Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0802 SHOOTFLYING HILL RD - Health
802 SHOOTFLYING HILL, CENTERVILL A= 192 039.001 ' I /Ili' J�REcrnEo�� UPC 12543 No. 63LOR 70, HASTINGS,MN 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for Misposal 6pstem Construction Vermit Application for a Permit to Construct( ) Repair Upgrade( )� Abandon( ) ❑Complete System ❑Individual Components Location Address q r of No. L o-f o7 I,, Owner's Name,Ad ess,and Tel.No. Assessor's9'® Map � 1'�.1 1 P 1 I 1 QJ•�6e n-V 1j 1 1 lX_ a/'�iA ei'SO T 11 ./ l 2. , Installer's Name,Address,and Tel.No.50 — 4/•7-7—Df"77 Designer's Name,Address,and 1.No.S 08—� &O 3j 11 Ron trxCct�t4i ��c: � Meyer " Sa n.5 irx. go BN $� 1 6 E. c Type of Building: Re_S i c n „'h- Dwelling No.of Bedrooms Lot Size e®q S AM6 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Design flow provided r gpd Plan Date 12 Number of sheets 2_ A Revision Date Title �iAbm U Lon M11 o U I n ` Size of Septic Tank E:x j }�i T�QQ (��, Type f S.A.S lb '50® on `1 Description of Soil 5k Q I(' 7 Nature of Repairs or Alterations(Answer when applicable) LLftV C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and of to place the system in operation until a Certificate of Compliance has been issued by this Board of Date — —'� Application Approved by s Date Application Disapproved by Date for the following reasons Permit No. Date Issued ---------------- ------------ ------ ------ ------- -- - -- 8 .T No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN-6 BARNSTABLE, MASSACHUSETTS Yes F 2pplication for Bispos.Y Opstem Construction Permit Application for a Permit to Construct Repair Upgrade Abandon Complete System Individual Components PP ( ) P ( >),�� ( ) ❑ P Y O P Location Address or of No. - C,...o c�� Owner's Name,Address,and Tel.No. �'aa Shoo 9 i kd.y Ge n'Cer'u t 1 .vim Nand e r r) Assessor's.Map/Parcel )9`i::- 9- 4 Installer's Name,Address,and Tel.No.GO?- q 7 7-p!77 Designer's Name,Address,and el.No.Sd$' (V 0 Ron fx c vq-�rt nC.. �p _M er 50 l nc, 013o�t die 1 1-,,n [� . - U i f I Ma Oeo_,M OW-1 . ,r1ntndk C.h 1"X 62-53-1 Type of Building: PW-6 Dwelling No.of Bedrooms Lot-Size i Qq 5 RUZ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .330 `gpd Design flow provided 3?a i a !� gpd Plan Date �r(j, 2 I Number of sheets Revision Date Title Pf D � b a `.. o:� nl t Size of Septic Tank X l oo ([a]�dt1 Type of S.A.S�F> 1� 'tw! ��Q QQ.��©n,��C,A w� Description of Soil �_IwQ P i mn J J,, , Nature of Repairs or Alterations(Answer when applicable) a 0.1„ 5 j jb I-baph 0 I rLi 11 i t l4a 1 t tAn Of n&LO H-20 Awc,41bulionlaw t In4riz...11 l.h 4 o ! �-12 __5 n Qad M Date last inspected: 3 Agreement: a 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 of to place the system in operation until a Certificate of Compliance has been issued by this Boad ofr east . - Date Application Approved by �///// 0 � 17/4W%�f f/ Date J / �1 Application Disapproved by Date 1-7 for the following reasons V 17 Permit No. '-j Cr Date Issued THE COMMONWEALTH OF MASSACHUSETTS u BARNSTABLE,MASSACHUSETTS Certificate of Compliance ``THIS IS TO CERTIFY,,that the On-sit- 3ewag�eJDiisp�osal"/syysttem Constructed( ) Repaired(�)� Upgraded( ) Abandoned( )by 19A 5M' l V f 1 1' I A Cn- / -ati�% S-�f (.�► H ��l � � has been cAnscted in a co dance withthe provisions of Title 5 and the for Disposal System Construction Permit Ndated Installer � �5 Fx a ,/Cft�H� Designer Ae('te� SG�1S #bedrooms Approved.design flow ,�`' �_ gpd The issuance of this prertniit��shall rnot be construed as a guarantee that the system will functio as de`i ed. Date. �! c}3 ( 17 Inspectors, ; . - - -- -• - - -- - - -- - - -------------- - -------- -- - --- -- - - �/') 4. f i. No6Jf/ / /'1 `< 4 Fee .-�_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Veposal bpstettt Construction permit Y Permission is hereby granted to Construct( /) Repairr(V ` Upgrade( �VV dSystem located at N� ! 1 \ \ \ Ta �� and as described in the above Application for Disposal System Construction Permit. The applicant recognized/his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be c plete'-)Withmthree years of the date of this permit.Date ' Approved by / J � r i Town of Barnstable ' Regulatory Services: s Richard V. Scali;Inte-jr.h m..Director • anMMBIM 9 " Public.Health Division. Fv n+A Thomas McKean,Director F 200 YIain Street;Hyannis,,MA 0264 + Office: 568-862-4644 Fax: 508-790-6304 Installer &Designer Certificati6n Form f Date: �� Sewage Permit# Assessor's MapCParcel Desi ner• C' S'611 g 5 N J- Installer: }h S' Ex�'l,i f'/ Address; �Q Address: r on _l �aa �JS ACC U�7'/�dl was issued a permit to install a (date) (instal lller) se tic.system at l tf t�` tt p Y based,on a design drawn by (address):` dated j l ( igner) I certify"that.the se ptic stem referenced above was instdRed substantially according to the design; which may inehide minor"approved changes such as lateral<relocation of the distribution box'and/or septic tank, Strip out (if required) was inspected and:the oils were"found satisfactory: 1,certify,that the septic system referenced above was lnstal}ed with major changes (;e. greater than I O'�.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 mspected and:the soils were found.:satisfactory. I certify that the system referenced above was:construct ' re withthe terms oPthe 1INkapproval letters -if applicable) (Installer's Signature) z Apr, (Designer's.Si' ature) Affiz-Desi ( gne .'Sump Here) . . PLEASE RETURN,TO B 'I ABLE PUBLIC HEALTH DIVISI6N.".CERTIFICATEOF COMPLIANCE WILL, NOT BE ISSUED °UNTIL BOTH THIS FORWAND�AS- BUILT CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU- Q;1SeptielDesignerGerti ication Form Rev-8-t4-13:doc k TOWN OF BARNSTABLE LOCATION C'�� ;� SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL /V P-`--0q 3 INSTALLER'S NAME&PHONE NO. faC'gMV .I 1'Aq So3_,/77 o f %? SEPTIC TANK CAPACITY 1000 LEACHING FACILITY:(type) Z fC bap (size) NO. OF BEDROOMS OWNER PERMIT DATE: , COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /�/{'/ Feet FURNISHED BY Z 20 ' 22 3 2 t - { , _ Town of BArastable. P# Department of Regulatory Services 711 's Public Health Division Date sbJ�q tee$ 200 Main strem Hyannis MA 02601 ;.n•F ~rfD t41A1 i• CA) :} Date Scheduled � L ' Time ) 0 Fee Pd.• I l 00 _a ' ,foil Suitability Assessment fop ewage Disposal Performed By: t .IV`f Ye ✓\ Me �j Witnessed By: i LOCATION& GENE 'Am INTORMA ONi Location Address �� S Kuor t-\) ifj(;r- N-(L4_� KV Owners Name Address l Assessor's MaplP;ircel: /�(9•-Y3 39 00 I Engineers Name M",4- NBW CONS1RUt20N REPAIR Telephone# 7 Land Use RG SJ DF PJT) Al- Slopes{4'0)yl 0 Surface Stones Distances from: Open Water Body WO ft Possible Wet Area 7�dit Drinking Water Well ' 2��ft Drainage Way >l O 0ft Property Line 7 I p ft Other ft SKETCH:(Street name,dimensiods'of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) �y01TV • I • s I , i Parent material(geologi Depth to Bedrock Depth to Groundwater. Standing Water in Hole:' / I Weeping from Pit Face Estimated Seasonal Migh Groundwater DtYMHNtTION FOR SEAS OVAL HIGH WATER TA9LE Method Used: Depth (Ibpervea standing,in obs.hole: in. Depth to Sall mottles: In. Depth toiweeping from side of obs.hole ln. araundwnter Adjustment Level— index Well# Reading Date Index Well level Adj.!actor,, __.._ Act.Clrtwnt9water LeVel.,,o . I . PERCOLATION TEST • Date 'Anse Observation I Tune at 9" N Hole# i 51 Depth Of Perc Time at 6" 1001 Start Pre-soak Time.0 End Pre-soak ^ 1 Rate Min./Inch i x Site Failed; Additional Testing Needed(Y/N) Site Suitability Ass0sment Site Passed Original:.Public 14ekith 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 C44servation Division at least one (1)weak prior to beginning. DEEP OBSERVATION HOLE LOG Hole# other Depth from Soil Horizon i Soil Texture Soil Color Soil Mottling (Structure,Stones,Boulders. Surface(in.) (USDA) (Munsell) onsistenc %G vel 3�u .9( 61OIAS�,)4�1 by R-7b- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sail Texture Soil Color Soil Other ' Surface(in. (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) 34 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consiste c %Gravel DEEP OBSERVATION HOLE.LOG Hole# KIA Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. nsisten 1 F Flood Insurance Rate Mau: Above 500 year flood boundary No Yes Within 500 year boundary No Yes, Within 100 year flood boundary Nor. Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviclus aaterial exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe vious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro me tal Protection and that the above analysis was performed by me consistent with the required i ,.expe i e nd xperience cribed in 3,10 CMR 15:01 . Signature Date Q:\SEPTICIPERCFORM.DOC i TMf T Town of Barnstable -Sarl�, Regulatory Services Department A Ame`ca�j BARNSPABLL MASS 9 , ; ,,� Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 6216 August 8, 2017 HENDERSON, STEVEN C 802 SHOOTFLYING HILL RD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 802 Shootflying Hill Road, Centerville, MA was inspected on 08/02/2017 by Matthew Gilfoy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE B ARD OF HEALTH Flr s ean, R.S., C Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\802 Shootflying Hill Road Centerville.doc 3 Town of Barnstable YAM Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA-02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 'Thomas A McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO*REPAIR FAILED.SYSTEMS (Town..Code §360-44 and Title V: 310 CMR 15,000) _ An`k"marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA. ❑Discharge or ponding of effluent to the surface of the ground w . ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe: ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE 1 YEARDEADLINE CRITERIA Static liqui eve a ove outlet invert due to an overloaded or clogged SAS or cesspool ❑An portion of the SAS cesspool, or privy below hi groundwater elevation y P P P j'Y � ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool- ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M r,W 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name -Q! information is required for every Centerville Ma 02632 8-2-17 .� page. City/Town State Zip Code Date of Inspection ' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information it91:� on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation r� Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 8-2-17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 approving authority. f+ ****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. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 �,p01�vs Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System 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 Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health 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: ❑ 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. CityTrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) _3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330gpd f t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes E. No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2015-45,000gallons 2016- 175,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- last pumped 5-7 years ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3'6" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): t Septic Tank (locate on site plan): Depth below grade: 2 6 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000gallons Sludge depth: 8 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 4 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is in need of pumping at this time and should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is Centerville Ma 02632 8-2-17 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was in poor condition and the liquid level in the d-box was over the outlet invert due to clogged SAS. I Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (1) 6'x4' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in hydraulic failure when opened. Liquid level was over inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 51'6" FRONT 45` 29'6'« � J 26' `✓ 47' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW @ 156" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8-22-86 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 802 Shoot Flying Hill Road Property Address Steve Henderson Owner Owner's Name information is required for every Centerville Ma 02632 8-2-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLLE l- '� d SEWAGE # LOCATION �o� Y)C'X7 I��(��/1 Gt ���0�3 /� VILLAGES `e4erolIl e- ASSESSOR'S MA�P/&LOT a9'.00__Z— ngR59 + WSr AME&PHONE NO.-a)rw��`, ; �n s 7cl e'tf 1-2!�2 SEPTIC TANK CAPACITY /004 LEACHING FACILITY: (type) ;Z� (size) 66D6 ��, NO.OF BEDROOMS BUILDER O ��Ri PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: OF Maximum Adjusted Groundwater Table and Bottom of Leaching Facility A3 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 leachi/n�fa � ' ) /�� Feet Furnished by&l��0 9i ��e• ` "�� ''rid' 0 19 0 y�' Town of Barnstable Geographic Information System May 5,2015 r 192138 #303 r 192057 212010 j 192015 7 #7 #93 #100 192139 212011 J #?91 V F192037002 192030 ti #120 #774 #230 � Q � k 192038 1#785 O 192148 #786' � y #292 ty 13 212020 - #119 192029 192042 13 #214 #798 � a 192013 #801 192039001 1 #802 � 212019 '. #143 • 192149 #262 1 + 1k S 192028 #198 192012 #817 i `_ 212018 192041 #161 #834 192150 #248 192039002 #806 ® 212017002 192011 #186 212017001 #839 #176 192151 13 192040 #236 #844 192010 192043 1#21 F et #857 7 #416 212023 2# 21 %% 192056 #2 #398 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:192 Parcel:037002 - boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:KARNIALA,R ANNELI TR Total Assessed Value:$310200 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:ANNELI KARNIALA TRUST Acreage:1.67 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:774 SHOOTFLYING HILL RD /! such as building locations. _ Buffer { fF b4 ll j2 BORTOLOTTI CONSTRUCTION, INC. �ubLV SUBSURFACE SEWAGE DISPOSAL SYSTE INSPECTION FORM Cb '016 1 Address Prop f /lI -- -- —--- at LI N-23-1995 C /SP 11 y-Ww Date of Inspec} Map Parcel Owner PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: l� PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. ONE 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 COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED, NOTE IF THEY ARE NOT AVAILABLE WITH N/A. 4/THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,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. E SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON—INTRUSIVE METHODS. --TM FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FL W CONDITIONS RESIDENTIAL No of Bedrooms No of Current Residents ����' �Garbg,Grinder } lv Laundry Connected to System /`,./ Seasonal Use NON RESIDENTIAL: -- Calculated flow WATER METER READINGS,IF AVAILABLE: Pumping Records and Source of Information: GALLONS Y / SYSTEM PUMPED AS PART OF INSPECTION?I Q IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF SYSTEM: •� Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool __ Privy Shared system (if yes, attach previous inspection records, if any). Other(explain) ------------- ---------- ----------------------.—__..--.-..-- -----, ---------------------------------------- Approximate age of all components. Date installed,if known. Source of information. SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? / �Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �M PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: Dimensions: , , �S�� F, s ,►'tom y 5- Material of construction: ✓ Concrete Metal FRP Other} Sludge Depth Distance from top of sl ge�fbottom of outlet tee or baffle Scum Thickness/O „ Distance from Top of ScuZm3q top of outlet tee or baffle Distance from bottom of Scum to bottom of outlet tee or baffle Comments: S kj i e Q oe- DISTRIBUTION BOX: DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: C i `�lSU /dIS, PUMP CHAMBER: Q Pum s in working order? Comments: SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE: Comments: / 7 L CESSPOOLS: A10 Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool !Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' S yS' DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: i �r � rah-► 1 4 S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA (Indicate Y-yes N-no ND-not determined.Describe basis of determination.If"not determined",explain why not) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? // Static liquid level in the districution box above outlet invert? I Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? j Required pumping 4 times or more in the last year? Number of times pumped _ Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration? tank failure imminent? Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? I Within 50 feet of a surface water? i j Al Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools &privies only,not the SAS)? 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,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 �I CERTIFICATION STATEMENT �I I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY 1 RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IIN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. II CHECK ONE: I� t �i I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS I STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS I FORM. / ? INSPECTOR'S SIGNATURE: I DATE: ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(d applicable),APPROVING AUTHORITY G;2— ti I , No Fs�—��� ........ ..:. (gyp THE COMMONWEALTH OF MASSACHUSETTS oU BOARD PF HEALTH .--.....OF.... . ..............AlQ.�/ Appliratiou for Biipnaal Workii Tomitrartion Vautit Application i hereb ade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: eta o / .. .v..�.__..�,��' ... .....-- ------------- ! �. �� Owner//p � / Address /I �. 4� ..e Installer Address Type of Building Size Lot../•.. ----- feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons--------9................. Showers ( ) — Cafeteria ( ) d Other fixtures .........�1 fA.A" e_2- �, ...........................•--...._.._.._..--•----•-•-•------•-•-•-•a......................................... W Design Flow........ � .........................gallons per person per day. Total daily flow.._.._.............................gallons. WSeptic Tank—Liquid capacity_/0%Wntallons Length.............•.. Width..____nn_.._.. Diameter________-____- De t ................ x Disposal Trench—No. ..O..N&...... Width.................... Total Length._.....�Z.'... Total leaching area..... 4 .....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below ' let.................... Total leaching area..2:b_.R_.sq. ft. Z Other Distribution box ( ) Dosing t k��) f Percolation Test Results Performed by... a... A ----------- Date__"l//1 ... Test Pit No. I...G__Z...min'utes per inch Depth est Pit...... ...... Depth to ground water.....O'VOW.A. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----ALa!✓ . ----- Descri Description of Soil-------0-- yoaC ....21a'!��1..... !�✓�_._ - ---.. P Q!/ x l� �' �C!.t�C `t SAC 9 j? P e V -----.----• --- - U Nature of Repairs or Alterations—Answer when applicable................................................................................ .................... ----------------------------•-------------------------------------------------------------------------••--•--•-•-•---------.................I.......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be s the board of heal . �� �7 ��. ,Date Application Approved BY......... :��..... ................:.......................................... i/ Date Application Disapproved for the following reasons-----------------------------------------------------------------------------•--•--------------------------••--•- ----------------------------•-•---•-----••-.-----------•-----------------......--------•--•-------------------------------------------•----•---•••---•••... ------------------------------•------- PermitNo -•-•---��-•-�--•----------. Issued-------------------------•---.............Date....................................................... Date „ 'No........ ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF.....4.............. ....................... C................................. Appilraffou for Uhipoiial Vorkg Tomitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .................. ........................... ................ Loc'at*'.'Address of Lot Na x, ............ .........7....................................................................................... ............... Owner/--, Address ............... ............ . .....Z ............. ................ .............................. ..........................................._. Installer Address Type of Building Size Lot... ' feet U Dwelling—No. of Bedrooms......... '...................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons......::�.................. Showers Cafeteria Other fixtures ............- .......................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow_-__-- .....................................gallons. 1:4 Septic Tank—Liquid capacity.~i"�_~.!:gallons Length._....,..._...... Width................ Diameter--.--___-____- Depth.....__......... Disposal ...... Total leaching area.............. , psal Trench—No. .... ...... Width.................... Total . -------sq. ft. Seepage Pit No..................... Diameter.._..........._..__. Depth below inlet.................... Total leaching area.......:_ ,::..sq. ft. Z Oflier Distribution box Dosing tank Percolation Test Results Performed by..... .............. Date_...._ ..................... Test Pit No. I___-:_.._.:':..minutes.......'..minutes per inch Depth of Test Pit....._.:: ...... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.__.........._.._... Depth to ground water..._._.............._... P4 .................................................. ----------------------------------------- ---------------------------------------------------------- 0 Description of Soil...... ...............;f' ............................. ................................. ............. ......................................... ........................................................................................................................................... ............... U ........................................... ........................................................................................................................................................................................................ 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 I T 1Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Com pjg 1* nce has b -,i e y the board of health................. ................................ ign . ..... ..... ....... igne ate Application Approved By. Z_AA�__.4” ... ......................................... ........... . ........... Jfl hate Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date ri ILI PermitNo.---- ........(;0...4.....4--------------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f . ..........................................OF.......... ..............1............................... (9rdifiratr of Tiantphatta THIS U TO CERTIFY, That-,the Individual Sewage Disposal System constructed or Repaired ----------------------------------------------------------------------------------------------------------------------------- Installer at...................... .........................................................................................................................................m....................................... has been installed in accordance with the provisions of TITLE- 5 of The State Sanitary Co-d e as described'be d in the application for Disposal Works Construction Permit N6;�_:4: ...... ....... dated- ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. Inspector....... ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4, 0....F!� .................. ..... ........................................................... ......... OF........... NFEE........................ U6posat Works Tonstrurtion. rantit Permission is hereby granted................ U ft_c . ....................................................................................................... .to Construct or Repair an Individual Sewage Disposal System at No................/ / / �. �, I I "(_ " �- . .............................................. ............................................---------------------- ---------------------------------- ................ Street -7 Date as shown on the application for Disposal Works Construction Permit No ................ ........................................................................... Board of Health DATE-------------------------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �J.I T C.f (9 /`T��. ' ' �ii ! .. , � �J /f 2 /C—`' O 5 Y �¢/ IV i 9Z-P00 , qbr,71 o ,- � i f tid/_aj-_Lra'T ,i:'- L _ 4 5. NZ/./.. .411J rLT F j 22! 10 1 41 c� L o U� ! OF lygss r _ 92y2 o PAUC A. rn 41 \ \ o CEVY No.10 0 `T U 04, GIs ~ \ o \CV, \ ,h .,LSIGN'rJG ENG LEER MUST SUPERvr,, 93 •,M1, �d, l g3>`S . �a-_,TALLATION AND CERTIFY IN. WtRl74E*iw- \ \ AE SYS fEM WAS INSTALLED IN ST I r PAUL A. 5 \ G JI LEVY i ! I04xo \ TO PLAN. R C No. 1.0517 y ,. cr1R�4� • � N, �� LEGEND EXISTING SPOT ELEVATION �AO�I EXISTua o CONTOUR --- �" - ss s CERTIFIED F'L0T PLANFINISHED SPOT ELEVATiON$"E® �Hoor�Lyisrr.,wr,.cl�D CONTOUR ® 2s sNao�- FL%/NG ,411�C P��f*� .; NOTE The location of any existing underg,•omid sewu-,•:tee, wells, or other utilities shown on this plan is uppr�c► - imate only as determined from records and/or verbal 0Is jZA/ S 77— f9 L� information. The contractor is responsible for the �Evr� E�ZZlg ' verification of the existing locations in' the field. SCALE 5/0 ®ATE 2 B " LEVY & ELDREDGE ASSOCIATES, INC. CLIENT -11-b//VL, I CERTIFY THAT' THE FROPOSED . a; E@dGBAIEERS- LANDSCAPEARCHITECTS JOB No. g6.--- --- BUILDING SHOWN ON THIS V L A N #i PLANNERS- LAND SURVEYORS � CONFORMS TO THk ZONI O LAWS, , DR.By OFC��� i4LEr MAS 712 MAIIN STREET CN. ®Y� \` " V Ewr dt VL.ANI� .;'�I�lY 9Ir�EET..L 0� A7 iiz- AO' SrA WA.Va.-: . zr:Ak.6-. 0 A./ C 0ev C,e j C- 7 7- cok�eoql /a pr. �w/A01. -Z4 'Ot -0 4J AC TA E . SWAZZ &F OA J6047 .7 P �A EXTRA Me C0.#vCRL A AVY CAS7'1oV0.JY 4=0V4 /I=/lov DORI vlrjvA Y, c 0 K C1-h7AAl -5A/V A") Aft 40ACA-10=11-L z*LAYER ;JO OF JIB ®RA L. 0 40' W,4 5HEO .5710N.-E 'rAAIX DI of 0 V4 0 P&M J-r. SEP71C a 0 a 0 41L & ep I a BOX 0 9 & 0 .0 0 4 1 a 0 4 WA5AFP STON 6,!!L PA GC � •®�00 4 13 4- OF 0 3 5. AfpCIK7 &ARVA77e-,VJ P/7 : 4 15E'er ,c &x7, Ar VK --3 F.r. fr AM OAO'). 0074 SEPTIC 'rAv,0< Fr 50,y SEC7110W 0-c' mx 67.7 ... F7., CIE VISROSA A. SKS7 VA :7A NSI ON -,A I-EACHIM6 -10/r 04 VAY YCA�LE DRSISAI CRlr-,r-*q1A 5 p- 76 7 rW TA t &3rlA%4 reo 4oczaw 0 G,4,j'1,oA-e :.-so IL res 7 jP/, 7 A/ OIL BESTr MUM8ER aAr-4eACAflNCr 73 -_!4 eie RXdFFbo.3 A 77E 0.4 r.,5 f-ZZ 51b4E Zg�."IMO 'C�11'�-.JR P1 T 5�g 2 -0y RESUILTS 3 6 0 7-rciW LEA CN.INC-Po R P1 r- FIA INCH 077 0 'rIOAf A7W rorA4 LeACHIW6 AREA AREA sip. 'Fr 32 P OF A OF iv, A16' f.4 es e PAUL A. 023 P,Au Z. L A10 i� LEVY --Z C3 C E VY 1-3 a o No 10050 0 1-3 Ca.;4,e-S 1 r LEVY,.6 E-LDREDirvE AS [ATES.'IN 7."D 1 -SOC c T '-WZ'NA 11V �AM- mb uAlo �)45 Oa, l. Y. T �14 Z4 " - -; �6 - ,'4Z-.,5 ,�,W ;Z- Wz, a. lEA 2'�, OR V G At I'w CO IA'A E74 Fe f 90cRe7_ :c s WA ZZ &AF,3R0&6R7 770 4 MA Do 44F. Al lF_x7-R',0q coVCR AllAl. A17CR ):;oRl V-=JIVA Y, co 8 RIF.? 2% lkf Iff. co K14=1T -/VO Cl_,FAA(!'��A L: LIfillo LEVEL. e J/19 r SMNE ap g&.,o Dlslr... A vv-Pon P-r WASAFP S PRECAS r Ste&RA 6 I)VV4-A-r &Z EVA 7/,OV IMYZ,q77 AT ffZ111_P1"6 Fr 114M _-E rA.8 Z IL.A rJ ON,) Fr. FT IC r,4,VK .97. VIAM 11V4, er-T 4OUT4=77$AEPT/C I'A JY X Fr 4 2- aoy - GROUND W,4TEIr TAOLe S,�EcrlaN 0,0 Fr A .-A IM4�G7- LEACHINa --17- 1 . '. `4: It ..'. . I.AEACHV"ia, 7A IMENS1 0AV A FT. D,FSladV CH17,WRIA AdltlM&,-R OF&EDROOMS O�L. -Z-O& P-60aj7 70 7A 4 &_T711-%4-reD F:ltOW a,&L./oA Y .SO l�L 7.,E57 .03 SO147 45S7 OA TZ OJT" SOIL TES 51,0.E 1,eACHIvo PAR PIT Sig PT. REsuj-rs kv1-rVzsS_-Z> AY 6 0 T-rOl-f L-,VA CHINO P_-R Plr- A 77. Tbf SOIL ReM COL A"?V01V VA 7-0 A' 4.2, m "/j Nw T07AI FLFtCO LA 77 0,V RA7--1cr MINVINcoy 3 lQ,55—=MV46 I-JS4C'Nl-'V6 AREA S4 R T. 15Hctir, Fir kiEr (-It- Lo 11;jVt OF F hf, s" L icySOW�57 ft�_�S SOKILE COGt-, PAUL PAUL A! ,. rn LE'" Nais . 10627 V. LEVY N(L 10M 40P LEVY & ELDREDGE ASSOCIATES, INC. 0 WISTS; AIAI V� 7Y 3 7/Z A1,411Y Sr�; T YX? kV 4 r&M WCO UIV i> a e,4 m!"r 14CA4- 110&W47! 0�2T� OF BARNSTABLE . �-7 . / LOCATION�Cs �i.Sl"/o /�/i�-�/yfll SEWAGE #eb/ 64$� q-oof VILLAGE ASSESSOR'S MAP & LOT 9? INSTALLER'S NAME & PHONE NO./�• C`,,f� a, SEPTIC TANK CAPACITY P �� LEACHING FACILITY:(type)�r (size) `'I W3 NO. OF BEDROOMP__7 PRIVATE WELL OR PUBLIC WATER 14?BUILDER OR 0WNEX � ft , / DATE PERMIT ISSUED: 7 ` y DATE .+COMPLIANCE ISSUED: ' 3© 7 VARIANCE GRANTED: Yes No t/ �X.10 Zv 9 S� 1 APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION 4>7_ 'ZS". ��fi�c7y-Zy.i.c�G /�jG L /��,�� NO. VILLAGE DATE APPLICANT FEES ADDRESS TELEPHONE NO. (Non-refundable) ENGINEER L���i,�y�2/] �" ll�zL Ny TELEPHONE NO. .3CZ-Z Z G C. DATE SCHEDULED /�?2/z e_ (Applicant' s signature) ASSESSOR'S MAP% LOT NO: SOIL LOG SUB-DIVISION NAME DATE_4,elL /B /y8C TIME /o:4,r/may EXPANSION AR A: .YES O O Lr. .CEzc ENGINEER TOWN WATER PRIVATE WELL f� .A n+1G1 ,�n BOARD OF HEALTH EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES: A of I �767 � 5 Ze,o G 0 w• PERCOLATION RATE: 77,yo I.11,y`jA-1 TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 1 ulQvr�.Go�-j l 2 fl 2 svd-.Svc L . 3 4 4 5 5 6 6 dof3' g 9 10 M 10 . 11 �'2�/62 11 „ 12 12!� 13 13 14 -14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES 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 q G 'Q I ^4 �r r \ • ri(o* 3 � J �' 0/7 \ �o4 3.t 1 12 (p4 AV 106 41sue."., }•6`� 01, dD !got k ;a W 10 T H( J 2S / 3 ( �� �1..�,,vl _O T 1 d ` x Jp s OFiygs o� P.AUL A. U LEVY No.10 0 l PA U L A. ' LEVY i I�7`� \ \ . S/� s° > No. 10617 yf ----- .. �- \'. <�✓ T..Mete, _ } , S R a WgsQ CIV'sF T/,P�S SUr' �z lao Tp p�A/� Tq<<FOfo� • t :EX13TI1N® SPOT ELEVATION �.O 1XISTING CONTOUR .--- ---- CERTIFIED PL01 PLAN. :' FINISMED. SPOT ELEVAI ION 5Moo mf4GA"® ° LaT S SHcoT FLYliv'&14144 /Zo/t6sx F111MD CONTOUR O \ c•-F-,y 7 ,F— ,P-V 1 Z E :NOTE: 'The location of any existing- un— derkA-off! sc:w��\sc , . .wells, or other utilities shown on. t} is°.'plan is ajrj)r IN a xa Amate only as determined from records-and/or verbs Tf in£ormution. The contractor is responsible tfor .the �,varification of the existing locations inkthe• field. SCALE° DATE 2 LE1fY & ELDREDGE ASSOCIATES' INC., I CERTIFY THAT` THE f'ROI'®SE,63,' JOB N®. SGo3o BUILDINO . SHOWN Old TH13 k,.PL ANENGI ��` PLANNERS-LANDSC�+PEARCHITECTS // CONFOR S `,70 THL ZON! (� '(,AaMSr'1 'PLANNERS- LAND SURVEYORS 3 0FCr—�DR w r ,AAA;, A 712 MAIIN STREET p CM'MT1 YA:'�PEE N� I .� 9VA��s• � rz N....a a�,p g@ /'�p T L� '"8.".-`�Kj.v�c,c-. 1�' 480'9�ZT..T�OF ",=M1�4,'/CE #.•''°�.::�4.. 9Y LEVY, ELDREDGE & WAGNER ASSOCIATES, INC. ENGINEERS-LANDSCAPE ARCHITECTS-PLANNERS LAND SURVEYORS - 669 WEST MAIN STREET CENTERVILLE.MASSACHUSETTS 02632 (617)775-2244 July 24, 1987 Town of Barnstable Board of Health 367 Main Street Hyannis, MA. 02601 Subj : Septic System Lot 25 Shoot Flying Hill Road Dear Sir: Please be advised that the Septic System at subject location was built according to the Proposed Plot Plan dated August 22, 1986. Very truly yours, LEVY ELDREDGE & WAGNER ASSOCIATES P 1 A. Levy, P.E. PAL/mlw 1043cn 88 WAVERLY STREET FRAMINGHAM,MASSACHUSETTS 01701 i s A , 3 N� �10 07 ' � Q Li ol r t 4 A� r4 ! LLERTIFY THAT THE .y SHOWN ON THIS PLAN IS M1yrv , LOCATED ON THE GROUND AS INDICATED PAULA. A \ LEVY . 0- 10617 7e00 TJ'V -7/10117 '049J DATE ISTERED r SURV OR r LEVY a EL.DREDGE ASSOCIATES INC. g.9Rvsrgatk CLIENT � V I PLOT PUMP- ENGINEERS �'ti — LANDSCAPE ARCHITECTS JOB NO.�. PLANNERS— LAND SURVEYORS DR BY IN 889 WEST MAIN STREET t:lD BY' CEltlTER !LLE, ice. 02632 .ET',,.4..OF. ... SALE, / 40 DATE.l 7U1 y`2 )4' LEGEND _ CENTERVILLE PROPOSED CONTOUR 1 ® PROPOSED SPOT GRADE ----� _ --98 -- EXISTING CONTOUR I. pip LOC S < WEQUAQET + 96.52 EXISTING SPOT GRADE `S'� LAKE W— APPROX WATER SERVICE 9 , 1 19 TEST PIT 0 9p SCALE: 1"=30' o 56 56 ROUTE 28 so 1 \ 58 LOCUS MAP v I \ ' LOCUS INFORMATION p\ "= \� PLAN REF: BK 408 PG 038 1710 ; \\ TITLE REF: BK 18993 PG 155 • ��'f \� I \\ PARCEL ID: MAP 192 PAR. 39-01 op �• O I Ir \\ I BENCH MARK o / r I �, N r � � FLOOD ZONE: "X" TOP OF FOUNDATION i as,'� �I COMMUNITY PANEL: 25001CO561J DATED:07/16/14 � I OHO � \ 57. 43 ; . SEPTIC SYSTEM N BARNSTABLE GIS DATU REPAIR PLAN �� ; LOCATED AT: ''° ff I `U°;' °m 802 SHOOTFLYING HILL RD. 20 ft x 58 _ �0 � ,M CENTERVILLEA PREPARED FOR _ ' STEVE HENDERSON \ I - I OWATER I 20 ft ® DRAIN I ' 251 6�--�— — — \\ GATE PA�/ED D IVEWAY TO 0TFL`(ING HILL Rp _ \\ I\ it % LOT 25 OCTOBER 12, 2017 AREA = 1.095 oc+— � PA( PL4N BOOK 408 38 aSSR MAP192 Ftt CL3 39-01 60— ---------_r_ DAf`\ESN-'��y\M ----- / l o. 1140 f P L AN 1 l � SCALE: 1 in = 30 ft ' �1 MNITWa O 30 60 8 w � 1 0 20 30 60 1i MEYER & SONS INC. P. O. Box 981 --� E. SANDWICH, MA 02537 PH. 508 360-3311 fax (774)413-9468 meyerandsonstitle5@gmail.com SHEET 1 OF 2 J 1680 l I NOTE: MAGNETIC TAPE TO BE PLACED GRADE SHALL NOT BE < EL•52.20 FOR A DISTANCE OVER ALL COVERS T.O.F. NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH _ EL: 57.43 NOTE: PLACE RISERS OVER ALL COVERS W/IN 6" OF GRADE FINISHED GRADE (56.0) 15' AROUND THE PERIMETER OF THE S.A.S. F.G.EL: 56.80 F.G.EL: 55.40 F.G.. EL: 55.0 VENT MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a• TOP TANK=EL. 53.41 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" STONE OR FILTER FABRIC a 6" DOUBLE WASHED STONE 4" SCH 40 PVC 10"t kEa ®®®• O ®®®® TEE'S ARE TO BE 14 6• S= 1%\0 (MIN.) ®®®®®®®®®® 4" SCH 40 PVC INV. 51 .65 2' EFF. DEPTH ®®®®®®®®®E3 INV. 52.10 INV. 51 .45 2 X 8.5' 4' EXIST. INVERT BAFFLE GASPROPOSED DB-3 •-"M ; DISTRIBUTION BOX EFFECTIVE LENGTH = 25Ar ' INV. 52.35 - (H-20) INV. ELEV.= 51 .20 EXIST. 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ?����` OF Mgsfe I BREAKOUT OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL, OR EQUAL D M AR N �' TOP CONC. ELEV.= 52.20 ELEV.- 52.20 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 0. 11 0 INV. ELEV.= 51 .20 �®®� �®® PIPE INVERTS PRIOR TO CONSTRUCTION - E3 ISMEM®®® . 2) D-BOX SHALL BE SET LEVEL AND TRUE TO E ®®®®®®®®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX SANITAR�p� BOTTOM EL.= 49.20 S FT. 3.75' ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN 3.75' 310 CMR 15.221(2) '6 i2 , 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 5.30 FT. EFFECTIVE WIDTH = 12.5' WITH GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGEDED,, OR UNDERSIZED. 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 43.90 _ SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON H2O LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA **NO PROPOSED INCREASE IN FLOW"' 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#: 15484 BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOM DESIGN 2 ALL WORK OF THE STATED ENVIRONMENTAL CODE, TITLE V A D S SHALL CONFORM TO THE ANY APPLICABLE DATE: SEPTEMBER 28, 2017 SOIL TEXTURAL CLASS: CLASS I (0.74 .GPD/SF) LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, CSE 1614 DESIGN PERCOLATION RATE: <2 MIN/IN - 310 CMR 15.405 (1) (B): DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. 1) A 0.80 FT. VARIANCE MIJ 310CMR15.221(7) TO ALLOW LEACHING WITNESS: DON DESMARAIS, BARNSTABLE HEALTH TO BE 3.80 FT (MAX) BELOW GRADE VS REO'D 3 FT. (H20/VENT PROVIDED) GARBAGE GRINDER: NO (not designed for garbage grinder) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Elev. TP-1 Depth 1 Elev. TP-2 Depth SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,000 GAL. SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE A A (330) = 445.94 S.F. DESIGN ENGINEER. 55.90 LOAMY SAND 0" 56.70 LOAMY SANG 0" LEACHING AREA REQUIRED: 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 10YR SAND 1OYR 3AN .74 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 55.32 7" 56.03 8" 1 ENGINEER BEFORE CONSTRUCTION CONTINUES. t' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B LOAMY SAND B L0� SAD USE TWO (2) 500 GALLON PRECAST H2O LEACH CHAMBERS W/ 4' 6. THE DESIGN ENGINEER IS NOT T RESPONSIBLE FOR THE FAILURE OF 53.15 OYR / 33" 53.15 34" STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF SANDY LOAM C SAVOY LOAM HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. C 10YR 7/2 1OYR 7/2 BOTTOM AREA: 25' x 12.5'= 312.50 SF 7. WATER SUPPLY PROVIDED BY MUNICIPAL WATER. 51.65 51" 52.03 56" 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED C2 FINE-MEDIUM C2 FINE-MEDIUM SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. PERC TEST SAND SAND 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY O EL. 50.32 2 5Y 6 4 Y TOTAL SQUARE FEET PROVIDED = 462.50 vs. 445.94 REQ'D THE / 2 5 6/4 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING3 - 49.2 80 49.70 84" DESIGN FLOW PROVIDED: 0.74 462.50 S.F. - 342.25G.P.D.( ) G D s. 330 G.P.D. req'd CONSTRUCTION. C3 MEDIUM C3 MEDIUM 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. 2.5SAND Y 6/6 2.SY 6/6 PROPOSED SEPTIC SYSTEM UPGRADE PLAN REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. 43.90 14 4" 44.70 144" 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 8O2 SHOOTFLYING HILL ROAD, CENTERVILLE ,MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PERC RATE <2 MIN/IN. (-C2- HORIZON) AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY NO GROUNDWATER OBSERVED Prepared for: Henderson 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. System Design and Topography Plan by: SCALE DRAWN 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. • 1. Darren M. Meyer. R.S.. CSE: hereby ce ' that I, am currently opp_ _ MEYER&SONS,INC. _. Y �Y roved by_MADEP pursuant to 310.CMR ts.017 _ N.I.S. - DMM. - 15. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED) to conduct`soil evaluations and.that the above analysis has been performed by me consistent with the - POBOX981 requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil EvaL Exam in October, 1999. EAST SANDWICH,MA 02537 DATE CHECKED SHEET NO. 508,W--2922 10/12/17 DMM 2 of 2