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HomeMy WebLinkAbout0123 NOTTINGHAM DRIVE - Health 123 NOTTINGHAM DRIVE, CENTERVILLE _ A = UPC 12534 No. 2153L�QFi °osr.cces HASTINGS, MN I TOWN OF BARNSTABLE �LOCATION /.1-3 fit,/® ;c Xo-., SEWAGE# LQ/0 ^ 6Y7 VILLAGE .(Q�r,1,ff ASSESSOR'S MAP&PARCEL 1 JZ — Y9 INSTALLER'S NAME&PHONE NO. 13 SEPTIC TANK CAPACITY /'p p O LEACHING FACILITY:(type) ,-.— 3 0 SV RZo (size) /O•Zi YO NO.OF BEDROOMS 3 > OWNER l7 Q,T„�► ®1 /�,.. PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: r� 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 0 FURNISHED BY 1 t f No. 0 — �� Fee / -P THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppfitation for 3Disposar Opstem Construttion 19Ermit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System Individual Components LocationAddress or Lot No. /�Z 3 �pf�l jy�y� 0/, Ow,(neer'Name,Address and Tel.No. Assessor'sMap��cel Ge� `^/v/ /I dd��a Installer's Name Address,and Tel No. Desi er's Name,Address,and Tel.No. 7, ' � Type of Building: �- Dwelling No.of Bedrooms Lot Size ✓ sq.ft. Garbage Grinder(✓ ® Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 /S gpd Design flow provided Z Zai gpd Plan Date 3—/3 Number of sheets Revision Date Title C.:F / aw Z Size of Septic Tank P Type of S.A.S. S= 30,50 d Description of Soil L10 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by ' oard of He h. Signed Date Z Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ,� ^®(� Date Issued f•'y::�,,,..,.w....... ,.,..,.,,.;."--.� ."_-^_�^'"�""�'^^."_ ",'y,�'Ki.'4'ict+"+Me.ry:r+n.rr{�;dl+u+w.'.""':'a.'r:.its.+u:w.rar^w'^.-.+..r-ow-^^^..n^w.=..•-�'-.._....�..... � .- `.�..ass.Nv�...R:.r.......",�....:-,.,,,,,.,�,...a. Fee /Q No. t I ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y' r PUBLIC(HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ,. . pplication for Misposar 6pstem Construction hermit Application for a Permit to Construct( ) Repair p (V) Upgrade( ) Abandon( ) ❑Complete System [I]I dividual Components Loca��Add®s//o��r Lot No. /� /U�Jff�� lj� �r Owner's Name,Address andTel.No. Assessor's Map/Parcel G610 �' Insfaller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. C�o��GI�I�✓Ca�rs�~ 77/�9 � cr.�� �,dd - �sy� Type of Building: t Dwelling No.of Bedrooms Lot Size ✓, aQ) sq.ft. Garbage Grinder(0)'�Q Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date j— Tj "/�� Number of sheets // Revision Date Title Size of Septic Tank /OG�g4� ,��/'/'.5)`�d� Type of S.A.S. .�� �jt�St%� ,.�N ✓l�j"�yj�'j/ S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: , The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of ` Compliance has been issued by this oard of Hea•th. Signed Date Application Approved by Date . Application Disapproved by Date for the following reasons Permit No. �d'^= ( Date Issued yr THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS .._..Certifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V� Upgraded( ) Abandoned(/ )by "4f-�Q /� Q at 7-3 /te eel'. ��i/�. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.; '/O ©Y-7dated 'T W10 Installer Aj, r 1�'19&/'1-10/J5I,>,--' Designer LA #bedrooms Approved design flow J\ 330 gpd The issuance of this permit shall not be construed as a guarantee that the system will funcct o as design Date �-�+ 10 Inspector �V �U, ^ No. .- �� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ;Disposal 6pst m Construction permit Permission is hereby granted to Construct( ) )Repair( le)n Upgrade( ) Abandon( ) System located at Z.,� �Yd jf///11�/y? �G/� C.— lJ. �/�/✓'/��,t� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction�/ust be completed within three years of the date of this permit.�A- Dat e Ll / S U Approvldbb TRANS. NO.: CITY/TOWN: APPLICANT: A-DDR-ESS: DESIGN FLOW: spy REVIEVVED BY: BATE: N/A OK NO Legal boundaries denoted [310 CMR 15220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for ✓% upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] ✓ daily flow ✓ septic tank capacity(required and provided) soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CIVM 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] ' Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment . given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 N/A Oil NO F ation of every water supply, public and private, [310 CMR20(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply ✓ within 250 feet of the proposed system location mi the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] - Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction V/' activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in310 CMR 15.102(2)( ) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] F[310 hole adequate to demonstrate four feet of suitable material? CMR 15.103(4)1 Holes adequate to confirm adequate groundwater separation?CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] f System c;orP;LU7AtiSP;-ques ot> 36" deep (unless Local Upgrade v! Y Approvalted) [310 CMR 15.405(1(b)] Sheet 2 of 7 Address N/A 33,,,,., OK NO �li: b f T'}ytr 45`^.... ._Y .�.... '� yt, F�L -.`!+! ra r,,. •'fit ,. "Kd i a.i tfCf'}#�v'". M;�taf Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CbM 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft fiom building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] k Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15223(1)(b)] First compartment 200% daily flow; Second compartment 100%" daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 Located at least ten feet from any water line? [310 CMM 15.222(2)] Disposal piping at least 18"below water line (when water and f sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided? [310 CMM 15.222(8)] Thrust blocks specified in force mains? 310 CMM 15.221(6)(c)] Slope of sewer Iimc not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) iv" Stable compactedbase [310 CMR 15.221(2) and 310 CMM 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMM15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] P�lY1�lP`� �� ���5 �. ,.• �� Wit.. �;-•. Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMM.15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, discomlects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating m_lead-lag mode. [310 CMM 15.231(6) and(8)] Stable Compacted Base [310 CMM 15.221(2)] Buoyancy calculations needed? Provided? [310 CMR 15.221(8)] �►--��i � 1��=ice;-���-ixf---i nt�,t.'.- S v �3-G' � Address Sheet 4 of 7 N/A OK NO �1L ABS 9 RUM �. + �' _: elfI! P Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection parts specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet ✓' every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must / be to grade) [310 CMR 15.253(2)] ✓ Aggregate I'minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] �dENSaiffizt� 4 ,e_ ® ael, ®�® moo gl���) minimum 2 distribution lines [310 CMRp15.252(2)(a)] ` Maximum separation between lines 6' [310 CM RI5.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] , Bottom area used in calculations only [310 CMR 15.252(2)(1)] Address Sheet 5 of 7 N/A ®x INTO Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CNIR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CNIR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CNIR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CNIR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] w(rcass� jaseaaa,:( 4 Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance 11Cde".ECL' v T. Are the variances listed on the plan? [310 CNIR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CNT R 15.412(4)] New construction or increased flow proposed- [Refer to 310 CNIR 15.4141 Sheet 6 of 7 Address N/A ®K NO Is the system in a Designated Nitrogen Sensitive Area (Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CNR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CNR 15 216(1)] �dS1�B��CEyt�OELSt� `1q? tt, yrr41 p.,. y ' �� ,• ,,�� � ��� �st.t,;,tl� ' Pumping to septic tank ? [ 310 CNa 15.229] Shared System [310 CNM 15.2901 Address Sheet 7 of 7 FRQM :down cape engineering inc FAX NO. :150836213880 Apr. 13 2010 08:39AM P1 (d _ ')g I } IBQT.b1A.`d.l II!'. �.nR,A�.(P,l"'. ��1QClFd:U.Q9V" ala -y -it Via 100 I.Vimin `--4reet,Hymnis,.MA 026011. 508-862-16411 Fax: 508-790-63011 ............... Wiz:- ARgz Pemlit# '�0/0 Amessor's M mpT Address: ?�V 1,9 t), -tied a permit to bastaff a (date) (i.tistaller) 60 Oased on a design(Ii-awn by J)tk S)'Sl[0111 iff (add re.. 1-14 chted that the septic System referenced above was jiistafl.ed- substantially according to (be desig,n, A-aict-i may iuch& TrAnor appi.-oved c hqnges such as latcrai relocation. offfic. disti-i butiori box andhn-se-1-yfic liar k- T certify Itqit the septic syAc-.YY1 referenced. '010VC 'ATIS illStalhd. Witt) T.1.14j0T ebaTign (ix'. Fievey fbaii 10' later-al relocatioll of the SAS of aTly V-n-lical relocation of may y compelle-IT of tits septic system) but in accord,'Incv with State Local Regulation. Plan re.vi.sion OT cerhfied as-built by designer tofb.ljow W All DANIFEL OJA S1 No,465()2 'k, Cc Z 4ffjrD 10 V A L. Usigpor,s Siplitircl, (A Designer's Sfcivap 11cro) .E!,4qF FLETUR14 TO MU-INSTABLE PURT,1C (.(fAL'j'jj V .131 ISI 01q, CERTMCATR OF 19NAIL BOTH '171TS FORM AIND AS-.RTIJJ,T CARD APIR A !"i YJLCE1VDYJVV DIVISION. TFANTK YOU. Q:lleulth/Se-ptic/D sig ace Cu tifluaboa Yo-m 3-26 04.doe ID>]EIE]P.6BS]ERV�.7[ION HOLE' LOG Depth from Sail Horizon �� Surface(in.) Soil Texture ]E$O�e #-_ (USDA). 5di1 Color Soil (Mansell) Mottlin Other g (Structure,Stoncs;Boulders, L Co istenc %' ravel 3G-132 G 1 M �cA- DEEP ®�S]El[��TA7[IONH®LC LOG Depth from Soil Horizon Hole # Surface(in.) Soil Texture Soil Color(USDA) Soil (Mansell) Mottling (Structurether ,Stones, Bou)ders. Cons" ene %Q avel 6a S i3. L 5 • 35-- 132- M/s 2_5y �fy DE Depth from Soil Horizon R HOLE LOG Soil #--- Surface(in.) Texture 5aj1 Color (USDA) Soil (Mansell) her Mottling (Structuree,tSlones,Boulders. Co si to c O vet ]Dr-EP OBSERVATION ROLE Depth from Soil Horizon g'®� Hole# Surface(in.) Soil Texture Soil Color Sol( (USDA) Other (Mansell) Mottling (Structure,Stpnes;Boulders, Consi ten c a 1 r,V®adl Insurance]Bate h4a t Above 500 year flood boundary No Ycs T Within 500 year boundary No Yes Within 100 year flood boundary No�Ye5 Depth of Naturally rally__c _cu¢rrun�]En��y___ io_�_s 1Vfater!al Does at leas[four feet of naturally occurring pervious material exist in all Areas observed throughout tho areI proposed for the soil absorption system? 2 If not, what is the depth of naturally occurring pervious mncfr rit,•I? A/ I certify that on �V (date)I have passed the soil evaluator examination approved y the Department of Environmental.Protection'and that the above analysis was performed by me cons stent with IPte aegitired if inilig, expertise and experience described in 10 CM R 15.017. Signature_ I ;� Date Z✓ 13 jo . Q,\S.B?Tlc\PERcroaM.DOC f Town of Barnstable P# l 2 ffs? T141 P JDep alrtmont of Regulatory Services + BAANaTABLV6 " 1P><ul�He �- ea th Division )Date o4 3 iMAB& 200 Main Street,Hyanuis NIA 02601 Date Scheduled /(0 Time j6 _ Fee ilUQii. G �V-• �� `oil Suitability Assessment for Seel-Page 3ispo alb Perronned Py: Witnessed By; t La/a S—�&4=tl ILOC��` ION �� �]E1qJERAL E\T4ORNIATION. Location Address /2 nOl[r J4ve Owner's Name /1/ll �LO�R� C! �e�, ( I ' ✓l�T(7' Address Assessor's Map/Parcel; / ly� engineer's Nami; .� 0 VjV\/ e NEW CONSTRUCTION / REPAIR Telephone It CJ()4-j Land Use wre5lr7c".CK.- Slopes(%) 5 3% Surface Slones Distance's frain: Open Water Body It Possible WEI.Area �' Fl Drluking Water Well ft Drainage Way ft Property Line Ft. Other Ft .t9 '�'��: (Slteel name,dimensions of lot,exact locations of lest hales 8c pere rests,locate we(lands 4 1 n proicintily to boles) oo.00 M 1-11- eO-1� LeT.1uS QBZy7��"� �S,nea -5 0 a IT0— � �. No TVA/QG-NAnA r Parent material(geologic) \"\ Depth tit Bedrock Zw Depth to Groundwater: Standing Water in Ffole: Weeping f all)Pit htlt:a Estimated Seasonal High Groundwater r /� DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Uscd: Deptli Observed standing in obs.hole: III, Depth to sQ11 Inottl.as;.,-- Depth to weeping Frain side of obs.hole: _ 1!], Groundwater AdJusllTtent„a fr. Index Well R Reading Date: Index Well level „ Ad1,f,.tetor AcJ,Ort7undwateY UVO 1['ICRCO LATIO i TEST m Data 11U.10 Observation Depth of Perc ��� 5 Time At 6" i Start Pre-soak Time @ 0 _ Time(9"-0") t End Prc-soak Rare Min./Incl1 .4 2— 1^'�`(''h N Sile Suilablllty Assessment: Site Passed_ Sit.G�Failed: Additional Testing Needed(Y/N) A Original: Public Health Division Observation Kole Data To Be Completed on Back----------- ***It percolatiou testis to be coaaciucted vviti➢in 100' of Wetland, you must f 11-Sit u➢otafy ffic. Barnstable Conservation Division eat least oxic (I) vveels prior to begia➢uh..og. QASEIyTl0PERCroRM.D0C — CO.MMON"E ALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE 'WINTER STREET. BOSTON NLL-k 0210E (617) 292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION .. Property Address:123 Nottingham Dr . , Name of Owner Doreen Licker Date of l «,enterxyille , MA Address of Owner33 Fairview Ave . ,Hamburg, NJ07419 ►4specti /`�—7 Name of Inspector:(Lease Print) Wm E • Robinson Sr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) CompnyName: 1AIM. F . Rnbingnn SpDtir Service Mailing Address: p BOX—18 gg, G e nt e ry; , s� MA Telephone Number: T� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: f/Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails e Inspector's Signature: 4, 1 Date: s-� The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner `shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS CAY 1 2 1999 N OF BARNSTABLE HEALTH DEFT. Y4 revised 9/2/98 Paget of11 ►�� Pnned on Recycled Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A i' CERTIFICATION (continued) 'roperty Address:123 Nottingham Dr . , Centerville , MA awner: Doreen Licker Date of Inspection: 3—i's—I I INSPECTION SUMMARY: Check( ,IB, C, of D: A. SYS PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. YSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. . Indicate y s, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator Figs provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within.twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed a� 1151 � r t�It1l.' I revised 9/2/98 Page 2of11 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 123 Nottingham Dr . , Centerville , NIA Owner: Doreen Licker Date of Inspection:3-19-9 1 C. RTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property 123 Nottingham Dr . , Centerville ,y Address: nterville , MA` Owner: Doreen Licker Date of Inspection: 3.-/9-$°Y D. STEM FAILS: You mu t indicate either "Yes" or "No to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes o Backup of sewage into facility-or system component due to an overloaded or-clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for <coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. RGE SYSTEM FAILS: You ust indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 1.0,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Ye 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 It of a public water supply well) The wner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional offic of the Department for further information. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1�3 Nottingham Dr . , Centerville , MA Owner: Doreen Licker Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes/ No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving rwrmal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. ✓ _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) The facility owner (and occupants,if different from owner) were provided with information on the proper maintenawco.of Subsurface Disposal Systems. revised 9/2/95 Page 5ofII S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Drop"Address: 123 Nottingham Dr. ,Centerville , NIA Owner: Doreen LIcker Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design How: 3-C g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms (actual):, Total DESIGN flow 3 G O Number of current residents: I Garbage grinder(yes or no): 0 Laundry(separate system) (yes or no):AO If yes, separate-inspection required Laundry system inspected (yes or no) Seasonal use (yes or no): ,.a 1 C�C�8 60 , 000 gal. Water meter readings, if available (last two year's usage (gpd): Sump Pump(yes or no):LO 1997 51 , 00Uga . Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: DLew: gpd ( Based on 15.203) Besign flow Gap present: (yes or no)_ In Waste Holding Tank present: (yes or no)_ Nary waste discharged to the Title 5 system: (yes or no)Wter readings,if available: L of occupancy:Oascribe) L of occupancy: GENERAL INFORMATION PUMPING RECORDS d source of information: System fumped as part of inspection: (yes or no).,e_—0 If yes, volume pumped: gallons Reason for pumping: TYPE OF YSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Attach copy of up to date operation.and maintenance contract Tight Tank Copy of DEP Approval Other q APPROXIMATE AGE of all components, date installed(if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)4 D revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address: 123 Nottingham Dr . , Centerville , MA ' Owner: Doreen Licker Date of Inspection: 3 BUILDIN EWER: (Locate on ite plan) i Depth belo grade:_ Material of construction:_cast iron_40 PVC_other(explain) Distance f om private water supply well or suction line Diameter Commen : (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction:_/oncrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or.baffle:1701 Scum thickness: / 1 Distance from top of scum to top of outlet tee or baffle: t Distance from bottom of scum to bottom of outlet tee or baffle:_y� How dimensions were determined: OW Jt�— 'omments: (recommendation for pumping, condition of inlet and outlet teesor baffles,.Opth of liquid level in rf lation to outlet invert, structural integrity, evidence of leakage, etc.) /0-0--0 TA 4 '02 d i GREA E TRAP: (locate on site plan) Depth b low grade:_ Material f construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensio s: Scum thi kness: Distance rom top of scum to top of outlet tee or baffle: Distance rom bottom of scum to bottom of outlet tee or baffle: Date of I st pumping: Comme ts: (recom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, eviden a of leakage, etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roperty Address:123 Nottingham Dr. , Centerville , � MA e Owner: Doreen LIcker Date of Inspection:.—i S 9 TIGHT HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate o site plan) Depth bel w grade:_ Material o construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensio s: Capacity: gallons Design fl w: gallons/day Alarm p esent Alarm I vel: Alarm in working order: Yes_ No Date f previous pumping: Co ents: (con tion of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:_L (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is eq I, idence of solids carryover, evidence of leakage into or out of box, etc.) - PUMP CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarm in working order(Yes or No) Com ants: (note ondition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2./98 Page 8oftt i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) `ropenty Address: 1�3 Nottingham Dr . , Centerville , MA. Owner: Doreen Licker Date of Inspection: SOIL ABSORPTION SYSTEM(SASE (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries,number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs pf hydraulic failure, level of onding, dpmp o , condition o vegetation, etc.) , oo C SPOOLS:_ (lac to on site plan) Num er and configuration: Depth top of liquid to inlet invert: Depth of solids layer: )epth f scum layer: Dimen ions of cesspool: Meteri Is of construction: Indicati n of groundwater: inflow (cesspool must be pumped as part of inspection) Comme ts: (note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRI _ (loc to on site plan) Mate 'als of construction: Dimensions: Depth of solids: Com ents: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/95 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) "�roperty Address: 123 Nottingham Dr . , Centerville , MAr. )wner: Doreen Licker Jete of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) l i C. lo revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) rop"Address:123 Nottingham Dr . , Centerville , NIA Owner: Doreen Licker Date of Inspection: Gj_ NRCS Rep rtname S Type_ T pical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells x Estimated Depth to Groundwater 6 Feet Please indicate all the methods used to determine High Groundwater Elevation: :� 0 ained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.)' Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 7- revised 9/2/98 Page 11of11 LOCATION SEWAGE PERMIT NO. LLAGE I (-,, . 117 1 N S T A tl-_E-)R'S NAME i ADDRESS B U I L D E R OR OWN ER Over es 7�h 3 bSr-n, ePL 65�% E PERMIT DA TE M ISSUED 7�� DATE COMPLIANCE ISSUED �� a vl/i i �� 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH oF...........�1.. -�.. ............. ---------- Appliration for DioVo, ial Worko Tonotrur#ion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . ............_.. .......... . ......................................................................... . ....................tion-Address rLNo�..1R ..L !. Lffa..�...................... .....----•...............•---......----_... .....................-----•-•-•--••.......--------- . ............................................. �� � �Owner Address ----...... . .. ....-- .. - ------------------------------------------------- -------------------------------------- .......------------........---------•--.... Installer , 3 Address fYl l UType of Building ��OVQX Q.Sc�ft ,-w• Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) aOther—Type of Building ...... ... No. of persons--------...�............ Showers Cafeteria ( ) Otherfixtures --------------•-•---••---•--------•--••--•--.........•------------•-•----•-•--•--••-•---•-••-----------•----- W Design Flow.......3:�..........................gallons per person per day. Total daily flow........ ....................gallons. WSeptic Tank 1 Liquid capacity,/q OO.gallons Length---------------- Width................ Diameter..-..-------_- Depth....--..----.... x Disposal Trench—No..................... Width..........�4...... Total Length.................... Total leaching area...........---------sq. ft. Seepage Pit No---------/--------- Diameter.--........F..::?-Depth below inlet........-...... Total leaching area.r-_)..6..f_-,...sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit...........--.---... Depth to ground water........................ f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.---.--...--............ a' --------------------- ................................ ------. ----......... ..........'=.----•-----•---•.........•--.---- Description of Soil ZI '...RS •--•-- ---°`-�` /L ..... --/�.---•--•----•---••--- x - V = ' �f ............................................................ ............ 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 TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. Signed...... ---- -- 11C........ ...............•----- --------•-••-• ........-....................... ate Application Approved By ............ ........... Date / Application Disapproved for the following reasons:.... ..... `-----•---------------------------------------------••----•--- •---••-•....--•----•........••----...••--•-•........--•--•-•-...--------•--------••...•-•--•---.....---••---...-•--•-••----•-•---•----•-•---•--•----------•-------••----•-----•-•--------------•-.----- Date PermitNo......................................................... Issued---- ... 7 7 .................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r1 - ...............oF..........., .. .-•--- Apphration for Disposal arks Tonstrur#inn .rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at V0....................... 'WX411i ... i Lo ation-Address orAm. ... '!..?�:. _m .-•---.................................... •-•............................................ .............................................. Owner Address � ' ...-- ............--------------------------- ---------•-•-•----- ------- >=•.. ............------•----•---------•--....... Installer Address tll Type of Building Size Lot............................Sq. feet U DwellingNo. of Bedrooms.._......•_:......_. ..................Expansion Attic .. No. of persons _______..,�„_ � Garbage Grinder ( ) — a Other—Typo Typo of Building .....� p ... Showers ( + "'— Cafeteria ( ) Other fixtures ----------- W Design Flow..... " _r...:.....................gallons per person per day. Total daily flow.......orb °:. .................gallons. WSeptic Tank I Liquid capacity/42:0.0.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. A.4..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit____...._:.......... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------•• ................................xx E . O Description of Soil ` = «» _.f0!.........0". --- '*» '" ".. W .. .. _ . ....................•--........--------------•---------•-•...------•-----------------.......--••-•-------- VNature 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 TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. Signed. .,. 7. M Application Approved By.... �..........:- � :- _.....�- ^ �nr_.. �"`..,,Y ate ._ ....... Date Application Disapproved for the following reasons----------------•--------•--------•---------------•------------•---••-----------••-----•----••-------------.._... ................•--------......---•-•----------•-----•-----....-•----......--•--------.........-----•---.._................-•----•-----. -----------------------------------•-•••--------•----•--•----•-- Date PermitNo........................................................ Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH J ............. L4��F.....................I, l :...... ... (9rdifiratr of✓Tlamptiam � TH IS CERTIFY, That the Individual Sewage Disposal System constructed ( '�­or Repaired ( ) by... s. ..r... ... Inst -- xz ------------------------------------------------•-----•-----•--- ..w .. � Insta at...... ... _ has been installed in accordance with the provisions of "' 5 ,,rThe State Sanitary Code as described in the application for Disposal Works Construction Permit N '__--_ 2i"'_ ........ dated 1 _._._.._.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT`°BE CONSTRUE® S A G ARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _ / DATE... 1? - C ........................ Inspector: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..�" ,!'�'7..OF...... �L%t`.........�..7�....... �. No......................... FEE... ................ Bispap rkii Tuon ion rant' Permission s eby granted _ ' '. * = . to Constru ( or Re '.2air ) n uldu Sewagat .e ril osal Sy �n Street as shown on the application for Disposal Works Construction�e�rmo...... . ....... ated................................ .� ---••--_-_ ••- - . •. /d— Y Q DATE....C%•----------------•----7-------•--..._.-----....-------•-----------------•-- Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS per:r l,�►�1 .t:'�,TA -... 1 � � YadiL�! t`t_c�w = %Io 4 3 3-4D J -rjb.v-.;►: - 33a: f S C % •.d�S 6.P.O. i ° S..'. 2.`=� + !� �S G.P.L . � � �� a• �.. �A yam: � l •p = �. f�•RD. ;. , . � � � d,a 1-` TOTAL t'7ESl6►.1 • •425 G.P.D. '3' to . -ate 1., tf�'GOl.�Y1t?al 4T6 : aLA CAA)IELJ-.. I����t', �1 ','�1.�If` LIl.f/4�1)I � 14 �, i t I .� �-.:.I' MCI' Y�.1.. .S� Ih r �1! ! !i �• �tt � ' Vj ' N x E �' .;:: Mtn J ADtl 'b ` { No, 19,3u Tor t w.eoo.do ;._ . 1 tllrF Lo d �io t o0o uM lj'�Pb blsr. IW. ls,at... qL. • , i I + , 1 3. _ s �� � T"i►MIG .... d ,.t. � r,� 1-L i PIT t � WAA4ED �`. STONfgo Ago Flue CaZTtFtEX=P ptror LoCATIO" t GGtL,Tt4=�( T1-•IAT T1-l� �.0p. MELL, s&40wwA�.� Rt�cQEwcE: 1 \A/►Tk Tt-AG: 51 DE.LtWei I T U�S� At,la �C7i?;�Gt` �G!vU1r;GN E-1-4TS :OF T64C '(o w►.� pr" C` Pc�1.3 S t A �. - Y(,; �'✓'K• Z �.. .. p G. e 4 iJA'CG l2EGIS t•C rZC D 1-AIWCP. SuZV�Yo;. '('l-�t5 ht_A►-1 1!, LiOT L'ASCC7 �; f �-f;.,t-- .✓ a:./.t~.�. �'� Tys" 'UF4:;�T�o �,odGfl►rt� �-:, ; 1 W SrL J ✓� _ 1 .v � A.1�Ip t..1 G A1�.d T �(�M� . �1.��r E',ta Uc,L,',. �`, 1��1.t�o".'.M. �►.8l_ 1-[�'�61 d_1.1.0�:�' Il.��d. F' � ._.- ,a ... .� :� � IL�,�1� i I , - o I . . - -- _ wvo42- TWI)L1v'4-1 II , tiGtl �1TM iZog-t 13F--DR ooM .. � te i �.I n1Ea j � RAcE O Phfl y o d M ' 3eD-�oo M #� - E-64 STA' �S 1... �v►N moor-t _._._ ,13 �t5£ItS N _-a _ .w-_.._._..... IN i ff I "Z1�F 4ZS I � I I I 4 r' SC ID I � ��.00R �EM•oDc.�-. �^ �<J r '•ti- 30 1�A1� 2UII�ELr�( C S 1� 1�1C�LF- J i t ' 3 0 y�tR. F�c.tl(TF C.l K�R� S►t 1 r.�c�C..E S .---�,.,....._ i F6sGI A �, r t'}LU N 1 rlJ H TTiCR�" 4 r �o w E.►-r+E R. i � ICtAAWS _ -- I l 21042 4 �auv�sc� TI#) G �� -T-wZlo* Tw 210 Tw¢reyZ LA)14 I TE- C F-,)&-[a- S H i i k � o - t Ti t j orF��.0 �f �'�"�A IAS i a F �E� �p�It'1ER AD- T 0 IQ Tttr- I.J&ATr+F_ � N �C7 `)�+aR �RCr+!!"1•�"c��r4gc — 2-�q IZ�DC,E F y IsTlnl� O Phi n •�� ,��..� a o 1 �.�Nt Rom._._ ----=�.�,-- `t �4�u H r au�•-i ��Zy�� �'` � o,� . �, I�oT� �1C0a�14404S a /6 FIT JnJSUL-P`rrOQ /�4 GNrTE CEDA;�,' f j1 c' 7-6 oR cyvLtt �X u v FLYc , ��_ T��j1.S I ]�3 0 t 115�4K"j i O N 1�s,,,? 4►/4 + .� ' 1' _ __ L✓ lL S EXIST 1 I�G, /, -P, 0 C, �t►li1 MR►+JG. o K rk r.>I s RE- lZooF J ITN 30 yEAP_Af,C 4."M 4K A 4 s aSOP_C 010 3-p,-rc_j4 IZ �t , r� 1 r1.ao TI _ ._ .. .r rrrll c2t T IF_ 3(2 t6LL-\.1 Cot. "?-o O'(_ , I _ Cas SAC_dC�1�►� : EZc�si, �- I Sc�4�E /4. - ! -0 3 �� O S It'fir► t•,/r-al'tE CE►�i►1Zr�� I W)��TF c- E7AR LAC iF E'�i$T ►� E-�I S� ►-14 �J�?E i�SS a 21 o J _ L r 1 I i n , b S SHALL SYSTEM PROFILE MMAARKEED WITHCMAGNETICTTAPE OR BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 5� 1. DATUM IS NAVD88 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE TOP FOUND. EL.62f PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING \ APPROX. 58.9' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE RE RED OVER SYSTEM 57.6' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. I_ 4. DESIGN LOADING FOR ALL PROPOSED PRECAST I RISERS (TYP.)CAST O UNITS TO BE AASHO H-MP. 'py x.. 2'. 58.24' 4'0SCH40 PVC " TEE PIPE LEVEL 1 ST 2 2 DOUBLE WASHED PEASTONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. OR GEOTEXJII� FABRIC '9s 92 EXISTING II 54.6' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE y� F 10" 1000 GAL H-10 14" 1:I *57.1' TEE SEPTIC TANK** TEE 56. '000000000.0.9'* WITH 00 310 CMR 15.000 (TITLE V.) pQ`� • PUMP TANK & �000,0o°o°o0 54.1' o ADD NEW TEE & GAS BAFFLE - 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND P� 54.67' 54.5' go 2 NOT TO BE USED FOR LOT LINE STAKING OR ANY LOCUS `$ 1.85' off` 52.1 OTHER PURPOSE. 6" MIN. SUMP 12" MIN. INT. DIM. H-20 3050 INFILTRATORS 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 6" CRUSHED STONE OR MECHANICAL 3/4" TO 1 1/2" DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR LOCUS MAP COMPACTION. (15.221 [21) CONCEALED WITHOUT INSPECTION BY BOARD OF OVERALL DIMENSIONS AND PERMISSION OBTAINED FROM BOARD DIMENSIONS TO OUTSIDE OF STONE: 40.0' X 10.25' 6.1� OF HEALTH. NOT TO SCALE ( 16% SLOPE) ( 1 % SLOPE) MIN. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR ASSESSORS MAP 172 PARCEL 49 EXIST. 14' , LEACHING CALLING DIGSAFE (1-888-344-7233) AND LOT 22 PB 9 PG 84 FOUNDATION SEPTIC TANK D BOX 3 FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & DB 12279 PG 9 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF LOCUS IS WITHIN FEMA FLOOD ZONE "C" UTILITIES AND AL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE , WORK. NOT A FLOOD HAZARD ZONE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. BOTTOM TH-2 46.0 11. ANY UNSUITABLE MATERIAL ENCOUNTERED PROPERTY IN A ZONE 2 SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. PROPERTY IN ESTUARINE OVERLAY DISTRICT EXISTING 3 BEDROOMS- NO ADDITIONAL BEDROOM 12. EXISTING LEACHING FACILITY SHALL BE PUMPED ARE PLANNED- OVERSIZE LEACHING FIELD FOR LEGEA I D AND REMOVED, ALL UNSUITABLE SOILS REMOVED LONGEVITY ONLY- 3 BEDROOMS MAX. ON SITE. Iy NO "NEW CONSTRUCTION" PROPOSED. SEPTIC REPAIR ONLY. 99- EXISTING CONTOUR VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE LEACHING CURRENTLY IN HYDRAULIC FAILURE. IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR X 99•1 EXIST. SPOT ELEV. BY HEALTH INSPECTOR 99 PROPOSED CONTOUR �p� PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED f9s.4 70 BY THE BOARD OF HEALTH REVISED DURING A PUBLIC ] PROPOSED SPOT EL. �� HEARING HELD ON AUG. 4, 2009 TH1 �� $6+�. 2) FAILED SYSTEMS ONLY. SEPTIC SYSTEM COMPONENT TO SYSTEM DESIGN" TEST HOLE �SO,t 0O?'l� ANDFOUDATION INSTALLED(10C IMPERVIOUS OR GREATERALLOWED) "LINER IS DESIGNED 2% SLOPE OF GROUND �O • GARBAGE DISPOSER IS NOT ALLOWED W p0 PROVIDE APPROX. 30' OF 40 MIL LINER AT 5' CC)_) UTILITY POLE 2NOo OFF SAS IN AREA SHOWN. TOP AT ELEV. 54.6', DESIGN FLOW:3 BEDROOMS ® 110 GPD = 330 GPD +� BOTTOM AT EL. 50.6't VIC FIRE HYDRANT Ma 17G 4 USE A 330 GPD DESIGN FLOW NOTE: NOT ALL SYMBOLSW-' r MAY APPEAR IN oRA 4p SEPTIC TANK- 330 GPD (2) = 660 15,000 "F" SHE USE EXISTING 1000 GAL. SEPTIC TANK** o TEST HOLE LOGS q� REMOVE 10" OAK TREE LEACHING: ENGINEER: DANIEL A. OJALA PE, PLS, SE / LOAM AND SEED UPON CONTRACTOR TO DE 4" SIDES: 2(40.0 +10.25) 1.85 (.74) = 137.6 GPD 123 1 WITNESS: DAVID STANTON RS EXISTING COMPLETION BOTTOM 40.0 x 10.25 (.74) = 303.4 GPD r8. DATE: 3-10-10 DECK 3 BR HSE SAVE NEW ACHING TOTAL: 596 S.F. 440.9 GPD TAN TH 40' X 10.25' PERC. RATE _ < 2 MIN/INCH sg j �� 3 USE (5) H-20 3050 INFILTRATORS, I 12857 // 68 0 s WITH 2.25' STONE AT ENDS AND 3' AT SIDES CLASS SOILS P# //6� 66 1.85' EFF. DEPTH X 40' X 10.25' OVERALL 65 A`Ooo REMOVE EXIS . ELEV. ELEV. 0•� cVd` LEACHPIT 0„ Q 58' 0" Q 57' 62 PLAYGROUND 3 DBOX 1299 FILL LS 11" FILL LS sp M BENCHMARK: MA A M WATERGATE APPROVED DATE BOARD OF HEALTH A LS A LS 10YR 3 2 10YR 3 2 59 A�O �R/ M �y° ELEV. 57.24 14" / 14" / 000. 0,'> q y M \ TITLE 5 SITE PLAN B B OF LS LS BENCHMARK:SURVEY NAIL- Nottingham Dr. 10YR 5/6 10YR 5/6 �� � 36„ 55.0 35" 54.1 ELEV. 5s.90 Centerville, (Barnstable) MA Q� aFq f4jK oFr�;�s PREPARED FOR C �4� C DANIELA oyG DANIEL PERC Richard & Holly Higginbotham H Nm .,, o Lq �, ! A. ®JA CIVIL A No.465 MS MS Cn ��, o No U80 _ 7 DATE: 3-13-2010 01sTr �G �>�o�itq �'•` +o off 508-362-4541 x,ass9c �ctMgSo fax 508-362-9880 A.2.5Y 7/4 2.5Y 7/4 � iAIVIEL tiG�� �oa�DANIELA.�cy�� ( downcape.com ©JALA o OJALA ai • No.40980 CIVIL in down cape engineering inc. 132" 47.0' 132" 46.0' � No.46502 NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' tgNo ss�ayo�. ��s�� Te _ civil ' engineers ®NA � y land surveyors 4 / 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 DCE # � 0-�46 0 10 20 30 40 50 FEET 10-046.DWG