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HomeMy WebLinkAbout0114 PLEASANT PINES AVE - Health 114 Pleasant Pines Ave ^~ Centerville A= 234-006 - No. 42101/3 ORA n col V 0(S12 oO © ® © 0 i TOWN OF BAR//1NSTABLE D LOCATION��� PC�:QrSFb.7T' j14ES AVc SEWAGE# Z0Z1 "028 VILLAGE 65l nayl LJ_6_ ASSESSOR'S MAP&PARCEL, Z3q INSTALLER'S NAME&PHONE NO. ©tA.9- �],� SEPTIC TANK CAPACITY �iJ 11L LEACHING FACILITY:(type) 5-CO%J. C. Pp-ASGC &(size) t2.83 X ?� NO*OF BEDROOMS 3 OWNER AO E}J PERMIT DATE: 1 ( Zak t 7-1 COMPLIANCE DATE: 3 $ Z Separation Distance Between the: ^® / Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility U 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) �I Feet FURNISHED BYl_:CJ- skly Ipj inej. z A � 3 Z 20 Li5 3 q2 355 9 A3, S 5.1 ,14.5 ii/jam No. !/" 02g Fee l v v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Misposal *pstpm ConstCULtion Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) 'Complete System ❑Individual Components Location Address or Lot No.I I Lt P/ FtSogrT �%','oi C S -Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2 3 �� `'�� a4e l "'� M o`er f✓h Z;y [/� !1 i u t� ft1U L•tia CT . Innssttaller's Name,Address,and Tel.do. 303 W(y,tr.5 17„p.rtj Designer's Name,Address,and Tel.No. Z CSs-f G/.a„6� !CA�ic,r �' . t)u t2 Lo. yu�'+«'�'f!� tyt►a" � .C..E v��,�-�-��� w�c►r�tl•�w» Type of Building: �f + Dwelling No.of Bedrooms Lot Size 0�2Z�► — sq.ft. Garbage Grinder( ) Other Type of Building 12f eyk No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 "� p gpd Design flow provided gpd Plan Date 1 1— 1(e ?10 1 Number of sheets 1 Revision Date Title l iq PI, V>, -t- P"A GS A%JT- Size of Septic Tank /610 O Type of S.A.S. /2)C ZS X -L, $y O 5✓ • L• Description of Soil Nature of Repairs or Alterations(Answer when applicable) q Xrj*j( A)t4,J l 3-b o Date last inspected: so I 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. Signed Date C! ' �i�2 i Application Approved by -' DateIV/it Application Disapproved by Date for the following reasons Permit No. 2ec7A Date Issued 12AZ Frsr, .. i. '—� "rr i+C n •,.'.'w• -••hi ••'�•.n'T t.-.JI.`;:.m.,.,.,. v- No. .V v� Fee Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for�lbI8posal 6pstrin Construction Verm t r.� Application for a Permit to Construct) Repair( ) Upgrade( ), Abandon( ) 'Complete System ❑Individual Components G Location Address or Lot No. 114( �1/ /q 4rw�T"{ >', .r C S�j� �Owner.'s Name,Address,and Tel.No. Assessor's Ma /Parcel Z 3 L � �t'l„�Q{A'nlVl,+ v l'T 't k`•m a,, r r1�, n p 1 v 't'G • �L, tJ; 1 I �?t r �• ,•,,s- l.tij•e"� ✓J C A Installer's Name,Address,and Tel. o- 36, Cd!t, } } 17,,1 Z, Designer's Name,Address,and Tel.No. Z e j y G��, y�,•.^y Rc, ',f2r Type of Building: ' E Dwelling No.of Bedrooms �.% Lot Size `'1 V, ���. ± sq.ft. Garbage Grinder( ) }T Other Type of Building `7 4+ a c.�� No.of Persons ._: Showers( ) Cafeteria,(, ) Other Fixtures y.: Design Flow(min.required), �j (j gpd Design flow provided tt t-{ I . �-{ gpd Plan Date 1 E- 1(0 ® 1 Number of sheets 1 Revision Date - Title 1 ►�t �I e_FrS✓kw t- f�,.,�'�r �1 ,a t C �, t P,,r���1� f' Size of Septic Tank Type of S.A.S. Z } j U y ✓� • G r Description of Soil , Nature of Repairs or Alterations(Answer when applicable) Tm 0,A i / AkA, j / )O 0 ;✓9- /V-/O - 7L r f Date last inspected: U 1 L -:Agreement: ,. The'uridersigned 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. Signed Date (cr - f Application Approved by %'� Date Application Disapproved by Date foIt r the follow_ ing reasons {3 Permit No. �,Qz-� '' Date Issued 1 �A THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed O. Repaired( ) Upgraded( ) 1 Abandoned( Y)'by 1L�'-(_,..n.t' C, at I i l lr �,r�.�1'- �.��t,t C �� = :` has been constructed in accordance with the p revisions of Title 5 and the for Disposal System Construction Permit No. ated ` I Installer .'( ,,�,�,t.t,1 �� /l ( a . ,�.,c( Designerin #bedrooms 3 a d Approved design flow gp The issuance of this permit shall not be construed as a guarantee that the system will ncffoKv� designed. Date �(/ Inspector I?S 1 1_ No. ��✓� U2JZ Fee ►op — � ~ r/ ti4i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction 3pernfi Permission is hereby granted to Construct(�.-, _ Repair( ) Upgrade(L r)'✓ Abandon( ) System located at t 1 L( o ��(�-S i�tn t��Irt�1 �2iyt .tI v► Y 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:Construction must be completed within three years of the date of this permit!�__F �'�"`` sr Date Approved by 4 i` Town of Barnstable P# Department of Regulatory Services u{ •�a,�,rtwa hr+�+s t�e, • Ip.. 0 blic-M It h Division y.M �! Date 16 200 Ivlaia Street,Hyannis MA 02601 Daft;Scheduled a l rj b} Timt ' " ` =—+— _u A Fee Pd.— Soil Suitability.Assessment for Sewage isposal Performed By: Witnessed.By: G Li w VOCATION& GENERAI,7NI'ORMATION n i Location Address A/ /�J rT` 1�' `i (.raids..��'[ ,( Owner's Name P , ri 5 �--1� �!* %. _> P y L-b� (i, y,!2�✓y/ Address LQ,� - CSC--17�; S I" V .. BaM Assessor s Map/Parcel:~ 3 -: d 0� -- �� ). Engineer's Name A NEW CONSTRUCT � ION .REPAIR - JA\ Telephone �Ep r , Te one# ' t y 1 " JCQo ! i and Use Slopes(30) Surface.Stones t Distances from: Open Water Body L. 1�ft Possible Wet-Area .Drinking Water Well ft LUn Drainage Way 'g ft Property Line .> to ft Other ft SKETCH.(Street name,dimensions of lot,exact,loca ,perc tests locate w tions.of test holes.& , etlands In proximity to holes) 1411 � f'a►zr i~ 1 , AV►� /'A. _ :1 c, i Parent material(geologic) _ Depth to Bedrock Depth to Groundwater. Standing Water in Hole: "0 ��a,���(� Weeping from Pit Face t" (.vul l�tv1G1 t} Estimated Seasonal High Groundwater . . Q--�-- DETERMINATION FOR-SEASONAL HIGH WATER TABLE Method Used '�� Depth Observed standing in obs.hole ln. Depth to soil mottles Depth to weeping from side of obs.hole: _ ,,T_in, `broundwater Adjualment {r index Well# Reading ate:' Index Well' v01 Adj.fac or _ Adj.drountlwnter7xvc!—. PERCOLATION TEST hate -ti► Time Observation Hole# Tiing.at 4n Depth of Perc 5�0 it 4 Time at G" Start Pre-soak Time @ _ i t l')L? lj'-Do- Time(91,, 1� . End Pre-soak i: I�: -11 Rate MinJInch G L 'Z �jl�ry Site Suitability Assessment: Site Passed V Site Failed: Additional Testing`Needed(YM) N Original:,Public Healtli,Division": Observation Hole Data To Be Completed 6:Back----------= 6 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:XS EPTIC�PERCFORM.DOC DEEP-OBSERVATION HOLE LOGS Hole f Depth from Soil Horizon Soil Texture Soil Color Soil. er Surface(in.) (USDA) (Munsell) Mottlin• g (Structure,Stones;Boulders. oti i teney,M vel 'd tu C{ti&;0 u L..A,17 . 4- CA l� ti����, SAD �o���f��. 11. •4,r�_►o,t •5-ro�s ' DEEP OBSERVATION HOLE LOG Mole# Depth from Soil Horizon - Soil Texture_ Soil Color. :. Soil .. �er Suface(in.) (USDA , (Munsell) Mottling .(Structure,Stones,Poulders. --_ C nsisten %Gray l v 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 %G vtl (p pl S i o 1L �I L �l-1tC- L�D s r✓ a — -1 Z ''mow L L ie—, l► L_ ar, t SA I�A 1> ttr �t �► 10L�` DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil . ther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten LL CA rt-A"k \-A:i.Z_ Flood Insurance.Rate-Map: Above 500 year flood boundary No_ Yes Within 500 Near boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious aterial exist in all areas observed throughout the area proposed for the soil absorptibn system') `- Y If not,what is the depth of naturally occurring pervious material? . Certification I certify.that on 1/ (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,exp se and experience described in 310 CNM 15.017. Signature D ate 'V_�v QM1 EPTIOPERCFORM.DOC Town of Barnstable Regulatory Services t Richard V. Scali, Interim Director • E46dSGBLE MAM �0 Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3-8-21 Sewage Permit# Assessor's Map\Parcel 234/06 Designer: =SC Eo�jcne_eaaS; '=r7a,ue Installer: Robert B. Our Co., Inc. (RBO) s . Address: 2-8Sl Cron\oe.rry 11ik1n y Address: 363 Whites Path cask wart l►am K d 2-53$ South Yarmouth,MA On 1 RBO was issued a permit to install a (d�e) (installer) septic system at 114 Pleasant Pines Avenue—based-on-a_design drawn by (address) C Ei 5icle-exto'1� TnC._ dated 11-16-16 (designer) X 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i fiance with the terms of the I\A approval letters(if applicable) „OFAWq 9 Cse �OHN L GF CHILL AL nstanSignature CML .11 o�. F (D (Affix De t p Here) PL SE RETURN TO ARNSTABLE PUBLIC HEALTH D SION. 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:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable # 1217 oETME'a`' Department of Regulatory Services MUMBrABLM : Public Health DivisionMAM Date T `200 Main Street,Hyannis MA 02601 ' Date Scheduled 0Time_ _ Fee Pd: 66 Soil Suitability.Assessment for Sewage isposal Performed By: Witnessed By: G+�r, t " Imo. OCATION & GENERAL INFOglylATION ^i v��� Location Address ��' (�/L�cA� �/1 4 er! s Name Q++�� :.:: Address d J Assessors Map/Parcel: `2 ,t7D� G�� g°M Engineer's Name NEW CONS RUCTION .REPAIR . Telephone# JYsle, Land Use t� �1` t Zit HC 'C l'P��� Slopes(3'0) ' i Surface.Stones +'1 _ Distances from: Open Water Body_L 14 ft Possible Wet Area l J ft .Drinking Water Well Drainage Way i7 ft , Property Line. _ft Other ft SKETCH:(Street name,dimensions of lot,exact locations.of test holes.&pert tests,locate wetlands in proximity to holes) 1 •c� for / i Oil 'Co : j ir�c.�S AVt-w hyN*li D C C�) I Parent material(geologic) Depth to Bedrock S1� Depth to Groundwater. Standing Water in Hole; 1�o LjA t�t��Q. Weeping from.Pit Face , t' (�I u lk_\ M IOU Estimated Seasonal High Groundwater �_ �i t W(4vb ILA__( > C-6') �— t•J M DETERMINATION FOR SEASONAL HIGH WATER TADLE Method Used: �p Depth Observed standing in obs.hole:. In. Depth to soil mottles: Depth to weeping from side of obs.hole: In, C3rnundwater AdJu5tment fr. Index Well'# "Reading Date: Index Well level�p __ Adj,factor Adj.Groundwater Level PERCOLATION.TEST Date -L 1 Time 1 Observation Hole# Tiine.at 4n Depth of Pere 5�0 tt ff 4 Tlme.at 6'.' Start Pre-soak Time @ \t:t7 19 k j t DD time(9",6" End Pre-soak Rate Min/Inch Site Suitability Assessment: Site Passed_� Site Failed: Additional Testing*Needed(YM) Vt Original:,Public Health,Division Observation Hole Data To Be Compleited 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:4S EPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOGY Hole# Depth from Soil Horizon Soil Texture Soil Color Soil er Surface(in) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o i tent % ve! DEEP OBSERVATION HOLE LOG ];Tole# Depth from Soil Horizon Soil Texture Sod Color Soil Q3rSurface(in.) (USDA) . " (Mansell Mottlm g ,(Structure,Stones,Pouldets. - - Consisten %Grav 11 .o 4 `Z 71 L C:. 1r� o oy..l t 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 %G ve L a-t_ .L HIt__ Sates i la .M � C_�KAIN%ALAVIC,. o -rb,' DEEP OBSERVATIONHOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil then Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. tt Consistency. ` `L - oll 1 D (o �� .. o`• Flood Insurance Rate-Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes - Within 100 year flood boundary No-Z Yes 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?. `- .K " If not,what is the depth of naturally occurring pervious material? . 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,exp se and experience described in 310 CNM 15.017. Signature Date '_'yL%07 Q:\S•BPTIC\PERCPORM.DOC a - COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ' • ti ' Q DEPARTMENT OF ENVIRONMENTAL P1, OTEUION. p M Q XR& TITLE 5CD OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY AS ESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM FC RM -- rn PART A CERTIFICATION Property Address: 4CJC2 Owner's Name: vMe 0% Owner's Address: � Date of Inspection: �y 1/ 1 0 0 3 F,(V Name of Inspector:_(Tlease print) '/G'r� ��� Company Name: L "p Mailing Address: 0 Ea Da 6 c.� Telephone Number: ,17 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340.of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: + , Date.._. �/ �o ..o _ _.._ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: // �e cN 9,%e f 141(-e. Owner: 6:44 Ct V v 1-G3� Date of Inspection: / A o Ps Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syste asses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title C incnPnfinn Anrmf./1G/7M11 2 Page 3of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: S . 2va ✓ i O�!�� Owner: a � Date of Inspection: / at O o Czconditions . Further Evaluation is. equired by the Board of Health: exist which require further evaluation by the Board of Health in order is failing to protect public health,safety or the environment. to determine if the system I. System will pass unless Board of Health determines in accordance with 310 CMR 15303 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 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 aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Tiiln C fnenantinn Rnrm </i;iinnn 3 Page 4 of 11 . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: ,C D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No / _ �/ kup 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 gged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or sspool Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow :Z-: Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number times pumped — _ may 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 �A ter supply. y portion of a cesspool or privy is within a Zone 1 of a public well. �'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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. TPrlo G fncnAnrinn Rn�m r%jj;11)nn 1 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: /.Iq exsGo A 3� s Owner• Milt,u S 3� Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes o 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? Ha a 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 u ? g P 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 of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge nand depth of cu condition Was the facility owner(and occupants if different from owner)provided with information on maintenance of subsurface sewage disposal systems? the proper The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria rela ted to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Tirlu G (ncnortinn Rnrm 4/I q/11)nn 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: PGIa n Al v'Y-,s Owner: 6—od" Date of Inspection: / .1 0 RESIDENTIAL LOW CONDITIONS Number of bedrooms(design): -�—Number of bedrooms(actual): U' DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 6� Number of current residents: 0 Does residence have a garbage grinder(yes or no):zO Is laundry on a separate sewage system(yes or no):, 2 [if yes separate inspection required] Laundry system inspected(yes or no):/(/h_ Seasonal use:(yes or no): -tj z f Water meter readings, if available(last 2 years usage(gpd)): Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): Pumping Records GENERAL INFORMATION 1 stem � � Source of information: /_ ®"✓►? Wass e y pumped as art of the inspection(yes or no ). If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic distribution box,soil absorption system _ cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all conigonents,date installed(if known)and source of informati n: Lgo, 00/ 0/'1 I Hal ,Le.��Lt /�` 1� Were sewage odors detected when arriving at the site(yes or no): Title i lncnartinn Fnrm pit ai�nnn 6 r Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C P SYSTEM INFORMATION(continued) Property Address: riCf "14k-e� Owner: �N of u 4 Date of Inspection: 0 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): or Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: 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.): GREASE TRAP: (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title S Incnartinn Fnrm 4/1 ciInnn 7 f Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: fly Pl✓t,,4 Ave., h / w Owner: G1n�% G Date of Inspection: 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_�lolyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): PUMP CHAMBER:k(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): T:tlo G 1na—rtinn Rn�m 4/15/7MA 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: / p/e�6-4- "i t f— ' v L� ki ►l Oa—�3�-- Owner: C—0 4 G l _ Date of Inspection: 0 0 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: TYP, �eachingg y ✓e �4 S s,number:1 J\ leaching chambers,number: ] leaching galleries,number:_ W leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): // ON rl ' o ^ aN � CESSPOOLS: (cesspool ool must be pumped as art of ins ection locate on site plan) ( P PAP P P )( P ) Number and configuration: I Depth—top of liquid to inlet invert: Depth of solids layer: f Depth of scum layer: Dimensions of cesspool: X r' Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition f vegetatio etc.): ly'Sf P`G -7eG� O Sit n s m� dra�. LrG PRIVY: locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level ofponding, condition of vegetation,etc.): Titlo C fncnari;nn Gnrrn All cnnnn 9 Page 10 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �PG1�,, �r e- ��i 4d(0 3� Owner: GU j t. Date of Inspection: l 1,95 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. s Or i v6 01)- Lea�h� Qti / CesfPoo/ /v b� 7�0 T1tl< Incnortinn Rnrm(+/I /7Ml1 10 I Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: el J Date of Inspection: �� ° SITE EXAM- Slope Surface water / n I Check cellar Shallow wells Estimated depth to ground water feet bg V Please indicate(check)all methods used to determine the high ground water elevation: Obtained rom system design plans on record-If checked,date of design plan reviewed: O_tseKed site(abutting property/observation hole witbin 150 feet. SAS) hecked with local Board of Health-explain: IQ Checked with local excavators,installers-(attac documentation) Accessed USGS database-explain: You m st describq how you established the high round orate elevation: �/o C Gt��P.✓ t -fh,f r T-0 ® nma CO 0 (0 fo I (0 Go Zoe{ G G = T41. inennr+inn 97nrm 4/1 VNIOA 11 L O CATION S WAG E PERMIT NO. ,,� %s" _(_ p e VILLAGE 4e/-c) d C INSTA L Lj R'S NAM i; ADDRESS E G U L D E Rom; OR OWN DA LE PERMIT I S S U E D DAT E- COMPLIANCE ISSUED r M No......82-.. ��..i Fizs........ ... .00.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .....................Totyn.....-----.OF..............Barxiatabl.e-.................................... 6b� !0o Appliration for lliipml Workii Tomitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: ...114 Pleasant Pines Ave.,__-Centerville_,--MA__ 02632 Location-Address or Lot No. --Joseph:Guduk_a_s.....-----•-----••-•...................•-------•------------- �14__Pleasant_. 2�1e;?..dive.,.....C.e tQzY.U1p.....Mk....02632 Owner Address a A & B Cesspool Service 128 Bishops__Terr_ce __H _ Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........2................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons_._..__..__2.............. Showers — Cafeteria Pa Other fixtures .....--••---••--•-•--------•---• - WDesign Flow...............:............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet......:............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date------------------------------------.... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------- ---------•----•----------------••-----•.........------------•---•-•-••-•..--••--........................................................ 0 Description of Soil...sand x V ..---•--------------•-•....-----•--•-----•----------•------•-------•-••----------........---•-•---------...•----•-------•---------------•-•••----------••----•-••--•-------------•-.......-------------- W U Nature of Repairs or Alterations—Answer when applicable.____inst-alj do _.�_.5_eet.7.01t1a1..� --stone_packed leach..P-it..( •---•---------------•-------- ---------------------------...-------------------------------------•-------••-••---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITRE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..............................................................----------••--•-•••-•-- ........Vl7/&2....... ]Date ApplicationApproved By........••---••-•.....•-•----------------------------------•-----••------=------------•---...... ................ 17/82....---- Date Application Disapproved for the following reasons:............................................................................................................. --•------------------•-------•-------••-...--•---------------••••---•--•••-••-----------...-•----------•--•...._........---•---••------------------••-•--............................................ Date Permit No................82- .................................. Issued....... ............................... Date I No . ..y 5,3 Fim$....... ...5. 0 .� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH P own.....-.....OF.............Barnstable. ApplirFation for Disposal Works Tonstrurtion rrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: , _�.i4 Pleasant 111. s A 'e; Centerville_,_.P.A: Oz 2 ., -••--.... ...........................• --.....-••-••......-•••--...... Location'.Address or Lot No. , --Joseph Gudukas 114 Pleasant Panes Ave'. Centerville t�_T� 02632 . ...................... ..... .......... -••_.. .... ...........-•----............•----••---•-•.... W A & B Cesspool Servec 128 Trish Terrace, H sannis W ....-•--•-•----- --.. -------------°�--------•---•-----._'........!. 'A 02E�Oi . installer Address UType of Building > , 2 Size Lot............................Sq. feet a Dwelling—No. of Bedrdoms ........................................Expansion A2ttic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .- _____________ W Design Flow..... ::....gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—I iquid"capacity -.gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No.-.................... Width.................... Total Length.................... Total leaching area....................sq. ft. ....E Seepage Pit No......................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box;1(` ,) Dosing tank ( ) aPercolation Test Results Performed by----------------------•-•••.......---•-•-•••-......---••------•----•-.... Date........................................ Test Pit No 1 ...........minutes per inch Depth of Test Pit.................... Depth to ground water................ Grq Test Pit No 2....; ` .._minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ n a s..T1d O Description of Soil . - ' U W ---- -- --------- -------- ---------------------- x 9nstaliat3 on of- a_ sectional pre-cast, U Nature of Rai r Alt erat-ons—Answer hen applicable.................................. stone pac ea .each pt'':(�verflow`vj. . •--------------------------•-------------•----------------•---------••-----•------•--.............-----•--------------------------•-----------------................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of-thee 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. �3/17/&2 Signed .................•-•- f. .. ApplicationApproved BY.................................................................................................. -------------------.__.._..-----......._ ;. _. Date Application Disapproved:for the following reasons:............................................................................--•-----------------------•--••-- .......................................•--------------------••--•--------------............-•---•------......---•------•-----------------------••----------------------•---------••---•--•-----•---•-- Date �/17/82 " PermitNo- -------------------------------------•-----------. Issued_ ----........... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable, ...........OF..................................................................................... �prtifaratr of TompliFanrr TI� I TO CFTIFY That the„Individuail Sewage Di a ystem constr c d ( ) or Repaired (X) at X j � easan A ne' eve., Gentery 11e, PJA 0 25- .r os S. vu U s y • -----•••..........--•-------------•----•-----•-•----------•---.............-----------•-•-•---•----•..................•. . by X� A L. B Cesspool' Service, f28 Bishops 'M"Eaee, Hyannis, MA 02601 a ......................................•--------•................................................................................................................................................ has been installed in accordance with the provisions of T1jFTF of The State Sanitary C1 1l cribed in the, application for Disposal Works Construction Permit No................. �.............. da.ted_....____f:�/.....___.___._.._._.......... 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 T 82- t/4 ...... ..own........... OF............Parr>stable.............................................. 5.00 1� o.................... FEE........................ �io�ros�t1 orko �on,stratrtion permit A & B Cesspool Service ", Permission is hereby-granted............................................................. to Con t ctP( ) or Regir-(, ) an�Iijoivi ual e�>a + Disposal�tem �, easant r ne =Ave. Cen ery _ .leg i34 2 - Jos. Cudukas atNo----------------- -------- Street 82- i t as shown on the application for Disposal Works Construction Permit No..................... Date .......................................... DATE.........................--f---0000'00-----------•-•-................................ Brd of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TOP OF FOUNDATION = 57.2 ± r-FINISH GRADE OVER D-BOX = 57.3'± FINISH GRADE OVER CHAMBERS = 56.4 PROP VENT WITH CHARCOAL FILTER TO ABOVE GRADE -� �F N E RAL N OT I�Q '± - 57.5'± PROVIDE EXTENSION RISER / - F SLOPE @ 2% MIN. OVER SYSTEM - 3/4" TO 1-1/2" DOUBLE WASHED r--REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE -: -i WITH COVER OVER INLET& FINISH GRADE OVER TANK EL.= I. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION RISER TO WITHIN 6" OF FINISHED GRADE � FINISHED GRADE OUTLET TO WITHIN 6" OF F G. 4" SCHEDULE 40 PVC ACCESS BOX WITH COVER TO GRADE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL �- FOUNDATION = 57.2 ± 56.8 ± - 57.8 5" DIA. OUTLET(S) MIN SLOPE 1% (SEE NOTE#21) N OF G OT XTI DOUBLE WASHED , CODE AND ANY APPLICABLE LOCAL RULES. @ i � STONE OR GEOTEXTILE FILTER FABRIC -1 20"MIN. ACCESS 2, ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER (3 TYP.) 36" MlAX. 1 , PLACE RISERS ON ALL DESIGN ENGINEER. PROP. SCH. 40 9" MIN. 39 .60' MAX. TOP OF SAS = 53.90 CHAMBERS WITH j PVC SEWER--,, ---T-�� rPROP. SC'H. -,0 , 36" MAX. 52.��� SEE NOTE 23 i I INLET PIPES T C 6" OF 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SE,,ER j } - ! BREAKOUT EL = 53.40 - _f SYSTEM UNLESS OTHERWISE NOTED. ��-- -'� -, I � FINISHED GRADE =--- - - - 2" DROP MIN. j 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - __ ------ - n�„�, si oaF�,��, 6„ � 3" „ „3" DROP MAX. 3 � L=21 ± , � - M,n,.sLOPE;a PROVIDE WATERTIGHT o ELEVATION = 53.40' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A 13" f 4" PVC IN FROM I _JOINTS (TYP..t 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.R S. AND THE TOP OF 14" -.- SEPTIC TANK ~; 4" PVC OUT TO ' 0 0 0 Q °° 0 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. ff 54.25 - + LEACHIN" FACILI= _o _ Imo , 55.00 i - `� _ �o f �'1 f f-1 (" 1 f�`�-1 I !T'-( 00 ~l (�! 1 I 5. SLOPE ALL SO�(u RIPE AT i.0% MINIMUM. 00 OUTLET TEE 54.00' MIN. 6 53.83' 2 00 0 0 0 0 (-� 0 �-! 00 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 54.50 48" V L- L_J 7 LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 6" CRUSHED STONE 0 0 1� o oo FILLING WHEN SYSTEM 15 NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 10.0' OFFSET TO FND GAS BAFFLE OVER MECHANICALLY oo °0 o I o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH I i T COMPACTED BASE //i 4 0' r T.. - { i` 4 ry I AND DESIGN ENGINEER. 4.0' 6" CRUSHED STONE I _5 _ OUTLET DISTRIBUTION BOX 1 -4,83 -- --- - -' 8. ELEVATIONS BASED ON APPROXIMATE M.S L. DATUM. BENCHMARK ELEVATION OF 60.00' OVER MECHANICALLY ---_- -------- --._ 1 _------ _-. �-] _ TO BE INSTALLED ON A LEVEL STABLE -- ----- --- -- ---- --- -- ------25.0' - ------- {�P ) ESTABLISHED ON A NAIL IN 20" BEECH TREE AS SHOWN ON PLAN COMPACTED BASE �� BASE. FIRST TWO FEET OF OUTLET , GROUND WATER ELEV = < 45.00' �� - C 5Q 00 - 12 83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL PROPOSED 1 ,500 GALLON H-10 CONCRETE SEPTIC TANK THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 2 - 500 GALLON H-20 CHAMBERS 5' MIN.- CHAMBER END VIEW CONTRACTOR TO REPLUMB EXISTING LENGTH 10�_" WIDTH _ 5'-a DEPTH 5 -8'� . (Dimensions per Wiggin CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES REPORT ANY DISCREPANCIES Precast Corp., Pocasset, MA) TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. SEWER PIPING AND EXIT HOUSE AT ' ''�• DIS-I PiPi �1\1 �r "( � ETAIL ' -1- u HuiVjH' K 1 I AIL_ THIS ELEVATION AND LOCATION AS NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. SHOWN ON PLAN BELOW. NOT TO SCALE _� NOT TO SCALE - - 11 NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING ST �� TA -EST PIT r-, I\TA REGULATIONS. TOWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM �- PERC NO. 12674 _ PERC NO. 12674 APPROPRIATE AUTHORITY. (Benchmark , li i �1 ENSPECTOR: David`JV. Stanton, R.S INSPECTOR: David W. Stanton, R-S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED r., j Nail in 20" Beech Tree / �` ; - : r - UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT; DRIVES, OR /`tiC -, EVALUATOR: S. Doyle EVALUATOR: S. Doyle Elev. -60.00' r , * ' f' "� y --�--- a - --------- TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING t. �}-� ; E_� ` C.S.E. APPROVAL DATE Oct. 1999 d C.S.E. APPROVAL DATE Oct. 1999 Approx. M.S.L. I .R ..;;j d ,s I 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. �- . (�,�+� DATE August ' DATE' August 21, 2009 21; 2009 j s� -�? =x ,- "�` \� ' , , ,# , 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE I cr w �,,.� ,. t ;rG TEST PIT# 1 TEST PIT# 2 �: '� -------- - I ------- MATERIAL IN AREA BENEATH AND FOR 5 FT ON ALL SIDES OF LEACHING FACILITY. I' I 20" 1 4' �-PROPOSED 4" PVC VENT- 20" l { ELEV TOP= 58.00 - ELEV TOP = 56.00 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, PROPOSED EXACT LOCATION PER OWNER �r.• 11 FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). INSPECTION PORT----. I BE m ELEV WATER = < 47.00' _ ELEV WATER = < 45.00' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PROPOSED 2-500 GALLON PERC RATE _ < 2 min./inch PERC RATE _ w H-20 LEACHING CHAMBERS _/ \ •�. ;_•__ 'j. :�- k \\ _ SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK WITH AGGREGATE a , ` ` �•� � ��'r! \` „ 16. PROPOSED PROJECT IS LOCATED WITHIN: ZON L _ DEPTH OF PERC = 50" -68 DEPTH OF PERC = N i - o Lri it , r f� 1'.. � ` ��. ASSESSOR'S "ZAP 234 PARCEL 6 TEXTURAL CLASS i TEXTURAL CLASS -PROPOSED mTP 4 L,r C` I OWNER OF RECORD. John M Montminy ti TP 3' fl I a V V -- ---------- 56x0' DISTRIBUTION BOX w ,t3cS. •�C• - . �` �; PROPOSED 1,500 GAL ' �• 0" L- ---- -�56,00' ADDRESS 36 Village Drive, APT 108 11 �■ r! .• A Sandy Loam p Sandy Loam j - SEPTIC TANK I j :• • . / 10YR 3/2 ! 10YR 3i2 ! Wethersfield, CT 06109� - PQ4 Ct tI* ' • 6„ LooseiNo stone 57.50' 6" Loose/No stone 55.50' i TP 2 �; f _ FEMA FLOOD ZONE X % ° MAP 234 hlrley , _ _ ' 56x0' tU ' t t Lewis Loamy Sand w Loamy Sand COMMUNITY PANEL# 25001C0562J O % TP 1 , x PARCEL 7 • .dl, +! / if is nd Bw 10YR 5/8 B 10YR 5/8 17. DEED REFERENCE: DEED BOOK 20664, PAGE 68 • Moderate Moderate a'rSf 18. PLAN REFERENCES 1. PLAN BOOK 1, PAGE 53 o Structure; Friable Structure; Friable ) Nye5 P07�� �• r+ l 2.) PLAN BOOK 10�+. PAGE 79 �1T / P ' ,J h a ) T }'' ffi"t `_;'� 42" 54.50' 42" --- -- ---- 52.50' 19 ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION �� PROPOSED 90° LONG SWEEPING SEND � *�.1, � � �`� 50 I N i,. • 53.83' o CO lip PROPOSED CI_EANOUT • • \+ ++ • Perc 20 PROPERTY LINE INFORMATION IS ONLY APPROXIMATE THIS PLAN IS TO BE USED ONLY ° WqL C\ `. �/a '�jq �. ~` * �p. FOR SEPTIC SYSTEM UPGRADE JC ENGINEERING WILL NOT ASSUME ANY LIABILITY 2.33' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. Stoney '�' 7 . ; , --£ , Medium Sand `s Medium Sand MAP 234 P o ,,j �`(r, C 10YR 5/6 C 10YR 5!6 21 A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A PARCEL 5 ' ' Granular w/ Granular w/ DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A eH 1 4-10" Stone 4-10" Stone REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. I s 18„ �� LOCUS PLAN HOLLY #114 �APPROX WATERLINE 22. OWNER /APPLICANT; CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. 3 BEIDROOM SCALE: 1" = 1000' DWELLING r 132" 47.00' 132" 45.00' 23. IN ACCORDANCE WITH 310 CMR 15.401 - 15.405, THE FOLLOWING LOCAL UPGRADE 1 \ 4 TOF=57.2± No Mottling Standing or Weeping Observed No Mottling; Standing or Weeping Observed APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): GARAGE r'k r (1 i A 0.60' WAIVER (3.60' - 3.00') FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY TEST nl-r n A:TA TEST PIT r' A T/ \ CO DESIGN DATA I C N C. p t PERC NO 12674 _ PERC NO -- 12674 _ C ORI��WqY qp = NUMBER. OF BEDROOMS (DESIGN) 3 INSPECTOR David W. Stanton, R.S. INSPECTOR _David W. Stanton. R.S. ( EVALUATOR: S. Doyle EVALUATOR: S. Doyle 5ux0' EXISTING SPOT GRADE � DESIGN FLOW 110 GAL/DAY/BEDROOM - \ \ C.S.E. APPROVAL DATE: Oct. 1999- C.S.E. APPROVAL DATE: Oct. 1999 50 -- EXISTING CONTOUR TOTAL DESIGN FLOW 330 GAUDAY DATE: August 21, 2009 - DATE: August 21, 2009 � PROPOSED CONTOUR DESIGN FLOW x 200 % = 660 GAL/DAY TEST PIT#: 3 TEST PIT#: 4 50 PROPOSED SPOT GRADE \ SWING-TIES SCALE: 1" =20' USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV TOP = 5800 - ELEV TOP = 56.00 _ EXISTING GAS LINE \ ELEV WATER = < 47.00' ELEV WATER = < 45.00' EXISTING OVERHEAD WIRES MAP 234 \ DESCRIPTION HC-1 HC-2 SC-1 I e PERC RATE _ < 2 min./inch PERC RATE _ ■ PARCEL 6 SEPTIC TANK COVER (1) 14.0' 25.3' S20' - --- --------- ■ TEST PIT LOCATION 40,276± S_F \ INSTALL 2 - 500 GAL. H-20 CHAMBERS WI AGGREGATE DEPTH OF PERC 50'*--68" _ DEPTH OF PERC EXISTING CESSPOOL -;r SEPTIC TANK COVER (2) 14.0' 31.8' 53.3' - CORNER OF STONE (3) 27.2' 43.6' 46.9' TEXTURAL CLASS: 1 _ TEXTURAL CLASS: 1 o SIDEWALL CAPACITY CORNER OF STONE (4) 30.9' 53.3' 5TU (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S-F.) = GAL/DAY EXISTING LEACHING PIT co 4 CORNER OF STONE 5 542' 70.9' 50.2' (25.0' + 12.83') ( 2 ) ( 2' ) ( 0.74 GPD/S.F ) = 112.0 GAL/DAY 0" 58.00' 0" 56.00' ( ) A Sandy Loam A Sandy Loam O O PROPOSED 1,500 GALLON SEPTIC TANK R�36 CORNER OF STONE (6) 52.1' 63.9' 37A' BOTTOM CAPACITY 10YR 3/2 10YR 3/2 1gQ9 S34�7 Loose/No stone Loose/No stone PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE 'LENGTH x JVIDTH, (0.74 GPD/S F.) = GAUDAY 6" 57.50' 6" - 55.50' Ny (25.0' x 12.83') (0.74 GPD/S.F.) = 237.4 GAL/DAY 13 Loamy Sand Loamy Sand PROPOSED DISTRIBUTION BOX �u�,��/J. �. / �O Bw 10YR 5I8 Bw 10YR 5/8 PROPOSED 500 GALLON H-20 LEACHING CHAMBER -- �vi A / ^ -(6I Moderate Moderate P TOTALS: - ------- Cq (5 12.8' SC-1 Structure; Friable Structure. Friable REV. DATE BY APP'D. DESCRIPTION (� TOTAL NUMBER OF CHAMBERS 2 __ I TOTAL LEACHING AREA 472.2 SQ.FT. 42" 54.50' 42" 52 50' PROPOSED SEPTIC SYSTEM UPGRADE 4� 0 TOTAL LEACHING CAPACITY 349A GAL/DAY 5( PREPARED FOR: a�«r or Pere �,asv CA _ CAPEWIDE ENTERPRISES o 6t' � .Ip N y�y O 3 Medium Sand Medium Sard J CHU HILL NOTES: � ) .t C 10YR 5/6 C 10YR 5/6 �R. Granular w/ Granular w,` q '. LOCATED AT 1.) MAGNETIC MARKING TAPE SHALL. BE PLACED ALONG THE TOP EDGE OF 4-10" Stone 4-10" Stone EACH SEPTIC SYSTEM COMPONENT (4 2) �� ! 114 PLEASANT PINES AVENUE 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE v± �) ,✓I jv CENTERVILLE, MA 02632 PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT 132" SCALE- 1 INCH = 20 FT DATE. NOVEMBER 16, 2016 DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF 132" -------- 47 00' ---- 45.00' HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. o t; 20 so FEET o No Mottling. Standing or Weeping Observed No Mottling, Standing or Weeping Observed HC-1 - � HC-2 3. PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2 AND THE PREPARED BY: GROUNDWATER PROTECTION OVERLAY DISTRICT. 1 N JC ENGINEERING, INC. 4114 RESERVED FOR BOARD OF HEALTH USE 2854 CRANBERRY HIGHWAY EXISTING EAST WAREHAM, MA 02538 3-BEDROOM SITE PLAN DWELLING 508.273.0377 SCALE: 1" =20' TOF=57.2'± Drawn By JC Designed By.JC "'necked By MCP JOB No. 3654