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0376 NOTTINGHAM DRIVE - Health
376 Nottingham Drive 071-091 Centerville �r Yp UPC 12534 0 �� No.2153LOR HASTINGS, UN r i 1-T 30 Al 40 Town of Barnstable eantri In§p—e_ct`or �'IME r Regulatory Services Office Hours ti 8:30—9:30 o� Thomas F.Geiler,Director 3:30—4:30 i BARNSTABLE, * Public Health Division MASS. 9 i659 � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE Date:May 29,2013 1. General Information: Size of Property.45 acre Address: 376 Nottingham Drive Centerville,MA 02632 Map\Parcel 171-091 Name: Jason Catania Phone#: 508-367-1114 2a. How many bedrooms exist at your property now?3 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?3 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO i If the dwelling is connected to public sewer,skip questions 44 through#9 below. 4. Location of dwelling is INSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE a Zone of Contribution to public supply wells? 6. Is the dwelling connected to an PUBLIC WATER? 7. Is a disposal works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. 9. Were any building permits obtained for construction of additional bedrooms? YES Zr- NO w 10. Is there an engineered septic system plan on file at the Health Division? YES r;or NO Q 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES o" NO ------------------------------------------------------------------------------------------------------------I------ can FOR OFFICE USE ONLY rz-o The Public Health Division has no objection to � bedrooms at this property. --- M Special Conditions: :I Sign Date: TOWN OF BARNSTABLE LOCATION =3%(r - �t,���nei,�. `�f t�j� SEWAGE# .2 Oj, VILLAGE ASSESSOR'S MAP&PARCEL /J/--�Q . 7 r� INSTALLER'S NAME&PHONE NO.�Dgjr;.!$ A7Z:,fnj"TLex_ scg:�a�_Lls L SEPTIC TANK CAPACITY EX LEACHING FACILITY:(type) A.iC _�zr, to C_ (size) NO.OF BEDROOMS 3 OWNER I rz,arfr. PERMIT DATE: t.1 2 Z I `5 COMPLIANCE DATE: 1 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 BYt f .,�5 y, f A oOz 3 3 2- 3 3 50 y �1 Zou:s o s- 3 - V c 3 H f No. U — Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Misposar 6pstem Construction Vermit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 7G A;c Tt'w6V,,, -Qf-,,jr_ Owner's Name,Address, nd Tel.No. Assessor's Map/Parcel /-7 1 '�� P', 10 Installer's Name,Address,an el.NoUW Designer's Name,Address,and Tel.No. t��g1u�, A 3Tvw�TNr 1�5'« --Tech Type of Building: Dwelling No.of Bedrooms 3 Lot Size /%$/!V sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) :�:j(7 gpq Design flow provided 3 gpd Plan Date �Lhj Number of sheets I.— Revision Date Title Size of Septic Tank 6x1gtInlSimo cir,J&j Type of S.A.S. A/f Description of Soil See-D is j Nature of Repairs or Alterations(Answer when applicable) Y,45 f-r A 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. Sign Date Application Approved by Date 2 Application Disapproved by Date for the following reasons Permit No. �`� t 3 3 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- B No. Fee �_ =THE COMMONWEAL : .OF MASSACHUSETTS Entered in computer: e PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS -'01ppYication for Misposal *pstem (C.oustructiou Permit . Application for a Permit to Construct( ) Repair(640"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 7G nJo TT bJ 1tG„� 1�� L Owne-is Name,Address,and Tel.No. Assessor's Map/Parcel )7 1 — P Jd Installer's Name,Address,an el.No l Designer's Name,Address,and Tel.No. D;o5)6y A 3row-jT,ic 4�co -Tech i../ r. Type of Building: r �• Dwelling No.of Bedrooms Lot Size /q 61�j sq.ft. Garbage Grinder( ) r' �a Other Type of Building ,,, No.of Persons• Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2,2, gpd Design flow provided :3 S`�, 'L gpd Plan Date Number of sheets 12— Revision Date Title Size of Septic Tank 1'`� ,;,JJ", Type of S.A.S.4 i6 36 /a( Description of Soil r,-,0 1,) Nature of Repairs or Alterations(Answer when applicable) !� ,v , S a. 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. Sign d Date Application Approved by Date Application Disapproved by Date - for the following reasons ~ Permit No. Z a I Date Issued Z - r - ---------------------------------------------------------- - - - - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of,Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned'(' )by A :)(MkA)I,1 T_tir J at 3 7 rP-J+r✓.jM 1e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 O-L jPdated 1V1,22 !3 Installerl—l `y, A 'V(t gA�'�AIC Designerr���, #bedrooms -a, j Approved design flow 1, gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed Date Z �'�/ Inspector - ---------------------------------- - - - - -------------------------- ---------------- No. Fee Ides THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( V<" Upgrade( ) Abandon( ) .� System located at_3?(, N e ! 4-„�,��c... , , ( )0" ?Ioft,� P 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. k Provided:Construction mu t be completed within three years of the date of this pe it. y Date �{ Approved by / �t�'. I 4 ( / i /� t a C�JLo . u1 t �c, cN r. v,Uw� �� IroI2 dJ1 Town of Barnstable oFIKME ram, Regulatory Services ti Thomas F. Geiler,Director Public Health Divis ion 1639• A`0 � Thomas McKean Director fD Mpl 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: I Sewage Permit# Assessor'sMap/Parcel Installer& Designer Certification Form Designer: D�^��� 6�G4WitiGWf , �� Installer: 97o�cic�s•/� �r�wN n;c Address: Tl�%a4e C r Address: On q _a 11 was issued a permit to install a (date) (installer) septic system at-5 76 1, `t wg6mi Of based on a design drawn by (address) VNID 0. C0v--66n9wr, RS dated�{�`�� ��� 2,�/3. (designer) V 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Loca Plan revision or certified as-built by designer to follow. Stripout (if req : d and the soils were found satisfactory. o`' DAVID cti�D. COUGHANOWR No. 1093 (Installer's Signature) GISTE� �• �iih'+'�� �S SgNI7AR\P� (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. gAoffrce formsWesignercertification form.doc TRANS.NO.: CITY/TOWN: ?-cy-n glq b If Ce14+e6 V 1 J1 Q APPLICANT: hmn' � guile Kyle ADDRESS: 576 ;a�q;6arh Orj e DESIGN FLOW: 63 0 gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted 310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided 310 CMR 15.2204 t Plan proper scale?(1"=40' for plot plans, 1"=20' or fewer for components) 310 CMR 15.220(4)] Easements shown 310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]-if not, a variance is required 310 CMR 15.412(4)] Location of impervious surfaces(driveways, parking areas etc.) 310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] J Location and dimensions of system components and reserve areas. 310 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220(4)(01v/ daily flow septic tank capacity (required andprovided) soil absorption system (required andprovided) whether system designed for garbage grinder o/ North arrow 310 CMR 15.220(4)(g)] i/ Existing and ro osed contours 310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220 4 h and i Location and date of percolation tests(performed at proper elevation?) r310 CMR 15.220(4)(i)] Percolation test results match loading rate? 310 CMR 15.242 Certification statement by Soil Evaluator 310 CMR 15.220 4 Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR / 15.220(4)(n)] -7 t , r Address /6 ���Iw6m I Jjr^ `�'. '��' Sheet 1 of N/A OK NO Location of every water supply, public and private, [310 CMR / 15.220(4)(k)] V within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR. 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.21l(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] V/ Test hole adequate to demonstrate four feet of suitable material? / [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR ✓ 15.000] System components not> 36" deep(unless Local Upgrade / A proval or LUA requested) [310 CMR 15.405(1(b)] Address 3�� � �I ag r�l Dr Sheet 2 of 7 N/A OK NO SEPTIC'TANK Size OK? 310 CMR 15.223 1 Inlet tee located ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14" +5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter 310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228 1 Separation between inlet and outlet tees(no less than liquid depth) 310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for / upgrades under LUA 310 CMR 15.405 1 k V/ Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR. 15.2228(1)and 310 CMR 15.232(3)(01 Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" b 7/07 310 CMR 15.228(2)] Access to within 6 " of grade -one port for systems<I 000gpd, two fors stems>1000 gpd 310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation 310 CMR 15.211 1 Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? 310 CMR 15.226(3)] Setbacks from resources 310 CMR 15.211 Multi=Com artment Tanks , rt Required when other than single-family dwelling or flow>1000 d 310 CMR 15.223 1 b First compartment 200%daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and 3 l� "U" pipe through or over baffle, outlet of each compartment with as baffle or approved filter 310 CMR 15.224(4)] "576 U�► h IJ J Address �jnI Ir Sheet 3 of 7 N/A OK NO BUILDING'SEWER-AND OTHER PIPING M. Located at least ten feet from any water line?[310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and sewer cross, see 310 CMR 15.21 l(1)[1]) f Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] ✓ Proper pitch on all runs? (.005 within gravity-distributed trenches / and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/(leachfield below pump chamber) Endca s or vent manifoldspecified? Size and orientation of discharge holes specified?(not smaller than 3/8"not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] V Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) DISTRIBUTIONBOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] w, ✓ Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 / CMR 15.323(3)(a)] V/ Riser if deeper than 9" [310 CMR 15.232(3)(0] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] ✓ Minimum sum 6" [310 CMR15.232 3 e ] Watertight cover if<2000gpd); waterproof manhole if>2000gpd / [310 CMR 15.232(3)(d)] ti/ PUMP CHAMBERS Capacity (emergency storage above working=design flow)? [310 / CMR 231(2)] V Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats- alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address —5 76 W of#w,� G.,m D Ir Sheet 4 of 7 N/A OK NO SOIL ABSORPTION SYSTEMS SAS),GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240 1 Required separation togroundwater? 310 CMR 15.212 Aggregate specified as double washed 310 CMR 15.247(2)] System Venting required/provided?(system under driveway or >36" deep) 310 CMR 15.241 V/ Inspection ports specified and within 3"final grade? [310 CMR 15.240 13 Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[41 and Guidance Document GALLERIES,•PITS;CHAMBERS, 310 CMR 45.253 Chambers and Gal. in trench configuration supplied with inlet / every 20 ft. 310 CMR 15.253(6)], Each structure with one inspection manhole (if>2000 gpd must be tograde) 310 CMR 15.253 2 Aggregate 1' minimum-4'maximum. 310 CMR 15.253 1 b 2' sidewall credit maximum 310 CMR 15.253 1 a In bed configuration, inlet every 40 s . ft. 310 CMR 15.253(6)] TRENCHES:•310 CMR 15.251,� Width 2'minimum 3'maximum 310 CMR 15.251 1 b r/ 100 feet-maximum length 310 CMR 15.251 1 a ✓ Minimum separation 2x effective depth or width whichever greater 3x if reserve between trenches 310 CMR 251 1 d Situated along contours 310 CMR 15.25 1 2 Breakout OK? 310 CMR 15.211 1)[41 and Guidance Document BED SAS°(Maximum 'size of bed`,or�field 5000'g 'd)":�"1 ' r minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252 2 d ,/ Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252 2 Separation between beds 10'minimum. 310 CMR 15.252(2)(0] Bottom area used in calculations only 310 CMR 15.252(2)(i)] Address \Sheet 5 of 7 1 N/A OK NO DID'THE. LANINVOLVE Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] (/ If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000g d) good to note on plan [310 CMR 15.254(2)(d)] V Construction in fall -Did the plan specify that the fill shall meet / the specification of 310 CMR 15.255 3 ? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional / Engineer [310 CMR 15.255(2)(a)] �/ Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and / Guidance Document] v At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gravelless System[I/A Approval Letters) w .ti:. .r.�•a, ;R Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge ✓ to scour soil interface Alternative Septic System[I/A Approval Letters] N Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? V/ Is the technology being properly applied and does it meet all / DEP Approval Conditions? V Is there a note on the plan regarding the requirement for perpetual maintenance agreement? 1/ Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? ./ Has applicant submitted a copy of a maintenance Variances E Are the variances listed on the plan ? [310 CMR 15.220 (4)O] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] V j�� f � Address -S 7 6 1y��T a P i Sheet 6 of 7 N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well? / 310 CMR 15.214(2)] t/ Are the nitrogen loads proposed in compliance? [310 CMR 15.216 1 Miscellaneous Pumping to septic tank? 310 CMR 15.229 Shared System 310 CMR 15.290 Address ` �� `ryl p r Sheet 7 of 7 DEEP-OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Stnucture,Stones;Boulders. r onsistency %Gmvel) to F,�lpnP �t iA [P C. W41um CfiWA 10 �(F�' �l Loose DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) C6 - 16 AP �oiwly LNri 6, one Frt6A tp Commy �ovtd SA WFh�bt� L DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consiste'n'cy,%Oravell DEEP OBSERVATION HOLE LOG ' Hole# Depth from Soil Horizon Soil Texture Soil Color -Soil Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consisten Flood Insurance Rate Map: - Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pgrv'ious material exist in all areas observed throughout the area proposed for the soil absorption system? `{e 5 __ If not,what is the depth of naturally occurring pervious material? Certification I certify that on 0� (� (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,expertise and experience described/in 510 CMR,15.017. �N OF414 Signature U4 (L ( �S� �` Date R t'I �� 2- ( g�o�� DAVID cyG� - o D. " COUGHANOWR y QAS.EPTICVERCFORM.DOC /CENS�� i� �VALUA�9 f Town of Barnstable P# 6 Department of Regulatory Services Public Health Division Date �iOlF16 9. 200 Mai n`Street,Hyannis MA 02601 Date Scheduled_ Time 1 Fee Pd. Soil Suitability Assessment for S e Disposal Performed By: yi C� �• 000(�C,VIQWr L` c Witnessed By: _ Ct LOCATION&GENERAL INFORMATION Location Address Owner's Name 3 7 G '" "►.wt�-�►���t�W, Dr ��11 F,ta��►ror � 14 �(E Address Assessor's Map/Parcel: A I - En ineer' Ct�Q y���v ' ( `� I g s Name NEW CONSTRUCTION REPAIR Telephone# 0 � � i t Land Use ``e�(Aey)6'ci I Slopes(96) ` �d Surface Stones Vb ke t + r Distances from: Open r �I�� p Water Bod ft Possible WeLArea 6�� Y ft Drinking Water Well ft g Drainage Way 1�0 t ft Property Line A t ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Zt(,.7D Ft o G" G O � TP-z• r,) • Parent material(geologic) r'0 6iCr 1 a I 00fV Q 5`"1_ I Depth to Bedrock Depth to Groundwater. Standing Water in Hole:_ A©Vl e Weeping from Pit Foce n O h Q Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used:Grovej, Gt4e • a6(iv5j-ynpn t Depth Observed standing in obs.hole: "01E of . $ In, Depth to soil mottles: � in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well#6IW-ZSZReading Date:3-2-013 Index Well level s Adj,factor i•S Adj.Groundwater level getav dr7-qD Zon< O PERCOLATION TEST Date !$ t 3 Thne G6�IA Observation. Hole# Time at 4" n 9 Depth of Perc 60 1 h Time at 6" w Start Pre-soak Time @ 0 6 'rime(V-60') End Pre-soak _ 35 _ Rate Min./Inch 2 ril Q t h C�S Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) ``t 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:\SEPTIdxPERCFORM.DOC T `r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is every 376 Nottingham Drive, Centerville MA 02632 August 16;2012 required for eve 9 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information L4� on the computer, vN use only the tab 1. Inspector: -31 tl key to move your cursor-do not Troy Williams use the return key. Name of Inspector Troy Williams Septic Inspections Company Name 19 Hummel Drive Company Address South Dennis MA 02660 City/Town State Zip Code j ' (508) 385- 1300 S1682 g Telephone Number License Number B. Certification 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, 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority August 16, 2012 Inspector's SignatuP6 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. ****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. t5ins•11/10 Title 5 official Inspection Form: b u ace Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old' or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or 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. ❑ Y ❑ N ❑ ND(Explain below): N/A t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 376 Nottingham Drive, Centerville M - 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 required for eve g g page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): N/A ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): N/A 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 15.303(1)(b)that the system is not functioning 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .."t 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 asses if the well water analysis, performed at a DEP certified laboratory, for fecal Y P Y P rY, coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: N/A D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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 %day flow t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'f 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is ry 376 Nottingham Drive, Centerville MA 02632 Au ust 16, 2012 requiredfor eve 9 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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. l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts rz Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 NottinghamDrive, Centervilleg MA 02632 August 16 2012 page. Citylrown State Zip Code Date of Inspection C. Checklist 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? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is 376 Nottingham Drive Centerville MA 02632 August 16 required for every � g , 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 11=65,000 gals. g ( y g (gp )) 10=63,000 gals. Detail: Sump pump? Yes No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): . N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A - r t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): General Information Pumping Records: Source of information: No pumping info was available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ® Other(describe): no d-box t5ins-11110 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Leach pit#2 was installed to existing Tank&pit on 4/30/80 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. Septic Tank(locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'X9'X6' 1000 gallon Sludge depth: - 4" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle .21811 . Scum thickness Thin layer Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle. 14" How were dimensions determined? probe/measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Concrete inlet baffle and outlet tee were found present and in working order. No evidence of leakage or damage was found. Grease Trap(locate on site plan): Depth below grade: /A feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): N/A Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): N/A `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive Centerville MA 02632 August 16, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(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 leakage into or out of box, etc.): No d-box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2-6'X6' leach pitwith 2'of stone. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: f ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit#2 was found saturated, full and in hydraulic failure at the time of inspection. Leaching is in need of replacement. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No t5ins•11110 • Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .' 376 Nottingham Drive, Centerville M - 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is required for every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately JA r�•��- O Al 3 5d' 3 5 2 f t5ins•11/10 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information isequired or every 376 Nottingham Drive, Centerville MA 02632 August 16, 2012 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 28.0'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® 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: USGS map for Barnstable shows groundwater to be approx. 28.3 below grade. Bottom of leaching at 10.0'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 376 Nottingham Drive, Centerville M- 171 P-91 Property Address Bill Fitzgerald Owner Owner's Name information is 376 Nottingham Drive,required for every Centerville MA 02632 August 16, 2012 ' page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A B C D or E checked P , ry , ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 17 of 17 I Town of Barnstable Bzw"stabie Uwe �,. e� P` Regulatory Services Department "ca'" '"teSTABM MAMr Public Health Division t639 �0 200,Main Street, Hyannis MA 02601 2007 FINAL ORDER Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 -Thomas A.McKean,CHO L; CERTIFIED MAIL#7008 3230 0002 5178 2800 December 18, 2012 Mr. &Mrs. William Fitzgerald 376 Nottingham Drive Centerville, MA 02632 The septic system located at 376 Nottingham Drive,Centerville, MA was last inspected i on 8/16/2012 by Troy Williams, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The cesspool had been overflowing to the surface; single cesspools automatically fail per Town of Barnstable Standards. A You were ordered to repair the septic system within sixty(60) days from the date of the system failure, However, as of this date December 141h 2012, we have not received any notice that the repair of the septic system has been done. Therefore you are again ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven (7) days after the day this order was served. PER ORDER OFT BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health QASEPTICVLetters Septic Inspection Failures or Future Evall376 Nottingham Dr.60 day notice.docFinal Notice a Town of Barnstable Barnstable p SHE T jL � , MASS. 0 Regulatory Services Department n"aC P �. � �IIA R :BLE,7 1 public Health Division d 9 MASS. OpA t6�q. \0 D MAC t' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 6666 August 29, 2012 Mr. William G. Fitzgerald 376 Nottingham Drive Centerville, MA 02632 The septic system located at 376 Nottingham Drive, Centerville, MA was last inspected on 8/16/2012 by Troy Williams, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit#2 was saturated, full, and in hydraulic failure You are ordered to repair the septic system within sixty (60) days from the date you receive this notification by replacing the failed leaching system. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. If you should have any questions, please feel free to call me at (508) -862 4640. PER ORDER OF THE BOARD OF HEALTH 4Thma`s')t/�cVeaan, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\376 Nottingham Dr.,Cent.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=11571 Logged In As: Parcel Detail Monday,August 27 2012 Parcel Lookup Parcellnfo Parcel ID 171-091 I Developeer LOT 31 Location 376 NOTTINGHAM DRIVE I Pri Frontage 100 Sec Road I Sec Frontage Village CENTERVILLE I Fire District C-O-MM Town sewer exists at this address No I Road Index 1 104 Asbuilt Septic Scan: Interactive 11, -. Map''' 171091_1 , Owner Info Owner FITZGERALD,WILLIAM G& DOYLE, JULIE A I Co-owner Streets 376 NOTTINGHAM DRIVE I Street2 City CENTERVILLE I State MA zip 02632 Country Land Info Acres 0.45 I use Single Fam MDL-01 I zoning RC Nghbd 0105 Topography Level I Road Paved utilities Public Water,Gas,Septic I Location Construction Info Building 1 of 1 Year 1973 I Roof Gable/Hip I Ext Clapboard Built Struct Wall Living Roof 16 Area 1820 I Cover Asph/F GIs/Cmp.I AC Type None ( woK a 1.4 Style Ranch I Int Drywall I Bed 3 Bedrooms 96 Wall Rooms tt r 3a Model Residential Int Floor Carpet Bath( Rooms 3 Full + 1 H I sAs BMT ;ZE Grade Average I Type Hot Water Total Rooms 7 16. 26, 26 Stories 1 Story Heat I Fuel Gas Found-I ation Poured Conc. Gross 3 Area448 Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=l 1571 8/27/2012 ZHE The Town of Barnstable + + BARNSTABLE. t "`" . Growth Management Department 367 Main Street,3rd Floor Hyannis, MA 02601 Tel:508-862-4678 Fax:508-862-4782 January 29,2008 John C. Klimn Town Manager Janet Joakim,Town Council President Barnstable Town Hall 367 Main Street Hyannis,MA 02601 Re: William and Julie Fitzgerald,376 Nottingham Dr, Centerville - studio accessory unit This letter is to inform you that the Accessory Affordable Apartment (Amnest� Program has received a request for a project eligibility letter under the Community Development Block Grant (CDBG) Fund and under Article II of Chapter Nine of the Code of the Town of Barnstable and the criteria for the Local Chapter 40B Program. This office is reviewing the request. If the Town has any comments on the project, please forward them to me so that they can be addressed in the site approval letter. This letter gives you official notice of our receipt of the above application(s). We will issue a decision as to the acceptability of the sites and the consistency of this development within the guidelines of CDBG. Sincerely, [ v N Elizabeth Dillen ZZ Special Projects Coordinator c ' Growth Management Department CA) �r cr Co cc: Building Division X . Public Health Division rn w r_ Town of Barnstable Health Inspector oFtME Tp� Office Hours Regulatory Services 8:30—9:30 „ * Thomas F.Geiler,Director 1:00—2:00 * snxtvsTns[.E. 9� . r Public Health Division ArE p �A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: �• Address: 21& Map 1-7 1 Parcel Name:�B I I 1� /7" /7/J Phone 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? {�b If yes, how many? 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? 3 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or CNDO If the dwelling is connected to public sewer, skip questions#4 through#9 below: 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 6W 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY �D The Public Health Division has no objection to bedrooms at this property. q Special Conditions: 7V"(2oa- S1-K411 G,,Ve. 2 'oG 'Nc� nnb hC J 1A i10 cr w Signed: Date: 't' og Q;/health/wpfiles/amnestyapp NO..... 0-�dl .. Frs$.... ... .r.00 ..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................. .:Town...........o F................Barr,,stable.---------------..................---------- ApplirFatiou for Bi-gatial Works Tons atiou runfit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: .37. ..MA.....OZ63 2-.................................................................................................. Location.Address or Lot No. ,Dennis.D isoq. .......................................................... . 4..L.mxood._Rd.•,...W411 sleya—9,..zA....o2181 Owner Address a .A.&..B..Cessgool_Ss�l.e------------------------•................._ 2&..HishQ .. x�aae;...Hyannis.--�....u6oa..-- Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..............3_...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons------2................... Showers — Cafeteria P-1 Other 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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.......--............... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......-----..--......--. a -------------•--------------------------------------------•---•---------......------•--------------•- O Description of Soil..........Sand _ V W ----------------------- UNature of Repairs or Alterations—Answer when applicable-.insta:Uatton.--o£-a--1,00G.-gallon---}a-e-�,cast ..sty--pa.cked_.leach--p:Lt---------------•---------•---•---•----.......--------...-----------------------=-:-------------------------------•-----------------------•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TyTL.L' y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of hea . D to Application Approved By...... ------ ...... .......... ...........4/2s,U............ Date Application Disapproved for the following reasons------------------- --------------------------•-------------------------------------------------•-•--•--•--•--- --------•-•--•----•--•-------•--------------------------------------•-.....-•-----------•--------..........-----•----•---•-------•--------------••--------------------••--------------------------------- Date Permit No........80.............................................. Issued.......412s180 Date 3 No....8®Y.e2_Qe!... FEB... ?... .q 9 ........ THE COMMONWEALTH OF MASSACHUSETTS w BOARD OF HEALTH -.. . .--......OF..........::. aG# �3e_ Appliration fear Ua4po,i al 10orks Tamuurulan Vamit Application is hereby made for'a`Permit to Construct ( ) or Repair''(Z), an 'Individual Sewage Disposal System at .376.. ..awta .a.HA...._20,?-............-..................................................................................... Location-Address or Lot No. �7,�., y ='Owner y, Addr�e}ss Q }�� y A �' 8 5? �e4..Rom`�'v .......................................... ..f?�b.fit F'tl a i....e, 24a¢._{61I8....� �5. Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......:...:. ..:.........•-_---_--,:.....Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building ............... No. of,persons — Cafeteria YP g P ( ) ( ) Pa Other 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit____________________ Depth to ground water-____-__-__-_-_--_-----. Test Pit No. 2..........:.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ ... �.. ............ _............................ D Description of .....Soil.--•--- Pand --- /�U --•••••• .................... �4r� , ... ---------•-•------------- --•--••-•----- --- ---•>------------ --••-- -------••••-..............•... -- --- ................................ UNature of Repairs or Alterations—Answer when applicable.- M11- a$im.-A _a.140.0.0 p=- brit }' ;.....................................................---------------------------...................................................... Agreement: r The undersigned agrees to ,install the afor"described. Individual.Sewagd Disposal System in accordance with TITTLE, the provisions of IT 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of heal Si ! - = = ';,a ' � 114� 0............ ✓ f�. e Application Approved BY•.:•• ---- .. . ---------=------------------ .......... --------- Date Application Disapproved-for the,'PI'lowing reasons:,,_................................. ......................................................................... - -------------------------------------- Date Permit No... ----- -------- ----------- Issued_----- Vi/$0---------........ ._..._...__. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH d�fw ........................T.C.Un ......OF......... ...................;t....................,........ Trrtif irFatr of Tomplidnrr T I •TO CEERTIFY Thai the u 'dual ew z e Disp sal System constru ed ( or a 'red ( ) A SepGv]. SGrVice, AW a_ 'dual ,er> a. ie. lA 4 1 - 5 2 by..................................................................................................................................------• ••••_.-- .................- • .............•_-- In taller a)' at 376 llottl�taam s.4 tr37�'�iine..: .��..� l i__ G�� ------------------ ---------------------- has been installed in accordance with the provisions of TITLE of The State Sanitary C df as �-scribed in the application for Disposal Works Construction Permit No._-___--•-.__,_�__ _.�_.._. dated-_...__--/_.-Y�t:_s_P........................ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM W.I L FUNCTION- SATISFACTORY. DATEE......... ..:..o --------------------------•-----_----- Inspector--- -t - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tom ...OF...ft"nSt&�19...................................................... FEE._ ...5.00 No. 1 ............ . ..� �i��u�tt1 urk� �nn�#rttr�inn �erutii Permission is hereby granted A B Ge ool, SG cep 2228 BleKopa Temee, Hyannis, MA 02601 -• . --•••••......-••••----------------••••......---••--•-----• •• •••• -••-••-••---•-••-•-- ......•........._•_..... to Cons t --LL` 11 Um Re air ($) an Individual Sewa a Dis sal System 14....0 h�aP .�3®e® Centerville. �426� DewAs• isc®17. at No. . --•--•••• .......... . treet ® �/ as shown on the application for Disposal Works Construction mit D.`?LR --.:_____ Dated.._..._.................................. .................................. Board of Healt a,� DATE--"------- ---�----•---------�--------------------------------------- r FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ` \�lIL (r/SrAge 5 ' Z . e o� r L�Se� of \Zo L` �p boo - U\°5 Or` 376 � LOCATION- J . SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS UILDE R OR OWN 0 ER I` OKI DATE PERMIT ISSUED "DATE COMPLIANCE ISSUED �� c3a _�� r • �,��, .' �� ,'�' �� . `�� � .. �,� _ r TOTAL AREA: EXISTING HOUSE - 1,335.5 S.F. STUDIO APARTMENT - 366.5 S.F. OVERHEAD STORAGE - 118.3 S.F. 1,820.3 S.F. EXI.STI N G 2 BEDROOM HOUSE 1 , 335. 5 SF LAUNDRY ROOM/ 2'_2j" 2'-7" CLOSET i 2'-8jj" i 77 1 1 13'-10 " f 1 V- " 16'-4 4!J5 " 8 38 " � I PULL-DOWN. 4'-4" ST .IRS. 'FOR. -ACCESS'. BATHROOM LIVING ROOM/ OVERHEAD 14'-4M" 5'-9" BEDROOM ( 6 . I 8'-21j" STORAGE 11'-4 118.3 SF DOUBLE SLIDIN " DOOR . 7-4 CHEN 3'-101" MAIN ACCESS 8'-2?A" '- 1 OVERHEAD L` -'J STORAGE FOOTPRINT EXISTING_FLOOR .PLAN-.__`I ATTACHED.:-1-._BR. . STUDIO.-.APARTMENT LOCATED AT �# 4' 0 4' 8' 12' 376 NOTTINGHAM DRIVE CENTERVILLE, MA. 02632 SCALE: 1/4"=1' MAP/BLOCK/LOT: 171/091/ RIAL COPY 0$- MADE w,I jEx.ist-,ijng ,f,1qqrj plan for MADE WITH A 1101AL COPY OF MADE W1114 A TRIAL COPY OF MADE WIIA A IPIAL COPY Of MADE WoI4 4 4,1 2 1311-House with attached Studio Apartment I tDraw bMar-(0c-aTeea.fk bm, .Uraww . 5, Draw Smart Draw- 376 Nottingham Drive Centervill% MA 02632 Map/Block/Lot: 171/191/ RIAL COPY OF MADE WIfN A 101AL COPY OF i'MAI)i W11 I A PIAL COPY OF MADE Wt I H A 4AIP COPY OF XA06 WITH 1% TPIAL COPY 0; MADE WrIR A V turaw SmartDraw- Sff a t V'raw � Sniartf Iraw- <0", Smart-Draw smar 0 Exterior Deck PIAL copy, u; MAjbt WCfN A, 10,1AIL COPT Of V.Ab-4 Wli�4 A, PIAI COPY 09 MADE WIT'M A IPJA fZ 0 R V G f MADE WIT!; A 1$!1AL COPY Of MAOC *Itt$4 A go Sma,1011.Draw- 7-> IRT�ia� tDraw Smard iriaw- SmartDraw- <el) smarl 12'8" .101 8. 52' ........... Alml. C ;;1Y OF MAbf W 111 6, TAI t COPY O AI)t WJJt,H A '1111I 1. COPY OF MADE WI,fM Ok ltI&L SPY OF MAl 1'14 0, TAIAt, T If MADE W V 11 Stairs to SMalt )r3jWr, je -Bathrooril asee -S Mr Smart.D aw *Ak 4 r,,,, iw- .,Wm I CD b) Kitchen Dining Room in Den Bedroom #2 U �o.._ _ _i - e W isli IL py, ot: MADE lovi)-m A liki Y COly 0 MAbf WV1,H A 14RIL OPY A � 00 ;(iAl olp y V,A0 t W H 1, ;M 9 PIOLL Chpy of S, 3' r C St A- 10lial,I Will' <�� SmartUIJ 'ma-t-Draw Smart D, ............. 3 N Studio Apartment 1 V7" L--7-10 ; 0, �See Attached Detail) 7 t 11111, 62" 14 '-p —718 (3T_ 710 L C. 41Y OF h-1,AVt %IttM A MAL CI)PY )F MADE A1111A A ;RIAL COPY 09, 5M 'i NT1 M—Al A 1, WI1ijMjM----- 4� UP Room ISmartDoN r Draw- -Te tDI aw ing am w , ;., zo f W z, LB a t h ro o 60 Ln co rn U L Vi� 'g�R 0 r M r aW* Bedroom #1 M �Py, Of MADE WIVN A IRIAI C )PY C MADE WOITH A YRIAL. COPY OF MADE, A 1,A I I'11i Y OF I ADC 4W119 A 101AL COPY Of ,;�M N M N 0 4) H T I rye �:;» r Bathroom --JLnraw- r 4 A*V+ t low'0 Ar* aw* X C) 160" 260" ............................ ............. FIAL COPY OF MADE WltM -k VAIAL COP-0 Of MADE W0)H A MAL COPY Of &,,AD( WITH A 1PIAt. COPY Of AAOE WII'(k d 'TRIAL COPY OF MAOC W044 A 1� i Basement Floor Plan for 2 BR. Existing. Home with Attached Studio Apartment DIAL COPY of MADE WIIN A tItIA€ COPY OF MADE WIII4 A TRIAL COPLocated At ADE WEt1? A TRIAL COPY OF MADE WIIN A 1RIA€ COPY Of MADE WtIfl A TO tD raw a te• OSMT:�T� 6-Nottingham�D^ri'v* . rtDraw ' artDra ' r Centerville; MA 02632 Map/Block/Lot: 171/091/ s 52'0" PIA€. rLy ns *Anp tie#i-tA A Yl,Ilt1 COPY Of. M^bst Wlr;t A fpf&t. ."r1AY na 'MxnF W01-0 A VOIXF COPPY OC MAD-E-WIE14 A. TArae � MAnc WA a4 A I$ v � rt 'ate►°` S rt a raw' O ""mar a al I' smart ' ' ,�'' RIA€ f'Y Of MADE WE11i A lWIA€ COPY OF MADE WEi" A TO[At COPY Of � MADF '. ITH A 'TPIAt �;JY 1F MADE WE1 d ATRIAL COPY Cif MADE WE f A ' E "� �aw* =° Storage SMt Game Room Office 2'0'_ PIA€ `' �lJ. E f1, A #A€ COPY OF MAOE WEIN A TRIAL COPY OF ADE WtI"E! A TOIAlE Orr )F MADE W11 A 1' IA€ COPY OF MADE Wt I A '@ raw 0 6`q°-0— N ' 10 4 5_4„ I T O„iM —2'4"� �g,0: CD ,\ I bo N 0 ALA 5PY OF AAADE Wt� A IA€ i IVY O MADE WE1 a A TRIAL COPY Of EAAOt 'W4 A ItIA€LdCCaP yf ASAI.�f WII`N A TPIA€ COPY OF Half WaltAUE WE f A � 2'0" Ll 00 Music Room co Boiler Room ED )PY OF # Fjf MADE WEifl A fPEAt COPY Of LaUrldryAROOmC�PY 3F MADE "hl !4 TFIAC COPY O; MADE 4VI f A "f v € SAE? I EV t law. • � Tal r :DramsSr a I 80 A ow Bathroom C) EO MAC CSPY Of MADE WIfff A TRIAL COPY 26'0" ADIF ti^t'Etff A TRIAL COPY Of N_ MAOF ,tfS1 3 A TRIAL COPY 3F .A-D4 Wtf A ! .IA€ COPY Of MADE WE f A `'1 jW= .r rare' OSmartDraw � rt aw• l— 0 v t %.�It "I" t v .m 4.�o �YV V �iI 'all 26'�„ F 'l rEve Ppne 'f , R2 A L'\ V � (��j � Ova rod a ' dose Ll 0 Zak CO e''l i rr f3e � 1GS A L lull) 5 o ' a OLD ASf/C S,4 GE. AOAD EY Dli/VE 58 215.70 f t L O 11 31 NOT /STCF ? TO 1 s9— \ AREA = 998941 a>� � �® A/�F SCALE ASSR MAP 171 Pa 19 \ / C CIR wAY / Q STONE DRIVEWAY �a A _ BENCH A H MARK m CENTERVILLE. MA TOP OF WATER GATE ' ® ® W �,,o LOCUS ,ELEVATION = 56.77 MAP II � paa BARNSTABLE GIS DATUM p I TER LINIIII E m o u e^^tl ® 1 ~ MINIMAL o WA Pn r—.; iQ CONTOURS R ADIN m py. EXISTING POSED ®-� -- PR POSED ® ® � I �® ® � O WATER THIS PLAN IS INTENDED SOLELY FOR INSTALLATION "' LE CHINE ° � GATE OF THE SEPTIC SYSTEM DEPICTED.ON IT. FOR ANY S Y TEM OTHER CHANGES PROPERTY ` _ y I PLACEMENT OFADDIITIONS. SHHEDSFENCES OR S Q SWIMMING POOLS. OWNER SHOULD CONSULT WITH dp A MASSACHUSETTS REGISTERED LAND SURVEYOR. m I GAR R / THIS IS A Z s OT Q n - OWED CO L�011 �l zm - PLAN a to ft o tEl LINE ; /59� / FULL .DETAIL IS BEST uu0 = GAS LINE VIEWED IN FULL COLOR. _ USE COLOR PLAN ONLY. -- 180.58 ft FOR INSTALLATION 58 A�9 P z-,-u �QFyoO SCALE: 1 in = 2.0 ft �`��SH°FMAss9c jHOF"�Ss `�•' 0 20 40 � DAVID. yG o�� gPti m DAVID a D. o� D. COUGHANOWR N 10 20 COUGHANOWRcn No. 1093 O Vwl p G�3 O [ U L Q �Q ra TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE SCH: 40 PVC AND TO. PITCH AT 1/8 in/ft MIN EXISTING EL 60.54 + b in OF FINAL GRADE April (q Z-O ' I000 Gad SEPTIC TANK SB.O. ' FOR SURVEYOR'S CERTIFICATION, REFER TO 'BUILDING LOCATION PLAN" SIGNED & STAMPED BY STEVEN W. RUMBA PLS ON FILE WITH THE BARNSTABLE BUILDING DEPT. © �® 3 ft INSPECTION 0 . EXISTING E CHPIr O�rE SEWAGE DISPOSAL SYSTEM PLAN MAX PORT: �G C,S, TEST -TO SERVE EXISTINC; ONELLINC; EXISTING TEE 55.03 o-eox.l3 Per WILLIAM FITZGERALD b 1ULIE Am EXISTING 1000 GALLON - = — = POLE r_ DOYLE OWNERS) OF RECORD EST SEPTIC `SANK 56.70 54.70 — - = — — = P R`y � 376 NOTTINGHAM DRIVE 1995 6_ in o + TREE !% '� CENTERVILLE MA SEE DETAIL ON BACK OIL ABSORPTION EXISTING. STONE * * 54.87 54.60 � . . � 2-P RON1�A� PROPERTY. ADDRESS BASE 22nnnn SEE DETAIL EXISTING MINIMAL SYSTEM O CONTOUR GRADING ASSESSORS MAP 171 PARCEL 1'CI EXISTING 6 in STONE BASE 19 ft O) 4-11 ft ON .BACK . . LO11 BE Qom . -PROPOSED 43 TRIANGLE CIRCLE ADJUSTED SEASONAL LOW --4o SANDWICH MA 02563 DATE: APRIL 19 2013 . 53.70 HIGH GROUNDWATER = 47.90 O8 364-0894 _ 5 : ETE-3714 Pv lY2 VERSION/4 DATE,OF:TEST: A'PRIL 18. 2013 SOIL TEST LOG D O� SOIL EVALUATOR: DAVID D. COUGHANOWR, R.S. D � � � � Il V V� � � V� � � !/'V � � O WITNESSED BY: DONALD DESMARAIS, HEALTH DEPT. PERC NUMBER: M922 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD NO GROUNDWATER ENCOUNTERED. SEPTIC TANK: 330 GPD X 2 DAYS = 660. .GALLONS DISTRIBUTION BOX NOT TEST PIT 1 PARENT MATERIAL: PROGLACIAL OUTWASH USE SHOREY PRECAST H-I0 RATED TO USE .EXISTING 1000 GALLON SEPTIC TANK IF IN PEAC AT 60 in 2 MIN/INCH IN C SOILS 3 INLET 5 OUTLET DISTRIBUTION BOX SCALE SOUND STRUCTURAL CONDITION. IF. NOT. INSTALL WITH SPLASH BAFFLE OR EQUIVALENT. ELEVATION. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER. NEW 1500 GALLON SEPTIC TANK. (MINIMUM ALLOWED) DISTRIBUTION BOX TO BE 58.05 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DISTRIBUTION BOX: USE 3 OUTLET. D-BOX. PLACED ON A STABLE COMPACTED BASE ONTO 0-10 FILL WHICH b In OF STONE SOIL ABSORBTION SYSTEM: HAVE BEEN PLACED TO .10-18. Ap SANDY LOAM 10 YR 4/4 NONE FRIABLE REDUCE SETTLING. INSTALL 20 ADS ARC 36 HIGH CAPACITY BIODIFFUSERS LINES EXITING D-eOX TO .18-38 B . LOAMY SAND 10 YR 5/8 NONE FRIABLE RUN LEVEL FOR 2 FEET ~` 54.88 20 UNITS x 5:0 ft / UNIT 100 L.F. BEFORE PITCHING DOWN �c 38-138 C MEDIUM SAND . 10 YR 5/4 NONE LOOSE 100:0 L.F. x 4.80 S.F:/L.F = 480.0 S.F. O INSTALL RISER TO FACILITY.TO LEACHING WITHIN O, 46.55 480.0 S.F x .74 G.P.D.. / S.F. = 355.2 GPD O O , b /n OF FINAL GRADE USE 20 ARC 36 HC BIODIFFUSERS AS CONFIGURED BELOW b In MINIMUM SUMP 41 TEST PIT 2 NO GROUNDWATER ENCOUNTERED — = 5 V# 355:2 GPD > 330 GPD REQUIRED 12 In MINIMUM 30 5 - PARENT MATERIAL: PROGLACIAL OUTWASH INTERIOR DIMENSION In 2 MIN/INCH IN' C SOILS REFER TO DER APPROVAL LETTER TRANSMITTAL # W000052 FOR CERTIFICATION OF ADANCED .ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DRAINAGE SYSTEMS BIODIFFUSER SYSTEMS: 57.90 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-8 FILL 8-16 Ap SANDY LOAM 10 YR 4/4 NONE FRIABLE 1000 GALLON SEPTIC TANK B LOAMY SAND 10 YR 5/6 NONE FRIABLE DIMENSIONS AND DETAIL SOM ABSORPTION 16-36 - 54.90 �p CONSTRUCTION SEPTIC TANK IS TO BE PUMPED DRY 36-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE S U S TEnn DETAIL 46Ao AT TIME. OF INSTALLATION AND IS TO USE ADS ARC 36 HC BIODIFFUSERS BE EXAMINED FOR STRUCTURAL GRAVEL FREE INSTALLATION — USE DEP GROUNDWATER ADJUSTMENT INTEGRITY.. INSTALL NEW PVC OUTLET APPROVED INSTALLATION PROCEDURES. TEE EQUIPPED WITH A GAS BAFFLE. EXISTING GROUNDWATER LEVEL INSPECTION INSTALL TWO INSPECTION ^ NOT PORT PORTS AND INDICATE BASED ON CONDITIONS OBSERVED .. I In NTO LOCATION ON AS BUILT CARD IN TEST PIT 2. TAPER - - OBSERVED GW NONE AT 46.40. �Il� ...ram SCALE 25.0 ft INDEX WELL SDW-252 B ZONE D 5 f t— READING DATE MARCH. 20138 in READING 46.5. ADJUSTMENT 1.5Lo GIN G BELOW 47.90 �; \0 N O T E 1) INSTALLER :TO OBTAIN DISPOSAL WORKS PERMIT :BEFORE STARTING WORK: 8 ft-6 In 5 O 2) .INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 20 UNITS TOTAL 5.0 ft PER UNIT BEFORE EXCAVATING FOR SYSTEM. INLET . CENTER OUTLET 3) ALL COMPONENTS INSTALLED SHALL. MEET THE MINIMUM REQUIREMENTS. COVER COVER COVER CROSS SECTION VIEW VIEW OF;MASSACHUSETTS TITLE '5 •SEP.TIC CODE (310 CMR 15): 17 .< . 4) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES 0,3 IN DROP . FLOW LINE AND APPLIANCES. AND PUMPING OF THE SEPTIC TANK EVERY .2-4 YEARS. _ 8 CKFILL VEGETATIVE COVER LEAN PEAC FROM 10 in = 14 TO SAND TO TOP OF CHAMBERS RESTORE 5) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL BUILDING 1R _ STABLE BASE THAT HAS BEEN MECHANICALLY. .COMPACTED AND ON TO WHICH D BOX SIX. INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING: 48 in LIQUID GAS 6). SYSTEM. IS NOT _DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT LEVEL BAFFLE PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM: 7) .EXISTING LEACH.PITS .TO BE PUMPED. .COLLAPSED, AND REMOVED OR FILLED: ►0.75 in HI-CAP rb arch EFF DEPTH UNITS TOTAL DEPTH _ 'EX ISTING 6 in STONE BASE z 2.875' SEWAGE DISPOSAL SYSTEM PLAN lA EFFECTIVE WIDTH 4 x 2.875' = 1..50' SUITABLE PAS 2 OF 2 . SEPARATION BETWEEN INLET & ..OUTLET MA-TER L TEES SHALL NOT EXCEED LIQUID DEPTH WILLIAM FITZGERALD. JULIE DOYLE - _ - USE 4 ROWS OF AR 36 H U O 5 G CADS CROSS SECTION VIEW BIODIFFUSER UNITS NO. STONE 376 NOTTINGHAM DRIVE CENTERVILLE. MA APRIL 19. 2013 ETE-3714 NU N�� � by 1 d 5 C- - ,I ins t lo.o t2 Cev�to V vL l�,e, Uv� A - o Z'Z Nne `3�'� VI ReA LE Roes M 1prnILe v fox �� T- V �' co OP T S f3 ai Glutv�' � t gyLt Z oar✓' Seeon 46,e a�T (04 E