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HomeMy WebLinkAbout0235 ROLLING HITCH ROAD - Health 235 Rolling Hitch Road Centerville A= 193-071 /11 SMEAD Na 2-159LOR UPC Inn afftestnam • Me&In UY 1l1IIOMNI�IQIM OIFI wiwwa000w�m TOWN OF BARNSTABLE G to Nr QJ SEWAGE# ��� '�Z)® VILLAGE-' C>Ji�k ASSESSOR'S MAP&PARCEL l l —07 INSTALLER'S NAME&PHONE NO. s_C H n.� :To q C, Go 6i 'SEPTIC TANK CAPACITY �C S `�'"®D LEACHING FACILITY: (type) 1 0 SOCK cnL (size) NO.OF BEDROOMS - ,T tivc lc�-Cc f sOWNER C,4® - PERMIT DATE: 3 ���° l`i. COMPLIANCE DATE: I �? Separation Distance Between the: $ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet I Private Water Supply Well and Leaching Facility(If any wells exist on site.or within 200 feet of leaching facility) INA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BYPIG� << F. • f 1 1 _ No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye — PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppl cation for Nsposal 6pstem Construction permit Application for a Permit to Construct( ) Repair v6upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. a 3S"lir 0 tk �.tl 1'li4C_ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel I C kr% fXjj Installer's Name,Address,and e.No. ^w ( Designer's Name,Address,and Tel.No. �✓td. U�(s U i U1)ka�l �G.0kGL1� ,1 S'S Crt o rz c)v Rj S C,1LCKjVA Type of Building: 76 Li Dwelling No.of Bedrooms Lot Size -3 3 Z w sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided o �� gpd Plan Date 3 t r S 15 Number of sheets Revision Date Title Size of Septic Tank (J06> Type of S.A.S. 3 Sb0 Crc�L 1'} �7 O L-y t✓M 6v-' j Description of Soil o Pa 6,x E4 1. (- X /a,t 3 X 2, Vfi Nature of Repairs or Alterations(Answer when applicable) -AV—t a.Xisy%,.S Lc4c,I, - aeLd 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 a o� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. rn [ !� Q Date Issued r .. 1 �fr No. 7C7d D Fee—� THE COMMONWEALTH OF MASSACHUSETTS Entered in co putenl r: µ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye '"` f application for Mis oral 6pstem Construction Permit Application for a Permit to Construct( ) Repair ( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. a S' (� p 11�..t1 1A VX f _. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel C rr. uv��Ut. k i r Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. N-G-�1� t S S Lx S C L&+ t r- Ua(�U I''!rk r (I ` UOIoS co 2 r}tI Rr) Type of Building: Fr 3(D Dwelling No.of Bedrooms 17 Lot Size 3 7 2 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided �'S`y j 8;L gpd Plan Date Number of sheets_ Revision Date Title Size of Septic Tank_�ti S t�i�� Type of S.A.S..3 S Z O G c,1- 1.4 Z)Q C-V c,,-n 6-t-J.. Description of Soil t I W a Q O f 6,K t! X I a k? X o R.p* � Nature of Repairs or Alterations(Answer when applicable) c�1n ��� ( �` 1� to C teE �cr rC 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 Date Application Disapproved by Date for the following reasons Permit No. c.� (> Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by rhFAr,�A t, ,� ,.,✓, at �, (� l �, 1a,' ..1n .ck_d h.,V 1\V_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No,.PCY dated Installer , CO A CA � Designer #bedrooms Approved design w '' gpd The issuance of t is permit shall not be construed as a guarantee that the system will ctio #designed. Date ( Inspector No. o Fee ( . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Bisposar *pstrm Construction jhrmit Permission is hereby granted to Construct( ) Repair(17 Upgrade( ) Abandon( ) System located at .'r g�` �,���� cc- R C ry\ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be compl.ted within three years of the date of this(by mit. Date Approved 3 C� ?CP AFFIDAVIT I, Christopher M. Fredo, of Centerville, in Barnstable Massachusetts, state that the property of 235 Rolling Hitch Rd of Centerville MA in Barnstable County has been a,five bedroom property prior to 2008. COMMONWEALTH OF MASSACHUSETTS . COUNTY OF BARNSTABLE PRINT FULL AME S NATURE Sworn to and subscri fore me this 215t day of February , 20 19 CHRISTOPHE ETTE .' ice, - Notary Pub Notary Public` „ - COMMONWEALTH OF MASSACHUSETTS My Commission Expires On May 03.2024> Page 1 of 2 r Town of Barnstable _ of T►as Regulatory Services Richard V.Scali,Interbil Director RAWMTABM- MAE& Public Health Division ri g Thomas NkKe. Director 200 Main Street", Hyannis;MA 02601' Office, 5.08-96246Fax:. 508-7 D-fi3U4 Installier Sc Desi ner Certification Etirtin. ` l _ gyp / 1latei � y 1. c� a e I'ermE, '� Assessor's MapTarcei. t d. F Inst, Her: — Mdress: I S5 GetR Address. AA3 \ G.c"�-� Jr", c� 71a lC VA Szc„r.k_was issued a permit o insttall a (date); ' (instal.lt?r by, peptic systertt at - lascti art"4a€le�;in dtawla (desaner I certify.that the septic system referenced.above was installed substantial I l according t th.c4c.sign, which ax aly"include n irior approved clulnt;cs sue h.a; tat I-Il relocation oft €€ distribution box and/or septic tame. Strip out: if required/) vas ii sfrccted and the soil ,. were 150.land.satisfactory; I certify that the septic system refdencecl above was installed with mior changg 4 ( e. greater than I0' lateral relocation of tlae SAS or"any vertical relocation of any component taf tltc septic system}but in, accordance ivith State & CC:-local lt2cgul.alioh%, :flan revision or certi"Ct d as-bbilt by dcsi p r to follow.. Strip out(if rcdluiredl was inspdOed";ind the soils" were found'sattasfaetory-i I certify that the systein referenced above was cOnstructe nce with.the teens of the R8 apprpyal letters(if aplil cable); , NO (Installer's Si%laaature) (Designer's Si natuie ...�.. (Affix Dcsigncrts tatnp.Hex PL,EAS.L. RE`TttliN TO, BARN ST"ART;E PU:R ,IC. IE.ALTA .DIVI IO.N, CERTII C ATE .OF COMPLIANCE WILL NOT BE "ISSUED UNTIL ROTH TRIS 'FORME AND AS-` BUI.LTCARD,ARkE RECEIVED BY`T`HE DARNSTABLE PURLIC HEALTH DIVISION. THANK YOU7 f}:Se�ticlt c ai rier" ratfici tic�n}i�ci t'"R.et 8-14-13.doc °Ft > Town of Barnstable P# Aff7 Department of Inspectional Services BAMSTABLE, Z �' MASS. Public Health Division Date MgFC4 t,74iq r� 039. ♦0 OrEp MAC• 200 Main Street,Hyannis MA 02601 A Office: 508-862-4644 Date Scheduled 3 I l Time Fee Pd. . Soil Suitability Assessment fo age Disposal Performed By: Witnessed By: LOCATION&FGEl�ERAY,.1FORIYIATION Location Address `235 Owner's Name a�I, -I,��ti C�tr,°5 vp r �PHyippv- PPL_ L i,'�f ry I Address 2-3 5 ll' h✓� F f C�► Q-� c�vie�.r, Ili', vuA O3Z Assessor's Map/Parcel: AM�p7l Engineer's Name D,, ����-�uvlaiv r Engineer's Email:; N iJ 14 ce v Q 41) 11`coli NEW CONSTRUCTION REPAIR Telephone# Sag- T d - t `�- � y Land Use �t 71C��l�l�) Slopes(%) Surface Stones I, Distances from: Open Water Body 106 t ft Possible Wet Area rR�00+ ft Drinking Water Well �u� � ft Drainage Way �� '1• ft Property Line L V 0 + ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of t;st holes&perc tests,locate,wetlands in proximity to holes) 1 QTp Z -n u , 0 I t©4. ` Parent material(geologic)T -��C i a I 60-,V0"► Depth to Bedrock tin O Depth to Groundwater: Standing Water in Hole: 0 h fe Weeping from Pit Face Estimated Seasonal High Groundwater oAd re- �q h l'�o I h Ttro A w 1 j"7CK-1 DETERNIINATION�TOR SEASONAL HIGI3iWATER TABY�E Method Used. M04 I Ott Depth Observed standing in obs.hole: in. Depth to soil mottles: Vldw- 44- in. Depth to weeping from side of obs.hole: I in. Groundwater Adjustment $. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Levelfi _ I :Time Observation Hole# Time at 9" 4-30 Depth of Perc Time at 6" 5- 4 Start Pre-soak Time @ 00� Time(9"-6'. ?—40 End Pre-soak Rate Min./Inch 12,m P I Site Suitability Assessment: Site Passed V/ Site Failed: Additional.Testing Needed(Y/N) 'V 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 Divisioii,at least one(1)week prior to beginning. Q:Wpplication Forms\PERCFORM 2018.doc I I DEEP OBSERVATION HOLE I;O"G Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. A Consistency,%Gravel) �Srivl)y Lain �(� �(o' It k6qb 1150 2 U�i�d; o•n S�y� l(�'�(� S� '� �a s� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Aa SgmA f,:xtvn max rl�►�[ -�Z W (oa kXX 'Sr'l q to R `/A '� �'r►GInt C. DEEP OBSERVATION HOLE IOG Hole#`: Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) i i DEEP OBSERVATION HOLE 1JOG Hole;# =; Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldets. Consistency,%Gravel) i i Flood Insurance Rate May: Above 500 year flood boundary No Yes Within 500 year boundary No V Yes Within 100 year flood boundary No✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring. ervicus material exist in all areas observed throughout the area proposed for the soil absorption system? 'te5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on ,)j jqq� (date)I have passed the soil evaluator examination approved by the Departtx>erit dfh Environmental Protection and that the above analysis was performed by me consistent with the required��i 'F A� s9c expertise and experience desc ibed in 310 CMR 15.017. s� DAVID tiU� D. Signature`(JPolk (� `f�( Date IMgtCh �S, 20(�( " COUGHANOWR i Q:Wpplication Forms\PERCFORM 2018.doc' i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector. Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that tha y information reported below is true, accurate and complete as of the time of the inspection. TheilhspQon was performed based on my training and experience in the proper function and maintenance of on eifd sewage disposal systems. I am a DEP approved system inspector pursuant to-Section 15:340 o'f, Title 5(310 CHAR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fail ❑ Needs Further Evaluation by the Local Approving Authoritya,lf/ Aric ' i•�., a'3"r 5/21/12 Inspecto 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 some or different conditions of use. a Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 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: Pumping suggested every 3 yrs to prolong the life of the system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: n/a ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a'surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21112 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a 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 %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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 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 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments „ 235 Rolling Hitch Rd Property Address Nugnes Owners Name Centerville MA 02632 5/21/12 Cityrrown 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 been 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)] Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a 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 the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): n/a Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Regular pumping per owner 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): Approximate age of all components, date installed (if known)and source of information: Septic Tank from 1978. New D-Box and SAS 1993 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 216"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Compartment style tank. Riser at center cover If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000g Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle >12' Scum thickness 3" Distance from top of scum to top of outlet tee or baffle >2" >21' Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 235 Rolling Hitch Rd Property Address Nugnes Owners Name Centerville MA 02632 5/21/12 CityrFown 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 alarm and)float switches, etc.): n/a "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level w/the bottom of the pipe 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.): D-Box 3' below grade and in average condition for its age Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 235 Rolling Hitch Rd Property Address Nugnes Owners Name Centerville MA 02632 5/21/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4 Infiltrators per file ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS was probed and soils are dry and compact. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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,inflow ❑ Yes ❑ No 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 of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 235 Rolling Hitch Rd Property Address Nugnes Owners Name Centerville MA 02632 5/21/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 1 1 2� Ll 1�s 2/ O �3� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 235 Rolling Hitch Rd Property Address Nugnes Owner's Name Centerville MA 02632 5/21/12 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: >12 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: 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: You must describe how you established the high ground water elevation: Per eleavation of home situated on significant hill TOWN OF BARNSTABLE LOCATION .r C7 SEWAGE # , : — S 7 IVILL AGE CPS/PLI, , 1 P ASSESSOR'S MAP & LOT//� 6 C INSTALLER'S NAME & PHONE NO. La 7Tl � �� -"-/Df-2 yo_ SEPTIC TANK CAPACITY vc'-? o LEACHING FACILITY:(type) ;` 0 d/'$size) NO. OF BEDROOMS_ _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: e (� DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No �/�— Ja .� a AM 4 j to , l .�0 a d Fizz-2 ....................... THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH SOMMble CoMmatian Depw"ent TOWN OF B A R N ST A B L E s�$�►e� liner l r il�paml Works Cnl mitrnrti n ramit Application is hereby made for a Permit to Co istr uct or Repair " an Individual pp y ( ) p ( ) Sewage Disposal System at. .. - '� 1 r r ��?.. yll _1................................ c �^ _ �. ss or Lot No. G;1�.....- S--------------------------------- ----— --...---------- ---- ----- ------------- --.. - 5 °----. - 0......-. � Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures ------------------------- ........................ W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench--No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ...... ...................................................................................................................................................... 0 Description of Soil........................................................................................................................................................................ W V ................................... -............ •............... •------- •------------------------------------------------------------------------------------------------------- --------------- W ---------------------- ------------•---------------------------------------------------------•. -------- Nate of Re airs or A terations—Answer hen a hcable._ X j'-•�-- V PP * F - - - --------------------------------------------------------------------------.--.-.-..--.---..-.---------.------------ Agreement: d The undersigned agrees to install the aforedescribed Ihdividual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by t ' board of health. ,G Signed — .. A. .......... ...�_e.�.. Application Approved B c Date Application Disapproved for the following reafo • .................. ...................................................... .................................................. ------.�.. -------..................----------..--------------------------------- .---- �.... / Dace ............. .....----- . Permit No. . �. ...... . . . . .._...... Issued ..../ ..p {%J................ .............. Date --'-- -------------------------- — —— — :.rye,.ygr�::y...:r...�t1 .-++,. ..:L.�•'V'.�'w.--.`-`^�.•L/.'"...•�..,'Wr.�..J.-. ... '.�.. -- _-. --.J- ... . .. v-- r, t. -... -..�.,..-- �. � ... ,.. .. ti No...! ---_------- Fizz...e........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diri wiu 1n rk,q Toustrnrtt n Vrrmit Application is hereby made for a Permit to Construct or Repair an Individual PP Y ( ) } ( ) al Sewage Disposal System at: - /� .... '... .......... � � �•• ..•••..• ••...... - v ---- ....- -••••- .... --•'""-' ,A �,ocahon-i\d ress- �- or Lot No. ----- ��- Otrncr L/ -Installer Address UType of Building Size Lot............................Sq. feet .-. Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) - Cafeteria ( ) d Other fixtures .................................----•--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter.-.------------------ Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........ ---------------•••••••--•••••••------•-•••••-•••............••--- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................:. --••----••••----------------------------••-=------•••••-•-•••--••-•••--.........••••-.....••••_...-•......................................................... ODescription of Soil......................... ------------•-----------------•--•------------------------------------------------------------•---------------------•-•-•..........-•......••. x V ._.---------•-------------- -------------------------------------------- •-------------------------•---------------_---------------------------------- ---------- •-•---------------- ----------------------------------•••-•---••••. ---------------------------•----------------- -- :--------- - x � = U Nature of Repairs or Alterations—Answer when applicable.__ r !---__ /�_.._ T � :_ .. f� L - } c �- Agreement: d The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed-. ...-_..... p` �..--S. .-------i......._.. e. Application Approved BY ...... /1•���...-._...d�...n.......!1. .v. - -------------------_.------------------------ .................--.............------- �� Date Application Disapproved for the following reason, . .. ..................................................................... ................. ...................... ............................................... l ......... Date Permit No. ----- ------------------ Issued .... _. .... .�...._ ...'� ` ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TD C-RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ....._-------%........; .r`'o` .L�(-tom./...-C .----- -- _......................................_..._-.....-- . ---............------- r' f Ins�allcr -� ��----� at .. ........f --..... %,./ .ii.... .../ram.f. t'.. ..... . .-. -- ... '� (. ...................... has been installed in accordant with�the provisions of TITLE 5 of tiThe State, nvir�nmental Code as described in the application for Disposal Works Construction Permit No. ..-..... -..-��/ *"'_ ..j dated ._..__-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. ..�.._........ .3........-------------------- .-.-.-----... Inspector ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD . OF HEALTH TOWN OF BARNSTABLE FEE- .. .._ a o No.........::: ... ... ..... L .. Dislimal Work,5 Tamitrurti.on "rrmit Permission is hereby granted, ,_ ///r_.�`-lC ----5............................... to Construct ( ) or Repair_(G)a Individual Sew ge Dispo ,�S)rstern at No.------ ...... = � ... = 71 Street as shown on the application for Disposal Works Construction Permit No"-�--1.._.V5/ ate ------A-----------...........4..1__.. � �'� Board of HeaE� DATE-----------------l... ... ------------r-------•---............--•---. 1 FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATIO f G / � G7 SEWAGE #,P VILLAGE fi�►y�.l�� ASSESSOR'S MAP Q LO.T/,3 6 7 I INSTALLER'S NAME & PHONE NO. L 3f f o`�Gc��� y�� Vo a SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �� / r Isixe) NO. OF BEDROOMS _PRIV TE WELL OR PUBLIC WATER �-- s BUILDER OR OWNER 4/�/ f S DATE PERMIT ISSUED: ��, DATE COMPLIANCE ISSUED: 222 el 2. VARIANCE GRANTED: Yes No i' 0,0 to t—C) http://issgl2/intranet/propdata/prebuilt.aspx?mappar=193071&seq=1 2/20/2019 LOCL,TION ' SEW&GE PERMIT UO. IWSTQLLER 5 1&ME ADDRESS - - - -LOAD alZ-94-z - - - - - - BUILDER 5 " &MF- ADDRESS DNTE PERMIT ISSUED D ATE COMPLI W,4C'E ISSUED ; r J 7 M, -17 62 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ............ . TOWN-------oF............CENTERVILLE.......................................... Appliration -for Ui.ipuottl Workii Tawitrurtinn Van it Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage isposal System at: oilin ...........................................................Hitch Road Lot No. 44 ----------•-----••---------•-•-•----•----------•. --•--•..................................... /1Loc ' n-Address .�� or Lot o. ----------------- ---------- ---.---`------ . ..... ..-•---------------......----•--•---•-- •-•------ .� .... .. -- ...........-- O Address W Installer Address 17 -8 4 9 UType of B ding Size Lot....._-_-_-i...............Sq. feet Dwelling—No. of Bedrooms-------_fOLtr'----------------- ----Expansion Attic (i/� Garbage Grinder ( X) •, p4 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a - - ------------------- W Other fixtures ---=----------•---••-• - • Total daily flow---------------..._._.....400 gallons. Design Flow..............5 0_.._.................gallons per person per day. WSeptic lank VLiquid capacitvl500galions Length_.1,�0.::-� M'vVidth..5.1;a"B Diameter---.- Dehtli_.5 -4" x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter_-10 '-0" Depth below inlet_.._6_4.-0�". Total leaching area.__534..........sq. ft. z Other Distribution box (X ) Dosing tank ( ) �- /'�G - 3-•/—7 7 '~ Percolation Test Results Performed by._ ' . ... t- --------------- Date.3.7Z-��-7°----------------.. Test Pit No. 1.....2--------minutes per inch Depth of es t Pit_..12.�`-��� Depth to ground water_.._none -------- f= Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.---.--_-----.-.--..-. ----------------------- -----•---..._...........-----•-•---•---•---•----..•--.................-----•--••--•--- -..----•-•-----•-------------------•-- O Description of Soil-------- 0-�-6" wood loam 7�-011, 12�-0'1. coarse����.. x 0 '4=' - 2 '-0" subsoil white sand p g ----------------------------------------------- ----------------------------------------------------------•--------------------------------------------------------------------------- W 2 1 - 7-'-0" clean yellow sand `� ass x ------ - --------------------------- -------------------------------------------------------------------------------� o�-- ---------- 9°ti V Nature of Repairs or Alterations—Answer when applicable......................................................................... :..__.___ ... P( C. ENWIC �- e m B. Agreement: ' p No. . 27654 O The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc , 12 44 ev— the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place operation until a Certificate of Compliance has b e iss d by the oard of he h. Sigd-- • - -- -------•---- - ---- ............................................ --------------- ---------------- - e Application Approved BY--------- - ------------- ------ ----------- -��-------- �-- -----..�...:�. . ----7--- Date Application Disapproved for the following reasons: -------------------------------------------------------•---------••••---------------- ••-•--••••----------------•-•---••----------------------------•-•---------•-----••--•--•---•--•-•-----•-•..••--••-•••---•--------••--•-••--••---•••-•-------------------------•-...•••------------------- Date PermitNo......................................................... Issued----------------- --------------------------•-------••-- Date s :a ' y Jj - No.•••-•--••/- __:.... Finis......../....` ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- .OF ........-..CENrMRVI................................................... ,����irtt#inn Application is hereby made &-k-Vermit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: . Rolling Hitch Road Lot No. 44 ................ ...... .........•--...._.---••••---............----------...------._.•--•- ..........-----•--•--•--•-----....-----•..............._...•-••......------.._....-----------•_--- �Locat' n•Address 4 r.-�— -_ Lot o. ` ............. .................... ...•• = - - W Ow ✓ Address `............. .. _____.1.1.'__._ _ ___ _ __..______.__.__.______..___._._.. __._ _____.._.-__._.._.____.___..._........___.__._._.._..__..._..._.__.____...______.__._.___ • Installer •Address 17 g n d Type of Size Lo ----------- feet Dwelling-No. of Bedrooms-_-__-_._£fur.......................Expansion Attic (1._� Garbage Grinder ( X) per, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures --------------------•-••----------- -----------------------------------•----------...................-•---•-•--------------------------------------- Design Flow---------------5........_..__.____..------gallons per person er day. Total dailyflow--------------------------------------- allons. WSeptic Tank- 'Liquid capacity_1540gallons Length_. �_ r®Width___6� $.��Diameter________ _____ Deptll.-- _�_`'�-�i Disposal Trench=; 0. ........... .. ..: Width.. ._,! ->-___ - Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No..... _-.,._-.__-.`Diameter_--3---- Depth below inlet.....f.-d.... Total leaching area-__53�-_____sq. ft. Other Distribution box,. Dosing tank U' �� .- L3-/- 7 7 ~ a - _ z O O a Percolation Test•Results Performed b .. p 12��,_._e�............... Date, Percolation Test Pit No. 1________________n�irlutes er inch De th of est Pit.._.__..-,?.�... Depth to ground Water---_AOAe -------- f� Test Pit No. 2.:..:..........minutes per inch Depth of Test Pit________-__-___.___- Depth to ground water__-____________-____---- --------- ----------- _...... O Description of Soil-_-_____ --�_ -- �'�" wo©d loam 7�-0" 12 0 coarse ►� x 0` & 2 _pt subso9- ----------------------- white sand � 2 ' -• .7'_-0" clean yellow sand •O ss VW ----------------------- -----------------• - --•--•--------•-•------•------•------•------ -----•••-------------------------------------- -----•-----•------------------------- �H f MA Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------- 9�y � RENWICK - - N ---- •------•------------- -----••-----•-----.....----•-•-•-••---...._....._......--•----••-----•------•------....--------•----••-•-•--•--•--••-•------_-_-__-------------------- -------g. Agreemen�: v CHAPMAN y The,.undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc NuiW6541p the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place th fiyi}g�G�F``' operation until a Certificate of Compliance has been issued by the board of health. /ON L ,. Sign ---•---------------------------------------------------------------------------------- -----------7 proved BY----- - -- - -- ----- -- f.. __--- Ye Application Disapproved for t to following reasons-----------------•--------- ----------------------•----•--------•--•---------------------- -------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Y Date el Permit No`....._' ............................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA ............/11,1�.............OF._.......::!V. ..:. -. ................................................... 4 ` �PXtifira#r of f�ntttltnrr A�y ' S T E FY, That-the Individual Sewage Disposal System constructed ( �or Repaired ( ) bY .. �- a ,�p tier t a}. (�!`.l... �' ✓..' �' __-___-- `--•--------------- has een installed in accordd ce with the provi ons of : XI of "rhe State Sanitary Code�„s d r' ed in the p dated---+........--------------�............-•-.. application for Disposal Works Construction Permit No........... _ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Inspector,- =:�-- ................................... ' e DATE. . - '"' °� ` { ' THE COMMONWEALTH OF MASSACHUSETTS B4OA R DJF,• H E T 7 / 9 r !.OF..-_ • ............................ No......................... FEE ..... Dinvnli or #rui Lion errant Permission ' ereb granted.-. d__________ ____ POO Yg to Con r t ) Re it ( ) an 4w du S, a� Di., Sal Sys in at Noyr 1� (.�E.ys- -""' -�'-- --_ .. .......... ......... __ ..-•--- -•- -•-.-- ------�:..----.------------. Str as shown on the application for Disposal Works Construction r it ____ ___________ Dated_. /-__ '.._!�._..._._:_._._ !/ ------------------- r Board ealth DATE- v - -----•! ?? FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - ./ SOIL LOS CaogflGo•�� 48•Z J/ , 2".PE AS TONE 4 LOAM B FILL 12" MAX B . r, 9�• s ° I 11 4 C.1. TL DIST. ° BOX r 29 M'N. 3'MIN _ D e° 1000— GAL. GAL. I °° ° PRECAST OR , SEPTIC S UUTtET 6 1� o • BLOCK I ° o� TANK to, ° ° SEEPAGE PIT � I ° ---- 20' MINIMUM o,° '• o ° °# �•'�,Tr FOUNDATION 7 I %z,! WASHED STONE SL f SCALE: I"= 4' r ELEVATION SKETCH I 10' --{ P119C9 PATa � SCALE 1" 4' TEST BY �.F.�J✓,Ts°yi5�/Q.V.cSe,c,t, TOWN INSPECTOR J�y�� A+����✓ BACKHOE OPERATOR {� w TEST MADE ON .n,�c.✓ L,_t O S.10 co v V✓ , N '-r✓ar Syrc+srGr,r� .y'-.s/eiz..+s�1 �17 \J j ' .✓co r a•/ wq s •<oc•e �"� d Y ✓ v$ ? v 2Ey° p�� eg .eeTa•a6 F•�z� .Svi2va�J o✓ `I / o �3� a ? � .n, °q�"1t 0 �� • °YB fi.lGl/ �S /977 . ni0 Gp,vCp{.,,rS r0 y.�.�t% 0 r. ,�p..r.^/�,4y•CMrBa� oa r,►/`' \ } — p� lj �y Tuv wJ d r tH dM �. ,i SEe°r/A ! I \ -14 Qr JAMES cyGN 9� `` ,'; - ,R WISWELL to !' 1 H. p TS A No. 110-29 '0 SUS APPROVED BY BOARD OF HEALTH DATE 19_ • i OF x.�a8 R�IVWtf;K � 1 c ; B• � - i i(HAPMAM •0 Nn' 27654 a FSS7flNAL E ELEVATION SCHEDULE PROPOSED . SITE PLAN , I. INV. AT FOUNDATION _ 7.80 0 2. INV. INTO SEPTIC TANK = 97, 92 GIEVAISM 9YOTUM DIRSIONIN 3. 1 NV. OUT OF SEPTIC TANK = ' 4. INV. INTO DISTRIBUTION BOX = . 97• SCALE: I"=30' '0'044• 19')") 5. I NV. OUT OF DISTRIBUTION BOX = �•�� C—��� 6. INV INTO SEEPAGE PIT = 94.70 CAPE COD SURVEY CONSULTANTS ROUTE 132 • 7. BOTTOM OF PIT = !P41` 719 HYANNIS,MASS. A DIVISION BOSTON .SURVEY CONSULTANTS, INC. B. BOTTOM OF STONE LAYER = 9a• ?a i' i i , CENTERVILLE. MA 79 78 98.00 ft r 96.82 ft -- Opp 9s THIS IS A P�� HaW- { cv SER COLOR OR pQ�`�' BEND �Q�P 03 � PLAN L �L \ USE COLOR PLAN ONLY p r� GARB 79--1— � � G a R. FOR INSTALLATION �O 0 DETAIL IS S srg0 �) NOT • \ � FULL BEST j l A O FULL OR �90 @� SCALE OWED VIEWEEDD IN r }, L qo F78 L 0 C U 3 Q "�'PAY 77ED LEGEND d,. `1T#Li�# r#E s- DR/;VE1NA y / SEPTIC COMPONENTS. GARAGE 77 U I ` WATER LINE I ......... 1 I 99 ! OVERHEAD WIRE 0 1500 GAL �� ��A, ZC / „ UTILITY SEPTIC TANK I ®� I / ^ POLE DISTRIBUTION BOX IN a TEST PIT r / J28 24 in ft e. OAK e' I I lk t d� 10 / • cv I I' 00 'O '1 EX/ST/NG SO/L -- ' o ®d "' PROPOSED SOIL v � t I ABSp,,�pTION ® _ _ ABSORPTION _ABq^i SYSTEM 1 _ pON IN PLACE . SYSTEM -SEE DETAIL ON BACK Q VENT � W AREA I= 15401 sf+- / PIPE ��PPNS`pglE GI5oq� VARIANCE REQUESTED v/7�� MAY BE GRANTED R HEALTH INSPECTOR. Z , C) 1 .. /Q �� /(4 PLAN BOOK 344 PAGE 78 � ED I DIRT TH NS ECTOR. I \ 1� u '-� R NT IMMEDIATELY 8Y HEALTH AGENT O �A / AssR M,?P 193 PCL 71 ON 310 CMR 75.22I(7) A= COMPONENT EXIST,N� ELEVATI AREA 17849 sf. a. co/vrc)ug T 79. 51 DEPTH TO FINISH GRADE. 36 in 1 PLAN BOOK 236 PAGE.I27 /T O�R MINIMAL ASSR MAP 193 PCL 71 I s` / OP OF FpUNDP��� MAX REQUIRED — VARIANCE TO GRADING / - - 60 in OF COVER -REQUESTED. ' PROPOSED THIS PLAN 15 .INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM .. .. . .. — a ON IT. FOR Y OTHER CHANGE TO THE PROPERTY INCLUDING ft DEPICTED N S G PLACEMENT OF ADDITIONS. SHEDS. .FENCES OR SWIMMING POOLS..OWNER SHOULD CONSULT WITH A MASSACHUS,ETTS REGISTERED LAND SURVEYOR `�H of �H of �oT` E DISPOSAL — p �] Mass9�ti SYSTEM - PLAN L � UV _ DAVID -GJ, _ 120.87 ft � D• a � DADVID TO SERVE' EXISTING DWELLING -- CO GH WR �n S COUGHANOWR Z 1 u ANo CHRISTOPHER AND I No. o. l� NOTES JENNIFER FR SCALE• l 'n � 20 ft 1093 N 461 C . •• �'� OWNERISI OF RECORD E O 20 3 40 781 0, -- INSTALLER MAY MOVE SOIL ABSORPTION SYSTEM. -UP TO U p` 235. ROLLING HITCH RD FGI OVE FIVE (5). FEET .LATERALLY IN ANY DIRECTION. ELEVA.TION5: 10 20 SgNSfER 9PpRAl O �� CENTERVILLE, MA 155 Geo Rder Rd S S _� C SPECIFIED. ON FLOW PROFILE. MUST- BE MAINTAINED: y PROPERTY ADDRESS INSTALLER MAY MOVE VENT: PIPE TO A DIFFERENT LOCATION. PRINT ON, It, X 17 In Chothom. MA 02633 PAPER FOR PRCK7PER SCALE DovidcouOHotmoil.com DATE: MARCH 15, 2619 -TREE .REMOVAL AT INSTALLERS.DISCRETION: 508 - - 364 0894 P�1/2 doe • ETE-4365 • � • � � o o USE SHOREY OOI TEST LOOG ' ' DBESIG �1 LCU A�, TIOo INS �1 000o G�'�1C��OnN1 ��G�T�� T�n�l� WSTG� OUTIOoNl BOX USE H2O SOIL EVALUATOR: DAVID D. COUGHANOWR, ASE #461 DESIGN FLOW: 5 BEDROOMS X 110 GPD = 550 GPD DIMENSIONS & DETAIL DIMENSIONS PIPES EXITING D-BOX TO RUN LEVEL WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. AND DETAIL FOR 2 FEET BEFORE PITCHING DOWN TEST PIT NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 550 GPD X 2 DAYS = 1100 GALLONS USE EXISTING TANK IF STRUCTURALLY SOUND. PERC AT 84 in - 2 MIN/INCH IN C SOILS USE EXISTING 1.500 GALLON SEPTIC TANK IF IN PUMP TANK AT TIME REPLACE WITH A NEW ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT. INSTALL OF REPAIR 1500 GALLON TANK INCHES HORIZON TEXTURE (MUNSELU MOTTLES - NEW 1500 GALLON SEPTIC TANK. I inIF CRACKED, ROTTED 12 in 76J5 0-4 Ap SANDY LOAM l0 YR 3/2 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. TAPER OR OTHERWISE c MIN 4-28 Bw LOAMY SAND 10 YR 4/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: COMPROMISED. _ -► 28-66 Cl SANDY LOAM 10 YR 5/6 NONE FRIABLE �` � FROM S : -� 71.25 THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE 66-150 C2 MEDIUM SAND 10 YR 5/4 NONE LOOSE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES o �. N TANK F U3 50 64.25 AS PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. 5 ft_ NO GROUNDWATER ENCOUNTERED TEST PIT 2 THE 41.5 ft x 12.5 ft x 2 ft LEACHING GALLERY o 8 in 2 MINIINCH IN C SOILS DEPICTED BELOW CAN LEACH: 6 in STONE BASE ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER aR t INCHES HORIZON TEXTURE - (MUNSELU MOTTLES BOTTOM AREA = (41.5 x 12.83) = 532.44 sq. ft. •+ f'`�� c't NGT 21 1n 2� CROSS SECTION VIEW 76.95 0-4 Ap SANDY LOAM 10 YR 3/2 NONE FRIABLE SIDEWALL AREA = [2x(41.5+12.83)] x2 = 217.32 sa. ft. " �(� 4-32 Bw LOAMY SAND 10 YR 4/4 NONE FRIABLE TOTAL AREA = 749.76 sq. ft. w i� T 32-68 Cl SANDY LOAM 10 YR 4/6 NONE FRIABLE FLOW CAPACITY = 0.74 x 749.76 = 554.82 Sol/day /U ft_ SCALE 71.28 68-144 C2 MEDIUM SAND 10 YR 5/4 NONE LOOSE ALL A 41.5 ft x 12.83 ft x 2 ft GALLERY AS CONFIGURED 6 /n SO#L� G t1 0 MOlf1ZPT§OIIV 64.95 BELOW. FLOW CAPACITY = 554.82 gal/day WHICH EXCEEDS INLET OUTLET M n� THE 550 gal/dogREQUIRED FOR A FIVE BEDROOM DESIGN S p SS TE CONSTRUCTION DETAIL COVER COVER USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL �3 IN DROP DRYWELLLINE DRYWELL UNIT 41.5 ft -INSTALLER TO OBTAIN DISPOSAL WORKS FROM 10 in - 14 TO BUILDING , 41 v w PEjfm���� - RMIT BEFORE STARTING WORK. 1n D-BOX 4- liz -ALL COMPONENTS INSTALLED SHALL MEET 48 in co ® ® ® �° cc! THE MINIMUM REOUiREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC LIQUID GAS CO -- I.O. CODE (310 CMR 15). LEVEL BAFFLE `� N „0 V.-; -INSTALLER TO VERIFY LOCATIONS OF ALL STONE - - ----UND.ERGR_OUND-_U-T-ILITIES. BEFORE.. - - = k EXCAVATING FOR SYSTEM. b in STONE BASE 4 ft 8.5 ft 4 ft 8.5 ft 4 ft 8.5 ft ft' -ECO-TECH RAPID RESPONSE RECOMMENDS SEPARATION BETWEEN INLET & OUTLET THE INSTALLATION OF LOW FLOW TEES NO LESS THAN LIQUID DEPTH 41.5 ft FIXTURES &PUMPING OFATHEAS SEPTIC TANK NCES, AND PERIODIC CROSS SECTION VIEW SEPTIC TANK IS NOT DESIGNED TO WITHSTAND 500 GALLON DRYWELL VEHICULAR LOADING. DO NOT PARK OR DIMENSIONS & DETAIL INSTALL ONE INSPECTION DRIVE VEHICLES OVER SEPTIC SYSTEM. RISER TO WITHIN THREE _ INCHES OF FINAL GRADE & INDICATE LOCATION ON AS-BUILT in ODOD usE TOP OF FOUNDATION ALL PIPE TO 4 in BE SCH_ 40 PVC VENT 5 U RAISE COVERS TO WITHIN AND TO PITCH AT 1/8 in/ft MIN EL 79.51 +- 6 in OF FINAL GRADE PIPE 77.25 CROSS SECTION VIEW �u/ USE INSTALL AN APPROVED GEOTEXTILE oD�L9OO//� 5 H-20 FABRIC OVER STONE USE H-20 MAX RATED EXISTR3 72.25 UNITS24 EXISTING PRECAST 28 3/4 in TO e EFFECTIVEi 3/4 1n TO 0 1-1/2 1n GAAVEL 1-1/2 In GRAVEL 8�0°000°goo°oSo -go0000�0�8 in } DEPTH ��p��� TA�K 76.00 °000 o°o 0o aoo° 71.38 DRYWELL o° a r 00 00 00000 o00000 000 + 6 in 48 in 58 in 48 in ExISTING REFER TO DETAIL BOX STONE SOO �L� A°,BSORRPT Oil 7L 55 71.25 _ 4- 154 in BASE �// n� REFER T O ALL STONE TO BE DOUBLE WASHED AND 6 in STONE BASE IF NEW 67 ft to ft SYSTEM O . EXISTING DETAIL BOX Lo FREE OF IRONS, DUST AND FINES IN PLACE BELOW NO GROUNDWATER OW 69.25 MOTTLING: OBSERVED. . 64.25 .. SEWAGE DISPOSAL SYSTEM PLAN 235 ROLLING HITCH RD CENTERVILLE, MA IMARCH 15, 2019 ETE-4365 PG 2/2