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0146 SHEAFFER ROAD - Health
146 SHAEFFER RID. CENTERVILLE A = I� IN UPC 12534 No.2-153LORr.�Nss` MAbTINOC UN TOWN OF BARNSTABLE LOCATION � i' i �PG"I� .�2� SEWAGE# Jpp!'. VILLAGE' ASSESSOR'S MAP&PARCEL 1 7/-- 5A' INSTALLER'S NAME&PHONE NO. 2- C.. I, • Q� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) -� '�( - (size) ��x 0�•��K�.• NO.OF BEDROOMSOWN ER e"CrUCt PERMIT DATE: COMPLIANCE DATE: : r 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 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 . s ' A- 3 a4 . 3 3 A�, 3T ' T No. �' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 6 Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliCatlon for MIStlosal 6pstem Construction i9Prmit Application for a Permit to Construct( ) Repair W) Upgrade( ) Abandon( ) ❑Complete System Vindividual Components Location Address or Lot No. 1116 Owner's Name,Address,and Tel.No. 7 7 y-� 83 a3 To CLn Assessor's Map/Parcel 01 S d" /y Ur%Pe A- 0a63�. Installer's Name,Add�ress,and Tel.yq. J'G�-7��-939� Designer's Name,Address,and Tel.No."V/g g�i� C'v ,0.-v. J3o�! vr� r/a7r 3�o (:70 Wn$ors Mills oa d Type of Building: Dwelling No.of Bedrooms 3 Lot Size 15;66 n " sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(miZou"i red) 330 gpd Design flow provided 13Y9, 33 gpd Plan Date o10/5- Number of sheets c9- Revision Date Title IiuS Ile Size of Septic Tank C x)Agrn iocd! c,Q Type of S.A.S I 7 19-193X�5 Description of Soil �p�&J/ Nature of Re airs or Alterations(Answer when applicable)V4.,UZ 07 916 5 lIM s eJ ,n "A' /� 83��C f' sblc� rem 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 lCCo t to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt ! ,.�' ed` Date Application Approved by Date 70/3 Application Disapproved b Date for the following reasons Permit No. 75 2)17 37,2- Date Issued /8l t.4- 00 No. Fee 1- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: YesVol PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plication for Disposal 6pBtem Construction permit Application fora Permit to Construct( ) Repair h( Upgrade( ) Abandon( ) ❑Complete System Individual Components a Location Address.or Lot No. 1 y6 \5h e 9 Owner's Name,Address,and Tel.No. r ,f 1 SU►14 t-r�GcYi-�- '�i bG�l�c�'�CO C��Ci'{'l Gt n Assessor'sMap/Parcel 191 �e17 rcii%/e vIA 0ae,3,--;, Installer's Name,Address,and Tel.No. Designer's Name,Addres§,and Tel.No. � AC, Type of Building: Dwelling No.of Bedrooms Lot Size `J, 666-— sq.ft. Garbage Grinder( ) Other Type of Building t No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3CO gpd Design flow provided 3��c/• 33 gpd Plan Date OLol bof s- ^� e Number of sheets C3- Revision Date -�� -- Title ; ,,//'e Size of Septic Tank >` s{.r /vOG�&& Type of S.A.S.f>)- 141e) ��lne.r� l_" ii .r, i�Q Description of Soil._ s Nature of Repairs or Alterations(Answer when applicable)`� LL�e r �(}���� ,,, f�.E �p., �;'x a7 /1/6 480�_ _j- 1 C�Gnnew F {z �,�. ) Date last inspected: 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-an'd Rt to place the system in operation until a Certificate of-- Compliance has been issued by this Board of Healt_,,r< Sig Date - �/ ��1 S Application Approved by Date Application Disapproved b Date for the following reasons Permit No.��! l7 37 Z Date Issued Zol --------------------------------------------- ----------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance j THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(J() Upgraded( ) Abandoned( )by &,-L a �n ,��}ri tC er►� , - at � (� j p� a�r ��. C�n�r;����� has been constructed in accordance v with the provisions of Tit�ley5 and the for Disposal System Construction Permit No.- ,Ig dated Installer /'���o�� Lrjn�,f[�., /nk2 :TPc Designer #bedrooms 3 Approved design flow 330 gpd The issuance of this permit shall not be construed as a guarantee that the system will e o as designed. Date d Inspector -- ----------------------------------------------------------------------------- ---- ------ -------- --------- No. Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *ystem (Construction J)Prmit Permission is hereby granted to Construct( ) Repair(X Upgrade( ) Abandon( ) System located at /�r!. 5 ,o rV f/Slui and as described in the above Application for Disposal System Construction Permit. The applicant recognized his er-du o comply with pP p Y PP g P Y Title 5 and the following local provisions or special conditions. Provided:gConstruction must be completed within three years of the date of this permi. ( Date_ I I W(T Approved by Town of Barnstable Regulatory Services a Thomas F.Geiler,Director MAIM m Public health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: IV-2-/ Sewage Permit# Assessor's Map\Parcel%7 Designer: Z-zz Az//q Installer: �hNo Y4&ze--A y Address: � /f � � Address: ��. �6�C Z1I On 9// /Z 5 /�o/6f �was issued a permit to install a (date) A /I (installer)septic septic system at �� SLg� o� based on a design drawn by L (address) dated / (designer) 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. 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_ ilt by designer to follow. tyit rdhk- my let's Si ature ul 1, (Instal gn } Ile, X t J�st� ( esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE NVML NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE B_ARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. L:HealddSeptic/Uesigm Certification Form 3-26-04.doc d� 3 Xdz4k trf / ' 1eQe4 i i Town of BAmstable. P# I`� °t Department of Regulatory Services115 ,; $ ' Public Heal�li Division Date 7/3 ssK"e'y. 200 Main Street.Hyannis MA 02601 A. UD Date Scheduled ��*= «,• 1 Time ,�`®`' Fee Pd. $oil Suitability Assessment for Sew • e 'sposa , Performed By: y �'/ `Gf 51,4aU 114 161eWitnessed By. A'J t �� i • LOCATI . NMENERALINFORMATION,�� Location Address'. /��p �GIP4 � Oe aces Name �oL(�(tY�i oa ,( / (iPG�1���✓///� ,(/'�7 Address r Assessor's Mapm4t+c& /7//7Y Engineers Name NEW CONSTRU1'ION REPAIR I Teiephone# Land Use Slopes(96) Surface Stotts -P Distances from: Open Water Body_htft Possible We�Arm _ft "�ng Water Wellft Drainage Way- ti ft. Property line ft Other ft SKETCH:($troet name,dimensions of lot,exact locations of 4t holes&perk tests,locate wetlands in proximity to holes) i /L -ZP i 10d, 0 Parent material(gedlogic) fu/4-9Gi Depth to Bedrock Depth to(iroundwabdr: Standing Water in Hole LOW Wexpin6 Aom Pit Pa1x — Estimated Seasonal;Jigh t3ronndwster Dt ON FOR SEASO"L HIGH wATEIt TA9LE Method Used: I' D th obperve d standing�in obs.hole )". aall tttottlla: Jn. `p i , Oroundwatw Adjustment ft• Depth telwzrping from side of ohs.hole iketor,.,.._�.Adj.Cmundwatcr Lsval...._. Index Well#__...,r Reading Date.: ender well it ' , ....... • PERCOLATION TEST Observation / I T1nte at 9" Hole# !/ 71me at 6" Depth of Perc ��• Start Pre-soak Time.Cd End Pro-soak ! c • t Rate MinJlnch Site SuitabilityAsscpsment: SitePas6ed_lL� Site Failed; Additional Testing Needed(Y" original:;Public Health Division Observatiod Hole Data To Be Completed on Back------- ***If percola Ion test is to be conducted within 100'of wetland,you> t first notify the Barnstable COI)servation Division at least one(1)week prior to beginning. DEEP OBSERVATION HOLE LOG' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil • Other Surface(in.) (USDA) (MUM11) Moog (Smw%SWAes,Boftls. Gravel)ennsistena Z-, 4 z s s�6,� I GUI DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munson) Mottling (Structure,Stones,Boulders. consistengX. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil 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 soil Other Surface(in.) (USDA) (Munson) Morning (Structure,Stones,Boulders. Consistency, 0MY.111 Flood Insurance Rate May: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes within 100 year flood boundary No✓ Yes Death of Naturally Occurring Pervious Material Does at least four feet of oaturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? 5 If not,what is the depth of naturally occurring pervi us material? __=,_._„ Certification // � I certify that on /11 W. (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 experience described in 3.10 CUR 15.017. /S Signature c��GiG�� '� llate �� . TP WN 9 BARNST LE ' LGC;ATION ��(S J ���Ir�ICA /l SEWAGE # f"al VILLAGE G Z1-�? I ASSESSOR'S MAP &LOT STALLER'SNAME&PHONE NO. �IN SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 2- ' S d (size) S 2 NO. OF BEDROOMS / t BUILDER OR OWNER .d.L x A / PERMITDATE: aZ8 `� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility. Feet Private Water Supply Well and Leaching Facility (If an/wells on site orwithin 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If anywetlands ' within 300 feet of leaching facility) "' Feet Furnished by 3� 1 S No. n � Fee $5 0 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS TippYication for Mi!5po!5a1 *pgtem Construction Vermit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components o do Addres o Lot No. Owner's Name,Address and Tel.No. 1 hae er Rd.. , Centerville, MA Audrey Farrand Assessor�Jap/POar�t, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E .' Robinson Septic Service PO Box 1089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) new Title-5 leach system, D-bay and 2 leach chamherg - 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 d of He th. ✓ �- Signed Date Application Approved by Date , " <g Application Disapproved for the following reasons Permit No. Date Issued�, C✓, No. I Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication,for -Mioogal *pgtem Con!5truction Vermit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components mj o�ti ddres o Lot No. Owner's Name,Address and Tel.No. hae fer Rd. , Centerville, MA Audrey Farrand Assesso r�jay/I:y4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service f PO Box 1089,,. Centerville;, MA Type of Building` Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria q Other Fixtures - , h, Design Flow gallons per day. Calculated dail flow g g P Y y gallons. Plan ,Date's Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) new Title-5 leach system, D-box and 2 leach chambers. 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 Complian�,e has been issued by this B and of He th. Q �Q N Signed Dateffj- J 7 Application Approved by Date Af- �2 g,;F Application Disapproved for the following reasons ' Permit No. Date Issued -2 r� THE COMMONWEALTH OF MASSACHUSETTS Farrand. BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired (X )Upgraded( J„ Ab d neaa b Wm. E . Robinson Septic Service at Nae-P-er Rd. , Centerville h s been constructed in accordance with the��visi li o fiTO�e 5 and Tle f�Disposal System Construction Permit No. :i dated Installer Designer Afi The issuance of this p i s 1 0 e construed as a guarantee that the _y, Vl fwne}d"n aQdesignDate Inspector No. _ —Fee $50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Farrand. Mtgpogar *pgtem Congtructton Permit Permission is hereby gl ed taCaoenstrucet� � .pair ��tLTpgrvdc: � brdon( ) System located at zi nn II II - eePr lV and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this t. Date: .g /' g;s /2 Approved by ' t 116/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. ASSESSORS MAP NO:_A 7 f PARCEL NO: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I William E . Robinson,S,rhereby certify that the application for disposal works construction permit signed by me dated "' / , concerning the property located at 14.6 Shaeffer Rd.. , Centerville , MA meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. — soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. V er are no wetlands within 100 feet of the proposed septic system • Ther are no private wells within 150 feet of the proposed septic system e in flow and/or change use e in proposed • The is no increase P . ere are no variances requested or needed. ® The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(1=4) feet above the maximum adjusted groundwater table elevation, Please complete the following: , A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation 35 +the NtAx High G.W. Adjustment . /t 3 DIFFERENCE BETWEEN A and B _L— / SIGNED : X, l DATE: [Sketch proposed plan of system on back]. q:health folder:cert r t i � 90 J _ 1 T WN 9f 13ARNSTAgLE LOCATION �� �� r/ Y /` SEWAGE # � ITVILLAGE Lf'? e ASSESSOR'S MAP &LOT 7 INSTALLER'S NAME&PHONE NO. L So SEPTIC TANK CAPACITY LEACHING FACILITY: (type) - s a �- (size) ,( S` 2 NO.OF BEDROOMS 3 BUILDER OR OWNER 4 X A '"'a PERMITDATE: �g ` g COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any/exis Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands Feet within 300 feet of leaching facility) Furnished by . II Q b � a COIMMO.NI EALTH OF MASSACHUSETTS EXECt;TIVE OFFICE OF E;�'VIRO�ME11\ AFF_�IR� DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTOI\ bLA 0210E i61', 292.550u 'c44 TRUDY COXF. Secretary ARGEO PAUL CELLUCCI DAVID B STRI'HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION , Prop"Address: 146 Shaeffer Rd.. Nameofow Aud.re,y Farrand. Centerville , MA Address of Owner: " a Date of Inspection: -9 Name of Inspector:(Please Print)Wm. E . Robinson Sr. I am a DEP approved system!inspector rsuant to Section 15.340 of Title 5(310 CMR 15.000) Co„panyName: Wm. E . Robinson eptic Service Mailing Address: PO Box 1089, Centerville . MA Telephone Number: 7�,�8 7 (� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site seage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluati By the Local Approving Authority _ Fails Inspector's Signature: _ .[�=�b_ Date: 7 The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent-to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS r �d1 a \ �1 C p 8 199g .� TOWII of B01114 " rtir H�11H DFP1. 1 �\ revised 9/2/98 Page Iof11 0.0 0—led on Recydrd Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM } PART A CERTIFICATION Icon tined) 1 "ropertyAddress: 146bShaeffer Rd.. , Centerville , MA ,)wrier: Audrey F•arrand. Date of Inspection: INSPECTION SUMMARY: Check 0 C, o/.D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. YSTEM CONDITIONALLY PASSES: a 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. Indicate y s, no,or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked;structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed , distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed l � r O y` revised 9/2/98 Page 2of11 I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION fcontinued) Property Address: 14.6 Shaeffer Rd.. Centerville Owner: Audrey Farrand. Date of Inspection: / g g Qj C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require-further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. I SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 41)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY'AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is'within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but"56 feet or more from a private water supply well, unless a well water analysis for col iform bacteria and volatile organic compounds indicIat. that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART A CERTIFICATION (continued) P►opertyAddress: 14.6 Shaeffer Rd.. , Centerville Owner: Audrey Farrand. Date of Inspection: �9 r D. SYSTEM FAILS: /_ You mu indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes o Backup of sewage into facility or system component due to an overloaded orclogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARG SYSTEM FAILS: You must i dicate either "Yes" or "No" to each of the following: T e following criteria apply to large systems in addition to the criteria above: T e system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public h alth and safety and the environment because one or more of the following conditions exist: Yes o the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well) The ow er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of Department for further information. revised 9/2/98 Page-4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Address: 146 Shaeffer Rd.. , Centerville owner: Audrey Farrand. Date of Inspection: 9or- � Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Y / No v _ Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection: t " _ As built plans have been obtained and examined. Note if they are not available with N/A. ✓ _ The facility or dwelling was inspected for signs of sewage back-up. J[ _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)I - _ The facility owner (and occupants;if different from owner) were provided with information on the proper maintenanc4"f SubSurface Disposal Systems. revised 9/2/98 Page 5ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 'rop"Address: 146 Shaeffer Rd.. , Centerville Owner: Audrey Farrand. t Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 4110 g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms (actual) Total DESIGN flow C//o Number of current residents: Garbage grinder lyes or no):_id Laundry(separate system) (yes or no),46 If yes, separate.inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):_A.0 1998 151 , 000 gal. Water meter readings, if available (last two year's usage(gpo): Sump Pump(yes or no):,&& 1997 104, 000 gal. Last date of occupancy: ��� COMMERCIAL/INDUSTRIAL: Type of stablishment: Design fl w: qpd ( Based on 15.203) Basis of sign flow Grease tr present: lyes or no)_ Industrial aste Holding Tank present: (yes or no)_ Non-sanit ry waste discharged to the Title 5 system: lyes or no)_ Water me r readings,if available: Last date f occupancy: OTHER: escribe) Last d cupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 9, System pumped as part of inspection: (yes or no) A— lf yes, volume pumped: gallons Reason for pumping: TYPED SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed lif known)and source of information: )<L-Y 10.0 Lt Z W 0` q / Sewage odors detected when arriving at the site: (yes or no)/, C/ revised 9/2/98 Page 6of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) 'ropeityAddress: 14.6 Shaeffer Rd..., Centerville ° OM►ner: Audrey Farrand. Date of Inspection: Sul ING SEWER: (Loca on site plan) Depth elow grade:_ Materi of construction:_cast iron_40 PVC_other(explain) Distan a from private water supply well or suction line Diam er Com ents: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Depth below grader � � Material of construction:d✓concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: (.� ``t D 4 Sludge depth:_ + + Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: d I Distance from top of scum to top of outlet tee or baffle:_ + I Distance from bottom of scum to bottom f outlet tee or baffle:J'6f How dimensions were determined: d AnA- Z 'omments: (recommendation for pumping, ondition of inlet and outlet tees or baffl s, depth f liquid le I in relation to outlet in ert, structural integrity, V y evidence of leakage,ytc.l GREAQE TRAP: (locate site plan) Depth bel w grade:_ Material construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensio s: Scum thi kness: Distance rom top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of st pumping: Comm ts: (reco endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evide ce of leakage,etc.) revised 9/2/98 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) -ropertyAddress: 14.6 Shaeffer Rd.. , Centerville Owner: Audrey Farrand. Date of Inspection: �� 6 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (loca on site plan) Depth low grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensi ns: Capacit gallons Design ow: gallons/day Alarm esent Alarm I vel: Alarm in working order: Yes_ No_ Date previous pumping: Com ents: (con ition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:V (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, eviden�pe of s lids carry ver, vid icAof leakage into or out of box, etc.) - � ��� 7 PUMP CH MBER:_ (locate on ite plan) Pumps in w rking order: (Yes or No) Alarms in rking order(Yes or No) Comments: (note condi ion of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C a SYSTEM INFORMATION(continued) 'rop"Address: 146 Shaeffer Rd.. , Centerville Owner: Audrey Farrand. Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): V (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number:-2--- leaching galleries, number:_ leaching trenches,number, length: leaching-fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, co di ion of vegetation, etc.) r. rs CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: ,. Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) • Commen s: (note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on ite plan) Materials f construction: Dimensions: Depth of olids: Commen s: (note c dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revise^ 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM k„ PART C SYSTEM INFORMATION Icontirwed) '►opertrAdares5: 146 Shaeffer Rd.. , Centerville 'weer: Audrey Farrand. Jate of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public.water supply comes into house) lie Cj . v 6 A ��V revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C t SYSTEM INFORMATION Icorronued) rowlyAddmss: 146 Shaeffer Rd.. , Centerville owner: of p"drey' Farrand. Date Ins on: -)' - NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells ' Estimated Depth to Groundwater /5��Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from.local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you7established the High Groundwater Elevation. (Must be completed) revised 9/2/98 Page 11ofIII APPLICATION FOR PERCOLATTION TEST AND OBSERVATION PITS LOCATION Lod \a.q �V1eG e� d► . _ NO. VILLAGE Cen e-,(V DATE /- APPLICANT a_g0. ,-. Cfo"8e`[ /Dj-(o FEE �as,on ADDRESS 1C)Y �laa- ` (Non-refundable) GQ1��r�vt�`� TELEPHONE N0. a� $_'115�1 ENGINEER TELEP!!:E:* NO.LAaT-0j 3k DATE SCHEDULED (Applicant' s signature • • • • • o 0 0 0 0 0 0 • o • o 0 0 0 0 • o e • • • • e e e • o o • • • • • • • o • • • • • • • e • • • • o • . . . • • • • e • o • o . . . . • • o • • • • • • SOIL LOG SUB-DIVISION NAME Y DATE ��r TIME EXPANSION AREA: YES i,-IN0� '�/y- ENGINEER TOWN WATER_4,:::�fRIVATE WELL ,�;' ����© f BOARD OF HEALTH EXCAVATOR SKETCH: (Street name,etce ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES : _ Y o PERCOLATION RATE: TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 2 `�'�S 2 4 �`� 4 8 8 9 C- 9 z , 10 10 12 12 13 � 13 14 14 15 15 16 16 SUITABLE FOR SUB—SURFACE SEWAGE: LEACHING FIELD ,/LEACHING PITSc/� LEACHING TREN:CHES_L._� UNSUITABLE FOR SUB—SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT LOCATION.' SEWAGE PERMIT NO. 4-6 j:tcl VILLAGE INSTALLER'S NAME i ADDRESS BUILDER OR WNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED t � /l t II s Fss .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD �OF HEALTH - ..........L...T�✓!'�.........OF....... . ........ Appliration for UhipvDal Workii Tomitrnrtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Ae ation Address or Lot No. \ s.Q . e-�.....................•..................._...... ...�.�1C...'�� ..s.?. ... �—.......................... Ow Address �N!`_... .............................. ........................... ........----......................•........ Installer Address Type of Building Size Lot......iI}OQ.d.........Sq. feet Dwelling—No. of Bedrooms..............._.._....____.._....__..._Expansion Attic (CVP Garbage Grinder (ACp p`4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures --------------------------------- . W Design Flow..........._�X.?......................gallons per person per day. Total daily flow__-_.__--_:3 ...................gallons. WSeptic Tank—Liquid capacity100.o gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.. lA. . A...�'.. `! --................... Date......-ti l.�I._�?�i.......•.._.. a Test Pit No. L.�-----_-_-minutes per inch Depth of, Test Pit.................... Depth to ground water..................... G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ l •• -------------------- --------------•--•--------------------------------•---- -- r ------•- -...... ----•-. 0 a O Description of Soil.. -- __2... ••-`••• .----� � .---- --•-• L�°tl!i'1�P ` V ----------------------•-----------•-----------•--•-------------------.-•---..-------------------...--------------..---------.-.----•---------------•-----------------•----•------------•-..... W VNature of Repairs or Alterations—Answer when applicable...............................................................................................:: Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be is,�,sunned, b the and of he lth. Si r� ••-••-�( -•-•---•----•-- Date ApplicationApproved By................' .. .......................................................................... Date Application Disapproved for th f of wing reasons:................................................................................................................. ---•--•-----•-••-•--•--......-•-•--------••.............•---•-------•-•---••---•--------•------........--•----•------..............-------•-•--------•-----------••--•-----••----•--••......---••-.----- Date PermitNo......................................................... Issued........................................................ Date --- -------------------------- _: 0............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ----------0 F..... .. ...................................................... A;iVfirafion for' llhivoiial Workii Ton ivation Vamit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 3. ............ ..V_. ....... .........................................................I...... ......... .... 01.... . ..... Address or Lot No. J> ............................................................ .......... .......................... . . ...................... Owne ...... cow, .............................. ............................................Address...................................................... Installer Address Type of Building Size Lot..... ........ Sq. feet U Dwelling—No. of Bedrooms................3........................Expansion Attic ((\C;> Garbage Grinder 69) aOther—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ....................................................................................................................................................... Design Flow............\X.0......................gallons per person per day.- Total daily flow...........:339...................gallons. 04 Septic Tank—Liquid capacityXgq®.gallons Length................ Width................ Diameter----............ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No-------:.............. Diameter--.---_---.-----.- Depth below inlet.................... Total leaching area..........-------sq. f t. Z, Other Distribution box Dosing tank . 1.4 Percolation Test Results Performed by.....12-434 . .....k 1)-�X-—----_-------------- Date......... ......... 04 Test Pit No. L. 1-� - I---------minutes per inch Depth of Test Pit.................... Depth to ground water.....................I..., 4q Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water........................ ....... f........................ $I...........0............... ....... ------ 0 ------------ ------- ��Description of Soil----41 ----- .......6........I....................... .....................------------*-------------------------------------------------*--------------------------------------------*-------- ------------ ------------------------------------------. ---------------------------*------------------ -----------------------------*--------*........"----------------------------------------*.............................***..........-------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees.to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of T IT 11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of.Compliance has be issued b2te and of h9lth. S1 ..... ............................................. .... 7 .... Date ApplicationApproved By.................1:e..................................................................... ....................................... Date Application Disapproved for the Ifol 1wing reasons:............................................................................................................... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7.............T03vJ.Jn............OF...... '** **'*"*.............................Tatifiratr of TontV1fttttrr THISS TO,.CERTIFY, That the Individual Sewage Disposal System constructed t-�'or Repaired by.. .........t,'P. .n ........................................................................................................................ Installr V. at------... ......V�.Ck......� R.-4. ..........I. ......I......eA'............% ............. --- ------- ------------- of TYFF has been installed in accordance with the provisions ryCode/ 'e.,f The State Sanita jl�p in the application for Disposal Works Construction Permit No....................?`_ ................... date( ..... .. r ................. THE ISSU MFE OF THIS CERTIFICATE SHALL NOT BE CONSTR SYSTEMW11 $QNCTION SATISFACTORY. "��PD AS A GUARANTEE THAT THE DATE....... .... ................................................................ Inspector . . __�/-------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '�a( r\4:k...........VZ. ......... ..........�OF........... .. .. .. ............................. N 1Z................. Jb FEE........................ Nork Tonotrurtion frrutit Permission is hereby granted............. EZ C%'%k C V C. \-�� z''A*....*--------...................... ...... ....... -----------------*...............*------------ I XSU N E WI N to Construct or Repair an Individual Sewag Disposal System------k -('\ atNo....... ....... .......... W. V 'S-- -------- -- ---------------------------------------------- Street -! as shown on the application for Disposal Works Construction Permit-No..................... Dated.......--...........--....._._............ ......................................................................................................... Board of Health DATE...................................... .................. FORM 1255 A. M. SULKIN, INC., BOSTON �j►t,.I(,Lai FAMILY - 5 BG.DRooM j ►,1D GA�iBAGE (SGUWDFs2 .Sh/LCQ� /`. /��• i _ _ 10n•►�.�( F1-oW 110 x 3 a Z30 G•P0, fq.3 5EPTIG. TARJW. I USE 100o GAL.. � '" Icy 0%,5posAL. Prr v4E 6Y' /o c54A.346,E cSe%�/T�F•E �•r a ?' I 4 � S/a1�'K��4G L A C5.4 =166 �/B8 S•� X Z<L� — 37w �.p, D. E.1�iST. �n� � Q A9 ,S. .r O.B3 = G f G..�!�. O /9 f a7 /z9 __ �— OF oz WILLIAM ALANC. yc •S� o W. N Y E �+ ' m -91 '9 w % Cl O S No. 19334 r -5100 O ' NO SURVF" v` a A To P FWU s S�• 6 �� 5�� INv. z- Tpqw�T looms INv. t> P► T. 517. � .3 • (000 IN�l, y7� To.NK n s i�f✓'C-- P I"r I N V. INV. WITH y7.y y� I ► ' WALKED � .. II � 6'ru N 6 CEQTIFIG0 PLOT PI- j .6:? �7 Z jj ,s/o PR,UFIL� L o L 4'T 10 N t4 O� 5 GALE `j GALE II Pt-•AN R�FE2GNGE �( 1 CE 9'rIFY THAT 'f Nis EXISrtNG FNDS>{cWN ° N6.RGON GGMPti-`(5 Y41TN"rH66 �,Io6.1.1NC-. i� AWP - E.T2AGK R.6Q�IREMEN7� oF 'fN� -To W N oF:: O AND ►s V.loT-- L.OGfsT D WITHI►,I T1d6 F1.Oo LAIN �s D�TG BA}CTEQ.e N`(E INC. IREG I SZ E.Q6'D 1..AW o•5 u 2,v II a A N C>5TEE2•VILLE• - `�s• �! 'Tins Pl.o1.1 I � NorT C3n5C�p v �j IuS-t-R•uM6NT Svev15�`( 'THE p1:FSE"r5 Stlou►,D No�T D� 'VSEOTO `Z/�\INE LoT ►. I►-1EJ APPLICA►'—JT p,4Lj!E-: c= aGvr ASSESSOR'S MAP: 171 101.42 GENERAL NOTES: PARCEL: 54 REFERENCE: PL. BK. 247 PG. 84 1. VERTICAL DATUM: __Assumed_________ NOTE: Contractor to confirm 2. MUNICIPAL WATER IS AVAILABLE. FLOOD ZONE: X Town of Barnstable 101.33 x 102,20 soils below leach facility and 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT #25001 C0561 J (07/16/14) ` remove any contaminate soils SYSTEM UNLESS OTHERWISE NOTED. O ' .48 and old leach components 4. ALL PRECAST UNITS TO CONFORM TO Q' �� o 2 prior Ito construction of new AASHTO: O ,�4 ej �0 Te �� leach, facility. 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE 0 101.2R 101.90 - �° WITH MA ENVIR. CODE (TITLE 5) AND LOCAL 00 F, �- 01.4 _ �,N REGULATIONS. OO 0 �. o°°°�°` 27-� ��°,� x 102:61 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES a - /�� o° ® .61 PRIOR TO CONSTRUCTION. r` " o �, 0`' oo TH-1 14 Benchmark set: LEGEND: N ao' Q //o ° . TH-2 Left cor. slate step EL.= 103.76 (Assumed) �-- ss ---f- PROPOSED CONTOUR m ` 101:01 �� x 102,71 1 "` o �' 9s PROPOSED SPOT GRADE ' ��`a' P I 3 IC ELEV: 102?' OQJ,� — 40 — EXISTING CONTOUR 101, 4 O �, . ... . .. _... . 102,43 S 0 X 30.23 EXISTING SPOT GRADE O c� `` O O. W EE::°>, � o MAG SET f 1 ' \ 00' F TEST PIT 101.04 .01. 1 29'\ \ ® EXISTING WATER SERVICE 100,85 1 2,82-0 \ o X o WORK LIMIT LINE 1:39 0 :.Paved ..:..i.,,; : ._ 100:89 ❑ �``.::Drive.. ': '. ?..::`. '.:.. y Deck \� Lot 129 `� pF Mgff9�y �F ,ygffq�y OL. .. :: .,.. ,_,. ,. �� #146 r z AMY L. G TERRY G 01,34 102:96 �cv 15,000± S.F. a o 102:46. TOF=103.37 VON HONE r ANN ❑HW\ 0.3t Ac. ti ti (.Assumed) \ o �" � WARNER 102.85:: : No. 1068 No. 38721 \ Garage i, \ Map 171 101.57IST \ Parcel 54G� E CB SEAL FND T 103,02 x 102:2A / NOTE: Existing Failed Leach Chombee��ros be removed including any contamihc�t' _ \ soils around and below system. 1 3.15 102.54 \Contractor must verify soil removal NOTE: This plan is to be used for septic system purposes only and is not to be Deck \ below proposed .leach facility is original � \ x 101.91 s considered a property line survey. pit. and not remnants of a prior leach �S �`SO 102:79 �) OQ , 00, oti oid Sto �00•1 x % 02ogo 1 146 SHEAFFER ROAD a OCUS e ROad 102:65 Pool 102:80 o o�� V H CEN TER VI LLE, MA o 14 o Shie A°' associates PREPARED Dr O C9 FOR: Jonathan & Barbara sEPnc SYSTEM DESIGN � a i 102,591 101,88 ult Road Stockman OO S ndwic 320 htMA 02563 O V O 102:77 508.833.0041 146 S h e a f f r F c e Road Centerville, MA 02632 O U 3 Surveying ying b Terry A. Warner.P.L.S. O O 22 Long Road his 2 if Norwich.t Norwich. MA 02645 DATE REVISED SCALE SHEET NO. LOCUS MAP N.T.S. (51018) 432-&Mg 09/01/2015 1» = 20' 1 of 2 h k► i Provide Riser over D-box NOTE: All components to be marked with NOTE: To prevent breakout, final T.O.F. (Full) to within 6" of final gradeil magnetic tape or similar prior to final cover. grade of EL. 99.0 to be carried EL. 103.37 (Cover to be watertight) out a minimum 15' beyond edge F.G. EL: 102.3-102.9t F.G. EL: 102.8 F.G. EL: 102.8 Maintain Min. 2� slope over leach facility to of leach facility. Existin . . Prevent ondin F.G. EL: 102.8 Install risers w/covers over inlet andMin. 2" of 1/8" - 3/4" Washed Stone or Inspection Port within 6" to grade outlet to within 6" of final grade "e* Geotextile Fabric ; EL. 101.07 L=15' (Access Covers min. 20" diam. per Code) r. �• 4" SCH T L=5 L=10' 3/4 - 1 1/2 Double Washed Stone4" SCH 40 PVC4" SCH 40 PVCTop of Peastone or Geotextile Fabric EL. 99.9 ®S=9.5% ta• CAS=3.8%(19 6 aaa 24" Eff. De th CADS=1.3� 0.5%�AIN PEL. 99.39Rnttnm aaaaaaBnstall Gas Baffle EL. 99.2EL. 99.03 969 EL. 99.6 PROPOSED DB-3 EL. 98.9 Use 2 - 500 Gallon Precast Chambers H-20 DISTRIBUTION BOX (H-10) with Double Washed Stone 519' (Install PVC Inlet & Outlet Tees) Watertest for levelness t 4' Ends, x ' Side x 2') EXISTING 1000 GALLON if more than one SEPTIC SYSTEM PROFILE ( outlet E . 91.71 H-10 SEPTIC TANK N.T.S. Bottom of TH-1 & 2 SOIL LOG ADDITIONAL NOTES DESIGN CRITERIA 1. Contractor to confirm soil suitability prior to installation. Contact BOH Number of Bedrooms: 3 Bedrooms SOIL EVALUATOR:, AMY VON HONE, R.S. S.E. #2517 and Design Sanitarian in the event of varying soils from original soil INSPECTOR: DAVID STANTON, R.S., BOH test. Design Sanitarian to certify soils at time of installation. Soil Type: DATE: SEPTEMBER 1, 2015 10:00 AM YP Class I (Cl Horizon) � Percolation Rate: <2 min/Inch PERCOLATION RATE:<2 MIN/INCH IN C1 2. Pump and remove Failed Leach Trench. Any contaminated materials PERMIT #: 14797 within 5' of proposed Leach Facility to be removed including unsuitable Daily Flow: 110 G.P.D./Bedrm x 3 =330 G.P.D. soils below Leach Facility. Replace with clean fill per Title 5 Design Flow: 330 G.P.D. (Min. Required) TH - 1 TH - 2 specifications. Contractor must confirm all unsuitable soil, including old EL. 102.71 EL. 102.71 leach facility is removed below new ,,leach facility. Garbage Grinder: Not Allowed 18" Fill 101.21 24" Fill 101.71 3. Water line to be sleeved at any sewerline crossings and within 10' of Leaching Area (330)/0.74 = 445.94 S.F. any septic components, as needed, per Water Department requirements. Required: Sandy Loam Sandy Loam Contractor to verify location of water line prior to construction. 1oYR2/2 1oYR2/3 Septic Tank Required: 330 G.P.D. x 200% = 660 G.P.D 22" 100.88 28" 100.38 4. Distribution Box to be placed on 6" crushed stone or compacted, level Minimum 1000 Gallon (Existing) Loa y Sand Loamy Sand base. Use 2 - 500 Gallon Precast Chambers with Double 36" 10YR5/8 99.71 38" 10YR5/8 gg 71 ' Washed Stone: 25' x 12.83' x 2' C1 C1 Coarse Sand Coarse Sand 2(25' + 12.83')2= 151.32 S.F. 2.5Y6/4 2.5Y6/4 FLOOR PLAN Sidewal l Area: I Bottom Area: 25' x 12.83'= 320.75 S.F. Perc Family 472.07 S.F. N.T.S. Total Area: 54" B ttom Room Desi n Flow Provided: 0.74 472.07 .F. = 349.33 G.P.D. 10% Gravel 10% Gravel 146 SHEAFFER ROAD Bed 1 0� o k Ghee �130'(-�d< V H CEN TER VI LLE, MA Clos. m K� PREPARED associates FOR: Jonathan & Barbara 132" 91.71 132" 91.71 SEPTIC SYSTEM oEscivs No Groundwater Observed No Groundwater Observed Bed Bed 3 �n�ng 320 Cotuit Rood Stockman D ' PERC RATE: <2 MIN/IN. ( C1 Horizon) <7" 011:29 minutes 2 1 Garage Sandwich, MA 02563508.833.0041 146 Sheaffer Road I, Amy L. von Hone, R.S., hereby certify that I am currently approved by ! S,,,,,eyiny by. Centerville, MA 02632 the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and Terry A. Warner.P.L.S. that the above analysis has been performed by me consistent with the 1 St Floor 22 Long Road requirements of 310 CMR 15.017. 1 further certify that I have Harwich, Aa 02645 DATE REVISED SCALE SHEET N0. successfully passed the Soil Evaluator's Exam on November, 1994. «1 432-8" 01 " =09/ /2015 1 20' 2 of 2