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HomeMy WebLinkAbout0033 RAINBOW DRIVE - Health V33ERainbowDrive, Centerville A= �III� /f J�QECYCIFp�O UPC 12543 No. •o��S)-CONSJ�,`o- HASTINGS, MN TOWN OF BARNSTABLE LOCATION 33 fAiN. i✓' /21PI6 0 ~" L-11—�7 SEWAGE # :7.;�S4r('7/on�' VILLAGE jJ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 42, 00 64 LEACHING FACILITY: (type) C env (size) /1 D©O G6�, NO.OF BEDROOMS BUILDER OR OWNER Tw'0 t yer°f e,? PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 g fa ' ity) Feet Furnished by r� a- U 0 �11 . IOC AVT ION -# 33 SEWAGE PERMIT NO. „L-o T 93 VILLAGE I N S T A LLER'S NAME i ADDRESS BUILDER OR OWNER I 0� DATE PERMIT ISSUED ODATE COMPLIANCE ISSUED iy3o � I _ t y� _ o 1,r ' � 9.�s �r s 9- ��id6aw ��z�d� TOWN OF BARNSTABLE LOCATION 33 RQ;n 6ow .D R SEWAGE# 9019)-`" 42 VILLAGE Ccn4cru►I I L ASSESSOR'S MAPS&PARCEL Ir6le INSTALLER'S NAME&PHONE NO. B+eB EXCaVa'1 i o/N SEPTIC TANK CAPACITY 1000 9 a.l LEACHING FACILITY: (t)pe) AbS ARC 34 Al Z 0 (size) ly x 20 NO.OF BEDROOMS 3 OWNER c-ru 5oZAntNc PcrK PERMIT DATE: JDJ QG J12 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 r� Al- 1�.�� Az- rv' 33 03 Cy - 3 No. Fee 0 THE COMMONWEALTK OF MASSACHUSETTS Entered in comp ter: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Y ftplication for Mls Dsal �& stem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 33-Rh I nbouo-DY ner's Name,Address,and Tel.No. Assessor's Map/Parcel �� f r`4-pe Installerf 's Name,Address,and Tel.No. signer's Name,Sddr(ess,and`Tgl.No. — (�► dv �XCgVC��ton n�Ct�ort. , �ssl77-53(3 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �1?S I H No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.(r�e uired) gpd Design flow provided gpd Plan Date f (2 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 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 this Boar. Health. n Date Application Approved by ate Application Disapproved by Date for the following reasons Permit No. Date Issued 3 Fee THE COMMONIl1t 'AL�T OF MASSACHUSETTS Entered in computer: Y X-0 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS In �I�IYILatiOn for MIsflOsaY 6psteln Construction hermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System [I Individual Components Location Address or Lot No. 33—R 1��OuJ�( wner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 5 O� Type of Building: Dwelling No.of Bedrooms . Lot Size sq.ft. Garbage Grinder( ) Other Type of Building es,Sl a Q t C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re uired) 2S gpd Design flow provided gpd Plan Date �"�I�� Number of sheets Revision Date Title j Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board Health. S' n d O Date Application Approved by i ate Application Disapproved by Date for the following reasons Permit No. Date Issued TH,COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by U7 !��XL�1zj.u�)n at r �c 4��-��1�(�l� `��t"( has been cons cted in acco ace with the provisions of Title 5 and the for Disposal System Construction Permit N Installer-"(�`7 1 La)V Designer �(1L?• r��t�5 #bedrooms Approved design flow D gpd The issuance of this permit shall not be construed as a guarantee that the systerti wil`l•fu ct om a igned. Date - Inspec�c -------- - -- --- -------------- ------------ - ------- ---- ------------ ---- ® _ - � No. � � Fee �THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS R�C 30isposai 6pstem Construction Permit Oen:nission is hereby granted to Construct( ) Repair{ ) Upgrade( ) Abandon( ) System located at I Clb ,! V(-4V P (P�l 1 00 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:Con bt' n u/be completed within three years of the date of this permit. Date Approved by 11/15/2012 09:23 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable ' Re lstoq Services Thomas F.Geller,Director Public Heaitb Division Thomas McKean,Director 200 Maio Street, Hyannis,NIA 02601 Moe: 508-862-4fM Fax: 508-7W6304 Dater l r Z., Sewage Permit# Assessor's Map/PareelInstaller&Designer Certification Form AL-g'n+-ea �E. �+ Designer: �r��; n.t.4,r�•....� We r�_ r c Installer: ? 0 Addrm: ,z W. ern is 14 1RA, Addrem: /y T"L Cr M,4 On E �� Iccc­-4046— was issued a permit to install a (date) (installer) septic system at 33 0-,j V, r� �� based on a design drawn by (address) dated (designer) Y 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required)wa 4 ted and the soils were found satisfactory. N OF PETER T. (Installer's Sign ) I MC NTEE CIVIL y No,36108 q signer'sSignature) (Affix Design } PIXASE TO BARNSTABLE PUBLIC HEALTH DI CATE F UCANC WILL NOT BE ISSUED UNTIL B D UBL RECEIVED BY THE BARNSTABLE PI HE ALTH DMSION. T AN K YOU. q:lof&e formAdesignereartificatlorn form.doc Town of Barnstable P# . of Department of Regulatory Services • '" _ Public Health.D`i ' 'Vision Date. 12. 200 M in Street,Hyannis MA 02601 Date Scheduled T l ca CV. Tune Fee Pd. Soil Suitability Assessment for Sewage Disposal` Performed By: e ✓ M C �0��� Witnessed By: LOCATION& GENERAL INFORMATION.; Location Address 3 3 n� � Owner's Name ` 1 Ce Lk,-1A IIQ Address 33 " Do-"i �✓ Assessor's:Map. a /Parcel: Ce�.�-e'�%�1� p /f" Z Engineer's Name RIA-..-tkc NEW CONSTRRUUCrION REPAIR Telephone# _'90E-7,3 7-4.7 G C- . Land Use S1oP W ' 'tr' Surface Stones /JG" Distances from: Open Water Body ZG--' ft Possible Wet AreaaOC'o ft Drinking Water Well Drainage Way N ft Property Line ���ft .Other` ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&.perc tests,locate wetlands fn proximity to holes) -t : L t .� i2A,✓t Parent material(geologic) tJ'���r�P Depth to Bedrock A/r Depth to Groundwater. Standing Water in Hole: ' Weeping from Pit RACrs Estimated Seasonal High Groundwater Ci DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to soli mottles: In. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.&ctor, ,om� Adj.Groundwater Level,,,o PERCOLATION TEST Date,�,.�, Time.. Observation Hole# 2 Time lit9" Depth-of Pere sG` � Time at 6" Start Pre-soak Time 0 'Time(9"-611) ._ End Pre-soak Rate Min./Inch L Z— Site Suitability Assessment: Site Passed -)4— Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEFrrIMERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (Munsell Mottling (Stricture,Stones;Boulders. .-.. ,. Consistency, ,1 S. ...V DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) `C.16l DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color 5011 Other Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Man; Ab.^ie 500 year:flood boundary No Yes ... Within 500 year'boundary No ° Yeses Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervipus �atenai exist in all areas observed throughout the area proposed for the soil absorption system? _` -- If not,what is the depth of naturally occurring pervious material? Certification I certify that on (� � a (date)I have passed the soil evaluator examination approved by the: Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 31U CMR 15.017: Signature Date Z --- Q:\SEPTIC0E1RCFORWI.DOC TOWN OF BARNSTABLE ® Q LOCATION .22 !rC Aml now -e- SEWAGE # VULAGE 7&-r di/-e ASSESSOR'S MAP & LOT 8' -- qZ INSTALLER'S NAME&PHONE NO. /n >n r_Z9 .4 _C e 4�i C 2 7Q-a e" SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ZIZ2��14 7-7&-r (size) -&,V 2_< NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: - �I—9' 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 lAlf d3 . Alp F•s� al` . .• t s 6� ���'Y A� � L T f Y ` No. Fee e� '^y / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migponl *pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ';K.4idividual Components Location Address or Lot No.�� Cam`ti -y�/� Owner's Name,Address and Tel.No. Assessor's Map/Parcel `l '''f `• � (j,j Q f �� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. hAID-C-164 � 15 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ��. 3,17) gallons per day. Calculated daily flow �ci gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank F t4 tic Type of S.A.S. G (-1 Description of Sod �4-r/l� Nature of epairs or Alterations(Answer when applicable) 10c7 1 n' J z C'�✓6X r l% ✓ c. . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be ssuedfthis Bo Signed Date 9r� Application Approved by Date 19—19 Application Disapproved for the following reasons Permit No. 179 ` .S �r Date Issued 9k TOWN OF BARNSTABLE p LOCATION 2J 1✓c'A/IV Za G✓ e- SEWAGE # I VILLAGE �,� �. 7i?r ill ASSESSOR'S MAP & LOT A Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) r/Y.2 5 NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: 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 s i3l_-7 03 C' No. 0 Fee !THE COMMONWEALTH SACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Digaar *pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System individual Components Location Address or Lot No.:?3 czl\l Owner's Name,Address and Tel.No. Assessor's Map/Parcel ) It —`, �,Q J d `C, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'C Vol f ' C) +-C, Type of Building: Dwelling No.of Bedrooms_!257 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ,� gallons per day. Calculated daily flow `� ► gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank arc , _ F V-c�r� Type of S.A.S. r:_t rc. Description of Soff 1 Z WV Nature of epairs or Alterations(Answer when applicable) Z ,j C ✓" (� ✓ e 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 Certifi- cate of Compliance has beissued by this o off Signed Date Application Approved by Date - /9 (101 Application Disapproved for the following reasons Permit No. 19 S g Date Issued` P 7 F., - --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance ,.. THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired;( � )Upgraded( ) Abandoned( )by at IT—fFet/V has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. `1'9-5 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector r ---q Q—----------------------------------- No. '- / —S F r Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi!6poal *pztem Construction Permit Permission is hereby granted to Cons t( )Repair( )Upgrade 6/7"Aibandon( ) System located at v4I n and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this-permit. S � Date: 1 `/ ` g/ Approved by C- i f 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated IF— 99 concerning the property located at 3 ��4 vt: 6_-c .' Ce CJ meets all of the following criteria: �- The failed system is connected to a residential dwelling only. There are no commercial or business ZI es associated with the dwelling. e soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system --• There are no private wells within 150 feet of the proposed septic system r/• There is no increase in flow and/or change in use proposed L,e4 ere are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • . If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: / A) Top of Ground Surface EIevation(using GIS information) ( ! B) G.W. Elevation /010 +the MA.K High G.W. Adjustment . /t:�7 DIFFERENCE BETWEEN A and B 3�` SIGNED : DATE: (Sketch proposed plan of system on back]. q:health folder.cen i v Commonwealth of Massachusetts FMA IVE® Executive Office of Environmental Affairs De artment of 9 1997 Environmental Protection ARNs Wllllam F.Weld CMmmor Trudy Coxe Secretary.EOEA David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 11 CERTIFICATION Property Address: 33 Address of Owner: Date of Inspection: M11131 k°kg7 (If different) Name of Inspector: Inuce h0X_C.A::-C�r Company Name, Address and Telephone Number: 8tit�to.� S% CERTIFICATION STATEMENT C7s�ecv..l�e j(�l4 Oa.6S� ya8V�a4 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: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: ^ Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 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: AJ SYSTEM PASSES: _Iz-1 have not found any information which indicates that the system violates any of the failure criteria as defined 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 ofdetermination 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 8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556.1o49 a Telephone(611)292-SM Printed on Recyded Paper SUB SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A y '.f CERTIFICATION (continued) Property Address: 110 l"NOT Owner: Date of Inspection: BI SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water a boxed in the The sysembution box is due to will pass inspection broken(with approval of he pipe(s) or due to a broken, settled or uneven distribution Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled 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(aith approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CI FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: y the Board of Health in order to determine if the system is failing to protect the Conditions exist which require further evaluation b public health safety and the environment. t) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT SYSTEM IS :OT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE _ 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 PUBLIC UP IE AND SAFETY AND IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PR OTECT THEENVIRONMENT: _ The system has a septic tank and soli absorption system and is within 100 feet to a surface wale, supply or tributary io a surface water supply. p well. _ The system has a septic tank and soil absorption system and is within t�n 50 feet of a private water well. _ The system has a septic tank and soil absorption system an d is 1 _ 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 and volatile organic compounds indicates that the well is of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 free from pollution from that facility and the presence ppm- DI SYSTEM FAILS: r moe of the following lure 5.303. The basis I have determined that the system violates olat s The Boardrof Health should be'eo criteria defined one o ntacted o dete miine,what will be lnf'�sary to correct for this determination is identified below. the failure. _ m component due to an overloaded or clogged SAS or cesspool. Backup of sewage into facility or syste _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. 2 (revised 9/15/95) t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1Lhl�nbo�J dlR, Q✓l�2(�v�'(G Owner: 17Av'�p Cvr��e2, Date of Inspection: 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($). Number 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 too feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I 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 above: The design flow of system is 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 6/15/95) 3 ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 33 �ZA: '0'j 'b2tu c Owner: �D Av�!Z CV rr%.e.2 Date of Inspection: Mn-t 3t 1Rq1 Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks 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 a5 part of this inspection. Zs built plans have been obtained and examined. Note if they are not available with N/A. Zhe facility or dwelling was inspected for signs of sewage back-up. Z'The system'does not receive non-sanitary or industrial waste flow _�_ 'he site was.inspected for signs of breakout. ZAII system components, excluding the Soil Absorption System, have been located on the site. -Z—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. 4The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. V/ The facility o%%ncr (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 6/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 33 2Anpo, ��ft, l �e��•�'C Owner: ZAU�':� C.v tZ2i e2 Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 'YLJQ allons Number of bedrooms: Number of current residents: Garbage grinder (yes or no)::F$ Laundry connected to system (yes or no): if-Ps Seasonal use (yes or no): NO Water meter readings, if available: 0 Last date of occupancy: OAGb"N' COMMERCIAUINDUSTRIAL: V Type of establishment: Design flow: >allons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_,6[0 If yes, volume pumped: t allons 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known)and source of information: /98 3 O W I)e;2 tzecc,k"" Sewage odors detected when arriving at the site: (yes or no)�O (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �A��bec �(i; Ct-r,Aer'V C' Owner: DAV�o C.v""2 Date of Inspection: ``� 31 kSq' SEPTIC TANK:_ (locate on site plan) u Depth below grade: Material of construction: I/concrete _metal _FRP _other(explain) r, rr Dimensions: k= =5 7 W: /0 Sludge depth:_ I,/ _ Distance from top of sludge to bottom of outlet tee or baffle: 33 Scum thickness: O Distance from top of scum to top of outlet tee or baffle: IVA Distance from bottom of scum to bottom of outlet tee or baffle: RA 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.) GREASE TRAP: LVA (locate on site plan) Depth below grade: Material of construction: _concrete _metal 'FRP —other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance from bottom nl Frorn to bottom of outlet tee or battle 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, et(.) (revised 8/!5/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: tj 1ft. CE•.�t+�.�Ic Owner: 17Au o (',." irz, Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: F.r/ Comments: (note if level and d;stribot c- e%�demce or solids c?­vnver, evidence of leakage into or out of box etc) 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.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3.1 Owner: 11)F4.z o Date of Inspection: hINl31kgo') SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: 00069 - Type i.s leaching pits, number: " CuLT't oZ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: / Comments: (note condition of soil, signs of hydraulic failure, level of pondinb, condition of vegetation,etc.) . A/0 6jaaj cr A b e CESSPOOLS: (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 groundrvatel. inflow (cesspool must be pumped as part of inspection) . Comments: (note condition of soil, signs of hydraulic failure, level of pending, condition of vegetation, etc.) PRIVY: _ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n L SYSTEM INFORMATION (continued) Property Address: `"� j A)Rk Ct' Owner: Date of Inspection: l�l kf 3,l CtC1 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' W 0 `1 �u Q i \ O DEPTH TO GROUNDWATER Depth to groundwater: M t feet 4'v-, method of determination or approximation: 1/.S 6S <S�Rvcm A�A� (revised 8/15/95) 9 24'-3 irz" '-0 3/4' 3'-10" 3'-10" 1'-11 114" 3'-6"�4'-6"�8'-0 -'� B-0 �4•-6•�3'-6" -4'-0 1/4" t . ` ( 11'-31/4" 12'-23/4'.1, 1 i 0 � - � t- 1.J `-� r !? DIRECT VENT I �`t N GAS INSERT �v o (Wei n CATHEDRAL - �+---o'— CEILING \= P1,gTF6RM-1 l_J GREAT ROOM W 'DECK q SCREENED PORCH SCREE X 8-0 11a'X S' SCREE'" 6-O ----- FRENCH DOORS HARDWOOD FLRS- f (� 3 X 6-8LH � 1-8RH 93o6e� ��6HIGH - p 2-8 X g i STEEL BEAM OVER, 3-0 X g.g - WALLTO BE RATED AND SIZED BY - L SUPPLIER ! C.O. "v WITH WOOD ENTRY� MN? I DOOR 'v `----'-'-----.___.....--- -' CAP n _ (1 u 4 '.`oa POST POST (� POST, z2.q _ _ T DESK/COMPUTER �- - = - _� - -- O TABLE W/LEAF ' 4'-9 1n" ° r POSTI I REMOVE 5" I 3 1 WALLANSTALL -LAUNDRY r I FLUSH BEAM to LAV, 0 5'X6'� 'OVER :0� - ---��--, � 2:_9" 2CAR GARAGE KITCHEN '3-0 iwesl 4 19,X 11'-6•' 4 iJ N s'a 10" aos. N I WALK-IN CLOS- i°, 4'SHWR. aQ -------- -P.EF:- 11066 2666 9'-11rz" m zz. \ --- 2-8 MASTER TH I 1 3'-3 IQ" ( 2-8 I 16'OVERHEAD DOOR I v a ° W/iRA- OVER WALL T ^ - - O �- 6'TUB teo7o 36" 1=�� WITHIGH WOOD CAP —.—UP.— MASTER BEDROOM (19._9..X JT_8") (yyp6`i <woo woi) 3866 -3'-5 1/4"1--5'-2'• 5-7 3/4" 12'-0" -12'-0"— PROPOSED ADDITIONS/RENOVATIONS FOR THE GABELMAN RESIDENCE ✓ REVI6ED 12%9%O5 3058 '2/14/06 _ — 136 RAINBOW DRIVE I - — CENTERVILL E, MA. HARVEY WItJDOWS REYBURN ASSOCIATES i PLAN VIEW/1ST LEVEL - —--- ---....— - --- -- --'- ----'--- ----' ----: RLEANS MA O _..�_.-.___-..—,.___ _—_�.-...— SCALE 1/4"=1' woo ;orY_ _ -- IDEs'cRiPnoN :coDE—' —w BUILDER TO CONFIRM ALL i I---.._..-------„'-------.._............. -----__._ __.--- i W00 2 1 !DOUBLE HUNG TW24310 DI - - - - -------; -MENSIONS ON SITE DOUBLE HUNG_:EXIST � � -.����--.�- - �- -' SH EET 1 ;1 DOUBLE FiUNG":SCREEN ; `- -`-'a------•---'--- 'W03 '. 6 1 DOUBLE HUNG-?TVi2442 UVITH t'TRANSOM OVER- W04----__; 3 1 DOUBLE HUNG JAN25'I(RO 2'-4 7!8"X 1' .WOS ,1 ;DOUBLE HUNG :T'W244G i '� 4 HAfRVFY WINDOWS NUMBER OTY FLOOR DESCRIPTION �_CODE_—_ _ _ _ —__,� GREAT ROOM ROOF i.—`W0-0 i DOUBLE HUNG i EXIST --------------- '— --------- ;AWNING-----'A3,-------------...�.-...-------' . `W02 i 3 2 'AWNING i AW25, . � I LW037----2_.__.-__-,-;FIXED GLASS�AFFW601(ROS'-i,3/4_'X 1'-10_'j ANDERSEN.--� SHED ROOF(PORCH) I J i1 ENTRY ROOF ILI L � ADD 14'DORMER - SET IN 3'FROM REAR WALL _ O2'-0 1!2" RELOCATED A ' 11 REMOVE WND. WNO. GARAGE ROOF m O BEDROOM _ 01 BEDROOM ��ea ease - BEDROOM _ � N - r COMMON AREA T-6„ OPEN TO BELOW PROPOSED ADDITIONS%RENOVATIONS FOR �W00 THE GABELMAN RESIDENCE 36 RAINBOW DRIVE CENTERVILL,E,MA. ' REYBURN ASSOCIATES --------- _.....-- ACE` ORLEANS, MA. PLAN VIEW/2ND LEVEL BUILDER TO CONFIRM ALL DIMENSIONS ON SGTE —'-"'-- SCALE 1/4"=1 -------_.._.----.., - --- SHEET 2 ,I 1 -- 106 -- EXISTING CONTOUR N x 100.98 EXISTING SPOT GRADE N 31' � RO�jE 2$ 33 OS' V1i W EXISTING WATER SERVICE 34 93' a G EXISTING GAS SERVICE U UNDERGROUND WIRES LOCUSCD ea c TEST PIT �,�`� �;o BENCHMARK a o. LEGEND �° d s R\�at R B�mP o 0 Bumps River Rd 0 LOCUS MAP NOT TO SCALE EXISTING II HOUSE#33) LOT 5 .�� MBL 188- 142 F ' 17,359±SF Aj o U, •`i i 69 a C �p 3 ` SHED 2 O O 1 c,� a �N 0) + 105.56 LA �1427- u� vi SPIKE N � LO N j �a N I ----------- S.A.S. LAYOUT 1 -"104 1 106.01 PK SE 104,03 103,88 GARAGE 1 106.12 BENCHMARK SET 1 104.53 i `__ - — •' �_ MAGNETIC NAIL SET _ �� _. ._ _ EL.=104.03 (ASSUMED DATUM) DECK , i 1 x 103.86 0E88 Z j 105.56 1 o I i Q- I1 i 103.36 02.52 I 102,28 EXISTING HOUSE(II33) _ : �l O 1 � T.O.F.=107.4t � I m i 104.9 EXISTING SEPTIC TANK i I TOP OF TANK, EL.=103.61 107.02 1Q5!67 1 102,481 J ) I INV.(OUT)=102.28f SHRUBS x x I 4, 8 INSTALL 40 MIL POLY LINER SHRUBS i o BETWEEN S.A.S. AND CELLAR 106,82'- 46J.'78o • �- �r TOP OF LINER, EL.=102.0 107.56 TP-1 TP-2 106,93 r BOTT. OF LINER, EL.=98.5.0 , c PARTIAL STRIPOUT r (SEE NOTE 11, SHEET 1) £ J 107.35 r \l v?T ;gj,85 i ,C 101,37 t 107.61 106,75 ll nY� /� i I, I EXISTING S.A.S. 1 TO BE REMOVED 1 .40 (SEE NOTE 11, ,SHEET 2) 106.28 I 10 _ 107,09 ,--' ` 3MP 101.46 105,17� .�- r' VENT & C� 03.99i x 9,7 . 104,07 0 / -J ' L=116- -242 1� / 01.16 100,4$'73 R=365.30' ,�' E 404----- --- 98,92 103,97 104,65 _� i� catchbasin a 103.58 10� PK SET 99,31 99.10 102.64 edge of povement 101.06 100.00 RAI NBO I N DRIVE INSPECTION PORT of 4gss9CyG PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN McENTEE CIVIL N 33 RAINBOW DRIVE CENTERVILLE, MA No. 35109 RfPSIER `�� Prepared for: Barry & Suzanne Peck, 33 Rainbow Dr, Centerville, MA P�F $ ENS OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. PECK, BARRY G & SUZANNE K Engineering Works, Inc. 1"=20' P.T.M. 225-12 33 RAINBOW DRIVE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (508) 477-5313 9/24/12 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.101.8 SEPTIC TANK PROPOSED D-BOX FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT PROPOSED S.A.S. PERIMETER OF THE S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE INSTALL INSPECTION PORT OVER END UNIT T.O.F. CHARCOAL VENT EXISTING F.G. EL.=105.3t F.G. EL.=105.5t F.G. EL.=104.5-105.8 MAINTAIN 2% GRADE (MIN.) OVER S.A.S. n 'P L = 26' L = 9'(MAX) INSPECTION S=1% (MIN.) ® S=1% (MIN.) PORT 4"SCH40 PVC 4"SCH40 PVC 6" 10"I B 14" 10.75" TO EXISTING 48" LIQUID INVERT LEVEL ADD L ►� GAS BAFFLE INV.=101.67 PROPOSED INV.=101.50 5 ROWS OF 4 UNITS AT 5.0'/UNIT = 20.0' INV.=102.28t D-BOX INV.=101.40 EXISTING SOIL ABSORPTION SYSTEM (PROFILE) EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: BREAKOUT=TOP 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP ELEV.=101.83 INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=101.40 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED BOTTOM ELEV.=100.50-� SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 2.83' 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF 3) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=14.2' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EXISTING SUITABLE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO G.W. TO EL.=94.2 - MATERIAL USE 5 ROWS OF 4-ADS Arc 36HC UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. SOIL LOG GENERAL NOTES: DATE: SEPTEMBER 4, 2012 (REF#13,724) 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL EVALUATOR: PETER McENTEE PE (SE#1542) BOARD OF HEALTH AND THE DESIGN ENGINEER. WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ELEv. TP- 1 DEPTH ELEv. TP-2 DEPTH OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 106.5 O 105.7 0 -310 CMR 15.405(1)(b): FILL FILL - - 1) A 10'-variance, S.A.S. to -cellar wall, for a 10' setback: 104.5 A 24" 104.7 A 12" 2) A 2' variance to the 3' maximum cover requirement, for no SANDY LOAM SANDY LOAM more than 5' of cover. S.A.S. shall be H-20 and vented. 104.0 10YR 4/2 104.2 10YR 4/2 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR B 30' B 18" TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE SANDY LOAM SANDY LOAM DESIGN ENGINEER. 10YR 5/8 10YR 5/8 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 102.5 48" 102.7 42" FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN C C ENGINEER BEFORE CONSTRUCTION CONTINUES. PERC 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 42"/54" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF M-C SAND M-C SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 2.5Y 6/4 2.5Y 6/4 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE PROPOSED S.A.S. 95.0 1 138" 94.2 138" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS IN 2 MIN . C" HORIZON AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE PERC RATE < ) DIRECTED BY THE APPROVING AUTHORITIES. NO GROUNDWATER ENCOUNTERED 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH THE AND FOR 5' AROUND THE PROPOSED S.A.S. 63.25" AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 15.255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY THE HEALTH DEPARTMENT PRIOR TO BACKFILL. 16" 34.5" DESIGN CRITERIA TOP VIEW 60" NUMBER OF BEDROOMS: 3 BEDROOMS END CAP END CAP ' SOIL TEXTURAL CLASS: CLASS I FRONT VIEW SIDE VIEW END CAP fffff DESIGN PERCOLATION RATE: <2 MIN/IN REAR/TOP VIEW It& 'i DAILY FLOW: 330 GPD NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW DESIGN FLOW: 330 GPD TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. GARBAGE GRINDER: NO LEACHING AREA REQUIRED: 330 GPD = 445.9 SF 4640 TD, OHIOEMAN BLVD ( ) EWS HILLIARD, OHIO 43026 Arc 36HC DETAIL fik .74 GPD/SF AWANCED DMNAGE SYSTEMS,INC. UNITS MUST BE STAMPED H-20 EXISTING SEPTIC TANK: 1000 GALLON CAPACITY, H-10 RATED PROPOSED SEPTIC SYSTEM UPGRADE PLAN PROPOSED D-BOX: 1 INLET, 5 OUTLET (MINIMUM), H-10 RATED USE 5 ROWS OF 4-ADS Arc 36HC UNITS WITH No 33 RAINBOW DRIVE, CENTERVILLE, MA SEPARATION BETWEEN EACH ROW & NO STONE Prepared for: Barry & Suzanne Peck, 33 Rainbow Dr, Centerville, MA BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) Engineering by: SCALE DRAWN JOB. NO. (Arc 36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF Engineering Works, Inc. N.T.S. P.T.M. 225-12 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(480.0 S.F.) = 355.2 G.P.D. (508) 477-5313 9/24/12 P.T.M. 2 Of 2 ............./ sue �; FE$.. ......_. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH -- ..... OF........ �......�._....-_--------- ....?�......................... �3 Appliratiou for Disposal Works Tonotrnrtion Vernfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Adddrejs� No. ... �=c .1..!!.t'� ..L..r 0. vzz.--..41...�fA..<.. __.....��......G ............................... .... n .._..... w er - Address ..................................................... ......••-_....---------•------•-••--...._...........__•-••--......._..........__.................. Installer Address o� Type of Building Size Lot_../._l___�..Sq. feet �. Dwelling—No. of Bedrooms...........:.... •---__---__..._----_Expansion Attic ( ) Garbage Grinder ( ) '4P4 Other—TYPe of Building ••--•-•--------------------- No. of persons.........._ Showers (`r Cafeteria ( ) Otherfixtures ----------------------------------------------------- -•------------------------------•--- -------............................... W Design Flow............................................gallons per person per day. Total daily flow............ __�,f�. .............gallons. WSeptic Tank—Liquid*capacity./94.cg'allons Length................ Width................ Diameter._.____._______. Depth................ x Disposal Trench—No..................... Width.................... Total Length....................Total leaching area___,2.6.4(;_sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tor—� •- ~' Percolation Test Results Performed by........ ,f�lr ._.�- .......... Date....._ ! _._l,..0._._ ._....��� .minutes per inch Depth of Test Pi�............. Depth to ground w ter_____._..__._.._....._ -Test Pit No. l�l__..._ - L� Test Pit No. 2--------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ O C.--.GJ.�4c /- Description of Soil........,�'�mx..c�.....C� ..� x 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ed by t oard o health. / -------•----------_----- ........... ----•-• �— at Application Approved By:.. � - '��. Date Application Disapprov f he following reasons:.......................................................................--..................................... •........................................ .............•-•-----•----•--•--------•-•••-••----------........ • Date PermitNo.........---.............................................. Issued....................................................... Date No........_....._....... FEE....,..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ....................OF........ Appliration for Uhipml Works Tontitrartion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal cyst at: A ........... ..........ir A_-0.00-00........................................................... �Lo ati n-Address r Lot No. 0- 0V ..................... ..4—Zeo. .....jvl-z------ �r,_.o.........rit2�t Owner 0,/ .....4 .................... :e ........ ........................ ................... .................................................................................................. Installer Address Pq Type of Building Size Lot_._. __ feet U Dwelling—No. of Bedrooms--- Garbage Grinder --------------7-------- Attic Other—Type of Building ............................ No. of persons....__.__.__ ............ Showers Cafeteria Otherfixtures ......................................................................................._........................7n......................... Design Flow............................................gallons per person per.day. Total daily flow.............;?--—----—-_---------gallons. 040 Septic Tank—Liquid capacity./6.6.tallons Length.......I.......... Width................ Diameter__._____.._..... Depth_............._. Disposal Trench—No....................... Width......_._._.._...... Total Length..___............._. Total leaching area.--.24.6sq. ft. Seepage Pit No..................... Diameter....._...___.__..... Depth below inlet.._................. Total leaching area..................sq. f t. Z Other Distribution box Dosing tank .., Percolation Test Results Performed by--------- ......... Date_._...._ _ ............ Test Pit No. Lj!�efj...mutesperinch Depth of Test Pit....._....... Depth to ground wMer/ rX4__ Test Pit No. 2.-J&Z-70.67— inminutes per inch Depth of Test Pit.................... Depth to ground water........................ ............ _­........ ......... ................................................................................ ................... 0 Description of Soil.......... Ao-m '3.. .. ............................................................................... 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 TLITIE 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been d by th and o iealth. tZha/rdo ieal.th ­<ign/. . . ... .. .. .............................. .......... ..... ........ VZ Application Approved By.... ........................................................................ .......... ....... ................. Date Application Disapprove or e following reasons:................................................................................................................ .......................................... .............................................................................................................................................................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tprfifiratr of Toutpliatta THIS IS TO CERTIFY, That the Indivi al Sewage Disposal ystem constructed or Repaired . .............................................................. by................0. e,e-k le.4. Installer ..................................................................................................................................................... ...... ---------X-------------- has been installed in accordance with the provisions of TITIER ate Sanitary Code as at........... .Min� the application for Disposal Works Construction Permit No.__...yl_ .... dated-.... . ........... . ....... . THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE.CONSTRUED-AS A GUARANTEE THAT THE SYSTEM WIL/F CTION SATISFACTORY. DATE../k'L.M. ....................................................... Inspectore< ------------------------------- ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH >.........., f3oo ..............71?.................OF...... 7.,a. 4...................... / ... ... 4............ ........... No FEE....... . ............ iosul rh'n Tli str"tt rautit Permission is hereby granted------............... ......... ... .............. ..4----/ !;�.............................. to Construct or Repair an Individual Sewage sposal System p atNo................................................................................................................... Street as shown on the i applicat , It application for Disposal Works Construction Permit No_ ---- Dated......................................... ......................... ...... ..................Z.................................................. DATE...l Z y .......................................•••-_..... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 61 el. T L�220/ Z�Lo ZL- h `� poi s r \ b \, 9b 01)� d T 4� �� z 1 v� •� o hoc o _r 0 7_ � �1 `_L. D , 3s� p), X AN S G \ o RSE -' Q No.10951�p Q FSSIONAL LEGEND mow'' CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION Ox0 r�<,tk uF; EXISTING CONTOUR ---.-- 0 --- o i-.S ROBERT FINISHED SPOT ELEVATION BRUCE ���✓7e'- �� L - FINISHED CONTOUR 0 v ELDRE IN ti APPROVED , BOARD OF HEALTH A TV-"k��� o�' � It�'l S"�° S 1 4,W�-�A • a lgNo DATE AGENT ' SCALE, l"- `�� DATE ' Ni ck A S $LDREDGE ENGINEERING CO. IN CLIENT. . I CERTIFY THAT THE PROPOSED F EGISTERE REGISTERED JOB NO. '9� BUILDING SHOWN ON THIS " PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER ,SURVEY R DR,BYl -4-''9` OF BARNSTAB E ,• MASS,, 712 MAIN STREET CH- BY' /Z, /3• 5. �� H YA N N I S, MASS.Z ' 5HEET,.L OF DA E REG. LAND SURVEYOR ?O F7 M/iK 70TF . /F A-=/7'NE.4 ::V5 .- a ' ScPTi_ ;AN:r OR 1 /O Jar. M/N A.fE /`'10RE 7,gA.V /2"'3.FL^.`V . $.4AOE, /4 2Q �O/�,N.,FT�.? �O yCR c?-E CC!/E �.,�•� • CONCRCrQ q'oYC O/Pt SNA EuG /T 7-0 G'TA DEr n• `- 2 COYERs LAYC AWN.PYr4V . PAW Or. 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