HomeMy WebLinkAbout0401 SHOOTFLYING HILL RD - Health (3) 401 SHOOTFLYING HILL, CENTERVII
A= 214 005
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COMMONWEALT14 ®f MASSAC14US ETTS
IBoard of Health, 9�srt-5�-R6 U , MA.
A ICATI®N FOR DISP®SAI SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) - QeComplete System ❑Individual Components
Location Ao Owner's Nam q.
Map/Parcel# .-ZI AC —00 -12;/VW14Qddress 9,0 Qa_X 2t MA
Lot# Telephone#
Installer's Name {fe'29'�!1 �" Designer's Name CL `
Address 7/ (�.� �l Address IZw.C�3SSttC d�e � r
Telephone# Telephone# ,7
7
' l 3 O��t
Type of Building 1�3'��a�1c`l c�:�� �0.� 't-� Lot Size 4 C j 7' sq.ft.
Dwelling-No.of Bedrooms A- Garbage grinder (
Other-Type of Building /y/4 No.of persons Showers ( ),Cafeteria ( )
Other Fixtures ��I&
AA
Design Flow (min.required) ` 1+0 gpd Calculated design flow er Design flow provided gpd
Plan: Date It I i a I-®q Number of sheets Z— Revision Date
Title Tti5,jS a-� � J'
Description of Soil(s) -TIP-I Z_ P 1l
r
Soil Evaluator Form No. Name of Soil Evaluator of Evaluation J4,1. L
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to installp5Ove described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees t "placetem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date `� -P�- p
44
.�tel
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f No. FEEWO
Board of Health,, ri� 5 NIA.
'APPLICATION FOP, DISPOSAL. SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Constrc_tO Repalr( .). Upgrade Abandon( ): 3'Complete System ❑Individual Components
L ocation s�Ci� Owner's Nam!:. Ol 1 ct
Map%Parcel# Address (' MA
Lot# ,.,,.. .- Telephone#; ��" �j l r3 � 0 7�3
Installer's Name f, ..:>k44fr� f_ Designer'slVame ! �A n
Address. A ff ..Ad'dress t^7W.(I— flap
Telephone# S�d. x'f le 9:11 Telephone# � ^�^�� 1 � �� 0�' �
Type of Building 3` n l :� --- .;.r.s tt . �.�. Lot Size -4 t , UO Sq.ft.
Dwelling-No.of Bedrooms Garbage grinder.(,)
l
Other-Type of Building '/y//� No,of persons Showers ( ),Cafeteria.( )'
Other Fixtures
Design Flow (min.required) 4� gpd Calculated design flow �i Tom-'. Design flow provided�gpd
Plan: bate It1 t q Q`l Number of sheens —Z••- ,rRevision Date
Title op� �G �'c S �-te , v� 1 40 l 4 i�i.� nc W, r P
Description of Soil(s) d"" I e r �`.1 �t 6,
Soil Evaluator Form No Name of Soil Evaluator PO � „cC .Date of Evaluation ,I)h,c—d�T—
•,
DESCRIPTION OF REPAIRS OR ALTERATIONS G•%L A(j�. P�(. s� � C-e�f 4 cG I S
The undersigned'agrees to install tle'above described Individual Sewage Disposal System,in accordance with the provisions of TITLE 5 and
further'a agrees told ./,�.�`
gr l��o place the tern m operation until a:Certificate of Compliance has been issued by the Board of Health-..
Signed//"W/� � Date �.7; �" a f
Ax/f 4P A�/9�7,
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No. r Ul
FEE_ I
/• COMMONWEALTH:OF M SSACHUSETTS
Board of Health, �f fL 5A 100 t4 NIA.
CERTIFICATE OF COMPLIANCE
Descmption of Work: 0 Individual.Component(s) Complete System
The undersigned hereby certify that the Sewage Disposal.Syste,m; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned (
/ . ,
has.been install• accq a 'e'emith the p o 's^� of 3110 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
-application No. dated V / & Approved Design Flow (gpd)
Installer n� 'i`5I �r--
Designer: /hr fir, . � 0 In spec or: Date: �/��t a�'`X �
'The issuance of this permit shall not be construed asa guarantee that the system will function as designed. '
OP
No.. .✓L! FEE
ICOMMONWEALTH Of MASSAC14USETTS
Board'of Health, s +c w�-e M.
DISPOSAL SYSTEM.CONSTRUCTION PERMIT. ;
Permission is herebyyV /granted o('fCo�n/sttrf{u�ct ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
V/
at I 1 I`��+ f"i�Y / 'r r �'��/`�V�� s described in the application for
Disposal System Construction Permit NOA00> dated
Provided: Construction shall be completed wit in three years of the date of t i�pe rn u cal co ditions must be met.
Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
f Public Health Division
Thomas McKean,Director
200 Main Street, Hyena,MA 02601,01-�
Pox: 508-790-6304
Office: 508-962-4644 sl �0 5,
Date: tt 2j 0� Sewage Permit# Asgeasor'sp/Parcel J
Installer&D"iveer Certiftation Form
Designer. �;,���rnti c.�vY�v �n C • installer:
Address: Cre,s S;.o-1 M 9A Address:
7-6yy 54W-1dw-*C,L7 M� pZSG3
on �A ap,n ►S was issued a permit to install a
(date) (m/staller
septic system at q o 1 S I 1 �� based on a design drawn by
( s)
ea-e�`T;M Lf„nt-eye ' E . dated 1 t 1 aLo
eshgnet i
I ceRify that the septic system referenced above was installed substantially according to
si which may include minor approved changes such as lateral relocation ofthe the
distribution box and/or septic tank. Stripout (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.
gmew 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. Stripout(if required) was inspected and the soils
' wort found satisfacttH 0`U46,
PETER T.
Si WEN TEE
er s H
CIVIL
No.36109
' IX D
gn ier's Signature (a
TO PA
STWqprrun
w9m N A
gAaf m fo,y weion fbrm.doe
TO 3!DVd S>IaOM 9NIa33NI9N3 6IESLLb86S 8b:ET 600Z/SZ/TT
4' / TOWN OF BARNSTABLE
L �/
OCATION ! �/ 19 /eQ� 1;�S SEWAGE
VILLAGE C(�✓1 t� CC;L ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 93 191,4r,?4#C (size)
NO.OF BEDROOMS L
OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance etween 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 facili Feet
FURNISHED BY ; 5 •
s �v
IN
i C 4,07
��
Town of Barnstable r# �
Department.of Regulatory Services
Public Health Division Hate ..
.b,JS&y. 200 Main Street,Hyannis.MA 02601 T
-Date Scheduled Time lQ Fee Pd.
Soil Suitability Assessment for Sewage isposal
Performed By: 1 �'� t "� � Witnessed By: ✓ �5
LOCATION& GENERA'L INFORMATION.
Location Address /1('�l Owner's Name �7,� ,,,, a� I J Ilk .1
Address
Assessor's Map/Parcel: 0 Q S Engineer's Name
NEW CONSTRUCTION REPAIR Telephone# Q 7 3-7 —4.7 C—e
land Use V41 Slopes(%) :2- Surface Stones
Distances from: Open Water Body � ft Possible Wet Area?(f U ft Drinking Water Weil t ft
Drainage Way 7 ft Property Linft Other
SKETCH:(Street name,dimensions of lot,exact locations of test holes&.pert tests,locate wetlands fn proximity to holes)
Parent material(geologic) y'` U`S Depth to Bedrock �/ l '3 Z
Depth to Groundwater. Standing Water,in Hole: i / Weeping from Pit Face
Estimated Seasonal High Groundwater �2
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In. Depth to sell mottles: In.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft•
Index Well.# Reading Date: Index Well level e-.,, Adj factors,q„a Adj.flroun&itu r Level
PERCOLATION TEST Date Thne
Observation
Hole# Time at 9"
Depth of Pere Z A �LOy�s Time at 6"
Start Pre-soak Time 'Time(9"-6")
End Pre-soak �` M
Rate MinJlneh, L' 2
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back----------
***If percolation test is to be.conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:XS EPTICIPERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole
Depth from Soil Horizon Soil Texture Soil Color. Soil . Other
Surface(in.) (USDA) (Munsell Mottling '(Structure;Stones;Boulders.
Gravel)
I C s ZA
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other`
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders.Consistency. Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other .
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones.Boulders.
Flood.tnsurance Rate.Mae:
Above'S00' ear..ood boundary No_ Yes ,
Y
Within`500year°boundary No Yes
Within 100 year flood boundary No Yes
Depth of`Natura By.Occurring Pervious Material
Does at`least four feet,of naturally occurring pervious matet iai exist in all areas observed throughout:.the
area proposed for the soil absorption system? _—
If not,.what is the depth of naturally occurring pervious material?
Certification
I certify that on l l C (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 tr ,expertise and experience described in 310 CMR 15.017.
j
Signature Date 1 $ b
Q\S.EpnC\pERCFORM.DOC
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• � COMMONWEALTH OF MASSACHUSETTS
y EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS '
r DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON. MA 02108 61 292-5500
- 2
WILLIAM F.WELD TRUD C E
Govcmor 350 MAIN STREET A /Q Se t
ARGEO PAUL CELLUCCI ilk WEST YARMOUTH, MA `r 'Y/�� �D STR
Lt.Governor 508-775-2800 ommissio
SUBSURFACE SEWAGE DISPOSAL YSTEM INSPECTION FOR
ART AM �Q,T"oF"T'qs�998 cr►
CERTIFICATION
MAP 214 PAR 005 _
PROPERTY ADDRESS: 401 Shootflying Hill Road, Centerville.' ADDRESS OF OWNER: 1 _I
DATE OF INSPECTION: March 4, 1998 Harvard Realty
NAME OF INSPECTOR : James D. Sears
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000)
COMPANY NAME: A&B Canco
MAILING ADDRESS: 350 Main Street, West Yarmouth, MA 02673
TELEPHONE NUMBER: (508)775-2800
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,
accurate and complete as of the time of inspection. The Inspection was performed based on my training and experience in the proper
function and maintenance of on-site sewage disposal systems. The system:
X PASSES
CONDITIONALLY PASSES
NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
FAILS
INSPECTORS SIGNATURE: J DATE: March 11, 1998
The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall
submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria as
defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B SYSTEM CONDITIONALLY PASSES:
N/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 b the Board of Health,
will pass.
Indicate yes, no, or not determined (Y, N, or NO). 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 is failure is imminent. The
system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
Page 1 of 10
(revised 04/25/97)
DEP on the World Wide Web:hftp://www.magnet.state.ma.un/d
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (CONTINUED)
Property Address: 401 Shootflying Hill Road, Centerville
Owner: Harvard Realty
Date of Inspection: March 3, 1998
B]SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to
broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will
pass inspection if(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed
pipe(s). The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A
MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system(SAS)and the SAS is within
100 feet to a surface water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone
1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet
of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100
feet but 50 feet or more from a private water supply well, unless a well water analysis
for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate
nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine
distance (approximation not valid).
3) OTHER
(revised 04/25/97)
Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 401 Shootflying Hill Road, Centerville
Owner: Harvard Realty
Date of Inspection: March 3, 1998
D] SYSTEM FAILS: N/A
You must indicate either"Yes" or"No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303.The basis for this determination is identified below. The Board of Health should
be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged
SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an over-
loaded 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 '/z 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 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) LARGE SYSTEM FAILS: N/A
You must indicate either"Yes" or"No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a
significant threat to public health and safety and the environment because one or more of the following
conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or
mapped Zone II of a public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of
the Department for further information.
(revised 04/25/97)
Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 401 Shootflying Hill Road, Centerville
Owner: Harvard Realty
Date of Inspection: March 3, 1998.
Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following:
Yes No
X Pumping information was provided by the owner, occupant, or Board of Health.
X None of the system components have been pumped for at least two weeks and the system
has not 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.
N/A As built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components, including the Soil Absorption System, have been located on the site.
X The manholes were uncovered, opened, and the interior was inspected for condition of 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:-
X The facility owner(and occupants, if different from owner)were provided with information on
X the proper maintenance of Sub-Surface Disposal System.
X Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation
of distance is unacceptable)[15.302(3)(b)]
(revised 04/25/97)
Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 401 Shootflying Hill Road, Centerville
Owner: Harvard Realty
Date of Inspection: March 3, 1998
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 g.p.d./bedroom for S.A.S.
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder(yes or no): NO
Laundry connected to system (yes or no): YES
Seasonal use(yes or no) NO
Water meter readings, if available(last two(2)year usage(gpd): 1996 3,000/ 1997 4,000
Sump Pump (yes or no): NO
COMMERCIAL/INDUSTRIAL:
Type of establishment.-
Design flow: gallons/day
Grease trap present: (yes or no):
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title 5 system: (yes or no)
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
NONE
System pumped as part of inspection:(yes or no) NO
If yes, volume pumped: gallons
Reason for pumping
TYPE OF SYSTEM
X Soil absorption system
X Cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known)and source of information:
UNKNOWN
Sewage odors detected when arriving at the site: (yes or no) NO
(revised 04/25/97)
Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 401 Shootflying Hill Road
Owner: Harvard Realty
Date of Inspection: March 3, 1998
BUILDING SEWER: N/A
(Locate on site plan)
Depth below grade:
Material of construction cast iron 40 PVC other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK: N/A
(Locate on site plan)
Depth below grade:
Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain)
If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet
invert, structural integrity, evidence of leakage, etc.)
GREASE TRAP: N/A
(locate on site plan)
Depth below grade:
Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet
invert, structural integrity, evidence of leakage, etc.)
(revised 04/25/97)
Page 6 of 10
• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 401 Shootflying Hill Road, Centerville
Owner: Harvard Realty
Date of Inspection: March 3, 1998
TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to, or at time, of inspection)
(Locate on site plan)
Depth below grade:
Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain)
Dimensions:
Capacity:
Design flow: gallons/day
Alarm level: Alarm in working order _ Yes-, _ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: N/A
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc,)
PUMP CHAMBER: N/A
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97)
Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 401 Shootflying Hill Road, Centerville
Owner: Harvard Realty
Date of Inspection: March 3, 1998
SOIL ABSORPTION SYSTEM (SAS): X
(locate on site plan, if possible: excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number: 1
leaching chambers, number:
leaching galleries, number:
leaching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool, number,
alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
ONE PRE CAST PIT H-20, 23" BELOW GRADE 1,000 GALLON PIT, 18" STEEL COVER, PIT DRY, COVER AT
GRADE IN BLACK TOP DRIVE WAY.
CESSPOOLS: X
(locate on site plan)
Number and configuration: 1
Depth-top of liquid to inlet invert: 7'
Depth of solids layer: 0"
Depth of scum layer: 0"
Dimensions of cesspool: 9' DEEP
Materials of construction: BLOCK
Indication of groundwater: NO
inflow(cesspool must be pumped as part of inspection) DRY
Comments::
(note condition of soil, signs of hydraulic failure, , level of ponding, condition of vegetation, etc.)
MAIN POOL DRY, 9' DEEP, NO INLET TEE, OUTLET TEE, 24" STEEL COVER AT GRADE IN BLACK TOP
DRIVE WAY
PRIVY: N/A
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
I
(revised 04/25/97)
Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 401 Shootflying Hill Road, Centerville
Owner: Harvard Realty
Date of Inspection: March 3, 1998
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100(locate where public water supply comes into house)
ppt��
r�1`
rR0
aY"
O
7-
1tv O
(revised 04/25/97)
Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 401 Shootflying Hill Road, Centerville
Owner: Harvard Realty
Date of Inspection: March 3, 1998
Depth to groundwater feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained fro Design Plans on record
X Observation of Site(Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
LOT HIGH OFF ROAD WAY, NO GROUND WATER PROBLEM.
(revised 04/25/97)
Page 10 of 10
e CF�o rem.,,.
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a
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} _. 9�' n 4y y �} h r wf ry.F R• b ` v v >� a � :..�
�o TOWN OF BARNSTABLE N
LOCATIONS 0//"' i SEWAGE #
VILLAGE ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO. _
it !� T A ATY �• CITY / QL dG C/
LEACHING FACILITY: (type) o0/ T / al D (size) /,0-"
\NO.OF BEDROOMS �3
BUILDER OR OWNER'
PERMTTDATE: 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 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
4.
gg x
6 31°
LEGEND
EXISTING CONTOUR Mid Cope Hwy
X 100.98 EXISTING SPOT GRADE Service Rood N
102 PROPOSED CONTOUR
-W EXISTING WATER SERVICE
LOCUS "
-G Shoot Frying EXISTING GAS SERVICE Hill Rd N
�r
e..HI-W.•- OVERHEAD WIRES
TEST PIT
BEMCHMARK a
� lokerv1ew ��
(0
LOCUS MAP
NOT TO SCALE
0
"VX
10.77
• rya �; �
w 128.08
48,306t S F. i
Map 214
X 127.32 r/124,02 Para'e/ 005 %
i ��
o � 118 06
Be'n chm ark Se t
`o 6utSide Corner A� Pad rn o
_------ x 121.67 , EL.=114.14 (As�umed) t o i
12 -_ �' x 115.60
__ �EXISTING SHED �120_2 5 -'. ----� oo' Q
-
(TO BE REMOVED)120 --- - 118
SHED
-j 25'- I 1 PERGOLA ,�
-�-' 1-16 _ 1 8;64 116- kf6.19
•119.53 '
- --- -- .t
VENT N r-- � -- � --i ' 116,14 115,21 4 i
---�-- -- --a TP-1 `k 115.74
�14.72 36 x }44.
-._115 1- 113. 115 11 34
116 --- - - �--- -p ! x ------- x i 3.24
POLYLINER 5' OFF S.A.S. 114.25 PATIO 114,70 T 77,
TOP OF LINER, EL.=111.5 X 1 ,---_ BH
BOTTOM OF LINER, EL.=110.0 �74� 114.69
PROPOSED
�\ IOUTLET, INV.=111.83 0 x 1 2,57,-/
EXIST NG �� GARAGE \ '
HOUSE #401) UNDER -}p$` 110,1 J
T.O.F.=113.83 10.13
06.47 106.43 110.87
106,E
Y I
C PA VED
DRIVEWAY
112.52 X _--- _
POR
113.01 - 106,L1
113.52 ' 115 0 '
105.
ae - _ �r� 171-278'R W I
1 .44
194- _ 4,36
_--_ x� 10,32 1 '�O '--__ 108.56 �\\ - --- I '108.02
-- --- '108 14 T _ - 110 8� 103,I `I x 107.21
--------104--- 1�53------- \\ - --- 107.24
-----------------� --- 100,54 _
LE 0.00-------- _ -
102.48
�02
-S-43_5,0'20"-W, --100-- '
7
---------------__- 9� 8 -- ---J _
X- xCVO
94,62 96.23 edge of pavement 9�.47
SHOOT FLYING HILL ROAD EXISTING CESSPOOLS
TO BE PUMPED, FILLED WE
SAND AND ABANDONED.
°F 4f
4
SS9�yG PROPOSED SEPTIC SYSTEM UPGRADE PLAN
o PETER
McENTEE 401 SHOOT FLYING HILL ROAD, CENTERVILLE, MA
CIVIL Prepared for: John Zappala, P.O. Box 921, Centerville, MA 02632
. 35109
A REGIS 10 Engineering by: SCALE DRAWN JOB. NO.
F G Engineering Works, Inc. 1"=20' P.T.M. 228-09
12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
(508) 477-5313 11/19/09 P.T.M. 1 of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
} FINISH GRADE SHALL NOT BE < EL:111.3
FOR A DISTANCE OF 15' AROUND THE
. PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
INSTALL RISERS & COVERS OVER INLET INSTALL WATERTIGHT RISER & INSTALL INSPECTION PORT OVER END UNIT
T.O.F. AND SET TO 6" OF FINISH GRADE. COVER SET TO 6" OF GRADE
PROVIDE ACCESS TO GRADE OVER OUTLET COVER CHARCOAL
EXISTING F.G. EL.=114.Ot F.G. EL: 114.5t F.G. EL: 116.3(MAX.) VENT
wommm
i MAINTAIN 2% GRADE MIN. OVER S.A.S.
INSPECTION
L = 10' L = 20' L = 8'(MAX.) PORT
S=1% (MIN.) ® S=1% (MIN.) ® S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC
6"
�o"I s 10.38 TO
Ir
1 4" INVERT
INV.=111.63 48" LIQUID INV.=110.9 ;-
LEVEL ADD 5 ROWS OF 5 UNITS AT 5.0'/UNIT = 25.0'
GAS DD�LE INV.=111.18 PROPOSED INV.=111.01
INV.=111.38 D-BOX SOIL ABSORPTION SYSTEM (PROFILE)
'm ' (5 OUTLETS)
PROPOSED 1500 GALLON SEPTIC TANK
FRALO ST1500 GALLON PLASTIC TANK MAY BE SUBSTITUTED
PROVIDE NEW SEWER OUTLET
AT, OR ABOVE, INV.=111.83 ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
NOTES: BREAKOUT=TOP
TOP ELEV.=111.39
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=110.9
INVERTS, PRIOR TO INSTALLATION.
2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=110.0
GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. SEPARATION
3) INSTALL INLET & OUTLET TEES AS` REQUIRED. TO HIGH GROUNDWATER EFFECTIVE WIDTH=14.2'
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO GROUNDWATER, EL=103.8 = EXISTING MATERIALITABLE
x AS MANUFACTURED BY TUF-TITE, ZABEL 'OR EQUAL. USE 5 ROWS OF 5-ADS Are 36HC UNITS WITH
NO SEPARATION BETWEEN EACH ROW & NO STONE
TYPICAL SECTION
SEPTIC SYSTEM PROFILE UNITS MUST BE STAMPED H-20
N.T.S.
GENERAL NOTES:
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOG
BOARD OF HEALTH AND THE DESIGN ENGINEER.
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: NOVEMBERBER 18, 2009 (REF.#12,781)
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: PETER MCENTEE (SE#1542)
-310 CMR 15.405(1)(b): WITNESS: DAVID STANTON-HEALTH AGENT
1) A 2' variance to the 3' maximum cover requirement, for 5' of
max. cover. S.A.S. shall be vented and rated H-20. Elev. TP- 1 Depth Elev. TP-2 Depth
-- 2) A 4' variance S.A.S. to cellar wall, for a 16' setback.
�3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR -- 1 t 4.8 0" 114.8 0"TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE FILL FILL
DESIGN ENGINEER.
114.1 8' 114.1 8'
4. ANY.CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING C C
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 36"
ENGINEER BEFORE CONSTRUCTION CONTINUES. PERC
5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 48"
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH, FOR PROPER INSPECTIONS DURING CONSTRUCTION. MED. SAND MED. SAND
7. WATER- SUPPLY PROVIDED BY TOWN WATER SERVICE. 2.5Y 7/3 2.5Y 7/3
8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S.
9:'ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
AGREED UPON BY OWNER AND-CONTRACTOR OR AS OTHERWISE
DIRECTED BY THE APPROVING AUTHORITIES.
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 103.8 132" 103.8 L -132"
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PERC RATE <2 MIN/IN. ("C" HORIZON)
CONSTRUCTION. NO GROUNDWATER OBSERVED
11.• WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
' 63.25"
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE' MATERIALS SHALL BE
INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
13., THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 16
IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
34.5".
DESIGN CRITERIA
NUMBER OF BEDROOMS: 4 BEDROOMS TOP VIEW
SOIL TEXTURAL CLASS: CLASS 1 60"
END CAP END CAP
DESIGN PERCOLATION RATE: <2 MIN/IN FRONT VIEW SIDE VIEW
DAILY FLOW: 440 G.P.D. END CAP
REAR/TOP VIEW
DESIGN FLOW: 440 G.P.D.
- NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
GARBAGE GRINDER: NO TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY 4640 TRUEMAN BLVD Arc 36HC DETAIL
PROPOSED DISTRIBUTION BOX: 5 OUTLETS MINIMUM HILLIARD, OHIO 43026 H-20 RATED WITH
ADVANCED DRAINAGE SYSTEMS,INC.a 18" MINIMUM COVER fik
LEACHING AREA REQUIRED: (440) = 594.6 S.F.
.74 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
USE 5 ROWS OF 5-ADS Arc 36HC UNITS WITH NO 401 SHOOT FLYING HILL ROAD, CENTERVILLE, MA
SEPARATION BETWEEN EACH ROW & NO STONE Prepared for: John Zappala, P.O. Box 921, Centerville, MA 02632
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) Engineering by: SCALE ''DRAWN JOB. N0.
(Arc36HC Units) 25 UNITS x 5.0 LF x 4.80 SF/LF = 600.0 SF . Engineering Works, Inc. NTS -P.T.M. 228-09
12 West Crossfield Road, Forestdole, MA 02644 RATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74(600 S.F.) = 444 G.P.D. (508) 477-5313 11/19/09 P.T.M. 2 Of 2