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HomeMy WebLinkAbout0173 NOTTINGHAM DRIVE - Health 173 Nottingham Drive, Centerville I S//// n p =J�aticrctfo�oym } UPC 12543 a No. 5rR O�PonCONSJ�� HASTINGS, MN i TOWN OF BARNSTABLE tt LOCATION SEWAGE# VILLAGE Ce, ASSESSOR'S MAP&PARCEL 1 INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY LEACHING FACILITY. (type) -u� (size) NO.OF BEDROOMS J OWNER vN,^ , PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)) Feet FURNISHED BY�-cnA�_A \��"'" �,k� c 3 ♦ J j I i No. ` s t •..- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y_�- es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Misposal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(_J Abandon( ) ❑Complete System t ndividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No.S'C---7 Assessor's Map/Parcel \ ,�� C s . Installer's Name,Address,and Tel.No. Sn`a B8`a'6©S" Designer's Name,Address,and Tel.No.-b-ZY'$•._?(So_33>> �G�o�•.` �c�Ti:`,.,-� ��Vim'� v����.r-���S e Irv„G. 005.3-7 Type of Building: Dwelling No.of Bedrooms Lot Size p OD sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 gpd Design flow provided o�, gpd Plan DateT� Number of sheets a� Revision Date Title Size of Septic Tank 0 GzL 'Type of S.A.S. Description of Soil �r_— Nature of Repairs or Alterations(Answer when applicable) _1Z, K ,��- Q �(�-'� �y� C) 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. SigmeDate Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 20 f ' Date Issued Tr+^.,.w... -.. . ...Y+b-� .. .. _.^.A'^rna�yd.. �w.T•. .ram- .�.N. «.. .yi✓.:'X+r•..��.. '.� .. r '.�,._. •�.-,{T+y„rns..-.,,,,'� ... .-r .� t t a � ' No: -Q 1 t + ��`n»M' e ° Fee mil/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippIication for Misposal �&pstem Construction 3permit Application for a Permit to Construct( ) Repair:(. ) Upgrade(;,Abandon( ) Complete System N14 ividual Components A' Location Address or Lot No. k^)3 � ,,.�,,�,��. Owner's Name,Address,and Tel.No. 7-0?(-©�t l Assessors Map/Parcel Installer's Name,Address,and Tel.No. Sz=,°Z 'lid 655 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size \Z"j C_�j©Q sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Z, Z gpd Design flow provided �-,L gpd `. Plan Date V�; (a t_ Number of sheets Revision Date 4` Title Size of Septic Tank Can C.'-,, k,�t�„� b� �",\Type of S.A.S.Cc•,,,<- ..,• :i•- C'�e,„.�1 c� v Description of Soil _ a ' Nature of Repairs or Alterations(Answer when applicable) J� c�i„i,l�,•� „ � �l.n:n...,l�to r-C c.�� �' S'".C"c��,,�2 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed- Date Application Approved by L Date t / Application Disapproved by y Date for the following reasons ' Permit No. d G _ 1 Date Issued - -- ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(i/) Abandoned( )by , ��"j. � t,.�•- , ,: at A7, _ ,,y has been constructed in accordance with the provisions of Title 5 and the for isposal System Construction Permit No. o j I dated Installer�.A.r Ds 4�T-;+- C e<, � Designer - #bedrooms Approved design flow___�i_ gpd V V' The issuance of 's permit s:all not be construed as a guarantee that the syste will fun tin ddee igned. Date Inspector s, -=` ;- -- - - - -- ----------------- No. U 1 0 t Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS - Misposal 6pstem Construction j9ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade(v)*' Abandon( ))! System located at ` � /� S�—t'"��v � ,,,, "Y,` pty; /iP and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with 5 and the following local provisions or special conditions. Provided:Con tructi n must be completed within three years of the date of this permit. 4 "",21- . .1 Date - /, Approved by •l.�. ` Unl fM w�UdF 3d1/ Id•� f I , /C r From, 06/21/2018 14:53 #596 P.001/001 Town of B17stable Regulatory Services ELARNRichard V. Scali,Interim Director "� Public Health Division Fot ' Thomas McKean,Director 200 Main Street,Ilyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 II-- Installer& Designer Certification Form Date: W �l �tg Sewage Permit# QM(Z 1�( Assessor's Map\Parcel 2 o qq Designer: 1- P,� S071S 1✓1 L• Installer: Address: T 0 �� Address: O-L< On ! r� �.e, `� (-- issued a permit to install a I (date) , installer) septic system at J 3 `iI8m fzo�-M Diz. C&4- zAased on a design drawn by (address) dated I � / ,,t n �ese�)V"Itj C 1 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 (il`required) was inspected and the soils were found satisfactory. I certify that the system referenced above was construct > a with the terns of the I1A approval letters(if applicable) p� 4_ Installer's Signature) ; No. 1140 (Designer's Signature) (Affix Designer amp Here) PLEASE RETURN TO B 'STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILLT NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q'.SeptiODesigner Cenification Fomi Rev 8-14-13.doc Town of Barnstable P 1"' (��3 Q Department of'Re ate, b'u1 ry Services Y F Public Health Division DateHAM 200 Main Stroo H als: 1 t, yen MA-02601 I , Data Scheduled " ' � ' `•'' , Fee Pd._ yj 71 Soil Suita—bill ;m ty Asses►�ment for S age Disposal Performed-Br. �'W Witnessed By: LOCATION&.GENERAL INFORMATION Location Address , O aor'e Name Address Assessor's Map/Parcel • � Engineer's Name`M ti ea NSW CONSTRUCTION REPAIRf- {� Tole hone# S(74,7 Innd Use I V E 1 t 0 Slopes(96) j Surthco Stones Distances from: Open Water Body ZLI g possible Wet,Ana ��D g Drinking Water Well 1 tt Dntlhage Way t9 d tt Property Une _? b ft Other ft SIH+TCHe(Stroet Heine,dimensions of lot,exact locations of test holes&pelo testa,locate wetlands?n proximity to holes) ys Parent material(geologic) �i/� OtAWA Depth t0 Bedroa it r Depth to Groundwater. Standing Water In Hole: ) Wooping fmm Plt Faoe N Estimated Seasonal High Groundwater_ /a� Method Used: DETERMINATION INATION FOR SEASONAL,JHQ I WAT]MR TA LIM Do lh Obso ed standing in obs:hole: In. Depth to loll moltlaet Do�th to weeping from side of obs.hole: In. Groundwater Adjutltmont , Index Wolld+ - Rending Date:_ index Well Impel. Adj;faotbr_Adf,©rau6dwAtw.Ls"l,,,,_, jr- Observation PERCOLATION TESx Did. - • 1 Hole# Z 15 t » � Time at 9" - Depth of Pero q -I o ' ! t7- Time at 6 03 Start Pro-soak 71ma @ t-l144 —,,-- _ Time(9"•6") , g w� ' Hnd Pro-soak Rate Min./Inch l Site Sul tablllty Assessment: Site Passed Site Failed: Additional Testing Noe l ad(Y/N) Odglnal: Public Health Dlvislon Observation Hole Data To Be Completed on back ***If percolation test is to be conducted within 100' of wetland,you must flr t notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISBPTICIPBRCFORM.DOC 1 � �r nepthfnm DEER OBSER Soil Horizon SATIONHOLE Hole# oil Texture Il Color LOG 5011 Other Surface(In.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. o tslatenc,y.%'l3rival) sat'.tot, �' l a (� 3lv ►� JQ DEEP OBSERVATION HOLL LOG Hole# Depth from Soil Horizon Soil Texture Sol]Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 3 r -d3v y DEEP OBSERVATION HOLE LOG Holo N I A Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.; i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sol[Texture Soil Color Soil Other Surface(In.) (U$DA) (Munsell) Mottling (Structure,Slopes;Boulders, Stoney, QMYII) Flood Insurance Rate Mau: Above 500 year Mood boundary No— Yes Within 500 year boundary Now,+_ Yea Within 100 year flood boundary No., 7 Yes Death of Naturally Occurring Pervious Maferlal Does at least four feet of naturally occurring pe ous material exist in all areas observed thrpughout the area proposed for th6 soil absorption system? If not,whatli'Abe depth of naturally occurring pervious material? . Ce at OACI I certify►that o.i L0 (date)I have passed the soil evaluator examination.approved by the Department of Envir nmental Protectlon and that the above analysis was performed by me consistent with . the required 6arxportis nd oxp rlenco described in 4 10 CUR 15.017. Signature Datb 3 l g `Q;1SBP'rICkPBRCPORM.DOC r COMMONWEALTH OF MASSACHUSETTS j EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION nI N ONE WINTER STREET,BOSTON MA 02108 (617) 292-5500 1 7 1.99.7 l<4 `•07BARNSTABLE `ALTH DCPL cc WILLIAM F.WELD r TRUDY p� Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 8 ARGEO PAUL CELLUCCI PART A A,rV�r B UHS Lt.Governor ner CERTIFICATION Property Address: 173 Nottingham Drive, Centerville, AM Address of Owner: 28 Ramblin Road Date of Inspection: October 30, 1997 (If different) Ostervflle, MA 02655 Name of Inspector: James M. Foal I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Telephone Number: (508) 775-7927 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: November 3. 1997 The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 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. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web http:Nwww.magnet.state.ma.us/dep Printed on Recycied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 173 Nottingham Drive, Centerville, MA Owner: Stetson Hall Date of Inspection: October 30, 1997 B] SYSTEM CONDITIONALLY PASSES (continued) 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). Describe observations: 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 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 APPROPRIATE) 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 to 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 1 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 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 173 Nottingham Drive, Centerville, MA Owner: Stetson Hall Date of Inspection: October 30, 1997 D] SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined 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 No 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 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. 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] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as 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 10,000 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: 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 H of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 173 Nottingham Road, Centerville, MA Owner: Stetson Hall Date of Inspection: October 30, 1997 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No V. _ Pumping information was provided by the owner, occupant, and Board of Health. ✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period.. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ _ As built plans have been obtained and examined. Note if they are not available with N/A. ✓ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ The site was inspected for signs of breakout. ✓ All system components, excluding the Soil Absorption System, have been located on the site. ✓ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: ✓ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. ✓ _ Existing information. Ex. 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)]. (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 173 Nottingham Drive, Centerville, MA Owner: Stetson Hall Date of Inspection: October 30, 1997 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: None Garbage grinder (yes or no): No Laundry connected to system(yes or no): Yes Seasonal use (yes or no): No Water meter readings, if available (last two (2) year usage (gpd): 1996-31.000 gals. 1995 - 58.000 gals. Sump Pump (yes or no): No Last date of occupancy: Unknown COMMERCIAL INDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present (yes or no): Industrial Waste Holding Tank present (yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Pu►►med on June 11196 -per treatment plant. System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed(if known)and source of information: On 42ril 23185 a new pit was added to the system. Sewage odors detected when arriving at the site (yes or no): No (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Nottingham Drive, Centerville, MA Owner: Stetson Hall Date of Inspection: October 30, 1997 BUILDING SEWER: (Locate on site plan) Depth below lgrade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: Yes (locate on site plan) Depth below grade: 21" Material of construction: ✓ concrete _metal _Fiberglass _Polyethylene _other (explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 1000 gal. (8'L X 57 X 4'6"M Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: I1" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How dimensions were determined: Measuring stick Comments:. (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Baffles were in good condition. Scum and sludge were minimal. No need for pulping. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene _other (explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Nottingham Drive, Centerville, MA Owner: Stetson Hall Date of Inspection: October 30, 1997 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene other (explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; _No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: None (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: None (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.) (revised 04/25/97) Page 7 of 10 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Nottingham Drive, Centerville, MA Owner: Stetson Hall Date of Inspection: October 30, 1997 SOIL ABSORPTION SYSTEM (SAS): Yes (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: 2 leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) A new pit wus added to the system on 4ril 23185. The bottom cf the pit to grade wigs 7'8". The pit vms dry at the time inspection. CESSPOOLS: None (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Nottingham Drive, Centerville, MA Owner: Stetson Hall Date of Inspection: October 30, 1997 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references, landmarks or benchmarks. Locate all wells within 100' (Locate where public water supply comes into house). W ATtr Lnc Brack „ 9 24 l�(3 O O 34 y5 Ex5►s+��� p,t y4� ao �(� •lni A t y.;)3.565 (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Nottingham Drive, Centerville, AM Owner: Stetson Hall Date of Inspection: October 30, 1997 Depth to Groundwater: 23.6' +/- feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers ✓ Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) High groundwater elevation was determined using the Cope Cod Commission Water Table Contours Mcp and the USGS Topographic Map. The maps showed the depth to groundwater. (revised 04/25/97) Page 10 of 10 AsBuilt Page 1 of 1 t-id- Y-1 L ION SEWAGE PERMIT NO. I -Z� NnT%NLHpm (Zr,PD GE C"E-NTEt2v�l..L� INSTALLER'S NAME ADDRESS 1���-� �.. 1�k��� �Ct��►�YryD GZr1ST' GUILDER OR OWNEJI DATE PERMIT ISSUED DATE COMPLIANCE ISSUED Z t o t GZ� aSiSTlf3(v I t��}� iboD C7P.L � PR�,•G,ts-r PST of i �1RPP�D w/�g' src,�6 Wit' I t cry 1 L�Nis http://issgl2/intranet/propdata/prebuilt.aspx?mappar=172044&seq=1 6/8/2018 L ION S-7`%�� SEWAGE GPERMIT NO. ! GE INSTALLER'S NAME A ADDRESS go5eeevs Ice,pe uv-,Wp cu--�sr 0 U I L D E R OR OWN EJI DATE PERMIT ISSUED � Z � � DATE COMPLIANCE ISSUED I , l � a Z" eS►sr►aJty c r44 , sSPT,C - AFaK W� �rS►s`�'►Nl� c I 600 GftL I P(2i,•GtS-r PCr I I pRow-caY L.►Mr-15 e a No.TSS: ?.'� F�s...l��............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........................................O F.......................................---------..........--------._............._....---- ApplirFatiun for Disposal Marks Tunstrnr#iun amit Application is hereby,made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: k;P'i W T.Z o&ft" >! 7. ...... - ..wt.....d Patio. ...........................177 .......................................................... Location-Address or Lot No. -------------------------- V.......-.�1! Owner Address Installer Address. U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__.......................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .----•------------------------------------------------.---------------------------------------•-•---------....------...---------•--------............. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------------------------------------------------------------•-------•-...---------------------...._._....--------------------.......---....--------....-- 0 Description of Soil........................................................................................................................................................................ U ....................................................-................................................................................................................................................... W U Nature of Repairs or Alterations—Answer when applicable........R.-ID-0....... lO ?_9`----..1T04MQ- "a ......1,a�_`r.ST'�-''� .......Jes uo t��!!. :a ' ._.�...Sa f,6'�Elt�i 1�- `-':a- YY� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has d by e b r o Signed -•-----•-- ( v Date ApplicationApproved By................................................................................................... Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------- - -------- ............................................•---........------•--•--------•------------•---••---.......----.........----•-------------------------------------------------....-------------------------- Date Permit No....... �--j — —...............�-------------------_. Issued-------�------�3----- ... Date "7 N.. . ............ Fing.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF........................................... Appliration for Dhipaiial Works Tonstrurtion ramit Application is herebX made for a Permit to Construct or Repair an Individual V Sewage Disposal System at: f— -0 f;fl ..............Pgwr.. ............ A.113........................................................... r Location-Ad ress or Lot No. j:A.vWN­!Sc.)e........................... e Owner Address ............. ......4a�_-Z.....��- -------------------------- ­­-- ...... .....�k Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms...5....................................Expansion Attic Garbage Grinder yp Other—T e of Buildin g ............................ No. of persons_._...___.__....._...__.____ Showers sCafeteria Other fixtures ......................... Design Flow...:........................................gallons 7 per person per day. Total daily flow............................................gallons. Septic Tank—Liquid*capacit I y...........gallons Length................ Width__.....:___._... Diameter---------------- Depth.....___.._..... Disposal Trench—No..................... Width.................... Total Length.......--..._....... Total leaching area....................sq. f t. Seepage Pit No..................... Diameter......_..__..._..... Depth below inlet.................... Total leaching area..................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%4 Test Pit No. 2................minutes per inch Depth of Test Pit._._................ Depth to ground water.___._..._...._......... 0 9 ............................................................................................................................................................ Description of Soil........................................................................................................................................................................ W U ........................................................................................................................................................................................................ W Z. ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable......1:4_0_0........(9 Pe.... ..........wnvv......0-0 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a'Certificate6f Compliance has Tntffi__� -_hjeen_issaedjb1y,�he b4T M. 3 <: Signed.. .............14-------- -- ............... ------------- Date ApplicationApproved By.................................................................................................. ....................................... Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date Permit No......................................................... Issued.......4_—­Z...3...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF THP,�ERTIFY, That the Individual Sewage Disposal System constructed or Repaired by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- kg�m C_ Installer at.......................... ................ .................................................................................................................................................. has been installed in accordance with the provisions of TIME 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_...__-__-....______..._________......._........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C STRUED 4ASGUAR TEE HAT THE �.SYSTEM WILL FUN TIoN—sATI.SFACTORY. �s . ..... .. ... ......................... DATE... _................ ................................. Inspector....... . ......... ........... ......................... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF..................................................................................... No..... FEE......... Disposal Works T-lanuitrudian "Pautit Permission is hereby granted...........F'11_;_1- ...................................................................................................... ............. to Construct on.,Repair man Individu I Sewage Disposal System atNo...................E:! .................Street-cet................................................... ---------- ------------ as shown on the application for Disposal Works Construction ............... -- ------------- ............................................................................................... Board of Health . DATE. V_; 5 T--------.. .......... FORM 1255 A. M. SULKIN, INC., BOSTON I LEGEND CENTERVILLE PROPOSED CONTOURA. ® PROPOSED SPOT GRADE s� EXISTING CONTOUR .r ,` _ + 96.52 EXISTING SPOT G"Mv W— APPROX. WATER SERVICE TEST PIT LOCUS= 9c Q' I 59 150.00' 58 57 LOCUS MAP o LOCUS INFORMATION } PLAN REF:o 247 084 TITLE REF: 26179/166 PAVED DRIVEWAY PARCEL ID: MAP 172 PAR. 044 N � \ V°NT 2 0 f t \ \ > --��13.00' \ FLOOD ZONE: PROPERTY NOT IN FLOOD ZONE 21.5' -.`.W--`.- _ _ ----- 0 -- W- - SEPTIC SYSTEM / \ 0 REPAIR PLAN o • \ \ w LOCATED AT: TP /' I \\ \\ o 173 NOTTINGHAM DRIVE z \ a �P95 -1 o `, o CENTERVILLE, MA �/ Z z Li- 0 I i w Q PREPARED FOR °~cfj �' Z JAM ES ARABY/ F w Ln 0 L I I W w � " LAUREN MURPHY / n 77/ JUNE 13, 2018 I NEo f w / LOT \1 1 0 ,/ of AREA = 1 5000�f+— AR PLAN BOOK 247 PAGE '8-4, Lj ASSR MAP172 PCL 44 �� � / z � O <- N 1140 "' Q \ / // O >o�� I �/ I � / -- — 59 --150.00' -- 58 -- 57 -- MEYER & SONS, INC. ' L '�\n ` P.O. BOX 981 BENCH MARK EAST SANDWICH, MA. 02537 TOP OF FOUNDATION SCALE: 1 in` = 20 ft PH: (508)360-3311 58.03 0 20 40 FAX: (774)413-9468 BARNSTABLE GIs DATU 20 4 meyerandsonstitle5 mail.com O 10 0 i c SHEET 1 OF 2 J 1894 ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (59.0) = 58.03 F.G.EL• 58.0 F.G.EL: 57.8 F.G. EL: 59.0 VENT MAINTAIN 2% MIN SLOPE OVER LEASi�}WG Aj2EA 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" F.G.EL 56.0 STONE OR FILTER FABRIC • .• . DOUBLE WASHED STONE 4 6" 4" SCH 40 PVC 10"1 a®®®• 0 E313 a' TEE'S ARE TO BE 14 H 6 ® S= 1% (MIN.) BB®®® ®®®®® :r 4" SCH 40 PVC INV.54.30 2' EFF. DEPTHT ®®®®®®®®®®® INV.54.75 INV. 54.10 4' 2 X 8.5' 4' GAS 1 _ .PROPOSED DB 3 EXISTING OUTLET BAFFLE EFFECTIVE LENGTH = 25' •. •., � DISTRIBUTION BOX INV. 55.0 r (H20) INV. ELEV.= 53.95 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ���`A OF '�gss9 BREAKOUT OUTLET TEE AS MANUFACTURED BY ��``' �y� ELEV.= 54.95 NOTES: TUF-TITE, ZABEL, OR EQUAL o DA N '` s^ TOP CONC. ELEV.= 54.95 1) CONTRACTOR SHALL VERIFY ALL EXISTING r ' ' PIPE INVERTS PRIOR TO CONSTRUCTION I 4 INV. ELEV.= 53.95 ® ®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO / ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX �F�/gj 133SE ® INCH CRUSHED STONE BASE, AS SPECIFIED IN \P� BOTTOM EL.= 51 .95 ®®®®®e® NITAR 3.75' 5 FT. 3.75' 310 CMR 15.221(2) r 'n 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK (/g_ `I(`!% WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 5.05 FT. EFFECTIVE WIDTH = 12.5' DAMAGED OR UNDERSIZED. 4) INSTALL INLET & OUTLET TEES W/ SEPTIC SYSTEM PROFILE SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED BOTTOM OF TESTHOLE EL: 46.90 �5) PLACE SANITARY TEE IN D-BOX (500 GALLON LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#: 15682 BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: JUNE 4, 2018 NUMBER OF BEDROOMS: 3 BEDROOM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE SOIL EVALUATOR: DARREN ,MEYER, R.S., CSE #1614 IN<2 MIN PERCOLATION RATE: LOCAL RULES AND REGULATIONS. EXCEPT AS REQUESTED BELOW: DESIGN / - 310 CMR 15.405 (1) (e): WITNESS: DON DESMARAIS, BARNSTABLE HEALTH DEPT. DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. 1)A 1.05 Fr.VARIANCE FROM 310CMR15.221(7)TO ALLOW LEAChINO To BE 4.05 Fr(MAX) BELOW GRADE vs REWO 3 Fr.P(H20/VENT PROVIDED) per. TP-1 Depth per. TP-2 Depth ( g garbage grinder) GARBAGE GRINDER: NO not designed for arba a rinder 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 58.90 0" " SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,000 GAL SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE A 59.15 A 0 DESIGN ENGINEER. 1OYR LOAMYSAND " L 100 R D LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 58.08 10 58.40 9" FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN B LOAMY SAND B LOAMY SAND USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4.' ENGINEER BEFORE CONSTRUCTION CONTINUES. 10YR 6/6 10YR 6/6 , , , , 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 55.72 3s" 55.90 39" STONE ON ENDS & 3.75 STONE ON SIDES: 25 L x -12.5 W x 2 D 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF C C THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF BOTTOM AREA: 25 x• 12.5= 312.5 SF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. MEDIUM MEDIUM SIDE AREA: (25 + 12.5))X 2 X 2 = 150 SF 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. PERc TEST 2.5Y 7/4 , 2.SY 7/a TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE ° °- '90 DESIGN FLOW PROVIDED: 0.74(462 S.F.) 342.25 G.P.D. vs. 330 G.P.D. req'd THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 46.90 144" 47.65 138" PROPOSED SEPTIC SYSTEM UPGRADE PLAN 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12' ND ISNOT TO BE CONSIDERED PLAN IS TO BE USED FORAPROPERTY LINE SURVEY SYSTEM PURPOSES ONLY PERC RATE <2 MIN/IN. ('Cl- HORIZON) 173 NOTTINGHAM DRIVE, CENTERVILLE, MA 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED Prepared for: Arab Murphy 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. Design and Site Plan by: SCALE DRAWN DATE 15. ALL PIPING TO BE 4" SCH 40 • 1/8-/FT (UNLESS SPECIFIED) MEYER&SONS,INC. N.T.S. DMM 06/13/18 • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX 981 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 02537 REV DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify thot�I have passed the Soil Evai. Exam In October, 1999. 508-3622922 DMM 2 of 2