HomeMy WebLinkAbout0041 MERIDETH WAY - Health 41 MEREDITH WAY,CENTERVILLE
A=147- 117
Owrford, NO. 1521/3 ORA
10%
mm
i
No. '3 Fee AlU —
,
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Yicatiou for his sad 6pstetn Construction Permit
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) [:]Complete System Individual Components
Location Address or Lot No.. . C r� O er's Name,Address,and Tel.No. �/
Assessor's Map/Parcel J� LIZ
Installer's Name,Address,and Tel.No. Designer's Name,Add re and Tel.No.
�3fi3 �xcavQfte)o 50-477- 065,� D6wnCrp._.
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building ZL5ICJ&A� . No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) _3 gpd Design flow provided gpd
Plan Date f �p f 1 '3 Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S( 3 Z X 3 X
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board f Health. (7 ff� `J
S, Date I I I
Application Approved by S Date 2-
Application Disapproved by Date
for the following reasons i
Permit No. 2-O 2� 3 Date Issued L /
z��
TOWN OF BARNSTABLE
LOCATION M,_r i a,=1 k W5g4 SEWAGE# 20 1-6 ' 2 G 3
`VILLAGE Ccniccvi I c ASSESSOR'S MAP.&PARCEL Iq 7 / 11'7
INSTALLER'S NAME&PHONE NO. A3-i B EX(2%ycL I aA y II-OL S3
SEPTIC TANK CAPACITY /000 9vgel
LEACHING FACILITY.(type)`1Pc/Nc)%r-S (size) 2 x 3 x 3Z-
NO.OF BEDROOMS 3
OWNER "
PERMIT DATE: - Z Z - 13 COMPLIANCE DATE:
Separation Distance Between the:
I Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Welland 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 F
a"a
300 feet of leaching facility) f Feet
FURNISHED BY
A)47
A - "
$3• � _ G F
REAR
A . t3
nsa TOArN� OF BARNSTABLE
LOCATION V/ o r r 9 rye k4-/V SEWAGE # C-^
C
VILLA.GE � C.P ASSESSOR'S MAP &. LOT /
NAME&PHONE NO. Tc� 60
SEPTIC TANK CAPACITY J CLr-P g Q
LEACHING FACILITY: (type) 1�' 1"f' (size) _ZV OJ
NO:OF BEDROOMS
.BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leachingrffi �� � `� h'eet
C Ft
Private Water Supply Well and Leaching Facility (If any wells aon site or within 200 feet of leaching facility) �� 2 .9 �QO1 fleet
Edge of Wetland and Leaching Facility(If any wetlands existwithin 300 fee f leaching faci�y) H�� 4RNSr eet
Ct�Ep7.
Furnished by . (/ Sj
_. _ _ �
`T�� / ,
7 �'
S� P
s�' `��
���
c� �� to U
"No. ) = - Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplitatlon for Misp6sal 6pstrm Construction Permit
Application for a Permit to Construct( ) Repair(UpgradeAbandon( ) ❑Complete System Individual Components
Location Address or Lot No. "7' /V I e red W —Oer's Name,Address,and Tel.No.
Assessor's Map/Parcel �./4 1 �' �Q rL �" %'i / -/Ure.5� CCCs Mr t L/?X -5M 92,1' -7U0J
Installer's Name,Address,and Tel.No. Designer's Name,Addre ,and Tel.No.
�xcaValle)n 5DR- Y77- 0653 DawnCap,,:,,
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building 7P 5jCjPn C t No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 ,30 gpd Design flow provided gpd
Plan Date 7 1113 Number of sheets Revision Date
Title
T> Size of Septic Tank Type of S.A.S� nD�c nP _ 1 .3 X
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
',accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board f Health. ry
Si _ Date / I•Z..Z I �J
i i`
Application Approved by �li, 1N. P r Date �2 /
Application Disapproved by Date
for the following reasons
Permit No. 2 U I b Date Issued Z /3
---------------------------------------------------------------------------------------------------------------------------------------
TH E COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( �) Upgraded( )
Abandoned( )by
at 'y (�(�1 h ��k\ has been constructed in accordance
with the_pxoa'sions of Title 5 and the for Disposal System Construction Permit No.7 01 .26 dated
Installer h L O 4 Designer \ /nni nP ((n
#bedrooms � ,/Approved design-flow gpd
The issuance of this pe i shall not a construed as a guarantee that the system wi nio design'ed J
!� ��//,��
Date / Inspector
tV
f r �
- - - - - - - - ---------------- -------------- ---- -----� - - - - -
No. G ' - - - - Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction Vermit-
Permission is hereby granted to Construct( ) Repair(✓) Upgrade( ) Abandon( )
System located at 1� d 1 I h WA (I f'
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 pust be ompleted within three years of the date of this permit.
Date Approved by V
FROM :down cape engineering inc FAX NO. :15083629880 Aug. 01 2013 03:57PM P3
bra:- � �y�:`, ,v,�'� �!'.F�.N.�1% p� �_•..]" ,�P&��°a
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1havJa1ats Ma: LT"(JU,,D;T-cdeTr
200�'�liilla 34T1' f'fi �11��n��uia,MA 0UP01
E) ce S0�'�E'�-4fi4 �axt 'iA,1 '7','0-60Y
nstafler a7:�.�;?rw.0p..aer CesV.ifw.:.A'pTa �+'wxyrt,t
Date: � ! � � °y�4Po T�;IC I�'@F7m]9i�?�t �,��3 � ssysrm.lr'� I1VJf.iIpTeOrcel
gL��arne>r� Ou?�1e furl ]fmmtitJslll�ir: !J �_� �cCa CJ4.1?�r-
I`LRl.A�JC�'+R: tJ .. Q �J L•' _ ,��d�l.�-e�s: -7 ._Iti°Jf.�'✓
On _ -,V,9.s i ss LLed.a penni L to uFst�tll,a
(daatc)
serdo sys'Lem air. l . e'�e �. .�Q, _hw;t.d oii a rlesi slrafwu I.y
(t si g.J.c:r)
_ onatify iiirtt the replin system re.ftF:.:nr.,r,d &hnve was ius't311ed substaatia.11y Lcuurdilx ; 'tu
_hc (;.c:Si.?n, wLi�.i may it�rl-adc -Hints aav�aoveri. changes such as 1LiTrtal_;einr;aFLiau of fhu,
di:;LFzbtTti.on )OX r'+IDVOr Stp'd(:tA.A.
f cer(ify that ffic, Septic. systrua referefnced atbowt ,Aral ;n:.�t�tllr:ri v�ith rfiajoi c haci.. es
reaLti fhF'n 10' :a:t�:.rai re,ocZ0-1)11 raft the SAS'S; ur may vnt ical rc;lOC.aiinTT of atuy GODVO-u'Vt
of the st.-Ptic ^yst ua) hit;T3 a ut...'u 41,iF: e'7d.fll SLaltf- v, I.",)Cal 1b;gLi13tir.nR. Plan rC V.t�"1 T71 U1'
c a:3 liu ltl-.}' di'si}; ii�JlciN!.
GANIE:.A•
ns n.JAt.AGIVIL
'a
SU �{G50
- r,4_
Pah
p�1 `i"TF �p`��
(�7esic:r':,ti,TgLai I A�.e) (A3F;_L cr yf tm.p.11r r:-)
kD9,i{, u �tEY�I3�' TO TIBTAC D?,A1,u.b: DIV010'ri. �'LK'A':P-fr" C TE Of
N.01R, E�ldayF, I�2Y'x;juL f r:? .�7t .A.L°d'! ,� -f3lJJU.:6' 4��lit]G.._.At1l�
; u�E,lOTi+�B7[,'A'!_fit+ 'VI1tR�,gC'R�hL'R'�A,A}JIV.V%1f TI[ U.
7f n,'{:)644(41w
Town of Barnstable P# �a
7� Departiment of Regulatory Services
Public Health Division Date G ,3 MASS.
t67>� 200 Main Street,Hyannis MA 02601
4M
Date Scheduled Time Fee Pd
►o Suitability .A.ssessm ent f0r Se a Dls ® ® o
Performed By:_ Witnessed By:
Location Address M CAT,�ON& gENERAL INFORMATION
r/ Cf(j
Q r.,J ai y Owner's-Name C
Address Assessor's Map/Parcel: ��� ��7 Engineer's Name
NEW CONSTRUCTION REPAIR / Telephone#
Land Use: (�R/•�-,-.r Slopes(96) Surface Stones N '
Distances from: Open Water Body ft Possible Wet Area > 1V ft Drinking Water Wcll �� t {t
Drainage Way ft Property Line — -ft Other
ft
SIM'TCH:(Street name,dimensions of lot,exact locations of test holes&pore tests,locate wetlands in proximity to holes)
dJ`
�xs � '� d
v ` w
C
C•3 o
V4
co TV
03
Parent material(geologic) r
Depth to Bedrock_- >goo'
Depth to Groundwater. Standing Water in Hole: k Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERNANAUON FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: Ia. Depth to sell mottles: jtt
Dcpth to weeping from side of obs.hole: In, Groundwater AdjuAlment ft.
Index Well# Reading Date: Index Well IaVel___ __ A41,factor �.� A .Groundwat-s�tl 1 evxi..
Observation PERCOLATION "t TEST bate 1 i. Thne
Hole# Time at 4" _
Depth of Pere Time at G"
Start Pre-soak Time @ v Time(9"G")
End Prc soak
Rate Min./luch
site Suitability Assessment: Site Passed Sitq Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back----------
***I£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:\S EPTIC\PBRCFO RM.D O C
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other
Surface(in.) (USDA)
•(Mansell) Mottling (Structure,Stones;Boulders.
p o i ten-y.%'Qravel)
�r Yh �v. rt iJA
vo G LA
DEEP OBSERVATION HOLE LOG Hole# ?r
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.
� ) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. -
`.� o sis en 3o C ve
P
1'lro�' tM `S
DEEP OBSERVATION HOLE LOG Hole#.
Depth from Soil Horizon Soil Texture Soil Color Soil Other*
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stones,Boulders.
Co 1 to c O e
. I
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders,
Co si ten
Flood Insurance Rate Map;-
Above 500 year flood boundary No Yes
Within 500 year boundary No_ Yes
Within 100 year flood boundary No. Yes
Depth.of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas obstrved throughout tha
area proposed for the soil absorption system? -49,47
If not,what is the depth of naturally occurring pervto s material?
Certification /�V 1 c�
I certify that on 1 V (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,experdse and experience described in�10 CMR 15.017. `
Signature Datt
QAS,BP T1aPERCPORM.'DOC
eo
LOCATION SEWAGE PE MIT N0.
VILLAGE �r
INSTALLER'S NAME R ADDRESS
e U I L DE R OR OWNER
v
DATE PERMIT ISSUED �a
DAT E COMPLIANCE ISSUED � � �y
Rr
aj
/ � �
�\ I ,/
,
COMMONWEALTH OF IWASSACHLTSETTS
ExECtnm OFFICE OF ENVIR®Nm:ENTAL AFFAIE:i
DEPARTMENT OF El-MRONMENTAL PROTECTIO1,
r
TITLE S
OFFICIAL INSPECT101 FORM—NOT l'OR VOLUNTARY ASSESSMEI,tT;
S rJBSUR1 ACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CER'ITIFIC 16TION
Property Addre:�4r
r
Owner's Name: aj C
Owner's Address:
Date of Inspection: ,; 1 t /� 92001
Name of Inspector:fpka print) T cfdle T pw EOFALTH pE'jftsTABLE
Company Name: S/ F PT
Maiiing Address:
:M2
Telephone Number:
CER'ITIFIC:ATION EEITATEMENT
I certify that I have personally inspected.the sewage disposal s;rsiem at this address and that the informstiori r
below is true, accurate anc clsrnplete as Of the time of the inspectionenanr . The' ection was ��
training and e:tperience in thy: 1O� Performed based can ny
approved system inspect,ir pursuant 10 Section 1� T;tle 5(310 CA�IR 15-site sewage &000 . thsposal e s sams.I am a DI ;P
)� system:
Passes
Conditionally Passe:
Needs Further Evalu ation by the Local Approving Authority
Fails
Inspector's Signatuim .;awlf
Date:
The system inspector shall 4oi t a cop.,,,of
DEP)within 30 days of coy: letleti this inspection rep`Xt to the Approving Authority(Board of I ie:1de 07.
ag this iaspecdm-If the syaM;n is a shared system or has a design now 4q llt;N: X0
9PdDE . greater,the inspector Find the systtn owner shad submit the report to the approprisas regional office ' . s
The original should t e:'ent to the s;;ystem owner and COO.'s sent to the buyer,if applicable,and the 3p];in,ving
authority. i
Notes and Comments
""This report only describes conditions at the time of inslrvtion and under the conditions of use ert tlh:.j i
time.This inspeCtion does,s4)t address Low the system will perform in the future ender the q®e or dliflbe ,o-af
conditions of use.
Title 5 Inspection Form 6,15l2000 page I
Page 2 of 11
OFITCIAL IigiF ECTNr►N FORM-NOT FOR VOLUNTARY ASSESSM]ENI
SUBSUIivFACE Sr vAGE MPOSAL SYSTEM INSPECTION F0FJV[ 1
PAR'1C.A
CERTIFICATION(continued)
Property Address:
Ditee of
D Iapection:
Ispwdon..4'was tary: :Iteck A,B,(:,D or K I ALMAYS complete all of Section D
A. System Panes: ..
1 X1 have-not founc, nTy informwaon which indicatks tbd any of the failure criteria described in 31 t� C'l" I.i
03 or i a 310 CMIt 15..�*4 exist;=.Any failure d not e.Valudtd ateind caled'befow.
COmments: \ 1
y
It. System Coadkioul ly Psaa:
One or more sye t.-rr.components as described in the"Co�uditional Pass,"secttreed W be replaaal ;
repaired.Tl�e•system, ulrrl compledcrn of the rep acemegt Gf i�pair,.a eipproved the hoard of Health,%0 it i puss.
Answer ypsi,no or not de:ettnined(Y,t1,ND)in the for the folio statements.If"not determinead"1.I :ase
explain. 1
The septic tank i:;:.netal and over 20 years old'or th:, c tank(whether metal or not)is struczunral!;
unsound,n:h:ibits subs xtitd intlltratiion or erdiltration ar ]k failure is imminent System will pass inslN%,*,:ca if tlxi
txisting tank is replaced iOh a comp,!yiag septic tack *X raved by the Boeird'of Health.
'A metal septic tank will pass insperction if it is y 30und,not Ieaking and if Ceetificate ofColtuFd : Moe
indicating that the tank is le::s than 20 years-old.,-
NM ]able;', "
explain:
Obspa'4don of seVage backup �..�$�'��
obstructed 1 ar+aalc out'�+seat a water level tal�he distribution box dire tc)b! I xn c»
P PeEa)or dote t:� f:bro toed or-,Unem di`st t�icttion box.,S stem will
approval Cf Board OfHesdlit): j pass inspection if I'Vit9
{ ankea> )aeo aq�;ai
otou' valor is mmoved
di10p beat .or��
ND explain. /
The system req d 13t rn �
ins in oil if �r�:wsl uttl:e IIc���a�din to broken or obstructed
brokem
P�(s)•?hes)�at;till
ND explain.,
Page 3 of 11
OFFICUL INS ECTIOK FORM•NOT FOR VOLUNTARY ASSESSMEwr6
SUBSURFACE SEMI AGE DISPOSAL. SYSTEM INSPEC rION FORM
PART A
CERTIFICATION(cominued)
Property Address: �.
Owner:
Date of Inspeetbn•C. Further Evaluation h Required by the Board of Health: !
Conditions exist wlii:h require 1.3ather evaluation by tite Board of Health in order to determine if thei i .stern
is failing to protect public 3cdth.safe or the environment.
1. System win past giles Board af,He&10 delterp*es In accordance with 310 C 5.303(1)4b) ti;at tape
systens is not functioning in'a mainner erhkh will protect public health,safe d the eavircarrti it:
Cesspool or plivy is.within'SO feet of a surface water '
Cesspool or privy is within 50 feet of a bordering ve`etsted. or a salt marsh
2. S stets will fa
y }4 the>lloai/rd ,,d,Pol;�lic Water Supplier,if any)determinq i,iuit ae
system is fouc�tioning n a mouser trbl!ic health,safety and environment..
Tire system hss c„septic_tan n s;stem(SAS)and the SAS is within 100 fet,rt jai
surface water supply 1x tributary suplAy.
'Thesystem has t.septic .an SAS end the SA;.is within a Zone l�of a public watw supply.
_ Tito system has s septiteal;and SAS and the SA„,is within S0 feet~of a� Private Water supply Miel .
_ The system his s aipo,
c UW:and SAS;snd the SAS is lest than 1 OO feet but 50 feet or more torn;
private water suppi,r/ MethW used to dewming distame
"'Phis,system pass the well,water analysis,perfonrt,ed at a DEP certified laboratory,for colifcn�si
bacteria and vo o panic compounds indicate:,PM tic well is fift from pollution from that fac ilia Md
the presence of ioctia4ritrogera and nilft c aruv*Vaqual to or less than S pprn,provldfA the,nbs 4 �
failure criteria tt i;fS;;ere&A sa py of the analysis muse:be attached to this form.
3. Other:
Page 4 of l:I
OFFICIAL III SPECTION FOR34—NOT FOR VOLUNTARY ASSESSME,14'1 S
SUBSURFACE SEWAGE DIRPOSAIL SYSTEM INSPECTION FORM
PAWI7t A
CERTMCATION(continued)
Property Address: eZ'
Owner:
Date of lnapection:
D. System Failure CritaAa sppliciible to all systems:
You ia=indicate"yes"cn• ne to eech of the following fa;r j&bNpections:
Yes No
Backup of sir rva$e into fas;:.Iity or system campo�rsnt due to averloaded or clogged SAS or ce:cs! .ol
Discharge or poadins of effluent to the surface oYthc'gr"o of surface waters due to an overivii ,ed or
clogged SASS or cesspool
_ Static liquid ievel in the-distribution box above i filet invert due to as overloaded or clagg,ri'.ii* 1oir
cesspool
Liquid depth i,cesspool is less than 6"below inmirt or available volume is less than%,day 11aiii
Required pw1009 more them 4 times in the last ytter HUdue to clogged or of times puvk�ld obstructed pipe(s). I'untixz
Any portion�ofOe SAS,owspool or privy is belavv hip around water elevation.
-,_ Any portion orcesspoo!or.privy is within ioo fey:::of a surface water supply or tributary to a sur:; cc
water supply.
Any pion-m F It cesspool or privy is within a ZaeN I of a public well.
Any portion u: s cesspool a:r privy is within 50 fes:of a private water supply well:
Any portion►Orr,e cesspool()I•privy is less than 1011 feet but greater than 50 feet from a privw:e w,11:r
$Wly well with no accep:able water quality snal)sis:(This system passes if the well watt:e:.,tn nlyslis,
performed at it DEP certliled laboratory,for eaajhgi tr bacteria and volatile orgaoic.coa�sgeuu�:ds
Indicates thott sale well is inane from pollution fans that facility- the presence or a a o mmi
nitrogen sec! airrate eitrvagen b squat b oar'ikut Jibe s PP214 provided that no outer.LLlru�e: iteriu are trlggeral. A Copy of the analysis sit, , asttaC14410-this form.) ,
(Yes/No)The syet:m fg&I have determined that one or more of the above failure criteria exia ors described in 10 Cm]t 13.303,tbetsfore the gystaa.Sias.The system owner should contact th:e;1',i ::u•d.of
l4ealth to detezn iCt what vit1 be necessary to comet the failure:
E. Lame Systeses:
To be considered a large sysr*m the s3►ateee sagest salves gu:t
� *' a e flow of 10,000
You must indicate either";re;;j"or"no"oo ales >�to 1.1,ilF I
(The following criteria apply to larges ofdoe fo
Yt,nams in to the cdoeria above)
Y� no
�,. the a-vstsm is witf is i 400 fleet oi'a:
dftkiqg watea supply
..., the system is within 210
�=;
aVNAWYto a surfice d6w*weary�plY
the system is locatul iu seas'Zone 1T ofa public vs or itivearea(Iatermnt WelNie lheed
FY 11 Protections Area_11�Pq
If you have answered )or a ct,a;c a d
),es"is Section 'D "Y �'ttnp questim'io UCpon E
1D
s�i8cant threat r Section 1 sYsMM leas failed. The owner or 1) c�ldeted a s'
l5.304. The s sr r Aile teat der motion D�l q:plPerator of y irge.,Yaat '°r
Y fats ownershcu,�i,, � an ��,� amvver:nc!
asidered sr
appropriate
regiansl,ottlea of the System m Ca wf h s r A
Page 5 of 11
OFFICLA,.IN&PECTION FORM—NOT JVR VOLUNTARY ASSESSMEJNT.;
SUBSLRI'A.CE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART B
® CHECIMIST
Property Addr�:
Owner—
Date of inspaedion:
Check if the followiag have been done..You mast iandicalte"yrs"or"no"as to-each of the following:
Yes No
Punnping inforin;etion was provided by the owner, :occupant, or Hoard of Health
: t r
Were any of tt r," tern coszlpon is `M
- east pusagped out iai the pre4•iotis two weeks
_ Has the system,received normal flows in the previous two weekponoo?
Have large vol runes of water. been introduced to thr!system recently or as part of this in on
Were as,built F laces of the sy;Metn obtained and exi Ained?(If they.were not available ante as;�il.A.
was the facility•o r dwelling•:insp=W for sigma of e;aswage back tip?
Was the site rots patted for siilm of break out?
Were all system caenponent* excluding the SAS,located on site
Were the Septic tank matthblas uncovered,o
of the baffles cm tees,mates i&:.ofconstnsri paned,+nad the interior of the tank inspect for the cos dition
dimerssionS,dep' S of liquid,depth of sludge and depth of scuts. >
Was the facility owner(algid.'eccu
pants IG—ance o1'subsurface se•sage ,mangy �if di
t$f •,3m on the owner)provided with informations afssPo yataraaa?ff F )pc.
The Size and locaaio:s of the SQ,il Aboorptioa Sya*ya(SAS)on the site has been determined Wed t,
no
Existing infarno ,&-n.For. a:nPle,&Plan at dw Hoard of Hem,
_ Determined in tf.s field(if any of the Failure criteria Mated to Part C is at i acceptable)(310 Cl-M l;.302(3)(b);! ssue approximation of if i �;e
Pap 6of11
OFFICIAL DIS.PEC 01-N FORM—NOT I{OR VOLUNTARY ASSESSMlitN7';
SUBSUR11A►CE SEWAGE:RISPOSAI,SYSTEM INSPECTION FORK[
PART C
SYSTEM I.NFOItMATION
de
Property Addit�eN:���
ctC'
Owner.
Date of Inspection:
IWW CONDITIONS
RISIDENTIAL
Number of boxrooms day' t0 : Numbs of bedrooms :actual : 3
DESIGN flow basted on 310!t': IR 15-2.03(for example: 110 ia)d x#of bedrooms): 5
Plumber of cimmat residents: I _
Does residence have a gatikige grinder(yes Or no):.�o
Is laundry on a separate see wage systeaayes or no [if you+separate inspection required]
Laundry system imps l( or no)0
Seasonal use:(yes or no):.A-.
Water meter iroadi;,if t..-rpolable.(last%yam usage(Flo)):_u0
Sump Pump(yes of no):JR2 ����/
Last date of occupancy:t 611'CCP/
COh9## >eRCL41d 1U1. TftL4 .
Type of establishment:
Design flow(based on 31 D CMR 13.203 sod
Basis of design flow(seetts'1Nsrsotts/ ,,etc.)•
Grease trap present{Yes or:ua):
lndnataial waste holding tug sent(yes or no):_
Non-sanitary waste disc eged to the Title S system(yes or no):
Water muter readings available.
Lest data of cc /mte:
OTH$R
C;ENERAL INFOR1rLMON
Pitmpt Records M ��
Source of information:
Was system primped as poor:of the ' x:tiom(yes or no):
111yes,volume pumped:_____gallons-••How was quantity p�nped determined? �.
Ream for puuaping:
TY OP S1t;r1TRM
Septic tank.distnbjd,xt box,soil ibosarp dan symm
Single cesspool
_Overflow cesspool
Privy
Shared system(yes of ro)(if yes,atucb previous hepecti+m records,if any)
InnovativelAlternativa: nchnology.Attach a copy of the current operation and maintenawe contract(tni to t: /
obtained firorci aystom owt.a-)
_Tigbt tadt _Arta c3:.s,copy of ithe DEP approval
Other(describe):
Approximate age of all core;)oments,date instaUed(if vvn)�xd source of information:
_�.Ar �._ _
Were sewage odors detected %ban aniviag at the site(yes or ao;:Alp
tt
I
Page 7 of 11
OFFICIAL DISPECTION FORM a NOT ROR VOLUNTARY ASSESSM1241
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
PART C
SYSTEM INFO i.TION(continued)
•Property Address:
.14
Owner:
Date of laspectlon:
BUILDING SZWER(lows on site plan)
Depth below grade:
Materials of construction: cast iron _jL40 PVC_other ;eacplain):
Distance from private water supply well or suction line:
Comments(on condition uf,joints,venting,evidence of Ieakal;e,etc.): f
SEPTIC TANK:s(lco:ate on site plan)
Depth below
fie:�_.
Material of construction:I concrete__total—fibdr8l= _-polyethylene,
otlterlexplait0 _
Iftank is metal list age:__ Is age,cold by a Cea'tificat�:of Compliance(yes or no):
c •__(attach,a cc�r. of
e rti8cate)
Dimensions: _
Sludge depth: 1
Distance froin top of stud le to botwm Of outlet tee or battle:
Scum thickness:__ _Itt_ 9
Distance from top of scvn r to top of owlet tee or baffle:�,
Distance front bottom of teum to bottom of outlet tee or lr
How were dimensions dartennined:
Comments um
o1� '�•-
( pumping as related t "'c"mmendat")ns, inlet and outlet tee or baffle conditi
o outl invert, widsnce of le,aluSe,etc.): on, structural integrity,liquid eve,s
rAJ
GREASE TRAP:._.._(10c at+:on silo pfi,n) -• -
Depth below V%de._
(explain
eexps ai )of consttyctioa:__�;oncreEe .-mew��--poly ylene—other
Dimensions: -- .
Scum thiclm1;i7— `
Distance from top ofs�:� of
Distance from bottom of op Otttlerc tee or
Date of last purr, baffle:
.m to bottom,9 ----._._.
piS: f outlet tee or bade:
Comments(on glum
p ncc►nlmendation;1,inlet and outlet tee et•batlkle cond'
as related to nutlet in ,eI;deatce of leak
aSe,etc.): ucttnnl ice® tY,liquid hi I.91s
.........
Pages Of l l
OFFICIAL INSPECTION FORM—NOT I'OR VOLUNTARY ASSESSMTf;N 1' i
SUBSLICRA►CE SEWAGE DISPOSAI,SYSTEM INSPECTION FORK[
PART is
SYSTEM INFORMVITION(continued)
Property Address: y�i'l���C k �(
Owner:
Date of Inspection: ���f==r— .,
TIGHT or HOLDING TANK: ,tank must be pumped-s�e of inspection)(locate on site plan)
Depth below jpde: _
Material of construction: concrate-metal berg,4ss__,_,polyethylene -other(explam): .
Dimensions: --- - -
Capacity: gallrni,
Design Flow: __ s/day
(Y Alum present es or no) -
Alarm level: _ At: n! ig order(yes or no):
Date of last pumping:_
Comments(condition of sWtn and float switches,etc.):
DISTRIBUTION BOX:.X__(if present must be opevedxlocate on site plan)
Depth of liquid level above outlet invwi�:g jdq
Comments(note if box is iie vt l and distal tiution to outlets equal,any evidence of solids carryover,any evidetr : of
leakage into or out ofbox,etc.):
PUMP CHAMBER: ate on site plan)
Pumps in working or (}es or no):. _,,,_
Alarms in wo der(��-s or no):`--
Comments(not ondition of rump chamber,condition of pwm.;s and appurtenances,cu.):
Page 9 of 11
OFTICL4L 1Eq,6iPlECTION FORAM-NOT FOR VOLUNTARY ASSF,SSME N'I S
SUBSLTF;F,kCIE SKWAGE DI(.SPOSAIL SYSTEM INSPECTION FOIL14
PARj['C
S!r STEM INFORMATION(continued)
Property Address;
Date of In-peetto®°
SOEL ABSORPTION SYSTEM(SAS): (locate on mite plan,e:eavation not required)
If SAS not locaDed e:cpLdr,why:
Inching pits,number:L
lnchog chstnbm;nwnber:w
leaching tl�teriess,;lumber '-
Inching tmaches,nwnbea,loilL
Inching ticlda,nu:almr,dimensions:
overflow cesspool, number:
imovetivdaloernatiw:system "ype/name of twi mloliy:
Comments(note conditi,:,n of soil,Sivas of hydraulic faik", level of ems.): r e ponding,damp soil,condition of"velt,41 tio»,
t a q [
CESSPOOI<,S: Ne;sj,00l must bis pumped as part of inivection)(locate on site plan)
Number and c6aft ratio 1:
Depth-top Of liquid to inlet invere:
Depth of solids layer.
Depth of scuts layer.
Dimensions off;_—
Materials of construction `
Indication of tester inflow �);
Comments(note condltior,o f so'
of hydraulic faiha+e, "Cl of
PO"M condition of vegetation,
PRIVY: (locate oo:ite plan)
Materials of construction:
Dimcosions:
Depth of solids -
. omments(note cond'�"iaos , '1,elg�ofhydra dic l9 UUM le+,el of
---- � ---___ _ condition of vagetati
Page 10 of l 1
OFFICIAL,IN,9:F►EWTION FORM—NOT IUR VOLUNTARY ASSESSM>EYU- i
SURSURF016'E SEWAGE DISPOSAL 5,YSTEM INSPECTION FORM �
PART C
SYS17EM INFORMATION(continued)
Property a7
A��'
Owner: 'A
Date of Inspeetlon:—ZL' -�
SKETCH OF'SEWAGE EA1z.POSAL SYSTEM
Provide a sked:h of the sev q,,c!disposal system including ties to at least two permanent reference landmarks cr,
benchmarks.Lcau all we[is within 100 fimt.Locate where pulsiic water supply eaters the building.
3
Page l l of l I
OFFICLA,L IN 3111ECTION FORM—NOT 'FOR VOLUNTARY ASSESSME,:XT
SUBSURFACE'SEMIAGE DISPOSAL SYSTEM INSPECTION FORNf
PART 6C
SYfi..,�TEM INFORMAMION(coneinued)
Property Address:
Owner: mk i
Date of Inspection: v� 7��r"'�0
SITE EXAM
Slope
Surface water
Check calla
Sballow wells
Estimated depth to grouncl water (cV.feat
Please indicate(check)all xr..ethods use l to determine the higi ground water elevation:
Obtained from systo.m design plats on record-If cbecked,date of design plan reviewed:
Obsem-d site(ab=t ng property/observation hole withk3 ISO feet of SAS) .
Checked with local:3oard of Health-explain:
Checked with local ox4avators,installers-(attach documentation)
Accessed USGS da.stgeae-explauc
You mast desqn'be bow poll established Yby ground water kvatio
•7 e—
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH,
040W .....................OF.... .A.�N..s�!Q 4P._-.---•---••-----......--•-----........---.---..
ppliratiou for UWVagal Works Tomitrurtiuu Frrutit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
Y.......................... ..l enn'5�a �4°:.:._..... Sc�'y !1��.�'�e! .........
Location-Address or Lot No. .
.........//......----....T�I.�T..-------••--•---••-•---•------------------------------ -cR)...s�A.la................. ..........................
Owner Address
-Aht-kPty...... !o^'................................. ... ............................................................
Installer Address
UType of Building Size Lot..&4_4k__Q......Sq. feet
t-, Dwelling—No. of Bedrooms.... .......................Expansion Attic (to) Garbage Grinder (.VCR `
a
A, Other—Type of Building,0Pe9y4A/......._.... No. of persons_74l-GP......_._... Showers (d) — Cafeteria (va)
P., Other fixtures ---------------------------- ------------------------------- -----------------•--•----------•--------•----...-------.----
W
Design Flow.................��a..._.._____....__..gallons per person per day. Total daily flow._.____....................��.......gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (L j Dosing tank ( )
a Percolation Test Results Performed by-_.._.d9X;-f_.C.._.4'tiY---F'.............:.............. Date....-2.'/.?- 8-7
----------------------
Test Pit No. I---------a...minutes per inch Depth of Test Pit-----�...._._._. Depth to ground water. !a..w9 '2
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -------•-------------------------------•--------...------....--•-•-•---.....---.....--•-----------•........................................................
0 Description of Soil....Q.-s?....•........ a!P Q _emu_ s oi:
U ..--•••---------------------------o7±-...A----------- ...............- ...........---------•--------------------------------------.
----•-------------------------------••----------•---•------•------------•---...-•---------••-----------------•••-----------------•----------•-----•-----••------•--.....-----•--•-•---------------------
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 iITLIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the bod of health.
Signed...._ csse.
PP PP y `A ✓� 1 Date
Application Approved B ---- •-- -----------------•s��i�y�•�--�-------•--•-••---•-••----------- ..._.L-:2:S:.��-...-----
Date
Application Disapproved for the following reasons---------------••-•--------------------------------------------•-------------------------._...-----••----..._....
•--•-•-•--•-----------------------------------------------------------------------------------------•---.•--------•------------------•-------•----•-•--•-----•-----••---------------•-•-----------.-----
Date
PermitNo......................................................... Issued.......................................................
Date
•
...........yr
..................
.. .. Fss
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................OF....: ?. rf. . .
Appliration for Disposal Works Tontrurtion rrnti#
Application is hereby made for a Permit to Construct ( sue') or Repair ( ) an Individual Sewage Disposal
System at:
t G 7 . /�r7,�✓P cam....di ......... ►,, !� /
..........-•-•---........_. ..................•---•--=-.�.....--•---^--•---------. #+�'�:..r r iCT�E%o....... C f .is/7rF'Il.,r�-'G ................ _
Location-Address or Lot No
......................L!/ T....F.✓... .---••---.....----•..................................... d / t....................... +r f Z,,o.........................
Owner Address
Installer Address
UType of Building Size Lot... ....Sq. feet
Dwelling—No. of Bedrooms....Y).�".f........................Expansion Attic (Ce.) Garbage Grinder (liq
`4 Other—Type of Building f? jct/ No. of ersons..7!A{to t._._..._... Showers c — Cafeteria v
Otherfixtures ---------------------------------------------------------••-----------•------------.,--_..---••----•-------.....-•----•---------••......--.............
W
Design Flow......................................gallons per person per day. Total daily flow..._-...----------------!':a-�-"t......gallons.
WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( csJ' Dosing tank ( )
~' Percolation Test Results Performed by........ ........................... bate.....R.
Test Pit No. 1..........'.F...minutes per inch Depth of Test.:Pit__--_-_�'R_......... Depth to ground
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •-•----•--•--•--------------••--•--•-•--.........----•---•-......---•--..........---•.....•••...----•--•-•••....."::::.........------......••....••...•••.
D Description of Soil:--•-0-.-2.............'ee.A7 e"` "
x ------------------•-•-••.......-•----•..........---
W
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
---------------------------•----------------------------------------•---••---------------...................................................................................................
Agreement: f
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1,;�. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the boof health.
igned---•--•. ... . C,,. .a
.. ..........................
''�° r �� ................................. _........._...�S-t
Application Approved BY • '"!�.....--
Date
Application Disapproved for the following reasons:.............•-•----------------------------------------------------------------•----------------.._............
--------------•---
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.?. ............................OF.....(6,''.'.:'=x 5'..(�"........................._................
Trdifirate of TontpliFanrr
THIS IS. TO CERTIFY, That the Individual Sewage Disposal System constructed ( Yj or Repaired ( )
by A'f u r:r, 'Al,_r-x-p l� ................
------------------------------------------------•......-----------------------------------------•------....-------•--
_ Installer
at.......10..e. �` p a ✓r'r<i.......Gv Y ' ' ''ta!t_Cv
has been installed in accordance with the provisions of TITLE' 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No........ .. ...._:e ......... dated__-.______________________.___-------_-_---.__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �J
DATE.......................................................... :18 �s?k Inspector..................... 1l�•..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ZyGlc++ ........OF.... v•,' ��sri ?.........................................
FEE........................
Disposal Works Cwonoir ion rrntit
Permission is hereby granted...... -':� ---.�'< .............
-•....................................................................... ..
to Construct ( or Repair ( ) an Individual Sewa e Disposal System
at No..../' --•-•-•- � ' r•? 1-9Y,............... e—�.`r:.c. C., ,
----------------------•---------••--------.....---.......................
Street
as shown on the application for Disposal Works Construction Permit No..................... Da d/..._._____..............................
---------•-------------------------
DATE-------•--------•-•-•---•-----=
...-•-----•....................................• Bob o Health
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 4
uo GAIZUAaS 64zt
L-�tL�f i`t�cw = uo K.3 s 33o G•Pb � � . , . . .. _. ,-k D�,..�: �r � .rc„,t�:' �` ;. : i
� -tc -rA..irc a S30,, Ir a • AS15 6-PD.
use %ooc=� 4sAl_.
POSLaL PtT I.�SE l�c� Gd... !': •.: : . `1; : :. • , ,!_" ;
775,
Lz
yam. A ►.o ti 60 �s.PD.
---- TdrAL. •1.7EStG1�1 d 5 G.vn. :_: - - :__ � ' " ' IO��tlDA7•ioil -tl- -
-- : .TbTA t_ vat t_�f Fc.cw � 33D 6►Ph, - .. : :: � : : ... ,'- :-. .t . . .. �./�!` . f •_.
Gt✓tZGDI.dT10tJ fZATE : �pW 2httu�0¢ l�iS. � .. .`.�`.; � { �._ AWN-
y-
i •. ;' r r
•ti � -- :-. '^^:;• -mot'- � �. . ! .. - � � ,
�• A . N ! �.
t FA:f-iAEiU `•`r..- Ze �' ,.y.1• • ' : ? i' ? E
��'Y�, lr,T'd ,�C)'.�$ - �ONp!.�NV� i : __... _. ; .• '., -r. , la�e 0 t % .� . � ()
__ f_�_ .c..,_.1-. .. ---- -�. .-._ '. .._.-.•--- - __"""_ _.:--' , • , �.+� .,! .,. • � FYI -
T�sr P-`788 - .. � , :. - , . .. .. : .: '�._ •FG�� • ' . . ;. •� Tar 1•No.Er�►,�S
! od 1 I
LoAAA +. . . . ,..._ •� PPe Io lug •� <. �� r
-lit+/•
'box G• SEvnc lc
L000
. : _ : TANK . � �� � `�{-s ; �•'��
1 . _ GAL. _ ;-:.'.4 2 : - - - :.-. ,�• ' ' r i:#' t :I
44.
A.
__ - --• _ . __�.__��. __ . . ... .. - CE�TI�IED PLOT
'EL+. PtZp�•tL� � •... .. : �.:.:-' 10GAT10W • , CE�I�vj"
. . ... _. . ... . ,
*AT6n
Cr.wriFq TkAl- TNE' �WvlI okmom SUowu P--A�.1 RtF�RE�.10E
{-1EQt�a�J G�KPLVS W►TtA TOZ: StD�.LIN� ! : :L jll
AND SC'r�t C4 �GQUlrGAAaWTS Ot= TNt:�
LoaATEb• Wi"rVAILA _ -rt•�_ MD_ C�*O PLAI44.
Ie•�`L .. i gaXTctiZ
•-ba�l'�. . � acc�scc:rzED ►..�Na'.- .Suev��oQ�
T�-lts nt_.ti►.i 15 uo-r �AScv 064 aN oszEev►�t.G o MASS.
It.ISfCcJAnc:wt• gvc:.itAY Tt{c.. cat=c•,�T�, e'4c'W r� ANPLl GA1-1T
_ . - - •eMt�C LOT - LI tJaI '�AVlrD AcT-I Tz
ALL
TEM
LL
SYSTEM PROFILE MARKED WITHCMAGNETICTTAPEAOR BE NOTES
PROVIDE MIN 20" DIAM. WATERTIGHT
(NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORT TO
WITHIN 3" OF FINISH GRADE 2. MUNICIPAL WATER IS EXISTINGTOP r
G
51.1'
3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. r
\ MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 48.0' ° \\o
4. DESIGN LOADING FOR ALL PROPOSED PRECAST D�o
PRECAST H-io UNITS TO BE AASHO H-M Loc �r a 47 s
RISERS (TYP.)
2 4"0SCH40 PVC z e�
47.3 2" DOUBLE-WASHED PESTONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. Qo�r
PIPES LEVEL 1ST 2' OR GEOTEXTILE FABRIC
6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Z °�r
10" EXISTING 14" WITH �ha
TEE SEPTIC TANK** TEE 45 9f r0000
°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°°o°o°o°°o° °o°o°o °o°o° 310 CMR 15.000 (TITLE V.) o 9Ui is
* °°°°°°°°°°°° 6" MIN. SUMP 44.96' g000g000 0o g000g00000gog00000goo�a�o�o�o�o o�o�o�o�o�o�o° ° ° ° ° ° 0 0 0 ° O o o ° o ° o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0GAS BAFFLE ::` °°°°°°°° 12" MIN. INT. DIM. o000000000000°°°°°°°°°°0000000000...202ogoo 0o,ogogoggggg 42.80
7. THIS PLAN IS FOR PROPOSED WORK ONLY AND
> 4" PVC SET Al .005/' SLOPE NOT TO BE USED FOR LOT LINE STAKING OR ANY
45.17 45•Q ON 6" DOUBLE WASHED 3/4 1 1/2" STONE OTHER PURPOSE. a
8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
5'
6" CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR
CONCEALED WITHOUT INSPECTION BY BOARD OF Route 28
COMPACTION. (15.221 [21) HEALTH AND PERMISSION OBTAINED FROM BOARD
OF HEALTH.
SLOPE) ( 1 � SLOPE)
BOTTOM TEST HOLES 1 & 2 EL 37.8' LOCUS MAP
( 1 +l 10. CONTRACTOR SHALL BE RESPONSIBLE FOR
CALLING DIGSAFE (1-888-344-7233) AND
FOUNDATION- EXIST SEPTIC TANK 41 D' BOX 6' LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE
FACILITY OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
WORK.
*THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT
ASSESSORS MAP 147 PARCEL 117
UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED
PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE
WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE _ SHALL BE REMOVED 5' BENEATH AND AROUND THE
CONDITIONS IF NOT SUITABLE +47.29 PROPOSED LEACHING FACILITY.
12. EXISTING LEACHING FACILITY SHALL BE PUMPED
AND REMOVED OR PUMPED AND FILLED WITH CLEAN
SAND.
,+47.22
SYSTEM DESIGN:
O /
GARBAGE DISPOSER IS NOT ALLOWED
DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD
USE A 330 GPD DESIGN FLOW
+45.54 /
0
/ /r6.36 100o SEPTIC TANK: 330 GPD (2) = 660
/
/ \46.53 LOT 13 RE-USE EXISTING 1000 GAL. SEPTIC TANK **
6 16,962 SF
46.12 46.8
\ 47.14 _ _ --------- _.LEACHING:
�{+ .32 (a) \
\ / SIDES: 2[2 (32 + 3) 2 (.74)] = 207 GPD
ti r . \ � \ 48.17 BOTTOM 2[32 x 3 (.74)] = 142 GPD
TEST HOLE LOGS 146.53 \
I \ 7.88 49.33 TOTAL: 472 S.F. 349 GPD
s \ \
PAVED
ENGINEER: DANIEL A. OJALA, PE, SE I DRIVE USE (2) 32' LONG x 3' WIDE x 2' DEEP
46.77 a 27 LEACH TRENCHES OF PERF. SCH. 40 PVC PIPE AND STONE
WITNESS: DONNA MIORANDI, IRS \ 49.40
.83
DATE: 48\60
JULY 16, 2013 -�-47.5 \ ��
\
PERC. RATE _ < 2 MIN/INCH \ \ 4 .82 t 49.34
\ �4 o EXISTING BENCHMARK
CLASS I SOILS P 14065 8 / GAS DWELLING +48 774 .92 COR BULKHEAD
METER TOP FNDN. EL. = 49.4'
EL.=51.1' 1.1
49.40
ELEV. ELEV. WAGE w,�w � M A
1 z APPROVED DATE BOARD OF HEALTH
Q" 47.8' 0„ 47.8' + 7.1 47. ` �\ ST EXIST. L +-43�4 .83
+4 64\1 **
A DECK 48.
TITLE 5 SITE PLAN
LS LS . 48.48
46 477 � / �
4" 10YR 3/2 4,� 10YR 3/2
LPIT t'�/�
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downcape.com
CI�IL down cape engIneering, inc.
47.65 �� G ' civil en ineers
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NO GROUNDWATER ENCOUNTERED ���'' ;` w" �`
939 Main Street ( Rte 6A)
3- >26 0 10 20 30 40 50 FEET 7.98 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675