HomeMy WebLinkAbout0009 MERIDETH WAY - Health 9 Merideth Way
Centerville
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UPC 12543
No. 53LOR �nCONS°
HASTINGS, MN
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No. v o`l— U 3 V Fee
'THE COMMONWEALTH OF MASSACHUSEfTS Entered in computer: ✓✓
Yes
` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for Migonl *pztem Construction Permit
Application for a Permit to Construct( . )Repair(Apgrade( )Abandon( ) O Complete System 911ndividual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel C_
Installer's Name,Address,and Tel.No. // Designer's Name,Address and Tel.No.
ZZ
Type of Building:
Dwelling No.of Bedrooms Lot Size JzZ sq.ft. Garbage Grinder
Other Type of Building 2 % r1GC-No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow // gallons per day. Calculated daily flow 3;S1?5) gallons.
Plan Date Number of sheets Revision Date
Title e
Size of Septic Tank zda2 Type of S.A.S. Q'-,,f/
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 Certifi-
cate of Compliance has been issued by is B and H __
Signed Date / d!
Application Approved by Date I L-
Application Disapproved for the foY owing reasons
Permit No. U tl�/—U3 b Date Issued I U
qo-
No. 0 O LI 030 Fee �-
j "THE�COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALT,) DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 'Yes
2pprication for Migozal *pztem Construction permit
Application for a Permit to Construct( . )Repair( t/)Upgrade( )Abandon( ) ❑Complete System D&lividual Components
97
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
eo!� i40
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
-7 ZZ
Type of Building:
Dwelling No.of Bedrooms 3 _� Lot Size 9j—sq.ft. Garbage Grinder
Other Type of Building , / T i°�1'CC`No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow �_3� gallons.
Plan Date S— V Number of sheets Revision Date
Title _ S/h�' 1/7n /i 7--
(�
Size of Septic Tank As10 Type of S.A.S.
Description of Soil,
j
Nature of Repairs or Alterations(Answer when applicable)
i.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board oo£Heeal�th. _ /
Signed 1 � y��F J� � Date �/ /ow
Application Approved by �,g l� Date / 2
Application Disapproved for the fol-Irwing reasons
Permit No. Q D d y—03 b Date Issued ) 121 A N
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CEZ,0�
that the On-site Sewage Disposal System Constructed( )Repaired( )'Upgraded( )
Abandoned( )by
at 9 .l//P // rr;,Z, / G� t �N' ' / i f has been constructed in'
accordance
with the provisions of Title 5 and the for Disposal ystem Construction Permit No. 5 U_p_?D dated I a l L
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system-will function -desi ned.
Date L 10! C im Inspector l�_
No. 0(1 L/ ) C) Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS
Migozal bps�tem�Cons�tructiori Permit
Permission is hereby granted to Constructs( )Repair( v)Upgrade(/ )Abandon( )
System located at ./��°�lGtl�'TLi R/Q, V
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 mu t be completed within three years of the date of tlu p t
Date: f U�/ Approved by ✓1
� c
TOWN OF BARNSTABLE
LOCATION SEWAGE #o7Cb5/-o?0
VILLAGE e-111 iIle ASSESSOR'S MAP & LOT f q —153
INSTALLER'S NAME&PHONE N0. �r� � � as�irc�ia-J V F—Y'9
SEPTIC TANK CAPACITY Gaon G�
LEACHING FACILITY: (type) W4,1 f4nadai �a� (size)
NO. OF BEDROOMS 3
BUILDER OR WNE v�
PERMITDA COMPLIANCE DATE: Ik-
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 Feet
within 300 feet of leaching facility)
Furnished by Aryv -ae C, ��«-•nA
r
y
yb
g lyera TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE �'��'" • ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) �� (size)
NO.OF BEDROOMS -3
BUILDER OR OWNER e-
I/� a✓
PERMTTDATE: 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,
within300 feet of leaching facility) Feet
Furnished by
49-
L� 1131
w
t ��
TOWN OF BARNSTABLE
LOCATION ����.�4 kJa� SEWAGE #oeQV-O.30
VILLAGE ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO. 4,1111L 4ol,1 14 0 V—YE 2'9;6
SEPTIC TANK CAPACITY GCoe) G� L
LEACHING FACILITY: (type) five^l 6162�rd.*.� (�� (size) i-2.f` x�f' x•��
NO.OF BEDROOMS
BUILDER OR
PERMITDATE: ���OT COMPLIANCE DATE: l U
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 J ov have
dw
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sl�'6' S�b �G,•
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I t ,
TROY WILLIAMS
SEPTIC INSPECTIONS
Certified by MA Department of Environmental Protection (508) 760-1819
40 Old Bass River Road
South Dennis,MA 02660
Commonwealth of Massachusetts 10
Executive Office of Environmental Affairs
ofi
Department of
Environmental Protection ' s -19,9,b1
William F.Wald T its
Gowaxx
Argeo Paul Cellucel ��Wvid B.Struhs
�somnhNon.r
'9i ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION I /
Property Address 3,21 n/V E ems, ��✓; J I e Address of Owner. J o N h kt//.c �✓
Date of Inspection: S//6 1y6 (If different)
Name of Inspect.ou�0 (�I vvt S Sc,_vtn c.
Company Name,Address d Telephone Number.
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Condition
ally Passes
Needs Further Evaluation By the Local Approving Authority
Fails //Inspector's Signature:� /J 1 Date:
The System Inspector shall submit a copy of this inspection report 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 yea, 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 exfultration,.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) 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Addreea: 3a 1 Al G
Owner. K¢ I�G t✓
Date of Inspection:
BI SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will 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 broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
3) OTHER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address 3ayG
Owner.
Date of Inspection: /l4f,1�4e,4/
D1 SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution boa above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(a).
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 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.
— Any portion of a cesspool or privy is within 50 feet of a private water supply well.
— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the
health and safety and the environment because one or more of the following conditions exist: system to a significant threat to public
the system is within 400 feet of a surface drinking water supply
— the system is within 200 feet of a tributary to a surface drinking water supply
— the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CUR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner.
Date of Inspeotfon:
Check if the following have been done:
Pumping information was requested of the owner,occupant, and Board of Health.
Pone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_,Z�Aa 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
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 or
/tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum.
V 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 Sub-
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Addreac �30� /V y b
Owner.
Date of Inspection:
RESIDENTIAL. FLOW CONDITIONS
Design flow: ,21-' gallons
Number of bedrooms:_,I
Number of current residents: 69
Garbage grinder(yes or
Laundry connected to system(yes or no):--S
Seasonal use(yea or no):--
Water meter readings, if available: 9 �j o 0 0
Last date of occupancy:
COMMERCIAL/I ND U S TRIAL. 11114
Type of establishment:
Design flow:------gallons/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 information:
Na �? '`"' - /`7-_r ��rt�t uc rL u w o—6 J �— !�0.✓� L
system Pumped as part of inspection. (yes or no) /Vd
If yea,volume pumped: ¢aLlons
Reason for pumping:
TYPE QF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
OverIIOw cesspool
Privy
Shared system(yes or no) (if yes, attach previous inspection records, if any)
Other(explain)
APPROXIMATE AGE o4 components, date installed (if known) and source of information:,
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 (oontinued)
Property Adder
Owner.
Date of Inspection:
<S//c, /'c
SEPTIC TANK
(locate on site plan)
i
Depth below grader
Material of construction:Zncret._metal_FRP—other(explain)
Dimensions: s
Sludge depth:_
Distance from top of sludge to bottom of outlet tee or baffle: a�
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 tomes or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of le ,etc.) Co ti y -- f-a .,�'���' C_-, je9 y L 'T �a •-, �c�'
GREASE TRAP-_/V
(locate on site plan)
Depth below grade:
Material of construction: _concrete_metal_FRP_other(ezplain)
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
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: / /Vim�
Owner. //
Date of Inspeotion:
/c
TIGHT OR HOLDING TANK: /(1i9
(locate on site plan)
Depth below grade:
Material of constriction:_concrete_metal_FRP_other(explain) -
Dimensions:
Capacity. gallons
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: /a-✓
Comments:
(note if level and distribution is equal, evidence of solids ver, evidence of leakage into or out of box, etc.)
zlr
o I CA LG.�r a Q e✓ c_V, eN
PUMP CHAMBER:_:�L49
(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) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 3a , /V y
Owner.
Date of Inspection:
SOIL ABSORPTION SYSTEM (sAs):�
(locate on site plan,if possible;excavation not required, but may e a b PProximated by non-intrusive methods)
If not determined to be present,explain:
Type:
leaching Pita, number:_jC�(n L i� /�C L Gc,c- /G% teJ r tj �S�°4t-
leashing chambers, number:_
leashing galleries, number-
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, signs of ydraulic failure level of n duig, condition of vegetation, ) �U
tea-.✓/ �- ,. w
CESSPOOLS:
(locate on site plan)
Number and conf guration:
Depth-top of liquid to inlet invert:
Depth of solids layer.
Depth of scam layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
in1low(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:-9(4
(locate on site plan)
Materials of construction:
Depth of solids: - Dimensions:
Comments: (note condition of soil, signs of hydraulic failure, level of a po ding, condition of vegetation, etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 3a/ >N y L- /P CK .
Date of Inspection: 6-116
SKETCH OF SEWAGE DISPOSAL SYSTEM:
indude ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
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L
)EPTH TO GROUNDWATER
-)epth to groundwater: `— feet adjusted high groundwater level -
' method f determination r approximation: dui i L.,. - c� � -
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go A
No....... V Z";X_3...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD',OF HEALTH
.A - p........ ...................OF........ 1 Y+J ..---•...............
rler� ,.
�C urliratiou for Biiplo iial Works Tongtrnrtinn amit
3�pplication is hereby made for a Permit to Construct ( Repair ( ) an Individual Sewage Disposal
Cam ► System at:
. ............. a .... ..... ... �. .. .... .......-----------------..._..-------- `......(.................................
�. ... ..._ G ............................. .0 -:3 4--, --• .. ....................................
nerjN Address
t
Installer Addresst
d Type of Building Size Lot__�__i.� ��'..Sq. feet
U Dwelling ? No. of Bedrooms............ ..................----------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures - _
W Design Flow.................G _.__._ ___________gallons per person gr day. Total daily flow____.___.___......_!..........gallons.
WSeptic Tank—Liquid capacity�_gallons Length___ _.'�rr". Width ..--��_. Diameter---------------- Depth..-. �.' .4�
x Disposal Trench—To..................... Width.................... Total Length.................... Total leaching area___-Z-------__•_sq. ft.
Seepage Pit No_________ _____ Diameter........6........ Depth below inlet.._.._��_........ Total leaching area._.._QQ...sq. ft.
Z Other Distribution box ( ) Dosing ank
Percolation Test Results Performed by...... ---"-.... !<20` ..............i__...__._.___...___.
P4 Test Pit No. 1..... Date____._.e?_��.�_�.I._....._._..
a
____minutes per inch Depth of Test Pit...._._ �__.__ Depth to ground water........
f=, Test Pit No. 2......-2,...niinutes per inch Depth of Test Pit-----------I. Depth to ground water......::Tn.............
! . -
•--------------------------- �- "
Description of Soil __. ___._____.t I G - 2 2
x ------ ---------.---
w
V Nature of Repairs or Alterations—Answer when applicable._.__...........................................................................................
-------------------------------------------•--------------------------------------------•---....--•-----------•-•••--•--••----------
Agreement:
The undersigned agrees.to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iyTL"
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has n issued by the board of health.
Si Ed. ------------••------•--------•......-••--•. ----- �..71
ate �Application Approved By-- . -- l y............................. �� 7{�........
% / Date
Application Disapproved for the following reasons:________________ _____ �_._......_.....
-W-—--------- - . ...
r
Date
Permit No........................... Issued-,` - --........
7 J,I F
No.........!i`i 'r � ,.. .. ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
---TV 1-.:....... .......OF....... •' � T ; i .----.........--•-
.Appliration for Bhgpoii al Works Tomuurtion Vrrmit
` Application is hereby made for a Permit to Construct ( to or Repair ( ) an Individual Sewage Disposal
System at:
z.27... .......................................L
VL �t t is
occation Addr s
r
/- /
. " __.......---� ...__ ...._-____
....................Loro.
Add
t�
a --•---C--------------- ----- ----- ••--•- --- --
Installer /
s«..W+
Type of Building] �, ,/� Size Lot___ __. .___._____Sq. feet
aDwelling No. of Bedrooms._________.:a_ ____________________________Expansion Attic ( ) Garbage Grinder ( )
p-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
P4 Other fixtures �
••- ---------- ------------
W Design Flow.---•--------.... `°z -•---gallons per person per day. Total daily flow...................."�:).........gallons.
WSeptic Tank—Liquid'capacity ,Q ,'1galions Length___ Width_ l(,�L` Diameter________________ Depth_._.`",.'"
x „ Disposal Trench—No_.................... Width.................... Total Length..................... Total leaching area....................sq. ft.
Seepage Pit No---------I...... Diameter--------- __.__ Depth below inlet.......6. ....... Total leaching area__ OK2._sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
`~ Percolation Test Results Performed by. . __ ___.. . ,_____________...__._______._.__-__ Date----- _ ' __ ___..___.__.
a
Test Pit No. J....... :_._mmutes per,inch Depth of Test Pit........12_---- Depth to ground water________ ___________
fs, Test Pit No`r
:2______'� __.minutes per iricfi Depth of Test Pit-------
....-1 ""I�., Depth to ground water-------:............
----------------------------------------•-------••-----------------
O Description of Soil I
- ..- . •• lJ -- -•---•- -:--------------------------------------------------------------------------------------
- �
................................................
UNature of Repairs or Alterations—Answer when applicable-------------------_---------------------------------------------------------------------------
----------------------------
----------------------------------------------------
Agreement
The undersigned agrees`to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE LE 5 of-`the State Sanitary Code- The undersigned further agrees not to place the system in
operation until a Certificate of, &fViance ha n. sued by the boaxd of health.
C. .---•-•-------------------- 7
----------------- ---
' ___ Date
Application Approved By!- = > ........................... V'
" Date
Application Disapproved for the following reasons- ----------------••----••-•-•................................................................................
------------------
Date
PermitNo.-----.T-------•-- :_-- --, a-•--- Issued_.......................................................
Date
THE COMMONWEALTH 07 MASSACHUSETTS
BOARD OF HEALTH
�: 1 ..... ...................
. . ... ............OF.....
CInrtifiratr of ('nrnapli rr
THIS IS TO CE TIFY, That the Individual Sewage Di a stem co r cted io�r epaired ( )
by---------------
•.. �---
• stau
ith i r
has been installed m accordance with the provisions of l of The State San' Code as described in the
application for Disposa s-works Construction Permit �To __. ___ daaed___.._ �- � '
-.--• /a q r'°............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM�WILL FUNCTION SATISFACTORY.
DATE................ _--3�--..�..... ........._------..._........--- Inspector............................................................................
w..__
'$
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No......_.(�-_ �i. ;..... '..............OF;-..- 1� � ...._.... FEE... .
Ravoll al lug (ton r i�
Permission i ereby granted `-------,- -- - ,f ..........................................................
to Construct or R�jair ( On vidual e Di osal em
at No. R'd� �• �,G d4 -Y. ���'K'R%
Street
as shown on the application for Disposal yt'orks{Construction e No____________________ d_____ __A.. ,7
Ofe.
yt ,...................
Bo r tl!ad
DATE------.....i---.............-------------------------------------------------------
FORM 1255 HOBBS IN WARREN', INC.. PUBLISHERS
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TROY WILLIAMS 1�
►'I�VQGQr
EPTIC INSPECTIONS
&7 so
Certified by MA Department of Environmental Protection w (5 /8, 385-1300
At-
19 Hummel Drive
South Dennis, MA 02660
COMMONWEALTH OF MASSACHUSETTSr?ytigc
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS QlTy�9�ll9e�
DEPARTMENT OF ENVIRONMENTAL PROTEsCTION
ONE WINTER STREET. BOSTON, MA 02108 617.292.5500
WILLIAM F.WELD TRUDY CORE
Govcmor Sccrctan
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
/ CERTIFICATION
Property Address: f U/V yG� C� Gr J I l t Address of Owner:
Date of Inspection: .S / �/, (If different)
Name of Inspector: Troy W 1 1 i a m 5
I am a DEP approved sy�em inspector pursuant to Section 1S.340 of Title S (310 CMR 15.000) / A/y a
Company Name: Troy .Williams Septic Inspections C All- .
Mailing Address: 19 Hummel Drive . South Dennis , MA 02660
Telephone Number: (908) 32 5-1300 O�2 6 3
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
asses
— Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report 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 repon 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, 8, C, or D:
A) SYSTEM PASSES:
V 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.
COMMENTS:
BI SYSTEM CONDITIONALLY PASSES:/V 119
One or more system components as described in the 'Conditional Pass section need to be replaced or repaired. The system,upon
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined', explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
Ir. —d 04/25/9,1) P.q. 1 of 10
f
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
321 Nye Road, Centerville,MA CERTIFICATION (continued)
Property Address: John Kelleher
Owner: May 14, 1998
Date of Inspection:
B) SYSTEM CONDITIONALLY PASSES (continued) AJ14
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more than (our times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Al
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has aseptic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance
(approximation not valid).
3) OTHER
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 321 Nye Road, Centerville,MA
Owner: John Kelleher
Date of Inspection: May 14, 1998
DI SYSTEM FAILS: A/M
You must indicate ei;,.er "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
_ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
gg spoo.
_ Liquid depth in cesspool is less than r;' below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
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 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.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS: A/�if
You must indicate.either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwatertreatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
i
(1-1.1--d 04/7S/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
321 Nye Road,Centerville,MA
Property Address: John Kelleher
Owner: May 14, 1998
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes, No it
Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
/ as part of this inspection.
As 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.
The site was inspected for,signs of breakout.
.t[ _ 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 or 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:
The facility owner (and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal System.
_ Existing information. Ex. Plan at B.O.H.
JC _ Determined in the field (if any of the failure criteria related to Part C is at is
sue, approximation of distance is
unacceptable) (15.302(3)(b)]
(r�vl ud 0{/25/971 -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 321 Nye Road,Centerville,MA
Owner: John Kelleher
Date of Inspection: May 14, 1998
RESIDENTIAL: FLOW CONDITIONS
Design flow:-_33 b g,p.d./bedroom for S.A.S.
Number of bedrooms:_
Number of current residents: �2
Garbage grinder (yes or no):-E 5
Laundry connected to system (yes or no):
Seasonal use (yes or no): Af6
Water meter readings, if available (last two (1)year usage (gpd): �/ 7 = S1,aou 9 4 //. s 1�� - �/ aov
Sump Pump (yes or no): A/C �/ ����0c+I
Last date of occupancy:�s�c�r
COMMERCIAUINDUSTRIAL•
Type of establishment:
Design flow: aallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title S 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 information:
Lc, y ,- . A,w- -. J, S /96 Doi— ... �n
System pumpedas pan of inspection. (yes or no) n/a `—' G�
If yes, volume pumped: gallons
Reason for pumping:
TYPE qF SYSTEM
y 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)
I/A Technology etc. Copy of up to date contract?
Chher
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no) /Vo
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 321 Nye Road,Centerville,MA
Owner: John Kelleher
Date of Inspection: May 14, 1998
BUILDING SEWER: A///a
(Locate on site plan)
Depth below grade:,o
Material of construction: _cast iron_ 40 PVC_,other (explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:
(locate on site plan)
Depth below grade:
Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions:_ "X C1 Ix- 6' /o o D
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: o? 1.2
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: �r
Distance from bottom of scum to bottom of outlet tee or baffle: /3
How dimensions were determined: g2r—o(, .
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.) VC_Tc ., ,,, ft 4— uh� Ca c `r`
L.
1.� J r- �., W O v ,. , o✓� .� U .S i h f o
t G- i s A O�� S .J C I/ I
GREASE TRAP:�/�
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene ,_other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(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.)
(—vi—d 04/25/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
321 Nye Road, Centerville,MA
Property address: John Kelleher
Owner.
Date of Inspection:May 14, 1998
TIGHT OR HOLDING TANK: N/(Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level: Alarm in working order_Yes; No
Date of previous pumping: _
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: c,'j.-
Comments:
(no a if level and distribution is equal, evidence of solids carryover, evidence of leakage into or.out of box, etc.)_D
PUMP CHAMBER:
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc,)
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 321 Nye Road, Centerville,MA
Owner: John Kelleher
Date of Inspection:May 14, 1998
SOIL ABSORPTION SYSTEM (SAS):
(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: O&-,4 x �L e c, 74vh
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note c9ndition of soil, sign of hydraulic failure, level of ponding, condition of vegetation, etc.)
Cl-
ot
�✓ "�� ✓ �_ ✓e__S L
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: N //9
(locate on site plan)
Materials of construction:
Depth of solids: Dimensions:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(—1..d 04/25/97) ., D.q• a or 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 321 Nye Road,Centerville,MA
Owner: John Kelleher
Date of Inspection: May 14, 1998
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
J361 C- k
how w���r
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pag. f of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address. 321 Nye Road,Centerville,MA
Owner: John Kelleher
Date of Inspection: May 14, 1998
Depth to Groundwater_ Feet _ adjusted high groundwntcr levcl
Please indicate all the methods used to determine High Groundwater Elevation:
V Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
V/Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
✓ c7 (../ t ti J (�t.� T t r '�'�✓�� lam.
'z 0- C._I h e l
r
TOP FNDN. AT EL. 53.18' PROVIDE IF NECESSARY SYSTEM PROFILE TEST HOLE LOGS
., ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN HADRADA LANE
BAXTER & NYE
6" OF FINISH GRADE
ACCESS COVER (WATERTIGHT) TO �MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM ENGINEER:
53.0' BARN TABLE BO H
WITNESS: S SUM v {
2" DOUBLE WASHED PEASTONE 6 g 79
EL. 51.4' RUN PIPE LEVEL DATE: / /
FOR FIRST 2' 3' MAX. PERC. RATE _ < 2 MIN INCH
EXISTING 1000
GALLON SEPTIC 50.0'f* 50.0' CLASS I SOILS
TANK (H- 10 ) GAS a
RE-USE BAFFLE �00000 49.32' o ,- o a a El C.J 0 `CB
49'49 0 49.17 LOCUS
a a a
6" CRUSHED STONE OR MECHANICAL R 0 � 0
COMPACTION. (15.221 [2]) go2So .17'2' 0 0 0 ED 0 47 Q' 53 0'
DEPTH OF FLOW - 1
4'
TEE SIZES: ( 1 % SLOPE) ( % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE
INLET DEPTH = 10" LOAM &
OUTLET DEPTH = 14,. SUBSOIL
30" 50.5' LOCATION MAP NTS
FOUNDATION-- EXIST. SEPTIC TANK 14' D' BOX 17' LEACH'AG
FACILITY 617' ASSESSORS MAP 148 PARCEL 153
*THE INSTALLER SHALL VERIFY THE •B4
LOCATIONS OF ALL UTILITIES AND ALL
BUILDING SEWER OUTLETS AND ELEVATIONS
Lu
PRIOR TO INSTALLING ANY PORTION OF MED
SEPTIC SYSTEM
a SAND
= 41.0'
> ---•FrQ,3`T -�5��50 39
�\A \\�-+,50,55
MEN p Pv�phE�_ 96 I A)
0,7R.
pp ��_ 50,60
l+;T95 0.36
�Ri I 1 - \i-50.66 144" 41.0'
52, NO WATER I�49, NOTES:
20 �' r I ENCOUNTERED
PAVED
51,30 DRIVE I ; -,EPTIC DESIGN: (GARBAGE DISPOSER IS NOT LOWED ) 1 . DATUM IS APPROX. NGVD
f
/
__<2 RATE T i
I GE R THAN LOT 6 j )EQIGN FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD 2. MUNICIPAL WATER IS EXISTING
io' FROM 19,532 SFf 3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT.
ti _ PROPOSED i JSE A 330 GPD DESIGN FLOW
10
-+52,55
51,85 SEPTIC SYSTEM i 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-
(� ` EPTIC TANK: 330 GPD ( 2 ) = 660 5. PIPE JOINTS TO BE MADE WATERTIGHT.
_ 1 } 50.15 USE A 1000 GALLON SEPTIC TANK (RE-USE EXIST.) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS,
2 52.03 COV, PO��H �` .68 LEACHING: ENVIRONMENTAL CODE TITLE V.
/
2(30 + 9.83) 2 (.74) = 118 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT� EXISTING 52 91 TEL H' > _ SIDES:
TO BE USED FOR ANY OTHER PURPOSE.
.13 DWELLING
GAS DWELLI18' a30TTOM: 30 x 9.83 (.74) 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
ETER BENCHMARK7 N i 1OTAL: 454 S.F. 336 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
1 COR BULKHEAD 52,92 � INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
ELEV=53.0' 0SE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH.
DECK
EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' 10. PUMP &- FILL W/CLEAN SAND FAILED LEACH PIT (IF NOT WITHIN
1 bETWEEN UNITS 5' OF NEW FACILITY) - OTHERWISE PUMP AND REMOVE
452,91 L�J X Z �
N M 49,62
LOT 9 (RE EXISTING
ST TH LEGEND
TITLE 5 SITE PLAN
+ 3•07 Ij 10Q.0 PROPOSED SPOT ELEVATION
-J OF
it 2 i 100x0 EXISTING SPOT ELEVATION 9 MERIDETH WAY
IN THE TOWN OF:
! POSSIBLE AREA OF FAILED - 53 1 1 00 PROPOSED CONTOUR
LEACH PIT (NC AS-BUILT 8 52,96 +52 x7 _ 70 i ( CENTERVILLE ) B A R N S TA B L E
AVAILABLE - LOCATION ELEC. TRANS
SITE PLAN)
SHOWN IS t AS PROPOSE \�w I PAD - 100 EXISTING CONTOUR PREPARED FOR:�53 �2 BORTOLOTTI CONSTRUCTION/DUNNE
PUMP AND REMOVE LEACH PIT `L� + 2' S 5 /
AND REMOVE ALL CONTAMINATED '� '� �� 52.14 / "oi 48 80 20 Q 2Q 4Q 6Q
SOILS IF WITHIN 5' OF NEW "'t
FACILITY p<qr I S .13 30
BOARD OF HEALTH
.08
' MA SCALE: 1" = 20' DATE: JANUARY 5, 2004
N�pGE <P V APPROVED DATE
s
off 508-362-4541
fox 508 362-9880
A" OF,yq ���ZH of
down cape engineering, inc. ��b� p�ELAH 9�T ono ARNE
H.
CIVIL 0 OJALA N
CIVIL ENGINEERS No.30792 A
LAND SURVEYORS Ago �F isj �o 96 °a
�3-373 939 main st. yarmouth, ma 02675 io a EN -, - s
,
ARNE 0JALA P.E., P.L.S. DATE