----........................... -------------------------------------------------------------------' Dale
Permit No. �.. .................. Issued
-----------------'---'---'---...---...- Date.---..--..-.----.---.-.-..-----'-----
.i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tonstrnrtiloln rrntit
Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal
System at:
Location.Address or Lot No.
.......................... A:v--�c✓L••----•-----........................... ................----. .
.....
Owner dress
Installer Address
UType of Building Size Lot............................Sq. feet
a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons........._------------------ Showers ( ) — Cafeteria ( )
Other=fixtures .:.............
W Design 'S`_••-•--._.•-•-•-----•-••__gallons per person per day. Total daily flow....... .......................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. Width....!;....._.... Total Length.....l.b`---------- Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. ,
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed,.by' Date Date
14 Test Pit No. I................minutes per inch Depth of Test Pit..................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit....................,Depth to ground water........................
.0 P4 .--•--•---••-•-•--••••-•------••--..........••••--••••....---•-••-•-----------------•••......--.............................................................
Description of Soil...............................................................................----•-------------------------•-•-•----------•---------------•--••......-•...-••--..._..
kx '
c.� ------•--•--•-•-•••••-••----••--•-•••--•-----•--------------•-••••......----••••••-------••-•--•-•••-•-----•-•-••-----------•-......--•-•••............................................................
V Nature of Repairs or Alterations—Answer when applicable-____{ .......`GZ •Sty- 2:,-_•_•---
------....��O t w _: S q.�"......c_.�ti0-may- !^ z`` ` . :.--------•--------------------------•
Agreement:
The undersigned agrees to install the aforedescribed�Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental`Code 1)T-'he,undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the bR and of health.
Signed - _ �.r 1 -------
Date
Application Approved BY ^" 4k-:a,,,._^-D----------------------------------------------------------------------------- --------�..-= /..� ....
Date
Application Disapproved for the following reasons: .............................. rj.
..........................
----- --------------- --------------------- -----------------------....................................... . ------....-----------------.......----- ........
/ Date
Permit No. �d. { ( Issued -------------------------------------
--------------------
+ j r ✓` Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ter#tftrate of 'U'Lluntylinure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by G�Y���-- `^rJ
..... r .... ....................................... Z .............................................................................................
In talle
at ... �j.c am.. -r ------------------------- G- ...'`
------------ -- ----------------
has been installed in accordance with the provisions of TITLE 5 of The State Environm�tal Code as described in
the application for Disposal Works Construction Permit No. ............�o.......� ..�5. dated.........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM1LL FUNCTION SATISFACTORY.
ff c/
DATE...r...�..1. ..v(.(?--------------------------------------------------------------------- -Inspector .� ............; ....---- ...........................................- ---------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�� ��c� TOWN OF BARNSTABLE
s ,
No.... - FEE.....
Disposal Works Tnnstrnr#inn Vrrntit
Permission is hereby granted..........G (�- !!! .. �L
to Construct ( ) or Repair ( `-)an Individual Sewage Di posal System
at No.. 1. -S .._...1�. .!^ .. c1G�!� GLc�...
Street
as shown on the application for Disposal Works Construction Permit No..2:\\... ..q Dated..........................................
•-•-•-•...................•-_....f.... .........................................................
DATE............4•'•-l'�= ..........................................
Board of Health;
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS
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DESIGN DATA
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1O Wianno Avenue
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CantwvilleN MA
CentmiOe•MA
WIT PLAN
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Catalono Architects Mc.
1158=d Street
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GENERAL CONTRACTOR
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C.I Riley Builder,Inc.
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_ Osterville.MA D2655
u R f telephone 500 420 5376
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Centervale,MA
Centerville,MA
BASEMENT FLOOR PLAN
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I Batton.MusarAlvans 02110
telephone 517-338-7447
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telephone SBd2&636
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FIRST FLOOR PLAN
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10 Nhanno Avenue
0aten60e.MA 02655
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tdephone 500-4284M
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Centerville,MA
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SECOND FLOOR PLAN
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DATE ThL,d V.jw wy31.2108
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115B SuW
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teleyhone 617.33e-7447
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Exioting Second Floe Plan 2 Pro osed.5econd Floor Plan 1M2
=N:WC0.51RULf.O4
SLAB = 6.10'
TOF = VARIES PROVIDE PRECAST CONCRETE EXTENSION 5" DIA. OUTLET(S) 4"SCHEDULE 40 PVC MIN_ SLOPE 1 % FINISHED GRADE OVER INFILTRATION= 1 1 .60' - 12.30'
" FINISH GRADE OVER RISER WITH CONCRETE COVER TO WITHIN REMOVABLE COVER SLOPE @ 2% MIN. GENERAL NOTE S
20 MIN. ACCESS COVER TANKS EL.= 5.20' - 5.7$' 6 OF FINISH GRADE OVER INLET&OUTLET COVER
(TYPICAL FOR 3) FINISH GRADE OVER D-BOX= 1 1 .80'
2.88' 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION
12" MIN. 12N MIN. METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE
- 36" MAX. 36 MAX. INSPECTION PORT WITH BOX TO GRADE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES.
(ONE PER TRENCH)
36"MAX. 4" PVC OUT TO 9,59' 9" MIN. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
6„ "Min. 6„ 4" PVC 2"PVC TEE LEACHING FACILITY 36"MAX. TOP OF SAS= 10.00' = BREAKOUT EL. OF HEALTH AND THE DESIGN ENGINEER_
SLOPE °min. I 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL
2" DROP MIN_ SLOPE 1%min. I BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED.
3" DROP MAX. 14" L=3.72'
L= 138' 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN
48" INV. OUT= 1.33' ELEVATION = 10.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS
INV.
��� LEVEL 1 .861 1 .80' O 0.92' (nrP ) A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
I INLET TEE
1" 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
6"
5.5' OUTLET 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL_
10.10' 9.90' 6.25' 2.83' 8.5' 2.83' 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN
TEE Z6" CRUSHED STONE 1 ,$Q
GAS BAFFLE OVER MECHANICALL 6"CRUSHED STONE (NP ) 5'MIN. (TYP•) (TYP.) SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO
COMPACTED BASE OVER MECHANICALLY 37.5'(TRENCH 1) BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH.
BAFFLE COMPACTED BASE 8. ELEVATIONS BASED ON DATUM OF 5.47'N.G.V.D. OBTAINED FROM A
43.8'(TRENCH 2) NAIL IN A UTILITY POLE AS SHOWN ON PLAN.
EXISTING 1500 GALLON SEPTIC TANK 1000 GALLON PUMP CHAMBER 5 OUTLET DISTRIBUTION BOX TO BE 8.67 GROUND WATER ELEV.= 1 .23'
9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
LENGTH 10'-6" WIDTH 5'-8" DEPTH 5'-7 INSTALLED ON A LEVEL STABLE BASE. FIRST THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE
TWO FEET OF OUTLET PIPES TO BE LAID LEVEL. 13 - HIGH CAPACITY INFILTRATORS INFILTRATOR END VIEW AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY
NOT TO SCALE NOT TO SCALE CROSS SECTION VIEW PROFILE DISCREPANCIES TO THE DESIGN ENGINEER.
10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
DISTRIBUTION BOX DETAIL STRUCTURES SHALL BE MADE WATERTIGHT.
*NOTE:1. TANKS SHALL BE INSTALLED ON A LEVEL STABLE BASE NOT TO SCALE HIGH CAPACITY INFILTRATOR DETAILS 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR
ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH
NOT TO SCALE
2. TANKS AND COVERS TO BE WATERTIGHT AND WATERPROOF DETERMINATION FROM APPROPRIATE AUTHORITY.
12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
�4 -4 INSTALL 1-1/4" PVC TO HOUSE. JOINTS TO BE MADE 4 ,�"` `� �'� , �� f c7 r` TEST PIT DATA A LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
ACH (20-FT L_O.) ROAD CB/DK WATERTIGHT_WIRE PUMP AND FLOATS TO SIMPLEX " " , n , v'` .- - THEY SHALL WITHSTAND H-20 LOADING.
LONG BE ____.__ �l ---
�pG F PAVEM�IT .,._;;a as
2'05"E - �ND CONTROL PANEL No. 1-CC2 NEMA-1 MFG. HOOVER .u.. ��: ,� �,
' /� � 13_ DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND
INSTRUMENTS. 1` C? U � i AGENT: Samuel White, R.S. FINES.
66.00' /
,X
4. x s.12 NEMA 4 JUNCTION BOX CORROSION RESISTANT& HOISTING CABLE 7 x 19 STAINLESS STEED ` 4.� ~ SOIL EVALUATOR: Samuel Philos Jensen
t F " . � 14_ WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND
TIP `'/ LIQUID-TIGHT CABLE CONNECTORS SUPPORTED 1/8" DIA./ 1,760 LB. STRENGTH " ` ' • !�' DATE: September 5, 2003
B.M.
63 N / UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF
< CONNECTORS SUPPORTED BY 1-1/4"PVC CONDUIT, >. a • ' -- LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
Nail in Utility Pole t7 9 EXISTING DISPOSAL AREA TO JOINTS TO BE MADE WATERTIGHT 2"BALL VALVE w/UNIONS SCH. 80 PVC '�"'_ �s' TEST PIT#: 1
Elev. =5.47' ;_ COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN
3E ABANDONED I I I GEORGE FISHER CO. MODEL NO. 560 q+ ELEV TOP: 4.90' ACCORDANCE WITH 310 CMR 15.255(3).
N.G.V.D. '29 18,�3, 3 w� �i• ti '• I ELEV WATER 15
PROPOSED 1000-GALLON '=. EXISTING 1500-GAL SEPTIC 13" 3" 2"SCH.40 TO D-BOX __ _ A `' ' - d : R _ CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
PUMP CHAMBER �5 TANK 6" �• `) ` SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
5s7 "SCH. 40 TEE w/CLEAN-OUT CAP .... . _ - ,-' PERC RATE: <2 Min./In.
X 6.N X 5.06 5 u * 5,_7„ ALARM ON - �lL i �, . ' - �ifG= 16. PROPOSED PROJECT IS LOCATED WITHIN:
EXISTING WATERLINE TO BE O _ 4'-6" MP ON �. �.' /` , w; • DEPTH OF PERC - 25" 43"
0 2.0 ► �.: - ` sir' . - - ASSESSORS MAP 205 PARCEL 029
SLEEVED 1 3 - _ 0 �` 0 � ' ,•+ TEXTURAL CLASS: 1 17.
rn Q 1 0 _ PUMP 2" OWNER OF RECORD: ROBIN REISMAN
BALL CHECK VALVE SCH. 80 PVC 100 , '°.: '/`'
6.08 �� 6 P.S.I. FLCWMATIC MODEL No. 208S ��, ,, � � '"'�ti o,`�' ' �.� •s "' ? - M -+f 0 4.90' ADDRESS 4 ROCKY LEDGE ROAD
WESTON, MA 02193
GARAGE 1.0' 1.6' .�l'��:�.• �� ,... �+Y�- F
SLAB EL. =6.10' (BARNES ON36 g)CONTROL FLOATS 1/4 WEEP HOLE IN DISCHARGE PIPE
,r► EMA FLOOD ZONES A13,AO
2 SCH. 40 PVC DISCHARGE PIPE t. Fill AS SHOWN ON COMMUNITY PANEL# 250001 0016 D
\ 6 X s.3U 1: PUMP ON/OFF 120 ACTIVATION `--- j f ♦tea: �8 ' "� X
2: ALARM ACTIVATION I�UbI1C $eILC 18. PLAN REFERENCE:
\ f STONE RETAINING WALL BARNES SE411 PUMP A H.P. 115 V 2" "f x
1 ' DISCHARGE PASSING 1-1/2"SOLIDS OR >�' Landing 1. LAND COURT PLAN 16724 B
co X 5.8, S?r "
X 24 EQUAL r ';A-', . ;-'' �,-:°"" -.,,...._-•-''• �,.''`
l .r
24" 2.90'
\ 0 6.5 %DH 1000 GALLON PUMP CHAMBER 25"
FND LENGTH 8-6 WIDTH 4'-10"DEPTH 5'-7 �/ '' Perc. 19. DEED REFERENCE:
7 6.99 #195 :: , �'� 1. CERTIFICATE 136256
\� 6.47 ISTING 4-BDRM
NOT TO SCALE
DWELLING G / 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION_
o C M-C Sand 2.5Y 7/2 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE_ THIS PLAN IS TO BE USED ONLY
TOP OF FOUND. �j NiE FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
U FOR USES F THIS PLAN OTHER
.�� ,,....._.•.--'"'"�-'"-"�-"• � O S O ER THAN ITS INTENDED PURPOSE_
X_•�` EL_ VARIES ,�' o v r .
f -
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M 5 DOSING & STORAGE REQUIREMENTSf- _
.M 1� a DESIGN FLOW: 440 GPD 44„ Standing Water Observed 1.23'
c� At Time of High Tide
CB/DH DOSING REQUIRED: 4 CYCLE/DAY LOCUS PLAN Assume Seasonal High
INSTALL TWO TRENCHES OF 2�.,.. UND 3 lE` 1�1 440 GPD/4= 110 GAL/CYCLE
HIGH-CAPACITY INFILTRATORS �.4 ENCLOSED ONE PP1 SN�`) DISTANCE REQUIRED BETWEEN PUMP SCALE: 1"= 1000'
(ONE TRENCH WITH 6 UNITS, T PATI2LAB Fk.000 Z Pp�OEp ON AND PUMP OFF FLOATS: LEGEND
ONE TRENCH WITH 7 UNITS) v o w L.=12.5' p ZONE 110 GAUCYCLE = 250 GAUFT = .44 FT/CYCLE DESIGN DATA EXISTING CONTOUR
v :-4 (USE 0.6 TO PROVIDE FOR BACKFLOW)
o D c"' STORAGE REQUIRED ABOVE WORKING LEVEL:440 GAL_ 5O PROPOSED SPOT GRADES
E
z n� NUMBER OF BEDROOMS: 4
STORAGE PROVIDED ABOVE WORKING LEVEL: 600 GAL. DESIGN FLOW: 110 GPD/BDRM 72" -1.10' '
TOTAL DESIGN FLOW: 440 GPD (Maximum attainable depth PROPOSED CONTOUR
DISTRIBUTION BOX - ��
DESIGN FLOW X 200 % = 880 GPD due to excessive slumping
EXISTING WOODEN PLATFORM o /--LIMIT OF LAWN AREA
37.5 iv of saturated soil) EXISTING OVERHEAD UTILITIES
TO BE REMOVED 14.8' c"- -`-'-�- USE EXISTING 1500 GALLON SEPTIC TANK
13.0'
EXISTING WATERLINE
HAYBALE LINE 43.8'
0 0 �-LOOD ZONE AO(DEPTH V) BUOYANCY CALCULATIONS INSTALL THIRTEEN HIGH-CAPACITY INFILTRATORS GAS EXISTING GASLINE
coil" FLOOD ZONE V10 (EL. 17)
_ -- o TEST PIT LOCATION
HIGH GROUNDWATER EL.= 1.23 SEPTIC BOTTOM OF SEPTIC TANK EL. = -2.44' SYSTEM CAPACITY
_.. TANK WATER DISPLACED= (1.23'--2.44')x 5.66 x 10.5=218 C.F. (TOTAL LENGTH)(7.79 SF/LF)(.74 GPD/SQ.FT_)=GPD Q Q Q EXISTING 1500 GALLON SEPTIC TANK
WEIGHT OF DISPLACED WATER= 218 C.F. X 62.4 LB/C.F. = 13,600 LBS_ (37.5' +43.8')(7.79 SF/LF)(_74 GAL/SQ_FT.)= 469 GAL. LEACHING/DAY
BUFFER TO SPRING 100-FT_ WEIGHT OF H-10 1500 GAL. SEPTIC TANK= 12,000 LBS. PROPOSED 1000 GALLON PUMP CHAMBER
_
HIGH TIDE LINE SOIL COVER= (5.2 -3.1')x 5.66 x 10.5= 125 C.F.
r;
__. --- WEIGHT OF SOIL ABOVE TANK= 125 C.F. X 120 LB/C.F. = 15,000 LBS. 4"SOLID SCHEDULE 40 PVC PIPE
27,000 LBS. > 13,600 LBS. (ACCEPTABLE)
2"SOLID SCHEDULE 40 PVC PIPE
HIGH GROUNDWATER EL.= 1.23'
PUMP BOTTOM OF PUMP CHAMBER EL_ = -2.70' DISTRIBUTION BOX
---
--11 CHAMBER WATER DISPLACED= (1.23'--2.70')x 4.8 x 8.5 = 160 C.F.
WEIGHT OF DISPLACED WATER= 160 C.F. X 62.4 LB/C.F. =9,980 LBS. HIGH CAPACITY INFILTRATOR
75� WEIGHT OF H-10 1000 GAL. PUMP CHAMBER=8,300 LBS.
SOIL COVER= (5.2'-2.9')x 4.8 x 8.5 =93.8 C.F.
WEIGHT OF SOIL ABOVE CHAMBER= 93.8 C.F. X 120 LB/C.F_ = 11,260 LBS.
..rg_ 19,560 LBS. >9,980 LBS. (ACCEPTABLE)
REV. DATE BY APP'D. DESCRIPTION
_7_ - PROPOSED SEPTIC SYSTEM UPGRADE
$9 - = X 7.16
X 6.41
PREPARED FOR:
7- i
X7.71 X7.88 ROBIN REISMAN
X 7.76
LOCATED AT
NOTES: 1. THE SUBJECT PROPERTY IS LOCATED ENTIRELY WITHIN THE _
FOLLOWING RESOURCE AREAS: ,,.--SPRING HIGH TIDE LINE 195 LONG BEACH ROAD
-BARRIER BEACH
,;.. ._. __..
MA
-COASTAL DUNE
RESERVED FOR BOARD OF HEALTH USE
-PRIORITY HABITATS OF RARE SPECIES
-ESTIMATED HABITATS OF RARE WILDLIFE AND CERTIFIED WATER ELEVATION 0.2'AT 12:50 PM SCALE: 1 INCH = 20 FT. DATE: OCTOBER 21, 2003
VERNAL POOLS TIDAL CORRECTION TO LW=0.0'" 0 10 20 40 80 FEET
MEAN SPRING RANGE=3.7'* �,Fr+s"°` ;
2. THE SUBJECT PROPERTY IS LOCATED PARTIALLY WITHIN THE ---
_� JoHr,+ PREPARED BY:
FOLLOWING RESOURCE AREAS: MEAN SPRING HIGH TIDE EL_ =3.9'
("SOURCE: NOAA NATIONAL OCEAN r
c CHURCHILL
-FLOOD ZONE V10 EL 17 JR. JC ENGINEERING, INC.
-FLOOD ZONE AO (DEPTH V) � SERVICE CENTER FOR No 141B 7 t 2854 CRANBERRY HIGHWAY
-FLOOD ZONE Al (EL 11) OPERATIONAL OCEANOGRAPHIC
PRODUCTS AND SERVICES)
EAST WAREHAM, MA 02538
.. 508.273.0377
SITE PLAN
SCALE: 1"=20'
`�/` 3 Drawn B SJ Designed B SJ Checked B JLC JOB No.515
Y: 9 Y: Y�