HomeMy WebLinkAbout0164 PRINCE HINCKLEY ROAD - Health 164 Prince Hinckley Road
Centerville F/R
�W A = 172 203
f
TOWN OF BALARNSTABLE
LOCATION / RJA' U. 0/11GL'`l SEWAGE #
VILLAGE Ce�T��V, ASSESSOR'S MAP & LOT �7a oZO
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY lrfw� FAILED INSPECTION
LEACHING FACII.I N: (type) P �S (size) /UU�
NO.OF BEDROOMS BUILDER OR OWNER /'1/� L A . 0' I�
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 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 leachi��`'' facility)
U�� / Feet
Furnished by �i1SDe
`r
• s��k
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- ia� aS
O O aa$ a�6
3 o�T 3
'A TOWN 0 B STABLE `
t"7CA'I?ON SEWAGE #_.�� ���
VILLAGE G, `���\ SSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 1
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size) 10, -1c
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility, (If any wells exist
on site or within 200 feet of leaching faciliy) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
r
14
���1 - -
No. _ t F Fee tJ®vz�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
0[pplication for Wgpoml *pgtem Cow5truction Permit
Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) �El Complete SystemXIdividual Components
Location Address or Lot No. vet-Tv,"Ge a,c Qd Owner's Name,Address and Tel.No. //
Assessor's Map/Parcel t M prey -5011tkmp
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
sQq�Ic rce
PTcu�� S-t-� P� G 2� �,Gt MOL c�
Type of Building:
i
Dwelling No.of Bedrooms—8� Lot Size 0��5 sq.ft. Garbage Gri}der jOther Type of Building NCKW- No.of Persons Showers(,✓) Caia
Other Fixtures t-.C.I n kc k C N-&A,
Design Flow 33� gallons per day. Calculated daily flow .s?>1 gallons.
Plan Date 1,0 Ile 1 d k, Number of sheets Revision Date
Title �\ S J�D Svtrr-c�e- s tt
Size of Septic Tank tab - -iQk. Type of S.A.S. (.beZ 2,4.15 t -.S r 1 FtLTV.AM-%
Description of Soil 2QLC �cO y
Nature of Repairs or Alterations(Answer when applicable) o ��
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 nvi mental Code and not to place the system in operation until a Certifi-
cate of Compliance has b issued by his oard of alt U` ko k�Si ed Date
Application Approved b Date 1,0
Application Disapproved for the following reasons
Permit No. Date Issued
. Fee—Vol
�—
I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
� rf 4 PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppYication for Mi000l *raem Construction Permit
-' Application for a`Permit to Construct( )-Repair Upgrade( )Abandon( ) ElComplete SystemXdividual Components
Location Address or Lot No. t(Ql� 1?��� V\1100 b Q6 Owner's Name,Address and Tel.No.
//
Assessor'sMap/Parcel Cro.��2cU�\fie t l`'�l'` M s�Y �jv��l OP
1 -4a `j G
Installer's Name,Address,and Tel.No. U y tg 5 31 O Designer's Name,Address and Tel.No. S4 8-p
o 't5 '�Z'6-�•c etc e 'S*aY ENU.
P
Type of Building:
�� r
Dwelling- No.of Bedrooms Lot Size,-,?(,,, 5 s .ft. Garbage Grider(/�f�A
Other Type of Building �lf�cuz No.of Persons Showers(7 Cafeteria
Other Fixtures t--Gl�[] .<.� �e� C.4�-c. S►�,k, �C'•Jt\�c�C
Design Flow ?3o gallons per day. Calculated daily flow ?:A gallons.
Plan Date 1, ito r y LV Number of sheets 1 Revision Date
Title �1
Size of Septic Tank 1 , 060 C,Q ' 2x iS/(k. Type of S.A.S. I Coil 2,4.X5 `'i inl f_tLreATVQS
Description of SoilQSS1C -'ICJ n1CA1
Nature of Repairs or Alterations(Answer when'applicable) _
"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 .hf'Envi mental Code and not to place the system in operation until a Certifi-
cate of Compliance has b issued by his oard of alt .Si Ake A , r Date L
Application Approved b Date
Application Disapproved for the following reasons
Permit No. a Date Issued 17 16 qJ
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTI Y,t_at the On Sewage Disposal System Constructed( )Repaired ( )Upgraded y )
Abandoned( )by
at to,C f N C e. �-c �. o C E h%i , has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Co struction Permit No. dated
Installer, Designer
The issuance Ithi)s ermi shall not be construed as a guarantee that t e syste hl funct*on as designed.
Date Inspector/
No. 1 3G7� -----------------------Fee �d THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mfi6po!ml *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair( y`U g�de( )Abandon( )
System located at OEsc _
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:Co/nstructio5 must be completed within three years of the date this p t.
Date:_._ / 17/ Approved by
T
TOWN OF BARNSTAALE
��
LOCATION n SEWAGE #.
VILLAGE NCZ�a� SS SSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) �.- (size) MkK 101 *ZC I 1
• o
NO.OF BEDROOMS
BUILDER OR OWNER �v t C'.%j
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility') Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
� I
U ` b7
Sep- 20-01 13 ; 52 BARNSTABLE HEALTH OEPT 5087906304
' s2s,oi
\C)TICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
PERCOLATION TEST AYD SOIL EVALUATION EXEMPTION
FORM
ti hereby certify that the engineered plan signed by me
Jetec t concerning the property located at
c=t\ee" k�i c cklt� c!f t T�'14meets all of the
t�l'o.v�ng ::r;tena
This failed system is connected to a residential dwelling only. There are no
:orlmercia! or business uses associated with the dwelling.
• 'F'e soil is cidss:,:ed as CLASS I and the percolation rave is less than or equai to
,t:,) ,t;s per inch 'i'he applicant may use histooncal data to conclude this f3c; or may
:onduct �re!irr,;;ar% tests at the site without a health agent present
• Therc :s no increase in Flow and/or change in use proposed
• There are rio va.,iances requested or needed,
• The bottom of the proposed leaching `acility will not be located less than fourteen
I;j f--et aoove the maximum adjusted groundwater table -levation. fAdiust the
nundwater table using the Frimptor method when applicable)
Please complete the following;
fop of Grounp Surface Elevation (using GIS information) _ 15 9--_
22
F; C W Elevat:or, 4.
^d;ustment for 'high G.W. _ J
.� 1 FRFt�t�F BETWEEN ., and B u
J
:6VED DATE: C�
NOTICE
3asec j-ori t,-,e above :r'.formaUon, a repair permit will be issued for 'oedr^oms
T2x�r.0 r `;r :dd�tional bedrooms are authorized to tti; future without engtncerec
:ep!.. syste -t plans.
Arun!r,.0u �cicc.�m9
Permit Number: Date:
Completed by:
HIGH GROUNDWATER LEVEL COMPUTATION
Site Location: Lot No.
Owner: Address:
Contractor: Address:
Notes:
STEP 1 Measure depth to water table 2�
to nearest 1/10 ft. .......................... .Date � O c�
mont /day year
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
site and determine:
OAppropriate index well....................................................
8 Water-level range zone
• � 1
STEP 3 Using monthly report "Current
Water Resources Conditions"
determine current depth to
water level for index well ........................... 3.
4moh/year
STEP 4 Using Table of Water level Adjustments
for index well (STEP 2A), current depth
to water level for index well (STEP 3),
and water-level zone (STEP 2B)
determine water-level adjustment ....................
STEP 5 Estimate depth to high water
by subtracting the water.
level adjustment (STEP 4)
from measured depth to water
level at site (STEP 1) .....................................
..........................................................
1;
Figure 13.--Reproducible computation form.
15 � �
I
Town of Barnstable
�FtHE Tqy, Regulatory Services
do
Thomas F. Geiler,Director
* BAMSrnai.E,
a 9 Public Health Division
'O�En 'tA Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 6/21/04
Designer: Shay Environmental Services Installer: Roberts Septic Service
Address: 34 Thatchers Lane Address: 5 Trenton Street
East Falmouth, MA 02536 Yarmouth, MA
On 6/11/04 Roberts Septic Service was issued a permit to install a
(date) (installer)
septic system at 164 Prince Hinckley Road, Centerville based on a design drawn by
(address)
_ Shay Environmental Services dated 6/16/04
(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' 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.
�ZN'DF MAS
Qz�-
(Installers Signature) ,�; 'Ut N G
No. 11 1
(Designer's Signature) (Affix D ' ��.q ere)
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
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
RECEIVED
FAILED INSPECTION JUN 1 5 2004
TOWN OF BARNSTABLE
TITLE 5 HEALTH DEPT.
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
MAPProperty Address: 164 Prince Hinckley Road ""t� ^
Centerville, MA 02632 PARCEL, ,
Owner's Name: Arthur O'Keefe LOT
Owner's Address: .
Date of Inspection: June 2, 2004
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O. Box 49
OstervUle,MA 02655-0049
Telephone Number: (508) 862-9400
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
Need Further Evaluation by the Local Approving Authority
✓ Fail
Inspector's Signature: Date: June 7, 2004
The system inspector shall submit 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 I
_ Page 2 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
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:
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:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
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
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 and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
D. System Failure Criteria applicable to all systems:
You must indicate either"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 '/2 day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_
✓ Any portion of the 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 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 (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 System:
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.
4
i
Page 5 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
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:
Yes No
✓ _ 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(3)(b)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 2
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIALANDUSTRIAL
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):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped in 2003-per owner
Was system pumped as part of the inspection(yes or no): 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)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
A new pit was added on 2124184-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC _other(explain):
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: 20"
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: 1000 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 3"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage.
GREASE TRAP: None (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.):
7
a � Page 8 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
TIGHT or HOLDING TANK: None (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/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: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level.
PUMP CHAMBER: None (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.):
8
n Page 9 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 2-6'x 6'(1000 gal.)
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
The newer leach pit was installed in 1984 and had 4'ofwater on the bottom. Solids were present. The scum line was to the top
of the pit. There were signs offailure. The bottom to grade was 9'. The cover was 1'below grade. The older pit was not dug up.
CESSPOOLS: None (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 or no):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (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.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
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.
A �k
� B
a
ia� as i
O O a�6
aag �
3 O/—D
PT 3 35 , S7
10
Page 1 1 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 164 Prince Hinckley Road
Centerville, MA
Owner: Arthur O'Keefe
Date of Inspection: June 2, 2004
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 25 +/- feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: Topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
_Using Barnstable topographic maps and water contours map the maps were showing approximately 25' +/- to Around water
at this site.
This report has been prepared and the system inspected and failed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
LOCATION .
SEW A< E PERMIT NO.
46
VILLAGE r '
1NS A LUR'S NAME i�;. ADDRESS
B U I L D E R OR OWNER'
DATE PERMIT ISSM' D W.
DATE COMPLIANCE ISSUED
;,;.r
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u. � ���.�..'f
�. � � ✓wry*��/y. Yt. �-P+ >
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
w oF.-...�� t.• sr6.Ie ----------------------------
Applir�a#ilan for Diapnsal orkii Tonstrnrtinn Urrmit
Application is hereby made for a Permit to Construct ( ) or Repair (YQ an Individual Sewage Disposal
System at:
...._.16A...../.A e.-----171.NGF1.� ........... G.r/T ....._..... ..........................................
--Location-Address or Lot No.
Owner Address
wv ! 0A.................................. --------------------------------------------------------------------------------------------------
a Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms__.(,�___________________________________Ex Expansion Attic� g— p ( ) Garbage Grinder ( )
Pk Other—Type of Building ____________________________ No, of persons............................ Showers ( ) — Cafeteria ( )
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 ( )
0-4 Percolation Test Results Performed by.......................................................................... Date......................................
._]
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 -•••--••--•-••-------•••---•-•-••-•-•-----------••-------------•---...._..------•-•------•-••_--•-•.........................................................O Description of Soil.......................................................................................................................................................................
W
U •--•-•••-•••---•---•--•---•-----••-•-••-----•--••••••-------------------•--•---------....------••---------••-•--------•....._•-------••-••----•-••--••-------••---•----••--------••-------••------------
w
x --•-•-----•------------------------••-•----•---•---•---••-----•--•--••---------•-•-•-•-...-••----•----------••••-----------•-•--•-•-
Nature of Repairs or Alterations—Answer when applicable_____-__-4 O ........................................................
..••----------•-----•-•••--------....•--•--------••------•••-•-••••---------••-••....................••-•••-----•--•••---••---••---•-•--•-------••-------••---•-•----------••---••-..._..---........-••.
Agreement:0
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System iti accordance with
the pirouisions of iITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been • sued by the bZrofheal.th.SI ned---•• -_. _... _
----------------
fate
Application Approved B
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------•-----•--••--•_-----
..................--•••-•...-•---------•----•---•••••••---•---------------•••--------•-•-------•••------••---------------•••----••••---•-•----•-------••••--•------••---•-••-----•--
PermitNo......................................................... IssuecL------------------------------
Dat
J �N
<Y'
N�..... ............ FEs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............OF...r 7 -s�- +. - � ................................
. pplira#ion for Uiipnsa1 Works Tonstrurtian' ami#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
....16. ----- C.e....... t. *Ie .........tfeIt./' ._....... ... ..
Location-Address or Lot No.
- ........'f e..11!� -------------------------------------------------------•---------- ............
-............
-................... ....._....... - .....:.
Owner Address
a -----Gam;,•-- ....---- --•--------- ------------------------------------------------------------------------------------•-------------
Installer Address
Type of Building Size Lot............................Sq. feet
1-4 Dwelling—No. of Bedrooms_ .`,,....................................Expansion Attic ( ) Garbage Grinder ( ),
aOther—Type of Building _______________---___--:-- No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ----------------------------------------------------- -------------------------------------------------
------------
--•------_---...------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
GG Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
W
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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................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........................
.•-••--------•-----------------••••---•---••-----•----...•--•---••-•--•-•-••----•--=......•-•-•-•............................................................
0 Description of Soil........................................................................................................................................................................
x
U .......--•----•----•••--••--•-----•-•---•--••••---------•-•-•-----------------•----•--•----•••-----•-•-••--•-•--••----•••.....•----••-••------•-•...•---.......--•---------....----••............--••-_..
w
x •-......................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable........!G _.___..I.C.ao..........................................................
--------------•---....-----------•--•-------...--•---------•---.....----.......-------•-•--......-•----------...----------------.........------•-------•---. ...........................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI.i 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beessued by the board of health.
Signed-----y tZ ----------- -----------• -_
�. Date
ApplicationApproved By..................................................................................................
Date
Application Disapproved for the following reasons:-------•----•-••----------•--------•.......-••---------•----•----••••-•-•-•---••-••---•--•-----••-•--••......---
.........................•......------------Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........1'.19., �'.......OF...... jy? ... ��i. ....411
.......................
Tutifiratr aaf Toutplittnrr
TH S IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by -*r-- !..ra.hr.....-•-------••-----------------•-----.....-----•-•-•----•--...-----•----.......................---.....--••----...------------.
Installer
has been installed in accordance with the provisions of TITL E 5 of The State Sanitary Code as described.in the
application for Disposal Works Construction Permit No......................................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE:CONSTR ED AS A GUARANTEE THAT THE
SYSTEM WPA. F CTION SATISFACTORY.
DATE•--- :.t ._.... Inspector .............................................
Z1 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1..��..''.L'!`"'' .........OF...... ..5-r.4..��zems=----------------------------
No......................... FEE........................
Disptto 1 nrk.6 �a1marttrti.orn amit
Permission is hereby gran ...
.../6, .w r !4` _. .............•...._......... _
to Construct ( ) or\Repair (-N/,) an Individual Sewage Disposal System
atNo. -; - _-�.76.11`_o�....--- .....................-------�= ........................................................
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
............................................=..................e# ^ti Board of Health
DATE................. t v . ................................
FORM 1255 A. M. SULKIN, INC., BOSTON
LO CAT 1 N {'�S� T SEWAGE PERMIT NO.
i"
Lot 130A Prinee Hinckley Rd.
VILLAGE
Centerville, MA.
INSTALLER'S NAME i ADDRESS
Alfred Fuller
995 Cotuit Rd. Marstons Mills, MA.
8 U I L D E R OR OWNER
Alan E. Small, Inc.
Box 536 Centerville, MA.
DATE PERMIT ISSUED 10-6-78
DATE COMPLIANCE ISSUED
r
II ��' � �,
-___. �I
Fmc
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® HEA
\� ----....OF......- ... .- ..........................
Application is hereby made for a Permit to Construct ( W) or Repair ( ) an Individual Sewage Disposal
System at: ,
.:.......�- ...9.. .............................................
�j: / L,ocaytion-Addrre s t
.............1.. ..41.}MI!� ..
O ner Address
W ............
Installer Address
Type of Building Size Lot...........................Sq. feet
UDwelling—No. of Bedrooms.............13.........................Expansion Attic (A) Garbage Grinder .(
Other—T e of Building No. of persons_•__________________________ Showers — Cafeteria
Q' Other fixtures --------------------------------------------------
W Design Flow..........I..1.P........................gallons per person per day. Total daily flow..........3.B '_........__....._.._.gallons.
WSeptic Tank—Liquid capacity.t04®-gallons Length................ Width_............. Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----------/-------- Diameter....... zj ..... Depth below inlet.....4......... Total leaching area....`•Z.._.!.Lsq. ft.
Z Other Distribution box (A-r Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1....2-r ..minutes per inch Depth of Test Pit.................... Depth to ground water-____________-_-_-,_--
GT4 Test Pit No. 2................minutes per inch Depth of Test Pit____-_-__-_.__._-- Depth to ground water........................
a . ..............:........... ..............
O Description of Soil------- ------ ---- ---- 1__--
c4 ---•--------------- --------------------------------------.....-----------------------....--------
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 iiTLE 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.
ned- ................. - .f 79
1 Date
Application Approved BY ,.. L ..--•----•..................... X 6_-
----------------- Date----------
Application Disapproved for the following reasons__________________________________________________________________________ __
---•----.....-•---------------•----•-----•--•------------------------------------•-....--•-••----------------------------------------••••---------•------•••---------•----...----------------•--•---•---
Date
PermitNo......................................................... Issued--A--_..... '. .� --..------•----
Date
y/
. `w
r' y
No.............. G� `�'°' `` FE$..............................
• THE COMMONWEALTH OF MASSACHUSETTS
BOARD O H E,&]
......... j,4i T.......OF....... ...wA' ------.......................... `
Appliraation for Uhipaii al Works Tom ttruvat Vamit
Application is hereby made for a:,Permit to Construct -( ) or Repair ( ) an Individual Sewage Disposal
System at
.....---
Location f.-Ad re s or Lot es
--------------------
�+*- caner Address
...................I --•.o...-- = ;: :�:.�_... .. ..._... ' ....................
�"� Installer Address
Size Lot..............................S feet
d Type of Building ,,,,, q.
V Dwelling No. of Bedrooms .........................Ex ansion Attic t*�
a g— p (`k)) Garbage Grinder (00)
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
QI Other fixtures -•••-------------------------•••••- -------
W Design Flow_.______.. . . �'........................gallons per person per day. Total daily flow..........?!_��.° _....................gallons.
WSeptic Tank—Liquid capacity.atb.gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........./......... Diameter.._...C...... Depth below inlet....4.......... Total leaching area...2..!?.l._sq. ft.
Z Other Distribution box (�< Dosing tank ( )
'-I Percolation Test Results Performed by.................•-------------------...-------••••-••-•••......--•••..... Date........................................
Test Pit No. 1.... _._minutes per inch Depth of-Test Pit.................... Depth to ground water........................
Gil Test Pit No. 2................minutes per inch',,Depth of Test Pit.................... Depth to ground water:.::,..____...._....____.
P4 •• - -•-
+ t 2 -.• . . LDescription ofSoii
W
VNature 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 TIT i.;•.
p 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.
Date
A r
lication Approved B
PP PP Y ._. �< � . A�
Date
Application Disapproved for the following reasons-----------------------------•------------•--------------------•---------------------............•••••...........
.....................•-•--------------•---------------------......--•----•-•-----•---------••-------...--••-•-•-•----•....---------•----------•-••--------•----•-••-----••..................•-•...•-----
Date
PermitNo...........................I.........--•••••-•--- ------ Issued.......................................................
Date
' THE COMMONWEALTH OF MASSACHUSETTS
t BOARD OF" EALTH
"� .. r ......:.oF.................... .. ' M
Trr, if irFatr ,af Toutph aatrr
T, IS T ERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
byi r ------_...-- staller .....................•.........._..._..._...•._..---•..
at. ��_ f �_. a .. ......
has been installed in accordance with the provisions of T ` of The State Sanitary ode a described in the
application for Disposal Works Construction Permit No. G` ............... dated__._ .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM 1All AJNCTION SATISFACTORY.
DATE...................-4.f---y--Z?....-•...................................... Inspector..... ----••--------------•--•------------------•----•-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......7; ...OF A.a.&n.....................................................
No..........6...�.7. FEE.......S••••........
Maps irk . (1511MAr it
Permission ' ereby granted.......
to Const c ( Repair ) a Indivi a e gage s SystQtn '
at No.. =� .•-•-..r........ t i..... .-• . . --•- A44�4. ... .............
Street
as shown on the application for Disposal Works Construction P - No _:__ _.___ __ Dated-------------� _------ _._------•- .
---------------------
7� Board of Health
DATE ( f.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .Q
Q0 GArZaAGF--
. Tj•d t Lam.( F L.OW a t l b +c 3 t 33 U G•p.D: , �� i.
Sv t- tc -r'AuK. = 33ov ir�o % • d�}S 6.Nt�. . . �� �'d. �`'�-� •.
U Ste-
PoSAL PIT - LJSE. I000 GAt_ -lO
SITt-vAt_.L_ J V-GA tc20 S.F.
f�X-�� G.P.U.
�A Sew. x 1 .0 So C�.RD. M
TOTAL DESIGN = 425
ToTA t_ va►Lam( r=c.r�w •
f+
t TAeJL'
..r�•���,�� �t,��`t, , '. '�N o� ,i�,�•a� � , � A a t j Dw� 51f E
In
r TsT rc=: To* Fyo •
Lo�M "P�e luv�91•d
¢ d "loco ifN - �+
"Sac. 4'Pp� "Dl iw• Gp� : _ a ,r r
lwv x 10
t
s
F3� GAOU
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w.
►-J o S.a t�,L�- r t.. SC.AL�
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%4S2 Crit.l CO PI..�lS w rriA roc-- �j i rr=_L-1641
A>Ja SET1<3AGlG i~'EQUtQEtit�uTS Off: '1'N� ,l , _ `"1,.
-Town 0>� ���5-r�
DATE � 15 'l� �` - D_ 'C + �J�c� {_ ., �. ��•
8 TC uY 1�.J
_ . • REGIS'lttZ�D L.A1.1L7 5tJ2v�YotZS
TI-{I5 at .A1.1 1,S WOT U5ASCC7 c�6,,1 AtJ OS'TE2ye�.LC o /MASS. , y:. s
►I�tSt-2va�C�.ir .rvczvt�Y .� Tt��, oFFS��"°,:.5i-lGwla�: . . -. 4.%
�r a� USEiJ _ _, t 1 .. �� . A•p1�t..1 GA.iJT ,
S
TYPICAL 1000 GALLON SEPTIC TANK ` '� � ys
*NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE (O least 24 Inches tail) NOT TO SCALE '.�+ �I I ' 1
10 min. from Schedule 40 PVC w/Charcoal Odor Filter SECTION A '-A 7,Yj
house to se tic tank2-18" DIAM. ACCESS MANHOLES
Existing Foundation a PROFILE VIEW OF ADDITION TO LEACHING SYSTEM T.O.F. slev. - 100.00 Septic tank covert must be 8 wRh1n 6 in, of finished rode9 Grade over over SAS - 09.00 3' of 1/8" - 1/2" Washed Peastone 'ySeptk Tank - 00.00 Grade over D-Box - 00.00 f3/4' to i 1/2 Washed Crvshed Stone �+� '- �-' �•-='• '" � T•
o_ +� 164 miner 101natrle Rd
S 0.02 4" PVC(CAPPED}INSPECTION PORT 10 BE
5 HOLE Top Load- Qev. -96.00 INSTALLED AND TO BE WITHIN E'OF GRADE •
10 5-0.01 a Greater (H-20) DIST. BOX Too of SAS- Elev. -95.50 \ f
l H INLET t. b
EXIST. PIPE L EXIST. 1,000 GA A OUTT
+ S- ,010^ er foot q
FROM FOUNDATION w 'x SEPTIC TANK 40' o" Effeetive Depth \
CV cv OO THE ACCESS COVERS FOR THE SEPTIC TANK, �. ,r �•( ,�
CONCRETE FULL FOUND,
> II to O 5 Units 2 6.25' = 30' �' DISTRIBUTION BOX AND LEACHING COMPONENT ` !t a •+
o 5 p 0 rn rn 0.83' 10 inches 3 3, .� r-•. ., t
I'mT rc +.i;,r, r !-^:ter r^ --^ -°'• SET DEEPER THAN 6INCHES BELOW FINISHED / °�
Y T PROFILE ' ` '' `' GRADE SHALL BE RAISED TO WITHIN 6' GF loom a
0 A II � 31.25' FINISHED GRADE. soa It
S S EM O LE v m Iu 37,25' STEEL REINFORCED PRECAST CONCRETE m 4 Ren N J.'"-"f l{ll P:D04 FLviO Imn 7�a rwloy(es f Not to Scale S v PLAN VIEW
i > 4' 4' R Effective length INSTALL TUF-TiTE GAS BAFFLES OR EQUALS
2 3-24• REMOVABLE COVERS GENERAL NOTES
0.
10, LD
6 In.of 3/4"--1 1/2" Effectivevldth " , 1. Contractor is responsible for Digsofe notification
compacted stone .�
m° INFILTATRDR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN f " %' '` �' 4 ;'''`' •, and protection of all underground utilities and pipes.
Bottom of Test Hole 1 Elev.-87.00 3 min. clearance •' 13. � 2. The septic tank once distri ution box shall be set
Obs. Groundwater - Test Hole 1 Elew.= NONE OBSERVED (OR EQUIVALENT) Not to Scale INLET s^ mn,�-j2' min. x,let to «,uet s•m� :< level on 6" of 3/4 -1 1�2" stone.
FT Lklurd level °U 3. Backfill should be clean sand or gravel with no
NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10" ,o'mM. ,. ., stones Over 3" in 912e.
5' -7• L_ S -7. 4. This system is subject to inspection during installation
4-0" min,o-eam. by Carmen E. Shay - Environmental Services, Inc.
Uquld depth
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6• BELOW GRADE .. 5. The contractor shall install this system in accordance
'1 with Title V of the Massachusetts state code, the approved plan
.� and Local Regulations.
-o• 4 -,o' . 6. If, during installation the contractor encounters any
CROSS SECTION END-SECTION soil conditions or site conditions that are different
from those shown on the soil log or in our design
installation must halt & immediate notification be
made to Carmen E. Shay - Environmental Services, inc.
7. No vehicle or heavy machinery shall drive over the
j PERCOLATION TEST septic -system unless noted as H-20 septic components.
8. Install Tuf-Tits gas baffles or equals on all outlet tee ends.
9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes.
Date of Percolation Test: JUNE 11, 2004 10. All solid piping, tees & fittings shall be 4" diameter
Test Performed By. CARMEN E. SHAY, R.S., C.S•E. Schedule 40 NSF PVC pipes with water tight joints.
Results Witnessed By. WAIVER per BARNSTABLE BOH
Excavator: Roberts Septic Service 11. Municipal Water is Connected to ALL OF The Residence and Abutting
Percolation Rate: Less Than 2 min./inch ® 42" BELOW GRADE. Properties Within 150 Feet.
.\ S
i Test Hole TH9E PROPERTY LINES ARE APPROXIMATE AND
st
st 1 COMPILED FROM THE SURVEY PLAN GENERATED BY
BAXTER & NYE OF OSTERVILLE, MA, DATED 2/13/78
DEPTH SOILS ELEV. ENTITLED " PLAN OF LAND IN CENTERVII I E,
0 99.001 BARNSTABLE, MA", AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
' •88� Loamy Sand i IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
10 YR 3/2 THE SEPTIC SYSTEM INSTALLATION. I
A� 98.33
100 -------- -
0"-8"
Loamy San
10 YR 5/6 I THERE ARE NO WETLANDS LOCATED WITHIN A 200' RADIUS OF THE SAS.
8"- 42' 8w 95.50',
Med
LOT ##130A Sand
26,325 Square Feet +/-
2.5 Y 7/4 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
42"-144' c, 87.001 FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED
OF AS PER BOARD OF HEALTH SPECIFICATIONS.
EXISTING SAS TO BE PUMPED DRY & FiLLED IN PLACE OR
REMOVED TO FACILITATE INSTALATION OF NEW SAS IF REQUIRED.
!
• y ASSESSORS MAP - 172 PARCEL - 203
' o� Perc #1 " ZONING - RESIDENTIAL
�
Depth to Perc: 42' to 60"
Perc Rate=<2 min./inch
Groundwater Not Observed
_BOTTOM OF TE_!ST_HOLE__E1ev.-_=__144=_ THERE ARE NO WETLANDS LOCATED WITHIN A 200' RADIUS OF THE SAS_
ADJUSTED H2O Elev. = No Adjustment Required.
ALL CUTLET PIPES FROMSHALL
THE LEGEND
DISSET LEVEL F BOA SHAH BE 12" -' CONCRETE COVER '
SET LEVEL FOR AT LEAST 2 FT.
17
V I
4" PVC K 6 - 5' OUTLET 2
VENT KNOCKOUTS 8X0 DENOTES PROPOSED
LOT ##129A CO f5.5 - 15.5' OUTLET �"I^I I 12• INLET SPOT GRADE
TEST HOLE #1 ,;�,, �.,�. ��, f : a" e• -� X DENOTES EXISTING
ELEV.- 99.00 ? .,, 104.46
•; ,55" SPOT GRADE
1.75•
" PLAN-SECTION CROSS SECTION I PL PROPERTY LINE
a
}; 3y 5' 3 HOLE H-- 10 DISTRIBUTION BOX �97-�- PROPOSED CONTOUR
W Failed ��{ NOT TO SCALE
r Leach Pit 97- - - - -97 EXISTING CONTOUR -
D-Box
LOT ##131A I
DEEP TEST HOLE &
co
�.,. Design Calculations
PERCOLATION TEST LOCATION
Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V)
Garbage Grinder: No _
Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per TItie V) FENCE
Septic Tank - 3 x 330 Gal./Day - 660 USE EXIST. 1,000 GAL. Septic Tank.
SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch00 PRIVATE DRINKING WATER WELL
� Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. 273.8 gallons
Sidewail Area: 0.74 gal./sq. ft. x 78 sq. ft. = 58 gallons REVISIONS
43.,5' 16 Providing: 331.80 gallons
0
EXIST. 1000 gal. Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, NO. DATE: DEFINITION
0 Septic Tank TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE
ON THE ENDS. NO STONE UNDER.
DECK
(
EXISTING *`
2 BEDROOM �•
HOUSE PROPOSED
PROJECT BENCH MARK #f64 PREPARED FO R .
TOP OF FOUNDATION
ELEV. = 100.00 (Assumed) SUBSURFACE SEWAGE DISPOSAL SYSTEM
OF
MARY SULLIVAN
I 1 �
- # 164 PRINCE H NCKLEY ROAD
164 PRINCE HINCKLEY ROAD CENTERVILLE, MA
I ASPHALT � "•q ,_ ��'-
S PREPARED BY:
DRIVEWAY t1 _- _ --� � �'� _
CENTERVILE MA 02632
-r" 69.96 c� SHA 1
30.67' o,o O' N ENVIRONMENTAL SER VICES, INC.
N 27d 21' 38" E I ` 1P P.O. BOX 627
Ji--------------------------------------------=------- -------------------------
- �__�------ - T� EAST FALMOUTH, MA 02536
SANITARI��
OA _D TEL/FAX : 508-548-0796
(50 FOOT RIGHT OF WAY) SCALE: 1 "=20' DRAWN BY: CES DATE: JUNE 16, 2004
PROJECT#SD-590 FILENAME: 5D59OPP.DWG SHEET-1 OF 1