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HomeMy WebLinkAbout0173 ROLLING HITCH ROAD - Health 173 ROLLING HITCH RD Centerville 'A = 192 — 101 SMEAD'I No.H1630R UPC 10259 smead.com • Made in USA f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments COP w,. 173 Rolling Hitch Road k M Property Address - — T. Robert&Anna Crocker t Owner Owner's Name 4�I information is Centerville MA 02632 February 18, 2015 required for every y page. City/Town State Zip Code Date of Inspection 4o t;:h ca Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, �-- use only the tab 1. Inspector: key to move your cursor-do not Patrick T. Sullivan use the return key. Name of Inspector Ready Rooter Excavating re Company Name P.O. Box 89 _ Company Address Forestdale _ MA 02644 City/Town State Zip Code 508-888-6055 S112843 Telephone Number License Number B. Certification 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority February 18, 2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. UD I I I I t5ins•3/13 Title 5 Off#1sp ion Form:Subsurface Sewage Di s osal�,ystem, •Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 173 Rolling Hitch Road Property Address Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. % The septic tank is metal and overa-tion 0 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial inf� or exfiltration or tank failure is imminent. System will pass inspection if the existing tank isTeplaced 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 t t the tank is less than 20 years old is available. El ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M •''y 173 Rolling Hitch Road Property Address Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out 9pbigh static water level in the distribution box due to broken or obstructed pipe(s) or due to/ rt�oken, settled or uneven distribution box. System will pass inspection if(with approval of Boar of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is le v led or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below).- obstruction is removed ❑ Y A❑ N ❑ ND (Explain below): C) Further Evaluation is Required by th Board of Health: ❑ Conditions exist which require furthe evaluation by the Board of Health in order to determine if the system is failing to protect publi health, safety or the environment. 1. System will pass unless B rd of Health determines in accordance with 310 CMR 15.303(1)(b)that the syste s not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 i . r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 173 Rolling Hitch Road____ Property Address — - Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption syit m (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a su ace water supply. ❑ The system has a septic tank and SAS and the AS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and supply well. a SAS is within 50 feet of a private water ❑ The system has a septic tank and SAS and t 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 ana sis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the resence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no o er failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts w . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ,•'' 173 Rolling Hitch Road Property Address ---— Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure e criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 40 feet of a surface drinking water supply ❑ ❑ the system is withi 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is to ated in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA r a mapped Zone II of a public water supply well If you have answered "yes" to a question in Section E the system is considered a significant threat, or answered "yes" in Section D bove the large system has failed. The owner or operator of any large system considered a significa t threat under Section E or failed under Section D shall upgrade the system in accordance with 0 CMR 15.304. The system owner should contact the appropriate regional office of the Depa ment. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 173 Rolling Hitch Road Property Address Robert&Anna Crocker Owner Owner's Name information is required for every Centerville _ MA 02632 February118, 2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has bee n determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms 355 GPD 3 (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Rolling Hitch Road Property Address - Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. CItyfTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2013=430 GPD* Detail: 2014= 331 GPD* *Note: High water usage during summer months due to pool and irrigation. Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to th Title 5 system? ❑ Yes ❑ No Water meter readings, if availabl . t5ins•3/13 Title 101icial Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,. 173 Rolling Hitch Road_ Property Address -- Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Ready Rooter records: Pumped Sept 2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 173 Rolling Hitch Road Property Address -- - Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Septic tank >20 years old. D-box and SAS installed 12/20/2011. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/a feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5' x 4.5'X 4.5' 1000 allons Sludge depth: 1 1. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 173 Rolling Hitch Road Property Address — - — Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 1"at outlet 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 14" How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet PVC tees in place.Liquid level at outlet invert. Risers bring covers within 6" of grade. Zabel 1801 Effluent Filter in place in outlet tee. Cleaned during inspection. Recommend filter cleaning every year and maintenance pumping every 2 years Grease Trap (locate on site plan): Depth below grade: feet Material of construction.- El concrete ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from tope or baffle Distance from bott outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Rolling Hitch Road Property Address ------ Robert&Anna Crocker Owner Owner's Name information is Centerville required for every MA 02632 February 18, 2015 page. CltylT'own State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fi erglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of arm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 173 Rolling Hitch Road Property Address Robert&Anna Crocker Owner Owner's Name information is Centerville MA 02632 February 18, 2015 required for every ry page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): One inlet, four outlets with speed levelers in place. Equal flow. No solids carryover. No high water staining over outlet inverts. D-box is H-20 with riser. Cover within 6" of grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump cham r, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 173 Rolling Hitch Road Property Address Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 20-ADS ARC3616 Units ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions,- El overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No standing liquid in inspection port at time of inspection. Light staining 2" up from base. No sign of past hydraulic failure. Inspection port is 4" below grade. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflo ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 173 Rolling Hitch Road Property Address Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of7signsso', ydraulic failure, level of ponding, condition of vegetation, etc.),. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 173 Rolling Hitch Road Property Address Robert&Anna Crocker Owner Owner's Name information is Centerville MA 02632 February 18, 2015 required for every ry page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0. C% = 3 , ' v4 101 'e : 10 C � 3 � 1 � a6'10 ' I i � I T6cJ+n. Wor t5ins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 173 Rollin Hitch Road ___ Property Address — — — Robert&Anna Crocker Owner Owner's Name information is required for every Centerville MA 02632 February 18, 2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >5.3 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12/12/2011 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain.- Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: maps.mass is.state.ma.us/oliver.ph You must describe how you established the high ground water elevation: Test hole in 2011 found no ground water at 10.5' (elv= 40). Base of SAS at elv=45.60 per engineered plans. accessed local ground water contours and topo mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 "-"---•- — U- ..r0«118 %J1111 - IMUL tvt rviutrtaty 11JJCJJIIICIIW 173 Rolling Hitch Road Property Address Robert&Anna Crocker n Owner Owner's Name information is required for every Centerville MA 02632 February 18 2015 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P# Department of Regulatory Services Public Health Division Date MAO& Main Street,Hyannis MA 02601 Date Scheduled / ) ),57 Time L/ Fee Pd. v Soil Suitability Assessment for Se e Disposal Performed By: Witnessed By; LOCATION& GENERAL INFORMATION Location Address Owner's Name kc,k, roc Y.c.r Address `�3 �o( (: +.� Assessor's Map/Parcel: 4 Engineer's Name NEW CONSTRUCTION REPAIR Tellephone# S-%Z)'P- 73 7 - V)7 Land Use a Slopes(%) — ®(o Surface Stoaes O Distances from: Open Water Body A ft Possible Wet Area N A ' ft Drinking Water Well N/A ft Drainage Way N I ft Property Line f ft Other ft t SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) -Tp-I G(,s+I S Bctf M Tp 5 e V Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: N Weeping from Pit FpCe ,A Estimated Seasonal High Groundwater I A DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: In. Depth to weeping from side of obs.hole: in. Groundwater Adjustment f. Index Well# Reading Date: Index Well level_., .__ Adj.&ctor— Adj.Groundwater Level PERCOLATION TEST bate Iz ► It Utne o',00a, Observation Hole# _TP_1 l Time at 9" }0 Depth of Pcrc Time at V Start Pre-soak Time @ y0"00 Time (9"-G") gi 00 End Pre-soak (� 00 RateMin./lach Site Suitability Assessment: Site Passed_� Site Failed: Additional Testing Needed(Y/N) f µ 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:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.%'Gravell low- 31 - 30 S)t, 30-Sl CI •F-K LS o LI la S i "l der Cti CLS 1'D Q- ��� �otlf!. G ruve, i;�rr d Sb u DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Grave b-1 A—+ -MSS b g,31� C-ASL Io�� s1te a-�- CI F-M Ls a ICI, L�-S • to o. 4& 4A Gravel • DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenev.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories:Boulders. Consistency, Flood Insurance hate Man: Above 500 year flood boundary No Yes_. Within 500 year boundary No ,+ Yes Within 100 year flood boundary No.:V Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material 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 ov �0�" (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 traini g,expertise and experience described in 10 CMR 15.017. �. Signature Date • QASEPTICTERCFORM.DOC TOWN OF BARNSTABLE LOCATION r 'Z 3 J SEWAGE# Qo\\- L` VILLAGE Ce-�z J v �� ASSESSOR'S MAP&PARCEL d INSTALLER'S NAME&PHONE NO.�z-o�Q" �;\�J"`�nc S'®9 `CTV SEPTIC TANK CAPACITY j�UC7 o� S C� •5�:� q� o SS LEACHING FACILITY:(type) QtZ A9NC-a r.l Co . (size) NO.OF BEDROOMS -zed` b�nb --S L-1 ry OWNER j-- PERMIT DATE: 1 Q I(t=, O` COMPLIANCE DATE: a 0 d a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7 Cj ' 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 C% =3 C O � La 3 ► In 4 o- - A Q _ i i I I - No.v`'I I — 1` T r Fee " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Disposal 6pstrm Construction 30ermit Application for a Permit to Construct( ) Repair( ) Upgrade(✓ Abandon( ) ❑Complete System Egfndividual Components Location Address or Lot No. — Owner's Name Address and Tel.No. t-�C fit•.< <cn (Z�I @.off-�r C 1C Assessor's Map/Parcel 0 Installer's Name,Address,and fel.No.9Ne.Ac_Q-,( RoaTtr ,Designer's Name,Address,and Tel.No. P.C), 2,nn(--x 3 `d 8g- 6 CAS.$- �� , 34 K `e?O3 O S­4 Se'- 2 S"6 �Je Type of Building: Dwelling No.of Bedrooms Lot Size i 067 n sq.ft. . Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3© gpd Design flow provided 2,s—s— gpd Plan Date (� \ S Number of sheets Revision Date Title Size of Septic Tank p�Z?O CtN COX:S777v,! >Type of S.A.S. AV" C, CICt Description of Soil Nature of Repairs or Alterations(Answer when applicable)`�,�, ,� - c-) p 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 of Health. Signed Date (� Application Approved by T, c Date Application Disapproved by Date for the following reasons Permit No. C901 1" q-11 Date Issued ) —(6 _` to No.gigot -.. � �' t Fee �/V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Misposal- pBtpm Construction Permit Application for a Permit to Construct( ) Repair(. ) Upgrade Abandon( ) ❑Complete System 55454ividual Components Location Address or Lot No. (.1 3 �o`\ �S �oQ� Owner's Name,Address,and Tel. Assessor's Map/Parcel c `_ '`� �'`�G _ Z� Installer's Name,Address,and fel.No.p o� moo-fir, Designer's Name,Address,and Tel.No.1. p�v g 60SS- Sow - -.,)G1-" - 3.7s Type of Building: Dwelling No.of Bedrooms Lot Size �t� �,h n sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) r gpd Design flow provided _� gpd Plan Date (/ �� (' Number of sheets ' Revision Date E Title Size of Septic Tank 1,C)20� Go\ �_t-y , Type of S.A.S.�C:�, I;Z C 3�\C � r rS Description of Soil t Nature of Repairs or Alterations(Answer when applicable) G) Date last inspected: Agreement: d 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 III Compliance has been issued by this Board of Health. Signed / Date \�T(C. _ Application Approved by Date 4) - 1 /o- / 'Application Disapproved by Date for the following reasons i -,TM Permit No.' i190 f/'- V Date Issued ----- ----- ----- --------- ----- -- ----------------------- THE COMMONWEALTH OF MASSACHUSETTS .4, BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by - at 1 1 7k ��T� ��T�— � _��,����; has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a t)J dated Installer C ,a-�-sT Designer #bedrooms Approved design flow `� gpd The issuance of this permit shall not be construed as a guarantee that the system wilVf—et'on as designed. p t Date ' .�#r Inspector --------------------------------------------------------------------------------------------------------------------------------------- No. a I ' Fee I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(-,I' Abandon( ) ti_ - System located at \c��, =D C"�?„--}-r• �,i g 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.' i i Provided:Construction must be completed within three years of the date of this perm4_. n / f r Date d - 6— / Approved by i t 1 Town of Barnstable Regulatory Services Thomas F. Geiler,Director a & Public Health Division t639. ``� Thomas McKean,Director Fn Mo+' 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 12 Sewage Permit#22 rl-'-lam Assessor's Map/Parcel �z o �7 Installer&Designer Certification Form Designer: CS NI Zn�,►ne.er,n� Installer: Address: 9,0 3a Address: was issued a permit to install a (date) 'nstaller) septic system at �Zj hA Mc YLA . Ccsl�Cr,/IIIt, based on a design drawn by (address) Cis+ r, dated JajI->-J it (designer) 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 ' s. Plan revision or certified as-built by designer to follow. Stripout (if requ 88D' s d and the soils were found satisfactory. y LINDA J. cy� / U PINT O CP A L (Installer's Signature) No 46 p G(S T ER������ . S�ONA L E��'\ (Designer's Si ature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\designercertification form.doc I ti Ll -51 � I QOl 71 ZZ �\ 1 I �P\ I lbvWl l ,I Pkl t� s r 1% e V' �' > c� LOCATION SEWAGE PERMIT NO. 11` VILLAGE jisic 4 1-73 INSTA LLER'S NAME i ADDRESS 0w ER AA 9 DATE PERMIT ISSUED -/QC/Aro DATE COMPLIANCE ISSUED - - �� r t* , � -� .� A w �. ��� ��� �J , .._.. ..... �y r THE COMMONWEALTH OF MASSACHUSETTS BOARD Qf HEALTH ...........OF......... ........ ..................................................... Apptiration for vwpaaal Workii Tomitrurtion Famit x Application is hereby,made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: ........ ..... . ` .....__...... ....._..............--- ---- ,: L tion-Address T• �, qi' Lot No./\ ..........................................•-- ........ �.-G%/C�u_/ W t,40 --• Owner dress ------------- ........................-................................. .._'- ----- - _. .. ......------•-•-----•-- a ; Address,� Installer � 5} n u d Type of:Buildin Size Lot... ... ......... Sq. feet aDwelling No. of Bedrooms._._...................................Expansion Attic ( ) Garbage Grinder p-, Other-Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria P, d Other fixtures ------------=----- -- - ----------------------------------------------------------- ------------------------- ...--------- W Design < low__:........._ ___ ._ Ly lions per person per day. Total daily flow...___._ ,. . _._ gallons. WSeptic Tank Liquid capacity_ �- allons Length________________ Width.......__._.____ Diameter--._-_________-- Depth.............._.. x Disposal Trench—No. .................. Width..._.. .._.......... Total Length............ ...... Total leaching area....................sq. ft. ..... Diameter.__...... _ Seepage Pit No............ ... �..__ Depth below inlet....... ....... Total leaching area.. :_aq. ft. Z Other Distribution box ( ) Dosing ( ) ��� Percolation Test Result Performed by. ' `�W Date&.. .t.e.,&n� �Test Pit No. 1_ s_ minutes per inch Deptl of Test Pit____________________ Depth to grour.._:...__............_, Lt, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-- ------------------ . Description of Soil.....Q v� - .t om'--- - - W Nature-of Repairs o. Alterations—Answer when applicable ....---•-----------------•-----•-•--•------------------•--•--------...------ U P PP Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with, the provisions of L i:I- y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to place the s stem�in operation until a Certificate of Compliance has been ' ed by the board o,f4iealth. Si Application Approved B .....__ _ _._ `_.2 ,at q afc PP PP Y �- --- --• -••--- ---��. .. ...--••..................•-- --� Date ...... Application Disapproved for the following reasons:................... • .• •- -------------••----••-...-------•------•-•--•-•._....--•••---•---•-•--- {- Date Permit No..........................,. .1 ....... Issued_ d -•---••------- 6� O —.� Date y .............................. THE COMMONWEALTH OF MASSACHUSETTS Q 0 A R D HEALTH .. ...........OF....... .................................... Appliration for Dhipmal Warkii Tomitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Systerun at ........ ....... .. ................................................................... ati.. Address LotN ..................... ......... 0 A---- . .... ner . A_r6w .. ddres .................---------------------------*­......... .............................................................. Installer Address ---- U Type of Build' Size Lot..1'9AAI� S fe t - Dwelling7No. of Bedrooms._._.sa__________________________________Expansion,Attic Garbage! Grinderq*;J)" a Other—Type of Building ............................. No. of persons............................ Showers Cafeteria Other fixtures .......................................w................................................ ---------------­-- ..................... Design Flow. ........ lions per person per day. Total daily flow------- ..........gallons. Liquid capacity/9 Septic Tank :1..�allons Length________________ Width._____._._._..__ Diameter..._.___________ Depth___.____.___._.. Disposal Trench—No .......... Width..,_p_._._.\6_e_ T6ta,Lengt Total leaching arcp_,-�-----------------sq.-ft. inlets T s(rj t. Depth Seepage Pit Nc........... below .... ........... Total ar 4 1 kV -� /' 4 Z Other Distribution box lz% Dosil�g nk,.(N ) "N Percolation Test Result Performed by---- ---- --�U-tr$,................................... Date- Dept17( Test Pit No. 17 �—. _-.minutes per inch of Test Pit-------------------- Depth to ground �fater.____..___......__._.__. 2- ­'i fZq Test Pit No. 2................minutes per inch Depth of Test Pit_______..__.______.. Depth to ground water________--___________-_. P4 . �'­_ - / ;7/ 0 ----- ---- 4-W-------------- -------- -- 7—------ ......................... DDescription f Soil..... .. .. MW.. .... ... /* .................................................... U ---­--------- ---------I ....... ---- - -- ------------------------------------------------------------------------ 'i tw U Nature of Repairs or Altera'ions—Answer when applicable._____________________ ------------------------------------------------------------- ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT1, 7 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been jsst.jed by the board of health. ......... ..P A S, .............. ..................... Date Qe Application Approved By....... A,, . . ...........z............... ........ . .... ....... • Date Application Disapproved for the following reasons:.................. ............V...................................................................... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 'BOARD OF, HEALTH "a r r...........OF...........Jg��. ............................................... Tertifiratr of Tompliaurr IS S CERTIFY, That the Individual Sewage Disposal System constructed or�Repa ed by ---- ................. ---------- ... .... ....... . --------------- ------­------ ------------------ Installer at ... ..... .... .... .......... .. ..... .. ...: - - .. . .,.Z ,-. . ..K- ---- ---------------­----­- e �i has been installed in ccord with the provisions of of e State Sanitary Cp�de as e5l;qied in the t 4�. .................. applicati6h for Disposal Works Construction Permit N ............... dated__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIV FUNCTION SATIS ACTORY. .................... ...............DATE_.......- ..po......................... Inspector.... THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH .......... ...04.1r, ..........0 F_. to. . . ........................ FEE....................No................. ... Permission is ranted.,A_1../..t............. .................. .._11ereby --------- --------------------- ......... ......... to Con uct Re..Kir an I ivi ual Sew' DrsyCs4 Syst at ... .. ....... 1Z Sheet as shown on the application for Disposal Works Construction t No.. ated... ... ............ .......... V A Ze"14 e A ............................. Board of Health DATE.. 67 ? a.............................................. FORM 1255 HOBBS & W RREN, INC., PUBLISHERS I TESLd ' tT G,L•. .• l S G ... _tt b Y7V S./-` l 2Q t jN'7�,� i f ,3vic i 0~O'Y2'L C7Ai'W 4 ,505 SO'L-- f 1 ' / c tl. rRr ev ^? A G }TW , 44 . 22 w lV; ;%t - f . •.n 7- ,•yY /'v6 ii?' ,J ♦V tir. t�./ 1r' �y,, T ,r. ry 4 4 9 i x - £r �, e 'r.; j+, z '•w4 T . 164 wD 1 '1 .6,w d W,Y .. x' i •4:a-'• ';9 `� l.. 't a 4 �'��""� •� ���' �'..:,,�,�,�' � J3 c. /•4-1� v� s E.T6� v7 -77 77 �{ + t 861712ov,A4 SEPTlG 5y5Tf.�1�;Co�:5T,2CJGT/O_ N `'• � a ; ,s SH�1:!_G CONF02M �7 M 4•S� : C7ES/GN ` FG'D(rt/`.`f; "' C7 G . 1 E:NV./ oivMGn/7AC..Gov4. 7i7� =l • yTz�GULA 7-/�`NS Et�aY n ... ,. I. ��.ai-:K'a"•..... "�.'.�r•a++6.:r:^�• . ..wy .:,. v,.....w'..t,-�o-��i....--,..:+.t•.++a:.,..w�+ w..?..a w�4._ y � 1�!G. � 7-� `�t::�lc+FD�?"�C,�h/ � � , M•c. .t ,x +--•-r'�'ery-4'° S."';�l S"'E`.+...� �, .7! !. a, �`"; M a Z . iw.^ `,. Cl2V c1.5 cove MA�lf1OLE Ga✓ET2_ 7o',,E.X,T-EAJZD 7-0 Q - J ,/f> /e1 ��✓�'� ,� " , s°� lr1//'7`f%/N /♦ 'QF' --.1�//�l7SHE•O �Jz'lI,DE.' �°r 70 4,nlT ♦C20M.lNF/L T2A 7/iV6 ?4 Co t!G-r?S I f 4 ! D -S'T !� ' 57oiv N�/. rl�J(//IQ Q,% eoCZA 777, x.. �` Nf/NrMUn/ _:6 nn„�, 3• iv 4, b!A'. ATb Z Ap/TG�I, .: Ft_Oui ca-IvE MiN Pi+TGH ��FC�OT, ;/O M/N �4. %Q�� OOT �� _ MiN. rrc�i �1� �%Z• D/A. •f'QCJ�1. �Mia7 ��,�� .... -- - `✓.I ��oor � - `��Y31.45-HE:L7_� GA L L O!� ivvEZr /AlVE'27 :�'- 'I /ivVf2T GA F�AC/ T�! ' :4fG�f!n�O. SE FAT/G ".TAA/.e ; j ELEt/. <i l T ! :y T: 'r r'� c�T2OM OF I+ to r �` • i'yl�i�yr. � ;,� `,Yo,! �y taF'�cx1'�` t.„,,,,x„,�. �.,.+►""M:•� r .k -77 Ad i !J SE7'/C :T�rv.�C�'.U%57'.tz/S[ TlanN 6C �' Ale c . X 5 k ``•y PeA l3� •C� C�� lCJ � � .WA o b 9' Wl L.0W` 7 APZZA7 , Na T :.TL9 g.F-. .'Z- I� n1 OA1 T/-- G U AS 6.rrC6t lAj A VZ:7 i T OF T-Li'E 1->A TE. yEGI L 774 , A PP,E'U�/4 L ' LEA ram , /, '" g.- CENTERVILLE, TOP Of FOUNDATION 24"diameter concretecouers LL=5 1.8 raised to wrthm 6"of frm5h grade 4"PVC VENT TWENTY(20)A05 ARC36HC q MA (or as noted) S Inspection Port and cap with magnetic 1 d CAP BY"SWEETAIR" (36/6BD2)LEACH CHAMBERS IN BED LDCUS d 3 marking tape to within 3"of grade MIN o 50.5-5/.2 3 CONF/GURAT/ON WITH FOUR(4)ROWS � Eating EL=50.8+ EL=5/./(max) EL= + OFF/f/E(5)CHAMBERS n Masth�d Vent r 25' 5.0' 5.0' 5.0' 5.0' 5.0' 1 8" min Cover for 48.6+ U1 0? Existing qB,/+ H-20 Loading - le N I +� 46.9+ I r N I h� O Existin 47.4+ �1117I g Enstn O _ 47.2* 46.80 N 46.63 46.50 N I m g - �_ Existing I N p< o Gas Baffle 45.60 N -BOX m ��ff �r�° ('n Longest Run TWENTY(20)AD5 AKC36//C 5 3,+ Inspection Port(See Note#4) 20'+-4 }-- 25' /o' (36/65D2)LEACH CHAMB6R5/N BED fx5hng D15-6 CONFIGURATION WITH FOUR(4)ROWS EXISTING /000 GALLON (1-1-20 Rated) OF FI VL-(5)CHAMBERS PLAN VIEW S 1 T E LO C U S SEPTIC TANK D-BOX LEACH CHAMBfR5 EL=40.3+Bottom of Test Hole SCALE: I" _ ►a NOT TO SCALE If LOW PROF I LE (H-20 Loading) I .) Assessor's Map 192 Parcel 10 I NOT TO SCALE 2.) Deed Book 3 158 Page 227 CONSTRUCTION NOTES 3.) Land Court Plan 33723A Lot 49 TEST HOLE LOGS VARIANCES REQUESTED 4.) Th15 property is not in a Zone II of a Public I J ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (3 10 CMR Bedroom Foyer Water Supply Local U rade A rova15: 3 1 0 CMR 1 5.403 Bedroom Livin Room 5. Flood Zone: C Panel #25000 1 00 1 5C 15.000): STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, 1'9 f P #2 #3 9 ) Garage UPGRADE, AND EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND Test Hole#I (EL=50.8i-) P#13493 Variances: 3 I O CMR 15.22 I (7)General Construction FOR THE TRANSPORT AND DISPOSAL OF 5EPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. Depth Layer Soil Class Soil Color Comments Requirements for All System Components: 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL 0"-9.. A Fine-Medium Sandy Loam I OYR 3/2 1.)Soil Absorption System > 3G"Below Finish Grade Bedroo113ath Dining LEGEND FOR VEHICLES O HEAVY EQUIPMENT TO PA55 OVER IT SHALL BE DESIGNED TO WITHSTAND 9-1 B Fine-Medium Sandy Loam I OYR 5/G R #I Room Kitchen AN H-20 LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE 30"-59" C I Fine-Medium Loam Sand I OYR GIG 5 1"Held 1 5"Variance Requested y (Not to Exceed 72") (Not to Exceed 3G"} EXISTING SPOT GRADE ATMOSPHERE. 59"-1 2G" C2 Coarse Loamy Sand 114/G 40%Gravel 24x5 PROPOSED SPOT GRADE 3.)TO MINIMIZE UNEVEN SETTLING, ALL SYSTEM COMPONENTS SHALL BE INSTALLED ON A Perc @ 50" EXISTING CONTOUR STABLE PLAN STABLE MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. 24- PROPOSED CONTOUR Test Hole#I (EL=50.8+) W WATER SERVICE LINE 4.)COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION - - - -- NOT TO 5CALE O OVERHEAD UTILITY LINES BOX, AND THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. Depth Layer Soil Class Soil Color Comments BENCHMARK u UNDERGROUND UTILITY LINES LEACHING FIELDS,TRENCHES, AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS Top Concrete Bound MANHOLES SHALL HAVE AT LEAST ONE(1) INSPECTION PORT CONSISTING OF PERFORATED 0"-7" A Fme-Medium Sandy Loam I OYR 3/2 EL=50.00(Assumed Datum) G GAS SERVICE LINE 4"PVC PIPE PLACED VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A 7"-28" B Fine-Medium Sandy Loam 115/G - - " -- - - - TOP OF BANK CAP,TIED WITH MAGNETIC MARKING TAPE, ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. 28"-59" C I Fine-Medium Loamy Sand I OYR GIG UP#i 2 LIMIT OF WORK 59"-12G" C2 Coarse Loamy Sand I OYR 4/G 40%Gravel 5.) PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID 125.00, Proposed5A5 ti EDGE OF CLEARING ON A MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2% FROM THE BUILDING TO THE (See Plan View) ~--~�-`- FENCE SEPTIC TANK, AND NOT LESS THAN I%OTHERWISE. DATE OF TESTING: 1 2/1 5/1 1 TEST HOLE LOCATION SOIL EVALUATOR: LINDA J. PINTO, P.E., CSN ENGINEERING Vent S 76o ST SEPTIC TANK G.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4"DIAMETER � 53 E DB DISTRIBUTION BOX BOARD OF HEALTH AGENT: DON DESMARAIS. �tEALTH DEPARTMENT r O S 40" SCHEDULE 40 PVC(OR EQUIVALENT)(AID AT 0.005 FT/FT. UNIJ=SS OTHERWISE NOTED. PERCOLATION RATE: LESS THAN 5 MIN/INCH IN"C I"LAYER � p-2 O LINES SHALL BE CAPPED AT END OR AS NOTED. TP-t SAS 501L ABSORPTION SYSTEM 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2)FEET BEFORE NO GROUNDWATER ENCOUNTERED` 3(5-l' I Reserve RESERVED FOR FUTURE U5E PITCHING TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL B D E WATER TESTED ® U1 ILITY POLE TO ASSURE EVEN DISTRIBUTION. (� ti° ifJ CATCH BA51N I CERTIFY THAT I AM CURRENTLY APPROVED BY THE FIRE HYDRANT 8.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE AN DRINKING WATER WELL STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL. DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT Exwstm _ TO 31 O CMR 1 5.01 7 TO CONDUCT SOIL EVALUATIONS 9 Paved` CONCRETE BOUND D 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED �M ° ° nVe SEWAGE DISPOSAL FIELD (DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. BY ME CONSISTENT WITH THE REQUIRED TRAINING, U r I EXPERTISE, AND EXPERIENCE DESCRIBED IN 3 10 CMR U N -,N OF MASS N (� I�1 Existing Leach Pit to be ,y 10.) IN ACCORDANCE WITH 3 10 CMR 1 5.22 1, ALL SYSTEM COMPONENTS SHALL BE 15.017. 1 FURTHER CERTIFY THAT THE RESULTS OF MY r W `�W_ I Abandoned(See Note#2/) MARKED WITH MAGNETIC MARKING TAPE. SOIL EVALUATION AS INDICATED ON THE ATTACHED SOIL p W_W Garage I �O LINDA J• s� EVALUATION FORM, ARE ACCURATE AND IN ACCORDANCE O LIGHT POST _�W` I Fxrstmg Septic Tank to tw A PINTO 1 1.)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED SOIL ABSORPTION WITH 31 O CMR 15.100 THROUGH 1 5.107 C) o� Utilized(see Note#20) O IL u, SYSTEM. j Patio I 4 2I 12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL GIST ��r RECEIPT OF THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED ANDFSSIONAL FCC FLAGGED TO PREVENT USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. Linda J. Pinto, Certified Soil Evaluator ' Exrst"13.) THE DESIGNER CONSTRUCTED AS SHOWN ON LL NOT BPLAN. ANY IBLE FOR THE CHANGES SHALL BTEM AS E APPROVED NED UNLE55 WRITING BY / Top of ound d000 DS Ihn9 Pool 00 O THE DESIGNER. .6:t O 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF m Surveil Work by.- THE BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT CIO A & M (,end Services THE SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE IS REQUESTED. I j i 818 Route 28, Suite 3 A'est Yarmouth, AM 02673 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE / LOT 49 Pb. (5t71B) ?97-19"I"I' veil anmlead�comcastnet FOR DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR ' TO COMMENCEMENT OF ANY WORK. THIS INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO Area= 15,000 5.F.± DIGSAFE, ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. ' �- Prepared for: I G.) CONTRACTOR SHALL VERIFY THAT ALL WA5TELINE5 ARE CONNECTED BY WATER TESTING Robert If Anna Crocker WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. 173 Rolling Hitch Rd., Centerville, MA 02G32 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ' ^ l cos 00, ANY SEPTIC SYSTEM COMPONENTS. SYSTEM DESIGN CALCULATIONS Proposed Sewage D15p05al System 18J INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL NOT SEWAGE DES/GN FLOWREQUIRED:3 BEDROOM DWELLING 0 I\/ 7'G 173 Rolling Hitch Rd., Centerville, MA BE USED FOR STAKING, OR ANY OTHER PURPOSES. l/06PD/BEDROOM=330GP0RE0UIRED 5340„ IN 19.)THI5 PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH ZONING 5EWA6E0E5/6NFLOWPROV1DED: TWENTY(20)AD5 UNITS IN BED SITE PLAN Prepared by: BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO, 51DELINE SETBACKS AND BUILDING HEIGHT CONE/GURATION IN FOURF1(4)ROWS OF (5)UNITS EACH. RESTRICTIONS, AS IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR ISSUED THE Vt=((330/0.74)/(4.6 FTz/FT)/5,0 LFJ = CSN BUILDING PERMIT. /9 ADS UNIT5 REQUIRED(20 PROVIDED) SCALE: 1" = 20' 20.) EXISTING 1000 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO BE INSTALLED ON 355 GPD PROVIDED>330 GPD REQUIREDEngineering INLET AND OUTLET PIPES IF NECESSARY, AND A GAS BAFFLE INSTALLED IN THE OUTLET TEE. SEPTIC TANK CAPAC1TYRfQUIRED: 330 GPD X 200% =660 GPD REQUIRED INSPECTION NOTE: 2 i.) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. SEPTIC TANK CAPACLTYPROV/DED: EXISTING /000 GALLON5EPTIC TANK 2 4� 6O P.O.Box2030 Phone:(508)299-3250 PRIOR TO FINAL INSPECTION BY THE ENGINEER, SYSTEM Tealicket,MA 02536 Fax:(508)548-5478 22.)THE ZABEL FILTER IN THE SEPTIC TANK OUTLET TEE SHALL BE INSPECTED AND CLEANED A 6ARBA6E9/51'05AL 15 NOT PERMITTED WIT/l TIi/5 DES/GN FLOW NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. SCALE 1°=20' ROUTINELY TO PREVENT CLOGGING AND BACKUP OF THE SEPTIC TANK. C:\CSN\RR-Rolling HitchWK-Rolling Hitch-5D5 Plan.dwg Date: 1 2/1 2/1 I 1 Scale: As Shown I By: LJP Check: MTA I Project No. C5NO200