HomeMy WebLinkAbout0175 OLD POST ROAD (CENT.) - Health t7S 00 Posy' Rd-
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No. ?Y�r J J (Y Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in compu eI r:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
4pliration for Misposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair(A) Upgrade( ) Abandon( ) ❑Complete System �Ylndividual Components
Location Address or Lot No.PT o 18-tl-'bS 7 6 d' Owner's Name,Address,and Tel.No.
„ A
Assessor's Map/Parcel 2-0 c9 DS-2/co ( !-7 a Id 7 - C
In�c7taller�.'rc Name,jd ress,an Tel.No. �1 Designer's Name,Address,and Tel.No.
O✓�Tf 1 uL..1K-i�,(4 �K G.An..r+"r�oi+ Li e,1 C1 S are�
��x b�� 54,/�Ck vl-�- W-2-4 co C- SGr `k 5-L*3 C 0
Type of Building: ^�
Dwelling No.of Bedrooms Lot Size 1734 34 2- sq.ft. Garbage Grinder( )
Other Type of Building 5L/1l ,(e �,i►-WAV No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 33z) gpd Design flow provided 3y2--2-5 gpd
Plan Date - Z `f (o Number of sheets 2- Revision Date h o'l
Title
Size of Septic Tank e.k t Jfl/l!5 1000 Type of S.A.S. R-ec„t1.54 / R0O Ck&&j o e, $
Description of Soil S-e-Q-VO(AeA
Nature of Repairs or Alterations(Answer when applicable) V_C O(,c4c_Q_ a et- w t4ci L2_)5bd
9 A W1 C;,,,4,n r be L11`Fin S+01--C
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Boar Healt
Si Date
Application Approved by Ap Date _ (G —I(-/G
Application Disapproved by Date
for the following reasons
Permit No. icy 6 3 Date Issued /U-
e
1
M �
No. y Fee de)
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplicatlon for -Misposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair(,)k) Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. n 5 0 j8. POS7 iecl N Owner's Name,Address,and Tel.No.
= r A 1 120(0-e, 17
Assessor's Map/Parcel 2-0 '0 Z p T � (l. S a I'd �S 7 y�'c' � �v,j
Ind}aller/'rs Name )ddress,an Tel.No. Designer's Name Address,and Tel.No.
O✓e.t't' �l(��s 1 .l Ct l/+'f -P9 c A ✓4 1�-•rof ,
r'�-e-(.(E'i a San s
601 1,,65 S,6✓F,1_4cti V4-�_ FS�- 2'1-00Rvk �1�r1 E Sah✓111L
Type of Building: "
Dwelling No.of Bedrooms Lot Size 7�� Z sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( ) ,
Other Fixtures -^
Design Flow(min.required) 3 3 d gpd Design flow provided 3 Y,2. 2-5 gpd
Plan Date " Z S ' 6 Number of sheets Z- Revision Date h 6,1
2
Title
Size of Septic Tank eX,S f {oo O Type of S.A.S. ?✓eC A!-4 ( !go�) C 0 a„vv,ro e S
Description of Soil cj-ek(P A i
Nature of Repairs or Alterations(Answer when applicable) P—e Q(q c..Q e (-t- L- i-(Ll C Z Sid
�(n4vo10e-f W(-�(n 54-v e:
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal,system in
I
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 Health.)
Date
Application Approved by ,� j J Date
Applications D,is approved by Date
for the following reasons
Permit No. Date Issued /U—
----------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
/ BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Jr) Upgraded( )
Abandoned( )by T>v C4"( L-�(t S D Una 2 f C( (j 4 C,7A C.4,, 4-(d.^
at ?�_ O(c( VO S 7 K-4 C e✓-k-,l' j j-0-- has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. O k—3 dated
Installer 3 V - ((S Designer (II-e(�Q..�► Spy
#bedrooms Approved design flow r D and
The issuance of this )erm't shall not be construed as a guarantee that the system wil funch n as designe<1.
Date t. Inspector
1 l • J
`
No. 3 f-(? Fee <U
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction permit
Permission is hereby granted to Construct( ) Repair OC ) Upgrade( ) Abandon( )
System located at (2 RS 7
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
i
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permi.
Date 1 0/1/ /,4 Approved by Ir T
From: 10/19/2016 13:53 #380 R.001/001
Town of Barnstable
Regulatory Services ,o
�vF o
Richard V.Scali, Interim Director n
BAR.NSTABLS.
,� ���
9� $� Public Health Division ,o
gFD Mr. 61 Thomas McKean,Director
200 Main Street, Hyannis,MA 02601 �
F.•
Office: 508-862-4644 Fa-: 508-798t304
Installer & Designer Certification Form
Date: `.`� Sewage Permit# Assessor's MaplParcel-C�f`{ ' 10
%
Designer: �� - `tS € �`C._ Installer:
Address: Ci
U . Address:BOk (o�
t
� l ��.� S ►� mac. 02-50
� t
On 1 d �� �SL ��{ was issued a permit to install a
(date (installer)
septic system at J. ,� W rO !. �� based on a design drawn by
( (address)
dated )
( esig er)
I certify that'�szptic system feferenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations, Plan revision or
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was construct e cye with they rms
of the LA approval letters (if applicable)
,i
< staller's Signature) i i�ia1114B
(Designer's Signatut- (Affix Designer amp Here)
PLEASE RETURN TO �Or UNSTABLE 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.
QnSeptic',DesignerCertification Form Rey'8-14-13.doc
f C •.
TOWN OF BARNSTABLE
LOCATION I ! Q �OS� /LC-4 SEWAGE 2-0 p S
VII:,LAGE deAk- t fL2 ASSESSOR'S
,MAP&PARCELZ64 05
INSTALLER'S NAME&PHONE NO. l;-S 0-0
SEPTIC TANK CAPACITY j 0 0-!:,, f-r•�Cit
LEACHING FACILITY: (type( (size) l L��LT)e t'
ENO.OF BEDROOMS 3
OWNER
PERMIT DATE: %®� COMPLIANCE DATE:
Separation Distance Between the: J9
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility l� Feet
Private Water Supply Well and Leaching Facility(If any wells exist on �0
site or within 20.0 feet of leaching facility) N 1 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) � Feet
FURNISHED BY
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A z6z, 10,
A 5 3-T -73- oL
le
ct
I
Town of BA rnsta•ble. P#
Department of Regulatory Services
' Public wealth Division
Date. g�9
: ssra = —
.t 6 F ems$ 200 Main Stree4 Hyannis MA 02601
Date Scheduled Time_JL0 Fee Pd. ,Q
oil Suitability Assessm'ent,fop Sewa e Disposal
Performed By: P� Witnessed By:
j
LOCATION & GENERAL INFORMATION
Location Address ] O L PO ST. - Owners Name
`LJ.. NT�RV I L,1...[ M A I Address
Assessor's Map/P4rcel: '� 1� / O S�QQ I I Engineer's Name 1'A�EYE,R ,%P13
v" 1r ' B 360
NEW CONSIRU�TION REPAIR 'Y` � Telephone# 60
Land Use DENT I A'V Slop'es(40) S Surface Stones
NA
Distances from: Open Water Body eft Possible Wec Area ��5� ft Drinking Water Well ,!,!"ft
Drainage Way 160 ft. Pmprrty Line 2 ft Other ft
SKETCH:(Street name,dimensiods'of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
y
l
Parent material(geologic �QG W� Gin►i'1HS� Depth to Bedrock N/
/1� I Weeping from Pit Face �✓�a-
Depth to Grouadwakdr. Standing Water in Hole: ) i P g
Estimated Seasonal VighGroundwater /✓/�
Dt TION FOR SEASONAL HIGH WATER,TA�3LE
Method Used: N
Depth gibs ed standing!in obs.hole: In. Depth to S011 mot1e9t tt
Depth toweeping from side of obs.hole: i in. Groundwater Adjustment
! _ A Aclor.,,,._._� Adj.Oroundwater Level
,,e
Index Well# _ Reading Date: Index Well level -- ��
I
PiERCOLATION TEST . Date '!Ime•
Observation f Time at 9" P ......-
Hole# t j
Time at 6" .....�---
Depth of Perc
Start Pre-soak Time.@ I rime "-6"(9 ) -- --16.17
End Pre-soak
Itdte IV[inJInch
al Testing Needed(YIN)Addition
Site Suitability Assessment: Site Passed�- Site Failed;
Original:.Public I,e$Ith Division Observation Hole Data To Be Completed on Back—
***If percolag6n test is to be conducted within 100' of wetland,you must first notify the
Barnstable 6 servation Division at least one(1) wedk prior to beginning.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
+'. onsistenc %Gravel
lD R 6
., 2, b/&
G E>D
W 15 f
'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)
6
DEEP OBSERVATION HOLE LOG Hole# AIM
Depth from Soil.Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
)
Consistenc 3o Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consisten ra I
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes )L_
Within 500 year.boundary No Yes
Within 100 year flood boundary No v Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervio s material exist.in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring per ions material?
Certification
I certify that on Z 0 Q q (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 require inin expertise and experience described in 3,10 CNM 15.0g17.
Signature Date
Q:ISEPTICIPERCFORM.DOC
V0000,
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
. Department of
Environmental Protection- 2 J ^ r
Wllllam F.Weld 6, rudy Coxe
GoNmor l ft.. ry'
Arpeo Paul Celluccl �Davld B.Struhs
u.000MCK Ci0111MW@1WW
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A -
1 7 5 Old Post Rd CERTIFICATION
Centerville
Property Address: 7—1 8—9 6 Address of Owner. Sherman Collins
Date of Inspection: (If different)
Name of Inspector. W.E. Robinson SR
Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6
W.E. Robinson Septic Service
P.O. Box 1089 Centerville MA
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site se disposal systems. The system:
_ Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspectoe's Signature: �fi v 4 Date: ����'� 4
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C,or D:
A] SYS PASSES:
7I have not found any information which indicates that the system violates any of the failure criteria ss defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection. -
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) `
The septic tank is metal, cracked, structurally unsound,shows substantial infiltration or enfiltration,.or tank failure is
nt. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292.5500
iJ Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oontinued)
Property Addrew 175 Old Post Rd Centerville
Owner. Sherman Collins
Date of Inspection: 7—18—9 6
Bl SYS CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C1 FUR EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) PYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
AFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is Brea
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or len than 5 ppm.
S)
(revised 11/03/95) 2
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 175 Old Post Rd Centerville
Owner. Sherman Collins
Date of Inspection: 7—1 8—9 6
DI SY FAILS:
I determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this rmination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
fail _
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
El LARD SYSTEM FAILS:
e following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone H of a public
water supply well)
The owner operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.,
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 175 Old Post Rd Centerville
Owner. Sherman Collins
Date of Inspection: 7—1 8—9 6
Check if the following have been done: `
Pumping information was requested of the owner,occupant,and Board of Health.
one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
du*4 that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
�' facility or dwelling was inspected for signs of sewage back-up.
'he system does not receive non-sanitary or industrial waste flow
_LThew was inspected for signs of breakout.
m components,excludingthe Soil Absorption System, have rP yste been located on the site.
_The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees,material of construction,dimensions, depth of liquid, depth of sludge,depth of scum.
size and location of the Soil Absorption System on the site has been determined based on existing information or
app ted by non-intrusive methods.
ty owner(and occupants, if different from owner)were rovided with information on t
Surface Disposal System. p he proper maintenance of Sub-
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 175 Old Post Rd Centerville
Owner. Sherman Collins
Date of Inspection: 7-1 8-9 6
FLOW CONDITIONS
RESIDENTIAL
Design flow: ns
Number of bedrooms:
Number of current residents:_'
Garbage grinder(.yes or no):�
Laundry connected to system(yes or no): t
Seasonal use(yes or no):-:4!-d
Water meter readings,if available: 1 9 9 4 77,000 gals
1995 101 , 000 gals
Last date of occupancy: 7 ^ 4
COMMERCIAL/INDUSTRIAL:
Type o establishment:
Design w:_galions/day
Grease tra fdings,
nt: (yes or no)_
Industrial WHolding Tank present: (yes or no)_
Non-sanitaryte discharged to the Title 5 system: (yes or no)_
Water meter, if available:
Last datejofpancy:
OTHER:Last datecy:
GENERAL INFORMATION
PUMPING RECORDS and source of informat' n: i-
Xt
System pumped as part of inspection: (yes or no)A,D
If yes,volume pumped: gallons
Reason for pumping:
TYPE O TEM
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)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source of information:
b �
Sewage odors detected when arriving at the site: (yes or no)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 175 Old Post Rd Centerville
Owner. Sherman Collins
Date of Inspection: 7—1 8—9 6
SEPTIC TANIQ
(locate on site plan)
Depth below grade: Ic
Material of construction:_concrete_metal FRP other(explain)
Dimensions:
Sludge depth: X/.. ,
Distance from top of sludge to bottom of outlet tee or baffle:sa4
Scum thickness: �l 7
Distance from top of scum to top of outlet tee or baffle: ,
Distance from bottom of scum to bottom of outlet tee or baffle: loll
Comments:
(recommendation for pumping,condition of inlet and owe tees or baffles,depth of liquid level in relation to outlet invert structural integrity,
evidence of ,etc.) c��
GREAS _
(locate on site Ian)
Depth below
Material of co _concrete_metal_FRP_other(ezplam)
Dimensions:
Scum thickness:
Distance from of arum to top of outlet tee or baffle:
Distance from m of scum to bottom of outlet tee or bane:
Comments:
(recommendati n for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of I etc.)
Iry
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 175 Old Post Rd Centerville
Owner. Sherman Collins
Date of Inspection: 7—1 8—9 6
TIGHT R HOLDING TANK_
(10_ on plan)
Depth below
Material of oo n:_concrete_ _metal FRP—other(explain)
Dimensions:
Capacity: ne
Design flow: ona/day
Alarm level:
Comments:
(condition of' tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
PUMP C BER:_
(locate on lm
Pumps in wor order:(yes or no)
Comments:
(note condition pump chamber,condition of pumps and appurtenances,etc.)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: 175 Old Post Rd Centerville
Owner- Sherman Collins
Date of Inspections 7—1 8—9 6
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type:
leaching pits,number:
leaching chambers,number:_
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number: /
Comments: (note coition of soil,signs of hydraulicf�1ure, level of ponding,condition of vegetationetc, .)
r, ca1a
C LS:_
(locate on 'te plan)
Number end zlilguration:
Depth-top of d to inlet invert:
Depth of so' layer.
Depth of scum yer:
Dimensions of pool:
Materials of cc on.
Indication of water:
infl (cesspool must be pumped as part of inspection)
Comments: (note edition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PRIVY:
(locate on site Ian)
Materials of oo n: Dimensions:
Depth of solids•
Comments: (note co ' n of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: 1 7 5 O l d Post Rd Centerville
Owner. Sherman Collins
Date of Inspection: 7-1 8-9 6
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
ISO G
J A
y
s!
J
gb
DEPTH TO GROUNDWATER
Depth to groundwater. zL- feet , )�
method of determination or approximation:
J
(revised 11/03/95) 9
Ippr, �
No.�. Fss. ..............
THE COMMONWEALTH OF MASSACHUSETTS
`BOARD OF kiEALTH
.............oF � 2 � . L--. .......................
115 Appliratiou for Mupuual Warku Tuuutrur#iun llumit
Application is hereby made for a Permit 'to Construct .) or Repair ( ) an Individual Sewage Disposal
System at:
................. __••-•---•••----------•--------- ---•-•- --••-----•- •-------
- Location,Address or Lot No.
-
.... __ �?-i.f._..1��1 --•----•-------•- ! .........................................................
ress
a ,.._. �j4-Z__............
• - Installer Address Q'•t
Type of Building Size Lot .'.).............Sq. feet
U Dwelling—No. of Bedrooms-___.._..�!!'!� _._-__...Expansion Attic ( ) Garbage Grinder 5,n-
04 Other—Type of Building ........._.................. No. of persons............................ Showers ( ) — Cafeteria
Q. - Other fixtures ------------------------•-----------•--...-..._.._..--•--••--•_---- •-
- WW Design Flow................ ......gallons per person per day. Total daily flow..............9'S -"-'....,.gallons.
WSeptic Tank—Liquid*capacity!' ?v_gallons Length.tv:S.... Width:.?:�1_ Diameter---------------- Depth_
x Disposal Trench—No..................... Width.................... Total Length................... Total leaching area_--_--______-_......sq. ft.
3 Seepage Pit No... Diameter__!o 'F__ Depth below inlet._G?.E Total leaching area. C'�: sq. ft.
Z Other Distribution box 0_4 Dosing tank( )
Percolation Test Results Performed by.............'...... 7.� -1 MA.�'.__.............. Date___M�.`C..?-`��.!`fk?
.....A
. Test Pit No. 1..` Z....minutes per inch Depth of Test Pit....JZr_"...__ Depth to ground water.6-?vNG'..-.
iz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0 Description of Soil_._......cso Z-`#' L cT 1 '"U4 b m�. .
•----•-----
t; ___-�-••------
U ....................................................7'_h �-``4f....-......- 1 . wf....re .---��"-=-----�-....��____ ��®
Uw l (l ..•--- ......._.�
Nature of Repairs or erations—Answer when applicable..--.L). _ _.... ._....._ :._ �.____-_.
• Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of LIT LTZ 5 of the State Sanitary Cod The undersigned further agrees not to place the system in
operation until) Certifica f Co li as been iss by th o rd f 1>th /
tgned......... (�,[,{/ ro
Application Approved By-•••---•--•-. .• .......0=:..........................
................................... 1............��
..............
Date
Application Disapproved for the following reasons:................................................................................................................
.....................................................................................................................................•--•---•-..__...--•••-•---------•......._.._.-.._...............•---
Date
PermitNo.... ............................. Issued_.......................................................
Date
3
THE COMMONWEALTH OF MASSACHUSETTS
4 BOARD, OF HEALTH
72
Appliratiun for Diin,aiittl Vorkii Tuntrurtion Vrrmit
Application is hereby made for a Permit to Construct �( ) or Repair ( ) an Individual Sewage Disposal
System at
..... ?.'__......... -= c...c....��i t........�
Location-Address or Lot No:
.. / LP_._ °._.._. ._ -------- ------- •�-�--UI--- .--------__________
� .— � �1..f.. C�7^70�_�_ ...... C g �- a ci!C =e..............................................
. -• ------
Installer Address
Type of Building Size Lot:...........................Sq. feet
14 Dwelling—No. of Bedrooms................ ...:..... ..__.__._Expansion Attic ( ) Garbage Grinder O
44 Other—Type of Building ............................ No. of persons...... r_:�.......... Showers ( ) Cafeteria ( )
Otherfixtures .......................................................... .....................................
x.i.-�
W Design Flow............... ......................
....gallons per person per day. Total daily flow.............................................gallons. .
WSeptic Tank—Liquid capacity��.'�''�'.gallons Length r ':..... Width..:;�:.�- . Diameter................ Depth.`
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................Sq. ft.
3 Seepage Pit No..G..... . Diameter..� '29EE.. Depth below inlet.__ • : Total leaching area_ �?�' .._.~'sq.ft.
Z Other Distribution box (.1-c-) Dosing tank
Percolation 'Test Results Performed by.............. .:A :.��-�?``��!`�� Date_..�!�.� �-�!- ►`��`....... ................
s Test Pit No. ....minutes per inch, Depth of Test Pit....).-7:- Depth to ground
fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-•-••--------•-✓r
----------------•--_............... _
I G CG N t at.d c3i 1 t? ' v` T'1! G C7a � ...
O Description of Soil.......... c--- ( �' ....... ....... _--.
...------•------�+rtr..--= /�ys --r '-•�-r-..e`.'.........h,1�zn r�c..._............................c� ...........................c>
�l ......................................•--•---...._..................._.••---
-•--- .......................................
U Nature of Repairs or lterations Answer when applicable �� j r' .. ..
•-••-•••...................s_ . �r ... ..... ....... .,_:.:_......................._..
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T I T LZ S of the State Sanitary Code The unders gned further agrees not to place the system in
operation until a`CertMcaof Co e"ces been iss e a by th o:rd of h h.
.. ........ _....y,Application proved By....---••---- __.............................................................1 �.� Cu11GDf�
... ...--Date
Application Disapproved for the following reasons:................................................................................................................
:' ---•-•...........................•----------•------•----------...---------------••-----...------........----------------------••-------------•-----•-----••--•---•-•-•-••--•-•-•-•..............•-_-•••.
Date
Permit No... . .rs...........C...•--.......... Issued...............................•-------.........._......
Date -
Y.iw904Yw Yrlor Ywl rr.wrr w.r4.}.w ..r ..Ywrir..r'iw:Rt■-'i'i'ir.Yr/rirww .Aw.F.r w.rwrrwa iw rw i.'r.///.rY6r/Y RtlwrY,.- .. w
THE COMMONWEALTH OF MASSACHUSETTS
r
D
BOARD OF HEALTH
........... lc>.�c.J..............:.oF....::: ... .....:.......
Qrrrtgf irate of Tomplittnrle /
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed, (k) or Repaired ( )
by........................... .. ..... % ' _ ......... .. _......_
Installer
at-----••- �7-T•---� -•---..a c_ --•��5 ..!........... . ..::. %..._.t' - f....�.. ......._. ................--. •----- .
has.been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No-- 1----- dated_ .....CP !.V - _
THE ISSPANCE OF THIS,CERTIFICATE SHALL,NOT'BE CONSTRUED AS A GUARANTEE TH, € -HE
SYSTEM MILL FUNCTION SATISFACTORY. .
DATE..................... '¢ .................................. Inspe-tor.••••-••----
�... -• - .....
•+....... b w r r®a m.....r.e...v...... w ......
iY
THE COMMONWEALTH OF MASSACHUSETTS
... - BOARD OF HEALTH
,��2h
No......................... { FEE........................
13ispouttl WOrkii Tunstrurtion Permit
Permission is hereby granted.......
to Construct �or Repair ( r-) an individual Sewage Disposal�System
at No........1.... =--u..�.� <�:. - ..... ....... .............• ---
Street 9'.S TSC 7 i
as shown on the application for'Disposal Works Construction Permit No.. ........ ... .Dated _.... ....
�
_ ......... Board of Health
DATE...
I
W",
LOCATA SEWAGE PERMIT NO.
/f
VJLLAGE _
INSTALLER'S TAME i ADDRESS
'? 7 ✓ �
d u I L D E R OR OWNER
DATE 1ARMIT ISSUED —�—
®ATE COMPLIANCE ISSUED �'� �
r�
a- 17
SECTION - SEWAGE
OLD POS 1 RO A D Ito F-r. WIDE-- PUBLIC WA t
Y )
i( -SEPTIC TANK- (rj - "D"BOX - -LEACH ( ) '
50 3 Dfa FDGE OF
TOP OF FDN
;;�=�(MSL)* ..2..OF INTO Vz"
WASHED STONE z. O , :Ys:a Gbi M R K
-Ella t
INS
IN• OUT. r I = �O.O
OUT- v
1'jOc7 G INS tt � C`z 5• :
,1 �_1
�'�L7 �45.8 SEPTIC ds.s� �� n-o { _ lamTANK
'.
ELEV.- ELEV. ELEV. _ Cp
j� ELEV.
i
v o oo°oa.
- ELEV. ELEV. 3$.g�, �i� -'L__ -s�Z �'` V' I ,cJ ♦♦♦
WASHED STONE
TEST HOLE LOG �- ➢ z -
TEST BY "FD UUMn� AIM GOr�ILCON S,O,H. "[<TEST DATE MAY 29, 1965 WITNESS 3 BEDROOM HOUSE
T.H. # 1 T.H. 2 DESIGN `
!k
OC— ELEV.46.1
ELEV.
NO
24" � 44,a PERC RATE 2 MIN/IN. DISPOSER DISPOSER �. ��/ .� /. � LOT
FLOW RATE 4f-)5 (GAL./DAY) I �w� I / , L.� 1
MEDf SEPTIC TANK '49 5 (I,S= 742,5 J szTl r:^ so r._•= --
�q� REQ'D SEPTIC TANK SIZE ti 5 O D
LEACH FACILITY a
SIDE WALL 1 O (o 12 .5(2.5 ) _ 4 7 1,Z G/D. .
wHrr� BOTTOM ll o) �l/,�-- 78.•( I.0 ) = 7 8's G/D. o
14,1" saN^ sa.3 TOTAL
USE: OIN C LEACHING
r(� (o' F,_,FF i✓CT I v� DE.P'T�-! x I O � EFL, VJ i D r N- - -- � � g� \ �� � � � _ = —WATER ENCOUNTERED. IQz.51�
NOTES: (UNLESS OTHERWISE NOTED)
1.DATUM(MSL):TAKEN FROM-----4.1'f/4-, .._....QUADRANGLE MAP V QF -
2.MUNICIPAL WATER L�-_--__--.----_..-_-AVAILABLE
3.PIPE PITCH:Vi"PER FOOT G
4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- -44 ARNE H. ,
5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. OJALA DISTANCE AS CERTIFIED
6.PIPE JOINTS SHALL BE MADE WATER TIGHT tg CIVIL
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. '�
_ L,O
- STATE ENVIRONMENTAL CODE TITLE 5 �• — _ SITE PLAN
of
LOCUS: LOr L_ OLD
_ E ARN CEN r�
REG.PROFE ZONAL ENGINEER H.
O ALA O REF: PLAN SODIL 329 PAGE 45
down cape engineefing 348 .
Off, ,p PREPARED FOR: R��r' 'RSID�. G(7NST�l.)CTI CAL)
CIVIL ENGINEERS s' )S
LANDSURVEYO — ---
C U Y CO_1--:I�T'T t
BOARD OF HEALTH REG. EYOR
CONTOURS (EXISTING)------------- �26tIAel/1S!"
(PROPOSED)—O-0—O-0— APPROVED DATE I'-?��►.l��r'°��� MA vAmnow MA
�� SCALE _ Q
DATE
LEGEND CENTERVILLE
PROPOSED CONTOUR P
0
® PROPOSED SPOT GRADE
P�
-- 98 -- EXISTING CONTOUR
O ,0c RTE 28 k k
+ 96.52 EXISTING SPOT GRADE ,O2
W— EXISTING WATER SERVICE v
Q
O OLD POST RD.
TEST PIT
SCALE: 1"=20' LOCUS
AREA = 17342 sf+ A��
PLAN Fool: 329 PACE 45 I
ASSP MAP 2O9 PCL 052/001 ��
�G 5k.
LOCUS MAP
LOCUS INFORMATION
yG PLAN REF: 329/45
TITLE REF: 10757/338
Q PARCEL ID: MAP 209 PAR. 052/001 IN STATE ZONE II
Q
O O
SEPTIC SYSTEM
c9 O REPAIR PLAN
LOCATED AT:
175 OLD POST RD.
— _ _ CEN TER VI LLE, MA
45.45 46 PREPARED FOR
46- - -
MARX/ DONE RIGHT EXC.
1
\ l EXIST. 1,000G SEPTEMBER 28, 2016
\ SEPTIC TANK
�- OF
4 G O'er � '� ��� Ass9�
TBM = EL. 47.2 — DA R N
BULKHEAD FOUND. TP-1 ^ R
1 �^ H
�' Q
44-
TP_; _ �� _ , - 44 �
� �-'
43.6 MEYER & SONS, INC.
\ N ° o 4 2_ _ P.O. BOX 981
'�
12, 25 OZ 5 \� � EAST SANDWICH, MA. 02537
\ PH: (508)360-3311
\� 43. \ FAX: (774)413-9468
meyerandsonstitle50gmail.com
�' _42 SHEET 1 OF 2 J 1808
ELEV. TOP NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS
FOUNDATION BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE
(Existing) _ FINISHED GRADE (44.5) VENT
= 47.0 � F.G.EL: 46.2 F.G.EL: 46.0 F.G. EL: 44.7
MAINTAIN 2% MIN SLOPE OVER LEACHING AREA
R
.s7,Y F.G.EL 45.0 L; 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2"
AOUTLU
7
7�7
C
• . STONE OR FILTER FABRIC DOUBLE WASHED STONE
4" SCH 40 PVC
o"I14 6 0 S= 1% MIN. ®13®®®®®®®®®TEE'S ARE TO BEINV.41 .70E =
( ' ) ®®®®®®®®®®®4' SCH 40 PVC 2 EFF. DEPTH ®®®®®®®®®®INV.43.70 INV.41 .50
GAS 4' 2 X 8.5' 4'
EXIS BAFFLE PROPOSED DB-3 ,
DISTRIBUTION BOX EFFECTIVE LENGTH = 25
INV. 43.95 (H-20)
INV. ELEV.= 38.95
EXISTING 1,000 GALLON SEPTIC TANK
GAS BAFFLE TO BE INSTALLED ON ����� Uf Mgss9� BREAKOUT
OUTLET TEE AS MANUFACTURED BY o� ARRE M yGr TOP CONC. ELEV.= 39.95 ELEV.= 39.95
TUF-TITE, ZABEL, OR EQUAL
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 1 0 INV. ELEV.= 38.95 •®®
PIPE INVERTS PRIOR TO CONSTRUCTION 1 rE3
®®®
2) D-BOX SHALL BE SET LEVEL AND TRUE TOcIE ° ®®®
GRADE ON A MECHANICALLY COMPACTED SIX S01TA0 BOTTOM EL.= 36.95 ®®®INCH CRUSHED STONE BASE, AS SPECIFIED IN ` I 3.75T: 3.75'
310 CMR 15.221(2) (� = ,3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 5.05 FT. EFFEDTH 12.5
WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE
DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM SECTION
4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL 31 .90 _
GAS BAFFLE AS REQUIRED (500 GALLON H-20 LEACH CHAMBER)
GENERAL NOTES:
SOIL LOGS P#:15147 DESIGN CRITERIA
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOOM
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: SEPTEMBER 8, 2016 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF)
OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN
LOCAL RULES AND REGULATIONS, EXCEPT AS REouESTED BELOW: SOIL EVALUATOR: DARRIEN MEYER, R.S., CSE #1614
- 310 CMR 15.405 (1) (B): WITNESS: DAVE STANTON, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D.
1) A 1.55 FT. VARIANCE FROM 310CNR15.221(7) TO ALLOW LEACHING GARBAGE GRINDER: NO (not designed for garbage grinder)
TO BE 4.55 FT (MAX) BELOW GRADE VS REO'D 3 Fr. (H20/VENT PROVIDED) SEPTIC TANK:
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Elev. TP-1 Depth Elev. TP-2 _Depth 330 gpd x 20OX = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER. 45.10 0" 44.90 0"
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FILL FILL LEACHING AREA REQUIRED: (330) = 445.94 S.F.
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 42,77 28" 74
42.48 29"
ENGINEER BEFORE CONSTRUCTION CONTINUES.
A A USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4'
5. ALL ELEVATIONS BASED ON ASSUMED DATUM. LOAMY SAND
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 1OYR 3/1 L 1�OYR 3/1 STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D
HEALTH FO CTOR OR PRO ER INSPECTIONS DURING TO NOTIFY CONSTRUCTION.LOCAL OF 42.35 B _ 33" 42.23 B 32" BOTTOM AREA: 25 x 12.5= 312.5 SF
LOAMY SAND (25 + 12.5) X 2 X 2 = 150 SF
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 10YR 6 8 LOAMY SAND
B.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED / 10YR 6/8 SIDE AREA
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 39.43 68" 39.40 66" TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE C C DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING perk • el. 37.7 MEDIUM- MEDIUM-
CONSTRUCTION. SAND SAND
10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 2.5Y 6/6 2.5Y 6/6 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
12. THIS PLANNSnTO BE UCE FOR SEDINEER FOR SEPTIC SYSTEM PURPOSES ONLY TION 32.10 156" OILS 156" 175 OLD POST ROAD, CENTERVILLE, MA
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY < GROUNDWATER
IN "C" SOILS
13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED Prepared for: Marx/Done Right Excavation
14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. Engineering and Survey by: SCALE DRAWN
15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) I, Darren M. Meyer, R.S., CSE, hereby certify that 1 am currentlyMEYER&SONS,INC. N.T.S.
approved by MADEP pursuant to 310 CMR 15.017 DMM
to conduct soil evaluations and that the above analysis has been performed by me consistent with the AO BOX981 DATE CHECKED SHEET NO.
requirements'of 310 CMR 15,017. 1 further certify that I hove passed the Soil Eval. Exam in October, 1999. E4STSAIVDKICH,M402537
5083sa2922 09/28/16 DMM 2 of 2