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HomeMy WebLinkAbout0109 OLD FARM ROAD - Health 1 109 Old Farm Road Centerville A -231 027 UPC 12534 No.2�LpR ,,,v� IIAYTIMGS.MY No. Zo( � - 3 I Fee I/oa 7J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for MIsposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(w,I'/Abandon( ) R/co-mplete System ❑Individual Components Location Address or Lot No. ((Zf:1k ®�c Q, ��r.w� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a3( a Bl A,vw �� G` , ` l� 4� ✓' Installer's Name,Address,and Tel.No. 34�7- Designer's Name Address,and Tel.No:� �- �r0 �\�����R.ear�1— 'ascz•ar�� �S �`•vw4 A ;F=%-6 /G3tJ p,czz MA oa c Type of Building: Dwelling No.of Bedrooms Lot Size -Sa c4S sQ-ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 9 k(fD gpd Design flow provided 7 y gpd Plan Date (©( t (�c�`'� Number of sheets Revision Date Title Size of Septic Tank--Dc!> k,51<�r>!!�,f;, Type of S.A.S.fl"S J)R(ZZO Co Lr,4cL,�mVrr�l-S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) .a%�.rp`� A-,rc%7 N j (5� gyp((�n\_, J A e� 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. 'gned Date S Application Approved by Datc/0 7-6(Z.. Application Disapproved y Date for the following reasons Permit No. 70 Date Issued t) Zo 1Z O. 2l'l f �' �I ` .� FeeC�nv r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION'-TOWN OF BARNSTABLE, MASSACHUSETTS Yes t � application for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon( ) R/Complete System ❑Individual Components Location Address or Lot No. ( ©�c Q Jdr• Owner's Name,Address,and Tel. Assessor's Map/Parcel D3( �Q 1 O Cal C Jar n.. .C :�.c;11 4�Q C3 cInnstaller's Name,Address,and Tel.No. Q-`r'�-C�55$5' Designer's Name L_Address,and Tel.No.$ ''--3`k`i- -5-0 VAA©QGc �,`max ao3J Type of Building: Dwelling No.of Bedrooms �( Lot Size •5�? ,pc cc,f sq-ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) C{<(d gpd Design flow provided 7 YT gpd Plan Date (o (n,'D Number of sheets Revision Date Title t Size of Septic Tank �_A-D© S<p:=>2k i�4, Type of S.A.S.fl'3S Description of Soil a� Nature of Repairs or Alterations(Answer when applicable)yn Z-.a\ Vt2'c a> -� t ©cam p h.�. S�-A�.� _7hAt< tA-Zo_ kCi� c b r 6�44QG Q, 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 1 Compliance has been issued by this Board of Health. gned Date 5 r A lication A roved b Y Dat o Zo PP PP Y Application Disapproved y Date ..I for the following reasons Permit No. 7 a t Z — 3)U Date Issued In��Z 0 1'2._ --------------------------------------------------------------------------------------------------------------------------------------- TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded("✓f Abandoned( )by � y, at �1 �� A re,.� �„ r ��� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.Z012-310 dated /6�5�2-0 1-4- Installer1�z<_4 �'- 'G�e�c�4 v.c, Designer L,,--(; 4 , �.�c��C�5�7\) #bedrooms Approved design flow 4.1 O gpd The issuance©f thi permit shall not be construed as a guarantee that the system wi 1 funct�on as deigned. j a Date ) 'I I (�L Inspector --------------------------------------------------------------------------------------------------------------------------------------- No.7,_0 (Z^ 3{ O Fee A)(D m" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Nsposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(_4 Abandon( ) System located at ('2 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi n must be completed within three years of the date of this permi. Date 1p Z O i Z Approved by Town of Barnstable �• Regulatory Services Thomas F. Geiler,Director MAE& ' Public Health Division 619- Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 , Office: 508-862-4644 Fax: 508-790-6304*'\ Date: i6i i c JQ_ Sewage Permit# 22Q 3cc-, Assessor's Map/Parcel a 31 7- Installer&Designer Certification Form Designer:g ,5�) �51r<P.e1'�nA Installer: Address: F0 60i 2,0 10 Address: ._11A.-I,c ktJ MA 0 2S 3 to r�s e ��y�1�(.-5;2 6yL On 1Tsi t a1 QeaQ_1 !�; e sue,�was issued a permit to install a (date) (installer) septic system at 10 bi d ran 6�. , (^p n AJ I� based on a design drawn by (address C S of n�)In B w)� dated �- L / (designer) U I certifythat the septic stem referenced above was installed substantially P Y a y 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 &Local Regulations. -Plan revision or certified as-built by designer to follow. Stripout (if required)was inspected and the.soils were found satisfactory. V�k;OF,dy_ (Installer'sSignature) P;NTO y� c C;:4/1L No 46604 10 P (Design 's Signature) (Affix De t re) 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. - gAoffice formAdesignercertification form.doc t TRANS.NO.: CITY/TOWN: APPLICANT: CSC t��r!Inc ADDRESS: 10-1 Olaf L--Arly% 6u, DESIGN FLOW: 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 u des]-i not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces(driveways,parking areas etc.) / [310 CMR 15.220(4)(d)] d Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve / areas. 310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required andprovided) 74 soil absorption s stem(required andprovided) whether system designed for garbage grindei North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours 310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on / each test) [310 CMR 15.220(4)(h)] ✓ Names of soil evaluator and BOH representative [310 CMR 15.220 4 h and i ] Location and date of percolation tests(performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.2421 Certification statement by Soil Evaluator[310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3)and 310 CMR 115.220(4)(n)] Address r�7.1 W Avm, f6i. Sheet 1 of 7 J 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 I of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR / 15.220 4 m if water line cross see 310 CMR 15.211 1 [1 t� Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR 15.220(4)(o)] Stamp of designer 310 CMR 15.220(1)and 310 CMR 15.220(2)] v 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)] 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)(g)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not>36" deep(unless Local Upgrade Approval or LUA requested) [310 CMR 15.405 1 b ] Address [0 Sheet 2 of 7 i 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 ;1 upgrades under LUA 1310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9"must have risers on all openings and on the d-box) [310 CMR 15.2228(1)and 310 CMR 15.232 3 Three access covers(inlet and outlet must be 20" or greater)- middle access at least 8" 7/07 [310 CMR 15.228(2)] Access to within 6 " of grade -one port for systems<1000gpd, 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)] .14 H-20 Where appropriate? 1310 CMR 15.226(3)] Setbacks from resources 310 CMR 15.211] Multi-Compartment Tanks f y Required when other than single-family dwelling or flow>1000 d 310 CMR 15.223 1 ] First compartment 200%daily flow; Second compartment 100% daily flow [310 CMR 15.224(2)and 3 ] "U"pipe through or over baffle,outlet of each compartment with as baffle or approved filter[310 CMR 15.224(4)] Address ['D c� b l al Sheet 3 of 7 i N/A OK NO BUILDING SEWER AND OTHER PIPING 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 15.211 1 1 Cleanouts required/provided? 1310 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/ eachfield below pump chamber Endca s or vent manifold specified? Size and orientation of discharge holes specified?(not smaller / than 3/8"not larger than 5/8") [310 CMR 15.251(8)and 310 CMR 15.252 2 Materials specified (310 CMR 15.251(5)specifies various pipe types allowed DISTRIBUTION BOX ' Stable compacted base[310 CMR 15.221(2)and 310 CMR 15.232(2) a Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" 310 CMR 15.232 3 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)] PUMP CHAMBERS Capacity(emergency storage above working—design flow)? [310 CMR 231 2 ] 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 pumpsspecified? 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)] IBuoyancy calculations needed?Provided? [310 CMR 15.221(8)] Address f yq 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(l)] 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 15.24 1 i/ 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)[4]and Guidance Document] GALLERIES,PITS,CHAMBERS 310 CMR 15.253 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 to de) [310 CMR 15.253(2)] A ate 1'minimum-4'maximum. 310 CMR 15.253 1 ] 2' sidewall credit maximum [310 CMR 15.253 1 a ] In bed configuraon,inlet every 40 s . ft. [310 CMR 15.253(6)] TRENCHES 310 CMR 15.251 Width T minimum T maximum 310 CMR 15.251 1 ] 100 feet-maximum length [310 CMR 15.251 1 a ] Minimum separation 2x effective depth or width whichever / eater 3x if reserve between trenches [310 CMR 251 1 d Situated along contours 310 CMR 15.251(2)] Breakout OK? 310 CMR 15.211 1 4 and Guidance Document BED SAS(Maximum size of bed or,field 5000= d) 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)(g)] Separation between beds 10'minimum. 310 CMR 15.252 2 Bottom area used in calculations only 310 CMR 15.252(2)(i)] Address]n 0 l d Sheet 5 of 7 L N/A OK NO DID THE PLAN EWOLVE 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 >2000 dgood to note on plan[310 CMR 15.254(2)(d)] Construction in fiU -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 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] At least 5 ft.from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 2 e ] Graveness System[UA Approval Lepers] " Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface ' Alternative S tic S stem[I/A Approval Letters] . Was DEP Approval Letter provided and/or have you / reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Variances �. Are the variances listed on the plan? [310 CMR 15.220 4 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 Address I c 9 b)A a r" aA. Sheet 6 of 7 N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone H 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 15.21 2 Are the nitrogen loads proposed in compliance? [310 CMR 15.216 1 Miscellaneous Pum m to se tic tank? [310 CMR 15.229] Shared System 310 CMR 15.290 Address (ocl 01d Sheet 7 of 7 r B - 26736 Po 1.a i5 "4'-r ff7923 DEED RESTRICTION Whereas, JOHN T. GRIFFIN, JR., of 109 Old Farm Road, Barnstable (Centerville), Massachusetts is the owner of 109 Old Farm Road,Barnstable(Centerville),Massachsuetts, as shown on a plan of land entitled"Plan of Land in Centerville,Barnstable,Mass.belonging to Ida M. Lewis, April, 1928"; said plan being recorded with Barnstable County Registry of Deeds in Plan Book 65,Page 83; and Whereas,JOHN T.GRIFFIN,JR.,as the owner of said property has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on the Lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000,State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; and Whereas,the Town of Barnstable Board of Health,as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the Lot be put on recorded with the Barnstable County Registry of Deeds and/or the Barnstable Registry District of the Land Court, as applicable, by recording this document. Now, Therefore, JOHN T. GRIFFIN, JR., does hereby place and impose the following restriction upon the Lot in accordance with his agreement with the Town of Barnstable Board of Health,which said restriction shall run with the land and be binding upon all successors in title: The dwelling constructed upon the Lot shall contain no more than four(4)bedrooms unless and until it is connected to the municipal sewer or the Board of Health of the Town of Barnstable permits otherwise. Property Address: 109 Old Farm Road,Barnstable (Centerville),Massachusetts I _ V , / For title, see deed recorded with said Registry of Dee ds in Book 8179, PageclO.OD Executed as a sealed instrument this 21 st day of September, 2012. hn T. Griffin, J COMMONWEALTH OF MASSACHUSETTS Barnstable, ss On this 21S`day of September, 2012 before me, the undersigned Notary Public,personally appeared John T. Grim, Jr.proved to me through satisfactory evidence of identification being: other state or federal governmental document bearing a photograph image; or C] Oath or affirmation of a credible witness known to me who knows the above signatory; or 0 My own personal knowledge of the identity of the signatory to be the person whose name is listed above and acknowledges to me that he signed the foregoing instrument voluntarily of his own free act and deed. Susa E. Clark,Notary Public My Commission Expires: 8/22/14 ? 5J'o�M122pjkA,�'f' I • i TOWN OF BAARNnSTABLE ?,A' LOCATION <�� C��C'� Ad"M SEWAGE# 20 3 l o VILLAGE < ASSESSOR'S MAP&PARCEL����— 7 INSTALLER'S NAME&PHONE NO ,q % ��',t'�IGt.1�t.� i„►�< SEPTIC TANK CAPACITY rSb� LEACHING FACILITY.(type) (size) a NO.OF BEDROOMS `-p T.to cQ ret,AL4 OWNER PERMIT DATE: COMPLIANCE DATE: t� Separation Distance Between the: r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility i •S. 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 B1QC�� oIZYIG144 \i Z . i (J , ol 01 45 7,r � t Crocker, Sharon From: Crocker, Sharon D� Sent: Wednesday, October 03, 2012 1:01 PM To: Crocker, Sharon Subject: FW: 109 Old Farm Rd, Cent NOTE TO THE FILE: Per Tim O'Connell 10/3/12 3 bedrooms upstairs, 4th bedroom in basement, Tim O'Connell measured ceiiling heights and all ceiling heights were ok. The owner wants 4 bedrooms. There was technically a 4th and 5th (was set up as an office.) TM had discussed this with Tim Oconnell and the owner will be permitted to have a total 4 bedrooms provided they record a four-bedroom deed restriction. Tim had done a rough floor plan at that time- However, it only showed the ceiling height of rooms (not the usual dimensions given with septic applications. Apparently, this was what Linda had mistakenly been told by owner that we had. (that rough plan is not in the file and would not suffice for septic plan. -----Original Message----- From: Crocker,Sharon Sent: Wednesday,October 03,2012 11:48 AM To: HeathDeptMailbox Subject: 109 Old Farm Rd,Cent Does anyone have a floor plana for the above address. Linda Pinto, CSN Engineering, had been told we have a copy of one here. (Not in file). Thanks, Sharon 1 Message -�- -_.._- `-'-----,� Page 1 of 1 Crocker, Sharon ( �C From: O'Connell, Timothy Sent: Wednesday, October 03, 2012 3:07 PM To: Crocker, Sharon Subject: FW: This is what I sent owner of this property. -----Original Message----- From: capegriff@comcast.net [mailto:capegriff@comcast.net] Sent: Friday, August 31, 2012 3:56 PM To: O'Connell, Timothy Subject: Re: Thanks, Timothy Will do ASAP. Have a nice long weekend...............................................Grill From: "Timothy O'Connell" <Timothy.00onnelI@town.barn stable.ma.us> To: capegriff@comcast.net Sent: Friday, August 31, 2012 8:35:53 AM Mr. Griffin, The director stated the Health Division would have no objections to a properly submitted and reviewed Title 5 application for 4 bedrooms at 109 Old Farm Road in Centerville, MA.. Although, you must accompany the submitted application with a properly worded 4 bedroom deed restriction recorded at registry deeds in the county of Barnstable. Timothy B O'Connell, R.S Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 (508)862-4646 Email: timothy.oconnell@town.barnstable.ma.us i 10/3/2012 Town of Barnstable P# 45c ' Department of Regulatory Services fi t;,►RrtaT-4 r ]Public Health Division DMAE& ate �✓9/ � 200 Main Street,Hyannis MA 02601 Date Scheduled Ti ✓ ,l . •me Fee Pd. 61)4!51 Soil Suitabilio Assessmentfor Sewa e Lisp®sal Performed-By: Witnessed By: A�i 2t CS LOCATION&GENERAL INFORMATION Cie Location Address/ Owner's Name To�n 6, t ! Address i q OC 0 Foy-", . Assessor's Map/Parcel: Engineer's Name 1, M,4 n Z°�i �GL 1-7L1 [/+ nJ!D NEW CONSTRUCTION 1 REPAIR Telephone# y 2:7 q,7 317 Land Use: Q \ ell +\ Slopes(%) �- 3 00'fl Distances from: Open Water Body Surface Stones 0 7 b ft Possible Wet Area (� ft Drinking Water Well A� ft Drainage Way. N ft Property Line _ � ft Other It SIC+'TCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) LV cc CD > -T o� of (2a1. Parent material(geologic) D ik,,,p C Depth to Sedrock Depth to Groundwater. Standing Water in Hole: I - Weeping from Plt Face Estimated Seasonal Hlgh Groundwater DETERMINATION FOR SEASONAL HI ' GI WATER TABLEMethod Used: Depth Observed standing in obs.hole: Id, Depth to soll mottles: ltt, Depth to weeping from side of obs,hole: In, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.tractor ,^ Adj.droutldwater level , Observation PERCOLATION TEST bate j—'Xing Hole# Tlma at 9" Depth of Pere_ Time at 6" Start Pre-soak Time @ :1)0 Time(9"-6") u End Pre-soak F ' -1 O Rate Mln./Iuch Site Suitability Assessment: Site Passed Sitq Falled: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***I£percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at Ieast one(1)week prior to beginning, Q:\S EPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (structure,Stones;Boulders. • i to �Y,%'Graved 6n SL �bA Val�. `1-120 CZ r . DEEP OBSERVATION HOLE LOG Hole# �- Depth from Soll.Hodzon Soil Texture Soil Color Soil Other Surface(in. (USDA) (Munsell � ) ) Mottling (Structure,Stones,Boulders. _Consistency,%Gra e • o•-b � MSL lam• a-s ti ' c0 -j- '5 I`- �'Lo Ct, DEEP OBSERVATION HOLE LOG Hole#� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Q e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stouts;Boulders. Co sit n 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 pervi us material exist in all areas obsdrved throughout the area proposed for the soil absorption system? ---�=S If not,what is the depth of naturally occurring pervious matcrlal? Certification I certify that on, (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 tra ing,expertise and experience described in 110 CMR 15.017. Signature Datb { �' Q:\S.EPTlaPERCPORM.DOC yp r n'e RI �krr ,amSiP.. 4`•.€�3 ��y`' ( N' � vrY, tx...*S,n. ar5 " t '-.i t ✓y 41 r � 't2'•,.�4�' .� &sh:-"�- ,,5�<,,.. I ..,, - T r • ;:•- ,,"y �sa J , COMMONWEALTH=OF MASSACHLTSETTS,,.y� EXECUTIVE OFFICE OF ENVIRONME � D/�S� NTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL a� PROTECTION � ,. � I TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1© C Ll Owner's Name: 3Z Owner's Address: Date of Inspection: Name of Inspector: (please print) Company Name: x Mailing Address: ,, Telephone Number: L/ r CERTIFICATION STATEMENT- < vy g d I'certify that I have personally inspected the sewage disposal system at this address and that the rmationpreported below is true,accurate and complete as of the time of the inspection.The inspection was performe based onny --' training and experience in the proper function and maintenance of on site sewage disposal system I am a 1EP r$ approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syst m: CA 0 r Passes � Con ' ' ally Passes Ne ds F ' r valuation by the Lncal Approving Authority F s Inspector's Signature: Date: --�—= The system inspector shall submit.a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments This report only describes conditions at the time of inspection and under the conditions of use at that tim e. This in spection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 �z 7��afr'k l�a�•+� �;i? '6� � a `�' ���r1 S � �r �� f'Y: :'f � � "�� k^� 7 � �.,b;y.��, „ �a - «" S ,Y- r ae 5 3 .`'# i Ai. •wr n' Rr h ,*s . ,.S '� 5 -. ,e :µs a s �' �.t.' .p• T. Ar �,"'H2OFFICIAi -INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE-SEWAGE DISPOSAL SYSTEM=INSPECTION"FOIM:: PART-A • " CERTIFICATION (continued) • Property.Address: 1K AA, ';.. Owner: Date of Inspgc ion: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: t I havenot 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. Syst Conditionally Passes: One more system components as described in the"Conditional-Pass" section need to be replaced or repaired.The s stem,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or n determined(Y,N,ND) in the for the following statements. If"not determined"please _- explain. The septic tank is tal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantia infiltration or exfiltration or tank failure is imminent. System will pass inspection if the °y <._... - existing tank is replaced with complying septic tank as approved by the Board of Health. . *A metal septic tank will pass ' ection if it.it structurally sound;not leaking and if a Certificate of Compliance indicating that the tank is less th 20 years old is available. ND:explain: Observation of sewage backup o reak.out or high static water level in the distribution box due to broken or f obstr kgte&* e.(s)-�or-due to a broken,se d=_or uneven distribution box. System will pass inspection if(with approval-of Board of Health): broken p\pe(s)are replaced r obstructio�is removed distributiontibox is leveled or replaced V-=,,_ ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health).- broken pipe(s)are replaced obstruction is removed `• ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: I d Q 1+9AA Owner: Date of Inspec io . C. Further valuation 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 ss unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not nctioning in a manner which will protect public health,safety and the environment: Cesspool or vy is within 50 feet of a surface water — Cesspool or pr vy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in"A manner that protects the public health,safety and environment: - _ The system has a septic tank and soil absorption system(SAS)and-the SAS is within 100 feet of a surface water supply.of fributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine-distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and,nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 3�j l{uk ]kaJwJ ��yf 3 �Y�x' is M�� tr Page 4 of 11 T OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 A4 Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ _!:I_ 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 ��tatic 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 _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number tyoirries pumped portion of the SAS,cesspool or privy is below high ground water or elevation. �ny portion of cesspool privy p p vy is within 100 feet of a surface water supply or tributary to a surface water supply. _ `�"ny portion of a cesspool or privy is within a Zone 1 of a public well. ✓_sty portion of a cesspool or privy is.withirn 50 feet of a private-water supply well. ✓Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other_failure criteria are triggered.A copy of the analysis must be attached to-this form.] - / (Yes 10 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 Syste. s: To be considered large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. f: You must indicate�eitter"yes"or"no"to each of the following: (The following criteria�p\\ply to large systems in addition to the criteria above) yes no l� — the system is wit -n 400 feet of a surface drinking water supply — _ the system is within 00 feet of a tributary to a surface drinking water supply — the system is located in nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water ply well If you have answered"yes"to any quests in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system s failed.The owner or operator of any large system considered a significant threat under Section E or failed un r Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page' of 11 OFFICIAL INSPECTION FORM-N.OT;FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 0 Q nLb ) Owner: l _ 9 Date of Inspection: Check if the following have been done.You must indicate"yes"or"no" as to each of the following: Yes No -(,Z_ Pumping information was provided by the owner,occupant, or Board of Health L,,Wlere any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period? i/ Have large volumes of water been introduced to the system recently or as part of this inspection? ere as built plans of the system obtained and examined?(If they were not available note as /A) Was the facility or dwelling inspected for-signs of sewage backup? Was the site inspected for signs of break-out? v 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: Yes no _VExisting information.For example,a plan at the Board of Health. s/ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] i ft"z .+ Page 6 of 11 OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): T 36 Number of current residents: I Does residence have a garbage grinder(yes or no):JUG Is laundry on a separate sewage system(yes or no):MO(if yes separate inspection required) Laundry system inspected(yes Qr no)•U Seasonal use:(yes or no): Water meter.readings,if available(last 2 years usage(gpd)): V4 Sump pump(yes or no):�j Q Last date of occupancy: COMM%desi AL/INDUSTRIAL Type of sbment: Design ased on 310 CMR 15.203): a gpd Basis offlow(seats/persons/sgft,etc.)Grease sent(yes or no):— Industrial vast holding tank present(yes or no):— Non-sanitary w to discharged to the Title 5 system(yes or no):— �Jater meter rea • gs, if available: Last date of occu cy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: jt l ,n 1, ����,� v-- y �,>�_ (1 L�,D� Was system pumped as pert of theipection(ye�or-no). S If yes, volume pumped: .gallons--How w quanti ped determined? LkA �.L--i,pj Reason for pumping: . TYPE OF SYSTEM Septic tank,distribution box, soil absorption system _ogle cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed(if ow11)and source of informat' n: Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of I 1 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of In ection: BUILDING SEWER(locate on site plan) Depth below grade: 3 C 1 Materials of construction: ✓cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condit n of joints,vent' , evidence of leakage,e c.): c..J SEPTIC'T —(locate on site plan) -. Depth below grade: Material of co'3 struction:_concrete_metal fiberglass_polyethylene other(expl ) _ If tank is metal fist age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate). - Dimensions: Sludge depth: Distance from top�f sludge to bottom of outlet tee or baffle: Scum thickness: ',, Distance from top of`7scum to top of outlet tee or baffle: Distance from bottom`of scum to bottom of outlet tee or baffle: How were dimensions I (ermined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): :_.. GREASE TRAP:— ocate on site plan) Depth below grade:_ Material of construction: concrete metal fiberglass__polyethylene other (explain): — — Dimensions: Scum thickness: Distance from top of scum to to of outlet tee or baffle: Distance from bottom of scum to ottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 7 �,-Y'a' .s, fR;-1�L`i'stt!Y��.#•yV,•-f',}n .. 3"^.�...� "'.tai. 7,x;n, s b_ '�.jt`•"`"� . yyb �77r;�7.'Am Page 8 of 11 ,F. - OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY.ASSESSMENTS (xy SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addre : 10L X$ Owner: Mi,�W, 17�-Fc I�', Date of Inspection: TIGHT or OLDING TANK: (tank must be pumped at time of inspection)(locate"-on site plan) Depth below ade: Material of c truction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present( es or no): Alarm level: Alarm in working order(yes or no): Date of last purr ing: Comments(condi ion of alarm and float switches,etc.): DISTRIBUTION B X: (if present must be openeA (locate on site plan) Depth of liquid level a ve outlet invert: Comments(note if box level and distribution to outlets equal, any evidence of solids carryover; any evidence of leakage into or out of bo etc.): PUMP CHAMBER: ( cate on site.plan) Pumps in working order(yes o no): _ Alarms in working order(yes o no): Comments(note condition of p p chamber,condition of pumps and appurtenances, etc.): R ` 'Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: T f " 1LrIb 114, Owner: rt'A _ Date of In ection: L)t,4v SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not loc ted explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number-,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note,condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,. _ etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth top of liquid to inlet invert: 11 Depth of solids layer: Z t 1. Depth of scum layer: (A Dimensions of cesspool: Materials of construction: _CR; Indication of groundwater inflow(yes-or no) Co en (note condition of soil, igns of by ulic failure, level f pon ' g;co it iongovegetation,etc.): ., PRIVY: (locate on site plan) Materials of,construction: _ Dimensions:`+ Depth of solids: Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 0 Page 10 of 11 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: (� W� ✓ �� Owner: Date of Ins ction: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. It ' - T f- � E - � i i � J 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1011077 U Owner: �4 Date of In ection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: (Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed uSGS database-explain: You must desc ibe how you established the high-ground-water elev ion: 11 Nov _ (i 0 5 ( i 2 5 A' C-0-MM WATER DEPT ` 6 p CUSTOMER STATEMENT ACCT NQ 3,357 l 1i18/2005 OWFINrT,JOHN ,I.oCATIQI�: 109 OLD FARM RD CEN ld2T:. M- &E PARCEL; 231027 Consumption History �aTeAU2 �►�N 06/30/05 578 21 12/31/04 557 19 06/30/04 538 24 12,131/03 514 1g 06/30/03 496 15 I2/31/02 481 38 06130,102 443 13 12/31/01 430 33 TRANSACTION HISTORY PAT DESCRUMON LA 0 31 to_60 61 to 90 Over 90 8/l/2000 STARTING BALANCE 0.00 0.00 0.00 15.00 8/18/200 PAYMENT 0100 0.00 0.00 -15.00 10/2/200 MINIMUM BILL .0.00 0.00 0.00 15.00 l/l/2001 M1N EX 0.00 0.00 0.00 52.70 1/17/200 PAYMENT 0.00 0.00 0.00 -67.70 4/2/2001 MIN 0.00 0.00 0.00 15.00 7/2/2001 MIN EX 0.00 0.00 0.00 38.20 8/3/2001 PAYMENT 0.00 0.00 0,00 -53.20 10/l/200 M1N 0.00 0.00 0.00 15.00 11/16/20 PAYMENT, 0.00 0.00 OA0 -15,00 I/i/2002 MIN EX 0.00 0.00 0.00 52.70 2/6/2002 PAYMENT 0.00 0.00 0.00 -52.70 Balance due: 0.00 MA,of FOUNCIA ION 2ti'criameter eonere e corers �L�►(�/ �[�/���L� �,/ I\( J a sed to within 6"of finish glade T3 V 11 1 Fi- cq raisedto,ai m6"ofhnshgrade �u.ati,ur_cJ LOCLU15 LL (r as noted) /nspectlon Port and cap with magnetic , NOT TO SCALE Bdrm Bth Bdrm Lake MA 30"d2metPr casf r o� rrrarzrrra[8pe to twtftrn 3"tiI yradB C};1�T"I LIT915 Pfl!ttINUTE cover at fim5h grade a W M wj +ec 53D M fL=43.0-44.0 fZ=430 44.0 EL=S/.O+ IL=48.4mm)-5/.0 Wecluacluet m i0 �raor,�, 2nd Floor 4ay 39.9i 39.8rt 2"Delivery Line tl> as due }° i C�� 48 -0+ �- 5 ' 51ttin9 49.2+ . � Ix q� o n Bdrm Kitchen �h a ti 0 10 N� E0 W "A in 110 iW Iw q?., 39.2+ 38.75 T� 38.50 38.40 I CF Poured 47.92 Cnf aCliYGn LENS PtryWUtt 6 sting p Check Val 36.40 ` Concrete 47.75 47.65 �O C _ Thrust Bloclang N at all bends LIVIn g �asPB��r 34.0- Pum 33.9* 473,31 PUMP CURVE Bth Bth g Dmin M �c \` F lid v >..- Longest Run TWEN7YF/I✓E(25)ADSARC36HC !Z5.± CID 24' -� : ' /9' 9' (36/6002)LEACH CHAMBERS IN BED s �---- 2' -� I st Floor 6 1500 GALLON( -20 Rated) /000 GALLON(H-20 Rated) DB-6 CONFIGURATION W/T,H FII/E(5)ROWS .5` � ,SEPTIC TANK PUMP / !q P C//^ Big (Il 20 Rated) OFF/l!E(5)C/iAMBERS 1 C//V!! / //`1lVlU /\ Ut,l Office � ©-f30X LEACH CHAMPER,5 L"L=34.6j Groundwater Lake Me ua vet � StraWber�(lift Waterproofed at Factory Waterproof d at factory R 9 Road TL=39.8 -Bottom of Test"o% Bdrm Living Storag 5 I TE LO C U S CONSTRUCTION N OTE5 VARIANCES REQUE5TED Storage NOT TO SCALE PUMP NOTES * REQUIREMENT5: Y13th] 1.)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (3 10 CMR Local Upgrade Approvals: 3 I 0 CMR 15.403 1 5.000): STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, 1.)USE A MYERS MWH50(1/2 HP) PUMP OR EQUIVALENT, CAPABLE OF PASSING A Variances: 310 CMR 15,221 (7)General Construction Basement I .) A55e55or'5 Map 23 1 Parcel 27 UPGRADE, AND EXPANSION OF ON-51TE SEWAGE TREATMENT AND DISPOSAL SYSTEMS p /� 2.) Deed Book 8 179 Page 90 AND FOR THE TRANSPORT AND DISPOSAL OF 5EPTAGE, AND THE LOCAL BOARD OF 2 SOLID AND PUMPING 19.0 FT OF HEAD AT 40 GPM. Redulrements for All System Components: FLOO K PLAN 3.) Plan Book G5 Page 83 HEALTH REGULATIONS. 2.)ALARM SHALL BE A RED WARNING LIGHT WITH AUDIBLE ALARM LOCATED WITHIN THE 1.)Septic Tank> 3G"Below Fm15h Grade 4.) Thi5 property 15 in a Zone 11 of a Public BUILDING AS SHOWN ON THE PLAN. 49"Held 1 3"Variance Reduested Water Supply 2.j ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS NOT TO SCALE f p Y 3.)THE CORD5 FOR THE FLOATS SHALL BE ONE CONTINUOUS PIECE FROM THE PUMP 2.)Pump Chamber > 3G"Below Fmi5h Grade POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT IMPERVIOUS P RVI OVER IT SHALL BE DESIGNED CHAMBER TO THE DISCONNECT PULL BOX. THE CORDS SHALL BE ENCASED IN 2-1/2"TO 3" 50"Held 14"Variance Redue5ted 5.} Flood Zone: C TO WITHSTAND AN H-2O LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. CONDUIT. SYSTEM DE51 GN CALCULATION 4.)ALARM AND PUMP TO BE WIRED TO DIFFERENT CIRCUITS. 3.)TO MINIMIZE UNEVEN SETTLING,ALL SYSTEM COMPONENTS SHALL BE INSTALLED ON 5.)ALL PUMP,WIRING, ALARM, AND FLOAT INSTALLATIONS SHALL CONFORM TO / SEWAGEDE5/GN FLOW REQUIRED:4 BEDROOM DWELLING @ A 5TABLF MECHANICALLY-COMPACTED BASE ON 51X INCHES OF CRUSHED STONE. MA55ACHU5ETT5 STATE PLUMBING AND MASSACHUSETTS STATE ELECTRICAL CODES AS WELL / / //0 GPD/BEDROOM=440GPD REQUIRED LEGEND- BOX, AS TO MANUFACTUREK'5 SPECIFICATIONS. 4.)COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION / ./ / SEWAGEDESIGN FLDWPROI//DED: TWENTYF/(/E(25)AD5 UNITS IN 8ED AND THE 50{L ABSORPTOOP! SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL /38 CONFIGURATION/N FII/E(5)ROWS OFFIVE(5)UNITS EACl/. 1 3 EXISTING SPOT GRADE GRADE. LEACHING FIELDS,TRENCHES, AND OTHER 501L ABSORPTION SYSTEMS 40 WITHOUT ACCESS MANHOLES SHALL HAVE AT LEAST ONE(1) INSPECTION PORT / / / / Vt=[(440/0.74)/(4.6 FT2/FT)/5O L17 =24.7 24x5 PROPOSED SPOT GRADE CON515TING OF PERFORATED 4"PVC PIPE PLACED VERTICALLY TO THE BOTTOM OF THE / / / AD5 UNITS REQUIRED(25 PROV10f0) --24 EXISTING CONTOUR 501L AB50KPTION SYSTEM WITH A CAP,TIED WITH MAGNETIC MARKING TAPE, Floats shall be mstalled PROPOSED CONTOUR so they can be reached / 3,, / / 444 GPD PROVIDED>440 GPD REQUIRED 2 ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. from manhole cover. -,)e, / C / / // W WATER SERVICE LINE 5.)PIPING SHALL CON515T OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE 2" Delivery Line J'� / /ac / / / SEPTIC TANK CAPAC1TYR5QV1RED: 440 GPDX20075 =660 GPD O OVERHEAD UTILITY LINES LAID ON A MINIMUM CONTINUOUS GRADE OF NOT LE55 THAN 2%FROM THE BUILDING Clean-out . SEPTIC TANK CAPACITYPROVIDED: 1500GALLON5EI71C TANK u UNDERGROUND UTILITY LINES TO THE SEPTIC TANK, AND NOT LE55 THAN I%OTHERWISE. Quick Disconnect / / / PUMP CHAMBER CAPACITYREQUIREO: 440GPDX200% =880GPD GAS SERVICE LINE G.) DISTRIBUTION LINES FOR THE 501L ABSORPTION SYSTEM SHALL BE 4"DIAMETER Gate Valve / PUMP CHAMBER CAPACITYPROVIDE9 1000 GALLON PUMP CHAMBER TEST HOLE LOCATION SCHEDULE 40 PVC(OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. // / / / ST SEPTIC TANK A GARBAGE D/SPOSAL/S NOT PERMITTED WITH TH/S DES/GN FLOW LINES SHALL BE CAPPED AT END OR AS NOTED. 3/8"Bleeder Hole �.O / .._ pB DISTRIBUTION BOX Check Valve 24"Safety Volume Deck HE FIRST TWO(2) FEET Alarm ON 'Concrete Poured / %�� / / / / SAS SOIL ABSORPTION SYSTEM 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR DISTRIBUTION BOX SHALL BE --,f Concrete /L /+\fig / �x BEFORE PITCHING TO THE SOIL ABSORPTIC7N SYSTEM. D(S PumpON Thrust Blocking p / WATER TESTED TO A55URE EVEN DISTRIBUTION, Pump °pump OFF at all bends k��� a. / o / BUOYANCY: 8.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE �G�t Sump o�� �c��i a° a Map 251 STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL 45,3± / i 34. / / V 4a.", Parcel 1500 GALLON SEPTIC TANK(H-20) Patio fi�/ ° ° 'a°.d WEIGHT OF DISPLACED WATER: (I 0.5'x 5.GT x 0.8')x G2.4 LBS./PI3. = 2,9?2 LBS. T 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE / '/ ^7 / / oo ,� a . . SEWAGE DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. 1 000 GALLON � Parc C 27 /f / � b� Or o ' . WEIGHT OF SEPTIC TANK(EMPTY}: 2 I,230 LBS.(PER MANUFACTURER SPECS} J, p Fj x t f e a _ I0.) IN ACCORDANCE WITH 3 10 CMR 15.22 I, ALL SYSTEM COMPONENTS SHALL BE PUMP CHAMBER Area=O/52 Acre5-+ � �o��m ! •4 4 ' as 2I,230 LB5.4, > 2,972 LBS.T(NO BALLAST REQUIRED) MARKED WITH MAGNETIC MARKING TAPE. Deck :42• a NOT TO 5CALE a -C- 42 1000 GALLON PUMP CHAMBER(H-20) Paved° ° G , WEIGHT OF DISPLACED WATER: (8.5 x 4.83 x 0.9`)x G2.4 LB5./FT3. =2,30G L55. T I 1.)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED 501L ABSORPTION / ,-'." / / ,�C Parkin WEIGHT OF PUMP CHAMBER(EMPTY): 14,500 LBS.(PER MANUFACTURER SPECS) 4, SYSTEM. I CERTIFY THAT I AM CURRENTLY APPROVED BY THE / , DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT 3G/ / / °4 ° e 14,500 LBS. > 2,30G LBS.T(NO BALLAST REQUIRED) 12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL / / / 43 , , ° a 1N Off TO 310 CMR 15.017 TO CONDUCT 501L EVALUATIONS / a4.2 RECEIPT OF THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND / " Existng Septic Components to s�C FLAGGED TO PREVENT USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. AND THAT THE 501E ANALYSIS HAS BEEN PERFORMED BY / / \�e . ° L,y t o e 1` 4 be Abandoned(See Nate#2I) LINDA J. yGrr ME CONSISTENT WITH THE REQUIRED TRAINING, / / EXPERTISE, AND EXPERIENCE DESCRIBED IN 310 CMR 38 / \ £ �paro Pit (3 fill TO 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DEoIGNED UNLEoS / *m vr/ 4 '' 43.45 CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY 101E 7. I FURTHER CERTIFY THAT THE RESULTS OF MY 40 4s.7 / \ � e� , / ea 501E EVALUATION A5 INDICATED ON THE ATTACHED 501E �.s\ ✓�'z � 4. / I L � THE DESIGNER. 42 ay ` 4s 46 0 EVALUATION FORM, ARE ACCURATE AND IN ACCORDANCE i / 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN WITH 3 10 CMR 15.100 THROUGH 15.107 G' / 47.1 ! �� _ BENCHMARK o•���iSTER����`" 44 Steeue Vlastebne �. a a ° Top of Railroad Tie FSS G� AGENT OF THE BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN TDNgL Ea / (See Note#23) LY � EL=44.G5 (Assumed Datum) WRITING THAT THE SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH 1-1 i 3 10 THE TERMS OF THE PERMIT AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE IS G' �- Y 4 I � 5 Guy $ 45 td(ii. REQUESTED. !f +..% �8Q a,j_� •��'� � 2 Ii Wire Survey )�OTlf liy. INSTALLER TO VERIFY THE \_^ � Linda J. Pinto, Certified Soil Evaluator � � � � 1 5.) LOCATION OF UTILITIES 15 APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE LOCATION OF ALL UNDERGROUND // G' y�R� r<a.: er I +r.e s. A & M Land Services FOR DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES AND OVERHEAD UTILITIES PRIOR ( � I 618 Route 28, Suite 3 PRIOR TO COMMENCEMENT OF ANY WORK.THIS INCLUDES, BUT IS NOT LIMITED TO, TO THE START OF ANY EXCAVATION 48 c I I �•--� (�`C� West Yarmouth, MA 02673 REQUESTS TO DIGSAFE, ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER TEST HOLE O LE LOGS �i ` x ��J ACTIVITIES AND RELOCATE AS fi Pb-. 508 737'--1 'I' Emaid er�mlend®comcest.net DEPARTMENT. Map 23 I NECESSARY (SEE NOTE 9 15) O I G.)CONTRACTOR SHALL VERIFY THAT ALL.WA5TELINE5 ARE CONNECTED BY WATER Test Hole#i (EL=49.8±} Parcel 2G i�\ REVISION 10/10/1 2: Revised Design Information; Added Pump Curve TESTING WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. �� G ~' Prepared for: 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION Depth Layer Soil Cass Sod Color Comments 5n 50 � Gravel OF ANY SEPTIC SYSTEM COMPONENTS. s i. Parking....:` :::'. John T. Griffin, Jr. 0"-3" A Medium Sandy Loam I OYR 3/2 25 ��' +; a 18.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL 3"-2 I" B Medium-Coarse 5L I OYR 4/G I/ I/ O Q 109 Old Farm Rd., Centerville, MA 21"-84" Cl Coarse Sand 10YK 5/G 40%Gravel ,� NOT BE USED FOR STAKING, OR ANY OTHER PURPOSES. 5 0 5 0 5 0 5 0 5 0 84'-120` C2 Coarse Sand I OYK 7/4 Perc @ 58' O Proposed Sewage D15p05al 5y5tem 19.)THIS PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH f - 109 Old farm Rd- Centerville, MA DEEDED OR ZONING BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO, SIDELINE SETBACKS Test Hole#2 (EL=50.2±) " c AND BUILDING HEIGHT RESTRICTIONS. OWNER IS RESPONSIBLE FOR OBTAINING SUCH A DETERMINATION FROM THE APPROPRIATE AUTHORITY. Depth Layer Sod Cla55 Sod Color Comments _.`'��' � � .- N Prepared by: 20.) IF SOILS DIFFER FROM THOSE SHOWN IN THE SOILS LOGS, DESIGN ENGINEER 15 TO 0"-G" A Medium Sandy Loam 10YR 3/2 � � � �� � � � �� � - .J I TE PLAN r. INSPECT THE SOILS PRIOR TO PROCEEDING WITH INSTALLATION. G"-2G" B Medium-Coarse SL I OYR 4/G � t �� t � �, �° 2G"-7G" Cl Coarse Sand 1 OYR 5/G 40%Gravel {� r r' � 5, �i '0� 1�_� _ 2 1.)EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN 7G" 120" C2 Coarse Sand I OYR 7/4 SAND AND ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. SCALE: 1° = 20' l► Engineering pp pq��/�+g./ $ >'Y, .,'i ;f'S'r 3'4v ,".".uf^ N I��,� i W M i 22.) INSTALL A 40 and HOPE LINER FOR BREAKOUT FROM EL=49.9-±-TO EL=45.9± AS DATE OF TESTING: 09/25/1 2 P#13750 SHOWN ON PLAN (SEE PLAN VIEW). SOIL EVALUATOR: LINDA J. PINTO, P.E., C5N ENGINEERING Inspection Port(See Note,04) 0 20 40 60 P.O.Box2030 Phone.(508)299-3250 BOARD OF HEALTH AGENT: DON DESMARAIS, BAKNSTABLE HEALTH DEPARTMENT PLAN VIEW Teaticket,MA 02536 Fax:(508)548-5478 23.)WASTELINE TO BE SLEEVED IN A 20'SECTION OF G"PVC PIPE CENTERED OVER THE PERCOLATION RATE: LESS THAN 2 MIN/INCH IN"C" LAYERS SCALE 1"i=20' WATER LINE TO MAXIMIZE DISTANCE TO JOINTS. SCALE: I'" = 1 0' NO GROUNDWATER ENCOUNTERED C:\CSNIRR-Old Farm\RR-Old Farm-SOS Plan.dwg Date: I GiG I I 12 Scale:As Shown By: LJP Check: MTA Project No. C5N0274