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HomeMy WebLinkAbout0047 MAUREEN ROAD - Health 47 Maureen Road Centerville F/R i A = 228 063 TOWN OF B STABLE LOCATION `1� 1 f-e-ery SEWAGE # 5;?006— VILLAGE' ASSESSOR'S MAP & LOTS—� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACMr Y: (type) _ �o �� (size) NO.OF BEDROOMS�`�_ BUILDER OR OWNER wU 1r�rV PERMTTDATE: s��� 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 © Vk el qa, �l �f "��7�� '3� s-r ��� 3 FEE .00 No. V C®MMONWF-ALT14 OF MASSAC14USETTS Board of Health, �h�. �� ,MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair�< Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Owner's Name o\i w Map/Parcel# aoZin ncp Address Lot# 4'3 Telephone# Installer's Name S\r, Designer's Name t o Address J �. Address e-\?` , fa_ 6� �` ��O�y� A Telephone# Telephone# 3 — Type of Building Lot Size ` sq.ft. Dwelling-No.of Bedrooms �2Q 3 Garbage grinder Other-Type of Building 6)brap No.of persons _Showers C afeteria N" Other Fixtures L-it,(�j,TtoV—'? . �i CGtiC� ctilk (�ut.99P�'tz Design Flow (min.required) J' bG gpd Calculated design flow 3'�J� Design flow provided�?!4 -014 gpd Plan: Date 3160 8 s Number of sheeeets I _ Revision Date Title �Cb�© �_(�' C �(_9.5 —M UDC�5-C Description of Soil(s) Soil Evaluator Form No. 0 Name of Soil Evaluator AeM v Date of Evaluation 310a5 Jo DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr s to pot to pla the system' operation until a Certificate of Compliance has been issued by the Board of Health. Sig Date Inspections • s ,r {LI'r' '- �,. �- ' '��, � :''r 'j ✓� .r. �, �a 'w "+e J'r-+'.Y. ..L. .+ ti � X +.: �.�-,. ;;ryi: .- FEE ! OV qF COMMONWEALTH OF MASSACHUSETTS Board of Health, MA APPLICATION FOR DISPOSAL. SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repairx) Upgrade( ) Abandon( ) XComplete System ❑Individual Components Location #4l- M P tOQ.EE-1 _D R_ Owner's Name Map/Parcel# C, (�(D 3 Address Lot# Telephone# Installer's Namep5 C S� , Designer's Name 54 � �V SACS Address S �TCe'-tl oh S `[aeMOJT\k Address' c). �oX Gnj I, Telephone# (a4\_8_5 31 Telephone# 39 Type of Building 5k C�l ' A Q\ Lot Size YP g \\ �a��� sq.ft. Dwelling-No.of Bedrooms ��C1��2 C J Garbage grinderN/(A Other-Type of Building ! bCl No.of persons Showers ('Cafeteria lr) Other Fixtures -+�IUA"rC�CZl� K�'CCtaCrs �5,,ik' , Lam,oNDR& 2 Design?Flow (min.re uired) � � gpd Calculated design flow 3� Design flow provided J 10-04 gpd Plan: Date 16�5 Number of sheets t Revision Date Title Description of Soils) 1�kC-C� Soil Evaluator Form No. ��� Name of Soil Evaluator �QtfeJ SWAY Date of Evaluation �� 16 DESCRIPTION OF REPAIRS OR ALTERATIONS Am DN"__� The under igned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr es of to place the system' operation until a Certificate of m Compliance has been issued by the Board of Health. Sig -ed-JW� 1 Date�.�` Inspections ,('' NW¶'A F ,('' USETTS FEE G O F Board of Health,. &17 � MA. - CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) Complete System The un ersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded,Abandoned ( ) by: DhGI' S at I, , / / �t! .Y �D p ��/ t1, has been installe in ac ord�{nce with the provisions p•f 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application o, /, . l1 -/ dated /Q1 /G Approved Design Flow 330 (gpd) Installer /h i Designer: h.elM Inspecto : Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. FEE ! O d Board ofHealth,l) ///,5.L!',J(",;�-. , M,4. DISPOSAL SYSTEM STEM CONSTRUCTION PERMIT Permission is hereby granted to- Construct( ) RepL-1 iir( ) Upgrade( ' Abandon( ) an individual sewage disposal system �( l at Nwlrm ' - v/ as described in the application for Disposal System Construction Permit No rJ05 113 ,dated Provided: Construction shall be completed within three years of the date-ima:�= s must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date � A/ U�Board of He'a3tt1_ TOWN OF BAIWSTABLE i LOCATION SEWAGE # 5;;FaZ6— VILLAGE SESSOR'S MAP & LOT � _ INSTALLER'S NAME&PHONE NO. SEPTIC-TANK CAPACITY qYAS � , LEACHING FACILITY: (typej' S 20 (size) Y l 0 r �� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: -3 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 4'A A Al . I F i i 9/16/03 . i i Notice: This Form Is To Be Used For they Repair Of Failed Septic Systems. Only i PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM i a A Y ,hereby certify that the engineered plan signed by me dated I O;Z, ( ci5 concerning the property located at ! i meets. all of the i following criteria: i • This failed system is connected to a residential dwelling only. There are.no commercial or business uses associated with the.dwelling. • The soil is.classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact orr may conduct deep test holes and percolation tests.at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 4_0 B) G.W.Elevation Ij"� +adjustment for high G.W. DIFFERENCE BETWEEN A and B ,. . �j SIGNirD : l- DATE: i i NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. I i i i i gASeptic\percexemp.dpc i i I Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: t� � I�CJd F'�A(1 ) (\ , . ��'C�� U�\ Lot No. Owner: �r1Q� C., `� ��� t��1,i+gw� Address: Contractor: �tiaA'4' rear e;�)UCS Address: Notes: I i STEP 1 Measure depth to water table tonearest 1/10 ft. ..................................................i..........,................ .Date s month/day year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well......................................�. JWater-level range zone ..................................... ........... STEP 3 Using monthly report "Current Water.Resources Conditions" determine current depth to water level for index well ...................... mon /year 'I � I STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), andwater•level zone (STEP 2B) determine water-level adjustment ........................... l e� I STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ........................ ............. ........ . lt• . .......................................................... ' i i i Figure 13,—Reproducible computation form, i 15 I I Town of Barnstable °fIHE Regulatory Services Thomas F. Geiler, Director • BARNSPABM 9� MASS. Public Health Division 1639. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 4/13/05 Designer: Shay Environmental Services, Inc. Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth, MA On 4/08/05 Robert Septic Service was issued a permit to install a (date) (installer) septic system at 47 MAUREEN DRIVE, CENTERVILLE, MA_based on a design drawn by (address) Shay Environmental Services, Inc. dated 03/30/05 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �X'C A OF MgSs9 CARMEN cyGN alle 'st* t�re) �� E. SHAY No. 1181 ��G1ST�R�O '--(Designer's Signature) (Affix Desig ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 67/11/2015 18: 12 FAX la 001/001 SUING TIE SCHEDULE INVERT ELEV. SCHEDULE PROPOSED ACTUAL CORNER A TO TANK INLET COVER 1e FEET EXIST. PIPE SEPTIC INVERT AT FOUNDATION CORNER B TO TANK INLET COVER 12 FEET NEW SEPTIC TANK INLET 91-25 91AD CORNER A TO D-BOY 18 FEET NEV SEPTIC TANK OUTLET 91.00 91.15 CORNER B TO D-BOX 25 FEET DISTRIBUTION BOX INLET 95.07 90.07 - CORNER A TO CHAMBER INLET COVER 81 22 FEET DISTRIBUTION BOX OUTLET 94.90 90.70 CORNER B TO CHAMBER INLET COVER •1 34 FEET INLET OF LEACH CHAMBERS 90.67 9D.60 BOTTOM OF TRENCH 66.50 66.60 N/F ROMAN CATHOLIC BISHOP OF FALL RIVER 86 - 56.28' ---�3 =---- ------- f '-'��' ' s•, - -8 VENT PIPE6 ------ optic c k^� � A � W LOT #40 EXISTING / ' 3 BEDROOM HOUSE / LOT #38 #47 / r i' LOT 9§I39 12,800 Square Feat +/— PROJECT BENCH MARK TOP OF FOUNDATION �\ ELEV. = 100.00 (Assumed) 100.00. MA ZJR E"E'N 14 OA D (40 FOOT RIGHT OF WAY) I CERTIFY THAT THE LOCATIONS WERE MEASURED AND ARE TRUE AND ACCURATE. THE ELEVATIONS SHOWN HERE I ARE ALSO TRUE AND ACCURATE AND WERE MEASURED WITH AN ON THE GROUND INSTRUMENT SURVEY. AS BUILT OF SEPTIC SYSTEM FOR DATE: AFRIL 13, .2005 #47 MAUREEN DRIVE C ENTERVI LLE, MA A E PREPARED BY: H- C14RMf'N -: S-ff,4 Y SNV/RONJIRNTAL & CfVJZ RNGINRBRlNC P o P.O. BOX 627 s T CR EAST FALMOUTH. MA 02536 S N/TA R PN TEL FAX : 508-539-7966 SCALE: 1"-30' DRAWN BY: CES I DATE: APRIL 13, 2005 PROJECT#ED713 I FILENAME: SD713AB.DWG I SHEEP 1 OF 1 COMMONWEALTH OF MASSACHUSETTS ` EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT_ECTION MAP ,.. moU 16 2004 FAILED INSPECTION PARCEL =,.._ .�� . LOT u1 TO OF BARNSTABLE --tea nr_AL T H CREPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 47 Maureen Road Centerville Owner's Name: Lois Hosmer Owner's Address: 488�Pinecrest Road st-nn MA Date of Inspection:-J[U— Name of Inspector:(please print) W i 11 jam _ •Robinson Sr. CompanyNamc: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (5081 775-8776 CERTIFICATION STATEMENT 1 certify that 1 have personally inspected the sewage disposal system at this address and that the information reported . below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: Passes Con ' onally Passes ds Further Evaluation by the Local Approving Authority ails Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heanhvr 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 4 7 Maureen Road ` °dR t ~� -•-� Centerville Owner: Lois Hosmer Date of Inspections Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. S stem Passes: have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 o in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments B. System Co ditionally Passes: One or ore system components as described in the"Conditional Pass"section need to be replaced or repaired.The sys em,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no o not determined(Y,N,ND)in the for the following statements.if"not determined"please explain. The septi tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,cxhib' substantial infiltration or Wiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal sep' tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating th the tank is less than 20 years old is available. ND ex in: Ob etvation of sewage backup or break out or high static water level in the distribution box due to-broken or obstructed ' e(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of ard of Health): - broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The syst m required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection' (with approval of the Board of Health): broken pipes)are replaced obstruction is Rmovcd ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 47 Maureen Road Centerville Owner: Lois Hosmer Date of Inspection: C. Further`t valuation is Required by the Board of Health: Conditi ns exist which require further evaluation by the Board of Health in order to determine if the system is failing to prot ct public health,safety or the environment. 1. System ill pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is of functioning in a manner which will protect public health,safety.and the environment: — Cessp of or privy is within 50 feet of a surface water _ Cessp of or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System ill fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is fu ctioning in a manner that protects the public health,safety and environment: _ system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a surfac water supply or tributary to a surface water supply. e system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply,well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more frodl a priva water supply well** Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteri and volatile organic compounds indicates that the well is Gee from pollution from that facility and the pres nce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure c iteria 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: 47 Maureen Road Centerville Owner: Lois Hosmer �Date of Inspection: .0— - 0 17 (D./System Failure Criteria applicable to all systems: ou must indicate"yes"or"no"to each of the following for all inspections: Yes No/ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ _ iquid depth in cesspool is less than 6"below invert or available volume is less than IA day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ✓/Any portion of the SAS,cesspool or privy is below high ground water elevation. 7/ Any portion of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or.privy is within a Zone I of a public well. _ —12 Any portion of a cesspool or privy is within 50 feet of a private water supply well. , Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private eater supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed at a DEI 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.] Vl (YestNo)The system fails.I have determined that one or more of.the above failure criteria exist as �/ described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. C10"o-C+ Ile c `o s d ocr i u% C tip► o v���' rlo�� � E. Large Sy tems. To be consi cd a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indic to either"yes"or"no"to each of the following: (The following riteria apply to large systems in addition to the criteria above) yes no the sy tern is within 400 feet of a surface drinking water supply the sys cm is within 200 feet of a tributary to a surface drinking water supply the sys eon is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 1 of a public water supply well If you have ans ered"yes"to any question in Section E the system is considered a sigtiifacant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of arty large system considered a significant thre under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The sy tern o«-ner should contact the appropriate regional office of the Department. 4 Page S of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 47 Maureen Road en ervi e Owner: Lois Hosmer Date of Inspection:_ .- /'Z�4- Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No �umping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? _'/ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection 7. / 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? ere all system components,excluding the SAS,located on site? n Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the b7Was r tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ the facili owner and occu ants if different from owner rovided with information on the ro r — h' ( P )P P Pe 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)13 10 CUR 15.302(3)(b)] 5 Page 6 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 47 Maureen Road Centerville Owner. Lois Hosmer Date of Inspection: /b®d al— FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): .>L O Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):A oo [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): �i v Water meter readings,if available(last 2 years usage(gpd)): 2003 — 27, 000 Sump pump(yes or no): 2002 — , 0 0 0 Last date of occupancy: G -3 COMMERCIAL/! USTRIAL Type of establishm nt: Design flow(base on 310 CMR 15.203): gpd Basis of design fl w(seatsJpersons/sgft,etc.): Grease trap pres nt(yes or no):_ Industrial wast holding tank present(yes or no): Non-sanitary aste discharged to the Title 5 system(yes or no):_ Water meter eadings,if available: Last date o occupancy/use: OTHE describe): GENERAL INFORMATION Pumping Records Source of information: X/ ,D Was system pumped as part o the inspection(yes or no): C) If yes,volume pumped:_gallons-=How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _§4tic tank,distribution box,soil absorption system _ ingle cesspool _Overflow cesspool _Privy Shared system es or no)(if es,attach previous inspection records,if any) _ Y (Y Y P P _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: ig G d Were sewage odors detected when arriving at the site(yes or no):/41"d 6 ]'age 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 47 Maureen Road Centerville Owner: Lois Hosmer Date of Inspec(lon:-/Q BUILDING SEWER cafe on site plan) Depth below grade: Materials of cons ction:_cast iron _40 PVC_other(explain): Distance from pri ate water supply well or suction line: Comments(on c ndition ofjoutts,venting,evidence of leakage,etc.): SEPTIC TANK:—(local on site plan) Depth below grade: Material of construction-_concrete metal fiberglass_polyethylene —other(explain) If tank is metal list ag :— Is age :on -by a Cert' Cate of Co ipliance(yes or no):certificate) 0 _(attach a copy of Dimensions: ` w Sludge depth: Distance from to of sludge to bottom of outlet tee or baffle: Scum thickness Distance from op of scum to top of outlet tee or baffle: Distance fro bottom of scum to bottom of outlet tee or battle: How were mensions determined: Comment on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as relate to outlet invert,evidence of leakage,etc.): GREASE TRAP: (locate on site plan) Depth below grad Material of cons ction:_concrete.- metal fiberglass_polyethylene_other (explain): _ Dimensions: Scum thicknes Distance Go top of scum to top of outlet tee or baffle: Distance fro bottom of scum to bottom of outlet tee or baffle: Date of last umping: Comments on pumping reconunendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related t outlet invert,evidence of leakage,etc.): 7 I Page 8of11. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 47 Maureen Road Centerville Owner: Lois Hosmer Date or,lnspectioo: V -- TIGHT or HOLD G TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construe on: concrete metal fiberglass polyethylene other(explain). Dimensions: Capacity. gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION DO (if present must be opened)(locate on site plan) Depth of liquid level bove outlet invert: Comments(note if ox is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or ou of box,etc.): ) PUDIP CHAMBER: (locate on ite plan) Pumps in working order(yes or no . Alarms in working order(yes or o): Comments(note condition of p mp chamber,condition of pumps and appurtenances,etc.): I i i 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 47 Maureen Road Centerville Owner: Lois Hosmer Date of Inspection: D r L SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,ezcavation•not required) If SAS not located explain why: Type leaching pits,number: `� O leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cess ool must be pumped as part of inspecti on)(locate on site plan) Number and configuration: 10 Depth—top of liquid to inlet rover: r Depth of solids layer: 3- Depth of scum layer: L/ G Dimensions of cesspool: K -� L, Materials of construction: Jl Indication of groundwater inflow(yes or no): td Comments(note condition of s il,signs of hydraulic failure level of ponding,condition f v getation,et ci V J PRIVY: (locate on" a plan) Materials of constructi Dimensions: Depth of solids: Comments(note co d' ion of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 47 Maureen. Road Centerville Owner: Lois Hosmer Date of Inspection: — SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. L 33j .. >� 14 LI 10 Page i 1 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 47 Maureen Road Centerville Owner.Lois Hosmer Date.of Inspection: U— L' SITE EXAM Slope Surface water Check cellar. Shallow wells / y� Estimated depth to ground water 2--eeet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: C�ed with local excavators,installers-(attach documentation) ed USGS database-explain: You must describe how you established the high ground wa r elevation: o-<) Y� 11 VENT PIPE (® Least 24 inches tall) i 0RA`�DMllltil1.1 Schedule 40 PVC w/Charcoal Odor Filter SECTION A -A ALL OUTLET PIPES FROM THE *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. PROFILE VIEW OF LEACHING SYSTEM DISTRIeunoN Box SHALL BE 12' -- 10` min. from--- SET LEVEL FOR AT LEAST 2 FT. - CONCRETE COVER y Existing Foundation house to septic tank Septic tank covers must be D-BOX cover must be Not t0, Scale. within 6 in- of finished grade within 6 in. of finished grade 3 - 5'OUTLET ode over SAS - ELEV- 95.00 a' 1 8' - I X' W-Aed P...tone KNOCKOUTS Grade over Septic Tank - 95.00 Grade over D-Box - 95.00 � / / i/! �`�, / s/�- w t r/s ' wa,A.d crwA.d sror,. - - s.s' OUTLET 12' INLET �\ S 0.02 3 HOLE H-10 4' PVC (CAPPED) INSPECTION PORT -0 BE 6 S-0.10 INSTALLED AND TO BE WITHIN 8" GRADE 3' Maximum over ( 2' 47 Mapreen Rd 21' NEW OR GREATER DIST. BOX S- 0.010' per foot A ToLn p of SAS-Elev.=90.00 --t5.5'-- 4" - SCH. 40 Te EXIST. PIPES - X 1,500 GAL. - OR GREATER 7.75' , FROM FOUNDATION w 20' f 1 PLAN SECTION CROSS-SECTION K; SEPTIC TANK 11 H-10 cr. 0O r- 20 Effective Depth 24 Effective C CRAWL SPACE FOUNDATION-1 4) 11 POLYETHYLENE o o O o I Sidewalt t i _ u an 6 0 5 �) s units e �' _ �>' � 3 HOLE H- DISTRIBUTION BOX u M 0) -- 2' .- L 2' o , 6 in.of 3/4"-1 1/2" a� u A 4 06 a NOT TO SCALE �SYSTEM PROFILE soa n compacted atone ; U A.''N}e.RxxlktN�Ay.8 Cormxv©Ct!?4 NAvTEri y.,..-` Not to Scale m 10 9' Effective Vldtt, > Effective Length GENERAL NOTES 6 In.ot 3/4'-1 t/r ` SOIL ABSORPTION SYSTEM (SAS) compacted stone o 1. Contractor is responsible for Digsafe notification m INFILTRAT❑R MODEL 3050 (H-20 LOADING)/ SUMNER & DUNBAR and protection of all underground utilities and pipes. T 2. The septic tank and distribution box shall be set (OR EQUIVALENT) level on 6 of 3/4"-1 1/2" stone. NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30' /EFFECTIVE HEIGHT IS 24" 3. Backfill should be clean Sand or gravel with no stones over 3" in size. MAY BE SUBSTITUTED FOR POLYETHYLENE H- 10 TANK 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental-Services, Inc. 3-24" DIAM. ACCESS MANHOLES 5. The contractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan to -s CUT DOWN GRADE OVER SAS SO AS TO and Local Regulations. F�- = _ '_ HAVE NO MORE THAN 5 FEET OF COVER. 6. If, during installation the contractor encounters any y �` I soil conditions or site conditions that are different cl from those shown on the soil log or in our design INLET / 1 / 11 installation must halt & immediate notification be INLET ` / ``/ (:0-1 O11 ET made to Carmen E. Shay - Environmental Services, Inc- - f° THE AccEss covERs FOR THE SEPTIC TANK, N/F ROMAN CATHOLIC BISHOP OF FALL RIVER 7. No vehicle or heavy machinery shall drive over the DISTRIBUTION Box AND LEACHING COMPONENT septic system unless noted as H-20 septic components. -T.r-. .�;� �� .r,T- SHALL BE RAISED TO WITHIN 6" of 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. - ' `' - -� FINISHED GRADE STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALS 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. PLAN VIEW ON ALL OUTLET TEE ENDS --------------- ------ 10. All solid piping, tees & fittings shall be 4" diameter ----- __ 86 -- --'- Schedule 40 NSF PVC pipes with water tight joints. 3-24" REMOVABLE COVERS ----- p p g I "'--- _\ � - - 11. Municipal Water is Connected to ALL OF The Residence and Abutting .. �;." 4 r;. 56.2 _-----� -3--- --------- Properties Within 150 Feet. 88 3• min. cleoronce - I `� IN 6' min 2' min. Inlet to outlet 73"f(LET ------_-___ 84----- ------ 3 __ _ _ �___ 6'mn. - ___- -_. -._ NOTE: ALE ,o(min. Ligwd I- „ OUTLET 6 ___- `� -------------- --------- ------ --1______ - --_- - THE PROPERTY LINES ARE APPROXIMATE AND 5' -7, ---J L_ -5' -7• 8 _ _ _ _ - -- _-_-- - - 6 COMPILED FROM THE PLAN BY NELSON BEARSE, YARMOUTHPORT, MA E� I 4'-0' min. 88----_ -----_-- -------_ ___-__ � ENTITLED " PLOT PLAN OF LAND IN BARNSTABLE, MA `oo �e"n. Liquid depth ____--- �' �' --__92 OSTERVILLE, MA" DATED DEC 20, 1960 PLAN # 30468-A ' AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN - i 92P g4P ��,_ IT SHOULD BE USED FOR NO PURPOSE OTHER THAN --94 THE SEPTIC SYSTEM INSTALLATION. 10'-'0" 4• " 5 -B" I Failed , , PVC 1 Cesspool _--- - __)' - --_--`29, , VENT PIPE CROSS SECTION END-SECTION ' 6 EXISTING SP T S CES OOLT 0 BE PUMPED OUT AN 10,�, ._ - 0 REMOVED TO FACILITATE INSTALLATION OF NEW SAS. ,YP�CAL.- 1-5C�(}.,, (>�L.��N - S.EPIIC TANI( � __� � _ � -_ `� ter-- � TEST HOLE #1 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE _ :: - - _ o ,�y�_:_ = ELEV= 96.00 FROM THE EXISTING CESSPOOL TO BE DISPOSED NOT TO SCALE I � ��1500 gal. Bx \- <-�J � _ Septic Tank -'r 98 OF AS PER BOARD OF HEALTH SPECIFICATIONS. (H-10 LOADING\ _ _ - �.. _ 1P _ _ N - / --_ Cesspool / 40 POLYETHYLENE LINER FROM ELEV. -� - O WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY` 9O PERCOLATION TEST ,' Concrete 196.00 to 92.00 AND TO EXTEND 10 BEYOND SAS ASSESSORS MAP 228, PARCEL 063 Patio 4" PVC LEGEND ate of Percolation Test: MARCH 25, 2005 / / 1O Cleanout Test Performed By: CARMEN E. SHAY, R.S., C.S.E. j �� ko to Grade Results Witnessed By. WAIVER( per BARNSTABLE B.O.H.) / I i EXCAVATOR: SHAY ENVIRONMENTAL SERVICES, INC. LOT #40 '' I ' CV 10471 DENOTES PROPOSED EXISTING Percolation Rate: Less Than 2 MPI ® 30" Below Land Surface I ,�/ it 3 BEDROOM I SPOT GRADE , r ------ - l l LOT #38 DENOTES EXISTING I Test Hole /� �/ I HOUSE X 104.46 No. 1 , / i #47 i SPOT GRADE DEPTH SOILS ELEV. / , 1 --� � i _ __ , t o PL PROPERTY LINE 0 96-00 Sandy / Loam �' I 11 I I i 96P - PROPOSED CONTOUR to rR 3/2 o -a Ap 95.25 ,''� - - - - -97 EXISTING CONTOUR Lo,o dy Q i 11` LOT #39 PROJECT BENCH MARK DEEP TEST HOLE & ,o rR s/s I ; I > a i ° \\ 12,800 Square Feet +/- I TOP OF FOUNDATION PERCOLATION TEST LOCATION $ 30• B.medium 93.50 i i i o Q 1 \\ I ELEV. 100.00 (Assumed) /Coarse 6 FOOT STOCKADE FENCE Sand I I I 1 \ I 1 I I 1 •c \ I 30"- 132 25 C�7/4 II I I \\ 1 00.00' j erc #1 P LOT PLAN Depth to Pc: 0" t �'�1 \\ ------------------------------------- I Der 3o 58" ------------------------� cD -'� Perc Rate= Less Tha 2 MPI r OF PROPOSED SEPTIC SYSTEM UPGRADE I Groundwater Not Observed No Observed ESHWT �7 �` PREPARED FOR �� �� �1 ®' ADJUSTED H2O Elev. = None A d 1. ®� MS . K AT H E R I N E SULLIVAN k' (40 FOOT RIGHT OF WAY) AT #47 MAUREEN DRIVE CENTERVILLE , MA Design Calculations , Number of Bedrooms 3-..Equivalent to 330 Gal/Day (330 Gal./Day Min. per Title V) Fri \ OF~4Ss REPARED BY: oy• ' Garbage Grinder: No � R sc, E. Sl l A Y Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) E Septic Tank - 2 x 330 Gal-/Day = 660 USE 1,500 GAL. Septic Tank. v ENVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 0 20 40 50 81 P.O. BOX 627 Bottom Area: 0.74 gal/sq. ft. x 290sq- ft. = 214.60 gallons p Sidewall Area: 0.74 gal./sq. ft. x 156 sq. ft. = 115,44 gallons G/ST� EAST FALMOUTH, MA 02536 Providing: 330.04 gallons gAlfTAR\P� TEL/FAX : 508-539-7966 Use: (3) HIGH CAPACITY INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, (4' W x 7' L) TO BE USED WITH 2' OF WASHED STONE ON THE SIDES AND SCALE: 1 "=20' SCALE 1 "=20' DRAWN BY: CES DATE: MARCH 30, 2005 4' OF WASHED STONE ON THE ENDS. PROJECT#SD713 FILENAME: SD713PP.DWG SHEET 1 OF 1