HomeMy WebLinkAbout1344 SHOOTFLYING HILL RD - Health 1.344 Shootflying Hill Road, Centerville
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Commonwealth of Massachusetts �t
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean =°
Owner Owner's Name
information is
Centerville /
required for every ✓ Ma 02632 5-12-'15.
page. CitylTown State Zip Code Date of 1pection
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 A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector: �� a
key to move your
cursor-do not Matthew F. Gilfoy
use the return Name of Inspector
key.
B&B Excavation
,Q Company Name
14 Teaberry Lane
Company Address
Sandwich Ma. 02644
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
5-12-15
Insp or'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.
****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
h the same or different conditions of use.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
page. Cityrrown 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
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
R e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
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 1/2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
i
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
page. CityfTown 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
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
page. Cityrrown 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): 330
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d see Below
9 ( Y 9 (gP ))�
Detail:
2013-90gpd 2014-55gpd
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
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
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
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:
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
4 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
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:
New leaching added 2010. Tank was existing
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
1'4"
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
At time of inspection building sewer appeared to be in good working order no sign of leakage.
Septic Tank(locate on site plan):
10"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallon
Sludge depth:
3"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
page. Cityrrown 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
33"
Scum thickness 1
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
15"
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.):
At time of inspection septic tank appeared to be in working order,Tees present no sign of back-
up.Liquid level equal with outlet invert.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
i
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,.' 1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is
required for every Centerville Ma 02632 5-12-15
page. Cityfrown 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:
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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
.'y 1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
required fo is Centerville Ma 02632 5-12-15
required for every
page. Cityrrown 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
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.):
At time of inspection d-box appears to be in working order with no sign of carryover.
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.):
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
4 v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: (20) H-20 arc
3616
❑ 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.):
At time of inspection leaching appears to be in working order with no sign of hydraulic failure. No
high staining or back up present
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
page. Cityfrown 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:
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
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r� 1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is
required for every Centerville Ma 02632 5-12-15
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:
Z hand-sketch in the area below
❑ drawing attached separately
3 O
CClWA OjF
O
�ear I
4
Aq 3g'
AS - S9. bz- 3o• Cz- -L,
63- IS' GI. 48'.
64-
GS- 67'
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
I
Commonwealth of Massachusetts
M - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
Z Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: No Gw 137"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: 11-11-10
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 at 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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1344 Shoot Flying Hill Road
Property Address
Janet McLean
Owner Owner's Name
information is required for every Centerville Ma 02632 5-12-15
page. Citylrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
TOWN OF BARNSTABLE
LOCATION %-; 14 4 S� OLA V" ,t d SEWAGE# 71(t40 r � S
VILLAGE Z"VI'Itc ASSESSOR'S MAP&PARCEL 1?q
INSTALLER'S NAME&PHONE NO. Cap.ew�e�e 4;.k.a� 3 y 2 c/vim
SEPTIC TANK CAPACITY JoOo \-1,1 o y s}v�r
LEACHING FACILITY:(type) Lzo) 4 c .?(®( l# 11 Z9(size) I t - 9 X ZS-
NO.OF BEDROOMS .3 t
OWNER 3 PA
PERMIT DATE: t J 2610 COMPLIANCE DATE: 1 (- l(o'Z.mCa
Separation Distance.Between the: ,
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N c, it 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)).. e feet
FURNISHED BY ( ioQs1 �'�TC�'�✓(��} LLL
a
. � C
:J60
ft q 61 97.o
i� S 3 z s-9•s 30.� c� a4.s iA
0 c2 aa•a I .
B4 41"a
"bS �� o
No. 0j T, Fee do
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�/
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppYicatiou for Misposai 6pstern Construction Vermit
Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 'I 3 Li� S'6aT Fh j� 4'(( Owner's Name,Address,and Tel.No. Tctn rt m G 1:�vvn
ee,i,re_, . C J t�i`I Y 57u�r�Gc+a 1AA4
Assessor's Map/Parcel c�.,7'S G�tl�evN 4,;4-
Installer's Name,Address,and Tel.No.e, 604 k i►/&pre$eS Designer's Name,Address,and Tel.No.
26 �p it �w.yi9o �
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size Si b�2 sq.ft. Garbage Grinder( )
Other Type of Building Sih i� No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.re uired{ gpd Design flow provided gpd
Plan Date I t .t *2-6 1 Number of sheets Revision Date
Title 13u,N SL.t At,;,
Size of Septic Tank I 00c; Type of S.A.S. 5-ply,�S }
Description of Soil s {)��.,, �+ �' << u 3 -3 `r
Nature of Repairs or Alterations(Answer when applicable) +P� -tt� oX
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site Y
sewage disposal system in
P
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Date I
Application Approve Date
Application Disapproved by Date
for the following reasons
Permit No. NO [L75 Date Issued
No. p/l g 40
• � D+. ..,. r - ,w - "' Fee
TH, E C-010MONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS . Yes ,
01pplitation for 30isposal *pBtem Construction permit
Application for a Permit to Construct( ) Repair VQ Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components
Location Address or Lot No. ( 3 N,,` S h o T N.� , I+r 1( Owner's Name,Address,and Tel.No. I-0t^rj m C,)z A rl
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Vike.5e5 Designer's Name,Address,and Tel.No.
u Viz ,% i�.' ..0� 4 �.��, ,,� �• .
Type of Building:
Dwelling No.of Bedrooms 31I f Lot Size � � ,1v42 sq.ft. Garbage Grinder( )
Other Type of Building `Jr� t� 4� No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.re uired gpd Design flow provided gpd
Plan Date l I ( 1 Zb t v Number of sheets "��,. Revision Date
Title I 3LW
Size of Septic Tank 1 000 Type of S.A.S. 5 /c)VA-)S
r,
y Description of Soil ��L
Nature of Repairs or Alterations(Answer when applicable) t S ti tom 3 oK
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
ed Date lI- ! Z ' 2oIJ
Application Approved Date
Application Disapproved by Date
for the following reasons
Permit No. Oo/D ,Y5 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired VI-) • Upgraded( )
Abandoned( )by �AOGv+r� T Qr�5 t S L.L I-
at 1 3�y 5 t+ �i ��-►�( 2 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No -'Y5_6 tdated I51at3
Installer (_9A ftw&, -P kK C�1 l C Designer F,yi(/6"4,lj Won,ki
#bedrooms_ Approved design flo gpd
The issuance of th s pe t shall not be construed as a guarantee that the system wil ctiI as de 'gned.
Date 1) 1 l u Inspector 1
i
-- ------ -
No. & J Fee f00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstrm Construction 3pCrmit
Permission is hereby granted to Construct( ) Repair(y() Upgrade( ) Abandon( )
System located at t 3q -1
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 ust be completed within three years of the date of thisermit.
Date J y � J?p Approved by �_ �
11/16/2010 21:40 5084775313 ENGINEERING WORKS PAGE 01
--....__.. _......_..._....--
Town of Barnstable
Regulatory Services
Thomas F. Geller,Director
l l Public Health Division
Tbomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
.Date: I l(V ) 0 Sewage Pern1w 20 to -qJJ Assessor's Map/Parcel Z
Installer&Desis mer CertiiiDcation Form
Designer: We4"r-f�. �V--+4{-t-c �.� Installer: (,{,cue.Wide Fhl44K- S&e4
Address: " �✓:!I' W01'l t S h C, Address: P•O, A 5�c 7 6 3�
CID l l J Zot 0 �c1fP �'� _ was issued.a permit to install a
( ) cc (installer)
er)
septic system at 13_y_l _ J mot- l y LNS tj 11 12d based on a design drawn by
(address)
d yt C dated i I It I I 0
(designer)
I certify that the septic system referenced above was installed substantially according to ,
the.design, which may include ininor approved changes such as lateral relocation of 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.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if re0. inspected and the soils
were found satisfactory. ytH OF Aet�
PETER T.
0whilMCENTEE
ler's Sign tore) civet
9 No,35100 C
F re
�t ��.
(Designer'sSignature) (A ix tamp ere)
PLEASE RETURN IQ BARNSTABLE PUBLIC HEALTH DMS1924 CERTIFICATE
OF COMPLIANCE W11,L N T BE ISSUED UNTIL BOTH T S F RM AND AS-
CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DMSIM,
THANK YOU.
gAoffice formMesigwmertiScation to[na,doe
k
t Town of-Barnstable P#
Jj Department of Regulatory Services
Q � t � (
a Public Health Division, Hate. 1
1639 200'Main Street,Hyannis MA 02601
' tN1a
f�Date Scheduled D Time M. U,t✓ .
Fee Pd.
Soil Suitability Assessment for Sewage isposal
Performed By:— @^�"���. �v�-f-¢Q ![S
Witnessed By: 1N S
LOCATION&GENERAL INFORMATION -
Location Address �?J(` (o SvL�U fII�� I�(c/l� �"� i"!� wner's NameYlCI
Q�CvIT'E4✓✓Z 1l3! Address 1�/`f' l
Assessor's Map/Parcel: Sa — Z� te�"M 19 Q
Engineer's Name
�1-e�Rz� Fw
NEW CONSTRUCTION REP AIR Telephone# �—7 '7 rp
Land Use PQ- t Slopes M ( �2 Surface Stones _
Distances from: Open Water Body 7 t ft Possible Wet Area ft Drinking.Water Well `�-6 $
Drainage Way t S U ft Property Line �d � ft .'Other
SKETCH:(Street name,dimensions of lot,exact locations of test holes&:pert tests,locate wetlands i'n proximity to°holes)
Yy ( I1
Parent material(geologic) u" SAS Depth to Bedrock AJ/C3
, f _ n �
Depth to Groundwater. Standing Water in Hole: " / " /�T Weeping from Pit Face
Estimated'Seasonal High Groundwater f 3 2 t o N Co
DETERMINATION FOR SEASONAL HIGH WATER T LE' Pa.
Method Used: "
Depth Observed standing in obs.hole: _ in, Depth to soil mott'as -•---
Depth to weeping from side of obs.hole: in, Oroundwater Adjustment f
Index Well.# Reading Date: Index Well)eVci. -„ Adj•factor Adj.d' ufldwater 1,,mrn
PERCOLATION TEST Date_._ � Thne
Observation
Hole# I_ Time at 4" _
Depth of Perc �-�� .3
Time at 6
Start Pre-soak Time @ G 15 a 9"-6") _
n rft� (
End Pre-Soak
Rate MinJlnch.
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:ISEPTICIPERCFORM.DOC
DEEP.OBSERVATIONHOLE LOG Hole#:
Depth from SoilHorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA), (Munselq Mottling (Structure,Stones;Boulders:
it vl
SL ao'Ve /,Z
L TINt ca
raw
372. c M ud Sot,,
z
DEEP OBSERVATION`HOLE LOG Hole#
Deptkfrom Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling. (Structure,Stones,Boulders..
Consistency.%
Cs f� s L LC3 0 k-
o 3
Z
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:
Sur&ce.(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders:
Congiste
Flood Insurance;Rate Man•
Above';SOU'yearfloodboundary No _ Yes _
"Willa"n'SUO'year'boundary No. Yes
Within 100 year flood boundary No_61— Yes
Death of Naturally Occurring:Pervious Material
Does°at-least fourffeet.of naturally occurring pervious a. n exist in all areas observed throughout-the
area ro osed for the soil absorption system?
-�
P ,P. _ -
if`riot,what is:the depth of naturally occurring pervious.material?
Certification
I'certify that ondate)I have passed the Soil evaluator-examination approved by the
analysis rformed by me consistent wi
Department of Environmental Protection and that the-above a was
y Pe
the required train expertise and experience described in 310 CNIR 15.047: `
-�- Date
1>
Signature cd
0SEPTIMERCfFORM:DOC
r
-\ COMMONWEALTH OF MASSACHUSETTS -
3
EXECUTIVE OFFICE OF ENVIRONMENTAL AF S hCrgirlow CIP.-
`�►
DEPARTMENT OF ENVIRONMENTAL PRO TRW 3 j997 +_
k
ONE WINTER STREET, BOSTON, MA 02108 617-292-5500, lOWNOFQ �
� HEACTHpFSjAB(E
V
y
A
WILLIAM F.WELD E y Y COXT
Govemor Secretary
ARGEO PAUL CELLUCCI DAVID 0-STRURS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissima
PART A
CERTIFICATION
Property Address: ii3� �� ' Address of Owner:
� '� 9
Date of Inspection: .27 (If different)
Name of Inspector:
am a DEP approved system in o pursuant to Section 15.340 of Idle S (310 CMR 1S.000)
Company Name: Q 'r4l se4ta;eey
Mailing Address: /lr 41A d 335-7
Telephone Number: 617— at 3-5,562-O
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 functiam and
maintenance of on-site
sewage disposal systems. The system:
X Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: � �i" ) Date: 7
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing the
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]_SY/STEM PASSES:
'7C I have not found any information which indicates that the:system violates any of the failure criteria as defined in 310 CMR 1.5301-
Any failure criteria not evaluated are indicated ow. I -
COMMENTS: • w-,. 2 �q sty.
11/I��k sill -
6] SYSTEM CONDITIONALLY PASSES:
One or more syste nents as described in the "Conditional Pass" section need to be replac d: The system, upon
completion of the replacemen air, as approved by the Board of Health, will
Indicate yes, no, or not determined(Y, N, or ND). Descry is of determination in all nstances. "not drmed"explain why t.
The septic tank is metal, unless the owner or ope as provided th tem inspector with a copy of a Certifi of
Compliance (attached) indicating that the tank was instal in twenty prinr to t of
the septic tank, whether or not metal, is cracked, structurally unsoun , ws substantial infiltration or exfiltration, or W*
failure is imminent. The system will pass inspection if the existing septic tan laced with a conforming septic tank
as approved by the Board of Health.
(revised 04/25/97) Page 1 of 10
DEP on the World Wide Web: http:/Mww.rnagnet.state.ma.us/dep
Printed on Recycled Paper
i
M
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A.
CERTIFICATION (continued)
�� � � II AAf✓1 /
Property I Address. J 3`i` .SLed4'
Owner: kR•
Y s
Date of Inspection:
BJ SYSTEM CONDITIONALLY
PASSES (continued) tj
Sewage backup or eakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a br en, settled or uneven distribution box. The system will pass inspection if(with approval.of the
Board of Health). Des 'be observations:
broke ipe(s) are replaced
obstructi n is removed
distributio box is levelled or replaced
The system required-pumping_m e.than four.times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the and of Health):
broken.:pipe(s)are eplaced
obstruction is remo
CJ FURTHER EV�LLUUATION IS REQUIRED BY THE BOARD OF EALTH: 'l
Cond1 0 s exist which require further evaluation by the Boa 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 HAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND HE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetl d or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATE SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLI HEALTH AND SAFETY.AND THE, .
ENVIRONMENT:
_ The system has a septic tank and soil absorption system (SAS) and the SAS is ithin 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 ne 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 t of a private water supply well.
The.system has a septic-tank and soil absorption system and the SAS is less than 100 eet but 50 feet or more from a.
private water supply well, unless a well water analysis for coliform bacteria and volatil organic compounds'indicates that
the well is free from pollution from that facility and the presence of ammonia nitrogen a d nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not va'd).
3) OTHER`
(revised 04/25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A .
CERTIFICATION (continued)
5�tov - � }ta( a�P C,�„ .ejZJi 11 c
Property Address: 13` `4 �/ h
Owner:
Date of Inspection: Ay q *,.7
D] SYSTEM FAILS: l V
You must indicat ei
vier""Y s" or"No" as to each of the following:
I have d rmined'that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this de rmination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge o nding of effluent to the surface of the ground or surface waters due-to an overloaded or clogged SAS or
cesspool.
Static liquid level i the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspo I is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more t n 4 times.in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorpti System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy i within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is wi in a Zone I of a public well.
Any portion of a cesspool or privy is within 0 feet of.a private water supply well.
Any portion of a cesspool or privy is less than feet but greater than (cepe
ee�� ater supply well with no
acceptable water quality analysis. If the well has n analyzed to be ac attach copy�f I.water analysis for
coliform bacteria, volatile organic compounds, am nia nitrogen and nigen.
E] LARGE SYSTEM FAILS: d1A
v
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 Bove:
The'system serves a facility with a design flow of.10,000 gpd or greater (L a System)and the syst m is a significant threat to
public health and safety and the environment because one or more of the f owing 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 Are IWPA)or a mapped Zone 11 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 roundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for furt r information.
(revised 04/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST `
Property Address: S�loo �Iy l�� ( �! C ,evi.II'
Owner: v at C",< G5 /
Date of Inspection: A A 5 pV
l 7
Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following:
Yes No
.. _ Pumping information was provided by the owner, occupant, or Board of Health.
)l _ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection. -
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.
_ The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
X _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition,of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ The facility owner(and occupants, if different from owner) were provided with information on'the proper maintenance of
Sub-Surface Disposal System.
_ 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) [15.3043)(b)J
C� wQ
0SiV54-09— (Le
p �
5e p' ;C_ PwU fC.►1 ;,J A442 9y a,,do J,...e 716
L•
(revised 04/25/97) Pago 4 of 10
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 13*44 S4od
�- 07'
Owner: "4.9. MTri4e-[
Date of Inspection:
7
qq9
V FLOW CONDITIONS
RESIDENTIAL:
Design flow: ;36 a.p.d./bedroom for S.A.S.
Number of bedrooms:_
Number of current residents:
Garbage grinder(yes or no):-tjo
Laundry connected to syste es or no):$e s
Seasonal use (yes t
Water meter readings,
if if available (last two (2)year usage(gpd): )z O
Sump Pump(yes or no):_A)6
Last date of occupancy:
COMMERCIA STRIAL:
Type of establishment:
Design flow:__gallons/day
Grease trap present: (yes or no)_ `
Industrial Waste Holding Tank present: (yes or no)_ N r
•�
Non-sanitary waste discharged to the Title'5 system: (yes or no)_ • �=L�l.y
Water meter readings, if available: /II
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS nd source of informati
t. wc4lt. o L rG<A 0 . L
Sysfem pumped as part ��&c
or no) O
If yes, volume pumped: s
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)
VA Technology etc. Copy of up to date contract?
Other - --
APPROXIMATE AGE of all components, date installed (if known) and source of information: (q�e1 i.JS '�rafl P� m'�r
Sewage odors detected when arriving at the site: (yes or no)
i6te..... aeeT;J ws�24 4
l� k, Y Lee.,e., e e � X'/�.- c% a r.
P P �
Oise 'ts . OJO.J vse-n �o we-eto.. Vs 6 3 Pco
(rwiaod 04/25/97) Page 5 of 10
. 4
SUBSURFACE SEWAGE DISPOSAL_SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 13W St-4v4- 4:1 y oiS
Owner: V4 a. pj,cJ m t 1 JcZ••S
Date of Inspection: _ Y ALI 97
SOIL ABSORPTION SYSTEM (SAS):—y<S
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined toMbe present, explain:
f
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 f hydraulic allure, level of ponding, condition of vegetation, etc.)
o� a.•., k r�� AfeC C�
CESSPOOLS: _ �UI�
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet inv
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
indication of groundwater: r�4-�y Xe
inflow (cesspool must be pumped as pa f inspect(on)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, ondition of vegetation, etc.)
PRIVY:_ /�
(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:)
(reviaad 04/25/97) Page 8 of 10
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 3T� ske"6 4— fr( r�J 14M
Owner: I-J.*t4oj W-0� r
Date of Inspection: 1,/ A*9 '.7
BUILDING SEWER: '
(Locate on site plan)
Depth below grade: /
Material of construction: _cast iron_40 PVC_other (ex J.Kel
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:, C.
(locate on site plan)
Depth below grade: 6
Material of construction: )Cconcrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal, list age_ Is age confirmed by Certificate of Compliance _(Yes/No)
�,L s_ -w x Y' 4 at) by pa w
Dimensions:
Sludge depth:. `
Distance from top of sludge to bottom of outlet tee or baffler
Scum thickness: 2 •r ��
Distance from top of scum to top of outlet tee or baffle:_
Distance from bottom of scum to bottom of outlet tee or baffle: �2,
How dimensions were determined: 0tC4S&PC-# .a T j4'c k
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffleplepth of liquid level in relat' n to outlet invert, structural
integrity, evidence of leakage,top
eee,.�...1 e.. JeA
P
• GREASE TRAP:—A�]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�ion 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)
i�'IWIT
. ..
Property Address: 134 S46A rr W/Il 46a C.-Jal✓-11-1%.'
Owner:
Date of Inspection: �� q
J
TIGHT OR HOLDING TA (Tank must be pumped prior to, or at time, of inspection4A
(locate on site plan)
Depth below grade:.
Material of construction: _concrete _meta Fiberglass_Polyethylene _other(explain)
Dimensions:
Capacity: gallons 1 /�
Design.flow: gallons/day �
Alarm level: Alarm in working order_Yes; _ No J. ket
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and.float switches, etc.)
DISTRIBUTION BOX:X
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of so ids carryover, evidence of leakage into or out of box, etc.)
' 'rvn D Sd 2
CdV - a -
e
PUMP CHA
(locate on si7plan'Pumps in wrder: (Yes or No
Alarms in working order((Yes or No) A J �
Comments: I"
(note condition of pump chamber, condition of pumps an nances, etc.)
(revised 04/25/97) Page 7 of 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
_ PART C
SYSTEM INFORMATION (continued)
Property Address: '3'�y $�so d�- ��y��J Ls. 4.V
Owner: t tx. e1$%C e.Q.( "I "
Date of Inspection: Zq � -
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)
H00 P
neck-
L c e cl
.
30l !b
O
aZD�
SS
(revised 04/25/97) Bag. 9 of 10
�a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued) '
Property Address: 134 SLcot R r% [it �t Zo
Owner: wt
Y
( Iry L r s
Date of Inspection: vZ� 5
�1' 7
Depth to Groundwater _ Feet JU o 4— dCt n- eJ'
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
_ Observation of Site (Abutting property, observation hole, asement sum 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)
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nnrooses.
(PREVIOUS
i. BALANCE
WATER BILLS UNPAID AFTER(30)DAYS FROM DATE OF ISSUE ARE SUBJECT PAYMENTS
TO INTEREST CHARGES, AND TERMINATION OF SERVICE FOR ACCOUNTS &CREDITS
PAST DUE (120) DAYS. ALL IN ACCORDANCE WITH CENTERVILLE-
OSTERVILLE-MARSTONS MILLS WATER DEPT.RULES AND REGULATIONS. INTEREST
TELEPHONE:(508)428-6691 CHARGE
FROM TO n I e6A
017/9`'r' 12/'15 1 0174_ 3313 19
FAT(::3 F'E.l} •T•I••I(JUS3r'1t D G d_.1..(Nl.; EXCESS CHARGE» 5j. 10
$J`i.. 00 t IUAR T E.RLY MINIMUM PERIOD COVERED MINIMUM
$2- 90 OVER 20 K. TO is 00 K JAW-MAR 96 CHARGE » 1 „ 00
CCTNSE:fc'..tC r RI.-F'AI1t LEAKS!
ANI.41JAL IN-fEf--,E 3'T RATE 14% U a 7()„ 10
RN 951
AFT .
REVIOUS
fr r .i ,L'. IiS �IU1f ® BALANCE
WATER BILLS UNPAID AFTER(30)DAYS FROM DATE OF ISSUE ARE SUBJECT PAYMENTS
TO INTEREST CHARGES, AND TERMINATION OF SERVICE FOR ACCOUNTS &CREDITS
PAST DUE (120) DAYS. ALL IN ACCORDANCE WITH CENTERVILLE-
OSTERVILLE-MARSTONS MILLS WATER DEPT.RULES AND REGULATIONS. INTEREST
TELEPHONE:(508)428-6691 CHARGE
E�iiK;tD,'CO'1�.E12�D P�tE O,U��E ��. URI2E �Il�IG E ���1o�8r<� a � E
U r F
_ FROM ,,,,.. .TO
1/95 c !95 I.C):1'7 V:'4 37
1=KFET 7 t'El;, THOU`:;AND (3Ad_.t_(JN1'3 EXCESS CHARGE y 49. 30
$15. 00 GTtlA=1Fi 1'E•T.'LY MINIMUM PERIOD COVERED mmmUM
$1'.• 90 OVEI'. 2() 1(. T i3 2()0 1(: Jt/L..Y-al�:f' 5 CHARGE � 15.1 0()
ANNUAL 7:#.!'Il:BEST RAI E. 1.4% �Rffl
��WAT ER LAWN 01-F' PEAK I{(BfJl::3! ! :�:t �'.,, 64.. 30
1114 959
O _ PREVIOUS
4 y- BALANCE
WATER BILLS UNPAID AFTER(30)DAYS FROM DATE OF ISSUE ARE SUBJECT PAYMENTS
TO INTEREST CHARGES, AND TERMINATION OF SERVICE FOR ACCOUNTS &CREDITS
PAST DUE (120) DAYS. ALL IN ACCORDANCE WITH CENTERVILLE-
OSTERVILLE-MARSTONS MILLS WATER DEPT.RULES AND REGULATIONS. INTEREST
TELEPHONE:(508)428-6691 CHARGE
FROM TO 001'80' A1. ..`* ..
0'7/S9"r 12/94- 996 1 C)3'7
RATE'S PER THOUGAND GAL..T_.(JW EXCESS CHARGE y 60. 9(
$15. 00 L•TUAR TE RLY MINIMUM PERIOD COVERED I MINIMUM
$2.. 90 OVER, 20 K T 0 200 K JAW-MAR 95 CHARGE ■� 15. G(
$3„ 9!"; OVER c-100 K
HAVE A SAFE AND HAt,F,Y NEW
YEAR! ANNUAL JN'T'f. F:l_ iT• RATE:
14�C '7.i„ r
SERVICE ADDRESS ACCOUNT NO. PREVIOUS
1344 S1400T FLYING H:C►_L RD 7 L5S BALANCE
WATER BILLS UNPAID AFTER(30)DAYS FROM DATE OF ISSUE ARE SUBJECT PAYMENTS
TO INTEREST CHARGES,AND TERMINATION OF SERVICE FOR ACCOUNTS &CREDITS
PAST DUE (120) DAYS. ALL IN ACCORDANCE WITH CENTERVILLE-
OSTERVILLE-MARSTONS MILLS WATER DEPT.RULES AND REGULATIONS. INTEREST
TELEPHONE:(508)428-6691. CHARGE
PERIOD,COV,ERED: PREYiOUS,METER CIJ�tRENTMETER CONSUMPT ;ION'' CiJRRENT
FROM TO
READII!IG,
ADING , I000'S OF GAL, CHARGES „=
0 i./97 06/97 1175 1.202
EXCESS CHARGE �(}w 3U
RATES PER THOUSAND GALLONS
`Ri 5a OO QUARTERLY MINIMUM PERiODCOVERED MINIMUM
$2. 90 OVER 20 K TO 200 K JULY—SEE 917 CHARGE 15. 00
$3,. 9 i OVER 200 K
PLEASE LIMIT OUTSIDE:.
WATERING FROM 8:OOAM•-8:OOPM IMP:�.QFiSS 4.roT
ANNUAL INTEREST RATE 14 U7/O?/97aMOurrrnuE 35n 3Q
EIS! 929
RETAIN THIS PORTION FOR YOUR RECORDS
SERVICEADDRESS - CCOUIVTNO. PREVIOUS
Iy3 a . . .:. .< — _tr BALANCE
1344 SHOOT FL.YING t4-nI riD 7 i58
WATER BILLS UNPAID AFTER(30)DAYS FROM DATE OF ISSUE ARE SUBJECT PAYMENTS
TO INTEREST CHARGES,AND TERMINATION OF SERVICE FOR ACCOUNTS &CREDITS
PAST DUE (120) DAYS. ALL IN ACCORDANCE WITH CENTERVILLE-
OSTERVILLE-MARSTONS MILLS WATER DEPT.RULES AND REGULATIONS. INTEREST
TELEPHONE:(508)428-6691. CHARGE
•,. PERIOD COYERED,� ', * REVIOUS METER URRENT METER CQNSUMPTION ' t CLIRREN;T
FROM TO BREADING: :wREADING`;= .a. 1000.s OF;GALr C$ GES
O 7/96 j 1.2/96 i.i.44• 1.17G;
EXCESS CHARGE .-
RATES PER THOUSAND GALL.ON;3 �1^ `'0
10.5„ 00 QUARTERLY MINIMUM PERIOD COVERED MINIMUM
$2. 90 OVER 20 K TO 200 K JAN—MAR 97 CHARGE � 10.. 04
WATER IS A PRECIOUS RESOURCE �
PLEASE REPAIR ANY LEAKS! AT�OF�SSUE TOTAL '�ti
ANNUAL INTE.r�I-:.� T' RATE 14X 01/0wl/9? OUNTD 4�n 9C?
DN 944 - ----- _��
RETAIN THIS PORTION FOR YOUR RECORDS
S_ER_VICE ADDRESS �" ; b I . . "'NT N0. s PREVIOUS
.� -.
fare SHOOT FLYING (t.tt._t_ RD 71 5l.3 BALANCE
WATER BILLS UNPAID AFTER(30)DAYS FROM DATE OF ISSUE ARE SUBJECT PAYMENTS
TO INTEREST CHARGES,AND TERMINATION OF SERVICE FOR ACCOUNTS &CREDITS
PAST DUE (120) DAYS. ALL IN ACCORDANCE WITH CENTERVILLE—
OSTERVILLE-MARSTONS MILLS WATER DEPT.RULES AND REGULATIONS. INTEREST
TELEPHONE:(508)428-6691. CHARGE
PERIOD;COV..ERED'�+ PREVIOUS'METERe CIJRRF.NT:METER GCINSUMPTIONm CURRENT' >�'
FROM TO AD h , xREADING' . I000's OF GAL ��HARGES ,
%.3 6
1•1••10I.J':,(iN) Gfli..i-_(7Ns
EXCESS CHARGE 31. 90
$1 f.. 00 I.lt•►or I L-5ZLY MINIMUM PERIOD COVERED
" �T—M,NIMUM
1ULY : t S' CHARGE2U } K
`. < (
G2« ii OV�F c ) K TO
P1AI1_:C�-!!a AT}l:'I��!"_•`.:i`'i C:t•1(-1t�1Gh:;�i'
r�ll)V!cil_: LI;a► �,',DATE OPISSUE TOTAL
RATE- 14-14. (i l/t}I is�; AHtouNTuvEI�� 46. 90
No.. .:. .b FizB .....
�:
THE'COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...........................................O F..........................------..........---.------.._...------------------..----........
Applira#ilan for Uiipusal Workii Towitrurtinaa ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: J
�lpti G P Lo jtion- d ess � or Lot No.
a _ dress
..------.....-----
.........•..... •....-.......... ow
............. ............•........----- .........��J ........ .........................! ... ----......_..._...... • ...
Installer �P/J
Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms........ ................ .. .Expansion Attic ( ) Garbage Grinder ( )
i✓' �_:.... No. of ersons____________________________ Showers — Cafeteria
p., Other—Type of Building .... .... p ( ) ( )
a' Other fixtures ----------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width....._.......... Diameter__._-__-_-__.._- Depth................
x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
R+' ----•-•-------------------••----•-•-----------._....._....-•--•.....----•------......__....•----._..........•--....--••-•••----.......-••.._..-•••-•--•------
0 Description of Soil........................................................................................................................................................................
x
c.,
W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
UNature 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 TITLi- 5 of the State Sanitary Code-The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
0
Signed
Application Approved ...........��%?� Cam[ Dat
Date
Application Disapproved for the following reasons-----------------------------•---------------------------------------------------•-----..........................
---------------------------------•--------------....------------------------------------------------•---•---------------•-------------------•-----------------------------------------------------------
Date
PermitNo--------------------------------------------------------- Issued.......................................................
Date
JW Fim$................:r'.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................... ....................OF.....................................
.
Appliratiun for Uiupu,aal Workii Towitrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sys em at•
----
.. Lo t /
on �dcl#ess I� t e or Lot No.
••-••--- ............................ .............. .................... - -- .....................................................
ow r s 0
/for
a : = or
..............••-......................................... _....... . -• ..... :... ....... ..------------•--- •---•-- .
Install.. er._ iy Address
� Type of Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms............. _____________________________Expansion Attic•,( ) Garbage Grinder ( )
a'4 Other—T ,�✓e ✓+
Type of Building __�_______ ___________ No. of persons.......................----- Showers ( ) — Cafeteria ( )
Otherfixtures ------------------------•-------------------------•---....-------------._..._...------------..__...-----•---...__........__...---••-••-._._.....••-••-
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................. Diameter-_.--___________ Depth................
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area.............:_:....sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date-----....=
Test Pit No. 1............:...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........................
01 •-------------------------------------------------------------------------
•-------------------------
--------------------------------
•-••-•---••--------
__----
0 Description of Soil........................................................................................................................................................................
x
W
•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-
U Nature of Repairs or Alterations—Answer when applicable.............................................................................___................
------------------------------------•---------------------------------------...•--------•--•........--•-••••--•---------------------•-••---•--••-•--•---------••••-•--••-•-•---••-...•---------••---•-••
Agreement:
The undersigned agrees to install the aforedescrib%d Individual Sewage Disposal System in accordance with
the provisions of TIT11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the board of health
Signed.__ 'y (✓'. � "t�4-.
__ •••. •-.--.•• --- ate. ...
Application Approved B !A- ------- •-••• 1 .. .
����- -• �� Date
Application Disapproved for the following reasons----------------------------••-•-.................-1a--•------•••-----------•-----•••-•-•--•Date..............
----------•-----•---.......--•----•---------•-----••-----•-------•••-•••--•---•------•••-••-•••-----••----•----•-----••---••-••••-•-•-•-•••-•--••••---•---•••---•------•-•---•••----•-••--•-•••...._....
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF................... .......
(9rdifiratr of Tomplianrr
THIS IS TO, ERTI Y, Th the Individual Sewage Disposal System constructed ( ) or Repaired ( )
inst
�/I •- -------------------•----.......--•------------
has been installed in accordance with the provision of TIT r 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No... �._`_` ___________________ dated------------------------..-..._.................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................................... . ...... . ...=----------•-----------. Inspector......... ft
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.f ...........................................OF.....................................................................................
No....:.................... FEE...,: f......-�._
nfit
Disposal _ ork onu lion ,,'
Permissionis eby granted---- ------------••---------------------------------------------------------------
to Constru ) or epair ( „fyd'vidual Se�Ta osal S t ,
at No r �.
Street
as shown on the application for Disposal Works Construction Permit No................. Dated..........................................
.........................................
oard o Aealth
DATE.................................. =Y/V. .............•--•-
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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LEGEND
,
i
LrX1�TLN0 SPOT ELEVATION 040 �h`Tt� of a��� , � cER� II�IED �°L®1` IPLA6V • , �� p'
xra�Tro CONTOUR --- o _ . a ' '
1�11�1NHE4 ' 'SPOT ELEVATION A R c r, L.=T I
WISHED CONTOUR
ORSE '
o ,A No.10951�Q ydie,
F
OVED �OA OF H�ALT� .. �QC �•� ,� Q• \�Ll r d$r
ECG �
E A®ENT
SCALE� I ' ,lc, 4
DATE s �:2a,e2 G
CL1SN7`t Drti�Cn.;
E�rst` --- 1 CEf�TOVT THAT: THE
PRSiPoa�l3 rh`j ,'
w Il�41STE�OtED JOB NO,
tl i CIVIL:, LAND BUILDING SHOWN ARI THIS I'L AN
F� �r RV DS.SY�-..... ,,...�;, CONFORMS THE ZONING t.A�YS
vc 0� 01�1R1V8T11® t ,
" 712 MAl N STREET CAI. f®Y� '
M 'A N N I s,. AAA$
or
AT , FILM. 'LAND SUs�Vl:YOIt
T
OCATION p SEWAGE PERMIT NO.
. VtLLAG,E
eAl le.
INSTALLER'S NAME a ADDRESS
BUILDER OR OWNER
DA-T E- P ERMIT ISSWE0 zi
DAT E C0M ►LIANCE ISSUED G
W
Y
CIO
-aq � \
Y)k CC
g a '
2 �
t;
Woadvale �or,aa^ �� LEGEND
_ o
D
N cor6eka^�^ —— 104-— EXISTING CONTOUR t
EXISTING LEACH PITS
x 100.98 EXISTING SPOT GRADE t TO BE PUMPED & FILLED
W EXISTING WATER SERVICE Bench ork E. Se f i W/SAND AND ABANDONED
Great Marsh Rd G EXISTING WATER SERVICE TOP OF SONOTUBE ��
L` EL.=101.34 (Assumed datum)
r �.H:W.— OVERHEAD WIRES
TEST PIT x 101,28 `� Pr' 131 (�
D
Gyve+y>i�a cif LOCUS BENCHMARK ` ---_-----, 1��--\\) �\\ p8 231
_ nor 1 10-- - SPIKE
ti + 1b0.84 -INSTALL
CLEANOUT
EXISTING SEPTIC TANK
Rota 0 �\ (TO REMAIN)
TOP OF TANK, EL.=100.47
LOCUS MAP DECK 0 INV.(OUT)=99.14f
NOT TO SCALE
C 051 �� `J6t. Shed /01,18 �\ 01.
2� i
% EXISTING i 0�.
HOUSE(#1344) Q
ACP
T.O.F.=102.47f 1
x 100,40 -��Q�p�`�, x loo.86
TN `ic�'TP-1 100,93 ` 101,03 ------___ J
I � >' 100.46 _--
-,ffl.04
I _
Paved LOT )
(LOT
Driveway 1
000 APN 189-128
/ 167.08' ----_ _ 15,692 S.F.t
0 .21" - 100.33 100.43 131
.74'N 19'53'09" E
99,43
N 25'32'S E
edge 99,75 of pavement �� 100 06
100 100 MAG. NAIL SET 100.19 100.68
99.84 99.47 100.00
SHOO TFL YING HILL ROAD 0 F Mgs � �
�H
GENERAL NOTES: o PETER T.
McENTEE
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. a CIVIL '
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL No. 35109
BOARD OF HEALTH AND THE DESIGN ENGINEER. 8• THERE ARE NO WELLS WITHIN 150' OF ;THE PROPOSED S.A.S.
�O � OWNER OF RECORD
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS A AEG/SZE� `�
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 'pO,rFS � JOHN McLEAN
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE SI NAl l�� �l(((� 1344 SHOOTFLYING HILL RD
LOCAL RULES AND REGULATIONS. DIRECTED BY THE APPROVING AUTHORITIES. CENTERVILLE, MA 02632
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PROPOSED SEPTIC SYSTEM UPGRADE PLAN
DESIGN ENGINEER. CONSTRUCTION.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 1344 SHOOTFLYING HILL ROAD, CENTERVILLE, MA
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN IN THE AREA BENEATH AND FOR 5' ON-ALL SIDES OF THE S.A.S. AND Prepared for: Ca ewide Enterprises, P.O. Box 763, Centerville, MA 02632
ENGINEER BEFORE CONSTRUCTION CONTINUES. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). P P P
5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE Engineering by: SCALE DRAWN JOB. NO.
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. Engineering Works, Inc. 1"=20' P.T.M. 226-1 O
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. (508) 47775313 11/11/10 P.T.M. 1 Of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
t4 FINISH GRADE SHALL NOT BE < EL.91.3
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
I DECK
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT
T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE
F.G. 100.8(MAX.)
EXISTING
F.G. EL.=101.2f F.G. EL: 100.5t
MAINTAIN 2% GRADE (MIN.) OVER S.A.S. �Dc6 EXISTING
RUA=
5 6g 5 HOUSE(#1344)�
INSPECTION Z ♦ T 0.F.=102.4 7t
L = 71' L = 7'(MAX) ,� S ♦ 4.3 '
® S=1% (MIN.) ® S=1% (MIN.) PORT �, SP ♦ 1
4"SCH40 PVC 4"SCH40 PVC I ',% O ' 63.3' 3
s" ,
10"I s" ��♦ PLOP � ,
14^ 10.75" To �' 58.7
EXISTING 48' LIQUID INVERT ,
LEVEL INV.=97.67 PROPOSED INV.=97.50 4 ROWS OF 5 UNITS AT 5.0'/UNIT = 25.0'
ADD
GAS BAFFLE
INV.=99.14f D-BOX INV.=97.40
EXISTING
SOIL ABSORPTION SYSTEM (PROFILE)
EXISTING SEPTIC TANK S.A.S.LAYOUT
ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS 6-t-4POLYSEAL
" fINTS
NOTES: 21" „
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE 2
INVERTS, PRIOR TO INSTALLATION. BREAKOUT=TOP .'' ,',.
TOP ELEV.=97.83 �
2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=97.40
GRADE ON A MECHANICALLY COMPACTED SIX ci INCH CRUSHED STONE BASE, AS SPECIFIED BOTTOM ELEV.=96.50IN 310 CMR 15.221(2). 2.83'
3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5 MIN. ABOVE BOTTOM OF
T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3'
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE N To View
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. EXISTING SUITABLE P D-6OX Section
NO G.W., EL=89.4 = MATERIAL
USE 4 OF36HC UNITS WITH
SEPTIC SYSTEM PROFILE SEPARATIONSBETW EN DEACHcROW & NO STONE NO �63.25"
N.T.S. TYPICAL SECTION
1s"
SOIL LOG
34.5"
DATE: NOVEMBER 10, 2010 (REF#13,125)
SOIL EVALUATOR: PETER McENTEE PE
WITNESS: DAVID STANTON R.S.
DESIGN CRITERIA HEALTH AGENT TOP VIEW
ELEy. TP- 1 DEPTH ELEy. TP-2 DEPTH
NUMBER OF BEDROOMS: 3 BEDROOMS 100.5 A 0". 100.41 A 0"
' - 60"
SOIL TEXTURAL CLASS: CLASS I SANDY LOAM SANDY LOAM END CAP END CAP
10YR 4/2 10YR 4/2 FRONT VIEW SIDE VIEW END CAP
DESIGN PERCOLATION RATE: <2 MIN/IN 99.8 B 8" 99.6 B 10"
REAR/TOP VIEW
DAILY FLOW: 330 G.P.D. SANDY LOAM SANDY LOAM
DESIGN FLOW: 330 G.P.D. 10YR 5/8 10YR 5/8 NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
GARBAGE GRINDER: NO 97.5 36" 98.6 34" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
C 1 C1 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
LEACHING AREA REQUIRED: (330) = 445.9 S.F. M-C SAND Hillill 4640 TRUEMAN BLVD
.74 M-C SAND 2.5Y 6/4 LL .HILLIARD, OHIO 43026 Arc 36HC DETAIL d
2.5Y 6/4 20% GRAVEL ADVANCED DRAINAGE SYSTEMS,INC.
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 20% GRAVEL PROPOSED SEPTIC SYSTEM UPGRADE PLAN
I
PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM) 94.5 C2 72" 94.4" C2 72" 1344 SHOOTFLYING HILL ROAD, CENTERVILLE, MA
USE 4 ROWS OF 5-ADS Arc 36 UNITS WITH NO
SEPARATION BETWEEN EACH ROW & NO STONE MED. SAND MED. SAND Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632
2.5Y 7/3 2.5Y 7/3
GENERAL USE APPROVAL FOR 4.80 SF LF OF UNIT Engineering by: SCALE DRAWN JOB. N0.
BOTTOM AREA:
( / ) 89.5 132" 89.4 132" Engineering Works, Inc. NTS P.T.M. 226-10
(Arc36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF PERC RATE <2 MIN IN.-RECORD C" HORIZONS 12 West Crossfield Road, Forestdole, MA 02644 DATE
(� ) CHECKED SHEET N0.
DESIGN FLOW PROVIDED: 0.74(480.0 S.F.) = 355.2 G.P.D. NO GROUNDWATER ENCOUNTERED (508) 477-5313 11/11/10 P.T.M. 2 of 2
i