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HomeMy WebLinkAbout0109 SHEAFFER ROAD - Health 109 SHEAFFER RD., CENTERVILLE A= UPC 12534 No.2-153LOR HASTIN©S,MN TOWN OF BARNSTABLE LOCATION 109 S tlEAgr-[k RoAb SEWAGE# ?zl-i - f 4/ VILLAGE dNTGRV ICtX ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.CXP8W(tE 5VT,1CjZW,12aS 3e94477-W77 SEPTIC TANK CAPACITY ( ,000 C—TALLp J LEACHING FACILITY:(type)&) 02 4 dtfA41. v ,5(size) al,X 3q r NO.OF BEDROOMS OWNER Ci4olva P7Aw MAN PERMIT DATE: '(C" -'D-0 L "1 COMPLIANCE DATE: Q 1 - Xc l`7 Separation Distance Between the:Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility NIA Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N/A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) � Feet FURNISHED BY C-i4t Gc.J t DC r?�,k154Sg A _2- A- 3 29' P FR`"T-- - --� A-4 - 31-S � i 2 Q•[ _ .lot a c � No. Fee 6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes licatiou for i of�� � ��o� *p!Aeut Congtructtou Permit Appl.ication for a Permit to Construct( ) Re air(X Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. Sf1&4F1=M Rb Owner's Name,Address,and Tel.No. ddv11_LG d ilL-wQ FA w mAk Assessor's MaplParcel t-la-to 4D.9 75 ALITT"10 _ Ut" !ctA Installer's Name,Address,and Tel.No. �QFa`� ��`���� Designer's Name,Address and Tel.No. C.&4,V 6W t 1*G tG a,1't K5� .SG L4�'I f Ada-9(JV _tAl c Type of Building: Dwelling No.of Bedrooms 3 Lot Size I StXS':ir sq. ft. Garbage Grinder ( ) Other Type of Building gG7l Q6jVTCA:j,, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 353,77 gpd Plan Date S^4—401:1 Number of sheets Revision Date Title loci Size of Septic Tank 1 t OOC� Type of S.A.S. Description of Soil Q"ASd:'&ID Nature of Repairs or Alterations(Answer when applicable) u.Si3' "JS—reu& i ,&00 0k&A4&J 7rA JQ i1 - 170 q"602G '�(5 �C�'(p C tf AA40 XS W fT01 F kZT OF S!D� ®j► E&OS Aw 0 3Fja—�c 3z9Ar 16�- 0#4 St D&S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed ON. 1 y _ Application Approved by / / �� _ ate Application Disapproved by: V Date l r for the following reasons Permit No. J Date Issued e b -- —'` --� '—s!'! ——— Fee THE COMMONWEALTH OFMASSACHUSETTS Entered in computer: ► PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �Bigpat r pgtein CCldnotructiou Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No"-1 Oct S1444FP F'2. Rn Owner's Name,Address,and Tel.No. 8 iAL-jm i P^tJ m4Ak Assessor's Map/Parcel (-�a -7 5 AL :5T e: U>ul" K e m A Installer's Name,Addre s,and Tel.No. 5 88-1, Designer's Name,Address and Tel.No. 54�T�7 —03`t'T C 6c� 7JC b'A/T SL �'G EJJG(A,/W:Xt t✓(5r 7teV�,, 15' cam. �'T' 144A SAP �55' ►g1yrL Nrc ay .t. t~� � Type of Building: ` -t Dwelling No.of Bedrooms Lot Size 1151a515" .-Asq. ft. Garbage Grinder ( ) Other Type of Building PG3 j C>6WTc,FL.r No.of Persons Showers( ) Cafeteria( ) fOther Fixtures Design Flow(min.required) ..330 gpd Design flow provided t gpd Plan Date 5-4-�L Number of sheets Revision Date -Title loci 45146AFFISt ROAD Size of Septic Tank 11600 Type of S.A.S. 5 c Description of Soil 00AASE 6_AVQ Nature of Repairs or Alterat►onsr(Answer when applicable) (>, E9�GIST�UL i IGeX� IC+� 5eFrK,,. 1-8-01 - Try1 13-8 O?G ?b (5) W tTi! ;Z F 4Z7- Date lai inspected: Agreement: r 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. C Signed Y „ �, A Date ✓ Application Approved by / v � �� � .v ate u /r � i � / Application Disapproved by: ` Date for the following reasons z Permit No. Date Issued L / THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - (Certificate of Compliance THIS IS TO CERTIFY,'hat the On-site Sewage Disposal System Constructed ( ) Repaired ( Upgraded ( ) Abandoned( )by EL (DE 6&REQ j at 14EOlLr Z 904? C.EN t has b en c nstruc± —cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. t�,_,( ��� � dated Installer CA9�}(D& �`r'�t7,66; Designer a - 7.�t=,t #bedrooms 3 Approved design flow .3 3® gpd The issuance of this permit shall of be construed as a guarantee that the system will function s e 'geed. Date 7-1 // Inspector __—� � [/ z:��..�—•1�4 i!ar No. / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS -Mi5po5ar i§pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair ( 4) Upgrade ( ) Abandon ( ) System located at 109 50">FIrGIAL R.06b 4 1G, ,1/IC4,J /i •'/ ( � ` f I and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty �� *) P_�� to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mint/U'ec�o f lete&within three years of the date of this pe ''it. Date ) !/ � Approved by s - - - #5509 P. 001/001 Town of Barnstable Regulatory Services Richard V. Scali,Interim Director MA Public Health Division �t�pe Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office; 508-862-4644 I Fax, 50$-790-6304 Installer& Designer Certification Form Date: fe'7"17 Sewage Permit# P a yi ` 141 Assessor's Map\Parcel J72 Designer; 37 G Cngt�1'Ge�t �_ Installer:' Caecw1,Je. 61-k."e6 se-S Address: 2$5`1 ara Jb'errT I iomiax_ Address: 15 3 Cdvow ercl',,L 54( e f cc15k ware,►ACA X A 62,538 N4 � 6 2. � y 9 j On —lIZ1`' CaQewtrle.. 60h4ertse..S was issued a permit to install a (date) (installer) septic system at CO E e r �d a d based on a design drawn by (address) -37C Eol inee.c�O� t,.., dated �OV / (desipdr) `1 1 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 bpx 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. I certify that the system referenced above was construe nce with the terms of the RA approval letters(if applicable) �o Jam L. yGF T<;::> C :!��.......... c° CHUR I VIL Insta is igq q N .41 s /ASE igner's ign (Affix igne s Sr rnpHere) PL RETURN. O BARNSTABLE PUBLYC HEA H D IS N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED U'NTYL BOT I% FORM AND AS- BUILT CARD ARF& RECEIVED BY THE BARNSTABLE PU C HEALTH DIVISION THANK YOU. WSeptic0esigner Cenification Form Rev 8.14-13.doc I i Town of Barnstable P 1 S�3 Department of Regulatory Services l axnrtarAn�a ' Public Health Division Date / I MAPS M` �, i's3A• � 200 Main Street,Hyannis MA 02601 i •, • �, G J' t C -Date Scheduled Time--� � Fee Pd. ! ,-:. �'°• Soil Suitability Assessment for age Dispo��al Performed By: ! I D/ntGY► CSE ('( Witnessed By: >� i I LOCATION&.GENERAL INFORMATION I ovation Address Owner's Name C.�I(.PU�r Ye4(J M�4}I AIA e o C Address LSTeAb ' yy ���� �•(li CAPE�>,E CS�p Assessor's Map/Parcel: ` 1 Engincer's Name •fe 1NF l 2 506-2-73-0 37.7 NEW CONSTRUCI70N REPAIR Tale hone# Innd Use Slo es 96 - �� • U \J p ( ) Surface Stones I Distances hom: Open Water Body ft Possible WotAren ft Drinking Water Wcll ft { • I Dralhage Way i ft Property Line r ft Other - ft SIMTCH:(Street name,dimensions of lot,exact locations of test holes&pero tests,locate wetlands-in proximity to holes) See, a4facked �I44h. i • i I , r i , • j I Parent material(geologic) Q(dWaSk Depth to Had+cak_ i j Depth to Oroundwater. Standing Water In Hole: Weeping from Pit FOoa "rBstlmated Seasonal High Oroundwatcr l i r b% . -. Y?' DETERMINATION FOR SEASONAL'HIGH WATER TA$LB'i Mcth�odUscd.- ►.rect-DbSerVd�i rg j Dc th Observed standing In obs:hole: 7 3 Itt, Depth ro soil mottleat ' Do ih to weeping from side of obs.hold: 7 a a .--In. aroundwatar AdJustment ih. lndox Wali; Reading Data: Index Well lmval'.� _ that r Al�r b _AdJ,prawidwatar•ixval ' PERCOLATION TEST Daiu ALA19 'i'lma ia! M 4%Hole,#� Time at D" Depth of Para Time at ti" Start Pro-soak'rimc @ io:16 AM Time(911•6") _ End Pro-soak 1Q:?y �m Rate Min./Inch Site Suitability Assessment. Site Passed SItp Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Hack ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conseirvation Division at least one(1)week prior to beginning. Q WEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture .Shcl Color Sall• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stonei,Boulders. Consistency.96'arival) r. 0-ld - 'Pill 11-14 k 16yr 3/1 _ 36-13�L Z.Ty 616 - e10.30% Cobbla g DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soli Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soli Texture Soil Color _ Brill Other Surface(in.) (USDA) (Munsell)' Mottling (Structure,Stones;Boulders, Flood Insurance Rate Man: Above 500 year Mood boundary No Yes Within 500 year boundary No 7 Yes Within 100 year flood boundary. No.,!_ Yes- Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious tntiterial exist in all areas observed thrpughout the area proposed for the soil absorptibn system? �e�s If not,what Is the depth of naturally occurring pervious material? er'tifleation I certify that on 10.1 a-; q (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 tralnin ,expertise an oxpe n a described In�10 CMR 15.017. Signature Date I ' Q;%SarrlCWancaORM.DOC 1. / / TOWN OF BARNSTABLE Date: 3 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: 140U` 59^'SQ'h S BUSINESS LOCATION: kc c .I;h A ( irC 1Z k�D oJ INVENTORY MAILING ADDRESS: Y Qn B O X 3Aki Gpirc A y)i, c- 02 63 9- TOTAL AMOUNT- TELEPHONE NUMBER: Ir--D gib k/ 0 p2 CA'oL p4 5 �lG� CONTACT PERSON: 0:A S;k I/4 EY)DI -f-p t EMERGENCY CONTACT TELEPHONE NUMBER: l -V,8 02 W -�g 14 O MSDS ON SITE? TYPE OF BUSINESS: 0Xn 1C-� C►Al. A,Jg eS,OC'nTI A�j I'-nC INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): a Metal polishes a I �C k of IC4 CID M70 Sp l„ Laundry soil & stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash �? WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's igrr tune Staff's Initials YOU. WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00_for 4 years). A business certificate ONLY.REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission o operate.) You_must rlrst obtain the necessary signatures'on this format 200 Main St., Hyannis. 's Office, 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and.get the Business Certificate that is Take the completed form to the Town Clerk required by law. - DATE: 201( " Fill in please: ,!v1Il6�"Z>i;t ':`z ' APPLICANT'S YOUR NAME/S: r - y� I Z•l.0 � ;.yl•'ri:�i;ti'?t$Ii'''' 'Ij 4;' BUSINESS YOUR HOME ADDRESS: !L `5hEA�F 12 02 U �,. -+ ;jL• P.Y1' ii;;: TELEPHONE # Home al�n G r.I Number E-MA I L: N1P 1�1 U C CA4�1 r 0 �� SOC I AL SECURITY OR E I N #: 1\10AE OF CORPORATION: NAME OF-NEW BUSINESS Ova' E��. TYPE OF BUSINESS D�iYl IaG rAl. P.JD IS THIS A HOME OCCUPATION? . YES NO ' ADDRESS OF BUSINESS. .IrQ S FA. �a� C���t- fi��'�VI ;�C.o MAP/PARCEL NUMBER. _ Noy (Assessing) When starting a new business there are.several things you must do in order to be in compliance with the rules and regul'ations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth ' Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your uslnes in this town. 1. BUILDING COMMISSIONEWS 0 �I � T COMPLY "JVITh HOME OCCUPATION individual has b en"i r r i iiremeants that pertain,to this type of bu s . RULES AND REGULATIOt-IS, FAILURE TO ,Authorized Signa ure** OMPtaY M RESULT ih.P FINES, COMM NTS: l 1 2. BOARD OF HEALTH This individual ha e n inform oft r ' requirements that pertain to this type of business. MUST COMPLY, ALL HAZARDOUS MATERIALS REGULATIONS. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: . . , - ,per COMMONWEALTH OF MASSACHUSE17S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 109 Sheaf fer Road Centerville Owner's Name: Janet Gillis Owner's Address: Date of Inspection: Name of Inspector:(please print) Will jam _ • Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville. MA Telephone Number: (508) 775-8776 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.1 am a DEP approved system inspector pursuant to Sec ton 15340 of Title 5(310 CMR 15.000). The system: asses ` Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 5�—a2 0 G `� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Healthvr DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approxing 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 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 109 Sheaffer Road Centerville Owner: Janet Gillis Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syst Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System onditionally Passes: One o more system components as described in the"Conditional Pass"section need to be replaced or repaired.Thies stem,upon completion of the replacement or repair,as approved by the Boa rd of Health,will pass. Answer yes,no r not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septi tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,ezhibi substantial infiltration or exfrltration or tank failure is imminent System will pass inspection if the existing tank is placed 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 a tank is less than 20 years old is available. ND explain: Obsqrvation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed liipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval o Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND a lain: e system required pumping more than 4 tires a year due to broken or obst vacd pipe(s).The system will pass ins ection if(with approval of the Board of Health): broken pipes)are replaced obstruction is removed ND explai C Page 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 109 Sheaf f er Road Centerville Owner: Janet Gillis Date of Inspection:. —�.n —0—Tg C. Further Eval ation is Required by the Board of Health: Conditions xist which require further evaluation by the Board of Health in order to determine if the system is failing to protect ublic health,safety or the environment. 1. System wi4ass 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: — Cesspooil�l or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functiot ing 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 kupply 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. P PP .Y _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The jtern has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more froul a private water supply well•• Method used to determine distance "This sjtcm passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria�nd volatile organic compounds indicates that the well is free from pollution from that facility and the pre?ence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failur criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 I Page 4 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 0 9 Sheaf f er Road —Centerville Owner: Janet Gillis Date of Inspection: r 0 D. System Failvvl riteria applicable to all systems: You must indicate' s"or"no"to each of the following for all inspections: Yes No , Backup of wage into facility or system component due to overloaded or clogged SAS or cesspool Discharge o�ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SA;or cesspool _ Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or cesspool Liquid dep in cesspool is less than 6"below invert or.available volume is less than'/2 day flow _ Required p ping more than 4 times in the last year.NOT due to clogged or obstructed pipe(s).Number of times pumped Any portio of the SAS,cesspool or privy is below high ground water elevation. Any portio of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface water supgiy. Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any porti n of a cesspool or privy is within 50 feet of a private water supply well. Any po bon of a cesspool or privy is less than 100 feet but greater than 50 f et Gom a private Katrr supply*ell with no acceptable water quality analysis. (This system passes if the well water analysis, perfo�tes ed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds Indic that the well is free.from pollution from that facility and the presence of ammonia /ar gen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria iggered.A copy of the analysis must be attached to this form.] The system fails.I have determined that one or more ofthe above failure criteria exist as ibed 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. Lar ,e 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: (Tlte 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 sy L is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone III� Y any in Section E tlu:of a public water supply well you ou have answlredes to"yes" an system is considered a significant threat,or answered Y "yes"in Section D above the large system has failed.The u%mer or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 y OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 0 9 . Sheaf f er Road Centerville Owner: Janet Gillis s Date of Inspection: $—oZ 6—o Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No I/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? V 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? V Was the site inspected for signs of break out? v — Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees.material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: 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 CRR 15.302(3)(b)j 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 109 Sheaffer Road Centerville Owner: Janet Gillis Date of inspection: 6 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x ii of bedrooms): C,l S 0 Number of current residents: Does residence have a garbage ' der(yes or no): Ld Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): v Seasonal use:(yes or no): /(,--d Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 4 29,000 Sump pump(yes or no): 2-003 — 2-4, 000 Last date of occupancy: COMMERCIAIANDUSTRIAL Type of establishment: Design flow(based on 310 MR 15.203): gpd Basis of design flow(sea /persons/sqft,etc.): Grease trap present(ye or no):_ Industrial waste holdi t1ank present(yes or no):_ Non-sanitary waste 91scharged to the Title 5 system(yes or no): Water meter readin s,if available: Last date of occup cy/use: OTHER(describe): GENERAL INFORMATION Pumping Records J { Source of information: Was system pumped as part of the inspection(yes or no): fJ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason,for pumping: TY OF SYSTEM YSeptic 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/Altcmative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all components,,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 r Page 7 of OFFICIAL INSPECTION FORM—NOT FOIL VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOIkM WART C SYSTEM INFORMATION(continued) Property Address: 109 Sheaf f er Road Centerville Owner: Janet Gillis Date of Inspection: $ P (l 'off-o•-8 S BUILDING EWER(loca(e on site plan) Depth bel w grade: Material of construction:_cast iron _40 PVC_other(explain): Distan from private water supply well or suction litre: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:J,/ocatcon site plan) Depth below grade: Material of construction:_concrete metal fiberglass_pol)•etlrylene _odrer(explain) If tank is metal list age:_ Is age confnned•by a Certificate of Compliance(yes or no):—(attach a copy of certificate) y y , Dimensions: Sludge depth: Distance Gom top of sludge'Iu bottom of outlet tee or banle: Scum thickness: /'—o- Distance from top of stun,to top of outlet ice or baffle: 1 Distance from bottom of stun,to bottom of (let tee or battle: I low were dimensions determined. 6 0,A/ 2 1 ;__f_ Comments(on pumping recon,n,endations, inlet and outlet tee or battle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):)n GREASE TRAP: ocaic on site plan) Depth below grade: Material of cons tion:_concrete_metal fiberglass_polyethylene _other (explain): — Dimensions:— z _ Scum thickncs . Distance Gon top of scum to top of outlet ice or baffle: Distance fro ,bottom of scum to bottom of outlet ice or baffle: Date of Iasi umping: Continent (on pumping recommendations,inlet and outlet ice or baffle condition,structural integrity, liquid levels as related to ouilet invert,evidence of Ieakage,etc.): 7 'agc 8 of I 1 l� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORNI PART C SYSTEM INFORMATION(continued) Property Address: 109 Sheaffer Road . Centerville Owner: _ Jan i 1 1 i G Date or Impectlon: eT iY TIGHT or HOLDING K: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construcconcrete_metal_fiberglass____polyethylene other(explairt): Dimensions: Capacity: gallons Design now: gallonstday Alarm present(yc or no): Alarm level: Alann in working order(ycs or no): Date of last pu ing: Comments(co dition of alarm and float switches,etc.): DISTIUBUTION DOa. (t f resent must be o icncd)(locate on site plan) Depth of liquid level above outlet invert: Conunents(note if box is level and distribution to outlets equal,an)-evidence of solids carryover,any evidence of leakage into or out of box,etc.): 64 I'UA1P CHAMBER: (I fate on site plan) ) Pumps in working order( cs or no): Alamis in working ordc (yes or no): — Cornmenis(note coed' ion of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 0 9 Sheaf f er Road , en ervi e Owner: Janet Gillis Date of Inspection: g"A, 0 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation'not required) If SAS not located explain why: ype // eaching pits,number: T _ ?leaching chambers,number. �2— leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic/failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must b umped as part of inspection)(locate on site plan) Na Number and configuration: Depth—top of liquid to inlet inve 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.): PRIVY: (locate on sit plan) Materials of construction Dimensions: Depth of solids: Comments(note con ttion of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 0 9 Sheaf f er Road Centerville Owner: Janet Gillis � Date of Inspection: 8' 6 l5 . SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply the building. l G$ .AL 3 103 10 Page 11 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 0 9 Sheaf f er Road Centerville Owner. Janet Gillis Date.of Inspection: r—'-U o s—, SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water d 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 ISO feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must descri�how you,cstablishcd the high ground water elevation: 11 TOWN OF BARNSTABLE -- 'LOCATION. /�d9 SEWAGE # 4n1:LAGE J MAP AP & LOT INSTALLER'S NAME&PHONE NO.�' �� �' _ �• 0� . � D) SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by PropertyAddrasc' 1U9'Sheerviafferhuau� en t e Owner. Janet Gillis i Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM , Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchtharks.Locate all wells within 100 feet.Locate where public water supplytenters the building. j l G, ('t° A B L, y E -, ,/TOWN OF BA.RNSTA-B�gLE _LOCATION 109 'NL_� ,/�'/'1=�L �( SEWAGE # VILLAGE C ca'-2, ,% ASSESSOR'S MAP&LOT 17 ®2 _ 60 INSTALLER'S NAME dt PHONE NO. /7 d Cs a SEPTIC TANK CAPACiTY���-'a LEACHING FACIL= (type) , -- 1 , � T(size)� NO.OF BEDROOMS , BUILDER OR OWNER w,h-S PERMTTDATE:,M L c�°—S'�` COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Botto eaching Facility Feet Private Water Supply Well and Leaching Faci ' (If any wells exist on site or within 200 feet of leaching fac' 'ty) ` Feet Edge of Wetland and Leaching Facility( any wetlands exist within 300 feet of leaching facility) Feet t Furnished by L1 ® ,> $50 . 00 No. m Fee THE COMMONWEALTV SSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWNRNSTABLES MASSACHUSETTS ZIppYicdtion for 3Dt-w5al & m Comaruction Vermit Application for a Permit to Construct( )Repair?�x)Upgrade( )Abandon( ) 11 Complete System ❑Individual Components Location Address or Lot No. 109 S h e a f f e r Rd. owner's Name,Address and Tel.No. 42 8—4218 Assessor's Map/ParcelCenterville Janet Gillis 109 Sheaffer Rd Centerville MA t r N e,Address,and Tel.No. Designer's Name,Address and Tel.No. . 0 nson Septic Service P 0 Box 1089, Centerville 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder PO) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand. A ( u uu 11ee1 Title 5 Leaching consisting of Naturbof�t(0 , aooncllte�ats'oriepac ea alpe'achi m 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 tie system in operation until a Certifi- cate of Compliance has been issued by this B and Health. Signe V 7 Date ^�J %3 Application Approved b � .. ,. ,.u•�•.-- /5.--i2/. �-�" _ "' - ILI 0 TOWN OF BARNSTABLE LOCATION 'Tj�f 1:!".L SEWAGE # VELLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. 7 5'--7 '? 4 SEPTIC TANK CAPACITY Ld-6-6 LEACHING FACELrrY: (type) ,;-- 5�1:4�,.r�� L C (size)o�NO.OF BEDROOMS + BUELDER OR OWNER PERMTTDATE:/d—/,3--5'�` COMPLIANCE DATE:/G _711 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Botto Leaching Facility Feet Private Water Supply Well and Leaching Faci ' (If any wells exist on site or within 200 feet of leaching fac- 'ty) Feet Edge of Wetland and Leaching Facility( any wetlands exist within 300 feet of leaching facility) Feet Furnished by No. ^' Fe$50.00 6 THE COMMONWEALT OF SSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN F ARNSTABLES MASSACHUSETTS 0[pprication for Migogal tem Construction Permit Application for a Permit to Construct( )Repair�X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 109 Sheaffer Rd Owner's Name,Address and Tel.No. 42 8—4218 Centerville Janet Gillis 109 Sheaffer Rd. Assessor'sMaaap/Parcel Centerville MA Insta�l)er'�,NO Deins onan e polC Service Designer's Name,Address and Tel.No. P 0 Box 1089, Centerville 02632 Type of Building: $ j Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder) Other - Type of Building ilk JP3s -g' Showers( Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated dail fl�v gallons. Plan Date Number of sheets R ision Date Title Size of Septic Tank Type o S,A. Description of Soil sand F' Natur?)of airs���lt at gin$ i e�fley alpfifte Title 5 Leaching consisting of 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 B and pj Health. Signe v Date Application Approved b Date Application Disapproved for the following reasons tZ gd Permit No. Date Issued is T�7 COMMONrALTH OF MASSACHUSETTS . Gillis BARNSSTABLE, MASSACHUSETTS (Certificate of (fompliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed 1( )Repaired (X Upgraded( ) Abandoned( )by at 109 Sheaffer Rd , Centerville has been constructed in accorda , e with the provisions of Title 5 and the for Disposal System Construction Permit No. AF dated/4 ,Installer `a E Robinson Septic Service Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ' Date Inspector {� \ .� ------ ----------- ---------------Fee$SO .00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Gillis iOogaf *pgtem (ton6truction Permit Permission is,hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 109 Sheaffer Rd. en ervil e installer : W E Kobinson Septic service and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thisrmit. �r°°'"' �< Date: `� '`� Approved e3'' NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) ASSESSORS MAP NO'. l PARCEL NO: I, William E. Robinson. Sr. ,hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 109 Sheaffer Road, Centerville, meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED:e5-;U' DATE Z6 '" -L/ LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). 7. t `1 t' IAp • M. R6 f a a I r- -- T.O.F. EL.= 59.4'± FINISH GRADE OVER D-BOX= 58.0'± FINISH GRADE OVER CHAMBERS= 57.6'± - 58.2'± GENERAL NOTES f PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4 TO 1-1/2 DOUBLE WASHED REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC MIN SLOPE 1% INSPECTION PORT WITH ACCESS " 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION 2 OF 1/8 TO 1/2 DOUBLE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE OUTLET TO WITHIN 6"OF F.G. BOX TO F.G. (SEE NOTE#21) WASHED STONE FI FSH RA 59.1'± F.G. OVER TANK EL. = 58,5'± r5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. - _-- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 9"MIN. TOP OF SAS= 55.23' PLACE RISERS ON DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 6"MIN. 54.40' 36"MAX. CHAMBERS" PIPED 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL • '-- - SCH. 40 PVC 4"PVC TEE 36 MAX. � INLETS TO 6' OF BREAKOUT EL = 54.90 FINISHED GRADE SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE - _ � SEWER PIPE --- ?'.�-� 3"DROP MAX - ' 0 0 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6 3 L-3 ± o 0 - 2" DROP MIN tSHALL N.SLOP®1% PROVIDE WATERTIGHT goc�o � ELEVATION = 54.90' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 13" 4"PVC IN FROM JOINTS (TYP.) 0 0 0 0 O 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF *55,5'± SEPTIC TANK 4 PVC OUT TO o ' 0 0' THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE - LEACHING FACILITY 1' oo o o 0 0 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN C) 001 ,� INLET AND OUTLET CONTRACTOR CONTRACTOR ' 12 _T- cD 0 0 0 0 o 0 0 0 0 <D 0CD 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDIOUTLET TEE 54.77 MIN. 54.60 1' o0000 0 o0 0 0 0 00 00 0 00 0 000 00 0 C>CX: 0 0 00 00� o CD 000 � o0 00 AND CONDITION OF EXISTING TEES �_ oco C o00 0 0 - o0 00 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK GAS BAFFLE 6"CRUSHED STONE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY 2.0' (TYP•) 2.0' 3.0' (TYP.) 3.0' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 6.0 3.0' AND DESIGN ENGINEER. 5 34.0' OUTLET DISTRIBUTION BOX < 471 O' 9•0, 8. ELEVATIONS BASED ON APPROXIMATE MEAN SEA LEVEL DATUM. BENCHMARK ELEVATION OF . - TO BE INSTALLED ON A LEVEL STABLE 2.40' GROUND WATER ELEV.= 59.00'ESTABLISHED ON CORNER OF A CONCRETE STEP AS SHOWN ON PLAN. �-- BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. 5'MIN. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK CROSS SECTION VIEW 5 - LC-6 CHAMBERS 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES "CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW TO THE DESIGN ENGINEER. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO 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 r ?- `0 ••• r PERC NO. 15339 APPROPRIATE AUTHORITY. NOTES: V INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED ""• 0�' 6 `=� UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR 1.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED • "' • . • EVALUATOR: Michael Pimentel, E.I.T. TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. r8nberry 1r C.S.E.APPROVAL DATE: Oct. 1999 LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. tiSOo�S?S - y a o . � 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH sr S� ` • , DATE: April 28,2017 TEST PIT DATA. �LJ, r • • __ +� • ` • �rQ/j. TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM AND UNSUITABLE MATERIAL • """" • • IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE ALL 2.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 11, GROUNDWATER MAP 172 • ` - •• /,�� • • , + ELEV TOP= 58.10' UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER PROTECTION OVERLAY DISTRICT,AND THE ESTAURINE WATERSHED AREA. .�- Q • " UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). \�- LOT 69 •*"•• • • . R'� 08 ELEV WATER= < 47.10' \ • ; + , ' "'� + *+ • •I 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN \+\ * , • , • . PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. \-�-\ 12" • » + DEPTH OF PERC= 36"-54" 16. PROPOSED PROJECT IS LOCATED WITHIN: \ II + • • ••� LOCUS TEXTURAL CLASS: 1 • • ASSESSORS MAP 172 LOT 68 114" At OWNER OF RECORD: CHUNG FAN MAH 16' \� cc,� e\ , + �" + • + •' •!r : ; 0" 58.10' ADDRESS: 75 ALSTEAD STREET + ,oJ + • , . Fill QUINCY, MA 02171 / • • + 4 12" Loamya 57.10' FEMA FLOOD ZONE X A 10Yr 3/1 COMMUNITY PANEL# 25001 C0561 J 14" 56.93' TP 2, �- \\ „ • • • 17. DEED REFERENCE: BOOK 20559, PAGE 265 58x3 g \ • . • Loamy Sand �� B " . + a'/ • . 10Yr 5/6 18. PLAN REFERENCE: P.B. 247, PG. 84 101, \r\ Illy1\ • , ZONE 2 // • • • •` 36" 55.10' a TP 1 \ � : : : Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. e.s 58x1' ` � h • 54„ ".: 53.60' N + • 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY m MAP 172 o +\�- l a + . • FOR SEPTIC SYSTEM UPGRADE. JC ENCJNEERING WILL NOT ASSUME ANY LIABILITY n LOT 68 GARAGE TWIN 20' \� % u --- ~- • »SLAB 59.3'± 5g-..., Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 15,255 = � � \+ \ � • •±S.F. \ / \+\ `- �� •' • , • + 2.5Y 616 21. A 4"PERFORATED SCH. 40 PVC PIPE SHALL BE FL-NCED IN A VERTICAL POSITION TO A C 3 �- / �% << ' • - +r+ DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A (20-30% gravel& REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. /�- cobbles) EXISTING DISTRIBUTION \ 6 1,V+� LOCUS PLAN 22• OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL „ REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. _ BOX TO BE ABANDONED 4" % /16 Benchmark (APPROX. LOCATION) 3 /- SCALE: 1"= 1000' Corner of Step / / _ 132" 47.10' - Elevation =59.00' _ o Approx. M.S.L. / / i No Standing, Weeping or Mottling Observed /-LSA- k, / BIT. �/ / /� DESIGN DATA TEST PIT DATA LEGEND - / DRIVEWAY 3 �PJ PERC NO. 15339 INSPECTOR: Donald Desmarais, R.S. 50x0' EXISTING SPOT GRADE NUMBER OF BEDROOMS (DESIGN) 3 #109 \�, / /e� / p EVALUATOR: Michael Pimentel, E.I.T. --- 50 -- . --- EXISTING CONTOUR EXISTING �'� DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E.APPROVAL DATE: Oct. 1999 3-BEDROOM TO 101, o�°' p0 3 o, TOTAL DESIGN FLOW 330 GAL/DAY DATE: April 28,2017 -L50 PROPOSED CONTOUR DWELLING 9A,o �°' ►�� - TOF = 59.4'± 'Qp+ / o / �Q DESIGN FLOW x 200 % = 660 GAUDAY TEST PIT* 2 r-5-0-1 PROPOSED SPOT GRADE FFE = 60.3'± / / 1 C-2 �� Oc � Q� J� USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 58.30' S �S (2 ❑/H/W EXISTING OVERHEAD UTILITIES J' ELEV WATER= < 47.30' S , W W-- EXISTING WATER LINE -LSA- / 3 ' a �Q' PERC RATE _ k, 1` 0 INSTALL 5 LC-6 LEACHING CHAMBERS W/ AGGREGATE GAS EXISTING GAS LINE HC- / I Cj ` DEPTH OF PERC= cgs EX. INV=55 5'+ O f 7L \ 3 SIDEWALL CAPACITY TEXTURAL CLASS: 1 TEST PIT LOCATION (LENGTH + WIDTH) (2 SIDES) (2 HIGH) (0.74 GPD/S.F.) = GAUDAY O Q EXISTING 1,000 GALLON SEPTIC TANK \ (34.0'+9.0') (2) (7) (0.74 GPD/S.F.) = 127.3 GAUDAY cgs �� / // 0" 58.30' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE � \ oo, / 22' 6 , / 3 �, BOTTOM CAPACITY MAP 172 -58C (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAL/DAY Fill ❑ PROPOSED DISTRIBUTION BOX LOT 67 9`P Q�H � � f a (34.0'x 9.0') (0.74 GPD/S.F.) = 226.4 GAL/DAY 12" 57.30' O . A 1OYamy ar 3/1 PROPOSED LC-6 LEACHING CHAMBER 14" EXISTING 1,000 GALLON SEPTIC TANK cq (1 ROPOSED I 13' 10 57. TO BE UTILIZED IN THIS DESIGN �� / INSPECTION 3 TOTALS. B Loamy Sand PORT \ •� �w / = TOTAL NUMBER OF CHAMBERS 5 10Yr 5/6 C6 `.1 0 36" 55.30' REV. DATE BY APP'D. DESCRIPTION PROPOSED DISTRIBUTION BOX '� O- i viy"v TOTAL LEACHING AREA 478.0 SQ.FT. TOTAL LEACHING CAPACITY 353.7 GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE ) PREPARED FOR: . � EXISTING SOIL ABSORPTION 5 PROPOSED 5 LC-6 LEACHING \ / SYSTEM (APPROX. LOCATION)TO BE Coarse Sand CAPEWIDE ENTERPRISES CHAMBERS w/AGGREGATE / REMOVED AS NEEDED AND 2.5Y 6/6 / REPLACED WITH CLEAN, COARSE C (20-30 o� gravel& LOCATED AT Cqf _ _SAND PER 310 CM 15.255(3) cobbles) 109 SHEAFFER ROAD SWING-TIES CENTERVILLE, MA 02632 DESCRIPTION HCA HC-2 132" 1 47.30' SCALE: 1 INCH = 10 FT. DATE: MAY 4,2017 CORNER OF STONE (1) 20.2' 35.1' g pig g ►IOF IJ��gss4 o s �o zo ao FEET No Standing, Weeping or Mottling Observed CORNER OF STONE (2) 36.4' 20.9' - -- - _._ ----- PREPARED BY: RESERVED FOR BOARD OF HEALTH USE .So JOHN L CORNER OF STONE (3) 42.0' 29.6' � CHURCCiH'LLJR. <<�� JC ENGINEERING, INC. No � E- 2854 CRANBERRY HIGHWAY CORNER OF STONE (4) 29.1' 40.9' SITE PLAN EAST WAREHAM, MA 02538 SCALE: 1"= 10' 508.273.0377 JOB No.3806 Drawn By: BJW Designed By: BJW Checked By: MCP