HomeMy WebLinkAbout0058 SEAN'S CIRCLE - Health 58 SEANS CIRCLE, CENTERVILLE
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i4i�W�.1W
TOWN OF BARNSTABLE v
LOCATION San l C�rc 4, SEWAGE# ,7w9
VILLAGE e®nkfcu ASSESSOR'S MAP&PARCEL /7a -
INSTALLER'S NAME&PHONE NO. Cape W ids S(0 a g
SEPTIC TANK CAPACITY /yOa !t t G
LEACHING FACILITY:(type) JJ'rg 4 (qp /3ro"D iPP(size) 69� 3 X 30
NO.OF BEDROOMS .3
OWNER��(,Ir/yi Jear+dt'e n
PERMIT DATE: (0- ®1 ®5 COMPLIANCE DATE: (o t.L' 2001
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility owe- // 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) j Feet
FURNISHED BY
�Z tea. -
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33 °
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y
1
No. goo
� � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIpprication for Mi!6pozal 6p5tem Couftruction Permit
Application for a Permit to Construct( ) Repair(41*'Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No.S& S eA44-1'-s U f6'2 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel ( "76 p S 7 O O S
Installer's Name,Address,and Tel.No. ,��i;(Q e4 30'j Designer's Name,Address and Tel.No. f; �' (�lcQtit
Po G=*;,_
Type of Building:
Dwelling No.of Bedrooms Lot Size S,CLO I ± sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 33 o gpd Design flow provided 3 (c • 3 gpd
Plan Date (,->—3—20 0?I Number of sheets Revision Date
Title ,S 5�—�
Size of Septic Tank I OOO Qwl.-4� Type of S.A.S. 1 J4_vt
Description of SoilQ_Q
Nature of Repairs or Alterations(Answer when applicable) (3(,c S/-Sl-t 1 / 44/p b,'-
A /L(^- 16-t3 ati j r2 T_ C _,� 5 TZA e (-t JS 7b T 4c.
Date last inspected: �oc�
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 alth.
Signed Date
Application Approved by L S, Date _ al — ?GO
Application Disapproved by: Date
for the following reasons
Permit No. 2-00-1— /, I,a Date Issued 1'280�
——————— — —————————
No. ;, i Fee /00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
iPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS "Yes
Zi prication for Miopoal *pgtem Construction Permit
.Application for a Permit to Construct( ) Repair(v) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
w.
F--:�Assessor's
ion Address or Lot No.S S J_✓1 h 5 f C) Owner's Name,Address,and Tel.No.
Map/Parcel ( 7 O p/� I`ler's Name,Address,and Tel.No.C.�✓a,^�c.j f;P U� R.'4''i sn.) Designer's Name,Address and Tel.No.
C t�v r m ✓� S a - 2 ? 3 -�3 7
Type of Building:
Dwelling No.of Bedrooms 1 Lot Size 1 O 1 sq. ft. Garbage Grinder ( )
Other f Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 5 3 U gpd Design flow provided 3` 1 b . 3 gpd
Plan Date to` 3 2 0 o S Number of sheets Revision Date
Title S arm
Size of Septic Tank 1 Oo O Q,�61,5 tit Type of S.A.S. S i Csv.cz -e )S T /-t*l t_i,
Description of Soil Q ig , (p
�. V
Nature of Repairs or Alterations(Answer when applicable) C r• r /�o o C 1 �a 1 Jr Tvr t 1 cJ
114,— '1) - f3 c i c� T"w 2� izn e ! r JS -r r -e,� cL,r ► 2 7U i L4L
Date-last inspected: 7no ej
Agreement:
The undersigned agrees to ensure,thetconstruction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of thEnvironmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board'of Health.
Signed Date — b Z o--1
Application Approved by e i1`, S, Date f'J ' Z00 7
Application Disapproved by: Date
for the following reasons
- Permit No. �0�" p(p Date Issued Zoo,?
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( t/) Upgraded'( )
•Abandon`ed( )by /7;16w,f,Qt (� /Or ) C) L C C
at �G S pjyJ�, C ��(-e has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 oo q dated
Installer �/a,��f�„�. ��/��Y rJ�i rj ( Designer .
#bedrooms 3 Approved design flow _ gpd
The issuance of this permit shall not
be construed as a guarantee that the system wi t)nctidn s desigZa
Date1 I 0_1 Inspector �
----- -- -- - ---- -- ----_____ _No. Fee��� .��
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
lwigpogal Abp!tem Construction permit
Permission is hereby granted to Construct ( ) Repair ( ✓� Upgrade ( ) Abandon ( )
System located at K,f SC 6" L yc
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Constructio must be completed within three years of the date of this pe it.
Date � O Approved by /
TRANS. NO.:
CITY/TOWN: Centerville
APPLICANT: Capewide Enterprises
ADDRESS: 58 Sean's Circle, Centerville, MA
DESIGN FLOW: 330 gpd
REVIEWED BY: DATE:
N/A OK NO
Legal boundaries denoted [310 CMR 15.220(4)(a)] X
Street, Lot, tax parcel number and lot number noted on plan [310
CMR 15.220(4)(u)] X
Locus Provided [310 CMR 15.2204(t)] X
Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for
components) [310 CMR 15.220(4)] X
Easements shown [310 CMR 15.220(4)(b)] X
System located totally on lot served [310 CMR 15.405(1)(a) for—
upgrades]- if not, a variance is required [310 CMR 15.412(4)] X
Location of impervious surfaces (driveways,parking areas etc.)
[310 CMR 15.220(4)(d)] X
Location all buildings existing and proposed 310 CMR
15.220(4)(c)] X
Location and dimensions of system components and reserve areas.
[310 CMR 15.220(4)(e)] X
System Calculations [310 CMR 15.220(4)(0] X
daily flow X
septic tank capacity (required and provided) X
soil absorption system (required andprovided) X
whether system designed for garbage grinder X
North arrow [310 CMR 15.220(4)(g)] X
Existing and proposed contours [310 CMR 15.220(4)(g)] X
Location and log of deep observation holes (existing grade el. on
each test) [310 CMR 15.220(4)(h)] X
Names of soil evaluator and BOH representative [310 CMR
15.220(4)(h) and(i)] X
Location and date of percolation tests (performed at proper
elevation?) [310 CMR 15.220(4)(i)] X
Percolation test results match loading rate? [310 CMR 15.242] X
Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] X
Observed and Adjusted groundwater(method for adjustment
given or indicated) [310 CMR 15.103(3) and 310 CMR
15.220(4)(n)] X
Address 58 Sean's Circle, Centerville,MA Sheet 1 of 7
N/A OK NO
Location of every water supply, public and private, [310 CMR
15.220(4)(k)] X
within 400 feet of the proposed system location in the case
of surface water supplies and gravel packed public water supply X
within 250 feet of the proposed system location in the case X
within 150 feet of the proposed system location in the case
of private water supply wells X
Location of all surface waters and wetlands located up to 100 ft.
beyond setbacks listed in 310 CMR 15.211 and any catch basins
located within 50 ft. [310 CMR 15.220(4)(1)] X
Water lines and other subsurface utilities located [310 CMR
15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) X
Profile of system showing invert elevations of all system
components and the bottom of the SAS [310 CMR15.220(4)(o)] X
Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] X
Stamp of Registered Land Surveyor(required if construction
activities within 5 ft. of lot line) [310 CMR 15.220(3)] X
Test Holes adequate (two in each of the primary and reserve
unless trenches as permitted in 310 CMR 15.102(2) or as
approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] X
Test hole adequate to demonstrate four feet of suitable material?
[310 CMR 15.103(4)] X
Test Holes adequate to confirm adequate groundwater separation?
[310 CMR 15.103(3)] X
Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] X
Materials specifications noted? [various sections of 310 CMR
15.000] X
System components not>36" deep (unless Local Upgrade
Ap roval or LUA requested) [310 CMR 15.405(1(b)] X
Address 58 Sean's Circle, Centerville MA Sheet 2 of 7
N/A OK NO
£SEP�TRIC'I�NK y '
Size OK? [310 CMR 15.223(1)] X
Inlet tee located ten inches below flow line [310 CMR 15.227(6)] X
Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR
15.227(6)] X
Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] X
Note regarding installation on stable compacted base [310 CMR
15.228(1)] X
Separation between inlet and outlet tees (no less than liquid
depth) [310 CMR 15.227(2)] X
Inlet/Outlet elevations at least 12" above high groundwater
(except as described 310 CMR 15.227(5)) or permitted for
upgrades under LUA [310 CMR. 15.405(1)(k)] X
Minimum cover 9" (Tanks buried more than 9" must have risers
on all openings and on the d-box) [310 CMR 15.2228(1) and 310
CMR 15.232(3)(0] X
Three access covers (inlet and outlet must be 20" or greater) -
middle access at least 8" (by 7/07) [310 CMR. 15.228(2)] X
Access to within 6 " of grade - one port for systems<1 000gpd,
two for systems>1000 gpd [310 CMR 15.228(2)] X
All at-grade covers secured to unauthorized access? [310 CMR
15.228(2)] X
> 10 ft from building foundation [310 CMR 15.211 1)] X
Buoyancy calculation Required/Done [310 CMR 15.221(8)] X
H-20 Where appropriate? [310 CMR 15.226(3)] X
Setbacks from resources [310 CMR 15.211] X
�Mu tq� Com;p�rtment hanks '� 0 �
Required when other than single-family dwelling or flow>1000
d [310 CMR 15.223(1)(b)] X
First compartment 200% daily flow; Second compartment 100%
daily flow [310 CMR 15.224(2) and(3)] X
"U" pipe through or over baffle, outlet of each compartment with
gas baffle or approved filter [310 CMR 15.224(4)] X
Address 58 Sean's Circle, Centerville,MA Sheet 3 of 7
N/A OK NO
B �%CL 15I NG SEWS �11�D T HEIZ PIPIT G..ems
Located at least ten feet from any water line? [310 CMR
15.222(2)] X
Disposal piping at least 18" below water line (when water and
sewer cross, see 310 CMR 15.211(1)[1]) X
Cleanouts required/provided ? [310 CMR 15.222(8)] X
Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] X
Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable
[310 CMR 15.222(6)] X
Proper pitch on all runs? (.005 within gravity-distributed trenches
and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] X
Siphonproblem/(leachfield below pump chamber) X
Endcaps or vent manifoldspecified? X
Size and orientation of discharge holes specified? (not smaller
than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310
CMR 15.252(2)(h)] X
Materials specified (310 CMR 15.251(5) specifies various pipe
types allowed) X
DIS�TRIIT' I'ONBOX may . vas
Stable compacted base [310 CMR 15.221(2) and 310 CMR
15.232(2)(a)] X
Splash plate or baffle tee required on inlet/provided? (when
pressure sewer to d-box or steep pitch of gravity sewer) [310
CMR 15.323(3)(a)] X
Riser if deeper than 9" [310 CMR 15.232(3)(0] X
Inside minimum dimension 12" [310 CMR 15.232(2)(b)] X
Minimum sum 6" [310 CMR15.232(3)(e)] X
Watertight cover if<2000gpd); waterproof manhole if>2000gpd
[310 CMR 15.232(3)(d)] X
Capacity(emergency storage above working=design flow)? [310
CMR 231(2)] X
Proper setbacks [310 CMR 15.211 (same as septic tanks)] X
Watertight 20-in minium access manhole at least 20" MUST BE
TO GRADE [310 CMR 15.231(5)] X
Service components accessible (not too deep with piping,
disconnects accessible) X
Alarm floats - alarm on circuit separate from pumps specified? X
Exceeds two units must have two pumps operating in lead-lag
mode. [310 CMR 15.231(6) and(8)] X
Stable Compacted Base 1310 CMR 15.221(2)] X
Buoyancy calculations needed ?Provided? [310 CMR 15.221 8)]T X
Address 58 Sean's Circle, Centerville,MA Sheet 4 of 7
N/A OK NO
S®ILABS�ORI'TI'O1SYS�T'EMS,�S '`S),G �fE1�A��� ��
Calculations correct? X
4 feet of naturally occurring material demonstrated? [310 CMR
15.240(1)] X
Required separation to groundwater? [310 CMR 15.212)] X
Aggregatespecified as double washed [310 CMR 15.247(2)] X
System Venting required/provided? (system under driveway or
>36" deep) [310 CMR 15.2411 X
Inspection ports specified and within 3"final grade? [310 CMR
15.240(13)] X
Breakout requirements met? (No violation of breakout elevation
within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and
Guidance Document] X
YGAI; E_RIES'P,
�.
Chambers and Gal. in trench configuration supplied with inlet
every 20 ft. [310 CMR 15.253(6)] X
Each structure with one inspection manhole(if>2000 gpd must
be to grade) [310 CMR 15.253(2)] X
Aggregate 1'minimum-4'maximum. [310 CMR 15.253(1)(b)] X
2' sidewall credit maximum [310 CMR 15.253(1)(a)] X
In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] X
Width T minimum 3'maximum [310 CMR 15.251(1)(b)] X
100 feet- maximum length [310 CMR 15.251(1)(a)] X
Minimum separation 2x effective depth or width whichever
greater(3x if reserve between trenches) [310 CMR 251(1)(d)] X
Situated along contours [310 CMR 15.251(2)] X
Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] X
ESAS,(Maximum sizeof�bed or fielS00Q gam)
P _
.;s,,,,..� .�
minimum 2 distribution lines [310 CMR 15.252(2)(a)] X
Maximum separation between lines 6' [310 CM R15.252(2)(d)] X
Maximum separation between lines and outside of bed 4' [310
CMR 15.252(2)(e)] X
Aggregate depth below discharge pipes 6" minimum, 12"
maximum. [310 CMR 15.252(2)(g)] X
Separation between beds 10'minimum. [310 CMR 15.252(2)(0] X
Bottom area used in calculations only [310 CMR 15.252(2)(i)] X
Address 58 Sean's Circle, Centerville,MA Sheet 5 of 7
a
N/A OK NO
DIDTHEPLA,N INVOL a t
Pressure Dosed System ? Provided pump and piping
calculations as required [310 CMR 15.220(4)(r)] X
Pressure dosing required on all systems>2000gpd or alternative
systems under remedial approval [310 CMR 15.254(2) and I/A
Remedial Use Approvals] X
If used in gravelless system-make sure jet is directed as not to
scour soil interface [Guidance Document] X
Inspections once per year(systems<2000 gpd) or quarterly
(>2000 d) good to note on plan [310 CMR 15.254(2)(d)] X
Construction in fill - Did the plan specify that the fill shall meet
the specification of 310 CMR 15.255(3)? X
Impervious barrier and/or retaining wall ? [Guidance Document] X
Impervious barrier installation must be supervised by
designer [310 CMR 15.255(2)(b)] X
Retaining wall must be designed by Registered Professional
Engineer [310 CMR 15.255(2)(a)] X
Side slope not exceed 3:1 ? [310 CMR 15.255(2)] X
Breakout requirements met? [310 CMR 15.252(2) and
Guidance Document] X
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
recommended) [310 CMR 15.255 2)(e)] X
Gra�vellessSystem�[,,I'�1���1o�uallet ,t
t�rSJ a y r
Check DEP Approval letters for credits and design conditions X
If used with pressure dosing do not allow pressure discharge
to scour soil interface X
Was DEP Approval Letter provided and/or have you
reviewed the letter for conditions? X
Is the technology being properly applied and does it meet all
DEP Approval Conditions? X
Is there a note on the plan regarding the requirement for
perpetual maintenance agreement? X
Any alarms involved on separate circuits X
Did the applicant submit an operation and maintenance
manual? X
Has applicant submitted a copy of a maintenance X
Are the variances listed on the plan? [310 CMR 15.220
(4)( )] X
RLS Stamp necessary on plan if a component is within five
feet of property line [310 CMR 15.412(4)] X
New construction or increased flow proposed- [Refer to 310
CMR 15.414] X
Address 58 Sean's Circle, Centerville,MA Sheet 6 of 7
N/A OK NO
1Vtrogeri�ensitive Areas%NJ W-1
'yG
Is the system in a Designated Nitrogen Sensitive Area(Zone II for
a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and
310 CMR 15.216 - also refer to Policy regarding upgrades of such
existing systems] X
Is the system proposed on the same lot as served by private well ?
[310 CMR 15.214(2)] X
Are the nitrogen loads proposed in compliance? [310 CMR
15.216(1)] X
z
Pumping to septic tank ? [ 310 CMR 15.229] X
Shared System [310 CMR 15.290] X
Address 58 Sean's Circle, Centerville,MA Sheet 7 of 7
.t Own of Isarnstame
Regulatory Services
'Thomas F. Geller, Director
bs , ' Public Health Division
A
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office, 508..862.4644
Fax: 50-h- K1,6304
Installer & Designer Certiflcatin Form
Bate. :Twoe 12, Zc,09 w
Desi aer; �wGn�tree ec c
Installer:
Address: 2-8.5'1_ CCc�nb��.r tl �iwnx Address: 13-a,c -?G3
c s+ Wcacean arri CA,,,("A, .t—_ �
Y Orr_ (J _"_1105� 0163L
. .__.__._. .._._.� .._,was Issued a permit to install a
(date) T (Installer)
septic system at based on a design drawn by
(address) ,
wG �5c��ec:c"��► .i.r�G.
...... ...�.....,.1 '>.,,,..... _ dated 5u�e 3, L u c9 '�
(designer) •
1 certify that the: septic system te:ibrencecl above was installed substantially according t::
the design, which may include minor approved changes such as lateral relocation cif'th(,'
distribution box and/or septic tank.
_ I certify that the septic system referenced above was installed with major changes (1.c
greater than 10' lateral relocation of the SAS or any vertical relocation of any compol,,01j,
of the septic: systern) but in accordance with State & Local Regulations. Ilan revistort C l
certified as-built by designer to follow,
�yKN f7N M.y,��
JOHN L
Ciil;Fy.0 'L1. n
-___.•.. (Irrst er's Sigriat a-e1-�. -. .���, `"
^wit.
(Designer's Si e) ~" (AffI ' esigher' Here
O BARNSTABLE PTJRI.T� E Vu IV O CE ` F'IGA'I'l;
OF COMP ANC I T S.
lg C B D YISI
THANK YOU,
Q: Heelth/Sepuc/faesigner Certification form
TO 'd L9£0 £LZ 809 ]N I2l33N I DN33r Wd b T : L0 600Z-Z T-Nnr
of�
Town of Barnstable P#
Department of Regulatory Services
8MMUrABLK : Public Health Division Date -1 o v
MASS. p�
�a39 �u 200 Main Street,Hyannis MA 02601
QED AAA't�
Date Scheduled_ Time Ah Fee Pd.
Soil u'tability Assessment for Sewage isposal
r
Performed By: h i t:6e,( funenteA f,CSb Witnessed By: V�
LOCATION& GENERAL INFORMATION
Location Address 5-8 <e kA,-N'j Ci Y A 2 . Owner's Name AF i S-,A
Address S�e f I
Assessor's Ma /Parcel: 1 C9l o> 7�c S s c�$ 't PV)) s 0 d
p Engineer's Name I"
-Sc �VlgMe.Eil'Yl,g
NEW CONSTRUCTION REPAIR Telephone# `4 2F'Jo 4 5 0 S 273-0�3 7
Land Use S110L F0444T/My4wry to
,A Slopes(%) / - 2 a Surface Stones -
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well - ft
Drainage Way - ft Property Line 7 !o ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pen;tests,locate wetlands in proximity to holes)
Parent material(geologic) bu}"'aA1 Depth to Bedrock
7 l 3 0 ,bg
Depth to Groundwater. Standing Water in Hole: 7 13 6"b 5 9 Weeping from Pit Face 7 S
Estimated Seasonal High Groundwater 7 1'3 0 65 S
DETERARNATION FOR SEASONAL HIGH WATER TABLE
Method Used: D1fect 6 -S tL4tfn
Depth Observed standing in obs.hole: 713 0 . -__- in. Depth to soil mettles: 7 13 O
Depth to weeping from side of obs.hole: Z 130 in. Groundwater Adjustment fr.
Index Well# Reading Date: Index Well level Adj,thetor Adj.Groundwater Level
PERCOLATION TEST Date b3"0q Time ��1417
Observation _
Hole# _ Time at 4"
Depth of Perc Zy.�y2 Time at 6"
Start Pre-soak Time @ pAt5 AR - --- Time(9"-6")
End Pre-soak 1 0 9
Rate Minjbch 4 'L
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) A/
Original: Public Health Division Observation Hole Data To Be 6tnpleted 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:\SEPTIOPERCFORM.DOC
J
DEEP.OBSERVATION HOLE LOG Hole# 1
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency.% ravel
5/6
M-cs 2 5 Ao _ 5Vj 5raVC
DEEP OBSERVATION HOLE LOG Hole# 2
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
2 LS
2 y 13U C- H-C S 2.5-� 416
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other.
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones',Boulders.
ons' t
Flood Insurance Rate Man:
Above 500 year flood boundary No— Yes ._
Within 500 year boundary No Yes
Within 100 year flood boundary No✓ Yes
Depth of Naturally Occurring Pervious Material
Does at.least four feet of naturally occurring pervious material exist in all areas observed throughout the
area for'the soil.absorption system?
proposed
If not,what is the depth of naturally occurring pervious material? ..
Certification
I certify that on /B.Z 7-9.9 (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training a ertis and exp nce described in 310 CMR 15.017.
Signature Date
Q:%SEPTI0PERCFORM.DOC
D
No. arw,,9 7 ! Fee J t/ I �—
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for 30iopool bpttem Con.5truction Vennit
Application for a Permit to Construct( )Repair(f✓)Upgrade( )Abandon( ) ❑Complete System Ce'l vidual Components
Location Address or Lot No.c Q ����� C )�G�� Owner's Name,Address an/dd Tel.No.
Assessor's Map/Parcel cJ® C.e-o7t?l/`ll1l
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicab e) IrL°�QGC
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued this oardpf Health.Signed G s Date 7_111�
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
.9 ��� 17D-dSToas
No. '�v 7 Fee ". -._
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
I PUBLIC,HEALTH DIVISION -TOWWOF BARNSTABLE., MASSACHUSETTS
2pprication for Migpooar *p!gtem Construction 3permit
Appjication for a Permit to Construct(' )Repair( 1/fUpgrade( )Abandon( ) ❑Complete System L97ndividual Components
Location Address or Lot No. F--� Serlos'c 1lG/e Owner's Name,Address and Tel No.
Assessor's Map/ParcelC e0
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�0t f��O f i ,5>`,
7/- 3 q
Type:of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
- Other Type of Building No.of Persons Showers( ) Cafeteria( )
Othef Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
5
Size of Septic _ --' Type of S.A.S.
Description of Soil
`1t 1
�J Y'
Nature of Repairs or Alterations(Answer when applicable) re e 1D e e e
Date last inspected:
w Agreement:
The undersigned agrees to ensure-the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5,of the Environmental Code and not to place the system in operation until a Certifi-
r•� ti`sate of Compliance has been issued b t oard f Health.
P 4
„ s 4 Signed Date a
App'Nbation Approved by C Date
r Application Disapproved for thefollowing reasons',
Permit No. ",Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS / l.A '7 C--
BARNSTABLE, MASSACHUSETTS /(
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage,Disposal System Constructed( )Repaired( V/ Upgraded( )
Abandoned( )by
at 19 z /'Y hasbefen constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 0 � I ! dated
Installer Designer-
The issuance of this permit shallrriot be construed as a guarantee that the system-will function asfdesignetd))
Date r i i ! /'90 Inspector A."�`�9 X� l�• �,,�.�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lwizpool &pgtem (Construction Vermit
Permission is hereby granted to Construct( )Repair( ✓/Upgrade( )Abandon( )
System located at 6 ,Ke--_ 15 i/'�'!"a
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit. . ��
Date: 2' /�'- � 7 Approved by
BORTOLOTTI CONSTRUCTION, INC.
45 INDUSTRYROAD, N[ARSTONS MILLS, MA.02648
508-771-9399 508-428-8926 FAX: 508-428-9399
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address:
Date Of Inspection Iloo Inspector's Name:
Owner's Name and Address: Wqz2z ,
U
CERTIFICATION STATEMENT:
I Certify that I have personally Inspected the Sewage Disposal System at this address and that the informa-
tion reported below is true,accurate and complete as of the time of Inspection. The Inspection was perform-
ed based on my Training and Experience in the Proper Function and Maintenance of On-Site Sewage Dis-
posal Systems.The system:
Passes
Conditionally, sses
Needs Furthe val tiony the Local Approving Authority
Failujrjor
Inspector's Signature Date: 3/ 6
The System Inspector shall submit a copy of this Inspection Report to the Approving Authority with Thirty
(30)Days of completing this Inspection. If the System is a Shared System or has a Design Flow of 10,000 gpd
or greater,the Inspector and the System Owner shall submit the Report to the appropriate Regional Office of
the Department of Environmental Protection. The Original should be sent to the System Owner and copies
sent to the Buyer,if applicable and the Approving Authority.
INSPECTION SUMMARY:
A) SYSTEM PASSES:
I have not found any Information which indicates that the System violates any of the fail-
ure criteria as defined in 310 CMR 15.303. Any Failure Criteria not evaluated are indi-
cated below.
B) SYSTEnCONDITIONALLY PASSES:
V One or more System Components need to be Replaced or Repaired. The System,upon
completion of the Replacement or Repair,Passes Inspection.
Indicate,yes,nor,or not determined(Y,N,OR ND). Describe bases of determination in all instances. If"not
determine ",explain why not.
The Septic Tank is Metal,Cracked,Structurally Unsound,shows Substantial Infiltration or exfil-
tration,or Tank Failure is imminent. The System will Pass Inspection if Existing Septic Tank
is Replaced with a conforming Septic Tank as Approved by the Board Of Health.
Sewage Backup or Breakout or High Static Water Level observed in the Distribution Box is due to
broken or obstructed pipe(s)or due to a broken,settled or uneven Distribution Box. The System
will pass Inspection if(With Approval of the Board Of Health):
_1 _
SUBSURFACES:SEWAGE,,DI,SPOSAI..E°SY$!'.FM INSPECTION FORM
PA 111' A
CERTIFICATION (continued)
Broken pipe(s) replaced
Obstruction is removed
Distribution Box is leveled or replaced
The System required pumping more than four times a year due to broken or obstructed pipe(s).
The System will pass inspection if(with approval of The Board Of Health):
Broken pipe(s)-are replaced
Obstruction is removed.
C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board Of Health in order to determine if
the System is failing to protect the Public Health,Safety and the Environment.
1)SYSTEM WILL PASS UNLESS BOARD OF HELLTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE
PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or Privy is within 50 Feet of a Surface Water
Cesspool'or Privy is within 50 Feet of a bordering Vegetated Wetland or'a Salt Marsh.
2)SYSTEM WILL FAIL UNLESS THE BOARD'OF HEALTH'(AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)'DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNER THAT PROTECTS THE PUBLIC HEA LTH AND SAFETY AND THE
ENVIRONMENT: r :r
The system has a Septic'Tank and Soil Absorption System and js within 106 Feet to a Surface
Water Supply or Tributary to a Surface Water Supply:'
The System has a Septic Tank and Soil Absorptio System and is with a Zone 1 of a Public
Water Supply Well.
The System has a Septic Tank and Soil Absorption System and is within 50 Feet of a Private
Water Supply Well.
The System has a Septic Tank and Soil Absorption System and is less than 100 Feet but 50
Feet or more from a Private Water Supply Well,unless a Well Water Analysis for coliform
bacteria and volatile organic compounds indicates that the Well is from pollution from
the facility and_the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm.
D)SYSTEM FAILS:
I have determined that the System violates one.or more of.the following Failure Criteria as defined
in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health
should be contacted to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overload or clogged SAS
or cesspool.
Discharge.or pouding of effluent to the surface of the ground or surface waters due town
overloaded or clogged SAS or cesspool :rr s
Static liquid I vel in the distribution box above outlet invert due to an overloaded or clog-
>.
.. ged-.SAS or cesspool. z rf _ __.
Liquid.depth,»cesspool is less than G;'below.,invert or,available volume'isless Phan I/2
day How.
Required pumping.more than 4 times_in the last year NOT,due to clogged.or obstructed
pipe(s). Number of times pumped.
- 2 -
SUBSURFACE SEWAGE DISPOSAL SYSTEM, INSPECTION FORM
PART A
CE11TIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to
a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a Public Well.
Any portion of a cesspool or privy is within 50 Feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 10,000 ggd or greater(Large System)and the system is a significant
threat to public health and safety and the.environment because one or more of the following
conditions exist:
`The system is within 400�Feet of a surfacedrinkmg water~supply`.
The system is within 200 Feet of a'tributary"to`a"surface'drinktng.water supply
Che system is located in a nitrogen sensitive area Interim Wellhead Protection Area
_ (IWPA)or a mapped Zone 11 of a public water supply well
The owner or operator of any such system shall bring the system and facility into full compliance with the
groundwater treatment program requirements of 315 CMR 5.00 and 6.00. Please consult the local
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
V"umping information was requested of the owner,occupant,and Board of Health.
j/None of the system components have been pumped for atleast two weeks and the system has
been receiving normal flow rates during that period. Large volumes of water have not been
/ introduced into the system recently or as part of this inspection.
/ As-built plans have been obtained and examined. Note if they are not available with N/A.
— The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
✓The site was inspected for signs of breakout:
' All system components,excluding the Soil{Absorption System,have been located on site.
The septic tank manholes were uncovered,opened,and the interior of the'septic tank was in-
spected for condition of baffles or tees,material of construction,dimensions,depth of liquid,
/ depth of sludge,depth of scum.
rhe'size and location of the Soil Absorption System on the site has been determined based on
existing information or approximated by non-intrusive methods.
- 3 - x
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
�,XChe facility owner(and occupants,if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
- - SYSTEM INFORMATION ,
FLOW CONDITIONS
RESIDENTIAL:
Design Flow:33C7 gallons Number of Bedrooms: Number of Current Residents: _
Garbage Grinder: )O Laundry Connected To System: Seasonal Use:
Water Meter Readings,if av ilable:
Last Date of Occupancy:
COMMERCIAL ANDUSTRIAi:-.A)U
b
Type of Establishment: ,
Design Flow:-gallons day Grease Trap Present: (yes
Industrial Waste Holding TankPresent: �-
Non-Sanitary 'Discharged To T1ie Title V Systeinc
Water Meter Readings,If Available: Last Date of Occupancy:
OTHER: (Describe)
Last Date of Occupancy:
GENERAL INFORMATION d�-_ �
PUMPING RECORDS any source of information: � Q(x �4%GL "?
System Pumped as part of inspection: If yes,volume pumped: -gallons
Reason for Pumping:
TYP"F SYSTEM:
Septic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach previous inspection records,if any)p
Other(explain):
APPROXIMATE AGE.of all,com orients,date installed(if known):,and source of information. . ..
Sewage odors detected when arriving at the site:
-4-
3
SUBSURFACE,SEWAGE ..DISPOSAL SYSTEM JNSP.ECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC'1'ANK:� �j' ��
✓
Depth below grade: Mal of Construction:Material concrete metal FRP Other
(explain)
Dimensions: ,, ,X s, Sludge Depth: /(a ii Scum Thickness: /'
Distance from top of sludge to bottom of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments: (recommendation for pumping,conditioin of inlet and outlet tees or baffles,depth of liquid level
in relation to out t invert,structural integrity,evidence of lea ge,etc.). r �, s /000
\,G .4 aAd af �.
ti
GREASE TRAP: /1.iZJ
Depth Below Grade: Material of Construction: concrete metal FRP Other
(explain):
Dimensions: Scum'Thickness:
Distance from top of scum to top of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth ofrliquid level
in relation to outlet invert;structural integrity,evidence-of leakage,-etc.)--- -•----•-
:-
TIGHT OR HOLDING TANK:
Depth Below Grade: Material of Construction: concrete metal FRP Other
(explain):
Dimensions: Capacity: gallons Design Flow: gallons/day
Alarm Level:
Comments: (condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
Depth of liquid level above outlet invert: 1t=p
Comments: (not if level and distribution is qual,evidence of solids carryover,evidedc of leak ge into or
out of box,etc.)
/
PUMP CHAMBER:_ �r)_ .. .... _.__ .._.._._.... ... .,.
Pump is in working order: _ _... ........... ._ _.. . ..__ _ .....
Comments: (note condition of puhii Oiamber,•condition oupumps anil appurte'nances,'etc.)
- 5 -
SUBSURFACE SEWAGE DISPOSAL 'SYSTEM INSPECTION.FORM
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS):_
(Locate on site plan,if possible;excavation not required,but may be approximately by non-intrusive
methods) If not determined to be present,explain:
Type:
Leaching pits,number: Leaching chambers,,number: Leaching.galleries,number:
Leacahing trenches,number,length:
Leaching fields,number,dimensions:
Overflow cesspool,number:
on�ments: (note conidtion of soil,signs of hydrauPF failure level of pondin condition of vegetation,etc.)_
ii
CESSPOOLS: A) '
Number and configuration: Depth-top of liquid to,inlet invert::
Depth of solids layer: Depth of scum layer: a Dimensions of Cesspool:
Materials of construction: Indication of groundwater: s
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soil,signs of hydraulic failure,level of ponding;condition of vegetation,
etc.)
PRIVY:
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil,signs of hyddraulic failure,level of ponding,condition of vegetation,
etc.)
�5 '.. -_. t ♦ `. .. i f s_"}- x.?ec iT sB'sF."4. .,s� . .. � �, �. e� .�..
-�....... '_"n__... .. '__....Si...r._.....,..�4..5._.. .._-_.-..S.. -.�..._ ._,.--","'-'...L�-.3{y�P,�_t r_...��.�w„��`k-. .._.»__t.3_E*�_ y.._..�..��•.,._._ k r.,,f__,
- 6 -
SUBSURFACE SEWAGE,.DISPOSAL_SYS_'I'EM ,INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
SKETCH .OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references,landmarks or benchmarks.
Locate all wells within 100 Feet.
r '
311 I
DEPTH TO GROUNDWATER:
Depth to groundwater: Feet
Method of Determination or Appr ximat'on:
- 7 -
T
tr!
r
COMMONWEALTH OF MASSACHUSETTS
s EXECUTIVE OFFICE OF ENVIRONMENTAL AFF ►WS
DEPARTMENT OF ENVIRONMENTAL O,TE-CTION�d
ONE WINTER STREET. BOSTON. MA 02108 617-2925500 ^ a
00
WILLIAM F.WELD ro; g 9 RUDY CORE
Governor I o ti9gNST Secretary
ARGEO PAUL CELLUCCI �FpTggze I`� VID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'..FORM Commissioner
PART A f` 5
CERTIFICATION 9
58 Sears Circle
Property Address: CQnterville, MA Address of Owner: George Hamrah
Date of Inspection: V-;L 3-5'? (If different) 96 Cary Ave
Name of Inspector: Wm E Robinson Sr Milton, MA 021 86-4223
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: Wm E Robinson Septic Service
Mailing Address: PO Box 1089 , Centervi 1 1 P MA 02632
Telephone Number 5 0 8 Y 7 7 5-R 7 7 6
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails Q
Inspector's Signature: L� Date: L `�2-3-1-7
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
AJ SYSTEM PASSES:
_0have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
BI YSTEM 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.
Indic a yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/25/97) Page 1 of 10
DEP on the World Wide Web: http:/twww.magnet.state.ma.us/dep
e'J Printed on Recycied Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 58 Seans Circle, Centerville
Owner: Ha mrah
Date of Inspection:
B SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed`pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
CJ RTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
T The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
(revimed 04/25/97) page 2 of 10
r
• L
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 58 Seans Cir, Centerville
Owner: Hamrah
Date of Inspection: 9--;L 73 -
D SYSTEM FAILS:
Yo must indicate ei;,,er "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped _.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LA GE SYSTEM FAILS:
You m st indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
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)
The ner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) Page 3 of 10
SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 58 Seans Cir, Centerville
Owner: Hamrah
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
tt _ Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal
/ flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
S _ The facility or dwelling was inspected for signs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
— The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
y _ Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b)]
J�
:l
(revised 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL"SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 58 'Seans Cir, Centerville
Owner: Hamrah
Date of Inspection: -_^�3-Q
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 33 O g.p.d./bedroom for S.A.S.
Number of bedrooms: 3
Number of current residents:
Garbage grinder (yes or no): A�o
Laundry connected to system (yes or no):jLr-"3
Seasonal use (yes or no): /L o
Water meter readings, if available (last two (2) year usage (gpd): 1995 - 90 , 000gals
Sump Pump (yes or no):L!G 0 1996 - 80, 000gals
Last date of occupancy:
COMMERCIAUINDUSTRIAL•
Type of establishment:
Design flow: gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
iCi�E1
System pumped as part of inspection: (yes or no) 4,p
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF,,S,VSTEM
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)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: R f
Sewage odors detected when arriving,at the site: (yes or no) p
(revised 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Seans Cir, Centerville
Owner: Hamrah
Date of Inspection: 9-A 3^9 ?
BI LDING SEWER:
(Loca on site plan)
Depth below grade:
Materi I of construction: _cast iron _40 PVC_other (explain)
Dist ce from private water supply well or suction line
Dia eter
Com ents: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANG—
(locate on site plan)
Depth below grade:
Material of construction. oncrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
t i L
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:3
Scum thickness: ►•
Distance from top of scum to top of outlet tee or baffle: F It.
Distance from bottom of scum to bottom of outlet tee or baffle: 13
How dimensions were determined: ® Fg n,
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) o K
GREAS TRAP:
(locate o site plan)
Depth be w grade:
Material f construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensi ns:
Scum t ickness:
Distan a from top of scum to top of outlet tee or baffle:
Distance rom bottom of scum to bottom of outlet tee or baffle:
Date of la t pumping:
Comment .
(recomm dation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
(revised 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Seans Cir, Centerville
Owner: Hamrah
Date of Inspection: 9 ^.Z 3^ R 17
TI/Ie,
R HOLDI G TANK: (Tank must be pumped prior to, or at time, of inspection)
(lon site pla
Delow gr de:
Mof co truction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dio
C : gallons
Dow: gallons/day
Alvel: Alarm in working order Yes; No
Dprevious pumping:
Cts:(cn of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP AMBER:_
(locate o site plan)
Pumps i working order: (Yes or No)
Alarms ' working order (Yes or No)
Comm nts:
(note ondition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Seans Cir, Centerville
Owner: 1jamrah
Date of Inspection: Lj —e_3-9-7 /
SOIL ABSORPTION SYSTEM (SAS):r�
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note)condition of soil, signs of hydraulicfailure, level f ponding, condition of vegetation, etc.)
CESSPO LS: _
(locate on ite plan)
Number and onfiguration:
Depth-top of quid to inlet invert:
Depth of solid layer:
Depth of scum layer:
Dimensions of esspool:
Materials of co struction:
Indication of gr undwater:
inflo (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:_
(locate on site pl )
Materials of cons ruction: Dimensions:
Depth of solids-
Comments:
(note condition of il, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 04/25/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Seans Cir, Centerville
Owner: Hamrah,
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
al
91
�sciL
l'
�l�l
(revised 04/25/97) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Seans Cir, Centerville
Owner: Hamrah
Date of Inspection: _�3 g 7
Depth to Groundwater i'2 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
L-, Check with local Board of health
Check FEMA Maps
Check pumping records
Check Focal excavators, installers
Use USGS Data
Describe in your own words how y u established the High Groundwater Elevation. (Must be completed)
�
(revised 04/25/97) Page 10 of 10
�oq
L AT10 �'� � SEWAGE PERMIT NO.
- %/V) �-
VId. LAGE
I S A LLER'S CMAME i ADDRESS
BUIL Rv OR WN ER
I
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED 12- 17_ 7�P
r
,r
�7
1
36 �� �
No......:.... " Fps. ... .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
...........................................0 F..........................---..._.......------------------.................---------------
Applira#ion for Diipnial Works Tnnitrnrtion rantit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at:
Sean's Circle, Centerville Lot 5
.....---•........................................................................•----••---••..... .....-----.....--------••••-----••----•--•----------------•---•--•----••••-•--•--...........•.....
jocasm i h ress or Lot No.
James Barnstable
......................-.......•- ...................... .........•----••-•-•••----...•-••--........•--••-......---...---------•••......-----............--
Owner Address
a Vetorino Bros. Baxxttab�e.
Installer Address
Q Type of Building Size Lot__1_5.__9Q2,---------S . feet
U ..........................Ex Garbage
Expansion Attic ba e Grinder nd
Dwelling—No. of Bedrooms...............3. p ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
W Design Flow.....................55..........._.._•._gallons per person per day. Total daily flow--------------3_31�----------------------gallons.
WSeptic Tank—Liquid capacr*QQQ...gallons Length__ .'6...... Width__4'.10 tr Diameter______________- Depth_.5.'4 tr
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area............____....sq. ft.
Seepage Pit No.......I............ Diameter......1Q.__._.._ Depth below inlet.......61........ Total leaching area..267_.......sq. ft.
Z Other Distribution box (x ) Dosing tank ( )
a Percolation Test Results Performed by.C.ap-e_._CQd...Survay...C-o2'cult-ant Mate......._8/29179............
Test Pit No. I.....2........minutes per inch Depth of Test Pit.....12__------- Depth to ground water.nOrie.............
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil.0&0_-0..$..W99d...loam*--.Q-.-8-3-,.Q---suhs_Q.7.a._,....3...0!!5_..Q...
gr�Y�l-,-. �
----•-......-••--•---•------•••--5. Q-T._5...med•----c.Q.a. e...y-e-ll.Qw--sand 7..5.-12_.Q_..me-d...1i
W ...............------------------- and----------------------------------------------------------------------------------------------------------- ----•-----•--•
U Nature of Repairs or Alterations—Answer when applicable------------- _ __________r. . . WICK m
----- - o- - -
..................
Agreement: /�� 7f o p No. 27654
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in (t
the provisions of iITLE 5 of the State Sanitary Code— The undersigned further agrees not to place F §� 6
operation until a Certificate of Compliance has been issued by the board of health.
Slap
Date
Application Approved By..^.._ ',FY ---------------•-_----- ---7 .....
Date
Application Disapproved for the following reasons-----------------------------------•----------------------------------------------..............................
.......................................................................................................................................................................................................
Date
PermitNo......................................................... Issued------...................................................
Date
t
No................. .... •` FR$...`...'S�.......��.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF° HEALTH
Town.s$ Barnstable
-•.... ..............._.....---.........OF..........................._............------------------------------------......_------.
Appliratiun.for Uwpoual Works Tutuitrurtiun Viermit
Application is hereby made for a Permit to Construct ( x) or Repair ( ) an Individual Sewage Disposal
System at
Sean-Is Circle, Centerville Lot 5
.................................................................................................. .......•-•---------•-...............------•--------•------------•-------.................---------
oca ion-tA dress or Lot No.
........................Jame® I.. In ..........Barnsta.......----------•-......
Owner Address
W Vetor ino Bros* ..........Rarn scab le.....................•--..•.................-•-•---•---------•--
Installer Address
U Type of Building Size Lot.1-.y 901----------Sq. feet
, Dwelling—No. of Bedrooms..............�...........................Expansion Attic ( ) Garbage Grinder (nd
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ----------------------------
Design Flow....................5.5...................gallons per person per day. Total daily flow.._......_...3.30......................gallons.
�4 allons Len h_8.1.611.... Width. t�t� Diameter..............: De th.. »
Gd Septic Tank—Liquid capaciti� _ _.__g gt �_. p �_..�.___-.
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..__............... Diameter-----10t....... Depth below inlet.._...6i1......... Total leaching area. 7.._.....sq. ft.
Other Distribution box A ) Dosing tank ( )
aPercolation Test Results Performed by.Cape...C.o.d..Sux".v.ev._..Coi iiultk intDate_.......&/.2.9/lam...........
Depth of Test Pit..._. ..._..__. Depth to ground waterYlQBE__._._.._..
Test Pit No. 1....2.........minutes per inch
fs. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-.....................
x = --•- ---- . --..._ ..... ... .... ...............
o C +<3 . wood 4 ...3.Q.._s b o .l .Q-� x_47.grave.Description of Soil....�- �Qt�,--- , _--. '�T' A)A oF'>a'�s
v --•------------------------•••.. 7.5 mid. GQ Q...YAII .w._s d�...7.. m12..Q..aad.. A 9oti
W ............... ............•---------mod ---•-----•----------//- RENWICK G
U Nature of Repairs or Alterations—Answer when applicable........................... ............c_... a. ....._ _B.
� CH,4PNfMV Z
.......................•-•--=... --•-----------•-----.S.......................................................... ---
Agreement: f 17,
/s rE�
The undersigned agrees to install the aforedescribed Individual Sewag Disposal System in
the provisions of iITIL 5 of the State Sanitary Code'.— The undersigned further agrees not to place t
operation until a Certificate of Compliance has been issued by the board"of health. _.
S* ' �........I...........-•-•------•.................................................. •---------•mate ••-•--
Application Approved B ....--•-----...� � � 9'"./, 9..
PPPP y....... -• -- --------•--- _C�_.... Date...............
t
Application Disapproved for the following reasons:.......................................I
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f - Town Barn.table..............................................................................O F......... .
Twerfifiratr of Toutplianrr
THIS ISVetOritRTJFoYt l the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by---------•-----..---• ,— . ---
----
.Installer
LOt 3= stt'• GilGq� ftC !ir�E >f] _...
at •. ---------
has been installed in accordance with the provisions of T S f T State Sanitary Cc�d e as des i ed in the
application for Disposal Works Construction Permit No................ '------_-- da.tad_-_. ---- r._ _- ................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL
FUNCTION.SATISFACTORY. "
-.... 7
DATE............ 2 .........
THE COMMONWEALTH OF MASSACHUSETTS
74 BOARD OF HEALTH
.......... own.....................OF............Ba,rnstaale.........__.................................... L3 0
No......................... FEE........................
�tu�o��ti�, � B� r�.tr�ion Pr1nt�
Permission is hereby granted......................................................................... ....-----------------........-•-•-----•--...........................
to Construct Repair.( ) an Individual Sewage BfflisSIC47 "le. Centerville
at ho-------------�......--•-••••---•--•--------•-----------•......----•----........---•--------....-•-••�i---•----•---•---------��------•.•------•�-•--/--•....__.._�...............
,street .,/;„7
ass own on the application for Disposal Works Construction P f 't _�`1._....._...._ ated-------____ _ __ ______•...............
,, .
zDATE. D ...................................... Board of Health
-- ... r
FORM 1255 HOSES & WARREN, INC.. PUBLISHERS
I +`� t - � _ •_h • . - _. SO,I L' LOG r
e .. .. u , ' .. . • l,Txl.ty/r..,c.�A.v,c.Sk,.,r.�... [�',.. �1i J,,.. 3 +�
4r�nK if f G•��• 4` r
e
T
:•�PEASTtiNE ...LOAM 0 FILL - 12 MAX
fov • � ' _
DIS.T. AEG [,
4. C.I. t•.'•'• ^ ° e • o IV
GA 000 •. • F BOX ^y ie s•': PRECA.1000 ST OR OR . • a o I _ '�--`�•—
SEPTIC i':• `.;•,- ° .: �—
. 10 MIN'. ., . .. .� - BLOCK �. '• MIN.•. '•• V �
TANK • t;.. •,D>,{" ^•
y s 1 :• SEEPAGE
`o PIT. , • 00
+r 20, MIN.
y - - . .>L - - - -- - - t 4
FOUNDATION.' M w
WASHED _"STONE
J
. I
EI.E:VATION,a SKETCH 10, = I PE E_
;
RC RAT �' �•�%�'�+`
f,",�$•Y, � •� - •. , SCALE'. i�!= 4� '". . ��.., r TEST G.f, ,6i��I?ltlG
n
I
�.� ;� • _ _ +7 .r1 n TOWN 'INSP CTOR: -
h .,BACKHOE OPERATOR': i " 7�2 A.r� Lq;EG t• '
�t -�` t L` t $• t art•. :TEST MADE ON :
I
a.
- i
l
+
�0�
c .,. ..-ems..-. _s a..: .. ��-.-,,, .-.. :-' "`fl-�..�. - - ---�'-^'--.�.. .,-•..-...__... wy _ - ; _. ....��-.•..�.,.,...:....w.�_ ....,. -....... .._.- ,.�.._ .. .. ...•.. '. _. �~ �
f..
-._ _ Ind �� . _ . i': . �� `* .. - •
i V
f •.
_ n
oft
AC
aJ Y •
a a. .. ',:r.••� qy. ,� -. � /� 7�.•..•.f ,�^'y` �' rii /rdrr .. •iw..+r.. , �. , � t
r -
- r c '"�%. a..�e.... ........yer..+ ...,.".,+..�� ..r.w....r....w.. a.wwNr..wwtiwy.,r.++� ii.w .�.w.�.ii.....,w +i.•e.r++�..."•.-- r , .,,.�,,,,,,,r,.
y
•
� 1
'c')xi �1 rod i�i#40,/IS �"�s�4.� �1940-
����� ,�".:s.�C'��-E�"' .�i".�/tt�" fry, .�"�d<G ,�„� -�Y'.r��. _ _ _ • _.,,.._ _ --- - -^ --_--_ .. _ ,. . _. __ _ _ ;
f
a
may.. .. .. - .. • - .
,
-
OF Alo'eA !� rlWZ
, , ' - /, e
F, F CHAPMAWi9r'•�� .7�. �•'hxa+� ."c''�./ �.�"7'-t9.�G�
j
At
• Gy i
JAM E
r o [APFiI E,Y
,. , . lSTE• �p V
f .
' kA su r
ELEVATION SCHEDULE
PROPOSED SITE PLAN r .
- I. INV. AT_ FOUNDATION
SEWAGE- SYSTEM DESIGN
2. I N V. INTO SEPTIC TANK I N "
'- ,
3. I N V. O U T O F SEPTIC TANK , — 'r �/ aQ/�• • t;, (G� $+� ��, ,tLr1r�* n
- t
4. INV.•; INTO DISTRIBUTION- BOX _ i
r -
SCALE; I.. 9'�a
-5.: INV. OUTeOF DISTRIBUTION' BOX • ,,- 7 ,• C
6 'INV.i INTO 'SEEPAGE PIT _ CAPE vCOD . SURVEY `CONSULTANTS
s x ^ h r ROUTE 132 -
lnr)n
C}
�• 1 7. BOTTOM OF PIT_ = - HYANNIS ,MASS.. `
tj
.•..y--�....�r•• 'w.+�.4. V.'��[.�-+..ram - •...r.+..w...e.......�•+.w�-...-.-•+r.w..�rwr-- - — _— .M-..<.-a_- ���".Mr'rMMG.-. -r
PROVIDE PRECAST CONCRETE G E N E G /` L NOTE S
T.O.F. EL.= 55.9'± EXTENSION RISER WITH CONCRETE FINISH GRADE OVER D-BOX= 53.2'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % ' _ i f��'1
COVER TO WITHIN 6"OF F.G. OVER
FINISHED GRADE OVER DIFFUSERS = 53.2 54.4
INLET AND OUTLET COVERS. REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE INSPECTION PORT WITH ACCESS BOX TO METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
@ FND. EL.= 54•0 ±
FINISHED GRADE OVER TANK EL. _ 5j4.0'-F- 5" DIA. OUTLET(S) WITHIN 3 OF F.G. (ONE PER TRENCH) CODE AND ANY APPLICABLE LOCAL RULES.
/ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
i
EXISTING 4" 4" 9" MIN.
PROPOSED 9"MIN.
3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
SEWER PIPE �� �- PVC SEWER PIPE 36" MAX. 36" MAX. TOP OF SAS/ B.O. = 51 .43'
SYSTEM UNLESS OTHERWISE NOTED.
3" DROP MAX PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
6" 3" 2" DROP MIN 3" 9 MIN.sLOPE @1i JOINTS (TYP.) ELEVATION = 51.43' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
10" 4" PVC IN FROM 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
iI " * SEPTIC TANK 4" PVC OUT TO 1.33' THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
• LEACHING FACILITY TYP
0.90' (TYP.) n10.75�;' TYP 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
12" 6" J[E I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
CONTRACTOR CONTRACTOR SHALL � OUTLET TEE 51 .40' MIN. 51 .23'
SHALL VERIFY SIZE 48" VERIFY CONDITION OF l ' 51 .00' -50.10' (LAID FLAT) 2.875'(34.5")-�+�-5.75'� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES 22"ZABEL FILTER 6 CRUSHED STONE 90, (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
EXISTING SEPTIC AND REPLACE AS MODEL#A1801-4x22 OVER MECHANICALLY NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY COMPACTED BASE (TYP.)
5' MIN. 11.50' AND DESIGN ENGINEER.
5 OUTLET DISTRIBUTION BOX 30.0' (TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 54.00' ESTABLISHED
TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN A FENCE POST AS SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 42.37' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
TO THE DESIGN ENGINEER.
*CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 12 - ARC 36HC (#3616 B D) BIODIFFUSERS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE _ NOT TO SCALE NOT TO SCALE /�
TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
" •'r� . . �; REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
0t+ »� ;'ri PERC NO. 12582 APPROPRIATE AUTHORITY.
•• «� ,�� !/ . ' INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
' ' •:•, LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
pk\ ; • / + + EVALUATOR: Michael Pimentel, E.I.T.
THEY SHALL WITHSTAND H-20 LOADING.
..,�� �, • � � ,t �J'� • . , C.S.E. APPROVAL DA :fE Oct. 1999
{ l<j : . • • DATE June A 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
0 4D TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
1/ MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
ZONE 2 //• • • • ELEV TOP = 53.20' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
ti
! �� -._.,.._`_ • . -+ ELEV WATER= <42.37' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
.--' ` ' • " PERC RATE - < 2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
LO
U +' • • • ' • SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
a • • . • . DEPTH OF PERC =
Q MAP 170 +� ` • • f . ra� 24"-42"
�• � � 16. PROPOSED PROJECT IS LOCATED WITHIN:
• +
Y PARCEL 210 r 1/� ••' „ /` :'•� . TEXTURAL CLASS: 1 ASSESSOR'S MAP 170 PARCEL 57-05
o Q � 40
° MAP 170 �/ •'� . • - OWNER OF RECORD: ALISON SCANDLEN
Z I _ _ . • ,�
a Benchmark
a ADDRESS: 58 SEAN'S CIRCLE
PARCEL 211 Nail Set in Fence Post " � ' "=^- • '
/` I 401 1 CENTERVILLE, MA 02632
j Elev. =54.00' Fill
j' '( • • ,,,/� ,!! 6., 52.70'
S79035,21., Approx. M.S.L.
E + .. P 1) B Loamy Sand
+� + • , ,_ 10Yr 5/6 FEMA FLOOD ZONE C
105.18- -�� MAP 170 �,.� • I
PARCEL 212r + a �• i5h 24" 51.20' COMMUNITY PANEL# 250001 0015 C
o t� Hatchlery Perc 17. DEED REFERENCE: DEED BOOK 12855, PAGE 27
42" 49.70'
18. PLAN REFERENCE: PLAN BOOK 327, PAGE 56
PROPOSED INSPECTION PORT WITH 1�2' -0 - - 0 75' / ��, !" ,r F, • + 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
ACCESS BOX TO GRADE (TYP OF 2)- 2w O 20, PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
B Medium Sand
t" ran CM! C FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
o TP 2 p� �� "�� 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
J l r (5% Gravel)
' r 4 • 1 �..
PROP. TOTAL 12 ARC 36HC BIODIFFUSERS 53.2
(6 BIODIFFUSERS EACH TRENCH)
��- Tila�' / - -
TP 1 --EXISTING LEACHING PIT TO BE
LP _ PUMPED AND FILLED WITH CLEAN
53.2' COARSE SAND &ABANDONED LOCUS PLAN
PROPOSED DISTRIBUTION BOX
\ No SCALE: 1" = 1000'
N
W SQ - O
54x9 �- -~ 130" 42.37'
No Mottling, Standing or Weeping Observed
N O -EXISTING 1000 GALLON SEPTIC -
M M DECK TANK TO BE UTILIZED AS PART
B.H. ? w OF THIS DESIGN DESIGN DATA TEST PIT DATA LEGEND
2 w N PERC NO. 12582
#58 \ °r d' INSPECTOR: David W. Stanton, R.S.
50xO EXISTING SPOT GRADE
CIONUMBER OF BEDROOMS (DESIGN) 3
EXISTING l ! 2 EVALUATOR: Michael Pimentel, E.I.T. - - 50 - EXISTING CONTOUR
__'54 3-BEDROOM / DESIGN FLOW 110 GAL/DAY/BEDROOM
� `u.� C.S.E. APPROVAL DATE: Oct. 1999
MAP 170 DWELLING MAP 170 TOTAL DESIGN FLOW 330 GAUDAY
MAP 170 TOF - 55.9'± 50 PROPOSED CONTOUR
PARCEL 57-04 sb o = 660 DATE: June 3, 2009
� DESIGN FLOW X 200 /o GAUDAY TEST PIT#: 2 ❑/H/W EXISTING OVERHEAD UTILITIES
PARCEL 57-05 PARCEL 57-06
15,901 S.F.± oI I l > USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP = 53.20' GAS EXISTING GAS LINE
/
ti
� ' ELEV WATER= <42.37' W W EXISTING WATER LINE
PERC RATE TEST PIT LOCATION
INSTALL 12 - ARC 36HC (#3616BD) BIODIFFUSERS DEPTH OF PERC -
i EXISTING 1,000 GALLON SEPTIC TANK
SYSTEM CAPACITY TEXTURAL CLASS: 1 LC)
\ 3�53 JSP PROPOSED 4 SOLID SCHEDULE 40 PVC PIPE
33 Q (TOTAL L.F. OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD
i52
(1 4) (60.0')(7.8 SF/LF) (0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING/DAY 0" 53.20' 13 PROPOSED DISTRIBUTION BOX
a,H,4 Fill
6' 52.70' PROPOSED ARC 36HC (#3616BD) BIODIFFUSER
°'Hw Loam Sand
S ` TOTALS: B y
EqN� 10Yr 5/6
(40�W/pE S CRC ` TOTAL NUMBER OF BIODIFFUSERS: 12 24" 5120
ui"�w
�AYOVT P w HC-1 B.H. DECK TOTAL NUMBER OF COUPLINGS: 0
RIVATE Ep °�"tee. TOTAL LEACHING AREA: 468.0 SQ.FT. REV. DATE BY APP'D. DESCRIPTION
GE OF P4VEME_ #58 C-2 TOTAL LEACHING CAPACITY: 346.3 GAL./DAY - -
PROPOSED SEPTIC SYSTEM UPGRADE
EXISTING
3-BEDROOM
DWELLING Medium Sand PREPARED FOR:
TOF = 55.9'± NOTE: C 2.5Y 6/6
CAPEWIDE ENTERPRISES
EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE (5% Gravel)
DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER LOCATED AT
MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO
NOTE: ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST 58 SEAN'S CIRCLE
MODIFIED JULY 23, 2008). TRANSMITTAL NUMBER=W000052. CENTERVILLE, MA 02632
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE = 1
TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. SWING-TIES SCALE: 1"=20'
130" 42.37' SCALE: 1 INCH 20 FT. DAT E: JUNE 3, 2009
�H OF 40 0 10 20 40 80 FEET
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE DESCRIPTION HCA HC-2 No Mottling, Standing or Weeping Observed ++�'
LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE BIODIFFUSER CORNER(1) 26.0' 43.2' cHURc LL PREPARED BY:
CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. RESERVED FOR BOARD OF HEALTH USE J .L JC ENGINEERING, INC.
REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS BIODIFFUSER CORNER(2) 55.T 68.T 2854 CRANBERRY HIGHWAY
ARE NOT CONSISTENT WITH TEST PIT DATA. BIODIFFUSER CORNER (3) 55.8' 64.8' EAST WAREHAM, MA 02538
3.) PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2. SITE PLAN BIODIFFUSER CORNER(4) 26.2' 36.6' 508.273.0377
SCALE: 1" =20' Drawn By: MCP Designed By:MCP Checked By: JLC JOB No.1623