HomeMy WebLinkAbout0019 NOTTINGHAM DRIVE - Health 19,Nottingham Drive
a Centerville`
A►'='-172t 253
No. 42101/3 (BRA
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TOWN OF BARNSTABLE
ATION _19 1Jt'1 SEWAGE CQ
' LAGECer 1 0 ASSESSOR'S MAP & LOT �/
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY >�
� y r
LEACHING FACILITY: (type) 3 c- (size)Q j&X,9S X 9 1
. NO.OF BEDROOMS
BUILDER OR OWNER z i
PERMIT DATE: A—,�'O COMPLIANCE DATE: D
!14,
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N/A Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) �JIA Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
`� .;
1 .
-.21M
ION
I� QCAT SEWAGE PERMIT NO.
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Fr'` ,. VILLAGE
1 7 ,
NAME i ADDRESS
INSTALLER'S,__
4or ��
B UILDER OR OWN ER '::,
4.
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DATE PERMIT ISSUED
�liYf,
ISSUED
DATE C0 M P L I A N C E
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;v TOWN OF BARNSTABLE o
LOCATION 4`t jr :It1�;�n'l SEWAGE
VILLAGEQei-Y-6-,,-3 ) 0_ ASSESSOR'S MAP & LOT O 3
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
y 1
LEACHING FACILrrY: (type) (size)/ AX,9S a
NO.OF BEDROOMS 3
P
BUILDER OR OWNERS o
PERMITDATE: "'�i—12'o COMPLIANCE DATE: ® "�
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
t
6
3v 5',
No. 1W6 CD Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
\\
RppYtcatton for Mtgpogar *pq;tettt Congtructtott Permit
Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) O Complete System It Individual Components
Location Address or Lot No. IQ NO77(AJ(ndak)! Owner's Name,Address and Tel.No.
C-eA ✓zic ll4► P"fwo Cr4,C_C.4q i
Assessor's Map/Parcel 1-7 2- 2-q
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
`R6aJft2(d Wr,eyev
o �Fgz- Tc�"S7 de-L-e az&4L( )e g /
Zoi o CAI S4v70 , JOS- ?6 Z S Z 2
Type of Building:Dwelling No. of Bedrooms 3 Lot Size //
gOa sq.ft. Garbage Grinder eVb
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 3`f S' gallons per day. Calculated daily flow.33� gallons.
Plan Date s 3 Number of sheets, Revision Date ® (b
Title
Size of Septic Tank
^^ 1 O 00 -eX c S f- Type of S.A.S. 4,e vS
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) it" ih-LR- _A4�7 (P Qt
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 of Health.
Signed d Date
Application Approved by Date
Application Disapproved fo the following reason _
Permit No. Date Issued
------ — ------=----------------------
{ oL' I11YJ /L„(Jr��
/ / x• �. / /n/ .
No. `�F� L/l V� M Fee
THE COMMONWEALTH OF MASSACHUSE7S Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN� OF BARNSTABLES MASSACHUSETTS
1, �
2VVYccation for cgogar *p6tem Construction Permit
Application for a Permit to Construct( . )Repair )Upgrade( )Abandon( ) ❑Complete System ��Individual Components
_ v
w. Location Address or Lot No. (Q No77(NS k_Aok / Ow er' Name,Address and Tel.No.
-eA1-e,rV t-e— Cvctpn r
Assessor's Map/Parcel Z� 3 04kou-4
f?Z
Installer's Name Address,and Tel No. De st ner's•Name,Address and Tel.No.
Q a✓� e(d S'c►n tf-F�r�-f 5�eve c t 7' Y by�v
,fox �c12 r'orCQST � c,�-a=azc�•cu �3ar 9� / ,
' 24o E,457 SA jfl - .10,k36.2 Z i Z z
Type of Building:
Dwelling No. of Bedrooms "� Lot Size/9 j�a� sq.ft. Garbage Grinder�v�
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures Q
Design Flow `f- r gallons per day. Calculated daily flow �3 Y- I gallons.
Plan Date 3 t- b Number of sheets Revision Date O !o
Title
Size of Septic Tank (o OG •PY t J•f- Type of S.A.S. 3 367 S2J Li/A.�-I to C v S
f Q
Descripiion of Soil S'�- A- (✓l n
Nature of Repairs or Alterations(Answer when applicable) -Ari-i (e OI 4
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 thi Board of Health.
Signed I yr d d 119n Date -10 (0.
�
Application Approved by 11 � Date r�. /
Application Disapproved for the following reason
Permit No. Tj 19 Date Issued
--------- ----- ------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (ComVftance
THIS IS TO CERTIFY, that the On-site Se age Disposal System Constructed( )Repaired(W )Upgraded( )
Abandoned( )-by f�O�5(=�2 (� S Ayt Icy SQ✓ c J2 �, C
y at__19 N0A e V1 .it&-L 4-4i v1/1-2- ha been constructed in accordance
with the provisions o Title 5 and the for Disposa ystem Construction Permit N.. �` dated
Installer 1 b✓`J (c(. S Ar► ��;Atf v[ �Q/cJ, ltrc Designer (.rQ i
The issuance of this pe it s 11 ti l be construed as a guarantee that the ystem 1 n do as designed.
Date 71
Pa" & Inspector
Date
No.-^-I�1'=�-L—�''af/ -------------------------Fee
—`7 THE COMMONWEALTH OF MASSACHUSE I TS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Migoot *pgtem (Con$truction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at al id1 G l4M a/t v t
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:Constr �tion st be completed within three years of the date of this e it. G i
Date: 6 Approved by
t
Town of Barnstable
O�-it E rOw
Regulatory Services
Thomas F.Geiler,Director
+ sARN51'ABEE, �
q " a Public health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: /0 3j U
Designer: /"/e�l Installer: /,/i
IV Z
Address: O- 130 x 991 Address: aJ�'
5A-P tQVl ICH OZS37 ref7�9'�e /fig oZ6 ��
On 9-a7 06 fiQ % r
vS Air<. � was issued a permit to install a
(date) (installer)
septic system at �_� 401T-1N0At1DV—W9 based on a design drawn by
n (address)
dated &V
(designer) _
j 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.
t� 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
w of the septic system)but in accordance with State&Local Regulations. Plan revision or
certified as-built by designer to follow.
(Installer's Signature) MEYER
No. 1140 b
� a
scISTER� 1(�
�NITARWA
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RE7l?iJRN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH -THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE AA12NSTABLE PUBLIC HEALTH'DIVIS101 . '
'THANK YO.U..
Q:Health/Septic/Designer Certification Form
310 cm 'S.220: Reparation of Plans.ana Specifications rt-IM ,4Ile 411e M M
(� The plans and specitications,for every on-site system shall be prepared.as follows:
(1) -Every system shall be designed by a Massachusetts Registered Professional Engineer
or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a
system designed to discharge more than 2,000-gallons per day pursuant to 310 CMR 15.203.
Any other agent of the owner..may prepare'plans for the repair of a system.designed to
discharge not more than than 2,000 gallons per day pursuant to 310 CMR 15.203 provided -L/UU wa`�4 fill-C
they are reviewed by-a Massachusetts Registered Sanitarian and.approved by the approving
✓authority; - SM Owe
(2) Every.plan submitted for approval must be dated and bear-the stamp and signature of N f_ -7 _ ex's �
✓the designer, r` y
(3) Every plan for a new system or plan for the upgrade or expansion of an existing system �^�,�u W n �ec
which requires a variance to a property line setback distance;*must.also reference a plan
which bears the stamp and signature of a Massachiisetts. Licensed Land Surveyor in J n �� WI'0
accordance with M:C`i.L. c: 112, § SID;
(4) Every plan for a System shall be of suitable scale(one inch=40 feet or fewer for plot S�ow h 1oC A�,d✓ll Wl ,J
plans and one inch =20 feet or fewer for details of system components) Ind shall include
depiction of. L S A OoJJ J_6s
__ __ ✓ (a) the legal boundaries of the facility to be served; !
(b) the older and location of any easements appurtenant to:or which could impact the
E ` 0 system; L QreS- ,4 p r es- ° $ -eFh',- buf f-Wo v ro
(c) the location of thte all dwelling(s)or building(s)existing and proposed on the facility
and identification of those to be served by the system; /
'(d) • the'lacation of existing or proposed impervious areas, including driveways and N p 2 U o H VCIrtlA-Q
parking areas; N/,� P(I. A,r
Wlocation and dimensions of the system (including reserve area); r 5_4 51ti.y
(f). -system design calculations,including design daily sewage flow,septic tank capacity
(required and provided); soil absorption system capacity (required and provided); and SQr�Uci� pT' A;�l�
whether system is designed for garbage grinder, `—
�/ (g) North arrow and existing; and proposed contours; U �?i
(h) . location and'log of deep'observation hole tests including the date of test, existing
✓ grade elevations marked on each test, and the names of the representative of the 0,A p JP r
approving authority and soil evaluator,
- ✓ (1) location and results of percolation tests including the Gate of test and the names of U1nrf,&10 Ce.
the representative of the approving authority and soil evaluator.
/ (j} name and certification number of the Soil Evaluator of record;
W location of every water supply,public and private,
1. within 400 feet of the proposed system location in the case of surface water
supplies and gravel packed public water supply wells,
2. within 250 feet of the proposed system location in the case;of tubular public
f water supply wells, and
3. within 150 feet.of the proposed system location in the case of private water
supply wells.
) location of any surface waters of the Commonwealth, rivers, bordering vegetated
wetlands, salt marshes, inland or coastal banks, regulatory floodway, velocity zone,
surface water supplies,tributaries to surface water supplies,certified vernal pools,private
water supplies or suction lines, gravel packed or tubular public water supply wells,
subsurface drains, leaching catch basins, or dry wells; and the location of any nitrogen
sensitive area identified'in 310 CMR 15.215 within which portions of the proposed
stem are located.
0 (m) location of water lines and other subsurface utilities on the facility;
(n) observed and adjusted ground-water elevation in the vicinity of the system;
✓ (o) a complete profile of the system;
a note on the plan listing all variances to the provisions of 310 CMR 15.000 sought
—Sep "ih conjunction with the plan;
(q) . the location and.elevation of one benchmark.within 50 to 75 feet of the facility
which is not snbjcct to dislocation or loss dining construction on the facility;
W when dosing is-proposed, complete design and specification of the dosing system
/ proposed including..but not limited to dosing chamber capacity (required and.proyided),
pump curves and specifications,number of dosing cycles and depth per cycle;
1v (s) when a Recirculating Sand Filter or equivalent alternative technology is required or
proposed,a complete plan and specification for the system.including a hydraulic profile;
(t) a locus plan,to show the location of the facility including the nearest existing street;
(u) the street number and lot number,if any, of*the facility; and.
(v) the materials of construction.and the specifications of the system.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
r
o d DEPARTMENT OF ENVIRONMENTAL PROTECTION
pqM SVe
TITLE 5
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:_Map 172,Parcel 253
_19 Nottingham Drive,Centerville
Owner's Name: Donna L.Mercaldo
Owner's Address: 19 Nottingham Dr.
Centerville,MA 02632
Date of Inspection:_April 27 2001
Name of Inspector: (please print)_Charles Gilstad
Company Name:
Mailing Address: P.O.Box 2618
_Oak Bluffs,MA 02557
Telephone Number:_(508)696-0763
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 the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 1-Z- 0
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
(I
Page 2 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: Map 172,Parcel 253,Centerville_
_19 Nottingham Drive
Owner:_Donna L.Mercaldo
Date of Inspection:_April 27,2001
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"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.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
-explain.
-N The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
_N_ Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
_N The system required pumping more than 4 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
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_Map 172,Parcel 253,Centerville_
_19 Nottingham Drive
Owner:_Donna L.Mercaldo
Date of Inspection:_April 27,2001
C. Further Evaluation is Required by the Board of Health:
_N Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_n/a_ Cesspool or privy is within 50 feet of a surface water
n/a 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 any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_N_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
N The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
N The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_N_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
Page 4 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_Map 172,Parcel 253,Centerville_
_19 Nottingham Drive
Owner:_Donna L.Mercaldo
Date of Inspection: April 27,2001
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow
_X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_I_.
_X_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_X_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
_X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
_No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
_X_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone R of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:_Map 172,Parcel 253,Centerville_
_19 Nottingham Drive
Owner:_Donna L Mercaldo
Date of Inspection:_April 27,2001
Check if the following have been done.You must indicate"yes"or"no'as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X_ _ Has the system received normal flows in the previous two week period?
_X Have large volumes of water been introduced to the system recently or as part of this inspection?
X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X_ _ Was the site inspected for signs of break out?
_X_ Were all system components,excluding the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the
condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of
scum?
_X _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X _ Existing information.For example,a plan at the Board of Health.
_X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable) [310 CMR 15.302(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION'FORM—NOT F4R VOLUNTARY ASSESSMENTS'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:_Map 172,Parcel 253,Centerville-
-19 Nottingham Drive
Owner:_Donna L. ercaldo
Date of Inspection: April 27,2001
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_3_ Number of bedrooms(actual):_3_
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_330_
Number of current residents:_5
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or no): No_ [if yes separate inspection required]
Laundry system inspected(yes or no): n/a
Seasonal use: (yes or no):_No_
Water meter readings,if available(last 2 years usage(gpd)): n/a
Sump pump(yes or no):_No
Last date of occupancy:_Current
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:_Owner
Was system pumped as part of the inspection(yes or no): no_
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
_X_Septic tank,distribution box, soil absorption system
_Single cesspool
_Overflow cesspool
Privy
_no_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:_16 years old
(owner)
Were sewage odors detected when arriving at the site(yes or no): no
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_Map 172,Parcel 253,Centerville_
_19 Nottingham Drive
Owner:_Donna L.Mercaldo
Date of Inspection:_April 27,2001
BUILDING SEWER(locate on site plan)
Depth below grade:_16"+/-
Materials of construction:_cast iron _X_40 PVC_other(explain):
Distance from private water supply well or suction line:_n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):_There was no sign of
leaking.
SEPTIC TANK: X (locate on site plan)
Depth below grade:_12"+/-
Material of construction:_X_concrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 1000 ga. 5'-0"(W)x8'-0"(L)x4'-10"(D)
Sludge depth 1"
Distance from top of sludge to bottom of outlet tee or baffle:_36"+/-
Scum thickness:_l"to 2"
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: 6"
How were dimensions determined:_measured
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.): The liquid level was at the outlet invert.The tank appears to
be structurally sounds.There was no evidence of backup.
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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_Map 172,Parcel 253,Centerville_
_19 Nottingham Drive
Owner:_Donna L.Mercaldo
Date of Inspection:_April 27,2001
TIGHT or HOLDING TANK: (tank must be pumped 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(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: X (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:_even with_
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):_The"D"box appears to be structurally sound,level,with no evidence of sewage
backup.
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.):
Page 9 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_Map 172,Parcel 253,Centerville_
19 Nottingham Drive
Owner:_Donna L.Mercaldo
Date of Inspection:_April 27,2001
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
X leaching pits,number:—I—
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): The leaching pit appears to work working properly. There was no sign of structural failure.The was no
evidence of ponding.There was+/-30"of liquid in the pit. It appears to be standard flow from the septic system
and not seasonal high ground water.
CESSPOOLS: (cesspool must be pumped as part of inspection)(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(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_Map 172,Parcel 253,Centerville_
_19 Nottingham Drive
Owner:_Donna L.Mercaldo
Date of Inspection: April 27,2001
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
Nottingham Drive
Waterline
Three Bedroom House
A B
Swing Ties Ol
A1= +/-26' septic tank
A2= +/-29'
B1= +/-15' 2 ,
B2= +/-20'
A3= +/-46' +/- 18"
B3= +/-27' "D"box
3 Leaching Pit
• Page 11 of 11
OFFICIAL INSPECTION FORM _NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: Map 172,Parcel 253,Centerville_
_19 Nottingham Drive
Owner:_Donna 1.Mercaldo
Date of Inspection:_April 27,2001
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water_12_feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
X Accessed USGS database-explain:
" You must describe how you established the high ground water elevation: USGS maps and
charts
G'G t-710
LOCATION SEWAGE PERMIT NO.,
Gf I km/` ,t ,�
VILLAGE
�en ����1/�
INSTALLER'S ._ NAME i ADDRESS
\j � co// �,
BUILDER / OR "OWN ERA
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
r -
e oo l
ter::
No..... .�`( Fims....:�o�—.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF
F HE �T Z `Z,�1
YwZ................OF....C/4Y,r' �5....Q------ -.-.k,_..._...........................
. Appliratiun for Dwpa t 10orkii Tunitrnrtiun 1hormit
Application is hereby made for a Permit to Construct ( (,,I"'or Repair ( ) an Individual Sewage Disposal
S stem t
Y
... ._..---- '--�. fir..:.. - _ 7:........_
..... � �; !�r ��� elf
,p,o L,00cation ddress / Lot p Jp t C
Ow er ( ddress
i
............................
0,1-
Installer Address
Type of Building Size Lot.. X_.",Ki�.Sq. feet
U Dwelling—No. of Bedrooms........ -Expansion Attic ( ) Garbage Grinder (��
pa., Other—Type of Building ............................ No. of persons....___________-------_-___- Showers ( ) — Cafeteria ( )
Otherfixtures .----------•----------------------------------------•-.•---•--•-•-------------------------------•-•---•---
W Design- Flow..............:�_.S................gallons per person per day. Total daily flow........... ..._...__._._.....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..................s ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by....�__l __! .�. ....!./t. e.r1�I ate__..._�l=
Test Pit No. 1,1,-3.5....minutes per inch Depth of Test Pit_:....pp __..__ Depth t ground water.
.__/_ _
(i, Test Pit No. ccr .minutes per inch Depth of Test Pit__.L..r ...... Depth to ground water_®C �f
P4 �. --- ............ -•- ----.. f. -
Description of Soil ; � �• -- .......�q ..............................................................................
� 1
.................................. C.Gt c• ... ..s��n ......------......... f
U ------- n
x .-...---- �._.. ��-------- P - I '�� �' r . art
U Nature of Repairs or Alterations—A when applicable................................................................................................
---...................----.............................................................................................................................................................................
Agreement: ,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITS 5 of the State Sanitary Code—The undersigned further agrees not to place the system i
operation until a Certificate of Compliance has been ' ued by the b rd'of healt �.
Signe ..... .. ............ . . .. . . . A�-•-•--•-----•-•-•--- •-•------ 1..-
1 fat
Application Approved By....... -- ------------- ----•- ------ ........................
Date
Application Dis\pproved for t e following reasons:.................................
-•...........................................•--....--•---------'-----------------------'•-•--........--....---------•---•--•-------•---------------•--------------------••--------.................
� `I e r; — Date
Date
Permit No....... ..........-- Issued._.. [- 9 --------------
Date
FEB TOP
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HE LETH
?....: .......OF.... "...
Appliration, for Disposal Works Tonstrn.rtinn rnmit
Application is hereby made for a Permit to Construct (4,)or Repair ( ) an Individual Sewage Disposal
Syst at
..... �..l--/1� .1---: e° ...............................................1 c s f----••- -----
Location ddress r r Lo o •
g2 r
• .5 - � — ............................ ............ 1 .... .... ............... ?.e ..
Owner ddress
a � .. � --- -------------•----..... - .
Installer Address
Type of Building Size Lot.,gJ� 7:4..Sq. feet
a
Dwelling—No. of Bedrooms-------- ................................Expansion Attic ( ) Garbage Grinder
04 Other—Type of Building ............................ No. of persons----_..._-_-____-•__-_______ Showers ( ) — Cafeteria ( )
Otherfixtures -------••--------•--------------------••-•-••-----•------••-•-•-•----------•------•----------------•-••. ...
tW
Design Flow.............. .. -_--.---_-.-___gallons per person per day. Total daily flow...........S.. _.a.................gallons.
Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter___________..... Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft.
x .
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total-leaching area....- ............s ft'
Z Other Distribution box ( ) Dosing
Percolation Test Results Performed b ��": r s
Y - ` "i.. ..--- tjDate-----Test Pit .No. 1 _�'.5,�____minutes per inch Depth of Test Pit........ ........ Depth tground water-_�_°J.
44 Test Pit No. qt kn ..minutesper inch Depth of Test Pit.. ....... Depth to ground water_!..
R-4 _ _
Description of Soil .f C ,� -
x
--------••-------•-• b P _-
x -------------- --------------- ------- ..........�-�•-- ,
V Nature of Repairs or Alterations—Answ when applicable.....:..........................................................................................
•----------------------------------------------------------------------------------------••-----------------------------------------------------------•---------------------•--•-----------•--•-•-----•
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal. System in accordance with f
the provisions of TITILj 5 of the State Sanitary Code— The undersigned further agrees not to place.,"the s: st em i
operation until a Certificate of Compliance has been,*ued by the bpW of healt1j."K
• at
Application Approved By......... -•-• . ....... • . .. ........................ ------ - ...... 4?
Date
Application Disapproved or t e following reasons:PP PP f f 9 '-
........---••-•-• ...----_.... --------••-•--•--------- -••-•--••----------------
-----------
Q .---Date
Permit No........9.5..... .�------------------------- Issued- " 1 '._G?. .
------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTIf
.............OF.... �., : � ..... � ... ..................
Tntifiratr of Toutpliatta
X S I1S 70 Cr
T,IF,r iat the Individual Sewage Disposal System constructed ( l'oor Repaired ( )
--------•-- -
�,y� Inst er ..� ' ,e7
at. �.� ........ / �f•r f-' "
•-•--._....--•-------•--------•---------------------------------
has been installed in accordance wi the provisions of TITLE 5 of The State Sanitary Cod as described in the
application for Disposal Works Construction Permit No.-____%5-__f<q............... dated_--..�._. ._1 _ .....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR N EE THAT THE
SYSTEM WILL Fig CTIO SATISFACTORY.
DATE................�__. . ................................ Inspector................ . . ---• •-•--. ••• --•-•-• ...• ....-----------
THE COMMONWEALTH OF MASSACHUSETTS
BOARP,, OF HEAeL
No......................... FEE...: ..
Dispolial 19orkA inn Vrrntit
Permission is ereby granted.::.
to Cons7tr cb ( t ., Pair ( ) an ividl S.e age Disp. System
Street as shown on the application for Disposal Works Construction Permit No..'�'S-q ----- Dated......
........................... -- ------•--------•----•----••......._.
. {{
06of Health
DATE----------- --------------------------------•----•-•--
FORM 1255 A. M. SULKIN, INC.. BOSTON
z
i1Sm Pet sa��j
�irc
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Nil.'
T
y J o
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' a 9
14-
1 3
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4 0_
OF
15
'F �`-� sue, " m
RSE
T 3 A '/<S Y r/ �" �. 7 i; v, No.10951�O �
0 ,o pFCI V l�
SIONAI. NV
LEGEND
LXI :TIN® SPOT ELEVATION Ox0 P�
1>�TIFOA CONTOUR --- 0 ---- 50
C, RTIFIED PLOT PLAN
FINIISHED SPOT ELEVATION ( x� ,"
� / /NDTTi�✓G /{�a,Ni r72i LIE.
1:�.'��yt�Fa, �aCyoT. .9
FI<arSwED ,cobTouR o >d ` r_ CC_/7 � .
N'Ott- 'The location of any existing derQ_;�__ ewerage, - A�
�w.el,ls, or other utilities shown on this plan is approx-
imate only as determined from records and/or verbal ah, -�� � ,
information. The contractor is responsible for the
verification of the 'existing locations 'in the field. SCALE : / - 9n, D.A�E ► /./ Z6,� '`
Gx2n/3Rik
,DREDGE ENGINEERING CO.IN " t ° �
CLIENT. I CERTIFY THIT,x�T� :E PROPOSED
" EQISTERE REGISTERED JOB N4. 0g076- BUILDING S,H GWN' ON ' THIS PLAN
CIVIL LAND CONFORMS ' THE ZONING LAWS
DR.BY A �-A - M
ENGINEER R --�---- OF. BARNSTA'BLE , MASS.
O
# a
712 MAIN STREET, CH. 4y T�.t3'.C- /� / ;' "r� ''` ,•� ' /- � _ �---
HYANN I S, MASS.. SHEET '� OF A E ,r`f I. REG. ,WAND, SURVEYOR
E/TNeR TNESEPT/C TANAC OR
L.Ef1CH1Nr P/T ARL= MORE TNAN /d"QELOIN
/O w7r.. M/". SXIlLL SW BROUGHT TO GJ;ADE.�AJ✓ "EXTRA
�---- 9"PVC PI Pd
CONCR�E MN I . P/TCN /=•i►E-4Vy CAST be OW COd.I? S/NAiL1- BE C/SE.0
Ig FT ' /F/N GR/VEy1/A y +
COVERS • .PFip
2 M/N. CO/VCRE TE
DE CO✓ER
G E N A O
i CL A S N
1
At a—
BAc je.
LAYER
R. ON�«CAST _ - � �
I PlPE
c o ' o
OAF fp ° a GAL. ° �` � � , • . '. . • • • o •
WASMFO SMVZ
D/ST o
%'PEit!r7 SEPT/C TA MIC • s i r . . • . • • a
SoX c n • � B • r. • r• � . r�
}� 'Z f�F- o p 1 • • ECG%✓E • ` • r 3/4 . - I V2p
ti3 ; 6k"8 •. • • • • DEPTH • • • • • . WASNA .STQiYE
j-a i �s(a0 �rYl in! S! x 2,S 377
• • t • • • • • •
�rLuo�- . /! 3 x !;o = 3 s a, a • • ;. • • • • • p p PKEC,AST szmowGE
p
OF'ca=✓ 0
C,fno,rs � 490.��L � ,9� o •o • • • •. . • , • • e o . O/7 OR E�l!/V.
IAIMCMT ELEVATIONS .T TY
INYERT AT OL//LDIMCF SgO FT. `3 G iT. p/ANt.
INLET .SE'PT/C Ti4NK SZ.$ FT, � FT. D/AM. C C.SEE T�4BUL4T/oiv�
OUTLET SEPTIC TANK _FT,
I/V,[ T DJSTR/B!/T/ON BOX ST'4` SECT/Q/V OF GROuNo tt�ITER TABLE
FT,
OuTLETO/STIR/B�/7YON BDX .5"?�:.z FT, f,
INLET LEACHING 4Cl/7' s7.0 Fr. SEJ�V�4GE O/SOAS.r1 L .SYST°E/�i TA4vvLATIDN_
L EACH//YG PIT DIA EN f/ou /l -. FT
DESIGN CR/TERlA ss.a�E %s" /` o'
DIAJ,�/YSlaN;- 8-�—
NIJAlBER OF BEDROOMS - 3
Gi!4R�GED/SPOSAL(//yIT "'AlG SOIL, LOG
3 SAL./o,4v sotL 'TEST ! $O/L TEST*2 51��1. 'TEST
TQTAL EST/MATED FLO*V 3 0
/NUMBER OF'!,E°ACX/NZ P/TS_L_ Ft Ei 6 O EL1FY ,D.4 TE OF SO/L TEST / z
S/DE LEACHI/VG PER P/T !s/ S+Q. I9T. � .1 ' RESULTS iYlTNESSEO BY���p ����"e_P
907-r0ML64CN/NGPER P/T 3 $Q. F7 Svr3 5'19t` PERCOLATION AAro,* LES MIM•IINCH
TOTAL LEACH/N6 �4REA 2-- '9` SQ FT ` PERCOJAT/ONR4'PE/k2 MIN�INCH
ZiD
RESERVE LEACHING AREA ( 4 SQ FT.
5 T
� �,���• �� ��' �H OF/H •� z Lam° n�K Y L-O 7- /9 trly Tr-t eu� H 4-Nl I72 t VE;
Ira � Mal-
..
� ?
SE
No:ip951. .DAT,,E S�,FA*l
?f$ scant s� NYA�/ �✓!s M,�t�
... f? 9IST r:; w
�L
.. �� ,.> `.:�®ciREJu/vD:`�.4r�i� e�/vcouv�-�-xEm► ��l.��r�R v�;e��r� . �`/
c -
,.rJ
"BOily
`G
,;�.,,.. _ �� � �.:ROlJIVO x%tits�TER R•T, �L Y ��O�_ �'0 7 6';
AiPn'J�C_T1Ui! F_Uxt E)' :ltC U :`,'l':i�1`i Tr �i' AL\;J U i,�1--::VE�'1'AO P i 7.�'
LocATlorr 1-7 /voT'7-1 9/-'1 -- NO
VILLAGE C�i�� �(� V �-�-� _ DATE
APPLICAN'I641EQ �,ur3R/E R FEE 3C7
ADDRESS EAl7 f, :)-63z- TELEPHONE N0.�27! 3(,, 6 (Non-refundable)
ENGINEERt_��SD�� ���K/yE�lZ/t..� �NC TELEPHONE NO. 5- 2_2_zt4-
DATE SCHEDULED 25 K" SLY
(Applicant' s signat re)
. 0 O•O O O O•O . O . O O O O O . . O . . . O O O . O O . . . . . . . . . . . . . . . . . . . . O . . . . . . . . 7 . O . O . . . . . . O . . . . . .
SOIL LOG y -
. SUB DIVISION NAME � r�, ��,,'/�� /�jE0 , DATE_c ?2f �51�4TIME /Q -3®�
EXPANSION AREA: YES ENO J &.'Zty;" ENGINEER ?<:
TOWN WATER ---VRIVATE WELL Ad C'/15rbw BOARD OF HEALTH
r � tg cyL[__ EXCAVATOR
SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes )
NOTES :
-7 0
Low 17 )
is f,
37-0 _
75 0CD
i�
.> 2 M iiy
PERCOLATION RATE: /n/C
! TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION:
3 12—'7L, p4,55 9 .5,91\/P 3
!' 4 4 -
t` 5 5
! , 6 a 6
7 7
8 7,L- 9 ° G LA y S,q,v D 8
I; 9 9
to �
! 2-° M62p to
11R�� � 11
12 0 12
13 Ivv Ct�t¢7 F� jV0vf� 13
14 Grp RV PAI4 4
F ci 15 l i 15
-16 i : 16
SUITABLE FOR .SUB-SURFACE SEWAGE :- --LEACHING FIELD' _LHING PITS__
LEACHING TRENCHES
UNSUITABLE FOR SUB-SURFACE SEWAGE . REASONS:
NOTE : `°` ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH
COPY: . RETAINED BY APPLICANT
V
ASSESSORS MAP : 112.` \/o4A-0cia NOTES:
'v T°
TEST HOL = LOGS
T
PARCEL : 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH
0R� � 510C*-AL15.21t TO A2r,&W LEAU�rrY1 SO l L EVALUATOR THIS PLAN, 1"5 MASSACHUSETTS TITLE V & TOWN OF: � ��W 'R� �
�1 �p��y�fArP�(� BOARD OF HEALTH REGULATIONS.
FLOOD ZONE: �01.1 ti1s2.�t1R+0 1aRE 'f Pr r-IWM SLh& VS. (D FT- WI TNESS:'QD14 VE.SM1�P�tS E)pceAS 5.47.}�_
REFERENCE: V,P 4k((,- mq DATE: U-v 24 . 2-W(o 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES,
PERCOLAT10 RAlE: J.'LMIN SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO
CL S $ So I L'5 I.TA-IL` o►'7 gWWI INSTALLATION.
�UQ.V�it� F>✓17-�.t�l
On TN- 1 P(,,:,t�0_SD On �TH-2 : (0 2_0 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM`INSTALLATION
41 Dow zJ Cl t I ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE
FLAT` OF LATX Q,�!
t � Fill `1 DETERMINATION.
t' Wt�o (IN.(� .
-&O.r7 Il l 4) ALL PIPING TO BE 4 SCHEDULE 40 @ 1/8 / FOOT. (UNLESS
R I.DAM4 loYf~3l i L0"N SPECIFIED OTHERWISE)
01
LOGAT I ON MAP (N T-5) I`t +J ZZ �0,2.5 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A
sibLZ6 (� GARBAGE DISPOSAL.
A"
S � '�
t OCF ?JD fS�I�) 1 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED)
52 F0 �/ / Sg p� 1 E 7/ it e1 N r; MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON
2.5� !s, c 57.E C 500 2.�y� c S� ABASE OF 6"OF CRUSHED STONE.
� O �y
6's j'L In) 065,FfL" No 61 W
A/ (Lor-An&N utitwWN)
� y
SEPTIC.' SYSTEM DESIGN �g
FLOW E TIMATE to- nl.At� IML o+. �1Njf __S. 1�_l 195 ` c `--1_
� BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY
1 Sg SEPTIC TANK
f '
�30 GAL/DAY x 2 DAYS - GAL
I
1 USE ( GALLON SEPT I C TANK EX+STIl Ci Rf-PL - W/ trued rallpYi
1 Sepn c Tfi*'K- I r' PAJ LoF-D, DA44"CO OIL-
e�A/C $OIL ABSORPTION SYSTEM uN 5mpj,
Tpo h
�oneM'��'l�
I RNSr e00, r ,
GIs�0'32 oo 5t yES 4 73 �'ST g Do awml; (?5 L �: i�-,�%,:�v '�
E�rsT• P i "I DE AREA:112.5)7t•r�12•i4�2� X2 101,`j�
I T
* 7) I BOTTOM AREA: 25 x t 2.I lay X D•1`f
PSEPTIC SYSTEM SECTION
I 7�
i
BQ-i ( 6° 5 Tb W jr„1 ;Rq�,�,arK/ r 4"Ins T r6+t
` h rs h ,�Adc� lab wj►�. of��
1 1 - y '� EL, s7.a
4 EXISTING i EXIsTTN 10 Wsr�u. Iq
1 DWELLING ���� I $� ohs T3RPT=tk .�' S$_ S ,.
TOP OF FNDN p '
D BOX -) 33
EL - 63.36 +- 000 GAL 7 Sb Wa �[St
6� S�kg El.:.S7.3f3'f' � -
1 ' SEPTIC TANK ({� ,�EyrjNeSS� -c�,qo ,40
I
00
` , f y .` PLAN
`�) V � ,y'� ,�z w1 3 * SITE AND SEWAGE
s ►�
/ �ZH OF y AfAS Joey ►, LOCATION : d071MI f :tit Diz.1yE
SC'1/CEO ; ° R -,
a MEYER `1�lAt�te�
I No. 1140 `
�---- -- - -- -- -- S't> e PREPARED FOR : LUGIn-1� I
75.0 ►STE /O At 1bCOrNto
� 6q 6Z �nrrraR�h
2m� - SCALE
tz.lc. DARREN M. MEYER, R.S.
EDGED F?AVEMENT DATE: -1 3t O�
Z
P.O. BOX 981
EAST SANDWICH, MA 02537
vTINGHA M DRI VEI�OT _
3
DATE HEALTH AGENT Ph: (508) 362-2922
Z .