HomeMy WebLinkAbout0104 NOTTINGHAM DRIVE - Health �-04 NOTTINGHAMIDR, CENTERVILLE
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No. 42101/3 ORA
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.Commonwealth of Massachusetts /�a -01--7--
P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,
104 Nottingham Dr
Property Address
P y
Fedele
Owner Owner's Name
information is :s
required for Centerville V1 Ma 02632 10-20-18
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out A. inspector Information a-io
forms on the
computer,use Douglas A Brown
only the tab key Name of Inspector
to move your D.A.Brown Inc
cursor-do not Company Name
use the return
key. P.O. Box 145
Company Address
Centerville Ma 02632
City/Town State Zip Code
508-4204534 S14297
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title
5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
C� • 10-20-18
Inspect6fs Signature Date
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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: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.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® 1 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:
At time of this inspection this system met all passing requirements. This report can not predict the
future performance under the same or increased usage. This report is not to be used for bedroom
count determination.
2) 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.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
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 exMtration 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.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc-rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
le Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. CityrFown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. 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:
t5insp.doc-rev.7/2612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
I
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
uV 104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. 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:
❑ 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.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more 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 fecal
coliform bacteria indicates absent 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.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
El ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
(P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1h day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent 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
and chain of custody must be attached to this form.]
® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® 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.
5) 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.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
g Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or"no"for each of the following for all inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
❑ ® 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?
® ❑ 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:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
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
Description:
This system consists of a original septic tank that is under the concrete patio under the deck a d-box
and a s.a.s of arc 36 plastic chambers. The original system is also still in place but shut off through
the d box for possible future use.
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ❑ No
Does residence have a water treatment unit? ❑ Yes ❑ No
` If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available (last 2 years usage(gpd)):
Detail:
16----------------------309 17-------------------287
Sump pump? ❑ Yes ❑ No
Last date of occupancy: unknown
Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
p , Title 5 Official Inspection Form
� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
•t, 104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
s.a.s installed in may of 2012
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: feet
Material of construction:
❑ cast iron ❑40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 2
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
Tank is under concrete patio at least partially but could be completly with one metal access cover to
grade.
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: appears to be 1000 gallon but it is
under a concrete patio
Sludge depth:
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
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
I always recommend pumping at time of transfer and at least every 2-3 yrs there after for
maintenance.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
c Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
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: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. 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 per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
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.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
- @ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. CityrTown State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: arc 36 20 units
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The observation port was found and opened and the units were dry at time of inspection with dark
soils in the bottom. No signs of failure at this time.
12. 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 ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
(P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
13. 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.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.� 104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view 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. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: none encountered at time of perc test
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: Date 8
Date
❑ 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)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
~ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
104 Nottingham Dr
Property Address
Fedele
Owner Owner's Name
information is
required for Centerville Ma 02632 10-20-18
every page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6 (Checklist)completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
Assessing As-Built Cards Page 1 of 2
TOWN OF BARNSTABLE
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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
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INSTALLER'S NAME&PHONE NO. 00&s A 11 cXv0 -TAIL CJ�eyo �
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OWNER Fedole
PERMIT DATE: COMPLIANCE DATE: s- 21 —
Separation Distance Between the: 1 ome e---)cc;vt,*e(-e0
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Tes- 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 ),n;S
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KOO
AT4�,
` i7Ci1 EXr��i� t�ecc�n;,.� �I�ut-c� G,vc�\e�i-i���ceee
iBI-40 1 3 aTc-,, 5q
1- 36 ; i 031�a'8
1 �tiH� �ti.2 YlZ6WSO 5-A(CM, 1%'3
3 SS,S ® I
obpt--60, q$,)
0b r
j
No. �ol� - l�� L
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIPPlitation for Vsposar *pstrm ConstrULtion prrmit
Application for a Permit to Construct( ) Repair( pgrade( ) Abandon( ) ❑Complete System El Individual Components
Lo tioor n A dress' r t No. /Gh�✓oa d��•f ti C^'l. Owner's Name,Address,and Tel.No.
Ass 's ap/Parce /7;L — OA;F �c r/er l�
d � �-'
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
�1i✓"fC s
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size / / sq.ft. Garbage Grinder( )
Other Type of Building /iaYi e No.of Persons' Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided '3 SS. 7— gpd
Plan Date ���/icy Number of sheets 2— Revision Date
Title
Size of Septic Tank Type of S.A.S. -3 4 IV
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 14-5 f a // A-C.-r® 5,
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date �—
Application Approved by Date S"/�
Application Disapproved by Date
for the following reasons
Permit No. R -7 Date Issued
isr `l"
q { l
4
No.
do ' / Fee t
'g '> THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppYiration for Bisposal pstrm Construction Permit
�I
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Lo Cft ion 1A 1 dress' of No. /O`/Noi Nf Owner's Name,Address,and Tel.No.
Ass sor's Map/Parcel /79. - Z" d �'
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
V-'J�� /7 /�/avvr� l ✓� 5 '-�/20�a/5`?`/ C^' ✓ c .r,— GJri//�5
Type of Building: " 4 O >'*°
Dwelling No.of Bedrooms 3 Lot Size f s,601 sq.ft. Garbage Grinder( )
Other Type of Building 4 ays L- No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 'Z !yn gpd Design flow provided 3 5 5. 2-- `'vk. gpd
Plan Date Number of sheets 2- Revision Date >
Title
Size of Septic Tank Type of S.A.S. G 1-1
Description of Soil
i
Nature of Repairs or Alterations(Answer when applicable) /.vs/G
I
Date last inspected:
i
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date S- / /^—
Application Approved by ` 5 Date S"/$ " 2'
Application Disapproved by U Date
for the following reasons
Permit No. o� 6 1 '� 0 S Date Issued
------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
-, Certificate of Compliance
THIS IS TO CCE�ERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by 1/v ./ 7 A /i Div N •-- 7, c
at /G'1/ /1-',/ .r ter/ ---�' l ~14Y /,���/Y has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.a0/.1 dated 5
Installer..-,/,z 11, /�i�a�^'r �.--� Designer J%„�,i .�r-�ii�i G✓r/�S
#bedroom 7 Approved design flo SS, 2 gpd
The issuance of this permit shall of be construed uarantee that the system w 11 fitnc as design d.
Date h- -I �).- Inspector
i
--------------------------------------------------------------------------------------------------------------------------------------- -
Zlv
aor� - ►S`� ��
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal6pstem onstrUction 'ermit
Permission is hereby granted to Construct( ) Repair( f Upgrade( ) Abandon( )
System located at /O-/ y/Al
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
1
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit. C
Date 57 v Approved by ` J
05/22/2012 06:06 5084775313 ENGINEERING WORKS PAGE 01
'down of Barnstable
Repl>atory Services
Thomas F. Geiler,Director
MAW $ Public Health Division
' Thomas McKean,Director
200 Main Street, Hyannis,NIA 02601
Office: 50&$62-4644 Pax: $09-790-6304
Dater Sewage Permit# Assessor's Map/Parcel I_Z
ligWilet&Designer CertiPic Rio@ Form
T.E.
Designer, h y: .� '.„. W e r 4 s� lnc . Installer: p•� • 1 e.►� N C�
Address: j z W. C_ri, s r E 1�c1__2,#. Address: d •d' ZIO)C t '
1;7a.s -A4(•c Nl a z�,y y �tr �rr.►�� 1.t M+4 p G 3
On V�A , Dro_-) was issued a permit to install a
(date) (installer)
septic system at 41�r Nb : n ,.c.0*%, i>t' . (r�4 based on a design drawn by
(address)
k---c P c., dated
(desiper) --
_ ' I certify that the septic system referenced above was installed substantially according to
the desip, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
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. Stripout(if required) clod and the soils
were found satisfactory.
INTER T.
telle Signature) �++CIV LEE
r's
�No,34109 O
(Designer's Signature) (Affix Design
PLEASE RETURN TO BARNSTAB E PUBLIC MULTH DIVISION. ERTIFICATE
OF COMPLIANCE WILL NOT BE ]ISSUED U = BOTH IMJEORM AND AS
BU I CARD ARE RECEIVED BY TUX PARNSTABLE P1 LIC HEALTH,J2TVISION.
THANK YUL
q:\cffice funhAd6sjimmertificffiion font Am
1
� Town of Barnstable
.
J Department of Regulatory Services
a SA -
„U�,� s Public Health Division Hate,MAM
Z i k... ..
200 Main Street,Hyannis MA 02601
• k
,Date _ Tlme'
Scledtlled _, _ ..... Fee
Soul Suitability Assessment for Se Disposal
Performed By: �'t,.�Cs/tb -e-2
Y `� Witnessed By; ..
LOCATION&GENERAL INFORMATION. .
Location Address , Owner's Name'
01 9v�n9 �Lq�pl • jV Sov� Fzc !'- if
C��-Ler•/`. l�,t Address 1'y I w`r�;h y Cove e1q F
Assessor's-Map/Parcel: 7 Z—��� Engineer's Nam�a'_s(bt/t-t 11 1 y Cr
�73/^�
NEW CONSTRUCT ION REPAIR x Telephone# :7�' !
Land Use fi e (.n�i�a Slopes(%) Surface Stones 74
Distances from: Open Water Body ft; Possible Wet Area 2-Qtj ft Drinking Water Well ,<Slbft
Drainage Way ft Property Line I �� ft Other ft
SKETCH:(street name,dimensions of lot exact locations of test holes&perc tests,locate wetlands In proximity to holes)
I
IJG rrf A)isk f,4 sM
i7r•�'`
J
' _
N 1a
Y'��
U ca
CP
F.
(geo ogic) L J`1 ash Depth to Bedrock
Parent material 1
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face e "a
�1 ` �
Estimated Seasonal High Groundwater '
DETERMINATION FOR.SEASONAL HIGH WATER FABLE
Method Used: c
Depth Observed standing in obs.hole: _--____in, Depth to s011 mottles:
Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft.
Index.Well# Reading Date: Index Well level ram„ Adj.factor Ad{:Groundwater Level
PERCOLATION TEST bete Time
Observation t
Hole# `- I „
Time at 0 ..,,�
Depth of Pent 2�yk� Time at 6
\ Start Pre-soak Time.® Y G1( ,d } Time(9"-6") 1 M
r .
End
3' �l
Rate MinJlnch. M 1�'► �'�^ ;.
Site Suitability Assessment 'Site Passed °'G Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division I "'• Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be.conducted within 100' of wetland,you must first notify the
Barnstable Conseii'vation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DEEP.OBSERVATIONROLE LOG
Hole# _
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders..
Consistency, v1
a-- 0Ye y/�L
. . . . 5 tv.y
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color, Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
ns' %
S to YfZ Jz
M s Z 45 Y 41y ,
,.
.t
'DEEP OBSERVATION HOLE LOG Hole#
Depth from -Soil Horizon Soil Texture Soil Color` Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. 0__e .
DEEP OBSERVATION HOLE LOG'. Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil. Other.
Surface(in.) (USDA). (Munsell)" Mottling (Structure,Stones,Boulders.
Con'
Floo d�Insurance Rate NYC
Above 506 year flood boundary No Yes Jd
:Withln 500 yearboundary NaA Yes,... ..
Within 100 year flood boundary No Yes
Depth of`Naturally Occurring Pervious Material
Does at leastfour-feet.of naturally occurring pervto s materiahexist in all areas observed throughput-,,ft..
area proposed for the soil absorption system?
If not,what is the depth of naturalty occurring pervious:material? ..�
Certification • . -
I certify that on . e( (date)-I-have:passed'.the soil evaluator examination approved by the
Department of Etiviro,mental Protection and that the.above analysis was performed by me consistent with
the required tra expertise and experience described in 31U'CMR 15.017.
Signature Date 1
Q:ISEpme' PBRCFORM.DOC
�JJ
/ TOWN OF BARNSTABLE `
L(�CP►1'dON 7"/ G SEWAGE #
�MLAG �'�` —ASSES 'S MA�P&
INSTALLER'S NAME&PHONE NO ✓`��Df �
SEPTIC TANK CAPACITY f fibrJ
/ � o
LEACHING FACILITY: (type) G �"r, ( -�. as:J (size) // �q X�_
NO.OF BEDROOMS 3
BUILDER OR OWNER -e f L
PERMI TDATE: P"al"95-- COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /,577'- Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) fi//* Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
Rio y ����
��� W 2
(.t� _
,r �,`c�
k
No.t.n.16-91 /FE,$.... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Alip iration for Di-ri.pnottl Works Tontrnr#inn Frrmit
Application is hereby made for a Permit to Construct ( ) or Repair (P-14 an Individual Sewage Disposal
System at: a4m D1244 lc�
4ocatiou-Address or 1, Jo-
- P14,
14, sM`tL '
a �•��il-(J--W v!-/-.----0�116'�l�%� R--/�._ ��AGI......W����--AC•-5----•---�-i_✓j�_./.�s.----
M Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms----------------------------------_____ ----Expansion Attic ( ) Garbage Grinder F--}/4'6
aOther—Type of Building ............................ No. of persons--------.-.................. Showers ( ) — Cafeteria ( )
POther fixt es -----------------•-----------------••-•---------------_--.------------- -•-------------
Desi n Flow_........ . _._ �®
W g _____________gallons per person per da . Total.d�ail3' flow..____._____.......___._..................._gallons.
WSeptic Tank—Liquid'capacity/!P_.galIons Length.-.--:� Width---------------- Diameter---------------- Depth.....y_!C=T
x Disposal Trench—No. ...... .......... Width......o.,Y-------- Total Length------2 ...... Total leaching area....................sq. ft.
Seepage Pit No...................... Diameter.................... Depth below inlet__ _ . Total leaching area..................sq. ft.
Z Other Distribution box (p4- Dosing tank ( )
14 Percolation Test Results Performed by..------------------------------------------------------------------------- Date........................................
a
� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.....................
4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ..----•---------------------------••----•....---•••-•-•---------•••-•----------••-•----.....--------.........................................................
0 Description of Soil.........................................................................................................................................................................
W
V ---•---------------------------•-------•--••---------------------------•------------------....-------------------------•-------------------------------------------------------..........•-•••-•....---
W
U Nature of Repairs or Alterations—Answer when applicable._.:.... . .......... �^i^i;n C,_4451�4..---!!�1�
y ---------- _... -
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance ben issue t boa d of health.
- �. �9f.....
Signed - - .. - - - .........._.. -...- -- - ---------
Date
.�
Dace
ApplicationApproved By -------- ---- ---- ------------------------------------------------------------ ' ......
Date
Application Disapproved for the following reasons: ... ... ............................................ ................. . ..... -- . ...
------------------------------------------------------------------------------------------------ --------- ----------- ------------------------------------------------------------------------------- ---------------------------------------
t
Permit No. .... �.---- 2 --------- Issued .............. ..c-e l.^ ............
Date
. t
No .. Q.f Fps.... 6..-....
THE COMMONWEALTH-OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Diripw3al Work.6 Towitrurtinn rrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (tom an Individual Sewage Disposal
System at: C,
-----------------------------•-••••-- .. _ ..••. ....•••-•••••....--•..._.....-•-_------• ---- •-•---••-•--••-
..... .... ... ... .... ...
Location-Address
— V �W/f,�b or Lot No.
......................— ---- ..
Owner 1'} �,�...- Address
tj
U Type of Building Installer r
Size Lot....................... ...Sq. feet
Dwelling No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder (---j /q0
aOther—Type of Building ---------------------------- No. of persons____________-______.•....___ Showers ( ) — Cafeteria ( )
0.1 Other fixtu es --------------•--------------- -- -
Desi n Flow........... .. 3 70 gallons.
W g ......... ..................gallons per person per day. Total daily flow_.__.___.___._......__........._...._..__
WSeptic Tank—Liquid capacity/0!�..galIons Length____--7, Width_.. _______ Diameter_.-_._._.__... Depth_._.. .r----'
x Disposal Trench—No. _._.... ........ Width......Z.�_------- Total Length..__t_r'..q_._._. Total leaching area....................sq. ft.
Seepage Pit No---------_-_------ Diameter.................... Depth below inlet__�:f�_.-`.. Total leaching area..................sq. ft.
Z Other Distribution box (-_,.e4-. Dosing tank ( )
aPercolation Test Results Performed bY---------- ......................................... ------ Date........................................
4 Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •-•••-•-.....................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
x
U •••--•••---•-•-•--------••••••••--••-•••••-•---••--•••......---•--....... •-•------•••-••••••••---•-•-•••-•-•-----------•-------•-•••-•--•••••--•--•---•••---••••••-••••-•-•-•.......---•-•..........••.
w
Z. Nature of Repairs or Alterations—Answer when applicable.--��)-.-----_X.____�W*�-�� ? .......� ...y;
` 7�n1 c......• S llrLfigs,..1/J_....1�......-.��-...........:�"�"":_s�/�J ...__.v��._.........__�.............................
Agreement:
' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
thepprovisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has?be n issue t Z boa d of health.
Signed
Date
ApplicationApproved By .......... ...-.. ... -4- .,, .... ..................... ........... ........................... ......�-_Dc,c c�5
Application Disapproved for the following reasons: ................. ...................................................................................................... .........
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ...............................
1` Date
Permit No. ....�. ........l.b. j .................. Issued --------------��"..-..�>.�.r-�4.:...............
Date
— —— —THE COMMONWEALTH OF MASSACHUSETTS 1 A e
BOARD OF HEALTH
TOWN OF BARNSTABLE
Clextifirate of Compliance '
THIS IS TO CERTIFY,_Datthe Individual Sewage Disposal System constructed ( ) or Repaired
by _.................. - F... ? G-�^� c",7a . .................._......
i�.,tanet
at ............................ �..------- ----..-.-.-...--------... -
has been installed in accordance with the provisi rfLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Pe mit No. ..1?_j dated ................:.........._-----.--_-.....--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................ .........K.� ------------------------ -
------..-------- Inspector .. �._ ---------..--------------- ------------------.
�....�w2-� -
-------------------- ------ _-------_------------------------------------'------
�
THE COMMONWEALTH OF MASSACHUSETTS T l �. `�' < 1-7
BOARD OF HEALTH
��yy /l TOWN OF BARNSTABLE
11ispo,oa1 Workii TomArtrtion prniit _
Permission is hereby granted................ a�--------------
e Disposal System
at No. '�•r.NG-- 1.4..^ --- ---,mot--- C.,�.....J i �✓a(�t�
-- ...
Street
as shown on the application for Disposal Works Construction Permit No. Dated...8�_.--{�-�--�.��rj•J.......
.................................
--------------------------------------------
Board of Health
DATE------...... _.- / --•-••................•-----•-
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
'fir.
tlo
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) .
Y
hereby certify that the application for disposal works
construction pemut signed by me dated concerning the
property located at O,L Gar meets all of the
following criteria:
✓ There are no wetlands within 300 feet of the septic proposed P system
`� • There are no private wells within 150 feet of the ro sed septic system
P Po P
C�The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
`� • There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
SIGNED: DATE:
LICENSED SEPTIC SYS M INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
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,
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1z� > ���,�. r ,,,� �. ,4 ��,,�.�c f ,rc.�r`r �,f 3 t� i,�:.�� �..�k ?tL�t:"s,T, �fy k -� '',.,,4 r �+��'. F`d i•5�„ w� s.,n«�i'4�. 'Y�nk ;},�.
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441
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No.•-•ZP]_........ F$s...✓`................._
THE COMMONWEALTH OF MASSACHUSETTS
E®A.RD OF HEALTH
Town ................_oF...-Barnstable NI
Appliration for Bispasal Works Tonstrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Nottingham Dr. Centerville Lot 7
...........................---...... ..................................................... ...........-------_. . ....t O l.....................................................
••••_-•Loc 'on-Address Ashley Dr. Cen��fville
....Norme s.. Homes Inc. ..•-•-•--l._.....---•--......._
James Dolloway °`"neY Five Corners R`.�5 Centerville.
..........
Installer Address
d Type of Building ;. 3 Size Lot...... 1.51000 Sq. feet
Dwelling—No. of Bedrooms............................................Expansion,Attic ( ) Garbage Grinder
`1 Other—Type of Building wood frame fj
a YP g •--=-•. No. of persons__________________________ Showers ( ) — Cafeteria ( )
Otherfixt}�res ----------------------•-------•---•-•----------............................................................
Desi n Flow.:.............. r 30.0
W g ........................gallons per person per day. Total daily flow....:....._..__.._............._.._.....__._gallons.
WSeptic Tank—Liquid capacity.19P(Igallons Length................. Width................ Diameter................ Depth................
x Disposal Trench—No..................... Wid�---S oje.... Total Length.................... Total leaching area----302.......sq. ft.
Seepage Pit No--------------------- Diamete ........-_P.aC.. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by -------------•.-_-----.....--...------••---.....: Date.,....
Test Pit No. 1................minutes per inch Depth of Test P...............
Depth to ground water-______---_:----___-._.
fXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
IYi ----- -• ------
Description of Soil...........................Sand.__&...gravel
U ................................-.......................................................
W
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 place the system in
operation.until a Certificate of Compliance has beqn issu d by the board of health•
Signed Q... :� ..._......
Date
Application Approved BY ....--.• -- �•••- --.-----_----•-- �..�...
Date
Application Disapproved for the following reasons:................................................................................................................
..----•-••----------•----•-----------•-••-•-•---•-•-•••••---•---•-•......-•-•-••.-•••••-•••-••....-••-•-•--
Date
Permit No. =--------•--• Issued........................................................
Date
------ ------------------------------
1
No. lrC F��..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........`own... ............OF.... ,instable.
.... . ... .....................................................
AvOratiott fnr 'Dispo'sal Works Cho"uotrurtioit runtit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot.. ............................................ ......... ......................
At No.
Loc on Address Ashley..Dr•4... g1L �3rville
.....Noxmest H®met ;�•......................................... .... ........ ................................
....... .........
Owner dress
a •....dame.....1 e3�owa r------•.............................................. .....................................................ve orner.. I...Centerville
ie
Installer Address
PA
UType of Building Size Lot.......15.*IQ®...Sq. feet
Dwelling—No. of Bedrooms................�......................_..Expansion.Attic ( ) Garbage Grinder ( )
a Other—Type of Buildin 'VOOd �Z'APP No. of persons............................ Showers
PA g ---•-----•-................. ---•-• --- ( )--- Cafeteria ( )
d Other fixtures .... ------ ----•---------------•------------•---•---•------•-
WDesign Flow...................50.._........_......_gallons per person per day. Total daily flow.__.__._.........��_..............._..__gallons.
P4 Septic Tank—Liquid capacity._ ,00%allons Length................ Width-,................ Diameter................ Depth................
Disposal Trench—No..................... Width...S.te)ne..._ Total Length.................... Total leaching area....3 .......sq. ft.
Seepage Pit No..................... Diamete ... ...P Depth below inlet....................Total leaching area.._...............sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by...................................................................:.••..... Date..------------------....................
H Test Pit No.. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-___--__.__--__-__..___.
GLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_---__--__-__...______-
a' ...........................•-•-•-•-••-•...---......----•-•----•---
��.21d r ...Soil...............................................
x
U
x Nature of Re----lr---•-r-A••••.. •.--•--•-_--•---••----•-•-•-------------•--.--•-•---- -••-•-......-------•=--..----- ---------------------------•--•--------------•-----------------
U Repairs o 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 place the system in
operation until a Certificate of Compliance has been i ued b the hoard of health.S
- �-
Signed------- .• ............. ........
\ / Date
Application Approved BY6 �> .....................
-/�h ate
Application Disapproved for the following reasons------------------------------••------•------•------•-----------------••••••--...--•-•-••--••• -•--.............
-------------------------------------•- -•---------•-------••-•-----•••.......---------•.....-•--•••---...•••---••••..._....-•--------••......-•-•------••----•--•--------•-•-••..........-----..........
Date
PermitNo......................................................... Issued......---------------------................_.
Date -...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
T° .................oF...........................Barnstable..........................................
I..............
Tertifirate of Toutpliaurr
THIS IS TO CERTIFY, That t ividual Sewage Disposal System constructed (V) or Repaired ( )
bY..........................................
ames o� oway
Lot ? 3ot t ngham r.I on sv
at...................... • -. .......:....•-•-------... .....................................-------------------------------------...........
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for. Disposal .Works Construction Permit No............................ .. .. ... dated_.__ ._..__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A Gl9ARAN EE THAT THE
SYSTEM WILL .FUNCTION SATISFACTORY.
DATE................................................................................ Inspector.
THE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town ,� Barnstable
..........................................OF....... .........._........... .........................................
No d"'--C�•�--•--- FEE
�lio�ro�ttl ori� C�on�tr�trttun �rrutit
Permission is hereby granted.
James olloway
.........................:............. •----._........-•--•-...................................................----
to Construct ( ) or Repptt�( J I avid 1 in Se e b .Disy�o al,S
at-No........................................... ...............•--•-......... .............'�......-
Street
as shown on the application for Disposal Works Construction Per it No.. Q_.� _.... Dated....... . ... .2
BuaId b lPe3
DATE_ S . .t ....e�. ...... ..... `%�'711R .. ..
FORM 1255 Hosas & WARREN. INC.. PUBLISHER$ V
X?GLEGEND _ NEXISTING CONTOU NO TTI NGHA M DRI I/E . x 16.82 EXISTING SPOT GRADE-W EXISTING WATER SERVICEG EXISTING GAS SERVICE94,69 95,74 0 edge of payment 97,95 CO -O:H:VYE- OVERHEAD WIRES
0 100,57 TEST PIT °�
si
97.79 100,55 $ BENCHMARK LOCU ce y
i 100.93
9 6.21 � �.
„ PC7LE 00
N 39*19 00 E
Pc ca
Z.., ...PAVED: 106�05 L f \ � 100,69
AM
DRIVEWAY:
LOT 17 ��,�°• a�o.00 LOCUS MAP
APN 172-117 �•\� --PK SET NOT TO SCALE
99.75 T
15,001 S.�.t y
9,08 GS 9 ,53 GENERAL NOTES:
x 98, x 99,01
I . . . 99g
V.4�8'08 99.05 GS 98,95 7.92 , yI�F578
99,23 Ret. wall T 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
z 95,49 97'09 ,� BOARD OF HEALTH AND THE DESIGN ENGINEER.
\
_ c> t93.91 .. . 1. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
�r P . OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
I q PAVES LOCAL RULES AND REGULATIONS.
EXIS77NG C' ..I . .
HOUSE(#104) � :do . DRIVEWAY :.` 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
O P TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
c� • DESIGN ENGINEER.
T.O.F.=100.24 I
\ I �5IFFERING
3170.. I` 4 FROMANY C�HOSE SHOWN HEREON SHNDITIONS ENCOUNTERED ALLNG BE CONSTRUCTION TDHE DESIGN
BENCHMARK SET I WALKOUT BASEMENT x 3,74 96,94 r-► ENGINEER BEFORE CONSTRUCTION CONTINUES.
\ �� shrubs �� w 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
TOP OF. METAL SEWER RIM � cn
{ 96.15 DECK �� � 0 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
EL.=93. ASSUMED DATUM ar CONC. PA Tl 0 BELOW W
(above) ( o rn THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
0 94.18 x 94.06
92,90 P1 1 - �-A o HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
`-3 e ' > , , � = 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
EXISTING SEPTIC TANK �' m 1 -o
RIM EL.=93.53 92.77 3 3 93,41 �\ + 94.59 g ° \ 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
INV.(OUT)=90.69t 92.62 shrubs x 93,50 �\ SPIKE m�� (� 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
� v J AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
DIRECTED BY THE APPROVING AUTHORITIES.
y 92 28 ,- 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
d1 ----
--'--�--r--'--� 95,81 � THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
PR POLED i--� �933II s CONSTRUCTION.
94`\ SHED --I-- - I I '- O 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
TP-1 I I 95,50 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
_ 55' -----1--Y'�'--�1 I U � REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
25' -�I x 92.59 II 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
I O INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
x 91,85 `94•� 136.05'TP_2 I
94.819 95,34 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
S 39'05'20" W IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
14. ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC
EXISTING S.A.S. SYSTEM COMPONENTS NOT SHOWN ON THIS PLAN.
OF MASsgCyG (LOCATION TAKEN FROM
o PETER T. r✓ RECORD AS-BUILT) PROPOSED SEPTIC SYSTEM UPGRADE PLAN
O
McENTEE 104 NOTTINGHAM DRIVE, CENTERVILLE, MA
o CIVIL
No. 35109 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO.
SS EN SUSAN M. FEDELE TRUST
+ SUSAN M. FEDELE'TRUSTEE Engineering Works, Inc. 1"=20' P.T.M. 158-12
141 WINDING COVE ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
l 4� MARSTONS MILLS, MA 02648 (508) 477-5313 5/14/12 P.T.M. 1 of 2
w
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL: 90.3
SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE
INSTALL RISERS & COVERS OVER INLET PROPOSED D-BOX PERIMETER OF THE S.A.S.
AND SET TO 6" OF FINISH GRADE. INSTALL WATERTIGHT RISER & B CK 0 HOUSE
PROVIDE ACCESS TO GRADE OVER OUTLET COVER COVER SET TO 6" OF GRADE PROPOSED S.A.S.
INSTALL INSPECTION PORT OVER END UNIT ECK
F.G. EL.-- EXISTING EL.93.3 MAX.EXISTING F.G. EL.=93.4t F.G. EL.=93.0f ) - -- 1 SPIKE SET
MAINTAIN 2% GRADE MIN. OVER S.A.S. � — 19, S�SI• �� ADS
! I INSPECTION, QS 6) rp��
L 18' L = 7'(MAX.) PORT 6' 2 �J 7' /�� 6
® S=1% (MIN.) ® S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC
101 6" -64 1075 TO
ia"
EXISTINGLLL 48" LIQUID INV.=89'90 RT I- ; S A�S.
LEVEL ADD 4 ROWS OF 5 UNITS AT 5.0'/UNIT = 20.0, , ,'-
GAS BAFFLE INV.=90.17 PROPOSED INV.=90.00
INV.=90.69f D-BOX SOIL ABSORPTION SYSTEM (PROFILE) ---25'--�
EXISTING (4 OUTLETS)
EXISTING SEPTIC TANK S.A.S.LAYOUT
ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
21" 6-4" POLYSEAL OUTLETS
NOTES: BREAKOUT=TOP 2" 2" -a' POLYSEAL INLETS
TOP ELEV.=90.33
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=89.90 t
INVERTS, PRIOR TO INSTALLATION. O O
2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=89.00 — N un y
ON A MECHANICALLY COMPACTED SIX INCH CRUSHEDto
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 4' MIN. SEPARATION 00
3) INSTALL INLET & OUTLET TEES AS REQUIRED.
TO HIGH GROUNDWATER EFFECTIVE WIDTH=11.3'
4 GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EXISTING SUITABLE N Top View D—BOX Section
NO GROUNDWATER, EL=82.7 — MATERIAL
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL.
USE 4 ROWS OF 5-ADS Arc 36HC UNITS WITH NO
SEPARATION BETWEEN EACH ROW & NO STONE 63.25"
SEPTIC SYSTEM PROFILE TYPICAL SECTION d��Wl
N.T.S. 6"
DESIGN CRITERIA SOIL LOG 34.5"
DATE: MAY 4, 2012 (REF# P-13,629)
NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE (SE#1542) TOP VIEW
SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS-HEALTH AGENT
so"
DESIGN PERCOLATION RATE: 3 MIN/IN Elev. TP— 1 Depth 'Elev. TP-2 Depth END CAP END CAP
DAILY FLOW: 330 G.P.D. 92.7 A 0" :92.7 A 0 FRONT VIEW SIDE VIEW END CAP
S O
DESIGN FLOW: 330 G.P.D. LOAMY SAND LOAMY SAND REAR/TOP VIEW
GARBAGE GRINDER: NO 92.2 1OYR 4/2 6" 92.2 10YR 4/2 6" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
B FINE B TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
NE LEACHING AREA REQUIRED: (330) = 445.9 SF LOAMY SAND LOAMY SAND DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
74 1OYR 5/8 10YR 5/8 4640 TRUEMAN BLVD
91.2 18 91.2 18 901m.HILLIARD, OHIO 43026 ITS M BE AMP H-20 36HC
STAMPED d
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY (APPEARS TO BE H-20) C1 C7
PERC ADVANCED DRAINAGE SYSTEMS, INC, UN
PROPOSED D-BOX: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED 24"/36" PROPOSED SEPTIC SYSTEM UPGRADE PLAN
USE 4 ROWS OF 5—ADS Arc 36HC UNITS WITH NO MED. SAND MED. SAND 2.5Y 6/4 2.5Y 6/4 104 NOTTINGHAM DRIVE, CENTERVILLE, MA
SEPARATION BETWEEN EACH ROW & NO STONE
Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) 83.7 C2 108" 83.7 C2 108" Engineering by: SCALE DRAWN JOB. NO.
(Arc 36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF SILT LOAM SILT LOAM NTS P.T.M. 158-12
SY 5/3 Engineering Works, Inc.
DESIGN FLOW PROVIDED: 0.74 GPD SF480.0 SF = 82.7 120" ' 82.7 5Y 5/3 120" 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
/ ( ) 355.2 GPD PERC RATE 3 MIN/INCH -NO GROUNDWATER OBSERVED (508) 477-5313 5/14/12 P.T.M. 2 Of 2
r t
k LEGEND N
P
G$ O� Goo
1 , -- EXISTING CONTOUR f
<J��1�0��l - NOTTINGHAM DRIVF i x 16.82 EXISTING SPOT GRADE
P�, � -y� EXISTING WATER SERVICE 0�N, o G°°rt
-C, EXISTING GAS SERVICE
-O.H.KL- -OVERHEAD WIRES
94,22 94,69 95.74 6 edge of pavment 97.95 c? o 100,57 TEST PIT �'° �\� 0� 090
s,
�� } 97,7i 100.55 - BENCHMARK
LOCUS ce i
,v 100.93 tis Qc� i
�• ... 96.21 � 00 a '2
95.35 •. �. .. .. N 39'19'00" E , PC7LE PcSeca�
106 05' 100.69
7PAI/ED:: ,�� LAM 01
9 A
4.
LOT 17 '�: ,-�K sOR0.00 LOCUo SCALE
MAP
APN 172-117 99.75
Z 15,001 S.F.t
f � i
Z i
x 98. x 99.01 GS 9 53 GENERAL NOTES:
. . . � 9,08 y 7
�. 448,08 99,05 GS 98.95 7,92 , Y1 5 8
v 99,23 Ret. wall 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
Z 95.49 97.09 �� - BOARD OF HEALTH AND THE DESIGN ENGINEER.
\
c1� c) 1.93,91 ,.:' .. �. ` .. 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
p j OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
'� 1 ..PA l/Eb LOCAL RULES AND REGULATIONS.
EXISTING
o HOUSE(#104) m DRII/EWA Y. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
O u! ' TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
T.O.F.=100.24 c • , DESIGN ENGINEER.
00
94-._ 9,3.70: 9 ,OS 4• ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
y� I �\ FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
�\ a�� I, WALKOUT BASEMENT x3,74 96.94 � ENGINEER BEFORE CONSTRUCTION CONTINUES.
BENCHMARK SET 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
TOP OF METAL SEWER RIM \� shrubs •' (A a
96.15 DECK CONC. PATIO BELOW O 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
EL.=93.53 ASSUMED DATUM a• 1 cn
(above) \ T THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
\� 92.90 P 94.18 (x 94,06 ap \ o �J HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY TO BE CONVERTED TO TOWN WATER SERVICE.
EXISTING SEPTIC TANK 3 3 O 93,41 \� - g 1 0 NO WELLS WI ROPOSED S.A.S.
RIM EL.=93.53 92.77 -�- 94.59 _
INV.(OUT)=90.69.E 92.62 shrubs •x 93.50 �\ SPIKE r,,��\ (� g, ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RES ORED AS
J AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
DIRECTED BY THE APPROVING AUTHORITIES.
92.28 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
--I-- --r--'--� 95.81 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
---- CONSTRUCTION.
1
_PR
9 �\ -, -�A•� I I � `0 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
1 -f I I 95.50 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
TP-
55' -1--'-'�'-- '1 G N REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
25TP-2� x 92.59 11 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
\ p 1 O INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
x 91.85 94•� 136.05' 1 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
S 39°05'20" W Q, 94, 95,34 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
14. ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC
EXISTING S.A.S. SYSTEM COMPONENTS NOT SHOWN ON THIS PLAN.
OF MASs9 (LOCATION BE
�AKDONED
FROM
PROPOSED SEPTIC SYSTEM UPGRADE PLAN
o PETER T. RECORD AS-BOIL T)
McENTEE 104 NOTTINGHAM DRIVE, CENTERVILLE, MA
CIVIL
No. 35109 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
A ��� �� 1 OWNER OF RECOR
REG/SZE D Engineering by: SCALE DRAWN JOB. NO.
'p0 EN SUSAN M. FEDELE TRUST
1"=20' P.T.M. 158-12
SUSAN M. FEDELE TRUSTEE Engineering Works, Inc.
141 WINDING COVE ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
(�.f �Z- MARSTONS MILLS, MA 02648 (508) 477-5313 5/14/12 P.T.M. 1 Of 2
i
r
%a
NOTE: TO PREVENT.BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL: 90.3
SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE
INSTALL RISERS & COVERS OVER INLET PROPOSED D—BOX PERIMETER OF THE S.A.S.
AND SET TO 6" OF FINISH GRADE.• INSTALL WATERTIGHT RISER & B CK 0 HpUSE
PROVIDE ACCESS TO GRADE OVER OUTLET COVER COVER SET TO 6" OF GRADE PROPOSED S.A.S.
INSTALL INSPECTION PORT OVER END UNIT ECK
e)
F.G. EL.-- EXISTING f F.G. EL.=93.4t f F.G. EL.=93.0t F.G. EL.93.3(MAX.) _
MAINTAIN 2% GRADE MIN. OVER S.A.S. `SAR, Gj1 SPIKE SET
A ' INSPECTION' �� 6'J COS
L = 18' L = 7'(MAX.) PORT �- 2. �j-7
® S=1% (MIN.) ® S=1% (MIN.) i
4"SCH40 PVC 4"SCH40 PVC '
N. tk6
1101 74„ 6' 10.75 TO ____ _-___ 1
OPOS
INVERT N�
EXISTING 48" LIQUID — INV.=89.90 ;-• I S.A.S. ,
LEVEL ADD 4 ROWS OF 5 UNITS AT 5.0'/UNIT = 20.0'
GAS BAFFLE
INV.=90.17 PROPOSED INV.=90.00 ____________
INV.=90.69t D—BOX SOIL ABSORPTION SYSTEM (PROFILE) --25'--�
EXISTING (4 OUTLETS)
EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER S.A.S.LAYOUT
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
21 6-4" POLYSEAL OUTLETS
NOTES: BREAKOUT=TOP " ''• ' 2" 2" 1-4' POLYSEAL INLETS
TOP ELEV.=90.33
.. ,
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=89.90 t
INVERTS, PRIOR TO INSTALLATION.
2) D—BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=89.00 — c� w O O
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 4' MIN. SEPARATION
3) INSTALL INLET & OUTLET TEES AS REQUIRED. TO HIGH GROUNDWATER EFFECTIVE WIDTH=11.3'
4 GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EXISTING SUITABLE N Top View D—BOX Sectlon
NO GROUNDWATER, EL=82.7 — MATERIAL
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. -
USE 4 ROWS OF 5-ADS Arc 36HC UNITS WITH NO
SEPARATION BETWEEN EACH ROW & NO STONE -63.25"
SEPTIC SYSTEM PROFILE TYPICAL SECTION
16"
N.T.S.
DESIGN CRITERIA
SOIL LOG 34.5"
NUMBER OF BEDROOMS: 3 BEDROOMS DATE: MAY 4, 2012 (REF# P-13,629)
SOIL EVALUATOR: PETER McENTEE (SE#1542) TOP VIEW
SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS—HEALTH AGENT
—so"
DESIGN PERCOLATION RATE: 3 MIN/IN Elev. TP- 1 Depth Elev. TP-2 Depth END CAP END CAP
DAILY FLOW: 330 G.P.D. 92.7 A 0" 9267 A 0" FRONT VIEW SIDE VIEW END CAP
DESIGN FLOW: 330 G.P.D. LOAMY SAND LOAMY SAND REAR/TOP VIEW
GARBAGE GRINDER: NO 9262 1OYR 4/2 6" 92.2 10YR 4/2 6„ NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
B FINE B TO CHANGE WITHOUT NOTICE, PRODUCT DETAIL MAY
FINE
LEACHING AREA REQUIRED: (330) = 445.9 SF LOAMY SAND LOAMY SAND DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
74 10YR 5/8 10YR 5/8 4640 TRUEMAN BLVD
91.2 18" 91.2 18" gmqx.HILLIARD, OHIO 43026 ITS MU'36 8E STAMPED H-20 AI d
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY (APPEARS TO BE H-20) C1
PERC C1 ADVANCED DRAINAGE SYSTEMS, INC. UN
PROPOSED D—BOX: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED 24"/36" PROPOSED SEPTIC SYSTEM UPGRADE PLAN
USE 4 ROWS OF 5—ADS Arc 36HC UNITS WITH NO IVIED. SAND MED. SAND 2.5Y 6/4 2.5Y 6/4 104 NOTTINGHAM DRIVE, CENTERVILLE, MA
SEPARATION BETWEEN EACH ROW & NO STONE Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) 83.7 108" 83. Engineering by:7 108" SCALE DRAWN JOB. NO.
C2 C2
(Arc 36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF SILT LOAM sILT LQAM 'Engineering Works, Inc. NTS P.T.M. 158-12
5Y 5/3 5Y 5/3
DESIGN FLOW PROVIDED: 0.74 GPD/SF(480.0 SF) = 355.2 GPD 82.7 120" 82.7 120" 12 West Crossfield Road, Forestdole, MA 02644 DATE 1 CHECKED SHEET NO.
14
PERC RATE 3 MIN/INCH -NO GROUNDWATER OBSERVED (508) 477-5313 / 2 P.T.M. 2 Of 2