HomeMy WebLinkAbout0316 PRINCE HINCKLEY ROAD - Health 31 i Prince Hinckley Road, Centerville
i
TOWN OF BARNSTABLE
;LOCATION ( yd,� �,, � � SEWAGE# 0,1V-
VILLAGE //f ASSESSOR'S MAP&PARCEL - /-7
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /Oc e d:;W ex- d'l'
LEACHING FACILITY:(type4 C6 /,6 /,. .2o, (size) yJ`3 ,SS ,e')"
NO.OF BEDROOMS
OWNER
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
92-3/b
Rear
oj7.(v
sib
�y
�f 6`
No. f� � Fee (/ CGG///+✓✓�///
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y
�O 01p citation for Mis oral 6pstem Coustructiou ermit
Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System &<dividual Components
LoG+Nl/a�Varcel
rp& or Lot
7No.
/, �j 1— dI l/ Owner's Name,Address,and Tel.No. f
As c714 P n&_14 I^I�Cf1/
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
13or os-7'7 S,TncQu4►'.y ;V- k—bunn&X V7MII wl 51nc i��l�vfo�-SI.S�/
Type of Building: °�
Dwelling No.of Bedrooms ✓ Lot Size 16013 sq.8. Garbage Grinder
Other Type of Building pme_ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.requir d) 3� ) gpd Design flow provided 330 0 Y gpd
Plan Date !C) Number of sheets Revision Date
Title
Size of Septic Tank 4?.d , Aow Type of S.A.S. SizLrvi
Description of Soil
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 the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued b Board of _..._.__.
gn d Date 3l
ills�
op
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. `�� Date Issued
No. _ _ y. Fee
r , THE#COMMONWEALTH OF MASSACHUSETTS r`Entere( omputer:
Y
PUBLIC HEALTH-DIVISION - TOWN'OF BARNSTABLE, MASSACHUSETTS
V 01pplifation for.MisposaY *p8trm Construction VermIt
Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System Individual Components
Lop tion Addre 9 or Lot No. , r✓�t / d Owner's Name,Address,and Tel.No.
n '§Ma V
As§es5or's Map/Parcel 314 ;nsk
Installer's Name,Address,
/and Tel.No. Designers�Name,Address,and Tel.No.
Pe
�Gf1��UTT� �Clf7 !!X]�Gy�'�Y[' 7Jr Lt1cYtJSttLJ Kc�" ��tiVY?l� t�rr')(v�'<i 51�'>C
Type of Building:
Dwelling No.of Bedrooms Lot Size 15,013 sq.ft. Garbage Grinder(44
Other Type of Building P10S "p nce— No.of Persons Showers( ) Cafeteria( )
Other Fixtures `/
Design Flow(min.required) 3 3o gpd Design flow provided 33y s 0 Y gpd
Plan Date Number of sheets Revision Date
Title Size of Septic Tank e-X;S+, lU00 Type of S.A.S.(dV)s{ rA(}.j 41►k k t� ���_
Description of Soil
` t
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: 3`
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 issu d b *yBoard of .1 _ __...
gn d e Date
Application Approved by Date J
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
CCertifirate of CCompfianre
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(f) Upgraded( )
Abandoned(' )by f �6/OT/1 1a4r+x' 6/i;1 0 '
at� o inf kk�&n�-rnd� has been const _.cted in ac o ante
with the provisions of Title 5 and/t e forr Disposal System Construction Permit N , ated
InstalletA6(�a�p i�Kl//J�Ti�y� Designer I �C•
#bedrooms 7 Approved design flow n 0 gpd
The issuance of th's p rrmit shall not be construed as a guarantee that the system will )oh as design d.
Date Inspector
f ,
"' - Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS
mispo8ar .6pstem onstrUttion permit
Permission is hereby granted to onstruct( ) Repair( Upgrade( ) Abandon( )
System located at ' e- ._ 1-/. -
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Constru io m/be completed within three years of the date of this permit.
Date Approved by / f
yA U✓� �GC�CN(a�--
1Departinellt of Regulatory Services
Public Heai th Divisions )Date
.t'' , u IIAFUIBTAHLE, o �-
RB& 200 Main Street,Hyanuis MA 02601
5 1�
RA
Date!Scheduled 3 d J Time [ U Fee Pd.
e DY) v0sa
Soil Suitability Assessmentfor Semag,
:/e
J�Ar lCl— - -)/1'111- � ✓�
1'crYonned.l3y: A o 1-E�PL � WiU�essetl By:
r
LOCATION& GENE RAL IlNF0RIm/1[A7[TION
Locution Address 2 / �j� �,/� Owner's Name
V GIXMT"' V)6 L Q ��!/j t•Yt Address / J� O-L-✓.
Assessor's Map/Parcel: 1-7I — / -7Q Cngincer's Namu
NEW CONSTRUCTION REPALR Telephone It
Land Use 1 — I ate' Slopes(%) 0— J surface Stones
Distance's from: Open Water Body fI Possible Wet.Arco ft Drinking Water Well ft
Drainage Way ft. Property Line Ft Other ft
SKETC� 6
H., (Sheet came,dimensions of lot,exact locations of lest.holes&perc tests,locate wetlands In proximily to Boles)
G7> o
D '
CU
w rn
p •
73'
l0S•-13'
y — `Parent'niaterat(geologic) CN11N' —f)`.�.. n - Uepth to Bddroelt
Depth to Groundwater: Standing Water in Hole: N y Weeplhg II'oltl hit fa OG
Estimated Seasonal High Groundwater N6 w
DETERMINATION FOR SEASONAL HIGH WATER TABLE
meth«I used: _
Depth Observed iaznding in obs.hole:N—A lu, Depth to soli InuId.n:
Depth to weeping From side of obs.hole: _ I!1, drnulidwuler AdJuehTtettt e ft.
Index Well✓# Reading Date: Index Well level r Ad�I,Atetot',_._,_,— AcJ.0r(A1J)lWUter Uvul
IFE'RCOLA C ION ' .'EST m lUala�t a 'llIU16-p TM
FObservation
�J- Tlnte tit 9"
epoere L� e �Q Time at 6"
Stott Pre-soak Time @ 'O 0 a�C Time(9"-6")
End Pre-soak 1 0
Rate Min./Inch
Site Suitability Assessment: ;Mite Passed sit.q-Failed: Additional Testing Nceded(Y/1\1)
Oriwal; Public Health Division m g Observation Hole Data To Be Completed on Back-----------
**,,If percolation test:is to be conducted 1viti1111 100' of wettand, you n iulst[iu'st Notify tHie.
Barnstable Corlserviltloll JAvisioll at]east 011e (I) Week prior to begimiling,.
Q:\SEPTtC\PEIKCroRNI.DOC
B��]f��TA7L'16 TIO LE]LOG
Depth from Soil]Horizon Hwe # '--,
Surface(in.) Soil Texture ;Sdil Color
(USDA), Soil. Other
Mun( sell
Mottling (Structure,Stones;Boulders.
Con iste c 5 ravel
,
------------
w G�.2gv�
D E]EP
Depth from � �' �'�Vf��'I® ®�,R ][,®�'Soil Horizon Soil Texture ITOIE! #
Surface(in.) Sail Color
(USDA) Soil Other
(Mansell) Mottlini; (Structure,Stones, Boulders,
A. (, Cons! enc %C avel
b -3o l()yrLI/
G
DERPOBSEIRVATIONIT
Depth from SOH Horizon ®�'� LOG #
.Surface(in.) Soil Textln•e Soil Color. --
(USDA) Soil
unsell) Mottling (Structure,Stones,her
(M Stones,Boulders.
._ Con sistrEU %Onven
a
4
1D1]E]CP 01BSEI RVATION�OLE
Depth From Soil Horizon ®r Hole#
Surface(in.) Soil Texture Soil Co' lo _
(USDA) Soll Other
(Munsell) Mottling (Structure,S
i tt?nes;Boulders,
`Consj�tency �k t7ravel_�__� '
Il+Vood InSUrance Rate Nina. /
Above 500 year flood boundary No Yes
Within 500 year bou ry No nda _�
'- / Yes
Within 100 year flood boundary No'✓ ye'y
�PTtu�enlra9ioccurring pe�viouS Ma erial
Does at least four feet of naturally occurring pervious matel Hal exist in all areas observed throughout the
arel proposed for the soil absorption system?
i t mot, what is the depth of naturally occun-in*
per ions mataria•l?
CeH>I-- fication
1 certify that on Nov 'cis date •
)I have passed th
e
Department of P h soil evaluator examination approved b the
P nvironmental.Pr k is
o ectioli'a n� that the about analysts was performed by me consistent with
the required trainin , expertise and experience described in CIO CMR 15.017.
DatbT/w
v
Q:\9I0PTlC\PBizcroRM.DOC
LX
CommonweoM of Mossochusetts
N Jo
Executive Office of ErMronmental Affairs ~ .PF i e V e 1®Inspectbr
Department of P.O. Boy/2119
Environmental Protection TehP � ��MA U2a��36 c<�
(S� �1.3
Of.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 316 Prince Hinckley Rd. Centerville Address of Owner:
Date of Inspection:1109197 (If different)
Name of Inspector:John Gracl Mcqlaun
Company Name,Address and Telephone Number:
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X Passes This inspection is based on criteria defined in Title V
Conditionally
P sses code 310 CMR 15.303.My findings are of how the system is
_ Needs urthe valuation B the Local A rovin Authori perfonninq at the time of the Inspection.My Inspection does
Y PP 9 tY not Imply any warranty or quarantee of the longevity of the
Fails septic system and any of its components useful life.
Inspector's Signature: J'" Date: t113197
The System Inspector shall s bmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B.C, or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair, passes inspection.
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.)
_ The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is
imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street 9 Boston,Massachusetts 02108 9 FAX(617)556-1049 9 Telephone(617)292-5500
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 316 Prince Hinckley Rd Centerville
Owner: Mcqlaun
Date of Inspection:1109197
_ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken,
settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
_The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
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 the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water
supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 11115195)
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 316 Prince Hinckley Rd.Centerville
Owner: Mcqlaun
Date of Inspection:1109197
D] SYSTEM FAILS(continued)
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
_ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5;00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11115195)
S
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 316 Prince Hinckley Rd.Centerville
Owner: Mcqlaun
Date of Inspection:1109197
Check if the following have been done:
X Pumping information was requested of the owner,occupant, and Board of Health.
X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
NaAs built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened, and the Interior of the septic tank was Inspected
for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge,depth of scum.
X The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 315 Prince Hinckley Rd.Centerville
Owner: Mcqlaun
Date of Inspection:1109197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: nla
Last date of occupancy: 1 months
COMMERCIAL/INDUSTRIAL:
Type of establishment: o/a
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) N0
Water meter readings,if available: nia
Last date of occupancy: Na
OTHER:(Describe) nla
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped in the last two years.
System pumped as part of inspection:(yes or no)No
If yes,volume pumped:0 gallons
Reason for pumping: n1a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) ( if yes,attach previous inspection records,if any)
X Other(explain) nla
APPROXIMATE AGE of all components,date installed(if known)and source information:
1982
Sewage odors detected when arriving at the site: (yes or no) No
(revised 11115195)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 316 Prince Hinckley Rd.Centerville
Owner: Mcqlaun
Date of Inspection:1100197
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 1'
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions: L 8'6'H 5'7"W 4'10-
Sludge depth:3'
Distance from top of sludge to bottom of outlet tee or baffle: 24'
Scum thickness:5'
Distance from top of scum to top of outlet tee or baffle:6'
Distance form bottom of scum to bottom of outlet tee or baffle: 19'
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
Septic tank is structurally sound Recommend pumping system every two years for maintenance.
GREASE TRAP:
(locate on site plan)
Depth below grade: n1a
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: nia
Scum thickness:nfa
Distance from top of scum to top of outlet tee or baffle:nla
Distance from bottom of scum to bottom of outlet tee or baffle:n1a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Na
(revised 11115195)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 316 Prince Hinckley Rd.Centerville
Owner: Mcqlaun
Date of Inspection:1109197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: Na
Material of construction:_concrete_metal_FRP_other(explain)
Dimensions: nla
Capacity: n1a gallons
Design flow: n1a gallons/day
Alarm level: n1a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n1a
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n1a
Comments:
(note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.)
nla
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
nla
(revised 11115195)
7
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 316 Prince Hinckley Rd.Centerville
Owner: Mcqlaun
Date of Inspection:1109197
SOIL ABSORPTION SYSTEM(SAS):x
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
n1a
Type:
leaching pits,number: 1,000 gallon leach pit octagon
leaching chambers,number:n1a
leaching galleries,number: n►a
leaching trenches,number,length: n1a
leaching fields,number,dimensions:n1a
overflow cesspool,number:n1a
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The sas is functioning properly and is sturcturally sound.It was empty at the time of the inspection.
CESSPOOLS:
(locate on site plan)
Number and configuration: n1a
Depth-top of liquid to inlet invert: n1a
Depth of solids layer: n1a
Depth of scum layer: n1a
Dimensions of cesspool: n1a
Materials of construction: n1a
Indication of groundwater: n1a
inflow(cesspool must be pumped as part of inspection)
n1a
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
nla
PRIVY:
(locate on site plan)
Materials of construction: n1a Dimensions: n1a
Depth of solids: rda
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
Na
(revised 11115195)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 316 Prince Hinckley Rd.Centerville
Owner: Mcqlaun
Date of Inspection:1109197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
� Lte
SCe=e'�
C) A
OUC
AA
i}
bA 'A
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9
r ^
L.O CAT 10 3f� SEWAGE PERMIT NO.
lot 2Q5 Prince Hi nekley Road 79-592
VILLAGE
Centerville, MA.
INSTA LLER'S NAME & ADDRESS
Alfred Fuller
995 Cotuit Road Centerville, MA.
d U I L D E R OR OWNER
Alan .E. Small, Inc.
Box A36 Centerville, MA.
DATE PERMIT ISSUED
9-10-79
DAT E COMPLIANCE ISSUED `�Y�_�r�
��J '
/` 1 1� "�'
�$ � � �-o
,�-��
i
N& ...
THE COMMONWEALTH OF MASSACHUSET.TS
BOARD,30F HEALTH
...... oF................ ......
ApplirFa#inn for Uiopau ai Works Cnnn,itrnr#inn rnmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
S gpi, i at*
..... .....U....... ............................. ............. ....... .. ..... ................ ........w
Loc i -Address Or,Lot No. .
._...... ... aim.:...__....11..................^--.......................... "--'•......... ............................
Owxe Address
a .....---- x...... �._._.. •--------
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic (X�>— Garbage Grinder (AP
pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
G4 Other fixtures --------------------------- .
...... a-------------
Design Flow......... .:: ........ ....-gallons per person per day. Total daily flow........ .__.��......................gallons.
WSeptic Tank—Liquid capacity .gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .......... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.. _F ,. � 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........................
f� Test Pit No. 2------- '__..minutes per inch Depth of Test Pit.................... Depth to ground water........................
•--•----------------------------------------------------------------------------•------''-"'......."-------•'-'-................. -•'"-•'•---------
0 Description of Soil.......................'-...............--------------------------------------------------------------•--------------....----•-----.........--•-•-...........----.......
x
U .---------------------------------------•---..._.........-•-------•--'......-•--------'.....---'------------........................................---------------..........................----------
w
UNature 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 iITM . 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance,has been is d by the.'bard of health.
Si --- --- - •--•---------------•--------------------'•-•---------•---------------. 4D-ate
.....(!.._.._'.'.!
Date
Application Approved By-----------•---•.......
Application Disapproved for the following reasons---------------------------------------------------------------------- ........................................
-•--------•-------------------------'---...............------...................-------"•---•._.........._....._..------------......----------._..•---------------------- ----------------.....'-------
c Date
PermitNo......................................................... Issued............. ....................
Date
N FEs....S G�. ...
THE COMMONWEALTH OF MASSACHUSETTS
BOAR�OF HEALTH
cc,.....................o .......... .:....: ... ...............................
Appliration for Eliipos al Works Tonstrnr#ion j1prmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sy�---- --- ....... ............................ ................................` ....�`"`y* ..
. ._ .. ..
f Loc�h n Address t No.
• Own
Addres
a .............. . ..:........... ....................... ................. .. -. --` ..s_.._......_..._...._...
Installer Address
Type of Dwelling Building �~ Size Lot............................Sq. feet
U
g—No. of Bedrooms............`.*:�..........................Expansion Attic ( Garbage Grinder
aOther—Type of Building ............................ No. of persons........----............--.. Showers ( ) — Cafeteria ( )
Otherfixtures --- ...-.............•------------------------------------•--• ®-
ellf ,,,,,a �
Design Flow.... !_ allons per person per day. Total daily flow__________ _ ___ + ___.._...... Ions.
W t`" - Y•.•• g P P P Y Y gal
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 ( )
aPercolation Test Results Performed bY.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--.
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................----
a' .........................=................................................................................................................. ---------
---
O Description of Soil.....................................:..................................................................................................... ...........
W
U ................•---•-•-•-•------••-•--•••-----•.....•---•-----•----......•---•-.........--•-••-•----.....-------•--•-•--------------•------••.........................................................
W
---•--•--•-......-••-----------•---•----•---•------•--•-------------•-••------•-----••----•---••------------•---------------------•----•--------------••-••-------•--•---...........--......-•----••--
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
-------------------•-•----...---•-•---•--•---------------•------...-•--------...........--•---....---•--.....-----•-----------------•----------•-•--------.......---------------...._...._......••----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT`.`: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i d by theroard of health.
..
Date
"Application Approved By..-------•-.-•-•- -- ... -%... . ................................................ -•- __11,1-1 t.2
Date
Application Disapproved for the following reasons:----•---------------•----•------------------------------------•---------------....------•-----•-------•-••......
-•..............•--------------.......--•-----------•---•-----------
Date
PermitNo.................................................... Issued..................•-----•---
.._. Date ..................••-------
-THE COMMONWEALTH OF MASSACHUSETTS
B . .ARD 7 F .HEALTH
OF........
* y0011, rrtifirtttf
o font li�anr�e
THIS I rd C IFY, e Individual Sewage Disposal System constructed ( ) or 4ed
by . ---_-- •---- f ........................... ---.•at....-- - �5�`.. ` I ler
has b n installed in.accordance with the provisions o T T F 5 of The ate Sanitary Coe as deapplication for Disposal Works Construction Permit No--. �.....---.�� dated.-...... +/,f .
THE ISSUANCE.OF THIS CERTIFICATE SHAL OT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
el
DATE.................q�.."A�......?--::......'........................ Inspector............
� �����_..... .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ltir► / ......:.......................... ...OF.......-•----...................
No......................... FEE ....:.....
�to�os�t o o � n rrnti�
Permission 41175
y granted.-- •• r ... _. ...�--------------•------...... --.... ....}...
to Constgnt ( `or Repa' ) an Indi ual Se r ge D.spo ystem` ;
at No....
S reet
as shown on the application for Disposal Works Construction Permit ............ , .......
................ ..
�,..• y oar of H alth
DATE....'at;""
FORM 1255 HOBBS & WARR'EfV, INC.. PUBLISHERS - -
r F ..
;E:::Y^('t C. T�=a--i K. = 330� f tiC % • 4�S 6.f?O. �
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SWC-WALL AV.E a, = l �-,c> S.P. �S
I--S t 04A 4.e1=A c ST=. 1 4 Mint, f3Za/�
ToTAc_ �GSIGtJ = 425 rAqg M
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FROM :down cape engineering inc FAX NO. :150836213880 Sep. 02 2010 02:27FM P1
oryt.-.
�o�/ 1 1,51n3nu it'. u:nen�cf, Of Tutu)]
.r ri.9N.M7�'A'i)Yl7Ad, I
�� ��. �N 1'nn��lu�° li-6a.a�fltlliv �ue�LL�IlCDffi
atily�, "F.haoma5McKean. Dira;ctuA'
ZOO maim 8tratet,E.T.'yv rni�,
_08-,iP,4644
Jlxlg aJl ti I!°yes l �•�:'sx�fiiine. �t ��n.Form
Ild'llb
DviiiguaeT: Ow,-) Cr4 Z r4e,,-/'i lnstaal(ler: r 4✓- (0 (/ l /1�7 1.tG
Address:
l 9 lCt.l•�.._.._ Addlirdim:
Oil V�(/�L! (/' xig' �L�/ �"' �✓'� `�' GVi1S 1ssUG1:I a PC:t7r1.it to I.t.11a)]. ..
(d.itc) (TUISLaller)
Septic System.a1.c_.314. . //)C' I»sed an adesign dravt)n by
(Licit'a css)
00/14f dal--d
(f�Ctil. !Cr)
1 certify that lhc; sc:pt:ic syste:J.I.referuccd ab0vo W-1s iustalied ,mbstaptially aucorditag to
tilt#: il.esi. ir, wlrich may iuisludc 7 fluor approw'd. chaugt:s such as lat.er:rl, relocatim). of thc
distri:biifion hox an.dior se.phe'Auk.
:1 certify I:liat tire, selAit, systeru refcrcucetl abirvc was installed vflth a.n:aj,o cha'ages (i_e.
gruater than 10, bate-ral,relocation of th.e SAS or a;uy vertical reline Aisru Of ally ('-0I11P0110.tkt
of Liie :,elrlit:SyStcxu) but i_ti s.caa�o:cla.Gtac vyitlttatc. r I_.ocal. I:etliati��nti. i'l�a.n revi:airn�. or
rectified zs-built try tlr_,sigttct'to foll0w.
jtl OF
DANIEL A��sch
OJALA
-..rr:>Lallt:r� . izi,�.tl7re) E,
CIVIL
N .4860a
� 4., t
F'iLTIv�.1 ltd y:.4°t.aK icy rs®.TiuIV;9`I'A ,u,;+' PUBIL.K.' A.L 11A 1rAV16Jt ld.
d'OTiii•i-:n.,JANCL.v D.,i, ,Vfff Rn,- -15`617ET) o PiTTF, PATH TMS VQ➢WA.-rLN3 A13-1iUl'T i= Tdi) ARE
'RF,C'ELVE]G+ )t"N.> LI 'H EItL'lf'1T DMSPTON. '9 IUA.Nk YaSill.
C3•" ra sr, lica'T7e;i:ne:L'crt:fiaai .i=! - A.ri r.
H.�.lth/_ p . L, .oni•��rnx G 0 �
SYSTEM PROFILE MALL ARKS^D EMWIT COMPON NTTAPSHALL E OR BE NOTES
PROVIDE WATERTIGHT MIN. 20" DIAM.
(NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD �a
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE r
PROVIDE INSPECTION PORTS TO 2. MUNICIPAL WATER IS EXISTING z ;�
TOP FO D. . 57.8' WITHIN 3, OF FINISH GRADE c
\ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o
MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 56.0' a
4. DESIGN LOADING FOR ALL PROPOSED PRECAST
PRECAST H-Io o
RISERS H-1 UNITS TO BE AASHO H-10 o �°
4
' "OS
PIPES LEVEL 1ST 2' 5. PIPE JOINTS TO BE MADE WATERTIGHT. td
G he
2'0 55.76 CH40 PVC t �a
6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE
10" EXISTING 14" WITH 310 CMR 15.000 (TITLE 5.)
TEE SEPTIC TANK TEE \*54.36p± 6" MIN. SUMP 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Locus--.
GAS BAFFLE:. °ogooag00000 12' MIN. INT. DIM. 53.5 NOT TO BE USED FOR LOT LINE STAKING OR ANY
4' LIQ. LEVEL (ACME OR EQUAL) 53.71 ' 53.54 °'67� 52 83' OTHER PURPOSE. �� y
8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
J00000000000000;0;000000000 p0000000�0;000000(.
O O O O O O O O 000 O O O O O O O O 000 O O O
0000000�000n0,0,.,000000000n0�,00000�0n0700000• -9�
- - - 9. COMPONENTS NOT TO BE BACKFILLED OR
OVERALL DIMENSIONS TO OUTSIDE OF UNITS: 24' X 11.3' CONCEALED WITHOUT INSPECTION BY BOARD OF 0,
6" CRUSHED STONE OR MECHANICAL (NO STONE PROPOSED) HEALTH AND PERMISSION OBTAINED FROM BOARD
COMPACTION. (15.221 [2]) OF HEALTH. Roo e
7.7 10. CONTRACTOR SHALL BE RESPONSIBLE FOR
( 5 SLOPE) ( 1 % SLOPE) CALLING DIGSAFE (1-888-344-7233) AND
FOUNDATION EXIST. SEPTIC TANK 13' D' BOX 6' LEACHING _ VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP
FACILITY OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
*THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT - WORK. NOT TO SCALE
UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE BOTTOM TH 2 EL. 45.1' 11.PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE (OR H-20 ANY UNSUITABLE MATERIAL ENCOUNTERED
SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP XX PARCEL X
SEPTIC TANK IF IT WILL BE SUBJECT TO VEHICLE LOADING). SHALL
PROPOSED LEACHING FACILITY. 67/ 1?0
12. EXISTING LEACHING FACILITY SHALL BE PUMPED
AND REMOVED OR PUMPED AND FILLED WITH CLEAN
SAND.
LEGEND-
7.55 SYSTEM DESIGN:
99- EXISTING CONTOUR
X 99.1 EXIST. SPOT ELEV. 56 Yo GARBAGE DISPOSER IS NOT ALLOWED
99 PROPOSED CONTOUR \ -
56.89
[98•4] PROPOSED SPOT EL. O .09 DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 110 GPD
56
TH1 O P USE A 330 GPD DESIGN FLOW
_q� 7 \
TEST HOLE �Q► 56. 57.26 SEPTIC TANK: 330 GPD (2) = 660
2'_ SLOPE OF GROUND RE-USE SEPTIC TANK**
PAVED DRIVE
UTILITY POLE O 57-61
��� �
of LEACHING:
�� o a
1 FIRE HYDRANT 10 �°� ;�55 \ ,6,. i\ s 4 7? F,/I_F �t 4, I FNGTH = 18.88 SF PER STD.
NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAMANG ( 'QK 4 UNIT
57.27 �
ro .61 330 GPD/0.74 GPD/SF = 446 SF LEACHING
0�
Cb` GARAGE REQ'D
TEST HOLE LOGS Q� P 7.57 446 SF/18.88 SF/UNIT = 23.6 UNITS
ENGINEER: DANIEL A. OJALA, PE, SE / I 57.27 ^ v THEREFORE, USE GRAVELLESS SYSTEM OF (24)
STANDARD QUICK4 UNITS IN FIELD CONFIGURATION
WITNESS: DAVID W. STANTON, IRS 295 / SUN OF 4 ROWS .OF 6 UNITS
DATE: AUGUST 30, 2010 56.58 15,013± S.F. / 0 PORCH �.
< 2 MIN/INCH X 56.52 24 UNITS x 'k§.88 SF/UNIT = 453 SF> 446 SF
PERC. RATE _ (OK)
EXIST. DWELL. 7 X 28
CLASS I SOILS P# 13035 TOP FND 8,=ELE �
X 57.30 h
6.71 , MA
ELEV. ELEV. APPROVED DATE BOARD OF HEALTH
1 2 0» 56.2' 0" 56.1' 7.05
X 7.80 5 %4 �76 X 56.44
A A
LS LS 05 4
10YR 4/2 10YR 4/2 6
6" 6" 7.96 X TITLE 5 SITE PLAN
7.16 i6.81
B B \C - 57 4" OAK OF
10" SPRUCE
Ls Ls 6. 7 316 PRINCE HINCKLEY ROAD
10YR 6/6 10YR 6/6 \6.57 12'� o K TH 1 24• °
30" 53.7 30 53.6 ��, CENTERVILLE
'6Q\
6.01 X 2
C1 C1 5 .9 s 2 X 4 PREPARED FOR
M CS 10% GRAVEL 56 6" WHT. PINE
M/cs 10% GRAVEL / BORTOLOTTI CONSTRUCTION/
TR. SILT TR. SILT
2.5Y 6/4 2.5Y 6/4 '
96 96aFM F
48.2' 48.1 ASs9 � "° "'gss��ti RADEMAKER
BENCH MARK - CORNER OF w o�� DANIELA Inn
DANIEL--I
ANIEL Gm
C2 C2 CONC. BULKHEAD EL = 58.0' X 55.63 a� QJALA � A.
CLEAN " N CIVILA.
2 �NoO 40980
�JALA AUGUST 30, 2010
CLEAN �� off 508-362-4541
F
PERC M/CS M/CSvale fax 508-362-9880
downcape.com
o c�JA iv A.
2.5Y 6/4 2.5Y 6/4 CIVIL OJA.LA down cape e!lgineering inc.
132" 45.2' 132" 45.1' 465D2 u.4o98D V civil engineers
Scale: 1"= 20' ��
v�F� ,E� G S �j land surveyors
NO GROUNDWATER ENCOUNTE D
939 Main Street ( Rte 6A)
O 9 9
DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
�/
0- > U / yj 0 10 20 30 40 50 FEET 10-181.DWG(SBO)
j� _