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HomeMy WebLinkAbout0029 SETH PARKER ROAD - Health 29 Seth Parker Road Centerville F/R A = 170 201 OxIord, NO. 1521/3 ORA 10% r k l 'I II D o / TOWN OF BARNSTABLE LOCATION a 4 Se SEWAGE# VILLAGE CeAkAv1 ASSESSOR'S MAP&PARCEL . /7u - -q1 1 INSTALLER'S NAME&PHONE NO. c,o e w i G�e L .,f q Z j SEPTIC TANK CAPACITY /otw l4 1 LEACHING FACILITY:(type) )01 A► e- 3 to t to (size) 3 x 3 NO.OF BEDROOMS 3 ° OWNER JOhv\ PERMIT DATE: 3' 30 2610 COMPLIANCE DATE: 4-1 -1 - -2-° t Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ✓Ud` C/. Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) � Feet FURNISHED BY Z I S n3 3y,5- a�.s Q4 -7o,o & TOWN OF BARNST"LE LOCATION Zp "- `(�\ A ka. . SEWAGE#Z02-0 VILLAGE CEM el- I.L - ASSESSOR'S MAP&PARCEL (-IO -+ ZO p INSTALLER'S NAME&PHONE NO. ►� eek;T 6.Q-xe Co- JOB-411-8617 SEPTIC TANK CAPACITY JO� . LEACHING FACILITY:(type) Aec 3(or- C size) I.5 Y, Z 5- NO.OF BEDROOMS 3 OWNER Vlee PERMIT DATE: $ 31 ZO COMPLIANCE DATE: N 1- Separation Distance Between the: uu� ''11 ` Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �0 r7ZV®10-S Feet f Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) . Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY R.. 2� 2 � ® 3 - I = 3 z'1 _ - f3-Z A-5 = 3o.z S -5- = (9•A No. y" _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpricatiou for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(X) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 2c{ S C i%A ?A e.K=2 2-0. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1-10 2.0 1 M STe ev,-Z,,., `, U v Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. iZC,kaA,C-V 13, Cb.a,r Co. czv_c_ S.C. vt 3 co bi ,p r •,C�^ by`-�1 vn Type of Building: Dwelling No.of Bedrooms 3 Lot Size �,a��� sq.ft. Garbage Grinder( ) Other Type of Building S i �„;. �,q�r.�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 O gpd Design flow provided Z 0 gpd Plan Date ,612,5 1 2_v `2.n® Number of sheets Revision Date Title t4 Size of Septic Tank 10 0 O Type of S.,S",CZ o )—I krC, 3r,, 4 a Description of Soil D(uEw• Nature of Repairs or Alterations(Answer when applicable) I Date last inspected: Aj X, , -T Zo'Z C) 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 ig-Z G — Zo Zd Application Approved by Date Application Disapproved by U Date for the following reasons Permit No. go ^ a 7 7- Date Issued fit.. .. " -, l� F'/.^•.'.y,^ '^T} 0' i✓ I y° � Fee. 1 THE COMMONWEAL�T�'OFMAS SAC HUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF+BARNSTABL'E, MASSACHUSETTS Yes ftprication for Disposal 6pstetu Construction 3permit -w„ F Application for a Permit to Construct( ) Repair( ) Upgrade O' Abandon( ) ❑Complete System ®;Individual Components Location Address or Lot No. Z9 S C T M VA a K.=(c 0-7, Owner's Name,Address,and Tel.No. ,•^ Assessor's Map/Parcel �"T 0 2 O { „P ei,., � � ire `d• U a �frj t Y+4,4 G o t ri'"Q'A 6 Installer's Name,Address,and Tel.No. v Designer's Name,Address,and Tel.No. '3 ka-S 4_0\'t, T C 5 .1./ i)Ar✓rf.-i Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ��i �„` Ze.+:^ 'L No.of Persons Showers( ) Cafeteria( ) Other Fixtures ` Design Flow(min.required) 0 gpd Design flow provided ��`$' , � s� gpd Plan Date x-5' j 20 -4 o Number of sheets �rRevision Date Title E:T tA Size of Septic Tank I O Type ofS Description of Soil 1.,, t /'� Nature qoof Repairs orAlterations((Answer when applicable) J�U,t,yt_� ,�� bra� 4-e L+•'-1&c Lt. 1,•� �. Y"A _ !f•O N"/� Y"'Q.i•� 7'"`.'�\ �st./l k / - Date last inspected: �;� Agreement: "' / qt �� ,. The undersigned agrees to ensure the construction and mamte an nce of the afore described on-site sewage disposal system in / r:,- 1 v accordance with the provisions of Title 5 of the Environmental Code and no to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. " Signed � w Date 'Application Approved by Date r 3/ Application Disapproved by Date .. ( a for the following reasons :-•, >'., Permit No a1*P' Date Issued ` �4 r T yet' --377 :.'t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance s THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired Upgraded 14 •Abandoned( )by 1`7 . Q%J C o &�r_i . 4_, 1 t �' �j"(a P fZ �P dZ, a�A,-, has been constructed in accordance k with the provisions of Title 5 and the for Disposal System Construction Permit No.70 20.l 7 "`dated r 6 Installer RU "F k7 . t j r CO. <.'-Nt.�C Designer# a Sn c• red • Ar bedrooms "� Approved design flow r gpd . The issuance of this permit shal/nIt be construed as a guarantee that the system willffunction designed • L Date 7 Inspector t Fee 07) THE COMMONWEALTH OF MASSACHUSETTS y PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ` Misposal *pstem Construction Vermit : fry,. -Ate:- : Permission is hereby granted to Construct( ) Repair( ) Upgrade(V) Abandon( ) ?;System located at 2_01 S e T i-A. P 44L V.r_.d' ("4d and as'described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Trtie-l'arid the`following local provisions or special conditions. . Provided:Construction must be completed within three years of the date of this permit.,,-_.rr •---�^ Date ' �3S'�r''• ` •/`- .'�• G► Approved by t �?.f Town of Barnstable Regulatory Services Richard V.,Scali, Interim Director CAB 1 Public Health Division 9 MASS. 8 �Ar 1639. p�� Thomas McKean, Director EO MA'I 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property Address: a� !So,i(n Q/r,,kR- r a ouo �,er o, e,_ Assessor's Map\Parcel: t -1 0 z Z 0 \ Property Owners Name: Vi V'�,i✓►t A t✓ U 4vvan rJl In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an 'Y' in the applicable box next to each line certifying the information. Yes N\A ❑ I have been provided a copy of the Title 5 I/A technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) ❑ I have been provided with the Owner's Manual ❑ S� I have been provided with the Operation and Maintenance Manual ❑ 64 For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval ❑ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) R ❑ If the design does not provide for the use of garbage grinders, the restriction is understood and accepted ❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303 I , i rc ti , �V;M o 0 A agree to comply with all terms and conditions above. ,Pro erty Owners printed name Property Owners Signature D to Note: This form must be submitted along with the septic system disposal works permit application for all I\A systems including new construction, repairs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\IA homeowner certification.doc Town of Barnstable �IHE tO�o Regulatory Services Richard V. Scali, Interim Director i M * HARNSTABr,E. « 9� b 9 �0 Public Health Division plEDMAtA Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 9-4-20 Sewage Permit# 2020 - 211 Assessor's Map\Parcel 170/201 Designer: SCG Eon jtne_eccti � Installer: Robert B. Our Co., Inc. (RBO) Address: 2 S`l Cranberry Ota�wnj Address: 363 Whites Path &n54 wctre_�iavy% 4.4 6 2.5 3 South Yarmouth, MA On 31 202o RBO was issued a permit to install a (date) (insta lef) septic system at_ 29 Seth Parker Road based on a design drawn by (address) -:TC Crll SioCt�1 � TnC. dated 8-25-20 (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils ' were found satisfactory. 1 certify that the system referenced above was constructed 1 iance with the terms of the I1A approval letters (if applicable) -1ji u SgyG c JOHN L F COURCHILL Jit Installer's nat CML .41 A ?SE ner's Signature (Affix De t p Here) PLRETURN TO ARNSTABLE PUBLIC HEALTH D"" f SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc °T Town of Barnstable HA.RNSfABLE, p 6 ,�� Inspectional Services Department rFD MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy-is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) lir/Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road V Property Address Ginny Guimond Owner Owner's Name- / information is required for every Centerville V Ma 02632 8-13-2020 page. City/Town State Zip Code Date of Inspection I Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Brett Hickey key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑■ Fails Brett Hickey :Digitally signed by Brett Hickey y ,_Date:2020.oe.17ta:4750-oa'oo 8-13-2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts ' �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f; 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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. ,t Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and 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. s ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s �J 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �¢-__ =-, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y- 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. ❑ 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 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 must be attached to this form. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts _ - -. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/z day flow ❑ a Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ El 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. ❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. E ❑ 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts -, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes"or"no"for each of the following for all inspections: Yes No El ❑ 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? M ❑ Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? a ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ E] Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? n ❑ Were all system components, excluding the SAS, located on site? El ❑ 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: 0 ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts _ - -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V % 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 Number of bedrooms (design): Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 346/GPD Description: I Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes 0 No Does residence have a water treatment unit? ❑ Yes ❑e No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2019- 111,000gallons 2018- 106,000gallons Sump pump? ❑ Yes ❑■ No Last date of occupancy: currentDate t51nsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 I Commonwealth of Massachusetts - ,� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: NA 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Owner-tank last pumped 4 years ago Was system pumped as part of the inspection? ❑ Yes ■❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Substrface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts .......................... Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is required for every Centerville Ma 02632 8-13-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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: 2010 per permit Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ■❑40 PVC ❑other(explain): Distance from private water supply well or suction line- Town waterfeet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts t -= ---- , Title 5 Official Inspection Form n Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 .8-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 000gallons 11" Sludge depth: 2511 Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 1411 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 4pSubsurface Sewage Disposal System Form -Not for Voluntary Assessments s uJ 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is required for every Centerville Ma 02632 8-13-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): 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.): i 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts - _== Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0" Depth of liquid level above outlet invert 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.): The d-box was in poor condition at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ........... 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber,condition of pumps and appurtenances,etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: 12 ARC36HC biodiffusers El leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts -_=- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): The SAS was in hydraulic failure at the time of inspection. Leaching was full over inlet invert when viewed. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): NA 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 eN Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form / i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑■ hand-sketch in the area below ❑ drawing attached separately XQWK vie a A. nr:sIMSIX LoCATjoN_jq e _;§ 4.1, r vS'RWAG r,tr 2 t - -& VI A. AGE 4'.t—tjt,,of -----.. .....�.._..LA ASSESSC'2R"5 iNGftPECc I'itR'C: L !?u r-,. au 7 INST:A€.,LER`sNAN49&PHONP-No, SEPTIC TANK CAPACJTS'' /G�r),a� s$ •� � �.:Y_%:S:`"� m..__ I.T?.ACWNG FA:CILMY_(ty&-) C E t Lc►'__ .._., (suss) __ '�to Q NO-OF BEDROOMS _.._.�.......: OWNER PEIZ-MIT I?AxE.. ... 3— 3- 2o;ses Gt 1MPI IANGF 771AI`Ii ' 4"¢t _. u It o. Sepwaxion 3?Patarwe Behvicees else; Mavcimum,"usWd Gmiandwater Table to the Bottom 0TLA1aChing'Facilkty. 10 tj Fovt Private tauter 3upliFy Well and'LractAng Fa�ciiily C »?Y welts exist on= airs or-within 200 feet of teachbW facility) Feet- :F3dge of Wed—d axfd.0 tutshins FAcilicy(frany w,atlands exist within 300 fiat at'teeching facilify;I Feat: VUR'bus"_ BY'_- Z 113 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts ............p Title 5 Official Inspection Form n Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 1 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ■❑ Check Slope ❑■ Surface water ❑� Check cellar ❑■ Shallow wells Estimated depth to high ground water: No GW @ 126" feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record March 27th 2010 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: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Seth Parker Road Property Address Ginny Guimond Owner Owner's Name information is Centerville Ma 02632 8-13-2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑■ A. Inspector Information: Complete all fields in this section. ❑■ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ■❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed �■ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No. 1010 Fee /. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS 2pplitation for Disposal 6pst>em Construction permit Application for a Permit to Construct( ) Repair(4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components o c ' S�fG a- l r /�' Location Address or Lot No. �`J Owner's Name,Address,and'del.No. eeltbA1,/r4 /vt.4 Oates Tchn OA0 Ynt Y, Assessor's Map/Parcel 0 V 2 0 , a q J. Pk po. 16" rj j O0,1 JtA.v/I-/- AM c' Installer's Name,Address,and Tel.No.Ac Designer's Name,Address,and Tel.No. A U Lape-WI C'IAd"alfle Tic LNS` +1/ o?f sY //-.,y Y,rU? /^vtt44 Rel 6 2.4, 3 J as" Type of Building: Dwelling No.of Bedrooms 3 Lot Size t s y6 &f sq.ft. Garbage Grinder( ) Other Type of Building S• No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 390 gpd Design flow provided 3 C& gpd Plan Date 3 Z 7 - /J Number of sheets J Revision Date Title Size of Septic Tank /UoD t'-,(,f f. Type of S.A.S. \Z AV'C 3 1 Co Description of Soil N toIt( \h - 1 Sr (- 3 ZU 5-e.a,. Nature of Repairs or Alterations(Answer when applicable) ut C.Q�-& Date last inspected: -2,b c1D 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 -3 ` L -to Application Approved by Date 3` `30 _ as I 0 Application Disapproved by Date for the following reasons Permit No. c!(0 _ fj ` Date Issued _3 U — D d -- _-------------- - - --------- - - O� Fee �UU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: J". PUBLIC HEALTH DIVISION' TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprication for -isposal *- pstrm (Construction permit J - Application for a Permit to Construct( ) Repair(PI Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. -9 9 re f� o• h� /I Owner's Name Address,and Tpl.No. ( -,,I IJA 1,IlC, 174.4 Jav3 Z. Tohn JV�0 v n ¢.,-. 0d(,3 Assessor's Map/Parcel \I U 2 U , 9; 3 f l r��/a,,- r(f} (l e„ vi�✓, /19/1 0 Installer's Na�T1e,Add ess,and Tel.No. 9Z sr 41011 Designer's Name,Address,and Tel.No. d V C'antwi�d^r f•rj�iil� �C ��S+naW �?f 5-1/ ✓G+n /Lwy yru I /'tt�rutt(it n� 0 zL 3 S ��J j G✓� Rlic�► .�2�� J ar� Type of Building: r �� /Dwelling No.of Bedrooms 3 Lot Size to b sq.ft. Garbage Grinder( ) Other Type of Building '01e s No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 U gpd Design flow provided 3 y(, ' 3 �.1 gpd Plan Date 3 Z -7 - iJ Number of sheets Revision Date , Titles Size of Septic Tank /000 Type of S.A.S. \Z A TC 3 � t 00 Description of Soil \ 1 \b .h.�. / - (� 13 Nature of Repairs or Alterations(Answer when applicable) 0a,c:-(A A Q �V G'a& 'A x Date last inspected: y�t r. 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. Sign, Date Application Approved by Date .. Application Disapproved by Date for the following reasons Permit No. aw 10 r tl 4 Date Issued _ U a� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compiianre THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V) Upgraded( ) Abandoned( )by ( u I at =9 l Tt L I u r km �((J � has been constructed in acco dance with the provisions of Title 5 and the for Disposal System Construction Permit No. oZ -OS dated Installer �c�a t✓r d t o,�/grg K t Designer P/n.Gc,- i!1V #bedrooms Approved desi flow 6. -T gpd The issuance of t1fis p r nit shall not be construed as a guarantee that the system w' fund i s designed. n Date U Inspector ---------------------------------------------------------------------------------------------------------------------------------------- No. 'o fv- -. _.. Fee og� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Misposar .6pstem Construction permit Permission is hereby granted to Construct( ) Repair 4k), Upgrade( ) Abandon( ) r System located at C2 S� /-�, Po.&LW-LW- `�II-- ,* l ,4 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 completed within three years of the date of this permit.ru �w Date - J O (o Approved r by r TRANS. NO.: CITY/TOWN: Centerille APPLICANT: ADDRESS: 29 Seth Parker Road, Centerville, MA DESIGN FLOW: 330 gpd REVIEWED BY: DATE: N/A OK NO �GENEh2AL��.. Y�. 4W1, • 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)(f)] X daily flow X septic tank capacity(required andprovided) X soil absorption system (required and provided) X whether system designed for garbage grinder X North arrow [310 CMR 15.220(4)(g)] X Existing and ro osed 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 29 Seth Parker Road, Centerville,MA Sheet 1 of 7 ' f 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)( )] X Materials specifications noted? [various sections of 310 CMR 15.000] X System components not> 36" deepunless Local ( Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] X Address 29 Seth Parker Road, Centerville,MA Sheet 2 of 7 N/A OK NO Size OR? [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<I000gpd, 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 Required when other than single-family dwelling or flow>1000 gpd [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 29 Seth Parker Road, Centerville,MA Sheet 3 of 7 N/A OK NO 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 15.21l(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 Siphon problem/(leachfield below pump chamber) X Endca s 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 DISTRI�BI7TIONB X, 4 r " Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] X Splash plate or baffle tee required 6n 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 PIIMPCHAMBERS 3rj �„, 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 [310 CMR 15.221(2)] X Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] X Address 29 Seth Parker Road, Centerville,MA Sheet 4 of 7 N/A OK NO SOIL�ABSORPTIO`M a SYSTEMS(SAS) GE1ERALr a z Calculations correct? X 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(l)] 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 15.241] 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 IGAI.LERIESPITSFRS 31Q C 15 2�53 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(l)(b)] X 2' sidewall credit maximum [310 CMR 15.253(1)(a)] X In bed configuration, inlet every 40 sq. ft [310 CMR 15.253(6)] X `>RENCHE3J<0 C1VIR15 25,1 h �F, �a .Width 2' mmimum 3y ., . � «. ..... H '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 V.I.. out OK? [310 CMR 15.211(1)[4] and Guidance Document] X SAS�lYIaximum size of beclor fie11f5000 d . . 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)(f)] X Bottom area used in calculations only [310 CMR 15.252(2)(i)] X Address 29 Seth Parker Road, Centerville,MA Sheet 5 of 7 N/A OK NO DIDTHE PLAN N�OLE��' � 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 (>2000gpd) 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 #1ravelle s System j 14 Appro1a1 I e tesj� 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 A°lief tive'Se tic Sy tem[I IA pp r va Le tersl uy A ,,..,. �. 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)(q)] 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 15.4141 X Address 29 Seth Parker Road, Centerville,MA Sheet 6 of 7 N/A OK NO ,Or, 6s;6nstttve 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 Pumping to septic tank ? [ 310 CMR 15.229] X Shared System [310 CMR 15.290] X Address 29 Seth Parker Road, Centerville,MA Sheet 7 of 7 Town of Barnstable =^ N Regulatory Services Thomas V. Geller, Director li rinRN8TA8LR, • Public Eealth Division MAflB. Thomas McKeon,Director 200 Main Street, Hyannis, MA 02601 Offiec: 50H-862-4644 Fax: 508 Date; l�'?'f Sewage Permit# 'zo to_raBT Assessor's Map/,Parcel Installer & Designer Certification Form Designer; 1_O c_. . Installer; C:cl ewide- C-hk-er tt s C , 4- L L, AddreSN: l "5y C cc�1 r f(.`r:)4�Wr'}� Address; 1"'5o>, 7�. ....-_ tun 3 �30 _ Za o_ _ ��-e �a�was issued a permit to install a s �- (elate) - CCT"istallcrj- -- septic Svstertl at F0�1C� based on a design drawn by .............._.,.....W...---..............._.........-............. ---._._..__.........-- (,address) Co tiileec(Ar .C'r)C, — dated HeLrCti (designer) 1 certify that the sr;ptic system referenced above was installed substantially according; to the design, which may include rrtinor approved changes such as lateral relocation ol'the distribution box and/or septic tank. Stripnut (if required) was inspected and the soils v,cre found satisfactory, _ 1 certify that the septic system referenced above was installed with inajor changes (i-e, greater than 10- lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Ilan revision or certified as-built by designer to IbIlow, Stripout (if red nspected and the soils \�ell1 ioU[ld S'Atltifactory. (l17> cr's SlLjl'IAt rc) No r, gt,I N. c - i(eisi�n je PLEASE RF"TURN.10. iARNS'I'ABLE PUBLIC HEALTH DI.VI.SION. E1Cj..I.FICA'I„ E nF COMPLIANCE WILJL 1VOT BE ISSUED UNTIL BOTH THIS FORM AND AS.- 91,111J.CARD ARE RECEIVED.BY 1.1IE I3A►RNSTABI..E PI.JI3LIC i-IEAL.'L li DIVISION, THANK Y<:>t1, i ,� l`.K�4'1:�'IC11 i'lICl1.UI UIIGJti.u!I.uI:1 tlUc r&A •A J CI401 j 7. RGIC ON I NAAN I DNaor Wle 9`i: 60 0 T 0Z-Z0-21dd CorrRapinB dHealthMay72007 May 7,2007 Thomas A.McKean Health Division 200 Main Street Hyannis,MA 02601 Dear Mr.McKean, I'm corresponding under the Massachusetts Public Records, to acquire the public record documents of all applications, inspections,complaints,forms,permits,records and everything in your file regarding Rapin Osathanondh and Women Health Center 68 Camp St. Hyannis,MA ' Thank you very much. Sincerely, S.Howey P.O.Box 870037 Milton Village,MA 02187-0037 c� �.c "n r vt Page 1 �U �a wAn c ry Town of Barnstable / P# c2 Department of Regulatory Services G . ,&RNSrABM : Public Health Division Date 0 200 Main Street,Hyannis MA 02601 Date Scheduled 3 oZ& O Time 1 Fee Pd. ® � " Soil Suitability Assessment for Sewage Pisposal Performed By:Jli c(r,ael i,nne i6c(, Eli—, C5ff Witnessed By: 4 v, LOCATION& GENERAL INFORMATION Location Address 'i, Ct S!1�1 PQn_ Owner's Name ` -V `v�l A\ e- Address .Z1 se� �A(1�-e✓' 2� Assessor's Map/Parcel: 1 7o/�p l t Engineer's Name o r - ^' c3 TC GOJcth�pr0 NEW CONSTRUCTION / REPAIR Telephone# b ��2�S - r 0 -2-7 3-0 5�7 7 \57Land Use S1nj)(e F�M6(y d (���5 Slopes(%) 6 - Surface Stones - Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well 7 ft Drainage Way ft Property Line 1 b ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&.perc tests,locate wetlands in proximity to holes) see Parent material(geologic) UU�W�SIn Depth to Bedrock Z i 7 J20 � 5 Depth to Groundwater. Standing Water in Hole: 7(2 tO S Weeping from Pit Face t`i Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 9(ft:c t use ru46vt Depth Observed standing in obs.hole: 7(210. in. Depth to soil mottlgs: 9 t in. Depth to weeping from side of obs.hole: 712� in. Groundwater Adjustment fr. Index Well# Reading Date: _ Index Well'level Adj.factor _ Adj.Groundwater Level, PERCOLATION TEST Date 3 z�-r a Time Observation Hole# f _ Time at 9" Depth of Perc J y y Time at 6" Start Pre-soak Time @ 5'7A M Time(9"4") Had Pre-soak i i ' 11 A n Rate MinJlnch 2- Site Suitability Assessment: Site Passed E� Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICNPERCFORM.DOC G DEEP OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistencv.% vel NO-12(c G M S 2..5 Y DEEP OBSERVATION HOLE LOG Hole# 7- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi %Gravel) 0*311 Z 3/6. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i to Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consistency. l Flood Insurance Rate Map: 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 proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on A-2'_ i (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and perience described in 310 CMR 15.017. Signature Date 3-21�I0 QAsEPTi0PERCPORM.DOC 1 No. Zoo3-dy7 Fee�✓ �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Mizpooal 6pgtem ConMrurtion Permit Application for a Permit to Construct( . )Repair(i/)Upgrade( )Abandon( ) El Complete System Individual Components Location Addressor Lot No. Owner's Name,Address and Tel.No. Z� �e QlY/s' Ina�4 Assessor's Map/Parcel Ge,.1 11f/'///l f I Zo-zot IV Installer's Name,Address and Tel No. Designer's Name,Address and Tel.No. ,�W; Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building & ) ejok 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 applicable) T 1��� ke�/ 9 je�_AA Zp 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 beAissue 's B and f He lth. Sign Date Application Approved by Date o Z F1.6 3 Application Disapproved for the following reasons Permit No. 200 3—&f' Date Issued Y .77163 ————————————————————————————- No. 2003-li50 Fee A ` THE COMMONWEALTH OF MASSACHUSETTS Entered in,coinputer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Mi.5pozal *pgtem Congtruction Permit _.Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) El Complete System ©Individual Components Location Address or Lot No. / // Owner's Name,Address and Tel.No. Z J�e7`Gj i'Q°�i ,el �'�� ' Assessor's Map/Parcel, / GE'`I/' 111 1,- 17o-2cf Installer's Name,Address and Tel No. Designer's Name,Address and Tel.No. 610 71-9J�9 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Z P51 e&e 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 applicable). �/�'� ' 1 �/Z6 9 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 by this Board of He lth. Signed / ^� Date Application Approved byhbz Date Z D 3 Application Disapproved for the following reasons Permit No. 200 3- O'f 7 Date Issued V 2-7 Zo 3 THE COMMONWEALTH OF MASSACHUSETTS �;5-�►-t b``-b0 t, BARNSTABLE, MASSACHUSETTS '` 0� Certificate of Compliance THIS IS TO CER Y, that the On-site Sewage Disposal System Constructed( )Repaired(Tf Upgraded( ) Abandoned( )by at 2 S has been construct in ccordance with the provisions of Title 5 and the for Disposal-System Construction Permit No. 2-00 3-4Y7 dated-_-Z Z G 3 Installer Designer _ The issuance o this permit shall not be construed as a guarantee that the syste c1t' esigned. Date Inspector --------------------------------------- No. 200 3- OW Fee S O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x1i5pozat *p$tem Construction Permit Permission is hereby granted to Construct( )Repair(✓,Upgrade( )Abandon( ) System located at 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: Cons ction st be completed within three years of the date of this permit. Date:_ 1 2 G.3 Approved by COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ��, 1oZ2 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL. SYSTEM FORM PART A CERTIFICATION MAP / PARCEL , Property Address: LOT Owner's Name: Owner's Address: fi(/ Date of Inspection• o RECEIVE® Name of Inspect • please print Company Narne _ xc JAN 9 2003 Mailing Address:, - yO—Za(�/� TOWN OF(ARNSTABLE Telephone Number: ��• HEALTHDEPT. 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 'asses V Conditionally Passes Needs Further Evaluation by the Local ApprovingAuthor.ity . Fils Inspector's Signature: - Date: t)) 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 orb eater,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. Notes.and Comments . ****This report only describes conditions at.the time of inspection and under.the conditions of use.at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/1.5/20.00 page 1 { Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Addrress: Owner: -1 Date of Inspection DA o/, /gype , 2�0 00 Inspection Summary: Check A,B;C,D or E/ALWAYS complete all of Section D A. System PassesjA}; 1'1'Sd% not.found any information which indicates that any of the failure criteria described in 310_CMR - 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. 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; ",.ill 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 ank 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: 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 distribution box is leveled or replaced ND explain: .The system requited pumping more than 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: ti Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SU]BSURFACE.SEWAGE.DISPOSAL SYSTEM INSPECTION'FORM PART A CERTIFICATION(continued) Property Address: dl�f ?,141 Owner: Date of Ins.pectio : 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 deterinines in accordance with310 C.MR 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 Z. 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_ 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 coliforin 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 ppni;provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Y Page 4 of 11 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: b Owner: Date of Inspecti :Q 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 _ v1/ Liquid depth in cesspool is less than 6'.'below invert or available volume is less than '/2 day flow _ V Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of.times pumped _ 11 Any portion of the SAS, cesspool or privy is below high ground water elevation, Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or.privy is within a Zone 1 of a:public well. Any portion of a cesspool or privy is within 50 feet of a.private water supply well. 1/ 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 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, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/No)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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the,appropriate regional office of the Department. •4 Page 5 of I l OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspecti a Check if the following have been done. You must indicate"ves"or"no"as to each of the following: Yes No l/ 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? �T Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site? r/ 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: Yes no 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(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: �U� Date of Inspectio : , CJ FLOW CONDITIONS RESIDENTIAL Number of bedrooms.(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: I lb gpd x#of bedrooms): Number of current residents: _ Does residence have a garbage grinder(yes or no):_ Is laundry on a separate sewage system ( es or no if yes separate inspection required] Laundry system inspected( es or no Seasonal use: (yes or n V" l Water meter readings, if available(last 2 years usage (gpd)): y G Oz- a;�i� Sump pump(yes or no),' Last date of occupancy: COMMERCIAL/INDUSTRIAL � Type of establishment: Desigri flow.(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sq.ft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the i spection yes or Ad If yes,volume pumped: gallons--How was quantit pumped determined? Reason for pumping: TYP; OF SYSTEM OF 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 froth system owner) _Tight tank Attach a copy of DEP approval Other`(describe): A age of all components, date installed(if known)and source of information: M Were sewage odors detected when arriving at the site(yes orno)-A'Q}'" 6 Page 7of11 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-INFORMATION(continued) Property Address: Owner: Date of Inspectio 0000- BUILDING SEWER(locate on site planvX& Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction liner - Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: locate on site plan) I/ Depth below grade: Material of construction: ✓concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate), Dimensions: Xx Sludge depth: '/ Distance from top of sludge to bottom of outlet tee or baffle: j Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet te e or baf e: � How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert, evi nce of leakage, etc.): 1 j► p dt� � GREASE TRA�locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): 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:.. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: jkM Owner: Date of Inspee d n: TIGHT or HOLIDING TANK:4At(tank must be pumped at time of inspection)(]ocate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX:_Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert.. carryover,an evidence of e ual an evidence of so lids a Comments(note if box is level and distribution to outlets q y rry y rl ae.into rout of box,etc.): — Se Ole PUMP CHAMBERJ (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of I 1 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ( Owner:: Date of){nspeCtio Q00 a SOIL ABSORPTION SYSTEM (SAS): locate on site plan,excavation not required) If SAS not located.explain why.: Type aching pits,number: / leaching chambers,number: 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, ) A 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 or no): Comments (note condition of soil, signs of hydraulic failure,level of ponding 'condition-of vegetation,etc:): PRI C (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.): 9 ' 1 Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL"SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ( Owner:. Ala) 'A "It It A 119,Nq Date of Inspecti 07 c:)000- SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system includinD ties to at least two permanent reference landmarks of benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. i ryryr `0 11 d r� a� 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: AOI & Owner: Date of Inspectio SITE EXAM Slope Surface water Check cellar Shallow wells Estimated.depth to ground water i 0 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: i 57 zq �S 11 Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location:_ �[ ��/^ eJn I G Lot No. Owner:_ V % _ Address: ��,,w Contractor: 2W* ®17, /^ M,S Address`. Notes: �/cc��f�s STEP 1• Measure depth to water table to nearest 1/10 ft. .............................................................................. .Date F�Lz761/� Cg month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine;" OA Appropriate index well..................... ®� ..... OB Water-level range zone ...........................:......................... STEP 3 Using monthly report "Current. Water Resources Conditions" determine current depth to water level for index well ........................... / '7 month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 213) ,I/� determine water level adjustment ............... ................_............................................................ 'J STEP 5 Estimate depth to high water. by subtracting the water- level adjustment (STEP 4) from measured depth to water l3'� levelat site (STEP 1) ............................................................................................................. Figure 13.7Reproducible computation form. . 15 `. i 1 i,,•.t .j�-� k �`_ '�.✓ - E�se.._..�...� �� � ®�/�/�.f may/ � ��� � �� E s �� ems' s.r.�� f ..�._..� ._ � �-.�,�����,��``��� . �Z� � vim' i Page 10 of'! OFFICIAL SP EC F ION 1�OR_M—NOT FOR V Ok U�d�APY ASS1✓SS't4E?NTS SUBSURFACE SEWAGE DISPOSALSYSTEM INSPECTION FOR: � PART C SYSTEM INFORMATION�contirnjed) Property Address-, :�� Owner: Date`of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a slceich Oi the Sewage disposal S}'stems includi ties Mat least two pesoanent reierence landmarks or benchmarks. Locate all wells wifain 100 feet:Locate wh:re'public water supply enters the building. I� i �� `F Paze 10 of 11 OFFICIAL! SFEE C T ION FORM—NOT FOR V0'L'U_NT_I,pY ASS SS it�F>�TS SUBSUR-FAC I E S 4VA E DISPOSAL SYSTEM-INSPECTION FORM PART C S YST M INFORMATION ION (continued) F:ropertyAddress: �' ti (. e� Cl',%�: ✓ Owner: JM Q ,Pir.' f Date of Insaectian: (� (I / )'y c;)7t SKETCH OF SEWAGE D SIPOSAL SYSTEM Provide a sketch of the sewage disposal sysiem including ties io at least two per-imanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply inters the:ouilding. F . I C( / o L e % � 6 • ,0 Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS P/ BOAR® HE TH .......f"r4wt.1-7.........OF.......0�&...............................I.................................. ppliratiou for Dhipaii al Workii Tontitrurtivaa ramit Application is hereby made for a Permit to Construct ( Repair ( ) an Individual Sewage Disposal system - ---- -------------- ------- --•--------- ---------------------------------•-------- L 'on- ress or Lot No. •. ......................... ........... -- Ow Address Installer Address PQ Q Type of Building Size Lot...-_-�_../dP._Sq. feet U Dwelling—No. of Bedrooms------------ .......................Expansion Attic ( /U Garbage Grinder (##V)Q Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other^fires�__Design Flow............ gallons per person per day. Total daily flow......... . ...............gallons. � Septic Tank—Liquid capacity l. ........ allons Length................ Width---------------- Diameter................ Depth................ Disposal Trench—No. .................... Wid .................... 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 Result&Pei formed by.......................................................................... Date-----------------------------------..... Test. Pit No. 1-----------_----minutes per inch Depth of Test Pit.................... Depth to ground water_-___________-_--_--___. (� Test.Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-___--_-____ --___. Q+' ------------ -------------------------------------- ------------------- "-------------------------------------------------------- 0 Description of Soil_.........' eQA.._ -.-so-- r______________________ x -----•--------------------•-----•------------------------------------•--------------- U ---•-----------------------------------------------------------------------•-----•-------------------.-.----------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------•----------------------------------•---------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------------ ____________________________________________________________________________ A ent: he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the rovisi ns o i T"� the State Sanitary Code— The undersigned rti.er agrees not to place the system in o io e 'fi i Compliance has been iss,40 the4boo� ea�lth.----- ---------_---------•--- Date lic on Approved y......... .. ... Date PPlieation Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- -------------- -----------•----••-----------------------------------•--.....•----------- <A � L Date PermitNo....... ................•--•-----• ---•--- Issued_....................................................... FE$...�..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----- -- 4...............----.OF...... ?s: ,4--pliration for Disposal Warkri Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( —)—or Repair ( ) an Individual Sewage Disposal System c,'. ..................................................t �............................... -•----••. � . ion- dress f or Lot No. :' C }�'� �s.aa^ f „A .. ......... .......................................... ......•. o v e °� 1 Address W . ... �>�1 . . � ,c�'1� /. �-*-�^-�... -�-----••--•----•------------------- ,-� � Insta,er Address Type of Building Size Lot .__,,�!................Sq. feet Dwelling—No. of Bedrooms.............. ........................Expansion Attic,( `l�` Garbage Grinder Other—T e of Building ___________________--_----- No. of persons................... Showers — a —Type g p _ � ( ) Cafeteria-( ) � Other fixtures......•-••••-•••--•------•-----••••••---•-•--•••...........................•-------•--•--•--•••••......--• •••• -•----- . W Design Flow......... ."���.................gallons per person per day. Total .7 daily flow....... _ .: ._.' ..............._gallons. WSeptic Tank—Liquid capacitit—OP.galIons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width................:... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No. �X_ _.. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( i} Dosing tank ( ) Percolation Test Results'' - ) ormed by.......................................................................... Date........................................ a t Test Pit No. 1______ ________minutes p'er inch Depth of Test Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------- ------- -- ------- -- -- - ---- - D Description of Soil.........C••- %s `-`--- --------•------••---------------------------- x U •-••-••••-•--•-•---•••••-•---•-••••••-•...------•----••-•••••-••----•-•-•••-••----•-•-----•••••••--••--•••-•-•--•---------••-•-•-••-•-•-•----•-•--------•--------•---•-----•--•-----------•--••-•••---- W U Nature of Repairs or Alterations—Answer when applicable..........<. .-`................................................................................ --------------------------•---••••---•---------•--•-----------•--•-•••--••-•-•-----•-•--•----•-•--•--•-•-•.....................•-•-•--•-------•••••--------•---•------•----------------•-••-•----••--• A ment: he undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the rovisions o i I :�:12 _ - the State Sanitary Code—The undersigne further agrees not to place the system in o e atio a, e�t1 f Compliance has been rasp-eed,by the board of`healthh. Signed..,,`-'-". ................................ l�'�` t�-�-- -- T �. Date li i n Appr ved By"........ ............... -ram---- r��7�' �....... iDate PPlication Disapproved for the following reasons:-------•----------------------------------------------------------------------------------------------------••-- ------------------------ - r Date Permit No.----- �-=-- -------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (PU>.0 ..................... (Entifiratr of Tout tliFatta THIS I -- O CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( , } bye ----•------ ,1� •-•--•--•-------•-------- •------------- ------- ---- ----- - ------ L. staller '�,G� at-------_-� ' w' -_------•--------- —_=?` _._...----•-...M= �r f "--•----•-- C --- has been installed in accordance with the provisions of TITIZ j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__5r�.._.�__.r�"'�.��___- dated-----71Er^S,`- __. ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT YHE SYSTEM WILL,FUtACTION SATISFACTORY. J /U DATE...-••---- ............................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF_HEALTH r .................o F................. t............ bU iV Garce- .- FEE.... :...x....... Diaapos al- aarkai '011aanstraartion rrmit Permission is hereby granted-------{` -------- ................................................................................ to Construct (v1r_or Repair ( ) an Individu l Sewage,Dis o S,,ystem ,- 7 �^- f at as shown on the application.for-Disposal Works Construction Permit N "._`___EW Dated..----- ~�.1- -a " --- .••-•........._...� tF. i ---------------- ••---••----------- yyDATE--------------- --21.--Lf�.....••-•-•................_....•......... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - f rj ETH RK iZ ai�Tj 'DAI L-',.< / : 11D x 3 Q 3sa CLYh S E�nc.Tiw�C: 33D ��sax' g956�P'a ►?�3 �� y� . Ll5 E 1 oaD G�.�t.o►a S<Qpnc 1 A1,1K �, 71s�os��prt•-%- use loam�C�ral.�,ou i�cr � -�'o�,�►�►��au,r, �lrM 1�.C2tJ5{-FG'p '6TOt l't:r SA - Aux t 1S0 sF Co,v.,& r(•6osa ol. t.o : s--a GPtZ i -r CoSZ —r'6-ML- 'p M616cj.1 FLo v/t 425 EMP �1 ��CAIAT.IaNRIisTC r7to? lk1 2KI".A F PUER %. A: SULLIVAN BAXTER tiS. No. 29733 a 2n(148 TEST N OLr- �1. 1 •3 ; _ TU 5'j,nor j 'I'QY aF Ff 117 �. sag 2 , q��'t'�!G S2. WA 51.5 14\1 INV '•m 5 L cH s ►uY s► .7 s1.9 Sync Rtl' lug ,N\ IJ wind Vor a l.,, 7 V-M)l *g C ERmFI ED ?Ln-t' ?I-At-1 wf sITZ14 LT — ► ,= �52 SEfy a�xc�2�] s. P)-AK .R F-t=r--RE:Nc-m ����1,S . . . �r�,��/1 L.►.:� t-�►mow►;..�.>,.�.v g i oV l► '� .. . __ T"�z.o t�c���t,� R�6•l 5�E Q �'•R SLt��I��� I C.E.t:1'1F`C Tl•-lpc"r'T�-4��c,a�.t V�"�?o��1's H rru}..� r-I�R��1.1 cz�M��.._`t5 �1(-C1•t-('1-4� 5 tr1��t,rJ>� ��.rl I� E,.►�t�s�Qs ANC •5��'�,�c.IC "FiEncl►?��4�NT'S iDFTt•lE �g /1-�-�I I-1..�./^-- t�h� , A i.11:1 let, �zaG�a-cam 1. '1 1M -rHF- �FI..DUI ALh11.�. THis RAnI 15 NZSt"$AStp ON,AN I45TRUMENT 5uKVEY AND THE OFFSETS 5HOY/N 5HZ)ULD T�IoT ESTI�'i3L15N �.-aT LINE 5. T.O.F. ±EL.= 58.0' PROVIDE EXTENSION RISER FINISH GRADE OVER D-BOX= 56.9'± ° GENERAL NOTES WITH COVER OVER INLET& 4" /o SCHEDULE 40 PVC MIN. SLOPE 1 FINISHED GRADE OVER DIFFUSERS = 56•4. - 56.9 OUTLET TO WITHIN 6"OF F.G. SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH ACCESS BOX TO FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE WITHIN 3"OF F.G. (ONE PER TRENCH) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 57.3 ± FINISHED GRADE OVER TANK EL. = 57,2 ± CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. PROPOSED 4" SCH. 9" MIN. I { 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL —EXISTING 4" 40 PVC SEWER PIPE 36 MAX. 9" MIN. OUTLET PIPE 5" DIA. OUTLET(S) � 36"MAX. TOP OF SAS/ B.O. _ rj3.90' SYSTEM UNLESS OTHERWISE NOTED. 3" 3" DROP MAX 9„ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2" DROP MIN 3 MIN.SLOPE@ 1% JOINTS (TYP.) ELEVATION = 53.90' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 4" PVC IN FROM 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF IT 10" ,� * 4" PVC OUT TO 1.33' THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 14 � 54.6 ± SEPTIC TANK 16 TYP O LEACHING FACILITY (�'P ) 0.90' 10.75"TYP � 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR SHALL CONTRACTOR SHALL 7 12" 6" + I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. VERIFY SIZE AND 48" VERIFY CONDITION OF OUTLET TEE 54.17 MIN. 54.00 53.47' \--52.57 (LAID FLAT) 2.875' (34.5")--1----5.75'� I 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK CONDITION OF EXIST. EXISTING TEES 6" CRUSHED STONE (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS SEPTIC TANK AND REPLACE AS 5'0� NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH ` � OVER MECHANICALLY , 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 57.00' ESTABLISHED I- TO BE INSTALLED ON A LEVEL STABLE e/�� ON A NAIL SET IN FENCE POST AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 5&fr t 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 SEPTIC TANK PROFILE DIST K L.)o FION BOX DETAIL 12 ARC 36HC #3616 B D BIODIFFUSERS TO THE DESIGN ENGINEER. CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR NOT TO SCALE 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 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING Ir ` '+ • • `�. TEST PIT DATt REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM 13 * "`e j• APPROPRIATE AUTHORITY. 1. + * •• ` �� • , PERC NO. TO BE DETERMINED �� r`: • ' » • + ' �`y ' INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 1 �� ` *•* :+.• f • •. ` EVALUATOR: Michael Pimentel, E.I.T. UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE + • THEY SHALL WITHSTAND H-20 LOADING. * �' t• i C.S.E. APPROVAL DATE: Oct. 27, 1999 t1 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. # • w ' DATE: March 26,2010 ✓'� ' ` TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE �� • ` : MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. �� • 1� ELEV TOP = 56.50' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, rry 11 * �� l! , • ELEV WATER= <46.00' 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 LOCUS • * SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. • ' DEPTH OF PERC - 36"-54" 16. PROPOSED PROJECT IS LOCATED WITHIN: SE7-H ' • .+ • TEXTURAL CLASS: 1 ASSESSOR'S MAP 170 PARCEL 201 ARKER ROAD OWNER OF RECORD: JOHN J. JR. &JOANNE V. MOYNIHAN , AD (50 wIDE) n rry ' . • .`• 0• 56.50' ADDRESS: 29 SETH PARKER ROAD •.�e. •, • `�+ CENTERVILLE, MA 02632 « r; • :•• Fill 7 _ w I ZONE 2 - • I EDGE OF Q 23 ' .. '•`+`: 16" Loamy Sand 55.1 T FEMA FLOOD ZONE C PAVEMENT - ) . * * �rJ �` �` f A 8, 10Yr 3/1 55.00' COMMUNITY PANEL# 250001 00150 C S6� CD "' 17. DEED REFERENCE: DEED BOOK 16721, PAGE 182 S7g°343 \ �� o � • • f> /1u B Loamy Sand p 3 10p.0p, / ` m ► r,,^ • ; ' 4 I 10Yr 5/6 18. PLAN REFERENCE: PLAN BOOK 386, PAGE 94 a a; * • iSh 36" 53.50' Hatc 1 rY Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. ?�" 52.00' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY Medium Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 57 2.5Y 6/6 �% r: �." C (loose) MAP 170 (5% gravel) PARCEL 200 \ 41\1 �~\` LOCUS PLAN 1 N Dcly t #29 (SLAB) / (FULL FND) EXISTING SCALE: 1" 1000'= 126" 46.00' co ' 3-BEDROOM No Mottling, Standing or Weeping Observed o DWELLING MAP 170 TOF = 58.0'± `t DESIGN DATA TEST PIT DATA LEGEND N ) PARCEL 202 O o TO BE DETERMINED � PERC NO. Benchmark INSPECTOR: David W.Stanton, R.S. 50xO EXISTING SPOT GRADE Nail Set in Fence Post Q B.H NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel, E.I.T. Elev. =27.00' O ' DESIGN FLOW 110 GAUDAY/BEDROOM - - 50 - - EXISTING CONTOUR N C.S.E. APPROVAL DATE: Oct. 27, 1999 Approx. M.S.L. �' _ EXISTING 1,000 GALLON SEPTIC TANK TO BE O '!TILIZED AS PART OF THIS DESIGN TOTAL DESIGN FLOW 330 GAL/DAY DATE: March 26,2010 Pew PROPOSED CONTOUR PROP. TOTAL 12 ARC 36HC BIODIFFUSERS f _� T '-- _�57y DESIGN FLOW X 200 % 660 GAUDAY (6 BIODIFFUSERS EACH TRENCH) h - _ _ L-AiSTING DISTRIBUTION BOX TO BE ABANDONED TEST PIT#: 2 E/T/C - EXISTING UNDER-GROUND UTILITIES y �`- - USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP - - 56.50' PROPOSED INSPECTION PORT WITH _ TP 1 - EXISTING LEACHING PIT TO BE PUMPED & FILLED _ - <46.00' EXISTING WATER LINE ACCESS BOX TO GRADE (TYP OF 2) X 56- X- 3 WITH CLEAN COARSE SAND &ABANDONED ELEV WATER 0,0' LP PERC RATE = GAS EXISTING GAS LINE X X X- - _ \1 _ X- _ INSTALL 12 - ARC 36HC (#3616BD) BIODIFFUSERS X- X X SHED DEPTH OF PERC = TEST PIT LOCATION 55x3 55x7 SWING-TIES SCALE: 1"=20' SYSTEM CAPACITY TEXTURAL CLASS: 1 PROP. "D-BOX" DESCRIPTION HC-1 HC-2 - - MAP 170 S6� BIODIFFUSER CORNER(1) 42.6 45.4' (TOTAL L.F. OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD EXISTING 1,000 GALLON SEPTIC TANK „ 56.50' (60.0') (7.8 SF/LF) (0.74 GAL/SQ.FT.)= 346.3 GAL. LEACHING/DAY 0 PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE PARCEL 201 BIODIFFUSER CORNER(2) 50.5' 51.6' Fill ❑ PROPOSED DISTRIBUTION BOX � 15,468 S.F.± N83"4327,,W BIODIFFUSER CORNER(3) 74.0' 33.4' TOTALS: 16" Loamy Sand 55.17' Q PROPOSED ARC 36HC (#3616BD) BIODIFFUSER 35.38' A 10Yr 3/1 BIODIFFUSER CORNER(4) 68.9' 22.8' TOTAL NUMBER OF BIODIFFUSERS: 12 18" 55.00' N72.4610 TOTAL NUMBER OF COUPLINGS: 0 B Loamy Sand 65 �8, W TOTAL LEACHING AREA: 468.0 SQ.FT. 10Yr 5/6 TOTAL LEACHING CAPACITY: 346-3 GAL./DAY REV. DATE BY APP'D. DESCRIPTION MAP 170 36" 53.50' PROPOSED SEPTIC SYSTEM UPGRADE PARCEL 6 1 #29 PREPARED FOR: (SLAB) ' (FULL FND.) EXISTING NOTE: Medium Sand CAPEWIDE ENTERPRISES 3-BEDROOM EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE 2.5Y 6/6 I DWELLING DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER C (loose) TOF = 58.0'± "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO (5%gravel) LOCATED AT NOTES: ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST 29 SETH PARKER ROAD HC-2_j/ MODIFIED FEBRUARY 18, 2010). TRANSMITTAL NUMBER =W000052. CENTERVILLE, MA 02632 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE F TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. B.H \-HC-1 SCALE: 1 INCH = 20 FT. DATE: MARCH 27, 2010 126" 46.00' 0 10 20 40 80 FEET 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE 4) No Mottling, Standing or Weeping Observed mmmmmimi LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE s P PREPARED BY: CHUK -- CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. 1) RESERVED FOR BOARD OF HEALTH USE JOH" �'ILL JC ENGINEERING, INC. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS AL 2854 CRANBERRY HIGHWAY ARE NOT CONSISTENT WITH TEST PIT DATA. 3) EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED SITE PLAN 2) 508.273.0377 ZONE 2 AND THE ESTUARINE WATERSHED. SCALE: 1" -20' Drawn By: MCP Designed By:MCP Checked By: JLC JOB No.1787 r FINISH GRADE OVER D-BOX= 56.6' T.O.F. EL.= ± 4" SCHEDULE 40 PVC MIN. SLOPE 1%.O ± PROVIDE EXTENSION RISER - FINISHED GRADE OVER CHAMBERS= 56,4 - 56.7' GENERAL NOTES WITH COVER OVER INLET& SLOPE @ 2% MIN. OUTLET TO WITHIN 6"OF F.G. INSPECTION PORT WITH ACCESS BOX TO i 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION REMOVABLE WATER-TIGHT COVER OVER WITHIN 3"OF F.G. (SEE PLAN FOR LOCATIONS) ff METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE , , RISER TO WITHIN 6"OF FINISHED GRADE @ FND. EL.= 57.3 ± FINISHED GRADE OVER TANK EL 57.2 ± - -- _------_- ___ __-._..._ _ _. -- ------------..-_ ------- --_--____-_ - -______ .__. . CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE N. DESIGN ENGINEER. EXISTING PIPE PROPOSED E PIP 36" MAX. 36" MIAX. TOP OF SAS/ B.O. = 53.73' 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL OUTLET P{PE �--- 40 PVC SEWER PIPE ; 5" DIA. OUTLET(S) SYSTEM UNLESS OTHERWISE NOTED. 60 3" 3" DROP MAX , PROVIDE WATERTIGHT 3 9 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2" DROP MIN MIN. LOPE L=14 ± JOINTS (TYP.) 47 ELEVATION = 53.73' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A MA13" 4" PVC IN FROM =iE+.71 1.33' 16„ 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14" *54.6'± SEPTIC TANKA 4" PVC OUT TO 0 90,5� Rfi (TYP.) tl .75"(TYP) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY + + 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR SHALL CONTRACTOR SHALL OUTLET TEE 54.00' 12" 53.83' 53.30' �-- 52.40' (laid flat) -�2.g75' (34.5")--I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. VERIFY SIZE AND 48" VERIFY CONDITION OF (TYP.) CONDITION OF EXIST. EXISTING TEES 5.0' 7, LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK SEPTIC TANK AND REPLACE AS 6"CRUSHED STONE (TYP.) 5' MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY 11.5' NECESSARY COMPACTED BASE REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 25.0' AND DESIGN ENGINEER. 5 L OUTLET DISTRIBUTION BOX L TO BE INSTALLED ON A LEVEL STABLE 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 57.00' ESTABLISHED GROUND WATER ELEV.= < 46.00 ON A NAIL SET IN FENCE POST AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. CHAMBERS (PROFILE) CHAMBERS (END VIEW) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION (BY INFILTRATOR SYSTEMS, INC.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW i 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES "CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (HIGH C� A PACITY) CHAMBERS TO THE DESIGN ENGINEER. TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NC-' rC SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. • N , ,f PERC NO. '# {,( • '' ` INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS �` . «• ¢'�• • •� :�, EVALUATOR: Michael Pimentel E.I.T. UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE •`" .!& THEY SHALL WITHSTAND H-20 LOADING. •° ' C.S.E. APPROVAL DATE: Oct. 27, 1999 ' _ N /�• DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. March 26, 2010 1. TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE •' ELEV TOP- 56.50' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. �� REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, SETy PARKER ?!ftf 11 • ELEV WATER= <46.00 FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 31-0 CMR 15.255(3). K 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN -�_ (50� WIOEf' �'OAQ i �,'' ) �-� i PERC RATE _ < 2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION F ) � ..,�' ..��... S „ O WORK. t� .rrg DEPTH OF PERC = 36 -54 16. PROPOSED PROJECT IS LOCATED WITHIN: �.. Z. TEXTURAL CLASS: 1 ASSESSOR'S MAP 170 PARCEL 201 tom. GE OF o y OWNER OF RECORD: STEPHEN J. GUIMOND&VIRGINIA E. GUIMOND PAVEMENT ran rry • « •` J y' • 0„ ADDRESS: 25 WATERFORD DRIVE I ; S ! 8 eif9 . , • : . . ` 56.50' . .. -< 3 , „ _ •. MARSTONS MILLS, MA 02648 33 E \ CI t __ ti': . • ' Fill o 100.00Uj , �" I »= fir; • ` IU 2 • s . _ 16 Loamy Sand 55.17 FEMA FLOOD ZONE X Q I M 10 N«•.• ..� . ~' •y_ "s A 8' 10Yr 3/1 COMMUNITY PANEL# 250001CO561J 55.00 `4 " • MM' Loamy Sand O 17. DEED REFERENCE: DEED BOOK 24555, PAGE 131 O 1 k y • B 10Yr 5/6 � • • 18. PLAN REFERENCE: PLAN BOOK 386, PAGE 94 ' --57 < . ` ' .� 36" 53.50' a e ' ' • 'Hatchery 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. • Perc 'h, J r' • � 54 ' `` 52.00 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. MAP 170 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY PARCEL 200 \ '" FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. Medium Sand 25Y6/6 o�u (SLAB) 1 EXISTING i C (loose) 21. EXISTING CONDITIONS SHOWN ON THIS PLAN WAS BASED ON A SURVEY PERFORMED IN (FULL FND) MARCH 2O10. co 1 3-BEDROOM (5% gravel) 1 DWELLING TOF 58.0'± N LO C U S PLAN = � MAP 170 � 1 a PARCEL 202 SCALE: 1"= 1000' Benchmark 126" 1 46.00' Nail Set in Fence Post ' B.H. No Mottling, Standing or Weeping Observed Elev. =27.00' TEST PIT DATA Approx. M.S.L. TP 2 TP 1 EXISTING 1,000 GALLON SEPTIC TANK TO BE DESIGN DATA LEGEND EXISTING 12 ARC 36HC PLASTIC 56.5 f 56.5 -'- - UTILIZED AS PART OF THIS DESIGN PERC NO. i CHAMBERS (6 CHAMBERS EACH TRENCH) ``"57 -EXISTING DISTRIBUTION BOX TO BE ABANDONED INSPECTOR: David W. Stanton, R.S. TO BE REMOVED (ALONG WITH SPOILED NUMBER OF BEDROOMS (DESIGN) 3 50x0 EXISTING SPOT GRADE SOILS) & REPLACED WITH CLEAN SANDS -EXISTING LEACHING PIT (ABANDONED) DESIGN FLOW 110 EVALUATOR: Michael Pimentel, E.I.T. WITHIN FOOTPRINT OF NEW SAS 156- - TOTAL DESIGN FLOW 330 AUD GAL/DAYOOM - 50 - - EXISTING CONTOUR X X-- LP C.S.E. APPROVAL arcDhA26,'2010 27, 1999 PROPOSED INSPECTION PORT X - 0 o - 660 DATE: 50 PROPOSED CONTOUR WITH ACCESS BOX(TYP OF 2) \ ~X X--X_ I DESIGN FLOW X 200 /° - GAL/DAY X X X SHED TEST PIT#: 2 EXISTING UNDERGROUND UTILITIES USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP - 56.50' PROPOSED TOTAL 20 ARC 36HC(HIGH CAPACITY) 55x3 55x7 ELEV WATER= < 6. 0' W w!- EXISTING WATER LINE PLASTIC CHAMBERS IN A FIELD CONFIGURATION t, PERC RATE = GAS EXISTING GAS LINE MAP 170 �ss\ INSTALL 20 - ARC 36HC (HIGH CAPACITY) CHAMBERS DEPTH OF PERC = TEST PIT LOCATION PARCEL 201 �' --� 15,468 S.F.± PROPOSED SWING-TIES SCALE: 1"=20' SYSTEM CAPACITY TEXTURAL CLASS: 1 / N83043'27"W DISTRIBUTION BOX (TOTAL L.F. OF CHAMBERS) (4.80 SF/LF) (0.74 GPD/SQ.FT.) = GPD O EXISTING 1,000 GALLON SEPTIC TANK HC-2 35.38' DESCRIPTION HC-1 (100.0') (4.80 SF/LF) (0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY -- 0 _ CHAMBER CORNER (1) 44.6' 48.2' TOTALS: 0" - 56.50' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE 460j"W CHAMBER CORNER(Z) 52.2' 49.6' TOTAL NUMBER OF CHAMBERS: 20 Fill Q PROPOSED DISTRIBUTION BOX TOTAL NUMBER OF COUPLINGS: 0 CHAMBER CORNER (3) 71.8' 34.3' TOTAL LEACHING AREA: 480.0 SQ.FT. 16" 55.17' Loamy Sand MAP 170 TOTAL LEACHING CAPACITY: 355.2 GAL./DAY A 10Yr 3/1 � � PROPOSED ARC 36HC (HIGH CAPACITY) CHAMBER ! PARCEL 6 CHAMBER CORNER (4) 66.5' 24.1 „ _.. 18 55.00 B Loamy Sand 10Yr 5/6 REV. DATE BY APP'D. DESCRIPTION � 36" 53.50' ' ----- PROPOSED SEPTIC SYSTEM UPGRADE � #29 NOTE: (SLAB) (FULL FND) EXISTING 1.) EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE PREPARED FOR: NOTES: 3-BEDROOM DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER ' CERTIFICATION FOR GENERAL USE ISSUED TO INFILTRATOR WATER Medium Sand ROB,_FT B. OUR CO., INC. DWELLING 2.5Y 6/6 TOF = 58.0'± TECHNOLOGIES, LLC., DATE OF REVISION: FEBRUARY 19, 2015, C 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF MODIFIED JUNE 12, 2015; TRANSMITTAL NUMBER=X264258. (loose) (5% gravel) LOCATED AT EACH SEPTIC SYSTEM COMPONENT. He-2 29 SETH PARKER ROAD 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE B H PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT C-1 CENTERVILLE, MA 02632 DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF ------ - HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. (4 126" 46.00' SCALE: 1 INCH = 20 FT. DATE: AUGUST 25, 2020 26'8, No Mottling, Standing or Weeping Observed .1 of M o �0 20 ao ao FEET 3.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2 AND THE 1) �Ssyr ? ti MMMAMMMMI ESTUARINE WATERSHED. PREPARED BY:RESERVED FOR BOARD OF HEALTH USE �o JOHNL N JC ENC EPING INC. 0 m - 4, EE .:. , 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY CHURCHILL JR.N ML 2854 CRANBERRY HIGHWAY FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS (3 25.0, IN THE FIELD PRIOR TO INSTALLING THE SYSTEM. CONTRACTOR SHALL 2) E a EAST WAREHAM, ILIA 02538 NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. SITE PLAN, 508.273.0377 SCALE 1"=20' i Drawn By' MCP Designed By:MCP Checked By JLC JOB Nc 1 ,57