HomeMy WebLinkAbout0041 OXNER ROAD - Health 41 Oxner Road
Centerville
A= 193-123
1521/3 ORA 101YO P2
TOWN OF BARNSTABLE
LOCATION 4 1 D)C A)E T) SEWAGE# 20/y - 2 2/'
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. ci_ x��SyAwe, -Xnx-
SEPTIC TANK CAPACITY`.�7
LEACHING FACILITY:(type) Qt\)&b (size) I , s x 3-3�
.N
NO.OF BEDROOMS
OWNER /Vt C N,r.cMe V-C,
PERMIT DATE: ` COMPLIANCE DATE:-7J 1-3 11
Separation Distance Between the: A)C7Ne E NCOJN
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility C . Feet
Private Water Supply Well and Leaching Facility,(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY r;Z)C�QC (O W e
t2Ack e2 AwT- I$
fir-12
2-G7
se f
2 .
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in co titer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYitation for bispisal *pstrm Construction j3ermit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. I OTC 0 e f• R Owner's Name.Address,and Tel.No.
Cog-e-010 IT) e J c v c3,NaC, t�k n-kc n tw. _p rC,
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
1--b-4c,s A -Jf ov_c,j m n't �c0,TeC�1
Type of Building:
Dwelling No.of Bedrooms y Lot Size ?C�� `3 sq.ft. Garbage Grinder( )
Other Type of Building (nC2,jS,R No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) "i`{y gpd Design flow provided e[y 4 Q gpd
Plan Date 9 y`V -% Zb i Number of sheets ,dc Revision Date
Title
Size of Septic Tank_e`(;1 S4-I co v Type of S.A.S. -%-4= qc,f l'b,j c L,,,,,�b pis
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) !tli9ItCe�, IJ@.,J S, A •S
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
S' ne �A4 Q Date
Application Approved by Date
Application Disapproved"b Date
for the following reasons
Permit No. Date Issued
" P /
j�
No. Fee, ` -''
— L41
THE COMMONWEALTH OF MASSACHUSETTS Entered in co uteri
PUBLIC HEALTH DIVISION \TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for 3isposaf 6pstem (Construction 3permit
Application for a Permit to Construct( ) Repair("Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.H I OK a le r 2 Owner's Name,Address,and Tel.No.
CPNa e,ry J) %e v i��,.u3c, Nl Nk r Nt r rG
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
"Cb,) S A z N 5 -� - �C.o—Tr cA
Type of Building:
Dwelling No.of Bedrooms Lot Size 2t-�P, 3 sq.ft. Garbage Grinder( )
Other Type of Building j8C,,,$,,e No.of Persons Showers( ) Cafeteria( )
Other Fixtures +'
Design Flow(min.required) r-1'-I.0 gpd Design flow provided N PJ G . C� gpd
4 Plan Date 3 y -L 2 b i 1 Number of sheets I Revision Date
Title
Size of Septic Tank (I*I S , Type of S.A.S. 5—J jo, j C L C,AA\.a p r S
r Description of Soil
` Nature of Repairs or Alterations(Answer when applicable) 1 rj-, c, /JtoW S. A
t
Date last inspected:
'Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in )
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.,, ,
S. ne ete i i E' i'3 Date 7
Application Approved by 11 �/� /r „ !/ Date
Application Disapproved b Date
for the following reasons
4 /
Permit No. Date Issued
P -
r l THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded
Abandoned( )by1 r.c 13/c9 w a S Nt
at ^,a e V oa Je has been constn cte¢i �'c r,led
ce
with t e provisions of Title 5 and the for Disposal System Construction Permit No. '1i
Installer�yc3CS A I5(hujrJ T i,Jc Designer IF ca rr
#bedrooms Approved des', ow Lj L4 C A gpd
The issuance of this permit shall of ec nk,ed a guarantee that the system n '•n as esi reed.
c
Date Inspector /�
/ f
---------- - J ' '-------------------------------------------------------------------------61- ------------ ----------------_--I
No. /J�l// `7 (�J/�'THEMASSACHUSETTS
COMMONWEALTH F CO ONWEALTH O MA SSACHUSETTS Fee
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
imisposil 6pstrm onstruttion 3permit
Permission is hereby granted to Construct( ) 1 Repair( _� Upgrade( ) Abandon( )
System located at 'I N4 P/g f 1
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construc'o mus e completed within three years of the date of this permit.
Date Approved by
r � Ii
f
Town of Barnstable
�oFtME roh o Regulatory Services
Richard V. Scali,Interim Director
[iARNSTABI.E. �
MAS& 9IX .Public Health Division
1639. Thomas McKean .Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form -7
Date: J v�D� Sewage Permit# Assessor's Map\Parcel
Designer: .vttcl �' C"0 ot1toa✓r Installer: a T6Aas W TAx
Address: >p Address: '
On `D4,,,�A was issued a permit to install a
(date) '(insta[ler)
septic system at �( Oiwr-- R0,14 based on a design drawn by
�^ (address)
D4Oki �= C��u�t�l olfTwr f �S dated 7ot7
/ (designer)
y I certify that the septic system referenced above was installed substantially according to
the design; which may include minor approved chan�oes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found,satisfactory.
1 certil�,, 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 references( above was constru liance with the terms
of the 1\A approval letters (ifapplicable) , tH ASsq�y
0 oAvio
D.
COUGHANOWR N
IIStallel''S SlbTlatlll'e) No. 1093
P�cf STE`��'PC
�o
INVITAW
(Designer's Signature) 4 (Affix Designer's Stamp Here)
s
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.
0ASeptickkDesigner Certification Form Rev 8-14-13.doc
LOCATION,;. _- 5EW&C-4E PERMIT t30.
_ T
II�ST�LLERS lJ�t�JI � ADDRESS
BUILDER 5 Q &MF- ADDRESS
DNTE PERNAIT ISSUED •,A�
DATE COMPLI &MCE ISSUED : ��� �
a
' o �
No.----•�- --Fr..... Fps.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEA TH
-
�Zs ...........OF.......... .. ... ...... .... . ... . . ...... ........................
y Application -fur Bhipoiittt orkii Tomitrurtion Prrutit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
`dy .. Location-Address Lot
........................ or . L
a /cane ess
'ta ..................-'• .� ----------------------------------------------
I.
sler Address
UType of Building Size Lot-.1�;ad -----------Sq. feet
Dwelling—No. of Bedrooms---J....................................Expansion Attic ( '') Garbage Grinder
-1 Other—Type of Building ............................ No. of persons----4--------------------- Showers (� ) — Cafeteria ( )
a' Other fixtures _____._u,�'' "!._.. __
d --------------------•-•-------------------------------------------------------------------------------------------
w Design Flow--------- ............................gallons per person per day. Total daily flow.__..10.0..............................gallons.
WSeptic Tank—Liquid capacit. __ -------gallons Length..4_.......... Width_.... ......... Diameter................ Depth__.---__.--._..
x Disposal Trench—No_ ____________________ Width-__-.__-__-__------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit Nol�P5�.7 Diameter.................... Depth below nlet_ ......_. ........ Total leaching area--_-______---._.-sq. ft.
Z Other Distribution box (�-)`- Dosing tank ( ) ® - AC le, `?/- ;?,4
aPercolation Test Results Performed by.......................................................................... Date---------------------------------------
,� Test Pit No. I................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water__..--_.___-..-.._.--_
(4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.._-_-._-___._--___....
tx -•V � . .G�; I ---�----r t
C� --- ••--
Description of $Oi_ 0 __.W`. �. Z y -._
-------- --------
-- .---- ------
w
U Nature of Repairs or Alterations—Answer when applicable._.-_--.........................................................................................
---------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Artie.XI of the State Sanitary Code— The undersigned further agrees not to place'the system in
-. operation until a Certificate of Compliance-has been issued by the bo 'd of health.
S. 7111
..............................
Z
Date
Application Approved By-- - .. ---------------------------'••-.
. 1_� < ...L_
Date
Application Disapproved for the following reasons:---•-------••-•-•-•-•---•-------•--------------•--------------------------------.-----------•-'•--•-•-----------
-•...........-'--'---------------•-------------------•-•-•'--•.......'---.........••••-••----•••-•-•--•-••----------.........._...._...-'----------•-----------•----------•--•---------------...........
' Date
Permit No......................................................... Issued........................................................
-• --•••--
Date
t
No......13.� ....... Flns..fs�1....................
THE COMMONWEALTH OF MASSACHUSETTS
` 1 BOARD OF H EA THE,
........ .l . ... OF......... .( �7�� . �� ....'.............
Appliratiun -fur M-spo ttl Workii Towitrurtiun Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
•---•-----•-•---------------•---------•----•----••--•---------------••........••----•-------_----- ---•-------------•----•-•------•-•••---•--•-••---•-•-------••-•--••--•••-•-•-•-•-----•--••---••-.
Location-Address or Lot No.
----------------------------------------------------------------•--.._............................ -•---•-----•-•---•-•---•••---•••-•._...........---......-------•--••-----•-••••----------------•--
Owner Address
W
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.............. .............................Expansion Attic ( ) Garbage Grinder ( )
114 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
a.' Other fixtures .......................................................................................................•••-•....--•-•-------•-----------•••--..__....
d
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter......---------- Depth----------____
x Disposal Trench—No. .................... Width-------------------- Total Length--_-___----__.-__-- Total leaching area--------------......sq. ft.
Seepage Pit No--------------------- Diameter----_______.__-_---_ Depth belowrinlet_..._..._..._...... Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank
PercolationTest Results Performed bY.......................................................................... Date........------------------. --------
Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.._-__.-._-.._---___.
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_._-.-._-----_-..-._.
N
!! /f------------------------------- ' ' .....
r -- f-- f `�
O Description of�Soil_.______�i.."._ __.�__ _
U
W
U Nature of Repairs or Alterations—Answer when applicable----------------------------------------.--.------.---_----_.--_-.--------.-...._--.--_---_-----
----_---•------------------•---•--•-------------------••--------------------------------------------------------------------•---------------------•----•--------------••-------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
S�gned....n--------------_-------------------------•----•------•---- •--•--------------.�.�..'., ........--•--•-/•-------7---�--.
----
Date
lAPPlication Approved BY -................................
Date
Application Disapproved for the following reasons------------------------------------------------------------------------------------------------------------•----
.........••••••-•-••-. -----•---•-----------------------------•--------•••••••---•-••--------•-----•-••--..
----------------------------------------------------------------------------
------------------
Date
PermitNo..........................................................
Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..1 1................OF..... .��-�.. . .....................�.............................
Tutifiratr of 0W.'untliliatta
THYS IS TO CERT--I-FY;That the Individual Sewage Disposal System constructed ( or Repaired ( )
= -c"2,-�` =1----- � --------------- --- ----------------- - --------- -------------------------------•---------------
( - r 4 -------------------
/
has b en installed in ac or ,Vice with the provisions of"Art'" XI of The State Sanitary,Coil as described in the
application for Disposal Works Construction Permit No.' -__-!�Zf!e........... dat . -_7�
' ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............................................................------••-•-•-•---- Inspector.--------------------------------- .................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH� r
r ........... ....C���........OF..... �G�1
No..... S-•f...r-•... FEE.---------
r
ttl fur �ut� tr-tiuit? rrutit
s h Permission ' ereby granted_—.---( 4�,,:.... _.`_.....`....,f-__GG....t z........ ...................Z....................................
to Construct�( .or/_ epair ( ) an!Individual Sewage Disposal Sys e!� f ,
( s.' ( Ly„ P7' - / -ll Z_ . alai
Str et
as shown on the application for Disposal Works Construction Permit N _ .__ 1. Datedl ___'__J..�............... -
1— �_ w.. Board of Healt
DATE. h, `
...../ �---------------------------------------------------------- L`
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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EATIFILD PLUT PLAN
k
-;Being lot # 37 as shown on a
subdivision plan entitled f
"Crosby Hill East" in Center
ville, by Charles N. Savery
Inc. , Hyannis, Mass. I dated
Aug. 21, 1973 and recorded
Barnstable Registry of deeds
OF
In book 277 page 98.
°'it,
ors 9cs -:Oct. 28, 1975
JACKSON Builder: I
ko.8937 H .Charles F. Stanley
<y"Fr'►STEv��Q` ' -Centerville, Kass.
o SUK f
II
AsBuilt-; Page 1 of 1
7 sZ�L
LOCQ,TIOKI 5EW&C,E PERMIT 'U0.
lws-T LLER5 1, &!> ADDRESS
7— -
bUILDER 5 Q &ME A. ADDRESS
DATE PER"17 155UED
D&TE COMPLI&KiCE ISSUED :
i
J `
a
o �
http://issgl2/intranet/propdata/prebuilt.aspx?mappar=193123&seq=1 11/7/2013
Commonwealth of Massachusetts ` 13- l a3
,F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4� vY„i
41 Oxner Rd
Property Address i
McNamara <.>
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. CityRown Satet Zip Code Date of Inspection
..,t
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: A. Inspector Information
When filling out p
forms on the �Y
computer,use Douglas A Brown
only the tab key Name of Inspector
to move your D.A.Brown Inc
cursor-do not Company Name
use the return
key. P.o Box 145
Company Address
Centerville Ma 02632
CitylTown State Zip Code
508-420-4534 S14297
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title
5(310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
3-1-19
Ins 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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 18
cam,' Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. CityrFown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
At time of this inspection this system met all passing requirements.
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
` Commonwealth of Massachusetts
�tl Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Citylrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c� Commonwealth of Massachusetts
r= ,F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�o;u 41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. CityrFown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
�d Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
V
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® 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 Y2 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 SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
.and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® 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.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
,ig Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�o
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or"no"for each of the following for all inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
❑ ® Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
moo, Commonwealth of Massachusetts
�p ,ip Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440
Description:
System consists of a original septic tank and a s.a.s that was installed in 2014 consisting of 3 500
gallon leaching chambers.
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ❑ No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage(gpd)):
Detail:
2017 2018 average gpd--------117 gpd
Sump pump? ❑ Yes ❑ No
Last date of occupancy: Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
` 41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: 2014 when new s.a.s was installed
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping: new s.a.s installed
t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
�d ,io Title 5 Official Inspection Form
�9
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑' Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
tank appears to be original s.a.s was installed in 2014
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: feet
Material of construction:
❑ cast iron ❑40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 1.5
.feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
1000 gallon
Sludge depth: Moderate
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness trace of scum only
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
If tank has not been pumped in the last 3 years I recommend pumping at time of transfer and every 2-
3 yrs there after for maintenance.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
�n ,F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�a•t, 41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
I
cam, Commonwealth of Massachusetts
,�-o Title 5 Official Inspection Form
!' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
„V 41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
box was functioning properly at time of inspection
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
�d ,9 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4�
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No"
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
"If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number:
3
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
�d Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
V� 41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach chambers were functioning properly at time of inspection with no signs of failure.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
f�
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. 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.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
�9 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;u 41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: greater than 5
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 2-2019
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
design plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
L
cam, Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
�e
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u 41 Oxner Rd
Property Address
McNamara
Owner Owner's Name
information is
required for Centerville Ma 02632 3-1-19
every page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6(Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
Assessing As-Built Cards Page 1 of 2
TOWN OF BARNSTABLE
LOCATION 9 1 N rU F Ik, _Q 7 SEWAGE# 2-01 y - 2 21
VILLAGE(�. �U•,II Q ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE N0. cl ,,�IoS Ac a�Tnx
SEPTIC TANK CAPACITY Ft N
LEACHING FACILITY(type) 5' C N (size) 12 d X3 3. Xi_
NO.OF BEDROOMS 4
OWNER � /V
PERMIT DATE: ` COMPLIANCE DATE: Z
Separation Distance Between the: t'NCt9tJ!d>t �
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility CltPE C 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
RMMSII7;D BY C \5t 8 W
3AC k CI I OXIQe i2 Aovt-ig
2-Gy
psef
z
https://townofbamstable.us/Departments/Assessing/Propertyyalues/HMdisplay.asp?mappa... 3/5/2019
Crocker, Sharon
From: Crocker, Sharon
Sent: Wednesday, March 23, 2016 3:13 PM
To: 'dbuczek1946@gmail.com'
Subject: 41 Oxner Road, Centerville
1
2016_03_23_15_10
_19.pdf(58 KB...
Attn: David Buczek
To Whom It May Concern.
Attached is the Certificate of Compliance for the septic permit pulled 7/09/2014 and completed
7/23/14 -they upgraded the septic system from pits to chambers.
Sharon Crocker
Administrative Assistant
Public Health Division
Town of Barnstable
1
VE Town.of C�
f Barnstable P�
De'partiment of Regulatory Services
Bt Public Health Division
Date
�p racy 200 Main Street, yannis MA 02601
• rEl)NlA't� ,
r
Date Scheduled— A' Time Fee I'd.
! _ n
Soil uitability Assessment for ,fie s 1 �
Performed By: `�PtV 11� �- C0(J& Pf Nb W Pz, 4`>'I Witnessed By:
LOCATION&GENERAL INFORMATION c Location Address 41- 4xer P,
Owner's Name 1', ' a 5
CCoelr l Address dxge, v
Assessor's Map/Parcel: fly
l��l� �t 2-3 Engineer's Name �
D1 U d Cov f- 06 w/ z,NEW CONSTRUCTION REPAIR , Telephone# sof 3G4 d�4 � ,
Land Use' J ld ` !O I Slopes(96) Surface Stones,. 110 he- J
Distances from: Open Water Body�^W ft Possible Wet Area P,�lft Drinking Water Well ft
Drainage Way `0} ft Property Line _ ,Q_{___ft Other ft
SIK ETCII:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to'holes)
71 nC t
"'
Z>'
� u---
r~rr
� �9, �.
4
00
Parent material(geologic) r0 %oll 0"5� Depth to Bedrock
Lo
Depth to Groundwater Standing Water in Hole: N Weeping iiotn Pit Fpee �a
Estimated Seasonal High Groundwater 6�?E I ll7 2 �t �Tot� S o f4q ce J
DETERMINATION FOR SEASONAL HIGI1 WATER TABLE
Method Used: _W#(,
Depth Observed standing in obs:hole: In. Depth to soil mottles: VOYte- Ot+ 144 In.
- ' Depth to weeping from side of obs.hole: In, Groundwater Adjustment
Index Well# Reading Date: Index Well level 'Ad,fact.,_,m 4 Adj.Groundwater level e
�— PERCOLATION TEST bate`I Jo l4 Thne 1i A M
Observation i
Hole# i Time at 9"
Depth of Perof�1 Time at G"
Start Pre-soak Time @ G`�® Time(9"-6")
End Pre-soak -3 Q V
Rate Min./Inch , N P j
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) `V
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DEEP.OBSER VATIQN HOLE LOG Hole'#
Depth from Soil Horizon S,oi1 Texture Soil Color Soil. Other J
Surface(in.) (USDA) (Munsell) Mottling (Stnucture,.Stones;Boulders.
onsistency,%Gravel)
O " 10 p �„oara ad lD `��'-`3t!Z 0r�i gble .
to - 3Z hw S� jo- S16
r32� l4�- C �'lecQ;um cxrh (p P- - w �DSr✓
DEEP 0I3SERVATION HOLE LOG Hole# -
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stones,Boulders.
Consistency,%Gravel)
t-0401 �cjq 3& �lDky
t'.abte
l� -34- 'Rw aun� end to YR S F m6 to
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con i to c Gravel)
DEEP OBSERVATION HOLE LOG: Mole#
Depth from .Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) r(Munsell) Mottiing (Structure,Stones,Boulders.
Cons' ten
Flood Insurance Rate Map:.
Above 500 year flood boundary' No— Yes
Within 500 year boundary No t�' Yes T
Within 100 year flood boundary No.Z Yes
Deoth of Naturally Occurring Pervious Material
Does at least four.feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? eS
If not,what is the depth of haturally occurring pervious material?
Ceatification �! J �4C1
I certify that on �y ` (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 requirqkrainin xperdsQ and experience.described in�110 CMR 15.017.
Signature Date
Q:%S.EPTIC\PSRCPORM.DOC
1
77 ' 76
135.13
77 '. �vv � �"�,a'� 3 Q � LOCUS
76
�_. -
\R+ O Q MASTHEAD
G fl LANE p
oT z 1 ELEVATION 4 = o
A OWED / MINIMAL 9 7 .59 �� x NOT
GRADING /2TS C�Q �� �J ti TO
0 PROPOSED I , POT ON BULKH�`� o�� LPQ = SCALE
� \. . \�• t 9QF Jao II
90 0�
CENTERVILLE. MA
0 w t
A TE,q l/Nf ✓
+1 -o THIS IS A
• / \ COLON
18-0
PLAN
.. COLOR PLAN ONLY
I*A1YC>;; USE CO /� /� p
0 FOR INSTALLATION LEGEND
�LS GLS UV D
OO a FULL DETAIL IS BEST SEPTIC COMPONENTS
_ \ VIEWED IN
%�r1 C�OnEX
G O 1 �l E'Kf e o FULL COLOR 1000ISTING
GAL - -
QQ p O N 76
\l / SEPTIC TANK
M 0
U V O TE S 77 G G Q �- 1 PQ�' \ 1 4 EXISTING
4,r O ®V 'v ►2-0 �.N LEACH PIT/
CESSPOOL
@-M
INSTALLER MAY MOVE SOIL ABSORPTION 78 - f I2-o DISTRIBUTION Box 0
SYSTEM UP TO FIVE (5) FEET LATERALLY
IN ANY DIRECTION. ELEVATIONS SPECIFIED ® TEST PIT
ON FLOW PROFILE MUST BE MAINTAINED. , i2-o
\77
INSTALLER MAY MOVE VENT PIPE TO
IS-O
ft
A DIFFERENT LOCATION. Fao t 30
'.
ld
1
TREE REMOVAL AT INSTALLERS DISCRETION. �� �n
.0 V \
11 !mil-1 11 V \ 2 \ PROPOSED SOIL
SCALE: I in 20 ft .� ABSORPTION
0 20 40 \ SYSTEM
-SEE DETAIL OFss9r OF�4Ss9C`
O 10 20 /98,9 A DADVID yG� DADVID
ON B CK
PRINT ON II x 17 in PAPER COUGHANOWR OUGHANOWR y
FOR PROPER SCALE . No. 1093 y No. 461
�' 78
LOT 37 1
AREA = 20.983 sf
TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE SCH. 40 PVC AND TO PLAN BOOK 277 PAGE 98
A1v L
in/ft MIN
EL = 78.63 +— b in OF FINAL GRADE PITCHAT 1/8 . ) .`
77.50 ASSR MAP 19L�9
(R9. - FOR SURVEYOR'S CERTIFICATION-REFER TO 'CERTIFIED PLOT PLAN'
DATED OCTOBER 28.1973 SIGNED AND STAMPED BY THOMAS A.
D—BO`�/f - - _ - 3 - JACKSON RLS ON FILE WITH THE BARNSTABLE BUILDING DEPARTMENT.
+ A
��n{������7 USE H-20 u� ..
MAX - . SEWAGE DISPOSAL
74.50 r SYSTEM PLAN
p p �p 000000ap4`o —
EX/STING 1000 Gr�L�L,OIIV o o;� o0000 - TO SERVE EXISTING DWELLING
PRECAST ° +
a�ooa$��o oo�o 0o VIRGINIA M.
00000 oqo_ �0000 5 M c N A M A R A
SEp��� TANK 74.80 73.85 = DRywE�L ',
6 inp p + ' ' OWNER(S) OF RECORD
EXISTING SEE DETAIL ON BACK 74.02 STONE 73.75 SOIL ABSORPTT D�
• . •
BASE O
41 OXNER ROAD
SEE DETAIL CENTERVILLE, NIA
y TINGSYSTEM - � P.O. BOX 1265
EXISG 6 In STONE BASE 45 f t DJ S ft ON BACK THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM PROPERTY ADDRESS
BELOW DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING WEST CHATHAM, MA
7I.75 LO
NO GROUNDWATER PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER 02669 DATE. JULY 3. 2014
�l
SURVEYOR.
- � 0 SHOULD CONSULT WITH.A MASSACHUSETTS REGISTERED LANDS
MOTTLING B _ 65.I
b) I2 ft T G OBSERVED/ED : . 80
S�8 364-�894 P�1/2 ,.IDer ETE 3829 B �
SOIL TEST Lao • • ; . D SI N CAC ULATTIO��N& DISTRIBUTION BOXUSE SHOREY
PIPES DIMENSIONS
DESIGN FLOW:. 4 BEDROOMS X 110 GPD = 440 GPD AND DETAIL •. 2 FEET BEFOREDOWN
SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE *461 SEPTIC TANK: 440 GPD X. 2 DAYS = 880 GALLONS
II
WITNESSED BY: DONNA MIORANDI. .HEALTH DEPT. USE EXISTING 1000 GALLON SEPTIC TANK IF IN
NO GROUNDWATER ENCOUNTERED SOUND STRUCTURAL CONDITION.NEW 1500 GALLON SEPTIC TANK.IF NOT: INSTALL
1
12 in
TEST PIT
PERC ATS0 in - 2 MIN/INCH IN C SOILS c MIN
bISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW.
ELEVATION DEPTH SOIL USDA"SOIL_ SOIL COLOR SOIL OTHER L —►
INCHES HORIZON TEXTURE (MUNSELL) MOTTLES SOIL ABSORBTION SYSTEM: FROM
THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE N TANK 4 a ,� So
78.00 0-10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES
10-32 Bw LOAMY SAND lO YR 5/6 NONE FRIABLE PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT.
75.33 THE 33.5 ft x 12.5 ft x 2 ft LEACHING GALLERY �� 6 In STONEE
32-144 C MEDIUM SAND 10 YR 5/4 NONE LOOSE DEPICTED BELOW CAN LEACH:I . I I I I I 2�
66.00 21 in CROSS SECTION VIEW
AREA = (33.5 x 12.5) 418.75 sq. ft.
NO GROUNDWATER ENCOUNTERED ` f• _ SIDEWALL AREA = [2x(33.5+12.5)] x2 =184 so. ft.
TEST P� T 2 TOTAL AREA 602.75 sq. ft.
2 MIN/INCH IN C SOILS _
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER FLOW CAPACITY 0.74 x 602.75 = 446.03 gal/day
INCHES HORIZON TEXTURE (MUNSELL) MOTTLES INSTALL A 33.5 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED SOIL A B S O R P T I O N
77 80 BELOW.FLOW CAPACITY = 446.03 gol/day.WHICH EXCEEDS .
0-10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE THE 440 gal/day REQUIRED FOR A FOUR BEDROOM DESIGN. TEMCONSTRUCTION DETAIL
10-34 Bw LOAMY .SAND 10 YR 5/6 NONE FRIABLE •' �� • ►'
74.96 34-144 C MEDIUM SAND 10 YR 6/4 NONE LOOSE 1000 GALLON SEP T 1 C TANK DRYWELL
b5.80 33.5 ft
1 • AND, DETAIL UNIT co
cq
TANK TO BE PUMPED DRY AT TIME OF INSTALLATION
AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL
cq L
NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. l®
v
CV
IE�:ll I
REPLACE WITH A NEW 04 M
�
-INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE 1 in 1500 GALLON TANK M
°0
N STARTING WORK. TAPER IF CRACKED, ROTTED STONE
-ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM OR OTHERWISE q ft 8.5 ft 8.5 ft- 8.5 ft 4 ft
REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC COMPROMISED.
CODE (310 CMR 15). H..
-INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND
UTILITIES BEFORE EXCAVATING FOR SYSTEM. ° co 500 GALLON DRYWELL
-ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION o +. NOT DIMENSIONS & DETAIL INSTALL ONE INSPECTION
OF LOW FLOW FIXTURES & APPLIANCES, AND PERIODIC •` TO RISER TO WITHIN THREE
PUMPING OF THE SEPTIC TANK. SCALE USE INCHES OF FINAL GRADE
INDICATE& LOCATION
-SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. - �(` H-10 ON AS-BUILT
DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. w ENO
leiUNIT.
8 ft-6 Et
n3
In A �0.
0.
INLET CENTER OUTLET
COVER COVER COVE R
c,� oQgo� �D0
- f
�3 I DROP
LINJE
102 in
N DR
IN
10 in
FROM ;. _
BUILD G - Ox CROSS SECTION VIEW
TE
48 in INSTALL AN APPROVED GEO XTILE
LIQUID
GAS FABRIC OVER STONE
LEVEL BAFFLE
0
28 - 4 In TO o 24 in 3/4 In TO
3/
b in STONE BASE IF NEW
I/2 in TO a EFFECTIVE 1-1/2 in GRAVEL
in o DEPTH
SEPARATION BETWEEN INLET & OUTLET
TEES NO LESS THAN LIQUID DEPTH
46 in: 58 in 46 in I
CROSS SECTION VIEW
150 in
i:j
ALL STONE TO BE DOUBLE WASHED AND
FREE OF IRONS. DUST AND FINES. IN PLACE
SEWAGE DISPOSAL SYSTEM PLAN 41 OXNER ROAD CENTERVILLE. MA 1ULY 3. 2014 ETE-3829-B PG 2/2