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HomeMy WebLinkAbout0077 LUMBERT MILL ROAD - Health E Lumbert Mill Road terville P 168 017 O(R/ aoy i 7 0 i.` Y � Z w YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: ( - Z- 2-c� 3 Fill in please: APPLICANT'S YOUR NAME/S: c L R5': USINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number INN NAME OF CQRPO.RATIONa NAME OF NEW BUSINESS TYPE OF BUSINESS 'IS THIS A HOME OCCUPATION?` - 1 - Pit7AP PARCEL.NUMBER. �� [Assessing) .ADDRESS OF BIJSINE8S` �� - �� / _ ses When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &.Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COVAut 'S OFF E This individinfer a of an per it requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION d ignatur RULES AND REGULATIONS. FAILURE TO COMPLY MAY RESULT IN FINES_ MMEN 0 S 2. BOARD OF EALTH This individual has.been it f e�$�fpthewerLy ALL e �i nts at pe ain his ty f business. Alzur 'thonn ; .. .TI-,Nc; t5 MUST ,UfVil'LY'VVITH ALL COMMENTS: 3. CONSUMER AFFAIRS (LI ENSINrA AUTHORITY) This individual has b n info r d the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: iJ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rppricotiou for Dioont �§pgtem Congtructiou Permit Application for a Permit to Construct( ) Repair(slqr Upgrade Abandon( ) ❑Complete System Individual Components Location Address or of No. Owner's Name,Address,and Tel.No. -�7 �OM 17e2-- M /l P4. (f4?1&Vv filAtz G� 6Rv GGL-e//) Assessor's Map/Parcel _ Af Installer's NX Address,and Tel.No. e 20 6® Designer's Name,Address and Tel.No. GECQ-��U7 Type of Building: 1 Dwelling No.of Bedrooms Lot Size / L�� !�G 6 sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures f Design Flow(min.required) 3W gpd Design flow provided3 hj gpd Plan Date d /C !-�9 Number of sheets Revision Date 2 C)/U Title Size of Septic Tank L66 y Type of S.A.S. %C Ze?4� 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 ar Health. Signed �''-.�"' Date 1243/0 Application Approved by Date 2 a Application Disapproved by:U Date for the following reasons , Permit No. 2.o (d —o Ky Date Issued s oZ O No. .1 10 U Q v . Fee f�10 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Digo!goY *p5tem con'5truction permit Permission is hereby granted to L l/Construct ( ) Repair O Upgrade ( ) Abandon ( ) System located at �7`7 ino w Iz 4- ,M/ 11 f4,P/ <f—ellT y 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: Construction must be completed within three years of the date of this p' ermt Date �( 10 Approved by YIT V V O i�T' � I 1 � R No. 0 I{/ -Fee fid ` ' /I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: y/ � PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Zitpotal *pttem Couttructfou i3ermit Application for a Permit to Construct( ) Repair(A' Upgrade(114' Abandon( ) ❑Complete SystemZ Individual Components t• Location Address or of No. Owner's Name,Address,and Tel.No. r r -77 Lolr or f l /( ea. fyj4214--- 6R6 SSL--'i/U Assessor's Map/Parcel _ / —7 7 umb g t // Installer's Nam ,Address,and Tel.No. '21y 2--30�j 0 Designer's Name,Address and Tel.No. J f) / 12w ` oc ` Q �.4d�C��G ,n Type of Building: { Dwelling No.of Bedrooms Lot Size t�, (� © 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 _J�C // , 2 vG9 Number of sheets Revision Date r� •2 4/ 2 o/U Title i Size of Septic Tank 1660 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: + Agreement: �tP �`pG{ 3/1 t�l�`� (,pj 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 thisBod—rd-OA Health. Signed Date Application Approved by /1.J Date %a Application Disapproved by:U Date / for the following reasons i Permit No. 2 0 /d U Ko Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired X Upgraded ( ) Abandoned( )by _1 / 1�(,oQ//U at �7 7 (J/y/ v0, -� /�� l� Gte/Plj/ has been constructed in accordance with the provisions of Title 5 and the for-Disposal System Construction Permit No. )0 /0 -0 go dated 3 b //0 Installer ad, U���ID/C //V Designer #bedrooms � Approved design flown 73(o gpd The issuance oft is 7 ermit shall not be construed as a guarantee that the system will�fun i�. as design d. Date In�l Inspector 7 �. '1 ' F �UeV'S"o wkic� TRANS. NO.: Oq eb 2¢, 20l CITY/TOWN: bA(W9U1E (C-EMUILG6- APPLICANT: R it K G r Z1e-;vt I Ky reh Pll O y e r ADDRESS: 77 [-vhQEZT fAiLL OAD DESIGN FLOW: 330 CPO gpd REVIEWED BY: DATE: N/A OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] ✓ Street, Lot,tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u) Locus Provided[310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] ✓ Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] ✓ Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e) ✓ System Calculations [310 CMR 15.220(4)( ] daily flow ✓ septic tank capacity(required andprovided) ✓ soil abso , tion system (required andprovided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? 310 CMR 15.2421 Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address W CUQW R l t-L RO ', Sheet 1 of 7 r N/A OK NO Location of every water supply,public and private, [310 CMR J 15.220(4)(k)] within 400 feet of the proposed system location in the case / of surface water supplies and gravel packed public water supply V within 250 feet of the proposed system location in the case ✓ within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.21 l'and any catch basins located within 50 ft. 310 CMR 15.220(4)(1)] V Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system / components and the bottom of the SAS [310 CMR15.220(4)(o)] V Stamp of designer [310 CMR 15.220 1 and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as / approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? f 310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? ✓ [310 CMR 15.103(3) Benchmark within 50-75' of system 310 CMR 15.220 4 Materials specifications noted? [various sections of 310 CMR 15.0001 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) 310 CMR 15.405(1(b)] Mill n,� � f �-f,� Address -71 `U1�9(�00- Mi l f Sheet 2 of 7 .:r N/A OK NO Size OK? [310 CMR 15.223(l)] ✓ Inlet tee located ten inches below flow line [310 CMR 15.227(6)] ✓ Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] ✓ Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] ✓ Inlet/Outlet elevations at least 12" above high groundwater (except as described 310„CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 / CMR 15.232(3)(0] ✓ Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" y 7/07) [310 CMR 15.228(2)] ✓ Access to within 6 " of grade - one port for systems<1000gpd, / two for systems>1000 gpd 310 CMR 15..228(2)] V All at-grade covers secured to unauthorized access? [310 CIAR 15.228(2)] ✓ > 10 ft from building foundation [310 CMR 15.211(1)] ✓ Buoyancy calculation Required/Done [310 CMR 15.221(8)] ✓ H-20 Where appropriate? [310 CMR 15.226(3)] ✓ Setbacks r from resources [310 CMR 15.211] as r 1 � "�°UP P ' �� Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1) ] First compartment 200%daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and 3)] "U" pipe through or over baffle, outlet of each compartment with ✓ as baffle or approved filter 310 CMR 15.224(4)] Address7) Lj and er Y'� I PA. Sheet 3 of 7 N/A OK NO W.,Y kY A Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211 1 [1 ) Cleanouts required/provided ? [310 CMR 15.222(8)] ✓ Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] ✓ Slope of sewer line not less than 0.01 (1/8"/R) 0.02 preferable 310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) 310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon probleml (leachfield below pump chamber) V Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Stable compacted base [310 CMR 15.221(2) and 310 CMR J 15.232(2)(a)] V Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 / CMR 15.323(3)(a)] V Riser if deeper than 9" [310 CMR 15.232(3)(f)] VII Inside minimum dimension 12" [310 CMR 15.232(2)(b Minimum sum 6" [310 CMR15.232 3 (e)] ✓ Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PAP Y I Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5 Service components accessible(not too deep with piping, disconnects accessible) V, Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] t� Stable Compacted Base 310 CMR 15.221(2)] Buoyancy calculations needed? Provided? [310 CMR 15.221(8)] Address 7 LU Sheet 4 of 7 N/A OK NO se. Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] ✓ System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] ✓ Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and ✓ Guidance Document Mi Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2 Aggregate 1 minimum- 4'maximum. [310 CMR 15.253(1)(b) ✓ 2' sidewall credit maximum 310 CMR 15.253(1)(a)] ✓ In bed confi ation, inlet every 40 s . ft. [310 CMR 15.253(6)]UR R .w.dd eetiY'4ST.' t�sC ° ,S Width 2'minimum 3'maximum [310 CMR 15.251 1)(b) 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches 310 CMR 251(1)(d)] ✓ Situated along contours 310 CMR 15.251(2)] Breakout OK? 310 CMR 15.211 1 [4] and Guidance Document] BE` Sk minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] (/ Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only 310 CMR 15.252(2)(i)] � I q Address Vb�f t l i Sheet 5 of 7 y N/A OK NO � w O Pressure Dosed System ? Provided pump and piping / calculations as required [310 CMR 15.220(4)(r)] V Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals) If used in gravelless system -make sure jet is directed as not to scour soil interface Guidance Document ✓ Inspections once per year(systems<2000 gpd) or quarterly ( >2000 dgood to note on plan 310 CMR 15.254(2)(d)] ✓ Construction in fill -Did the plan specify that the fill shall meet the s ecificdtion of 310 CNIR 15.255 3 ? Impervious barrier and/or retaining wall ? Guidance Document] V Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer 310 CMR 15.255(2)(a)J Side slope not exceed 3:1 ? [310 CMR 15.255(2)] ✓ Breakout requirements met? [310 CMR 15.252(2) and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended [310 CMR 15.255 (2 e "A , e Check DEP Approval Rletters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface MINQ : Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? ✓ Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has a licant submitted a copX of a maintenance Are the variances listed on the plan ? [310 CMR 15.220 4 ✓Y ( ( RLS Stamp necessary on plan if a component is within five feet of property line 310 CMR 15.412(4 New construction or increased flow proposed- [Refer to 310 CMR 15.414 �7 L-*690 U�1�1 a"I rA Address � � Sheet 6 of 7 N/A OK NO itrog She ifive�irr tt .. - ,.. 11 Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such / existing systems] V Is the system proposed on the same lot as served by private well ? / [310 CMR 15.214(2)] t/ Are the nitrogen loads proposed in compliance? [310 CMR 15 216(1 Pumping to septic tank? 310 CMR 15.229] Shared System [310 CMR 15.290] AddresM b4mr' 'gyp` P u",,'N r� Sheet 7 of 7 Town of Barnstable P`0,*IKErqs�° Regulatory Services Thomas F. Geiler,Director • ► iexrtsr�Bt.e, '"'`�63 Public Health Division i9. ♦0 j0lfo Moy Thomas McKean,Director 200 Main Street,,Hyannis,MA 02601 a. Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: a Designer: DhVIO D� C0vGNPrwUw9 .,(,,5 Installer: �� � - Msn Address: 43 TpiAVGLL CjPCLV_ Address: `'75 �,* /4- ke�e, Q� On �f�• YW621 vu was issued a permit to install a (date) (installer) septic stem at '%7 o VA b e 11 Al 11 R P Y based on�a design drawn by (address) �gV�,,A (,,1Crh1A V)OW dated 0e6 2010 (designer) f � tfI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic-"system referenced above was installed witI major°chang(Es (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. DAVID D. stalle-r's Signature) COUGHANOWIR No. 1093 O OfSTERE At AR\N (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLICt-EALTH 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. TOWN OF BARNSTABLE LOCATION 7 L—V �°�' f SEWAGE# VILLAGE C 6W-1-t/ ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. t% p'l u SEPTIC TANK CAPACITY /6 6a LEACHING FACILITY-(type) /0 64,0 � (size) NO.OF BEDROOMS OWNER PERMIT DATE: • g — /Q COMPLIANCE DATE: v 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 42 -:�,5 No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplitation for Misposal Opstem Construction Permit Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location AdL_Urvldress or Lot N . 31 er s Name,Address,.an4 Tel.No. Assessor's Map/Parcel �� �iti�'� C,6?�-kE -v Installer's Name,Address,and Tel. o._ 75-0-"(p Designer's Name Address,and Tel.No..3Q9—3i�,4•Q sci 9 Type of Building: P� 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 "L` JZ X611ri Type of S.A.S. rri �d JrM Description of Soil Nature of Repairs or Alterations(Answer when applicable) -S(�s` (��'r.L} "T,qj e,`J �eack\ 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 Boar"f He th. a� S" Date Application Approved by &J. Date Application Disapproved by Date for the following reasons Permit No. 2 o i'9 -7 Date Issued 1.2 THE COMMONWEALTH OF MASSACHUSETTS C-CCK�SI'din BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by �1�, ��obr,Sc S4L P�{ Cr at -n L(,mbew`4 �ii t t ( PX\4e,V)1,1 e_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No• p P Y ��� "' �7 dated I Installer Designer #bedrooms , Approved design flow 3,? 0 d gP The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. 2U�� �a Fee iyD.— THE COMMONWEALTH OF MASSACHUSETTS c�S�ea N PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Bispo8AY 6pstem Construction i3Qrmit Permission is hereby granted to Construct( ) Repair(Y. nU,pgrade( ) Abandon( ) System located at `7'] {_ 1 ,"ff-\b t' ,k, Tw G� Cer\4fx �O e- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. p Date I-aT / �q Approved by I i/h/• IC j ►---^+.r r..-^►v ...... ... -N�- .. ` .. .�^A�c�.a,....a,......ti..r.-u�.���.+w� :a..^'`.-s..+.....,w'!�A-+.+-.-..r+ ,.... y.....,-*,-+F� .. V� f � �y�� •� ..,.c �x,��.n � Fee V No. / r THE COMMONWEALTH;'OF-MASSACHUSETTS Entered in computer: ,/ " PUBLlC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes rapplitat on for Misposai *pstem Construction Permit .a�a - Application for a Permit to Construct( ) Repair(,4 Upgrade-('') Abandon( ) '❑Complete System ❑Individual Components Loca,tio•n Address or Lot No Owner's Name,Address,and Tel.No.50 o� Assessor's,M1��'1�l I I II�.�Ej-�12-�!;1 k�1-7 �nl�� M.l le►1 �-n�C'V� i 1e.. Installer's Name,Address,and Tel.No.� -7�75�07�tn Designer's Name,Address,and Tel.No'S08-369-0$q 9 T ck)�Q15 5�4+L CCU'"TPA Type of Building- !� Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder VVq 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 E Size of Septic Tank 0 d _ Type of S.A.S. 0 p L J r Description of Soil l Nature of Repairs or Alterations(Answer when applicable) rnS4O , e rj Suss Aa soles � 4 E-v-c 'NO, 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 Boar"f He th. a� S'gned drj Date Application Approved by f/i�l. . D �S Date Application Disapproved by Date for the following reasons , Permit No. 2 D R j—�f -7 Date Issued ! --d -a THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by U)r"(\ at -1-7 LQM&__-4 �A r I 1 ZQ(4 A CP&\4f_f d► 2 5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.:�110 9- .2 7 dated -G 9 Installer Designer #bedrooms Approved design flow _2 d gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector TRANS. NO.: CITY/TOWN: C&-Vl. e(v IT 'L APPLICANT: Aark trots [e d'" ADDRESS: ?1 b vnhe✓- Obit( kbg 1t DESIGN FLOW: 3 3 D D gpd REVIEWED BY: DATE: �ec IZ r �60q N/A OK NO aF d y s s >� r « Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u) ✓ Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required 310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR ✓ 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)( ] ✓ daily flow septic tank capacity(required andprovided) soil absorption system (required andprovided) ✓ whether system designed for garbage grinder ✓ North arrow [310 CMR 15.220(4)(g)] ✓ Existing and ro osed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] ✓ Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.2421 Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] ✓ Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address 77 (t-L Zo A Sheet 1 of 7 � ' 7 N/A OK NO Location of every water supply,public and private, [310 CMR ✓ 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. 310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR ✓ 15.220(4) m (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system ✓ components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220 1 and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction / activities within 5 ft. of lot line) [310 CMR 15.220(3)] V Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.4 05(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3) Benchmark within 50-75' of system 310 CMR 15.220(4)( ) Materials specifications noted? [various sections of 310 CMR 15.0001 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405 1 )] Address -77 14 f LI- Sheet 2 of 7 G N/A OK NO .� SEIP'T f ��✓ Size OK? [310 CMR 15.223(1 Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR ✓ 15.227(6)] Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] Note regarding installation on stable compacted base [31.0 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2 Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9"must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 / CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] ✓ Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] `� > 10 ft from building foundation [310 CMR 15.211(1)] ✓ Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] ✓ h� Compa�xtmen Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1) b First compartment 200%daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and 3 ] "U" pipe through or over baffle, outlet of each compartment with / as baffle or approved filter [310 CMR 15.224(4)] ►/ Address -7 7 L u K�C P T R I L l_ DAD - Sheet 3 of 7 i N/A OK NO � � .RNN Located at least ten feet from any water line? [310 CMR / 15.222(2) V Disposal piping at least 18" below water line(when water and sewer cross, see 310 CMR 15.211 1 1 ) Cleanouts required/provided ? [310 CMR 15.222(8)] ✓ Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) 310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] ✓ Siphonproblem/(leachfield below pump chamber Endca s or vent manifoldspecified? ✓ Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232 3 e Watertight cover if<2000gpd); waterproof manhole if>2000gpd / [310 CMR 15.232(3)(d)] � OW i . ._. Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] ✓ Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] Stable Compacted Base 310 CMR 15.221(2)] ✓ Buoyancy calculations needed ? Provided? 310 CMR 15.221(8)] Address �7 L-O M&P-1 t Q L L , 1`Q ft g Sheet 4 of 7 N/A OK NO 01, Calculations correct? ✓ 4 feet of naturally occurring material demonstrated? [310 CMR / 15.240(1)] V Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or ✓ >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.21.1(1)[4] and Guidance Document]Ak"I `� xc U?�,-"v_,. •,. .. ... aao.�n . 1z, a 'L I Chambers and Gal. in trench configuration supplied with inlet / every 20 ft. 310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must / be to grade) 310 CMR 15.253(2)] Aggregate 1'minimum- 4'maximum. [310 CMR 15.253 1 )] ✓ 2' sidewall credit maximum[310 CMR 15.253(1)(a)] ✓ In bed confi ation, inlet evM 40 s . ft. [310 CMR 15.253(6)] TWIL Width 2'minimum 3'maximum [310 CMR 15.251(1)(b) 100 feet - maximum length [310 CMR 15.251(1)(a) ✓ Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251 1)(d)] ✓ Situated along contours 310 CMR 15.251(2)] ✓ Breakout OK? 310 CMR 15.211(1)[41 and Guidance Document] ✓ minimum 2 distribution lines 310 CMR 15.252(2)(a)] ✓ Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] ✓ Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)( )] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] ✓ Bottom area used in calculations only 310 CMR 15.252(2)(i)] Address L U yh 6 e f} 0 61'( Sheet 5 of 7 N/A OK NO Y _ _ Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] w Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] ] If used in avelless system-make sure 'et is directed as not to � Y J scour soil interface Guidance Document Inspections once per year(systems<2000 gpd) or quarterly (>2000 dgood to note on plan 310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3). Impervious barrier and/or retaining wall ? Guidance Document ✓ Impervious barrier installation must be supervised by / designer [310 CMR 15.255(2)(b)] ✓ Retaining wall must be designed by Registered Professional ✓ Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] ✓ Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] ✓ At least 5 ft. from impervious barrier to edge of SAS (10 ft. y recommended .[310 CMR 15.255 2 (e Check DEP Approval letters for credits and design conditions ,/ If used with pressure dosing do not allow pressure discharge to scour soil interface V, Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? ✓ Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has licant submitted a co of a maintenance x:;.... IR Are the variances listed on the plan? [310 CMR 15.220 (4)( RLS Stamp necessary on plan if a component is within five e 310 CMR 15.412 4 feet of property line [ ( ] New construction or increased flow proposed- [R efer to 310 CMR 15.414] Address Lv MC--R-r �ktLL V0 A'Q Sheet 6 of 7 N/A OK NO 4 AY l i1r� e� �5` iitrv; ,artWNW .: f. Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such / existing systems] V/ Is the system proposed on the same lot as served by private well ? / [310 CNM 15.214(2 V Are the nitrogen loads proposed in compliance? [310 CMR / 15.216(l)]7MA am V , . Pumping to septic tank? 310 CMR 15.229] Shared System [310 CMR 15.290 Address--? 7 L V tAbef Sheet 7 of 7 Town of Barnstable P# 7 7-2— Department of Regulatory Services Public Health Division Date ��G 1, zdd y � 16391. �� 200 Main Street,Hyannis MA 02601 �fD tAld� Date Scheduled C Time�o en Fee Pd. �I d r 1 { Soil Suitability Assessment for Sewage Pisposal Performed B 1 1 - Y� ._ _ .. Witnessed By: �s -LOCATION�& GENERAL INFORMATION Location Address .� L c�v►q�Pf t �l' Qa q. Owner's Name Vl q ri( 6POYS Ie'rb cell t of irl 4(p 77 Z�►0 0,pr-i IM�Il1 R9 Address cots fir v l Ile Assessor's Map/Parcel: 16� i'7 Engineer's Name �g✓�1� Q �Blt1El�D�r NEW CONSTRUCTION REPAIR Telephone# Land Use /�eh t! Slopes(%) Surface Stones 1A°we Distances from: Open Water Body (0 0 ft Possible Wet Area 00 ft Drinking Water Well to t ft Drainage Way so � ft Property Line �O f ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) WERT M1►- "°ma GROUNDWATER ADJUSTMENT P EXISTING GROUNDWATER _ BASED ON TOWN OF BARNSTABLE �-- GIS DEPARTMENT RECORDS. \\ INDICATED GW 15.00 INDEX WELL SDW-252 ZONE B READING DATE DEC. 2007 \ % READING 22.2 a " /0, ADJUSTMENT 1.2 ADJUSTED GW 17.2 se 5t22 Parent material(geologic) 4G-1 l �J' Depth to Bedrock fL&'K Depth to Groundwater. Standing Water in Hole: �) Weeping from Pit Face �fJ fL Estimated Seasonal High Groundwater 'Gee el"y e v e DETERMINATION FOR SEASONAL HIGH WATER TABLE' Method Used: 52� 4 oV — Depth Observed standing in obs.hole: __— in. Depth to soil mottles: in. " Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: index Well level a Adl.factor Adj.Groundwater 1 evei PERCOLATION TEST hate' 1101 Thne I.a k Observation ` / Hole# r I Time at 9" � Depth of Perc v®t ji Time at 6" Start Pre-soak Time @ LQ`6 Time(9"•6") End Pre-soak Rate Min./Inch 2,kp l Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTICU'ERCFORM.DOC SOIL TEST LOG DATE TEST: D R 11. 2008 SOIL EVALUATOR: DAVID AVID D.D. COUGHANOWR. R.S. WITNESSED BY: DAVID STANTON. HEALTH DEPT. PERC NUMBER: 12792 NO TEST PIT I PAARENTUNDWATER MATERIAL: PROGLACA LED OUTWASH PERC AT 60 in — 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 41.65 0-3 0 WOOD LOAM 10 YR 4/2 NONE FRIABLE 3-5 E LOAMY SAND 10 YR 4/1 NONE FRIABLE 5-10 A LOAMY SAND 10 YR 4/6 NONE FRIABLE 36.65 10-36 B LOAMY SAND 10 YR 5/6 NONE LOOSE 36-144 C. MEDIUM SAND 10 YR 6/3 NONE LOOSE { 29.65 NO TEST PIT 2 PAARENTUNDWATE MAATERIA ENCOUNTE PROGLACA LED OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 41.75 0-4 0 WOOD LOAM 10 YR 3/2 NONE FRIABLE 4-6 E LOAMY SAND 10 YR 5/1 NONE FRIABLE 6-10 A LOAMY SAND 10 YR 4/6 NONE FRIABLE 33.75 10-36 B LOAMY SAND 10 YR 5/8 NONE LOOSE 36-136 C MEDIUM SAND 10 YR 6/3 NONE LOOSE 30.25 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) .(USDA) (Munsell) Mottling (Structure,Stones,Boulders. C psi to Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other . Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. consistency, Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes, Within too year flood boundary No, Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on u®d N S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consist en 1N OF the required training,expertise and experience described in 310 CMR 15.017. LE � o? . °yo S �� DAVID� Signature " , Date U D. COUGHANOWR `r0 elCENSE� Q- Q:LSEPTIMERCFORM.DOC ALVP�O FV Health Complaints 04-May-06 Time: 12:15:00 AM Date: 4/19/2006 Complaint Number: 18760 Referred To: DAVID STANTON Taken By: ELLEN WADLINGTON Complaint Type: CHAPTER II HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: Number: :7,-Z Street: LUMBERT MILL ROAD Village: e-eh 11�. Assessors Map_Parcel: +�v� Complaint Description: STATES 2 STORY HOUSE, ARE OPERATING A PAINTING BUSINESS OUT OF HOME; THERE ARE LOTS OF TRUCKS GOING IN AND OUT IN THE AM AND PM. THEY LOAD LADDERS (STEEL); SO NOISY HE HAD TO MOVE HIS BEDROOM. STATED DONNA MORANDI HAD BEEN OUT AND TALKED WITH THE NEIGHBORS WHO MOVED TRUCKS, BUT WHEN DONNA LEFT THEY RESUMED AGAIN AND PUT UP A FENCE. Actions Taken/Results: Previous inpsection-see file-indicatesd they are roofers-not painters. Jack Fitzgerald snd DZM were on site. If they are painting out of this house then it is truly a zoning complaint. The problem house indicated by complainant is #39. Mr. Kelly is a nice old man who is trying to sell his house and the realtor has told him he won't get his price due to the present condition of this house. DS WENT TO SAID LOCATION. DS WENT TO THE WRONG HOUSE ACCORDING TO THE ABOVE NOTES, DS ASSUMED THAT THE "2 STORY 1 i Health Complaints 04-May-06 HOUSE"WAS NUMBER 77 LUMBERT MILL, NOT#39. ANYWAYS, #77 IS A VERY CLEAN WELL MAINTAINED HOME, WITHOUT ANY VIOLATIONS OBSERVED. AS STATED BY DZM, IF IT IS A BUSINESS COMPLAINT IT IS ZONING ISSUE, IF IT IS A NOISE COMPLAINT, IT IS A POLICE ISSUE, IF IT IS A MOTOR VEHICLE VIOLATION, IT IS A POLICE ISSUE, NOT A HEALTH ISSUE. NO FURTHER ACTION REQUIRED. Investigation Date: 5/4/2006 Investigation Time: 2:02:00 PM 2 TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 1 A COMMONWEALTH OF MASSACHUSETI'S EXECLITIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMEN'I' OF ENVIRONMENTAL, PROTECTION 'I'l'l'LE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMEN'1'S SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A RECEIVED CERTIFICATION Property Address 77 Lumbert Mill Rd. MAR 1 2 2003 Centerville,MA Owner's Name: Tony Carter I flTowr, ;ABLE Owner's Addres,: 77 Lumbret Mill Rd. 1. --PT. Centerville,MA 02632 qMAP Date of inspection: March 4,2003 ® Name of Inspector: Troy M.Williams Company Name: Troy Williams Septic Inspections PARCEL D , Mailing Address: 19 Hummel Drive LOT 5 Telephone Number: South Dennis,MA 02660 .... —may (508)385-1300 CERTIFICATION STAI'EMEN'1' 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. 1 am a DEP appro-ed system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sv tem Passes Conditionall.v 111sws Needs further Evaluation by the Local Approving Authori1) Fails Inspector's Signature. -S� Date: 3 /111o3 The system inspector shall submit-a copy of this inspection report to the Approving Authority(Board of I lealth or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This Inspection represents the conditions of the system on the Date of Inspection noted above. ****This report only describes conditions at the time of inspection and under the conditions of use wa(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 pace 1 of 11 Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Lumbert Mill Rd. Owner: Centerville,MA Date of Inspection:Tony Carter March 4,2003 Inspection Summary: Chee* 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 CN4R 1 T.303 or ui 310 C MR 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"ConZrmined" ss"section need t e replaced or repaired. The system, upon completion of the replacement or repved by the Bo d of Health,will pass. Answer yes. no��r not determined(Y,N,ND)in the for the fatem us. If"not determined"please explain.The septic tank is metal and over 20 years old* or the septiether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or t ank faiinent. Svstem will pass inspection if the existing tank is replaced with a complying septic tank asapproveard of Health. •A metal septic tank will pass inspection if it is structurally s nd,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availabl . ND explain: Observation of sewage backup or br out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,se d 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 tern required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass ins tion if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page3ofII OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 Lumbert Mill Rd. Owner: Centerville,MA Date of fnsfrectiou: Tony Carter March 4;2003 C. Further Evaluation is Required by the Board of Health: Conditions exist whibh 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. SYstettt „ill pass unless Board of Health determines in accordance with 310 CMR 15.303(1) )that the system is not functioning in a manner which will protect public health,safety and the en onment: _ 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 m sh 2. System will fail unless the Board of Health (and Public Wate upplier,if any)determines that the system is functioning in a manner that protects the public he ,safety and environment: __ The system has a septic tank and soil absorption tem (SAS)and the SAS is within 100 feet of surface �N ater supple or tributary to a surface water pply. __. The system has aseptic tank and SAS d.the SAS is within a Zone I ofa public water supply. The SN stem has a septic tank an AS and the SAS is within 50 feet of a private water supply well. The system has a septic t' 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 pass if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and vo tle organic compounds indicates that the well is flee from pollution from that facility and the present ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure c ' eria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 Lumbert Mill Rd. Centerville,MA Owner: Tony Carter Date of Inspection: March 4,2003 D. System Failure Criteria Applicable to all systems: You must indicate"yes"or lino"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 t19 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than''%,day flow _,L Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of tunes 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. NL, Any portion of a cesspool or privy is within a "Zone 1 of a public well. gLj Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Aq4 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.i Np (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CNIR 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 d ign 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 Grit is above) yes no — _ the system is within 400 feet of a surface drink g water supply the system is within 200 feet of a tribu to a surface drinking water supply _ — the system is located in a nitro sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water su y well if you have answered"yes"to question in Section E the system is considered a significant threat,or answered "yes"in Section D above th arge system has failed.The owner or operator of any large system considered a significant threat under tion E or failed tinder Section D shall upgrade the system in accordance with 310 CMR 15.304.The system er should contact the appropriate regions office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 77 Lumbert Mill Rd. Owner: Centerville,MA Date of Inspection: Tony Carter March 4;2003 u Check if the following have been done. You trust indicate'yes"or"no"as to each of the following: Yes No I,inu information was provided by the owner. occupant,or Board of I l aIll, __. ✓ 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? Niq 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)) eY :y: Page 6 of 1 I OFFICIAL INSPECTION.FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 77 Lumbert Mill Rd. Owner: Centerville,M.A Date of inspection: Tony Carter March 4,2003 FLOW CONDITIONS RESIDENTIAL " Number of bedrooms(desigp)II 3 Number of bedrooms(actual): 2 } l DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 3 3 o Number of current residents: It Does residence have a garbage grinder(yes or no): niu Is laundry on a srliarate sewage system (yes or no): (if yes separate inspection required) Laundry system inspected(yes or no):Av/- /VO Seasonal use: (yes or no):^/o Water meter readings, if available(last 2 years usage(gpd)):p a- yg,d,� o r = y , Sump pump(yes or no): iyo —�—� y Last date of occupancy: 4 ,i COMM ERCIAL/INDUSTRIA L 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 no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): Al�� If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: — TYPE OF SYSTEM ,/Septic tank,disw4butien WK,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: oe Were sewage odors detected when arriving at the site(yes or no):No Y 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Lumbert Mill Rd. Owner: Centerville,MA Date of Inspection: Tony Carter March 4;2003 'u BUILDING SEWER(locate on site plan) Depth belu�� grade: /8 Materials of construction: ,/cast iron _40 PVC mother(explain): Fl, 1,41— 6-� � i Dkianc:• from, private water supply well or suction line: ,�/A p't Comments(on condition of joints, venting, evidence of leakage,etc.): _.�LLuS�t,a �.�<. f tr-�, .A 7`Lu....1 G-/� --`-=__�`�J-=i' c�`r`^ ✓- "/5 T G y;� o ....� %�v►✓l`(� FI SEPTIC TANK: ;/(locate on site plan) Depth below grade: Material of construction: ✓concrete_metal__fiberglass_polyethylene —other(explain) If ficate)is metal list age: _ Is age confirmed by a Certi certirti fificate of Compliance(yes or no):—(attach a copy of Dimensions: `k Sludge depth: _ Distance from top of sludge to bottom of outlet tee or baffle: A ' 7 Scum thickness: -T A;,, /4 �— Distance from top of scum to top of outlet tee or baftic: 6 "_ Distance from bottom of scum to bottom of outlet tee or baffle: Ilow were dimensions determined: P.yb- Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:,concrete_metal__fiberglass_poly ylene_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 r baffle: Date of last pumping: Comments(on pumping recommendations,in and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of le e,etc.): �t4 . 7 Page 8 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Lumbert Mill Rd. Owner: Centerville,MA Date of Inspection:Tony Carter March 4,2003 TIGHT or HOLDING TAk: (tank must be pumped at time of inspe ton)(locate on site plan) Depth below grade: Material of construction: concrete metal_—__fiberglass olyethylene other(explain): Dimensions: _ Capacity: gallons Design Flu% —gallons/day Alarm present(yes or no): Alarm level:— Alarm in working or (yes or no): Date of last pumping: Comments(condition of alarm and fl t switches, etc.): DISTRIBUTION BOX: (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, an evidence of leaks a into or out of box, etc.): y 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 pumps and appurtenances,etc.): 8 its„ P P' Y Page 9 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Lutribert Mill Rd. Owner: Centerville,MA Date of Inspection: Tony Carter March 4;2003 SOIL ABSORPTION SYSTEM(SAS):-Z(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: p. leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: _ overflow cesspool,number: innovative/alternative system Type/name of teclurology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): l O� � c.J u..�----•�-cam ,n c.�t__�h / W ram-S�'b y h c Q �/� n. y ��o./` �nJ iw +-c r y�v-c.-S<r. yL ca..i- l^J. W u-It S �Jh� !l'..t/t-c.�✓� CJ�bOl/'�— .S�. l.) �.-c --_�I61110 ��1.�✓ 77v CESSPOOLS: _(cesspool must be pumped as part of inspection)(1 to on site plan) Number and configuration: Depth--top of liquid to inlet invert: - Depth of solids layer: _ Depth of scum lay er: —---- Dimensions of cct�spool: — --- Materials of construction: Indication of groundwater inflow(yes or n Comments(note condition of soil,sign f 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 ure, level of ponding,condition of vegetation,etc.): . 4$a we 9 Page 10 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Lumbert Mill Rd. Centerville,MA Owner: Tony Carter Date of lnspectiun: March 4,2003 !r u 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. 23 32,6 „ IR Page 11 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Lumbert Mill Rd. Owner: Centerville,MA Date of Inspection: Tony Carter March 4,2003 SITE EXAM �. Slope ✓ Surface water Check cellar ✓ Shallow wells Estimated depth to ground water _3Z.3 feet , Adjusted high ground water elevation�s feel Please indicate(check)all methods used to determine the high ground %cater 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: �J�s __ Checked with local excavators, installers-(attach documentation) V w ,( Accessed USGS database-explain: �,;, L—) ;7 z n,� ��_2•y l d You must describe how you established the high ground hater elevation: 1— . '7 ' �, h t ,,. 5 �( 4- This report has been prepared and the system inspected as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied, relating to the system,the inspection and/or this report. 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL DEPARTMENT OF ENVIRONMENTAL ONE WINTER STREET,BOSTON MA 02108 (617) 2 - ,,N WILLLAM F.WELD �C7 Ir` Ut 0 KE Governor T 8 Y C0 Secretary ARGEO PAUL CELLUCCI 4199 Lt. Governor J D . STRL n omnussione: J�� f B � f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 8 PART A CERTIFICATION Property Address: Lu vn14t, V- Vn Q.A,(n ,�kk� Address of Owner: VILA k tv, W. CX w.u.-(9 Date of Inspection: k b4\c, (If different) Name of Inspector: dress a,, il Com an Name Address an �ko�qwn�ee_NA_9e A _t-%L ���>rtet•�Nv Q.o.�xa y , '1�fw �Ar , 02tayi scrb CERTIFICATION STATEMENT t ritZ- 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: Passes _ Conditionally Passes Needs Further Evaluation By the Lo I Ap vi g uth 'ty F 'Is Inspector's Signatur Date: ,1 `�� The System Inspector shall submit a copy of this inspection to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 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, 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 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A # CERTIFICATION (continued) Prope y"Address: l �_ Ow er Date of Inspe tiiann� B]SYSTEM CON DITIONALLY)TASSESc(continued) tE^! Sewage backuI3,o breakout or high static water level observed in the distri tion box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system ill pass inspection if(with approval of the Board of,Health):'� broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more.than four times a year due to roken 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 pf Health in order to determine if the system is failing to protec 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 SA AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surfac water Cesspool or privy is within 50 feet of a bor ring vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF H TH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES TH THE SYSTEM IS FUNCTIONING IN A MANNER HAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and so' absorption system and is within 100 feet to a surface water supply or tributary to surface water supply. The system has a septic tank and oil absorption system and is within a Zone I of a public water supply well. The system has a septic tank an soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank a d soil absorption system and is less than 100 feet but 50 feet or more from a private supply well, unless a well w er analysis for coliform bacteria and volatile organic compounds indicates that the well free from pollution from tha facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less th., ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DI SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as efined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to etermine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overload or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surfac waters due to an overloaded or clogged SAS or f cesspool. Static liquid level in the distribution box above outlet invert due an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or availa a volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT ue to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 fee of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zo e I of a public well. Any portion of a cesspool or privy is within 5 feet of a private water supply well. Any portion of a cesspool or privy is less an 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the ell has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic com ounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large sys ms in addition to the criteria above: The system serves a facility with a d sign flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the e ironment because one or m re of the following conditions exist: the system is within �t'0 feet of a surface drinking water supply PP Y 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 11/03/95) 3 - 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 6 CHECKLIST Property dress: 17 L��n10e+LVY11\l Owner: 1\22,`Cti I Date of Inspection: t 1ZZ1 q, Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. . None of the system components have been pumped for at least two weeks and the system has been receiving normal flow ra: during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. WAs built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. l�The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles c tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of �t:: Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: LVWt�pe*—I-V Owner: t:bucv..acl Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: allons Number of bedrooms: Number of current residents: O Garbage grinder(yes or no): l�c� Laundry connected to system (yes or no): �-CS Seasonal use (yes or no): ►.>cj Water meter readings, if available: Last date of occupancy:G"Ww's���1�� COMMERCIAUI NDUSTRIAL: Type of establishment: Design flow: eallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informatio Stack �Y. di'S No-i t�c�_,R? F t N Syst�e r -pumped as part of inspection: (yes or no)� If yes, volume pumped: eallons 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) Other (explain) 7V -+ ( Sb CP C APPROXIMATE AGE of all components, date installed (if known) and source of information: 't -ZLfJ u y-S Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:Owner: 73 L Pt4%1vtC VA �v�bra� -, Date of Inspection: 1,"r',\,'- SEPTIC TANK:ws (locate on site plan) Depth below grade: Ar 611P;i;,�� Material of construction: concrete _metal _FRP—other(explain) Dimensions:) Q 19A Sludge depth: a lA Distance from top of sludge to bottom of outlet tee or baffle: 1 o t i Scum thickness:_G1 11 Distance from top of scum to top of outlet tee or baffle: 10�r Distance from bottom of scum to bottom of outlet tee or baffle:- k Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet i Vert, structural integrity, evidence of leakage, etc.) , 6v tv GREASE TRAP:_�J(D (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: / TIGHT OR HOLDING TANK:_ / (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: t allons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: % Comments: (note if level and distribution is equal, evidence solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �`` II SYSTEM INFORMATION (continued) Property Address: Owner: DtAQ0 Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_}--G3 (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: (,x (.,`b, leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: omments note condition of soil, signs of hydraulic failure, level of ponding, ondition of vegetation,etc.) VL Ve.c CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:( (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.) _ Uev;sed 11;C3i 95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Property Address: 711 L-",�'= �� l i SYSTEM INFORMATION (continued) Owner: fNlOv,�D Date of Inspection: i`ZZI SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' QCu.rL�. ` I 3Q•- DEPTH TO GROUNDWATER Depth to groundwater: ± 14 feet method of determination or approximation: O ' lf.�a.1'S-•t FLT S c Caw TO plS S�n Iy< — T (revised 11/03/95) 9 T0 vVN OF BARNSTABT j1 It Lt7.ATION SEWAGE # VILY:AGE a L9 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 Z (01 ryk? L LpS&- p I _ Q� MAIN FLOGR EXISTING I �i of � y t i t 9 r r t t LOV�fF� Vl� EXI-ST9 SIG c r" Via. 24 O.C. ATTIC TRU ' ---' --( F_ ATT.AG''{t C' :`P P.- l �4'/- - — - :;. 1 . �va...w... ..ate._.,-.,......�,.- ,.-.- ,.r��:.,r..ua...•,.. A- __ 50 FIr"ZE'C,,DE_ DRYWA'..L1,....�:.. I 4 CONCRETE SLAP.— , I 1 A POURtC CONGREII Ij f 4DS Z-y,. _ � N I PULL I [:ON ATTIC — ' '•N i - STAI f,S .___..._-.. .. -. ........ _ _..--._.__. _-----___. .._ ._ .... i 1 I. ! I i "1. I I i. i i 2X6@ M r-J FL NkILI�.h Q +vIRGMV/�K- r -I fRVSS CLI/s'. 142.5A Tlvt) 1b wa41 pcA76S �I - 1 C1 —' N2,5A' wAK PLATGS sn+u5 O 5�^¢ ,}ucihM. 6aLIS AT 4' o•c. I a � 4 Oo-6-5 24c si"' F { 3z3x��ia PLh7E wrsNcaS• pU1•s05 1 I �• _ i _ � Ir �►{ws-sns as (ipvs-sosz-s �� ( 3•z vi �Z L�Ya0.s %z pLY °7 M i *I GAcuG 6"Cb?a. MOR. • .n, —,�,,_, �` _ 1 2 JACKS 2"C-S 21Atxs ! I -- - AN - OF i I ..._ l \ 7 0R,. "A• AI1,. =1.=0 77 LUM_6ERT MILL H.U.ra.�) 0ENTER,ViLLE MA a . G C� Ar � �`� �� "17 f{- - FANEL I I{ TILS 1, ILL STCRAGO i , I C' A/r DOWN 1MA�. .�� '�• L -4c HEADERS 22X6 ------- .._ •_._.__---. .__. .---- _....___-__ •.r .:� F.i�VR P,�:LFCs_-"f SCHEDULE ._... �DULE I _ { • I -u,, _ i.;. IAA,. I,.`. 2?.4:a'IC .DEL,HU NC JJ I I j C U ` N I{ 3� i 4.5-2. � r _ — _ _ __.... :y _�,:''_....-,-x._-.�.c.:. - - - A DT'Ht Y}tiT70�Y 4 c — ~ TAT r---µ 11 .. L ARE EX STINU. I 2X.4 WALLS 11TH P 7, Sf L`' 11 vi. EX._ _ 3ED—L d ' I _. i LGL1�'r. L `IrL FZF ,[i ~LE VAT1:(D `W'iNCOVJS — - — — HEAf?ER c 2-2XG w/CEN TER GUPPQR? _.. "R 3-G ,INSUL EXISTING' TRUSS ROOF - ,/° _ _ I - _+ ._ EXIST'NG' DECK r I LIVING I, r Py . tl ❑ ,• ,� � _� 3 ' if ;I:S..�: ALL N+ _ � R II CR. ELT';Lr I I I.I A: L : � I I. f Lj } 1 , i 1 i i >•�tAS I n BAT I I D fvlN',. ;i' � ;.i 14 "- - }i CLOSE IN DR!' V:E UNNIZE,R CAR AGE� _rl } ILC 'Hij _ _ ,, h s � NC ' _ r �• I , { PW �_—__ ALL ALi ERA 1G:nI N THfN XT'iN F7GTFRlNT C d j _ u � cT rv,l�_ �Ac TO -A L NUMALc" .:) B DRGC. !.S- /6ATHROOM; G � 1+ - C _ ..... - _ e MCG �14 a L�:�: ri6�A'' :;..:.. ewwN T..4 ----- ._.....-_._. ..:-_,._..__--- - PROPOSED. flL.iEPtA71Qti r NOTE.• THERE WAS A TAKING d OF LAND (LOT 15) LOT 13 OF 3600 SQ.FT.± BY THE TOWN. RECORDED IN _ PLAN BOOK 210 PAGE 73. a �0' ;� 3N Feet 7 LOT 14 °5r' �.�' LOCUS MAP PLAN REF.- L.C.P. 31043—A -yam 8 �O CERT REF 168804 4MAP-�t�, ASSESSOR'S MAP- 168—017 2 8. ZONING: "RC" �o "� SETBACKS. 20' — 10' - 10' FLOOD ZONE.• C PANEL NUMBER. 250001 0016 D DATED. 0710211992 = 15.4ft ..................... ................ .............. PROPOSED *'12.4ft PLOT PLAN OF LAND GARAGE LOCATED AT 0 ,► "'''�. 77 L UMBERT MILL ROAD \ 9 '(H Or 11g5'S q ?LOT 15 \\ N o��a�tiG :TcRFo°tip' CENTER VILLE,, MA ' CB (off ) ASSESSOR'S MAP- 168-017 � � � � STEPHEN N � 14663.7 SQ. FT. V CO''L v v LOT 40 S 0.3 ACRES �- r 2° LOT 16 ® `C)Fz S% oQ PREPARED FOR- s,�� 61.2ft N ���y'�° MARK GROSSLEIN CB (OFF) JANUARY 27, 2009 � 67.°�>, REV REV LOT 47 REV YANKEE LAND SURVEY LOT 42 Co., INC. GRAPHIC SCALE so o is 30 so 40 INDUSTRY ROAD MARSTONS MILLS, MA 02648 LOT 46 TM 508-428-0055 FAX 508-420-5553 1 inch = 30 ft. SHEET 1 OF 1 JOB ,#• 54474 SH CENTERVILLE. MA NOTES CONTOURS <�,� LEACH PIT LOCATION FROM AS BUILT n � EXISTING - - - - - - - 50 CARD OF 1122197. EXISTING LEACH PIT IS / \ MINIMAL GRADING PROPOSED �, �'r<< N TO BE PUMPED. COLLAPSED AND FILLED. m a LOCUS .pogo li �rn no ENT E. \ O=W + / \ / --A I~-Q Jc 4 m /mJ� P Ln / \ 46 / O� > - �'° �� LOCUS MAP m(L <� GARBAGE GRINDER \`/ NOT TO SCALE 00�2 m ow IS NOT ALLOWED �3 �- w m << WITH THIS DESIGN. / Z� \Z o o` m w w o / P5 r \\ o� �o� < L7� > �j �� r \ \ Ufa LEGEND f� <conzW U3 = W W o 7c� / / O��L ♦♦� / EXISTING w W} U —i J u� o / �`� 1000 GALLON z J� ,, �� _j O < N <_ / / '9� �' SEPTIC TANK p <cn ,max 0_p Z / / \ ♦ \O—p "Z '� "' w < w O 44 / \ ♦ EXISTING LEACH \ \ O PIT/CESSPOOL • CD <o m o Pow/ E Q �i�S� �J� UTILITY POLE$ DRAIN 19 Ow< \` >e z J� m P�0// �0��� O � O� /� �I� ♦♦ TEST PIT D-BOX ❑ LU Ld w0 Ow Z Q m m `� m BENCH MARK �� �'� 0 ® DECIDUOUS CONIFEROUS TREE q9p TREE e0~O �� m m '" TOP OF CONC BOUND / � "9 ��� Q % deb Iz-M Iz-P W Z T L"LL 0 m n ELEVATION = 41.25 42 x� / Q t- U ff O BARNSTABLE GIS DATUM \ REFERS TO s9C'-NUMBER DIAMETERIN WZ INCHES. LETTER DENOTES TYPE. w - Z w W TP-2 O-OAK M-MAPLE P-PINE C-CEDAR0-LL Ow H OF MgS ZH OF U? c Mgss9c O U z / F �� o� DAVID tiG o�' DAVID tiG o ~ U m O C� SS / D. `�� �� D. J~ O W= 41 \ \ �, �O 44 COUGHANOWR N "; COUGHANOWR WO ~ Z� i m ,, O \�` / No. 1093 W� Lo 03 + z amo �+ ♦♦ IS-O \ / �FG ��O s0 ��cENSE0 �W j 0 N 4007 ! - w Sq IITTO PN ,� FVA uP�o _� 0 e w 4\ Cl L�C ew w 24 FL x 12.5 Ft x2 ft ♦ I8_o /0,0 ` L ma LEACHING GALLERY ♦ /,ti°' �e� ( � 'ZOO w J z s`J�' \ { \ 4z ®� �� SEWAGE DISPOSAL SYSTEM PLAN H J Z J `Z \♦ / �� �� -TO SERVE EXISTING DWELLING LL o o 0 m U 38 \ \ \ �41 EST. MARK GROSSLEIN & KAREN MOYER O Z o w (f) \ e / OWNERS OF RECORD m II WE) n �♦ 38 SHED —r40 77 LUMBERT MILL ROAD o + � � \\ ��® 1995 ��� CENTERVILLE. MA 0 ` I / �ON PROPERTY ADDRESS 3 FLAN �� e; LOT 15 % 43 TRIANGLE CIRCLE AssEssoRs MAP 168 PARCEL 1� c, z tea♦ AREA = 14664 of +- / SANDWICH MA 02563 LAND COURT PLAN 31843-A 0 0 " z SCALE. 1 in = 20 Ff- \ / 5�8 364-�8J4 � N DArE: DECEMBER 11. 2009rt x w w 20 D 20 40 �' �� / JOB #E T E-3 2 8 8 PAGE 1 OF 2 VERSION: THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED 0 10 20 `�` SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS: OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. E SOIL TEST LOG DATE OF TEST: DR 11. 2009 DESIGN CALCULATIONS SOIL EVALUATOR: DAVID AVID D.D. COUGHANOWR. R.S. WITNESSED BY: DAVID STANTON, HEALTH DEPT. PERC NUMBER: 12792 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD TEST PIT NO GROTUNDDWATER ENCOUNTERED L OUTWASH SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL PERC AT 60 in - 2 MIN/INCH IN C SOILS CONDITION. IF NOT, INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 41.65 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: A 24 f t x 12.5 Ft- x 2 FL LEACHING GALLERY CAN LEACH 0-3 O WOOD LOAM 10 YR 4/2 NONE FRIABLE Abot = ( 24 x 12.5 ) = 300 sf 3-5 E LOAMY SAND 10 YR 4/1 NONE FRIABLE Asdw = ( 24 24 12.5 12.5 ) x 2 = 146 sf Atot = 446 sf 5-10 A LOAMY SAND 10 YR 4/6 NONE FRIABLE Vt 0.74 x 446 = 330.04 GPD 38.65 10-36 B LOAMY SAND 10 YR 5/8 NONE LOOSE USE A 24 Ft. x 12.5 Ft x 2 ft. GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED 36-144 C MEDIUM SAND 10 YR 6/3 NONE LOOSE 29.65 NO GROUNDWATER ENCOUNTERED LEACHING GALLERY 1000 GALLON SEPTIC TAW TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH USE SHOREY PRECAST 500 GALLON NOT TO DIMENSIONS AND DETAIL NOT TO 2 MIN/INCH IN C SOILS LEACHING DRYWELL (H-10 LOADING) SCALE USE EXISTING H-10 UNIT SCALE ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER CONSTRUCTION DETAIL SEPTIC TANK IS TO BE PUMPED DRY (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING AT TIME OF INSTALLATION AND IS TO 41.75 DRYWELL UNIT S T O N7 BE EXAMINED FOR STRUCTURAL 0-4 O WOOD LOAM 10 YR 3/2 NONE FRIABLE INTEGRITY. INSTALL NEW PVC OUTLET 24.0 ft TEE EQUIPPED WITH A GAS BAFFLE. 4-6 E LOAMY SAND 10 YR 5/1 NONE FRIABLE m 1 1n 6-10 A LOAMY SAND 10 YR 4/6 NONE FRIABLE -0 m � Tin 38.75 10-36 B LOAMY SAND 10 YR 5/8 NONE LOOSE N Im LO 36-136 C MEDIUM SAND 10 YR 6/3 NONE LOOSE � E� v`` N 30.25 mm o O DISTRIBUTION BOX 3.5 Ft 11 8.5 FL 6.5 F .5 Ft Ln GROUNDWATER ADJUSTMENT DIMENSIONS AND DETAIL USE SHOREY D8-3 H-10 24.0 Ft m 1� EXISTING 'GROUNDWATER LEVEL �1 BASED .ON TOWN OF 'BARNSTABLE 500 GALLON DRYWELL �-6 In A �� GIS DEPARTMENT RECORDS. NOT TO 12 1n DIMENSIONS AND DETAIL INLET OUTLET INDICATED GW 15.00 SCALE MIN INDEX. WELL - S D W-25 2 USE H-10 UNIT COVER COVER ZONE ' B FROM C INSTALL ONE INSPECTION READING,DATE DEC. 200Z O C TANK [TO RISER TO WITHIN THREE _� �3INDROFLOW LINEREADING 22.2 AS INCHES OF FINAL GRADE ADJUSTMENT 1.2 0 0 AND INDICATE LOCATION FROM = —FLLL- � ADJUSTED GW. 17.2 ~ ON AS-BUILT PLAN BUILDING 10 ! 14 1� 6 In STONE BASE 46 In to D- BOX 155 1G�� CROSS SECTION VIEW LrourD GAS� LEVEL BAFFLE In 00 33 00 00 0000000�000 �00�0 1n SEPARATION OF INLET AND OUTLET TEES NOTES ���0000 8 SHALL BE NO LESS THAN LIQUID DEPTH 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 10z In CROSS SECTION VIEW 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. CROSS SECTION VIEW 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 21n PEASTONE 21n PEASTONE SEWAGE DISPOSAL SYSTEM PLAN 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 24 BEFORE EXCAVATING FOR SYSTEM. TO SERVE EXISTING DWELLING 3/4 u,TO 4 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. 28 EFFECTIVE 3 in TO 261n ->r2,,,criAVEL DEPTH 1-112'nGRAV1- 1n MARK GROSSLEIN & KAREN MOYER Z) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. 46 1n 5B 1n 45 1n 77 LUMBERT MILL ROAD CENTERVILLE. MA 8) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT EEO-TECH ENVIRONMENTAL PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 150 1n INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL FABRIC IN PLACE OF THE-2 in. PEASTONE LAYER SPECIFIED. y 43 TRIANGLE CIRCLE SANDWICH MA 02563 STABLEBEEN ON T BASE THAT HAS B MECHANICALLY COMPACTED AND O WHICH SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-32881 DECEMBER 11. 2009 1 1212 I� , CENTERVILLE. MA NOTES' CONTOURS <�, \ - - - - - T • LEACH PIT LOCATION FROM AS BUILT ,; n � EXISTI#�1G 50 CARD OF 1122197. EXISTING LEACH PIT IS / ` MINIMAL GRADING PROPOSED <� N TO BE PUMPED. COLLAPSED AND FILLED. ; m LOCUS po � a �o w n ENT 0 CDi / \ � o \ m m R O W J '} 46 Lri 46 w Q �J° \-7 FOCUS MAP m a~ < GARBAGE GRINDER /` \ m=z z� / / NOT TO SCALE o 0 w o� IS NOT ALLOWED ` = 3� w^ c6 < WITH THIS DESIGN. / 1� \2 l wJa m N W3 / 5 V rn \ \ x r O o o r P \ m G w � a f- JSO J Z �y w O a Z �.�. w END 3 LEG J U Z U) i--+ LL � W 0 41 J w w} U —i > o "- - / ^ �T`� \\ / � EXISTING � J� � �❑ � � O J ❑� � 1000 GALLON O L,X 0_ z < cv z SEPTIC TANK ❑z a m 1 W1r� EXISTING LEACH O J V 44-1/ �O \ PIT/CESSPOOL O w z o w � cn CD w p rmi p4/ : Q/��S� ��J� UTILITY POLE$ DRAIN 19 z ❑ P �` ;J,p �� 'pO I/C O �P R TEST PIT® D-BOX O W w �¢of ED XQ m `�`� BENCH MARK / �'� \� 0 y//L ® DECIDUOUS CONIFEROUS O Z "� m u�- / S l� \ ZI (n W LL m W __ TOP OF CONC BOUND / ✓�<� C� Q / TREE Qopq TREE = �� m ° ELEVATION = 41.25deb�2-M IWO U F- U Q OLi 42 X *12-p BARNSTABLE GIS DATUM \ OTES TYPE W W Z Z / INCHES. REFERS TO DIAMETER IN �W X O w WFDU / TP-2 O-OAKS MEMAPLETTER D PNPINE C-CEDAR eO ~U ~ .p N OF hfgs ZH O� Z w? TP-1 syc ssgo �U. T W m F � C OHO I o` DAVID �, o� DAVIDO Z 0 �, S \ o D. � o D. zo wyCOUGHANOWR w o z 41 0 � 1414 No. 1093 U COUGHANOWR � O 3 +m z m \\ �� O \ / �FG ��O `r0 l�CE N SEA w N P IgTE /� t, W > N \ t_0� SqM R\Nl FVAL J w 40_\— ew w 24FLx125FLx2Ft \ A ,8_0 cn LEACHING GALLERY s\ \fib \ \ /��� Dec (itth ZDp� w J p Z �N� 42 ®a �� SEWAGE DISPOSAL SYSTEM PLAN i--i J Z J \\ / �c -TO SERVE EXISTING DWELLING LL o o co U 38 �� \ <47 EST- MARK GROSSLEIN & KAREN MOYER 0 o J cn (� �, \ / OWNERS OF RECORD I� w I�' X ED SHED �° d 77 LUMBERT MILL ROAD I'. W W \\ 38' �40 �� 1995 �'T CENTERVILLE. MA + ED (n �\ ; / /90N��� PROPERTY ADDRESS O % ASSESSORS MAP 16 8 PARCEL 17 3 IL FLAN N` LOT 15 43 TRIANGLE CIRCLE �� z ? SCALE: 1 In = 2� f t ���� -AREA = 14664 sF +- / SANDWICH MA 02563 LAND COURT PLAN 31043-A N X X 508 364-8894 DATE: DECEMBER 11. 2009 I W W W 20 2� 40 �\ / JOB #E T E-3 2 6 B PAGE 1 OF 2 VERSION A LL_ THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED B 10 20 \\\ SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM � ` ' DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING v PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. �� 2 DATE TEST: DECEMBER 11. 2009 SOIL TEST LOG SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. O E S I G N CALCULATIONS WITNESSED BY: DAVID STANTON. HEALTH DEPT. 1 PERC NUMBER: 12792 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD NO GROTUNDDWAT R ENCOUNTERED OUTWASH SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS 1 TEST PIT USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL PERC AT 60 in - 2 MIN/INCH IN C SOILS CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 41.65 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: A 24 Ft x 12.5 Ft x 2 Ft LEACHING GALLERY CAN LEACH 0-3 O WOOD LOAM 10 YR 4/2 NONE FRIABLE Abot = ( 24 x 12.5 ) = 300 sF Asdw = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sF 3-5 E LOAMY SAND 10 YR 4/1 NONE FRIABLE At o t_ = 446 s F 5-10 A LOAMY SAND 10 YR 4/6 NONE FRIABLE Vt 0.74 x 446 = 330.04 GPD 38.65 10-36 B LOAMY SAND 10 YR 5/8 NONE LOOSE USE A 24 ft- x 12.5 Ft x 2 Ft GALLERY. Vt. = 330.04 GPD > 330 GPD REQUIRED 36-144 C MEDIUM SAND 10 YR 6/3 NONE LOOSE 29.65 NO GROUNDWATER ENCOUNTERED LEA CHI NG GALLERY 1000 GALLON SEPTIC TANK TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH USE SHOREY PRECAST 500 GALLON NOT TO DIMENSIONS AND DETAIL NOT TO 2 MIN/INCH IN C SOILS LEACHING DRYWELL (H-10 LOADING) SCALE USE EXISTING H-10 UNIT SCALE ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER CONSTRUCTION DETAIL SEPTIC TANK IS TO BE PUMPED DRY (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING AT TIME OF INSTALLATION AND IS TO 41.75 DRYWELL UNIT STON7 BE EXAMINED FOR STRUCTURAL 0-4 O WOOD LOAM 10 YR 3/2 NONE FRIABLE INTEGRITY. INSTALL NEW PVC OUTLET 24.0 Ft TEE EQUIPPED WITH A GAS BAFFLE. 4-6 E LOAMY SAND 10 YR 5/1 NONE FRIABLE IDII 6-10 A LOAMY SAND 10 YR 4/6 NONE FRIABLE 4J 'il -0 TAPER 10-36 B LOAMY SAND 10 YR 5/8 NONE LOOSE IE�ll � M 38.75 � Lo � 36-13B C MEDIUM SAND 10 YR 6/3 NONE LOOSE Lo 30.25 1 m o co O -4.) DISTRIBUTIDN BOX 3.5 Ft 8.5 Ft 6.5 Ft .5 F `� GROUNDWATER ADJUSTMENT Lo DIMENSIONS AND DETAIL USE SHOREY DB-3 H-10 2 4.0 F t 1� EXISTING GROUNDWATER LEVEL BASED-ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. 500 GALLON DRYWELL i NOT TO 12in DIMENSIONS AND DETAIL INDICATED GW 15.00 SCALE MIN INLET OUTLET s TNDE.X +WELL SDW-252 � _� � USE H-10 UNIT COVER COVER • ZONE ' - B O FROM c INSTALL ONE INSPECTION READI.NG;DATE DEC. 2007 [ TANK TO RISER TO WITHIN THREE 3 IN DROP READING` 22.2 O —> FLOW LINE ASAS INCHES OF FINAL GRADE _ADJUSTMENT 1.2 O AND INDICATE LOCATION FROM 10 to Iq TO ADJUSTED GW '17.2 ON AS-BUILT PLAN BUILDING in D-BOX ,� 6 in STONE BASE 48 in - CROSS SECTION VIEW LIQUID GAS 15 1� LEVEL BAFFLE 5ln 0 33 0)ppp O In pppp�ppppOpp 00000 SEPARATION OF INLET AND OUTLET TEES NOTES pppp0 0 8 1� SHALL BE NO LESS THAN LIQUID DEPTH 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 1021n CROSS SECTION VIEW 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. CROSS SECTION VIEW 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 2 in PEASTONE 2 in PEASTONE SEWAGE DISPOSAL SYSTEM PLAN 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. o C TO SERVE EXISTING DWELLING 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE.. 28 tea,,ro EFFECTIVE iq,n 24 ro 26 In In '�1 ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES -�in GRAVEL DEPTH 1-1121,GRAVEL MARK GROSSLEIN' & KAREN MOYER AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. 46 In 58 in 46 In 77 LUMBERT MILL ROAD CENTERVILLE. MA 8) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT ECO-TECH ENVIRONMENTAL PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 150 In INSTALLER MAY SUBSTITUTE . APPROVED GEOTAVER SPILE ECIFIED. 43 TRIANGLE CIRCLE SANDWICH MA 02563 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL FABRIC IN PLACE OF THE 2 in. PEASTONE LAYER SPECIFIED. STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS, BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-32681 DECEMBER 11, 2009 1 12121 1 t t S z NOTES CONTOURS CENTERVILLE. MA �- o O `9 = \ - - - - - - - a c2� LEACH PIT LOCATION FROM AS BUILT n EXISTING 5D "?� tLo n =F CARD OF 1122197. EXISTING LEACH PIT IS / \ MINIMAL GRADING PROPOSED Mf<� N �' 0m� `% 0_j3 TO BE PUMPED. COLLAPSED AND FILLED. ; 1 m LOCUS po 0<w � F-Z❑ , / 6 9p F J� + moz c� FNT Dcnzi a m(nc}n m owe \ GARBAGE m o 1�0 zw a �-- 2_ m <m0 j / ` / G B GE GRINDER m m m OFz a `� IS NOT ALLOWED ) m >a �J d L. 46�/� WITH THIS DESIGN. o P GROUNDWATER ADJUSTMENT 46 / o EXISTING GROUNDWATER LEVEL \ O C u S M A P unllnnllllllllll BASED A TOWN OF BARNSTABLE > �I�nnnlnillllllllll / L w GIS DEPARTMENT RECORDS. / \ �3 NOT TO SCALE (n Illllllllllululwuul i I) Z Illllllllllulullluu° INDICATED GW 15.00 O = unmulllllllllll ow0 """'Iinlnllllllllllll U` INDEX WELL SDW-252 5 �I� / hl -7 rZW lllllllllllllllllluu w / W GCS Illlllllllllllululluu > ZONE B P I- \ 1 ullullllllfli'll w READING DATE DEC. 2mB� ' G r \\\fre J LEGEND W= w� '°��nnnlllllllll r—t � •8 -�U �-�� U READING 22.2 W Z zow Illllllllllllllnu / �'- ?aa = z ADJUSTMENT 1.2 a IIIIIIIIIIII ADJUSTED GW 17.2 \ " Illlllnllllllllli U e Illlulllllllulmullll J 1L \ EXISTING z Illllllllilllulnmlll, W < i / <` 1000 GALLON W z u? �lllllllllllllll w / , 9� �- SEPTIC TANK W llllllllllullll W 0 / \ \ \O LI: x IIIIIIIIIIIIIIIIIIIIIIIII / \ / W (�') llllplllllll � w _ EXISTING LEACH �— ❑ nunllllllllllllll J w 44 \ ❑p ""°Illlllllllullllll N - PIT/CESSPOOL W ZI Q Illllllllllllllllwulll ' / / �P ♦♦ ry Illlllllllllllulwnlll m O W O ulllunlllllllllll p�`x/ �J UTILITY POLE$ DRAIN Lu "" nlllnllllllllllll < W 0 > �' LI X Lq m � tiP� / � p �< O v�P R ♦ TEST PIT® D-BOX El wz m m �' BENCH MARK �� \ 0 ® DECIDUOUS CONIFEROUS )Q W 0 o m n� TOP OF CONC BOUND / `�1�<� "Q` > TREE o TREE JQ 0 ELEVATION = 41.25 42 x / > CJ6Ui2-M *2-P W Q U O w BARNSTABLE GIS DATUM \ -NUMBER REFERS TO DIAMETER IN W z w / / INCHES. LETTER DENOTES TYPE. (n W [ C O � \ r® t O-OAK M-MAPLE P-PINE C-CEDAR Ll.l 4 J CO CD(n�] TP-1 �'p / �ZH�F MgSS9 (H�F iygS ��oj DADVID ctiG o�'� DAVID s9cy�, Lo o D. LLJ + „ 'IT � '9C �� 44 COUGHAHOWR N " COUGHANOWR m m 4 N r \ �s o \� No. 1093 e w \ \ ( \ GISTE��O sO���CENSE� 0Q- TAR FV 8-0 i+� \ po t-eb 74, 20 f0 ? CD z -SEE DETAIL ON REVERSE SJ\\ \ O 3 �Q z Nam \ 1' 42 ®� �� SEWAGE DISPOSAL SYSTEM PLAN 0 0 �m U \\ / �� -TO SERVE EXISTING DWELLING �nzo o `L 11, m 38 \ ql EST. MARK GROSSLEIN & KAREN MOYER r' / OWNERS OF RECORD e I W q � , ° + (� ♦♦ 38J SHED ��40 _4 7 r7 LUMBERT MILL ROAD o m m �� 1995 ��' CENTERVILLE. MA Q \♦♦ / ®�ON��� PROPERTY ADDRESS O J N N N PLAN �� { LOT 15 43 TRIANGLE CIRCLE ASSESSORS MAP 166 PARCEL 17 O X AREA = 14664 _- +- / SANDWICH MA 02563 LAND COURT PLAN 310 4 3-A w w w SCALE: 1 In = 20 FL 508 364-0894 �\ DATE: DECEMBER 11. 2009 20 0 20 40 ♦♦ / JOB #E T E-3 2 8 8 PAGE 1 OF 2 VERSION. THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED 0 10 20 `♦♦ SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM V DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. -SOIL TEST L O G DO L EVALUATOR: DAVID DE COUGHANOWR. R.S. DESIGN CALCULATIONS WITNESSED BY: DAVID STANTON. HEALTH DEPT. PERC NUMBER: 12792 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT 1 PARENT MATERIAL: PROGLACI N C SOILS SH I PERC AT 60 2 MIN/INCH N C SOILS . USE EXISTING Imam GALLON SEPTIC TANK-IF IN SOUND STRUCTURAL CONDITION. to - IF NOT, INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 41.65 0-3 O WOOD LOAM 10 YR 4/2 NONE FRIABLE SOIL ABSORBTION SYSTEM: INSTALL 10 ADS HIGH CAPACITY BIODIFFUSERS (160OBD) 3-5 E LOAMY SAND 10 YR 4/1 NONE FRIABLE 10 UNITS x 6.25 Ft / UNIT = 62.50. L.F. 62.50 L.F. x 7.90 S.F./L.F = 493.75 S.F. 5-10 A LOAMY SAND 10 YR 4/6 NONE FRIABLE 493.75 S.F x .74 G.P.D. / S.F. = 365.3 GPD 38.65 10-36 B LOAMY SAND 10 YR 5/8 NONE LOOSE USE 10 HIGH CAPACITY BIODIFFUSERS AS CONFIGURED BELOW 36-144 C MEDIUM SAND 10 YR 6/3 NONE LOOSE - Vt = 365.3 GPD > 330 GPD REQUIRED 29.65 REFER TO DEP APPROVAL LETTER TRANSMITTAL # W000052 FOR CERTIFICATION OF ADANCED DRAINAGE SYSTEMS BIODIFFUSER SYSTEMS. NO TEST PIT 2 PAARENTUNDWATE MAATERIA EPROGLACIRALD OUTWASH 2 MIN/INCH IN C SOILS NO T TO ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER L EA CHING GA L L ER Y SCALE 41.75 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING CONSTRUCTION DETAIL 0-4 0 WOOD LOAM 10 YR 3/2 NONE FRIABLE USE ADS HIGH CAPACITY BIODIFFUSERS l#16008D7. GRAVELLESS 4-6 E LOAMY SAND 10 YR 5/1 NONE FRIABLE INSTALLATION - USE DER APPROVED INSTALLATION PROCEDURES. 6-10 A LOAMY SAND 10 YR 4/6 NONE FRIABLE 31.25 F L �j 10-36 B LOAMY SAND 10 YR 5/8 NONE LOOSE L- 38.75 1 1m 36-138 C MEDIUM SAND 10 YR 6/3 NONE LOOSE m 30.25 �j N 4- SEPTIC TANK IS TO BE PUMPED DRY 1000 GALLON SEPTIC TANK AT TIME OF INSTALLATION AND IS TO Ln DIMENSIONS AND DETAIL NOT TO BE EXAMINED FOR STRUCTURAL EXISTING H-l0 UNIT ,9 INTEGRITY. INSTALL NEW PVC OUTLET USE E SCALE E TEE EQUIPPED WITH A GAS BAFFLE. m m INLET OUTLET 31.25 FL N COVER COVER I In TAPER CD � �3 IN DROP LINE CROSS SECTION VIEW FROM 101n 14 TO [ BUILDING 1n D-BOX 48 in �0 coj LIQUID GAS 4 !n USE H-20 LEVEL BAFFLE RA TED UNITS 16 11.3 In .... ._. I^ EFFECTIVE 1� SEPARATION OF INLET AND OUTLET TEES DEPTH zn SHALL BE NO LESS THAN LIQUID DEPTH CROSS SECTION VIEW I 34 in (2.83 FL) 68 In (5.66 FL) 34 to (2.83 FL) N O T E S DISTRIBUTION BOX 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. DIMENSIONS AND DETAIL USE SHOREY 08-3 H-10 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). NOT TO 1z 1n SEWAGE DISPOSAL SYSTEM PLAN 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES SCALE MIN BEFORE EXCAVATING FOR SYSTEM. —' -TO SERVE EXISTING DWELLING FROM �O) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. O C TANK TO SA MARK GROSSLEIN & KAREN MOYER ( IY) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES O (o �� LLJMBERT MILL ROAD CENTERVILLE. MA AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK: 8) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT s 1n STONE BASE 1 PARK OR DRIVE VEHICLES OVER SEPTIC_ SYSTEM. 15 1�• CROSS SECTION VIEW ECO-TECH ENVIRONMENTAL �1 SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 5 In 43 TRIANGLE CIRCLE SANDWICH MA 02563 STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-3288 DECEMBER 11, 2009 2/2