HomeMy WebLinkAbout0020 NORTH PRECINCT ROAD - Health ENOWH PERCINCT RD., CENTERVILL
//// ° 2Z
UPC 12534 o-
No. 2 1153 pR •a�On.��5os�
HASTINGS. MN
TOWN OF BARNSTABLE
LOCATION -jD Al,-,r-K=`E'egg ron j: SEWAGE # 7
I VILLAGE �'a✓I ui G�a ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. S�„. f '5-6
SEPTIC TANK CAPACITY l0 0 6 QA IS`
LEACHING FACILITY: (type) j a .0- (size) l V? eQ,)r
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: s COMPLIANCE DATE:
Separation Distance Between the: ,
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ti° f Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site orrwithin 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
-117
Z I fit® . a
bi 60.
TOWN OF BARNSTABLE
LDCATION A0 lJoOAIN`�-C-MIC7 SEWAGE #
+C'VILLAGE ` -V' XJJ `��_�__ ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY k(DO Cw W
LEACHING FACII,TTY: (type) Q1T (size) VZC Q 4 J! = _
NO.OF BEDROOMS 3
BUILDER OR OWNER
-PERMMATE: 0\bkC1s COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �U Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) N�0 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) N K• Feet
Furnished by �(��
S
Bap
i
No. 6 J w Fee !'(�v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplication for ;Migaar Op9tem Cougtrurtion Permit
Application for a Permit to Construct( , )Repair(44:2)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. a o noQr A fcc c;mt 5 e nj Owner's Name,Address and Tel.No.
Lot 0,3 C�..kaui\fie n'►v� o2b�1 'r- De-vA(db bAsi%VA
Assessor's Map/Parcel o tn. ercci-%<r fz, ad
Cc�t 1't.c v�\le t^1 ra
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
GN<Al�3 x�)3Fr�yzs 54—Y
P--o• 4.J6„K 6i7
1�S9 —79�,�
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 2®g/oo sq.ft. Garbage Grinder( )
Other Type of Building 5 rti le fm", y No.of Persons- Showers(V,) Cafeteria( )
Other Fixtures
Design.Flow 3 3 b gallons per day. Calculated daily flow gallons.
Plan Date $ t ' Zoo S Number of sheets l Revision Date
Title
Size of Septic Tank 1000 +i- -, Type of S.A. ?)5bu !j ryl• N r,-%-L a,
Description of Soil Cee— p)t4,
Nature of Repairs or Alterations(Answer when applicable) Sp_�
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 issue by t ' d of Health.
Sig d Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
No. J G / T , Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
01ppYicatiou for 30is;pool Op6tem Cott!6truction Permit
Application for a Permit to Construct( . j Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. a (� r a Q(� i efi a o AJ Owner's Name,Address and Tel.No.
oY 3 Ce.nber��\\e mYi oib3i �e--A1db bASi1VA �
Assessor's Map/Parcel 2 0 Y\• Peck-cT (2 o r'd u
CC-1 FIC,-<%J:\,ke 01 �.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
GA�7tw-%iNQ CA1e_r(ii>eS SNA ErivltJf]wvCw�Q1
CO . 7L'3 K 6L-7
C.C, ✓,\Ja
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 2n�/oo sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( Cafeteria( )
Other Fixtures
Design Flow b V gallons per day. Calculated daily flow 3 3\ gallons.
Plan Date, g 200 1 Number of sheets' Revision Date
`r Title Zo w
t Size of Septic Tank 1000 �i File s h��. i Type of S.A.S.z) .Sorg 15;n
Description of Soil O)", -
k
Nature of Repairs or Alterations(Answer when applicable) D)►4-, _
Date last inspected: y .. k
\.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 t ' d of Health. 7''
Sig .ed t Date
Application Approved by ~ -Date »�
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-s)''te Sewage Disposal System Constructed ( ) Repaired( )Upgraded�)
Abandoned( )by_�} k..�.(�e (r�i�trl2�ej Q,(-- -.
at 20 /1o4Xk^ tp! [,,,.�'t- &1„ACf_:1 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.� S 4k-7 dated( 13' I S
Installer .#";,&.L ep_-,,V- Designer S U-Z4>1
The issuance of t1iiis permit sshh,a.,ll not be co strued as a guarantee that the sy(�tei`�Il f'u'� n ion asdesigned.
Date 'C I�; Inspector `� l,� t
-7 - /)
No. c�CJO 5 G / Fee o c)
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Miquar *pztem CZon5truction Permit
Permission is hereby granted to Construct( )Repair( ,)�UpgradeLVQ Abandon( )
System located at 24D
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date-of this pe(mm t.
Date:_ � Approved`by —
��
9/16/03
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems. Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
hereby certify that the engineered plan signed by me
dated- t 0� concerning the property located at
t4 , ` 6cclt meets. all of the
following criteria:
• This failed system is connected to'a residential dwelling only. There,are no.commercial or
4 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 or.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) 8
B) G.W.Elevation <30 +adjustment forhigh G.W.0 0`4
DIFFERENCE BETWEEN A and B ( 'la O
SIGNED : DATE:
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.
gASeptic\pereexemp.doc
1 '
Town of Barnstable
°Ft"E r°y Regulatory Services
0
Thomas F. Geiler,Director
+ BARNSTABLE.
9� MA Public Health Division
A'ED '�A Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 8/30/05
Designer: _Shay Environmental Services, Inc. Installer: . Capewide Enterprises
Address: P.O. Box 627 East Falmouth Address: P.O. Box 763
MA 02536 Marstons Mills, MA 02632
On ( A J C7 S Capewide Enterprises was issued a permit to install a
(date) (installer)
septic system at 20 North Precinct Rd, Centerville, MA based on a design drawn by
(address)
Shay Environmental Services, Inc. dated 08/18/05
(designer)
XX 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.
OF.MgSS�cyG
nstaller's Si a CARMEN s�
E.
SHAY :N
No. 1181
0
�F A�
esigner's Signature) (Affix D �� I 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
Date: I I 1041v.:c
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: ?6 kc"i—v NG
BUSINESS LOCATION:QO p a ge—_c Sve 1, PC)
MAILINGADDRESS: � `?09 o �c" Mail To:
TELEPHONE NUMBER: C 4§N �100 996)S Board of Health
T— Town of Barnstable
CONTACT PERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601
TYPEOFBUSINESS:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES _C NO '
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your mailing
address:
ADDRESS: -20 (� - F_ecNe—N C- &Q1 LLF— A.c (�-
TELEPHONE: n2g! —L2, O �` V 94-
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides_
NEW USED insecticides herbicides rod n i i S ( e t c des)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
5 Z Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor & furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids tv
4 _
r evAC, 4 4 leApe" f e o✓e.rr
(dry cleaners) VA
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- W S
Date;
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: SuNAo �k, S 1�C� �C�1 NG
.BUSINESS LOCATION: �o j� 4�c c��'� -� �%�►�(4WLt C� '
MAILING ADDRESS`. � -• �v V? � ` i � � Mail To:
TELEPHONE NUMBER: (�509 two ` Board of Health
Town of Barnstable
CONTACT PERSON 0•. " -r 4 4
-. . ' P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601
TYPE OF BUSINESS:
Does your firm store any of the toxic or hazardous_ materials listed below, either for sale or for you own
use? YES NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your mailing
address:
ADDRESS: �0 N t� ►_< tti '� t� �t� r-tZ�l� C c C - r4
TELEPHONE: f30 f - J 2 0 S ? 9$
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(fo,r gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes �, . Road Salt (.Halite)
_ h
Hydraulic fluid (including brake fluid) \ Refrigerants
Motor--oils,," PesticidesNEW USED (insecticides,,herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
4Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes - Leather dyes
I Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
L Lacquer thinners Other chlorinated hydrocarbons,.
NEW. USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with"poison" labels
Paint brush cleaners
(including chloroform, formaldehyde,
Floor & furniture strippers hydrochloric acid, other acids)
. Metal polishes
Laundry-soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids L/ f
(dry cleaners) e I'
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY US.I�., .
i
CON1'_\1O.'\-WEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
` DEPARTMENT OF ENVIRONMENTAL PROTECTION
—� ONE WI\TER STREET. BOSTON ILA 0210E (617)292-5500
8 /
e9
TRUI>Y COXE
le, �S_ec etary
10
ARGEO PAUL CELLUCCI B. ST THS
Governor Co s o er
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR y,O,i. �9 �
PART A d `�ll,���
CERTIFICATION 99 �'`
Property Address: oZl7 rJCQ.� ,�'r-(t-C���\ Name of OwnerSi�, 1
Address of Owner:
Date of Inspection: C'1`- kC%C\ �/
Name of Inspector:(Please Print)! [ Cyr Q c- lI`�EC_K U
am a DEP approved system inspector pursuant to Section 15.
/`340 of True 5(310 CMR 15.000)
Company Name: ��„ Y #2 k le,;'rc-,L. &,, rf H+ram F
Mailing Address:�. � Ana � g4• N/4<N mil= /`1'>9 oLC�E
Telephone Number: e!� �{�;� ) (f 7
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
_ 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 (Board of Health or DEP)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 ttre
system owner and copies sent to the buyer, if applicable, and the approving authority.
NOTES AND COMMENTS
�s�-C.nr��d�SS,•2i �J�c.` S'��c GY..�T��, 1�1p ���q.� c�- ll.�(�.1�X1�, �(�1A
1 1
g�Ctt..w� �..•e.c9•S �w.�.n,� l7uc. � l-t,�y4. .
revised 9/2/98 Page IofII
:ice Prmied on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
"roperty Address: aV N• �� �`'"��
Jwner:
Date of Inspection:
INSPECTION SUMMARY: Check A, B, C, or D:
h
A. SYSTEM PASSES:
Ihave not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below. _
COMMENTS:
7
B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon
completion of the replacement or repair, as approved by the Board.of Health, will pass.
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 complying septic tank as
approved by the Board of Health.
_ 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
revised 9/2/98 Page 2of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the stem is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 R 15.303(1)(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SA AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt mar h.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATE SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AN SAFETY AND THE ENVIRONMENT:
_ The system has a septic tank and soil absorption system (SA and the SAS is within 100 feet of a surface water supply or
tributary to a surface water supply.
_ The system'has a septic tank and soil absorption system a the SAS is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system d the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system nd the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis r coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the pr sence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
property Address:
Owner:
Date of Inspection:
D. SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 R 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what ill be necessary to correct the failure.
Yes No
_ Backup of sewage into facility-or system component due to an overloaded orclo ed 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 overl ded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume' less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clog ed or obstructed pipe(s).
Number of times pumped_.
_ Any portion of the Soil Absorption System, cesspool or privy is low the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a sur ce water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a blic well.
Any portion of a cesspool or privy is within 50 feet of private water supply well.
Any portion of a cesspool or privy is less than 100 et but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has een analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, a monia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the follow- g:
The following criteria apply to large systems in ad tion 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 becau a one or more of the following conditions exist:
Yes No
the system is within 400 fee of a surface drinking water supply
the system is within 200 eet of a tributary to a surface drinking water supply
the system is located' a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public
water supply well)
�I
The owner or operator of any such stem shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for furth information.
i
revised 9/2'/98 Page 4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: ee10 t.1•'gip r�c.�`��T_
Owner:
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
NoPumping 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.
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:
Ft Existing information. For example, Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)
[15.302(3)(b))
The facility owner (and occupants,if different from owner) were provided with information on the propermaintanaa"-of
SubSurface Disposal Systems.
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
'roperty Address: :�O N,IP-4&cA>JCT—
Owner:
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 3NO_g•p•d./bedroom.
Number of bedrooms(design): O'�, Number of bedrooms (actual):Q3
Total DESIGN flow�0
Number of current residents:-05
Garbage grinder(yes or no):jpa
Laundry(separate system) (yes o no If yes, separate inspection required
Laundry system inspected es or no)
Seasonal use (yes or no): 1.3 }
Water meter readings, if available (last two year's usage (gpd): �..
Sump Pump (yes or no): J3
Last date of occupancy: T
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: gpd ( Based on 15.203)
Basis of design flow
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:
�J�fP��Gwv►�-C.v�
System pumped as part of inspection: (yes or no)�3
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
Septic tank!dietriidtiew-�oxlsoil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed(if known) and source of information: } 010�1►-5
Sewage odors detected when arriving at the site: (yes or no)
revised 9/2/98 Page 6ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
%roperty Address: av N.4tL�Ca.�T
Owner:
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
Depth below grade:_
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:;.O_
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: 1O0b qa.
Sludge depth: 0.11
"Distance from top of sludge to bottom of outlet tee or baffle:? _
Scum thickness: ( %
Distance from top of scum to top of outlet tee or baffle: �t l `
..Distance from bottom of scum to bottom of outlet tee or baffle:_(
How dimensions were determined:
-,omments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid le el in relation to outlet i vert, structural integrity,
evidence of leakage,etc.)
IL
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.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,
PART C
SYSTEM INFORMATION(continued)
'roperty Address:
Owner:
Date of Inspection:
TIGHT OR HOLDING TANK: (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 present
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:_000
(locate on site plan)
Depth of liquid level above outlet invert: -`
Comments: _
vidence of leakage into or out of box, etc.)
(note if level and distribution is equal, evidence of solids carryover,
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 umps and appurtenances, etc.)
revised 9/2/98 page 8oril
I CI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
'roperty Address:
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): '
(locate on site plan, if possible; excav tion not required, location may be approximated by non-intrusive methods)
If not located, explain:
Type:
leaching pits, number:bv*.Io
leaching chambers, number:_
leaching galleries, number:_
leaching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool, number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, cor)ditio of elation, etc.) T
I t
S
i 'J
CESSPOOLS:
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
)epth 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:Al
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
. revised 9/2/98 Page 9ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,
PART C
SYSTEM INFORMATION (continued)
$roperty Address: a e)
)wner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
Z0
t1
�J 3
Kk -Sell Ci\
r�3--13' 53 ael'
revised 9/2/98 Page 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
roperty Address:GZd
Owner:
Date of Inspection:
NRCS Report name -r>O
Soil Type_ --
Typical depth to groundwater _
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope t-'G
Surface water NjD
• Check Cellar-
Shallow wells VIP,
Estimated Depth to Groundwater tvweet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site (Abutting property, observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers ,
' Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
16
y.c�kaC t:a � ..» c1 d'Qc,\oo`;t�'
r- J
r -
revised 9/2/98 Page 11of11
f LOCe T 1.0 ode - 5EW CE PERMIT UO.
--- -1- TQLI_ER'S-1JdtJlE �- DORESS_ --
-
--Q -MF-- — QDD-RE.SS— ------- —
DIQTE—PE-R.KAIT-I-55UED
1
a..
1
S
Y � 1I
p�,V a
No......................... FEE *f.......................
THE COMMONWEALTH OF M�S;CHUSETTS
OARD 09r A
.........OF............................... ....................
Appliration -for Uhipviial Works Towitrurtion Prrutit
pplication Is hnqreby**made for a Permi to onstruct (.--Y *or Repair an Individual Sewage Disposal
Syst at
S. ....................................... --------------- ........... .................................................................................................
ocatio dre or Lot No.
Addr s s
.......................
............... .................. •.... ........... - -------------------A——.........................................
Installer Address Type of Building Size Lot.._..`.. q. feet
Dwelling—No. of Bedrooms............ ..........................Expansion Attic Garbage Grinder
Other—Type of Building ____________________________ No. of persons.-__-___-_-_________--___-_- Showers Cafeteria
Otherfix es ------------------------------------------------------ ..............................................................................................
Design Flow______________SA _____________________gallons per person per day. Total daily flow.................grig-V------------_gallons..
Septic Tank—Liquid capaci ( gallons Length________________ Width............._.. Diameter_----_--.-.__-_ Depth.-.--__----..._
x Disposal Trench—No................ �11 i---------------- -..,Xotal L h---- ------- ----- Total leaching area-..7&0�.sq. ft.
-------- ing area-----------------
Seepage Pit No...... ........... V5 o Total leach* -sq. ft.
10 ;Z
Other Distribution box Dosing tank ( ) I'//-
Z 71*4
Percolation Test Results Performed by.......................................................................... Date---------------------------------------
a Test Pit No. I----------------minutesperinch Depth of Test Pit-.-_____-___-_____-- Depth to -round water--.---.-_.--..-.--.-.-..
fZq Test Pit No. 2................minutes per inch Depth of Test Pit.....___.........__. Depth to ground water.............---_------.
r4 -------------------------------------------------------------------------------------------------------------------------------------------------------------
0 Description of Soil------------------ .................. .. w�---- X
- ------------- -------------------------
. ................
U ....................... .................. .......... ------------- -- ----------------
& og
-------------- - - ------------------------- ..... ----
�ii oe�__*- V41-
U 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 Article XI of the State Sanitary Code— The undersigned further agrees not t"lace the system in
operation until a Certificate of Compliance h b issued the boa �f health
as 'ss 6
gned Z-----------------7---------------
........... ................. ... ��?14------
Application Approved By.......... 4,jr.." late
------- 7J-
Date"
Soi
Application Disapproved for the following reasons:---------------------------------------7-
..........................................................---------------
......................................................................................................I-----------------------------------------------------------------------------------------------
--2-- �- J. to
PermitNo......................................................... Issued...1......... .........................................
Date
No. ••------•---•.. F z$.... r...............
LTH
THE BOA RDAC,��' FI-B�ALTSETTS li��-
/�
1
Appliratijan -fear Mspwial Works Tomitrurtilin Permit
Application is he eby made for a Permit to Construct ( —rior Repair ( ) an Individual Sewage Disposal
System at: � f r
........................----............................. ---------•-•-•- -------•-- ---•-•. -••--•-••-••--••-•••-•---•------•--•------•----••-•-----•---•--••-••-•--•--...---•-----
Lo ation dress 5 ' or Lot No.
•' -- • ------ •- ---IF-----•---------•--------------------------•--•--...._-•-----•--•-------------.....•_..
caner Address
Installer Address
PQ
UU Type of Building Size Lot---... q. feet
Dwelling—No. of Bedrooms.............-3 ______-_-____-.__---_--Expansion Attic ( ). Garbage Grinder ( )
per, Other—Type of Building ..........................__.- No. of persons____________________________ Showers ( ) — Cafeteria ( )
a' Other d fixtures ................................... ....................... ------ -----..........---------------.._.......__......---------•-----
W Design Flow_..- .5�. •---------•----_gallons per person per day. Total daily flow................���._.---.........gallons.
WSeptic Tank—Liquid capaci�(�? gallons Length---------------- Width........_..._.. Diameter_____..-..-_--_ Depth----------------
x Disposal Trench—No ......... h----------- otal Lele-M
......_ ..... Total leaching area.--._7_,�_4r):-__sq. ft.
Seepage Pit No--------
�J-? D :_-- e o _._ Total leachin area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) O0 `/�� � /Q- ;2
Percolation Test Results Performed by------- ---------------••--•----....-••---..._.._---••--•-------•--__••-- Date____---------------------------•-•------
,� Test Pit No. 1................minutes per inch Depth of ' est Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of 'Lest Pit.................... Depth to ground water--------------------
----------------------------------------------------•--------------- ------------------------••-•••-•-•--..................................................
O Description of Soil----------------- ------•-------- -...---•••--- �r
// :� _. __r_.._.. j
---------- I .. ` `ram .._.. Zv /2`— .-G'r J
u., �a-- .. ------ - -- -------- --- ,- --------
U 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 Article XI of the State Sanitary Code—The undersigned further agrees not, to lace the system in
operation until a Certificate of Compliance has be issued y the board/df health.Carl iii///- ,(,,{ /.
ned �.. •-------- -
Li Date
Application Approved B
Date
Application Disapproved for the following reasons:--------------------------------------- ------------------------------------------------------------------
--•---••-•---•-------•--------------------------------------•---------------•----------------•------_ .... ,-
PermitNo......................................................... Issued.•-- - ........Da'------------.....Date-•----
Date
THE COMMONWEALTH OF MASSA£I�USETTS
BOARD F HEA 'T
..........................................OF.... .......... ...............................
�er�if ir�tr gf f�nrnt�iittnrr
THIS IS TO CERTIFY at the Individu Se� Disposat
e o stru e ( or R pair d ( )
by ....................y "'. --- a= ------- #-----------
,y iZ st Iler
at-------------------------- � - • �/`Jy ✓--% �- -- - -- ---•-------------•-----___-__-
has been installed in accordance with the,.provisions of Article XI of The State Sanitary Code as described inj_j-he
application for Disposal Works Construction Permit No 7S.__.- .Z�.......... 'dated...._./D_--)..7-------- -__j-•-•---•-
THE ISSUANCE OF THIS CERTIFICATE SHALL"RIOT BE CON ® AS GUARANTEE THAT THE
SYSTEM WIL� FUNC ON SATISFACTORY.
-
neco
DATE.... -------- ---••
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE LT
No....... .... ..... FEE-----....---------------
Permission is ereby granted___
to
at No Construct ( _ orr eWj."' ( J %H ic)ug. pal yst m
.----•--••--•---•-•---•-J...............................---- ----------------------- -----------------------------------------------------------
St e t
as shown on the application for Disp'osah'tVorh'�'Construction P
� ws + No. ____ -
........_..._.
of". eath
DATE------ rwM
-..- ,.
Vow
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS.,,..
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a'"�'fl b�.6/ ®A✓ T6d/�$ .4CP4,Qh/ IS 40CA7-E0 OA1 TNE. 1` i fir�
.� �AVOWid/ M��'��t/ �iti/D TN�iT I,T � 3 '+
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C/v/iL
EO'A-fOC/T E
min. from *NOTE, ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A • � � + r / `� `
ALL OUTLET PIPES FROM THE , `Fe
Existing Foundation �-,...1.0,to septic tankLEASTX 1 «►
PROFILE VIER OF LEACHING SYSTEM SET LEVEL F TRIOUTION BOAT SMALL°2E R 12 CawcRETE cov><R
Septic tank town must be D-BOX cowr mint h•e � +
0 within 6 in. of pniehed grade ado ow SAS - ELEV- 99.00 �' ' •� �•�' 2 e \within 6 k1. of finished rode 3 - 5. OUTLET
` Grade o.r Septic Tank - 99.00 �Grade o.er D-Boa - 99.00
I• eo I G4 • we""4YrMN seem d I/1• - I/7• seeped Arlewe �`\,^ KNOCKOUTS /
INSPECTION cover mint be -15.5• •'• -) + l 12• INLETQf._r�l
within 6 in. of finished prods WTIET a• vA+/T � 1
S 0.02 1 HOLE H-10 ///
DIST. BOX 3' Maxknum Cowr Top of SAS-ELev.-96.73 \ :�, - e 2 / Y
g 12 LEXIST S-0.01 a Grectr S- 0.010• per foot ~15 S• �� !1
FXIST. PIPE ^ ^ GAL. 15' o 0 000ot - SCH. 40 T FROM EXIST. FOUNDATION o, TANK ao 20' CM o Effecom De h PLAN SECTION CROSS-SECTION2 'Jnits Q B.S' 17'CONCRETE Ftx.l FOUNDr1 u u0 II 45 rn I 03 q' 4 d d �.
e M.ot J/4•-+ , r > ; � '-' zb. 3 HOLE H-10 DISTRIBUTION BOX
SYSTEM PROFILE > / $ �� 12'compacted stone Effective Length NOT TO SCALE ;
Not to Scale - _'c Evc•caw Width > aM�YM>rY a CqI 93",11 '1
_c'I _'c C1 -6 SDIL ABSORPTION SYSTEM (SAS)
6 in.of 3/4•-1 1/2' 5' PROVIDED o 500 - C H-10 LEACHING UNITS / WIGGINS PRECAST GENERAL NOTES
0 WITHIN 6" BELOW GRADE compacted stone
NOTE: ALL COMPONENTS MUST HAVE RISERS T Bottom of TeeHole 1 Elev.- 6 GO7.0o Not to Scale 1. Contractor is responsible for Digsafe notification
----------_---------------_____------ and protection of all underground utilities and pipes.
Obs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED 2. The septic tank onq distribution box shall be set
level on 6" of 3/4 -1 1 2" stone.
3. Backfill should be clean sand or gravel with no
stones over 3" in size.
4. This system is subject to inspection during installation
PERCOLATION TEST 5. by Carmen E. Shay - Environmental Services, Inc.
The contractor shall install this system In accordance
with Title V of the Massachusetts state code, the approved plan
I Date of Percolation Test: AUGUST 17, 2005 and Local Regulations.
Test Performed By. CARMEN E. SHAY, R.S. 6. If, during installation the contractor encounters any
Results Witnessed By. WAIVER (per BARNSTABLE B.O.H.) soil conditions or site conditions that are different
EXCAVATOR: Shay Environmental Services, Inc. from those shown on the soil log or in our design
Percolation Rate: Less Than 2 MPI ® 42" installation must halt & immediate notification be
,. made to Carmen E. Shay - Environmental Services, Inc.
M;L - -- -� 7. No vehicle or heavy machinery shall drive over the
" , Test Hole Test-Hole-
est HOIe septic system unless noted as H-20 septic components.
No. 1 � -- No. 2
134.00' 8. Install Tuf-Tite gas baffles or equals on all outlet tee enas.
DEPTH SOILS ELEV. DEPTH SOILS ELEV. Failed 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
0 99.00 0 99.00 Leach Plt TEST HOLE #1 f55' �'
Loamy Loamy 10. All solid piping, tees & fittings shall be 4" diameter
ELEV.= 99.00 f �� Schedule 40 NSF PVC es with water tight joints.
Sand Sand 25' + pipes 9
10 r 3/2 10 r 3/2 0 - -- ---- 11. Municipal Water s Connected to The Residence and Abutting
0"-6" A 98.50 0•-6" A 98.501 ^ .r<,'.'- a
Properties Within 150 Feet.
Loom I` NINOb3� ,i1 TEST HOLE 2 '
is y Loamy �'' 'I # THE PROPERTY LINES ARE APPROXIMATE AND
Sand Sand ELEV.= 99.00 i COMPILED FROM THE SURVEY PLAN GENERATED BY
10 vR s/e 10 rR 5/6
I-0 I 4' DOWN CAPE ENGINEERING, ENTITLED
B"- Q. (3• 97.50i 6•- 42" Be 97.75'
D-Box "CERTIFIED PLOT PLAN FOR LOT LOT #3 NORTH PRECINCT ROAD, CENT., MA,
Tt
Sand Sand 1000 GALLON
Med. Med. EXIST. 1i i DATED OCT. 15, 1975 and (PLAN BOOK 281, PAGE 73)
t: I
2.5 Y 7/4 I 2.5 Y 7/4 H-10 SEPTIC TANK L 29.5' & THE DEED DESCRIPTION ( BOOK 12241 PAGE 048)
40*-144"1 C, 87.001 42•-144• C, 87.0o f IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
I PROJECT BENCH MARK I i pJC� THE SEPTIC SYSTEM INSTALLATION.
I TOP OF FOUNDATION
ELEV. = 100.00 (Assumed) L EXISTING TANK & LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE
f �
98---_ ----_--- EXISTING 11 ' NOTE. ANY STRIPPED OUT SOIL CONTAINING LEACHATE
EXIST. 9 FROM THE EXISTING TANK AND LEACH PIT TO BE DISPOSED
3 BEDROOMGARAGE �' OF AS PER BOARD OF HEALTH SPECIFICATIONS.
HOUSE
NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY
i #zo � ,' LOT #2
LOT ##4 ASSESSORS MAP 148, LOT 121 of -
2 v E N
# C I �' 0 104X1
1 DENOTES PROPOSED
Pert
SPOT GRADE
Depth to Perc: 42" to 60"
Perc Rate= Less Than 2 MPI I i
Groundwater Not Observed I i i X 104.46 DENOTES EXISTING
No Observed ESHWT ________-- I I �� f �' SPOT GRADE
ADJUSTED H2O Elev. = None --_
PL PROPERTY LINE
PROPOSED CONTOUR
-- z I EXISTING ; - - - - - -97 EXISTING CONTOUR
DRIVEWAY I i
'� I I f I
LOT #3 + - i �'� j_4
DEEP TEST HOLE &
20,100 Square Feet / 3 '_-_ ' i PERCOLATION TEST LOCATION
I I �
2-16• DIAM. ACCESS MANHOLES I
e'
I I 6 FOOT STOCKADE FENCE
r r b92
INLET f \ + 0_- ---------------- ----134 DO' I I PLOT PLAN
/ OU T
l
,� '`ti• THE ACCESS COVERS FOR THE SEPTIC TANK, \ I l
' •,;-ro, �.4- � Tc;. •c �-;-.M SE DEEPER+THAN INCHE AND LEACHING
tBELOW FINISHED __ ,' ', ____ _ _____ _ ______ OF PROPOSED SEPTIC SYSTEM UPGRADE
GRADE SHALL BE RAISED TO WITHIN e" OF -------------------------------------------------
STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. PREPARED FOR
PLAN VIEW INSTALL TUF-TITS GAS BAFFLES OR EOuA�S I D E V A L D 0 8c C R I S T I N A D A S I L V A
3-24' REMOVABLE COVERS
11 NOR TH PRECINCT ROAD AT
{ t. # 20 NORTH PRECINCT ROAD
3 min. clearance " +
NLET _ min.T_lK min. Inlet to outlet a. m� C E N T E R V I L L E, MA
F7 L1qu�Tewl OUTLET
10• mtn. I ,�•
5 -r * ---- S L__ 5' -7• Design Calculations PREPARED BY:
;. ? '• 4'-0• min. /� �/ E.
0 /�
i o.ew. Liquid awtn Number of Bedrooms: 3 Equivalent to 330 Gol./Day (330 Gal./;,ay Min. per Title V) C1'1 RMl/ N L� . AJ H!1 Y
o
Garbage Grinder: No � vc
Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) R N tiG
.. ,• •' �' t• r: "' } Septic Tank - 2 x 330 Gal./Day - 660 USE EXIST. 1,000 GAi.. Septic Tank. O 20 40 50 o E ENVIRONMENTAL SERVICES, INC.
6._0• 4 -t0• SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch " S
CROSS SECTION END-SECTION Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. = 222.00 gallons I P.O. BOX 627
Sidewall Area: 0.74 gal./sq. ft. x 148 sq. ft. - 109.50 gallons �o EAST FALMOUTH, MA 02536
Providing: = 331.50 gallons OfsTER
TYPICAL 1000 GALLON SEPTIC TANK SCALE: 1 ' =20' SANI �P� TEL/FAX : 508-539-7966
NOT TO SCALE Use: (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH,
TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND 1 "=20' DRAWN BY: CES DATE: AUGUST 18, 2005
4' OF WASHED STONE ON THE ENDS. PROJECT#SD790 FILENAME: SD790PP.DWG SHEET 1 OF 1