HomeMy WebLinkAbout0130 NOTTINGHAM DRIVE - Health 130 Nottingham Drive
Centerville P
A = 172 019
e'
No. 42101/3 ORA
ESSELTE
10%
a O O
4'
I ,
TOWN OF BARNnnSTABLE
LOCATION �® at t" �� �` Wr' SEWAGE#
VILLAGE CAA IlLt 'ASSESSOR'S MAP.&PARCEL �7a
INSTALLER'S NAME&PHONE NO. o6
SEPTIC TANK CAPACITY Lr)Cl a®
LEACHING FACILITY; (type) p1® ;now_ (size) _x
NO.OF BEDROOMS
OWNER
PERMIT DATE: P/ I f 1 - COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
f 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 �l
1
w
GZ (VS
No. �fJ 0 ' Fee
E COMMONWEALTH OF MASS HUSETTS Entered in com uteri
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Rppfication for Disposal *pstrm Construction Permit
Application for a Permit to Construct( ) Repair(V<Upgrade( ) Abandon( ) ❑Complete System FIlIndividual Components
Location Address or Lot No. Or Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel i Lo(,-,v V__�>:N_' 0 4t j d
Installer's Name,Address,and Tel No. Designer's Name Addr s,and Tel.No.
Type of Budding:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(IUP
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 336 gpd Design flow provided 11 gpd
Plan Date I-Z r ` Number of sheets Revision Date
Title
Size of Septic Tank �� 5 . I EX t) 1-aL Type of S.A.S. cQ SIC Gr,,,L H off,o a
Description of Soil Dec.I�
Nature of Repairs or Alterations(Answer when applicable) 2, (( UO L C,1, Ck-.AA 'S
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. ( f
ggn d Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
��� Lip iu ���1_�
No. (✓ J; � �f t / Fee
E COMMONWEALTH OF MASSA HUSETTS Entered in co m uteri Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Rpplication for Misposal 6pstem Construction 3dermit
Application for a Permit to Construct( ) Repair(V<Upgrade(; ) Abandon( ) ❑Complete System ®Individual Components
st
Location Addressor Lot No. k�o PJd"%^� W"1 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel t l I C, C
Installer's Name,Address,and Tel.No. esigner's Name Address,and Tel.No. +
-3 6 + d u� o �. ���c� P. A 03 0 16
f wFy
Type of BuAding: {{
Dwelling No.of Bedrooms Lot Size l sq.ft. Garbage Grinder(A �7 `•
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) O gpd Design flow provided gpd
Plan Date t 1a I Number of sheets Revision Date
Title
Size of Septic Tank pk ( 5 0 64 E.. Type of S.A.S. Q. GAL H oa Q Ci�`�•�"`6""1`-�a�
Description of Soil .� R} �'i?Jc 1.11/S+n r, y J.I
Nature of Repairs or Alterations(Answer when applicable) p 12 C,i 1~' L
t
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.
Date
_..,� APPlica ion Approved by � r�� � 1 ! }.. _ Date
Application Disapproved by Date l
for,the following reasons ,
ji
Permit No. Date Issued
_ __ -•-- - -- --- -- ----=-- - - -- -- - - - _
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance 1,
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Lei Upgraded( )
Abandoned( )by 5c<1 jFrn f V%_
at � f CAJ 01Q • has been conskucted in cc-ar ance
with the provisions of Title 5 and the for Disposal System Construction Permit No. "� dated
Installer Designer
#bedrooms s Approved design flow�hdde,,
A/ gpd
The issuance of this permit shall
not be/construed as a guarantee that the system w{tl'1 fiuict' �d. ---. ,
Date . 1 / 1 l Inspector
>
No. / 14p; Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
]Disposal 6pstetn Construction 3permit
Permission is hereby granted to Construct
st( ) Repair(V/) Upgrade( ) Abandon( )
S ystem located at �y;� ��►�Gnl� Qf C .t� 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 must be completed within three years of the date of this permit.
Date r Approved by
! t/
'l
Town of Barnstable
Regulatory Services
Richard V. Scali,Interim Director
� .
Public Health Division
tes +° Thomas McKean,Director
2%Main Street, Hyannis,MA 02601
Office: S08-862-4644 Fax: S08-790-6304
Installer& Designer Certification Form
Date: k_Lh8- Sewage Permit# 61 Assessor's Map\Parcel a �!
Designer: 5&1E- RF_1,� A_kA1kS,Ta Installer: 5e-4511- A- ►1— t'J6�`"
Address: ? tom• ksSC t , Address: ll� ®� �A�dv"r'f-1
02&&0
On I ( � 0 _ was issued a permit to install a
(date) (installer)
septic system at �. rb�sCd on a design drawn by
(address)
4 AJ&, dated la l r
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed i Hance with the terms
of the IAA approval letters (if applicable) `+
(Installer's Signature)
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 8-14-13.doc
4J7
down cape engineering, incSIEVE SOILS ANALYSIS 130 NOTTINGHAM DRIVE CENTERVILLE, MA
DATE OF REPORT: 1118/18
.JOB : GRAIN SIZE ANALYSIS-SIEVE TEST
SITE: 130 NOTTINGHAM DRIVE, CENTERVILLE
LOCATION: HASS ENGINEERING TEST HOLE
SIEVE ANALYSIS Weight Sample(Grams): 125.5
SIZE :WEIGHT RETAINED € % RETAINED % PASSED
(surer-)- €
--------------:............... .....................I..............:---------------------
lot .................... o.
0.0 0.0 :: 100.0/o
--------------.................................. ....._---------------------�------------------
3/4" ' ............................................�:�.--------------0.0%: 100.0%
1/2" 0.0 0.0% 100.0%
--------------p.....................................................r---------------------r------------------
3/8" 0.0.:--------------0.0%€ 100.0%
--------------...................................... ----=------------------
#4 -0.0: 0.0%; 100.0%
--------------............................... .....>-----------------
#10 14.0' -----112% -88.8%
--------------..................................... .........:-------- ---.
#20 41 2: 32.8% 67.2%
------_-'-----.................................................:....i--------__-----------i.....................................
#40 78.2: 62.3% 37.7%
-------------:......................................................:------------------a- ...............................o..
#50 ....�.��..... -----------85_6/o:......................14:4/o
�. --------------p...................................
#80 : 123.7: 98.6%' 1.4%
--------------.......................................................:-------------------- ......................... ..... ......
#100 124.5� 99.2%: 0.8%
-------------............................... ............
#200 ................125.2: 99.8%€----------- 0_2%
------------ ........................ ..5......------- ----
PAN_- --- 125.2 100.0%;= ---------- 0_0%
- - - --------------------------- ------
SAMPLE: 125.5
f NOTE:TEST ON PASSING#4 ONLY, 28.5% RETAINED ON#4<45% O.K.
RESULTS:
SOIL CLASSIFIED AS AASHTO A-1-b (GRAVEL&SAND) (UNCOMPACTED)
PERCENTAGE OF MATERIAL PASSING#4 SIEVE :
#4 100% (TEST ONLY MATERIAL PASSING#4) OK
#5010%-100% OK
#100 0%-20% OK
#200 0%-5% 'OK
SAMPLE MEETS TITLE 5 FILL SPECIFICATION
>99% SAND
RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MINJIN. MATERIAL -
NONCOMPACTEDp ,-z0 Frr
SOIL DESCRIPTION: -MEDIUM/COARSE°SAND' }6L
(7.JAIA
CIVIL
No.46502
GISTS
([ Via--Ale
Town of Barnstable P1t
Department of Regulatory Services
aROuRNIMABijka Public Health Division Date
200 Main Street,Hyannis MA 02601
Date Scheduled )
�' Time Fee Pd.
Soil Suitability Assessment for S e Disposal
Performed-By: � a6;7 Witnessed By:
_LOCATION&.GENERAL INFORMATION
Uwnor's Namc•
Location Address tt A '
`dV C� ,H �l�•���Nj\�,,•�i � o
"\ Address
Assessor's Map/Parcel.- ` 1 / Engineer's Name
NEW CONSTRUCTION REPAIR Telephone#
��� Jac. +��` Slo es 96
' Lnnd Use• p ( ) Surface Stones
Distances from: Open Water Body N A ft Possible Wet Area ft Drinking Water Well ft
Dralhage Way Aa 1* ft Property Line /o ft Other
ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
(
-it
Parent material(geologic) gt'-T"'A-S Jm4 Depth to Bedrock Z6�
Depth to Oroundwater. Standing Water in Hole:_ N l k Weeping*otn Pit Face iV /-
Estimated Seasonal High Groundwater N /E
DETE ATION FOR SEASONALIHIGH WATER TABLE
Method Used: N
Depth Observed standing in obs.hole: In. Depth to soll mottles: In.'
Depth to weeping from side of obs.hole: In, Oroundwater AdJustmant ft.
index Well-# Reading Date: Index Well level _, AdjAketor- Adj.Groundwater Leval,.,,_,
PERCOLATION TEST Dille- "me
Observation
Hole# Tinto at 9"
Depth of Pere Time
Start Pro-soak Time @ . ime(9"-6")
End Pro-soak
Rate Mio./Inch .
_ Site Suitability Assessment: Site Passed Sitc Failed: Additional Testing Needed(Y/N)
Original: Public Health Division 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 Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PBRCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# 1
Depth from Soli Horizon Soil Texture Shcl Color Soil• Other
Surface(in.) (USDA) (Mansell) Mottling (Stnucture,Stones;Boulders.
o isistency.96'Gravel)
t4 P1 t"--
s
i
��' �� 15 . In Y� z�3 �,�-►�--'�
DEEP OBSERVATION HOLE LOG Hole# Z
Depth from Soil Horizon Soil Texture Sall Color Soil Other
Surface(in.) (USDA) , (Mansell) Mottling (Structure,Stones,Boulders,
Coinslatency.
lv LS t0 'lz
L 5
l3z e HS 10YA-
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders..
onsistency.
DEEP OBSERVATION HOLE LOG Hole#
Depth fraip Soil Horizon Soil Texture Soil Color Soil Other
Surface(In.) (USDA) `(Munsell) Mottling (Structure,S;ooes;Boulders.
Consistency.
Flood Insurance Rate MaR: /
Above 500 year flood boundary No— Yes ✓___
Within 500 year boundary No Q/ Yes '
Within 100 year flood boundary No. Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious mtitorial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on ' a •i� `f (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training, rtise and experience described in�10 CMR 15.017.
Signature Date
Q:wEFTIC HRCFORM.DOC
COMMONWEALTH OF MASSACHUSETTS.
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
c DEPARTMENT OF ENVIRONMENTAL PROT, CTrI N E IVE:D
OCT 2 J 2002
TOWN OF BARiJSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A _
CERTIFICATION . �4
Property Address"OD MAP �72
Owner's Name: PARCEL
Owner.',s Address: ' LOT
Date of Inspection: p
Name of Inspect- (pase print)Company NamMailing Addres
Telephone Number: SQL. `7-2I -9 rY
CERTIFICATION STATEMENT
I certify that,I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant Zasses
tion 15.340 of Title 5(310 CMR 15.000), The system:
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fai
Inspector's Signature: Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP..The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use.at that
time. This inspection does not address how the system will perform in the future under the same or different,
conditions of use.
Title 5 Inspection Form 6/15�20.00 page 1
Page 2 of l 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
UR
t
Owner: .
Date of Inspection: 000a
Inspection Summary: Check A,B,C;D or E/ALWAYS comple'te.all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria.not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system, upon completion of the replacement or repair; as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits.substantial infiltration or exfiltration or:tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
' Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
3
dt/A
Owner:
Date of Inspection:
C. Further Evaluation is Required by the Board.of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass.unless Board of Health determines in accordance with 310 CMR I5.303(1)(b)that the
system is not furctioning in a manner which will protect public health,safety and the environment:
_ 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
2. System will fail unless the Board of Health (and Public Water Supplier,if any).determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ 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, m for colifor
bacteria and volatile organic compounds indicates that the well.is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner:
.Date of Inspection: e cgooi:Z
D. System Failure Criteria applicable to all systems:
You must indicate"yes or"no"to each of the following for all inspections:
Yes No/
_ 1�//Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ V Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
/ clogged SAS or cesspool
V Static liquid level in the distribution box above outlet invert due to an overloaded'or clogged SAS or
Vcesspool
Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
✓,r Any portion of the SAS, cesspool or privy is below high ground water elevation.
V Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
/ water supply.
_ V Any portion-of a cesspool or privy is within a Zone 1 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.[This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from.that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,:provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form:]
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve-a facility-with'a Aesign flow of 10;000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ 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
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"Yes" in Section D above,the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 1.1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner: 41in, t/ILe�
Date..of Inspection: j '.Q0.2
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
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?
i/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
-AZ _ 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
Zn�e-nance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Ye no
>� 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(3)(b)]
5
Page 6 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner:
Date of Inspection: 0�00 J
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): �3 Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example:11.0 gpd x 4 of bedrooms):
Number of current residents:
Does residence.have a garbage grinder(yes or no):: .. ` .
Is laundry on a separate sewage system(yes or no):V [if yes separate inspection required]
Laundry system inspected(yes or no
Seasonal use: (yes or no):
Water meter readings, i available (last 2 years usage(gpd)): ®®—��/�a� elf—17rVP
Sump pump(yes or no) K
Last date of occupancy: /�'� ✓�)��GLGx�P�LC
COMMERCIALANDUSTRIA.L'Ju
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.): _
Grease trap present(yes.or no):—
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as PaA of the inspection(yes o no)•
If yes, volume pumped: gallons--How was quantity pumped determined?
Reason'for pumping:.
TYPY,OF SYSTEM
eptic 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)
_Tight tank _Attach a copy of the DEP approval
_Other:(describe):
proximate a e o all co .ponents,dat instal ed(if kno n)and so e of information:
Were sewage odors detected when arriving at the site(yes or no .�'"-
6
Page 7 of l 1
OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION(continued)
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER(locate on site p]anL460--
Depth below grade:_
Materials of construction:_cast iron _40 PVC.—other(explain):
Distance from private water supply well or suction-line:
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK:oocate on site plan)
Depth below grade:L��
Material of construction:_ vcloncrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:__ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate) _
Dimensions: -5. X (A K S'
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: �f7
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: 3
Distance from bottom of'sc:um to bottom of outlet tee or baffle: 7-f G'%Lv
How were dimensions determined:s�?
Comments.(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
s related to outlet invert:, evidence of leakage,etc.):
a ,
it
GREASE TRAP40Iocate on site plan) ���
Depth below grade:_
Material of construction:__concrete_metal_fiberglass_polyethylene_other
(explain): _
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of'scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid.levels
as related to outlet invert,evidence of leakage,etc.):
7
I
Page 8of11
OFFICIAL INSPECTIONFORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:.
Owner:
Date of Inspection: a
TIGHT or HOLDING TANK
tank must be pumped at time of inspection)(locate on-site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene—other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches, etc.):
DISTRIBUTION BOX: V (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:. _
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of
eaka�e into or out of boxy te.): /� <.
PUMP CHAMB (locate on site plan)
Pumps in working order(yes or no): .
Alarms in working order(.yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.):
8
Page 9 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION(continued)
Property Address-, _M YUW
�
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): (locate on site.plan,excavation not required)
If SAS not located explain why:
Type
aching pits,number:
leaching chambers, number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields, number, dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,
m
i
CESSPOOL5 .(c:esspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:_
Dimensions of cesspool:
Materials of construction:
Indication of.groundwater inflow(yes or.no):
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.):
PRIV (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.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
i
Property Address:
Owner•
Date of Inspection: /z', Ua
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide.a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
�Lplu
o,
01
10
Page 11 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: L -
Date of Inspection Aff. P.M
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated.depth to ground water feet
Please indicate(check),all methods used to determine the high ground water elevation:
Obtained from sysstem design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with.local.excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
42ze
S
11
lC GPO.tJ�iC-'tiV_4-= LcV'tL C.OMPUTA;ION
J ram/ /y /�//J /�1/a /�,/ `
Site LOce !on: 3d, 1(1/ 1 !i/ 1� N (/C/ /!/` G.� Lo: iNIG..
�, �— Address--
Contrac�or: G/el Ml®� O I p//4�/ Address:
dotes:. any fug
STEP 1 MeaANe depth tO•W2ter table
e 1EaiBr]':.ta_. _..................... ate
�o z lg
-noun%cay/.Y'=-r•
Using.Water-Level.Range Zone
and lh.dd.x locate
sit. a. ;min6:
S�I1� r
�A Appr'o.pnate.lndex w.EI'I................__........._._..._..........__....._._ . �. ��
zorrE_._.........................
_._..
ST---F .3:: Using•mo„tnly, .repo.rtt."Curr=nt
Wetter esources-Conditions"
deL—.mine curreni dam.tn'io
water. i-e'vel lor-indez wel-I
month/year
5-� — Using,; * .� e
._. a�?I�.On• Ls�..,�,l.,v:el ,AdJI!Stmen.t5 I• _
or index Weil (STEP 2,13,.currYnt de.o& I-
to waaerIevel for.index weia 'STEP 3.
and.w_-,:er-level zone fST=?•2B) ! i
de ter mF•ne•wzte:-level adiustmera ...................:...............:... ..............
STEP-. 5 stimaze-ceptia to:hian water
by subt::acti ie tn.e water•
level 2djustnar1,-(STEP'-) ll
i,-om measured-.depth to.watEr
i
level at si'ta.(STEP 1)' 4 '
i IC;at v' '.J:'-^aG ivy ,bIe vv:l;IHUT.aIG 1'vi M,L
35
i!
1
ze�vi
`,MO L Z
i _
`G TOWN OF BARNSTABLE
LOCATION �� /�� 1� '.'/�1 ��i SEWAGE#
.J( WII,:,AGE t°�7 ��/ L� ASSESSOR'S MAP&LOT/ 7Z��
INSTALLER'S NAME&PHONE NO. F� L® j C®W517% ;77/
SEPTIC TANK CAPACITY le w o G L
LEACHING FACILITY: (ty S�cw / ���tiro, 11r 4-Yj (size) )3 x f',(.2
NO.OF BEDROOMS .3
BUILDER OR& _7
PERMITDATE: OMPLIANCE DATE:/127
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
A
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) V O Feet
Edge of Wetland and Leaching Facility(If any wetlands exist / {� Feet
within 300 feet of leaching facility)
Furnished by
1
a3-y5'�
13;- �
4Y
► ', `IT
ASSESSOR'S MAP NO. 1 1`2_ PARCEL �1
li :qk Ir 14N 5 E W A t; F
`V L,L A G E
I N s T A L L F R 1 5 hAe z L ADDRESS
3UIL0ER OR QWPEft
DATE ' kRM T ISSUED
D A T L �G � J ti C Y !C-��v.Ry iLu Pas G _
G SWA^f 1;�'OmiPikX-P JW-& E;I-
,ctl6b
/t/ogrT,'Al.
s `
,
�� IR>-
— elf
No. '=r/P a v'.
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for Digponl *pgtem Conaructiou Permit
Application is hereby made for a Permit to Construct( )or Repair( OC},an On-site Sewage Disposal System at:
Location Address or Lot No. Owner' Name,Address and Tel.No.
WW
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
`�GiE.t�c.0 Gte�13"i CO O/V V_Lj LA_ 1 odd..�-
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flower gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) /%b
�,,Pt
13 y
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this o of
Signed Date //,
Application Approved by r'
Application Disapproved for the following reasons
Permit No. C . if"—s Date Issued
t 3o--
No. ". _ Fee
THE COMMONWEALTH OF MASSACHUSETTS -
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
[pprication for �Mtgpool *pgtem Congtruction 3permit
;Application is hereby made for a Permit to Construct( )or Repair( Kan On-site Sewage Disposal System at:
F
Location Address or Lot No. Owners Name,Address a Teel.No.
C F_n7;F U 1 u.E. , AA4 G 6 3� /3 v r-�oT17 o.1�k�+M
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
1 4S cn/htL J3-f /C
,MA- Gml-&4?
Type of Building:
Dwelling No. of Bedrooms 3 Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3�d gallons per day. Calculated daily flow ,.��+ gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1%,D
Date last inspected:
Agreement:
s The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance'has been issued by this oaz of
z' Signed 1^ Date
n; ,.:.
Application Approved by
Application Disapproved for the following reasons
Permit No.
- Date Issued
=__=_=_=__=_ —Z—_=-------
THE COMMONWEALTH OF MASSACHUSETTS I
7 o/a
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance -
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( >4,on
by *s 44_-T13L0_ 1 CA N S-r-A-V cw-7 UQ for �h 6� C . (-4+J C44,4.42Z
ar 13 a tJ c (JA,-j r- C f--r7VWI LA has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit � dated
Use of this system is conditioned on compliance with the provisions set fo li elow:
- D
` No. / 172- ! `, Fee U
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTAB�E. MASSACHUSETTS .
Dig;p0ar *pgtem Congtruction Permit
Permission is hereby granted to �O LA V 7 Ck Aj <�) C,77 VAJ
to construct( )repair( b<.an On-site Sewage System located at /3 6 N P-r ► J C---"4M O/W 6
C
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
All construction
must be completed
within two years of the date below.
Date: ,//� �i ` `Z-ZJ Approve
i
• 7 ,
f
CERTIFICATION OF SKETCH AND APPLICATION FO
R A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, _d&4EK-0—, :ho w�7, hereby certify that the application for disposal works
construction permit signed by me dated /111-4 concerning the
property located at l30 ,c Jai oJ&A-4i-1 0/4j,2. C �'�c
meets all of the
following criteria:
• ere are no wetlands within 300 feet of the proposed septic system
/ - There are no private wells within 150 feet of the proposed septic system
v 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 SYSTEM 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].
k k
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,q.,.S:.zj)a„c,e ;,.:a tw ' ,Y^.d� ;f,,�yrra.k. .;.Y' +l *v��z�i...� _,r. •4 i:i..'�� 7....•,,y. xi.a._..�" z €�i. �z d€' � -Yzr. -``� .,�; �hN-.�.'k�i�+�,�
a•.• �P -'f'x #i s,�. 3� 4}?�""F °a:z' {,.€4;g�'� +Y+'s �_ rsa� '+... ��,M �4'�'� tea'' .r�-a�`�' � t�k '�i � �t >:A �`r' 'i.�w s'�,�s ,,�.
`' ' ;`' .4..• s :M: � ,r ;^�;ct �r7 ..�+ "�"�y�:.j�' Lf2`r�' a.^+�`t � 6k.�r.r �r��o:^ #'� a�b.M,,fir.
75
NFimic...f......,...............
THE COMMONWEALTH OF MASSACHUSETTS
E30AR® OF HE H
94= --------------------oF. !I._ ...../ � ...
Applira#iaan for Mopma1 Works Tonstrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...........___J:A:4 ..................................................................................................
Location-Address or Lot No.
e
� Uwner-- Address
-•---------------------------------------------•--........---------------••-......._........•--•--
Installer Address
Pq
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...............-3.......................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons____________________________ Showers — Cafeteria
dOther fixtures -----------------------------------------------
W Design Flow.............j...�......................gallo s per person per day. Total daily flow.___._.._._-___30_0________._._____gallons.
WSeptic Tank"—Liquid capacity_��''_ .gallons Length---------------- Width................ Diameter................ Depth................
x Disposal Trench--No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......../........... Diameter____________________ Depth below inlet-------------------- Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( j a
Percolation Test Results Performed by-----=. �r_W�a /�,-�------6ur, �'' ... Date
� Test Pit No. 1................minutes per inch Depth of Test Pit.......___.____...__�Depth to ground water........................
0-4
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________.
O Descriptio f Soil-...-•---• ... f''�r1 . ' f' � -y`x' i f- / ''fl
x
W C % ' - kas •x � - ,c� !� ' fir_
-- --------------•- � ' � ----- �
U Nature of Repairs orrations—Answer when applicable.-•.--.•---------------------------•--.--•-------------------•---._.t �____.........__.
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 ssued by the board of hea th.
grid_.,
�- /ilatApplication Approved BY••--•.... r.-. � -•-•--•••--. .. -•-• � -•--..
Application Disapproved for the following reasons___________________________________________7______________________________________________________________________
.................................................•--•-------.....__.._.....------------•-------•-------•---------------•-----•-•---•--•••••-•--...f-•__.... _..__.....••••••--•------fe-----------...
Issued.. =`�� -��
Permit No.......................................................... -
Date
or
No......1 .� f�........ Fs$...//................
�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Of HE: H
•
- OF..
t' ..........................
Appliraiion for Rfivooa1 Works Tonsirur#iott ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
] Location-Address or Lot No.
tuner Address
!�.)
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling-No. of Bedrooms_______________ .....Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type of Building No. of persons............................ Showers — Cafeteria
Otherf}xtures -•----•-------•--•-------•------•.........................................................------•----•------------------------------•---------••--•-
W Design Flow.............5_ 0......................gallons per person per day. Total daily flow............... ................gallons. i
WSeptic Tank'—Liquid capacity./ gal ons Length................ Width--------_------- Diameter---------------- Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No_______ ___________ Diameter-------------------- Depth below inlet......__._.____..... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( „) � t" • ,3' `J
Percolation Test Results Performed by. ., 'u ,+__ ___ _.._. Date........................................
,aa Test Pit No. 1................minutes per inch Depth of Test Pit.....................With to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit._..._..._.._....... Depth to ground water........................
---. .......... . --
O Descriptio s f Soil t�...
_ `: =.
x �
�,. -
x �
_ ----- -.
V Nature of Repairs o�•Alterations—Answer when applica le.....................................................................Wr.- ....................
-----------------------•--------•----------•-------------- -------------------......-•-••--_---•------••-•••---•------------•<•--•--•--------••-••----•••--•------•-•---......-----------•-----•--
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 bee issued by the board of health.
gned ,Cliff!_.` + .. . ...........
at
Application Approved By........ ..... ... ._. � �------
.. ate
Application Disapproved for the following reasons--------------------------------------------------------=------------ ..........................-.................
••-----------------••-------•----•---------...•--••-•----•--•••-•-•-•-•••.._.......---------------••-•••.-•-•--......._.._..----....••-------••-------••-•-•--•-------•-----•-•--•--.--------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF..................0F........ '.0 HEALT
!4-v1�"" '.
(Irtifgratr of T.omptiatta
TIAS Z9 TO CE IFY, t the Individual Sewage Disposal System constructed ( ) or Repaired ( )
_----- ----•--- __---•- -------------------•-------•-•--------_------
I taller
. ---
has been installed in accordance v�i the provisions of Article XI of T e State Sanitary Code as scribed in the
application for Disposal Works Construction Permit No..._._..._. _ ____________________ dated---.- .___ ....................
TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A A ANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD015 HEALTH...... .. . ... . ....... ..... .0 F..
.._
rL...... FEE. ..._..... ..- c
0tfol osi i orks n 14an rrutt
Permissionsrhereby granted I
to Const c ('� R' air idual Sew tapo Sys '
at No ----/. . '_-
tr .r..
as shown on the application for Disposal Works Construction �` mit --._-----_ Dated. . : __
'"� --
Board of Hea
DATE-'..:............. ........................
FORM 1-2.55 HOBBS &'WARREN, INC., PUBLISHERS
I CHARLES N. SAVERY , INCORPORATED ,
712 MAIN ST. HYANNIS , SS. '
PL OT PLAN S HOW) NG PROP05-11-D BUILDING
IN
CERTE.RVILLE B A R N S T A .B 1,... E MASS.
FOR
1 . BART SI M O NE LL I
DATE ' MARCH 25, Ici75
139 140 141
+ � I
LOT I OG
15.3000 S. F. '
0
t
10 -7 o 0 105
0 20-
N 0
PROPOSED lP
3 13ED ROO M I GAR. j
Dv�J ELLI NG
20 IO' I
1000 GAL. (�
SETIC TANK}.�
c�'V ,
W17 so,
Box 3I�n
/Y_
T. I
I O o 0 G A L-1 FUTURE
I 1000 C*.LEAGN I N G LEACHING PIT /�� PIT
8' oIAM. Ip�l!o -24—f '
ro' O E P T H
10
1 OO.0O
NOTT 1 N GHAM DRIVE.
N OF
ROBERT
P. t
i BUNIKIS
I T, No.22152 0
E;T
SfS ,�Ci
L
CHARLES N. SAVERY , INCORPORATED
712 MAIN ST. HYANNIS , MASS.
PLOT PLAN SNOWING PROPOSED BUILDING
1N
1 CEKTERV ILL E B A RN STABLE MASS.
1 1 FOR
R KART 51 M O NE LL I
SCALE. 1 "= 30' DATE. ' MARCH 25 19-IS
1
139 140 141
i
LOT I OG
I
1 5,000 S. F.
.0
1 0 `t 0 0 1 0 5
0 2A
0
PROPOSED I lP
i 3 IBE-D Room I GAR.
� 1
DvV ELLI Nei
10' I I
1000 GAL. I�
5ETICTANK}� 0I2
r/ Hv 50
D I ST. <I N
Box T,
1 000 G AL. I FUTURE I
LEACHING PIT IOOOC3Al,LEACNIN
P G
'"�� �
�P►T�H l o-J,�c�-r-24 IT, �'� 1
10' I O I
IOU 0
NOTT I N GHAM DRIVE
OF r�4ss'�
i
�o ROBERT
P.
( BUNIKIS
o No.22162 0 +
14AL�a(
75o14
LOCATION Hof "� SEW&C,E PERMIT MO.
P
WSTQLLER5 W&ME ADDRESS
15U1LDER 5 Q &MF— ADDRESS
1wa fir
Dt.\TE PERM T ISSUED
DATE COMPLI &N ACE ISSUED ;
IOOe 5r
/999 xe
36
14
.S r,,e a 7` '
ACCESS COVERS MUST BE WITHIN 9` MINIMUM.6" OF FINISH GRADE 6 ' MAX/MUM COVER
INVERT ELEVATIONS : DESIGN CR I TER I A : GENERAL NOTES :
FIRST 2' TO INVERT OUT SEPTIC TANK: 89.5 DESIGN FLOW:
BE LEVEL MI N 2" OF PEA STONE INVERT IN DI ST. BOX: 88.57 3 BEDROOMS AT 110 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION
OR F I L TER FABRIC INVERT OUT D I S T. BOX: 88.4 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE D 1 SPOSAL SYSTEM ONLY.
4' DlAM PIPE INVERT IN LEACH CHAMBER: 85.3
3 - I !/2- D 1 A. NO GARBAGE GRINDER 2. VER T I CAL DATUM I S ASSUMED, FOR BENCH MARKS
o� �
;/ 89.5 88.4 2 • FH-20 .3
DOO "0- 8 .3 ADJUSTED GROUND WATER: N/AUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 83.3 SET, SEE SITE PLAN.
BAFFLE_
88.57 1 85.3 SEPTIC TANK REQUIRED:
N/A
3 OUTLET 2-500 GAL LEACHING CHAMBERS OBSERVED GROUND WATER: 330 G.P.D. X 200% - 660 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND
EXISTING D-BOX W/4' STONE AROUND. 12.8 'W x 25'1 x 2'd BOTTOM OF TEST HOLE tel : 78.0
SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL
1000 GAL H-20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
SEPTIC TANK 6` CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
COMPACTED BASE
DESIGN PERC RATE C 5 MIN/INCH
N PROFILE : NOT TO SCALE SOIL TEXTURAL CLASS - I 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
EFFLUENT LOADING RATE - 0. 74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
330 GPD / 0. 74 GPD/SF - 446 S.F. REQUIRED THAN 3 ' 1N DEPTH SHALL BE CAPABLE OF WITH-
STANDING H-20 WHEEL LOADS.
PROVIDED: 2-500 GAL LEACHING CHAMBERS
W/4' STONE AROUND. A-471 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
471 S.F. x 0.74 - 348 G.P.D. APPROVED EQUAL.
SOIL TEST PIT DA TA& 6• SEPTIC TANK AND D-BOX SHALL BE REINFORCED
PRECAST CONCRETE OR APPROVED POLYETHYLENE.
INDICATES V rV EDD
PERCOLATION OBSERVED BOTH SHALL BE WATERTIGHT, D-BOX SHALL BE WATER
_
TEST GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE
TP sl Ps15782 TP s2 OUTLET.
0. HORIZON TEXTURE COLOR 91.5 0 HORIZON TEXTURE COLOR 91.5
FILL FILL 7. BEFORE CONSTRUCTION CALL "DIG-SAFE`.
1-888-D/G-SAFE AND THE LOCAL WATER DEPT.
14' - - - - - - - - - - - - - - - 90.3 10' - - - - - - - - - - - - - - - 90.7 FOR LOCATION OF UNDERGROUND UTILITIES.
A LOAMY IOYR A LOAMY IOYR
SAND 5/2 - - - - SAND - - - 512-
20- - - - - - - - - - - - - - - - 89.8 18 - 9o.D 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
B LOAMY IOYR B LOAMY IOYR
` SAND 576 SAND 516 DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION
\y 36' - - - - - - - - - - - - - - - 88.5 30" - - - - - - - - - - - - - - - 89.0 OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE
Cl COMPACT /OYR C/ COWACT WYR CONSTRUCTION 1 NSPECT I ONS.
/� % LOAMY SAND 7/3 LOAMY SAND 713
A 1 i S' 74" - - - - - - - - - - - - - - - 85.3 74" - - - - - - - - - - - - - - - 85.3
,f / .S0 C2 MED I IAW IOYR C2 MED I UM IOYR 9. EXISTING SEPTIC TANK TO BE PUMPED AND CLEANED.
90.0 /' i, y� SAND 714 SAND 714 INSPECT AND REPLACE INLET TEE AND LINE IF
J 16 V � K;� p ! REQUI RED.
/ 162' NO MA TER 76.0 I32" NO WATER 80.5
0 i
DATE: SEPTEMBER 27. 2018
TEST BY: STEPHEN HAAS
/ OT 9 WITNESSED BY: DONALD DESMARAI S
a// Fa PERC RATE: ( 2 MIN/INCH. C2
PF�F4� L
-- 15. 001+ S. F.
� .y. 9
89.7 / / 9/.5 / \
�1 VARIANCES REQUIRED :
/ // �ry .' :.'.'.'. 9 \ � 40
/� / 12 ROCK'HOLLY / 6
TITLE 5. MAXIMUM FEASIBLE COMPL 1 ANCE
SECTION 15.221:17J GENERAL CONSTRUCTION REQUIREMENTS FOR ALL SYSTEM COMPONENTS
/' THE TOP OF ALL SYSTEM COMPONENTS SHALL BE NO DEEPER THAN 36" BELOW GRADE.
t/ c T/ ' �/ BM. CORNER STEP A VAR I ANCE IS REQUIRED FOR THE SAS TO BE UP TO 6 ' DEEP. VENT PROVIDED.
D;BOX EL-93.55
IV
- ._---- ----- 24-OAk TPs2
Cw�
\ � E1gIS71NG .J Q ""�,, N
TPsr SJFPTIC TANK
c IL
04/w
� Ott
5
S EP T l C S YS TEM ODES / ON
0 130 NO TT / NOHAM OR / VE . MAP 172 . PARCEL 19
RACE LAB BARNS TABLE . ( CENTERV 1 LLE ) MA .
PREPARED FOR :
/ d
L OCUS LEGEND L O R l B O T O L l NO
0 CB CONCRETE BOUND
oQa� -W WATER LINE SCALE / 20 NO MEMBER 2 . 2018
O HYDRANT
GAS LINE STEPf-IEICI A . HAAS
W- OVER L t GHTHEPAOD POST
_ ENGINEERING
--E- UNDERGROUND ELECTRIC LINE / �� _� P . O . B o x 1 6
-T- UNDERGROUND TELEPHONE L I NE JJIN South D qe n n 1 s MA 02660
-CTV- UNDERGROUND CA8LEVISION LINES 'i ( 508 ) 362-8 1 32
+ 40.4 SPOT ELEVATION
IV
40---•--- EXISTING CONTOUR
LOCUS l VI A P 0 /0 20 40 40 PROPOSED CONTOUR JOB NO: 18-023