HomeMy WebLinkAbout0050 OXNER ROAD - Health 50 Oxner Road
Centerville'
A= 193-116
N SMEAD
No. 53LOR
UPC 12543
smead.com • Made in USA
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TOWN OF'BARNSTABLE a
LOCATION 50 ®Xu,39RC\ SEWAGE# �
Yj LLAGE ASSESSOR'S MAP&PARCEL l i Ce
INSTALLERS NAME&PHONE NO. p ��11SL�
SEPTIC TANK CAPACITY Ob S1 its
LEACHING FACILITY:(type) 5}png_J 5S "ie\c\ (size) J2.0 x�(�� )( •' S,
NO.OF BEDROOMS
r-
OWNER ---Tt3S*
PERMIT DATE:�_3Q 1 — COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5+ Feet
Private Water Supply Well and Leaching Facility(If any wells exist 1
on site or within 200 feet of leaching facility) . A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist /
within 300 feet of leaching facility) c Feet
FURNISHED BY
R g T►� �.2>,S �1
ho
TOOT�
Fee. ,No. .
D
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
IIIPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
P Rpplication for Ito onl stem Cougtruction Permit
Application for a Permit to Construct( ) Repaix Upgrade( ) Abandon( ) El-Complete SystemXlndividual Components
Location Address or Lot No. So O x n1E2 Owner's Name,Address,and Tel.No.
Ce4j � I1e M`'r 5�e-Pn Strom le�sk,
Assessor's Map/Parcel SCam
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
-�koAnA-,� �Sha� _ 80o C9,a�€ll S% aY
LkLeType of Building:
Dwelling No.of Bedrooms .3 Lot Size 1$ sq. ft. Garbage Grinder
Other Type of Building j(i �q, No.of Persons Showers( v/ Cafeteria(✓)
Other Fixtures LGV2C. L*, V4r, (16—,
Design Flow(min.required) 3 Q gpd Design flow provided (.3 gpd
Plan Date �o OOl Op, Number of sheets ` Revision Date
Title Je��sUC�r.P{QC. YI��SG Lf
Size of Septic Tank 110 C90 4 4` 8$1451 Type of S.A.S.
Description of Soil f
Nature of Repairs or Alterations(Answer when applicable) O�\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 En 'ronment de and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of
Signed Date
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued 0
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�} uc 41
No. d„
I` s` _ Fee L
*'' }/ Entered in computer:
THE•COMMONWEALTH OF MASSACHUSETTS p
01P_UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
cy
A pplication for Diq ogal .5tem Cou5truction Permit
eApplication for a Permit to Construct( ) Repai Upgrade( ) Abandon( ) ❑Complete SystemZIndividual Components
Location Address or Lot No. Owner's Name,Address So X r�E2 1
,and Tel.No.
5�e ran 5�I-� Ir�nk t
Assessor's Map/ParcelCe nQ� I I�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
A LA 6- a 8co CAS s� S71-�Y-
Type of Building:
Dwelling No.of Bedrooms Lot Size I Lj i Q sq.ft. Garbage Grinder
Other Type of Building d`¢'``i�„� ;�1 No.of Persons Showers( 1,4 Cafeteria(� )
Other Fixtures I_�,�AP. �.
Design Flow(min.required) :I,9 gpd Design flow provided gpd
Plan Date Number of sheets 1 Revision Date
Title �r7 r t��a �,`�� t{ o2%__3 r—c I hSG J(.a Size of.Septic Tank C)f ���, T Type of SA iS\
Description of Soil rn�
C �� t
' Nature of Repairs or Alterations(Answer when applicable) -7;Z c.�
,
Date last inspected:
Agreement: k
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in,. g
accordance with the provisions of Title 5 of the Environmenta erode and not to place the system in operation until a.Certificate of
Compliance has been issued by this Board of He�.
Signed ��.,� ? Date11
4 v
Application Approved by Date
Application Disapproved by: Date w` \P
for the following reasons X ,
`�.h(��_ �e �� Date Issued F
Permit No.
.W -. -------
THE COMMONWEALTH OPMASSACHUSETTS _�Z -
BARNSTABLE, MASSACHUSETTS"
Certificate of Compliance ; � ` ��
Y THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired::(Upgraded ( )
Abandoned( )by
at rim J1 X 41.0 has been constructed in Accordance
y /1 ���
with the provisions of Title 5 and�t'he for Disposal System Construction Permit No. / dated
Installer Designer_C 2 G+�., / �fj,a,.�,,•ti , J,
U
#bedrooms Approved design flow r✓ (/9;�d gpd
The issuance of this permit s 1.1 not be eonstru as a guarantee that the system w 11 fun
ctionas dee)signed/, 4/fi
B�
Date Inspector _—��/'/ I�l I��fi/.l, /A i I. a'j
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
F PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
�Xgpo!gal *p,5tem Congtruction Permit
Permission is hereby granted to Construct ( ) Repair ( ✓) Upgrade ( ) Abandon ( )
System located at ex-0
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
G
Date o Approved by ,(/!
,v
Town -of Barnstable
OF IME 1p�
o Regulatory Services
Thomas F. Geiler, Director
* BARNSTABLE,
9 MASS. Public Health Division
�j 1639• ♦�
A'F039. A Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 7/15/08
Designer: Shay Environmental Services, Inc. Installer: Rodney Fisher
Address: P.O. Box 627 Address: 585 Kelley Street
East Falmouth, MA 02536 Harwich,MA
On 6/30/08 Rodney Fisher was issued a permit to install a
(date) (installer)
septic system at 50 Oxner Road, Centerville, MA based on a design drawn by
(address)
Shay Environmental Services, Inc. dated_June 30, 2008
(designer)
XX I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
., greater than 10' ,later location of the SAS or any vertical relocation of any component
of the septic system)bLy in accordance with State & Local Regulations. Plan revision or
y certified as-built b signer to follow.
e
OF MqS .
S4n ,y
�.o`' CARMEt�� �Gm
I st 's Signature) E.
SWAY
No. 1181
0
Fois1�R •,
(Designer's Signature) (Affix p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q: Health/Septic/Designer Certification Form
Town of Barnstable P#
Department of Regulatory Services
oFa9 r, Public Health Division Date
y o� 200 Main Street,Hyannis MA 02601
BARNSTABM
039.t&,b Date Scheduled Time Fee Pd.--
Soil Suitability Assessment for Sewage Disposa '
Performed BY: Witnessed By:
ii:isi::,,:.:.,::i,:,::r,:.:•:,:i...,
�,.::,...r:.:r.r,!._•� :....�.,:,,,,. ri Ir:•r!•L!.r:.,r•r:•:'.T�.r.l ..:.�: ,.�... �..!„_:.......,.
.t.
.. .............r.r..::.,.r.6:..:.
„ r
Location Address J8 �X -7 0 ND Owner's Name S (�H� SEYw►`��Si�I
Cen Address J��
Assessor's Map/Parcel: 03 3 b Al Engineer's Name CO sZM FAJ S�1
NEW CONSTRUCTION REPAIR Telephone# ,�3F3
Land Use 74^lid"CA Slopes(0/0) oZ I Surface Stones
Distances from: Open Water Body�_ft Possible Wet Area /,A'+ ft Drinking Water Well -WIA—ft
Drainage Way ft Property Line—ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to.holes)
CC
HIM I
Parent material(geologic) y J+t )o6r, Depth to Bedrock P,
Depth to Groundwater: Standing Water in Hole: IAgl7e Ohl• Weeping from Pit Face
Estimated Seasonal High Groundwater
MINN'
::;•:v!!r:!511:r.:-..ii:r:::r-_.::?:.-.-...s a._e::;m...r:.::.::::v..r_..l:,I.a:.::.n...',.:;.Ir;:.,in....-_.n.:.r:.::,.. m...r:.:.n.r r.rr.n,.r:tr..:>.:,..ri.:a,::y:.a.�..:;.:.,;:..i:r,.:..u;.._.:.:.i-..n..a..n..:.......1.....r... .....Wt: Ai - cx H
,:,:u::,4:rrr,;;.e:�:i:u::�r:..ur,^::::�;;�,A,rr;.r:;,c::::.:�r•�.r.n_�,y:
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
_SIF
--
::,ir:::......rr:,::::,::;
„r......:......r....:.r.:........r:.:.....:.::..:..i.......:..i.r,.:r............:_i..........r...r.r....r........_.........,....r....................�::::::r:r.r::::::::::.:..:::>�::�:.:�:..::....::::_::..._.._..._....,•:....r.:�::..:..::,:rrr.r•::.:.u.::
Observation i
Hole# Air 1 Time at 9" :(q113.0
Depth of Perc 1� -�8 Time at 6" J'_1,1 a
Start Pre-soak Time Qa — �' Time(9"-6") O` Mth
End Pre-soak S: l
Rate Min./Inch L ,�F
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) /V
Original: Public Health Division Observation Hole Data To Be Completed on Back-------r—
Q:I-IFALTRVP/PERCFORM
..................................t.,.�....}..�:.::/:�..:�.j.:........�.:,t.:::r.�.y..:......,.}.��.�.......: �y���
iiY `:E� �'I� S::l.11�.;.i� .�';Y's':''i�li�i.,.� :`.;:!n...�>:�����.� 3i:::::: r•::?r?tt �?>>f%"t4'i':���������?� iE:i:i�i:�E'i.� sfi: `�:i:iS'iGi `i%� >;
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency %Gravel)
o A LS o 2SIl N A
LS �a�e sly R-101�0e
.:::::>;::>:>::.;:::>
D EISATZ(QI H
:;>:;:.....:::::::::.:::.:::.::::;:;:.::... ..:.::...t :..:...... :::::::::;;:;:.....
Depth from Soil Horizon Soil Texture. Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consisteric Gravel)
10 LR SSf l fj/A �c��1
LID �c� rrs 1 D`f iz5
0 Ci MRA Loa- —i
................................. .
P:::: : ERA. 'T. : ::I ( :: . : .::::::.:.: :.::: . ;:•;.;;::.;::.:::.::..
Depth from Soii Horizon Soil Texture Soil Color Soii Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistengy.%Gra
F}
Q 1
.SERVATO ::I�.tD.LE.:. C;.G
f,.:o. Soil
Other
Depth from Soil lIoriion Soil'Texture Soil Colo 0
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
I en Gravel)
r
. I
h.�
Flood Insurance Rate Man_ /
Above 500 year flood boundary No_ Yes
Within 500 year boundary No_L/ Yes
Within 100 year flood boundary No Yes
Ll
Depth 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? �2 5
If not,what is the depth of naturally occurring pervious material? 1N 1 P-r
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,e e ise d eri I a described in 310 CMR 15.017.
Signature Date 26 uU
` Commonwealth of Massachusetts
�u u Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer, I
use only the tab 1. Inspector:
key to move your
cursor-do not Carmen E. Shay
use the return --
key.
Name of Inspector
Shay Environmental Services, Inc.
vi reb Company Name
111 Thornberry Circle
Company Address
rerwn Mashpee MA 02649
City/Town State Zip Code
508-539-7966 3080
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and th5r,56--i
information reported below is true, accurate and complete as of the time of the inspection. fffe inqeection
was performed based on my training and experience in the proper function and maintenanZof o9site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section` .3�of
Title 5 (310 CMR 15.000). The system: w
® Cn
Passes ❑ Conditionally Passes ❑ Fails 'o l
� � s
cn
❑ Needs Further Evaluation b e Local Approving Authority ►-
4r r-•
7/20/10 _
Inspe ignature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage isposal System•Page 1 of 17
` Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 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:
No evidence of carryover noted in D-Box. No evidence of current or past hydraulic failure.
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ 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):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
uv�
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
I", 50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ . The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 'h day flow
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
_ W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100.feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 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 D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304.The system owner should contact the appropriate
regional office of the Department.
l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
H Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
1,500 gallon tank with 12.7' x 26' Stoneless Leaching field - 24 Quick -4 Infiltrators
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d Municipal Water
9 ( Y 9 (9p ))�
Detail:
Not available
Sump pump? ❑ Yes ® No
Last date of occupancy: Current
Date
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
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is
required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: No pumping info available
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
6/30/08 per BOH records
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1.75
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 25
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
No evidence of cracked or broken piping
Septic Tank (locate on site plan):
Depth below grade: 1
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
No evidence of cracks or leaking, tank appears to be structurally sound, inlet and outlet tees in good
condition.
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No
Dimensions: 5 x10 x 5
Sludge depth:
48"
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle 28
Scum thickness 1/2" scum layer
Distance from top of scum to top of outlet tee or baffle 5,
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
inlet and outlet tee in good condition. No evidence of carryover.
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
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
„M 50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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
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
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert D-box present
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.):
liquid level equal with inverts. four outlets present. no evidence of solids carryover. D-box in new
condition
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•09108 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:.
❑ leaching pits number:
❑ leaching chambers. . number:
❑ leaching galleries number.
❑ leaching trenches number, length:
® leaching fields number, dimensions: 1-12.7x26
stoneless field
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
No liquid in inspection port
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
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,.w 50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
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.):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
IJUL.20.2010 10:30AN BARNSTABLE BOARD OF HEALTH NO.693' P.1i1
too
TOWN OF BARNSTABLE 01 C308 —
LOCATION C� O' i.5�2 SEWAGE
LAQE —ASSESSOR'S MAP&PARCEL f
INSTALLERS NAME&PHONE NO, e
SEPTIC TANK CAPACITY 21
LEACHING FACILITY:(type) ��io ICES � \ (size) la,lay �"
NO,OF BEDROOMS
C)y i I'Ai I
OWNER c l
PERMIT DATE: COMPLIANCE DATE: ^
Separation Distance Between the;
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _ 5+_ beet
Privato Water Supply Welland Leaching Facility (If any wells exist 1
on site or within.200 feet of leaching facility) n► Feet
Edge of Wetland and Leaching Facility.(If any wetlands exist
within 300;fcet of leaching facility) Feet
FURNISHED BY
$ Tip b�
O ,TOO
r
a �
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: gNo groundwate @ 11' per perc test
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
® Checked with local excavators, installers- (attach documentation)
® Accessed USGS database -explain:
TOPO Map
You must describe how you established the high ground water elevation:
Refer to soil log and plans on file at Board of Health
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Oxner Road
Property Address
Amanda Packard
Owner Owner's Name
information is required for every Centerville MA 02632 7/20/10
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® ,System Information — Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
LOCATION ) SEWAGE E PERMIT NO.
VILLAC.tE
f
INSTALLER'S NAME ` ADDRESS
BUILDER' OR OWNER
BATE PERMIT ISSUED 14 � 3
DATE C0 M P L I A N C E ISSUED _ 20 _
ut'0•
j
16
.:.NoO...... 1....... FimB ........................
THE COMMONWEALTH OF MASSACHUSETTS
0 BOAR® OF HEALTH
.................................OF......................................................
ApplirFation for Baipngal Workfi Tomitrnrttun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst at
• .................. ......_ .._..,_...-------------------•--...........
Lo n-Addr ss /
._.....----•--•------• -------•---_.....
Own r Address
Installer Address
U _ Type of Building Size Lot............................Sq. f t
Dwelling—No. of Bedrooms............a ___ ____________________Expansion Attic ( ) Garbage Grinder ( �
aOther—Type of Building .. a?__0.............. No.No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures -------------------------------•---------------.._............-----••.
,Tl Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
a Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter_--__-__-__--_ Depth................
W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by _-----•----------------•--------------- Date
Test Pit No. 1_______________minutes per inch Depth of Test Pit.................... Depth to ground water........................
rZo Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_._____--__-___--__-_-_.
a •--•-•---•--•----------------••-•-•--•--•---•-•-•••-----•---•-•----•----...-•--•---..................-•----------•-•-.....---•-••--•-•-----------...---_--•--
0 Description of Soil........................................................................................................................................................................
w
x -•-•--•--------------•-----------------•---•--••---......------------•--••-----•-•-•-••-----••••--------•-•••-••-•---•----------------••-------•----------•-•-•---••---•-•-----....----..._...--•_•-•---
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 iITI- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Complian has b en issued by the,49,o3rd of health.
ApplicationApproved By... .----- ........................... ..................................................... .... /X111
Date
Application Disapproved f or ' e following reasons:................................................................................................................
---------------------------------•----•---------.....--------....----------------•----•----------------.._...-----------•-•---•-------•-------••------•--------------------------------•-•--•---••--•---
Date
Permit No.................................=
t
�.y
No..: p .L....... Fits..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........................ .. ............OF..................................._...--------------------.......................
ApplirFa#ion for Uiopooal Workii Tons rurtioat ranfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Systemat: •�,,.......................... ................................................... .............._•--•-----------.........--
-------- ------------
i Location-Address or Lot N�,o.
....._...;^If� .-...�..-.....Owner..... --_----•-••-•----•-------•-- -•.....................(_...........---...Address...._::c---------------- .........»...
(� ,.-----.=-`=.':-:...............•-----•. --••----•-••---•= -_::.:::. ..
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms_____________` ...................Expansion Attic ( ) Garbage Grinder C!*;Ie)
pa, Other—Type of Building __ ...... No. of persons____________________________ Showers ( ) — Cafeteria ( )
Q' Other fixtures ........................._.........................................................................................................................
W Design Flow.............................._.............gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................. Width................ Diameter................ Depth.................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--_--------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
W Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
RS •------------------------------------
-.......
----------------------
__---------------------
-.........
...............
_..........
--••--•••---------------•------
ODescription of Soil......................................................................................-------------------------------------•--•--•-----.__...._......_•-----._.......--
x -
V .---------------•-•-•-----••---=••---•-•-------•-------------•------------•---------..__._.....•---•---•----••••••-----------------•----=•-•--•----------•----•-•-••-..__........•-•--------•-•----_--••-
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 TIT1Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complia has bgen issued by the board of health.
.' Si ed ' " ° . .. �........` � a•---
Application Approved By... .................................................
Date
Application Disapproved for lie following reasons----------------------------••--•------------•-•--------•----------------------....--•••••-•••----•----..._------
........................•----------•-_....._.._...-•••••-•-------•---•-----••-•--•--•---....-•----•-------_.._._..-----•---------•••-----•---••-••-•--•---•-•--••••--•--•-•-•----•--••••••••-••...._....
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
TrdifirFate of Tautplitturr
S 'TRTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by
Installer
at------- ......... -
has been installed accordance with the provisions of T LE 5 of he State Sanitary Co as scribed in the
application for Disposal Works Construction Permit No---t2__: _'__ _ ______________ dated_. °.. ,�::. ��...______.________._.
THE ISSU CE F THIS CERTIFICATE SHALL NOT BE CONST S A GU ANTEE THAT THE
SYSTEM I FUCTION SATISFACTORY.
DATE.... ....20 ...2... ..... Inspector--- ------ ---- .__..:.............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF..------............._.........._...................................................
_._ FEE...".. ..........
i
tso -rko �oatorttrion rruti#
Permission is ereby granted.: :_s .
to Constr or Repay,, ( Kn Indio' Sewage Disposal System
at No.. . - -- -- ... �t ---- ..............
Street as shown on the application for Disposal Works Construction Permit N -------- _ Dat�d__��..r__
................
Board of Health
DATE "-���-•
kFORM 1255 HOBBS & WARREN. INC., PUBLISHERS
f
5 S D CA.>4Y17 ! 77 j17
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jz
iv iz'�,w/&
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r . � Ilk -
:!- /�t�Lu ,Q
1� /'2?t w1 r ,
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p
Lip Ira -
yr
/ e C_
� L
UND
PLAN OF
. THIS slA zS'HWSCERT1F THAT IN` - 'I
THE-ACTUAL LOCATION� C_�" THE . t. s �?�/yT �"�o j�, ,MASS.
STRUCTU:R= O . LAND AND :. -
THAT I CON 9�3�2 S wI'f�! .TN E,"
OWNED BY
BY-LAWS Off' 'T TOWN
ci -44,, FRAN ` ` ' OR�NK FRANK CONERY 12 BRE2t ER LANE ;
/' ry CONERY irs q a. I
u . COlNERY -� CENTERVILLE, MASS. 02632
alo:6232 O N#s 6:73 e i
REGISTERED ENGINEER fl•LAN�f_SURVEY09 9
7y, llol
G/51EQ`�``v a
* a: sum �s io�r,�> ��'�� SCALE i IN,-,i2OFT,
4- : ,
-18' DIAM. ACCESS MANHOLES
- -
" f+ 3,
e - a • . :t•• i•' t�. {1. :.3,4: Sf31 s lit S .......... : S t. >y 4. +w•'a""',
r :5tt °3 S)# i \' s;r S S�. )S 3 4 .,,';;d�' reA' 4 s ,:f 4.k � '-H'+F`".•'.""*'
NOTE: ALL PIPES ARE TO BE 4 SCHEDULE 40 P.V.C. .'-0. . •":ii f�' •P�:y�''•�� .i•..♦ f.
10' min. from . si. r
Existing Foundation house to septic tank
�C a r
0-80X cover must be
_ Septic tank co re must be
TOP OF FOUNDATION ELEV. 100.00 wkhin 6 in. of finished grads u 3L ftt >t 3 f)I t
t within 6 in. of finished grad.
Grade over Septic Tank- Sae.so Grade over D-Box- 88.25 de over SAS - g625 ESTABLISHED VEGETATIVE COVER
y 3 f 1t 5 .-•d 5 4 y ss
INLET 1 l z
•1 \ ;+ ate T
S . .� ! 4%t Lf }tsf t f.`•• .,„s.;tlr;kzs33 rs z)
11 T V
0.02 0 HOLE H-10 BACKFILL WITH CLEAN SAND '� w L z3:
� s
r• a' ti•••n•' h.•« y• h• THE ACCESS COVERS FOR THE SEPTIC TANK. ,I
, IST. BOX .... ... .. ..� •, . ,.. .r .' �:S 0.01 3 Maximum Cover 1 .. r •1. .o. •, .1 .• .`{n ". ,. .•�, 1•......•., •., .. . . !,
« 1 :•+' " NATI R PERC SAND DISTRIBUTION BOX AND LEACHING COMPONENT �; f s St+, s
t VE 0 1
EX IS •1. ' �.� (4'PVC CAPPED INSPECTION PORT TO BE .• `:":,:` •... ',!y r.. •4 ,.t :{:.}. '1.. II
-b' THAN
nr
C .ii) 4 1 , -ro h +w
0• ,• SET DEEPER 6 INCHES OW FINISHED•: •1 •,t-• BEL'1• "'7 .r M
D. t r Se 3 D L
• 55
cXtc_T. PIPE N 1000 GAL , S. . INSTALLED AND TO BE WITHIN a OF GRADE ,. . .. ..,•t;,. 1 •, .•. .••q• :• •'. ••�. ,.., .. ., J, .,
- 0.01 1 ...,.r., r .• .+ . 1.•,1,•y ..., .. .. .;.,.y...l,.. ..• t +.„+ .1. ''t. GRADE SHALL BE RAISED TO WITHIN 6" OF
15 Per .>,n P /aat •�,.. { . A. •`. •.` . v .. ,.... n .. v .. •. 1••.r•. , ., .,. ... ,1. 5 tt' ,• ,.,.
SEPTIC TANK 1� FINISHED GRADE. £
FROM EXIST. FOUNDATION SE C ..:`• : •. ., r
Twn TOTAL TOP OF UNIT ELEVATION - 95.25 • • 1 • ... , r... ,1 r• �..
o rc � I :+t+ n• A;" '.+ ,� •; • ?• ••' {• •a,\•"' STEEL REINFORCED PRECAST CONCRETE
of fG 4 : pa :••.. 1 ' ..."1'l':y { ✓ `,; .,S Y' 1 ''• Y „t s 4 s t.: s i i S
Y/ 1 '•I 1 -•, 1'' •1, •t, bi:1. 1. •1 )'i; t >.::L){' > S. ,F '>
01
•,,;; t , i4 INSTALL 7UF-TITS GAS BAFFLES OR EQUALS E
u) VIEW
II H 10 PLAN � � z
CONCRETE WADS-011T '
•� � t
II ui � INV. ELEVATION N - 9 ',• ••t .tG"•1•'�:.� ,,• � >' y:•'
II > E 0 5.00 1'�: a t.;•. ,.
0o I, f3 4y4., s1, s
It o I) :.. 1t S ••'.. 3-24' REMOVABLE COVERS '�duiAM':�dlowso �o giii'A'fe'AWillty ane Jti�i dtla4fna s•?
v 6 in.of 3 4'-1 1 2"
,..,.`r 1... ! �,..,, 1, •�
O c compacted stone > .
4 Rows BOTTOM ELEVATION - 94.25 :nr ` r
Z SYSTEM PROFILE > of a uwTs AT 4'/UNIT t 2 END CAPS 2e.00' '' ,,, 4• ��
_ 3 min. clearance .� GENERAL NOTES
S. - INLET e" mn,T- 2" min. Inlet to outlet e"mh. •' 1. Contractor is responsible for Di safe notification, VERIFICATION
Not to Scale 8 in.of 3le-1 1/2" 5' MIN ABOVE BOTTOM OF OUTLET " P Dig
safe
stone ' 4 B 4 uq-il T•vs� r and protection of all underground utilities and pipes.
c TEST PIT OR GROUND WATER 10•m� +�• '
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE EFF. WIDTH 12.70= EXISTING SUITABLE MATERIAL 5' _p a �' S• _�" 2. The septic"tank on j distribbution box shall be set
E� �. level on 6 of 3/4 -1 1,/2 stone.
BOTTOM OF TP-1.: a 88.50 i• u�e min. 3. Backfill should be clean sand or gravel with no
+•
v °p stones over 3 in size.
BOTTOM OF TP-1.: _ 88.50 SOIL ABSORPTION SYSTEM (SECTION) ;t : 4. This system is subject to inspection during installation
INFILTATR❑R QUICK 4 CH-10 LOADING)/ GE❑RGE ❑'BRIEN ''' ;•.,,�j by Carmen E. Shay - Environmental Services, Inc.
r' "• ` • 5. The contractor shall install this system in accordance
(OR EQUIVALENT) a,-or 4 -10" with Title V of the Massachusetts state code, the approved plan
NOTE: OVERALL HEIGHT of INFILTRATOR IS 12' CROSS SECTION END-SECTION and Local Regulations.
6. If, during installation the contractor encounters any
TYPICAL 1000 GALLON SEPTIC TANK soil conditions or site conditions that are different -
from those shown on the soil log or in our design
,
NOT TO SCALE installation must halt & immediate notification be
^ made to Carmen E. Shay - Environmental Services, Inc.
PERCOLATION TEST 7. No vehicle or heavy machinery shall drive over the
12-�Cl-u septic system unless noted as H-20 septic components.
8. Install Tuf-Tate gas baffles or equals on all outlet tee ends.
t Date of Percolation Test: JUNE 26, 2008 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes.
i Test Performed By, CARMEN E. SHAY, R.S., C.S.E: 10. All solid piping, tees & fittings shall be 4" diameter
Results Witnessed By. Donald Desmarais, Barnstable BOH
EXCAVATOR: Shay Env. Svcs. Schedule 40 NSF PVC pipes with water tight joints.
Percolation Rate: <2 MPI ® 40" 11. MUNICIPAL WATER IS AVAILABLE TO THE SITE and Surrounding
- Properties. NO PRIVATE WELLS WITHIN 150 FEET of PROPOSED SAS
Test Hole Nest Hole
No. 1 No. 2
DEPTH SOILS ELEV. DEPTH SOILS ELEV.
0 98.50 0 98.50 NOTE,
Loamy Sand Loamy Sand THE PROPERTY LINES ARE APPROXIMATE AND
COMPILED FROM THE PLAN BY FRANK CONNERY, PLS
10 YR 5/1 10 YR 5/1 CENTERVILLE MA, ENTITLED "CERTIFIED PLOT PLAN OF LOT #30
0"-s" As 98.00 0"-6" As 98.00 OXNER ROAD, CENTERVILLE, MA, DATED JANUTARY 12, 1982
AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
Loamy Sand Loamy Sand iT SHOULD BE USED FOR NO PURPOSE OTHER THAN
10 YR 5/e 10 YR 5/e THE SEPTIC SYSTEM INSTALLATION.
6•- 40" Be 95.17 6"- 40" B• 95.17
Medium Medium
I Sand Sand NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
2.5 Y 7/4 ZS:Y 7/4 FROM THE EXISTING LEACH PIT TO BE DISPOSED
PROJECT BENCH MARK
�. o"- 120 q 88.50 "- 120 G 88.50 OF AS PER BOARD OF HEALTH SPECIFICATIONS.
TOP OF FOUNDATION \
ao \ 1 I EXISTING LEACH PIT TO BE PUMPED DRY &
ELEV. = 100.00 (Assumed) REMOVED TO INSTALL SAS
qQ
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LOT #3 i 141.86' / I ii o, ASSESSORS MAP 193 LOT 116
I `�`� 0 ZONING - RESIDENTIAL
15,419 Square Feet +/ �• �� �! i1 Perc #1
eq II Depth to Perc: 40" -58"
Perc Rate- Less than 2 MPI
- -7------- ---'I O Groundwater Not Observed
DECK I O NO WETLANDS ARE LOCATED WITHIN A 200' RADIUS
EXISTING 1 / i L` BOTTOM OF TEST HOLE Elev. = 88.50 or 120" OF THE .PROPERTY.
ADJUSTED H2O Elev. - No Adjustment Required. -
-'t I GARAGE
\ 1 ALL OUTLET PIPES FROM THE
\ DISTRIBUTION BOX SHALL BE .'
: -----------
C+2 N �� ------- _- _ f SET LEVEL FOR AT LEAST 2 FT. 12
�� Failed �\ 1 �y •y.•,, 't: CONCRETE COVER
•, - _ 6 5" OUTLET :1 r. 1 2 LEGEND
>. LEACH PIT \ I I 1 ,a KNOCKOUTS
1991 EXISTINGle�' ► I i , r..,,
I 1 1/ 15.5" OUTLET + 12" INLET 8X0 DENOTES PROPOSED
\ 3 BEDROOM TEST HOLE 1 1 1 /
20' # / // O ,� 6" ;, SPOT GRADE
I ELEV.= 98.50 /
HOUSE / l � ;, 8"
�\ , /� .; - f;,1...,,lt, 2 DENOTES EXISTING
#50 O 2 ; / i; 15,5" X 104.46 SPOT GRADE
EXIST. 1.75"
loco gal. PLAN-SECTION CROSS SECTION pL
Septic Tank PROPERTY LINE
9z, Bax 6 HOLE DISTRIBUTION BO-X PROPOSED CONTOUR
\` \\ \\ \ ----a99�--' �' NOT TO SCALE
's �s TEST HOLE #2 � r .'�,� 97- - -- - -97 EXISTING CONTOUR
ELEV.- 98.50 �.9910J �p ' Design Calculations
' NOTE, 15 FOOT BREAKOUT TO ELEVATION 95.00 MET ® DEEP TEST HOLE &
_92
0 \�`. \�` NO LINER REQUIRED PERCOLATION TEST LOCATION
9 r ,-
`\ Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V)
Garbage Grinder: No FENCE
Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V)
�� �\ `.�_-- Septic Tank : - 2 x 330 Gal./Day - 660 USE EXIST. 1,000 GAL. Septic Tank.
8$ `� ` ` SOIL ABSORPTION AREA: Usin ercolation rate of <2 min. inch
Bottom Area: 0.74 gal/sq9 ft. x 490.88 sq. ft. - 363.25 gallons ' PRIVATE DRINKING WATER WELL
��` �\ \ 7�•__ �.v- Sidewall Area: NOT USED
_90 n Providing: = 363.25 gallons REVISIONS
Use: 4 ROWS OF 6-OUICK4 STANDARD CHAMBER UNITS WITH NO
� �p�l N0. DATE: DEFINITION
00, `_-� OF STONE FOR AN SAS HAVING THE DIMENSIONS: 12.7 x 26.0'
i'
.i 86 y-�'" -� R Bottom Area: (General Use Approval for 4.72 SF/LF of INFITRATOR
j' 208• O FOO 6 UNITS + 2 END CAPS per ROW - 26.0 FT
4 ROWS x 26.0 x 4.72 SF/LF = 490.88
O DESIGN FLOW PROVIDED: 0.74(490.88 S.F.) 363.25 GPD
I
t � PROPOSED
PREPARED FOR :
SUBSURFACE SEWAGE DISPOSAL SYSTEM
OF
PETUNIA REALTY TRUST #50 OXNER ROAD
#50 OXNER ROAD CENTERVILLE, MA
CENTERVILLE, MA 02632 PREPARED BY:
L C
o m m Dining Kitchen ��oi S�y�T
N � CARMEN E. SHAY
GARAGE
0 20 40 50 SH n L'NVIRONMENTAL SERVICES, INC.
I Bedroom BedroomLiving Room
185 ASHUMET ROAD
STIE MASHPEE, MA 02649
SCALE: 1 "=20' SANITAR\�� a'
TEL/FAX : 508-539-7966
3 BR HOUSE FLOOR SCHEMATIC
SCALE: 1 "=20' DRAWN BY: CES DATE: JUNE 30, 2008
(Description Provided By Owner) PROJECT#SD-1093 ILENAME: SD1093PP.DWG SHEET 1 OF 1
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