HomeMy WebLinkAbout0007 SHUBAEL GORHAM ROAD - Health 7 Shubael Gorham Road w
A = 171 - 131 r
Centerville J
! r TOWN OF BARNSTABLE
,�
L&ATION �� J tv i�Z S �ar�1. �� G _ SEWAGE# DC07-53
VILLAGE ASSESSOR'S MAP&PARCEL / l
INSTALLERS NAME&PHONE Na 1+ K
SEPTIC TANK CAPACITY I 0 06) f
LEACHING FACILITY: (type) -�' ICY (size)
NO,OF BEDROOMS
OWNER
l PERMIT DATE: COMPLIANCE DATE: 4271�
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 'v Feet
Private Water Supply Well and Leaching.Facility(If any wells exist
on site or within 200 feet of leaching facility) Al Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) a'�� Feet
FURNISHED BY
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J._� - 301
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Depaa tment of ReilthSafetyi and Envir-on ent-ns Semites /
PublicHealth NVISIOR s _ .
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C EJ��V�//� Addres§
Assessor's Map%Parcel: f 7 f h 3 f l—0� , ,�7i Engineer's Name
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NEW CONSTRUCTION REPAIR Telephone d SD$ S:�''j �
Land Use ���a�.a� ® �� Slopes(%) Surfa a Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft .
Drainage Way ft Property Line ft Othec '' it
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MethodUsed In.
Depth Ubserved standing in obs.hole: in. DePih to'scil triatttes.
Depth:to weeping froin side of obs.hole:
in, GmundwaterAdJustrnent ft
•RPadln� :---= Index Well level__ j.thdor Adj.Groundwatei Level--
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Depth of Pere
mir at
Start Presoak Time @ �(9'�'�
End Pre-soak
Rate Mi�1.�Rth
Site Suitability, sessrnent Sate Pam_ Site Failed: -- Ad€lition.€ci'festing�ieadwd
Cs;igi gal: Public iiealils Division
observation oJe Data To Be Cow-plete�on Bad—Copy- -�--
Applicant ;
I
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Depth from Soil Horizon Sol Te lnm Soil Color - Soil Other
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Surface(in.) (USDA) (Mot iQ Molting (Structure,Stones,Boulderes.
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Above 500 year flood boundary No Yes
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._.-- 9� 1 J TOWN OFBARNSTABI,E
C2� I
L ATION S1'1v &rr 4,e+ ack SEWAGE# e _6�77- 5-3�
VrLLAGE Cr n k r w/le, ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. ��, °rl • C� frf f e�
SEPTIC TANK CAPACITY ` 0 00 r'
LEACHING FACILITY:(type) Cf�j`'/lR`A (size) le? -Q r1
NO.OF BEDROOMS 3 ,
OWNER 2 'G
PERMIT DATE: 7 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility & i` Feet
Private Water Supply Well and Leaching Facility(If any wells exist f on site or within 200 feet of leaching facility) If1j/l
Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Iq Feet
FURNISHED BY
3� 301
No. 2-W� -s��{ ;
r�,
Fee.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Replication for Dtgogar *yztem Con.5tructiou Verna
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 7 JH eo - 6y>f'm �- Owner's Name,Address,and Tel.No. I-11A,H,6AWK&56V
Assessor's Map/Parcel I"7' - 131 DENAcrs /7,4 oa(0� 39S_go
Ins ller's Na e,Address,and Tel.No. 6V�-3 Designer's Name,A d ess 4nd Te No. S 59 V—
i�m CDIi 45, C S�14� �1-DCovi�e6��
'lope of Building:
Dwelling No.of Bedrooms 13 Lot Size JZ j05 sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ��3(� gpd Design flow provided -- qQ 'f gpd
Plan Date �( f J `' 0? Number of sheets / Revision Date
Title
Size of Septic Tank f Xt 5TI i)C- /oo a, Type of S.A.S. C
Description of Soil S �
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees toe e the construction and maint an e of the afore described on-site sewage disposal system in
accordance with the provisions o Titl of the Envi en 1 C an not to place the system in operation until a Certificate of
Compliance has been issued by t is o o ea h.
Signed q� Date 11 L7/01
Application Approved by V Date l — 7 '0 7
Application Disapproved by: Date
for the following reasons
Permit No. _?_OC) 3 Date Issued 1l- 4 7-0 7-
�, /
No. �� �� f �, Fee
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
a
21pplication for ]h6po$al lbp.5tem Con.5truction Permit
Application for a Permit to Construct O Repair(Upgrade O Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot No. J►iV - l9Un m T 14 Owner's Name,Address,and Tel.No. PIAf,yFNP,<1 eK54F1Y
Assessor's Map/parcel , , InA Q0�p� 39!S_q00q
In ller's Na a Address,and Tel.No. J7 - Designer's Name,A d ess and Te N . $ "�7
1gym Cb�rr�>yc 5 3 -�r�-�co ,Jv/
P0. &X77'5, MA QD4,4 r
Type of Building: P I
Dwelling No.ofB drooms - Lot Size _j /dam sq.ft. Garbage Gr rider ( )
Other Type of Building,? ` No.of Persons Showers(, ) Cafeteria( ) �
Other Fixtures
Design Flow(min.required) r �3e�o v R gpd Design flow provided "���(7 . `J - gpd
Plan Date. �(�� / '7 102 Number of sheets Revision Date
Title 1 �i
Size of Septic Tank ,EXI`JTI 06- /006 aOL. Type of S.A.S. � F_itI Cff k) �a�Z
Description of Soil Z-0141h V S14/0 ._� /�'l�o S��I� 7 IYI, `D/���.J S(�vyl�, _•
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees toensur�e the construction and main
t Nance of the afore described on-site sewage-disposal system m
accordance with the provisions of Titleof the En�ironm ne tal C d and not to place the system in operation until a Certificate of
Compliance has been issued by t is�Bo r o�f<Health.
Signed ` Date
Application Approved by �T Date ^--7
Application Disapproved by: t Date
for the following reasons
Permit No. ,?O Date Issued 1[- 1 7 o
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (!�
Abandoned( )byat -17 S 14u ba/__ �blt'l�I�IY7� y� hasgnocostructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. V 7"" -53� dated �1-17 ° -
Installer P671 Designer :Vyco ,FAAIIJ-�oAJIVk 129-L
#bedrooms ` Approved design flow , gpd
The issuance of this permit shall of bp
f y construed as a guarantee that the system l fd,ction as,designed�
/ )/f i,P
Date / ,!(/ / ` Inspector
-------- )—�j—�-----
No. _5 2 J Y Fee (�V
THE COMMONWEALTH OF MASSACHUSETTS
a
f
PUBLIC HEALTH DIVISION —BARNSTABLE, MASSACHUSETTS
ti
-Mtgpogar *p5tem Construction ermit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( )
System located at ? 54U$8EL.. 66,04 M, 60,
and as described in the above Application for Disposal System Construction Permit.The applic, recognizes his/her duty 4
to comply with Title 5 and the following local provisions or special conditions. -
Provided: Construction must be completed,within three years of the date of`this-per-mat.
Date 2- 7_G Approved by_ `�
�'Town of Barnstable
yorIHEr� Regulatory Services
Thomas F. Geiler, Director
BARNStABLE,
9q� b S. Public Health Division
AJfDN1D�p Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: /0-J-6 7 Sewage Permit# g?007-6 3Y. Assessor's Map\Parcel /
Designer: ! (ACO 1 f, W4nstaller:
Address: c-N Address: .3Y13 Hoc < t1w i'Z��l;,�_2Q. �Cj COX
On rl was issued a permit to inst+ 11 a `
(date) (installer) a
v .
septic systemxatr � .r� i �oI �:a�tg_ (Z(_ . based.on a design iawn-bp,
t:. (address) , o
:Ug/ Mis
r25dated
(designer)
I certify that the septic system referenced above was installed substantial y accoving M
the design, which may include minor approved changes such as lateral r._ocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
(Installer's Signature)
Tfh:Y <,
tvo.
(D signex's Signature) �F��sT���° �/T (Affix Designer's Stamp Here)
a
`ctiM _4
PLEASE RETURN TO BARNST �LIC_. HEALTH DIVISION. CERTIFICATE OF
COMPLIAINCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT C;kRD .,,_RE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q: Health/Septic/Designer Certification Form 3-26-04.doc
TO O/ _F- BARNS ABLE
60r�a `
LO( T10'i ��vba�� � SEWAGE#
VILLAGE �S' �"I��'V/(��— ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (ty ) �t 'J (size)
i NO.OF BEDROOMS
� /l
B $ER�OR O
PERMITDATE: 157 �
7 �eCE DATE: 2 no 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /z / Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Ede of Wetland and Leaching Facility(If st
within 300 feet of leaching facility `UVOWN Feet
ACCU SEPCHECK
Furnished by
S.DENNIS,MA 02660
=� blowUsd
lf'3
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A l
CERTIFICATION
Property Address: s 64 L O J a
C ell y�✓✓//►� l
Owner's Name: 1 0 d1r I C As cA C a �a O rCA MC b 0Wtj1 M'T'rj
Owner's Address:
8 410
6oX
��Date of Inspection: o '7 ��3
Name of Inspector:(please print) Joseph M.Martins
Company Name: Accu Sepcheck
Mailing Address: 17 Northside Dr., S.Dennis,MA 02660
Telephone Number: 508-385-5891
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based onmy
training and experience in the proper function and maintenance of on site sewage disposal systems.I;am a DER t-
approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.004 The system':
Passes
Conditionally Passes <` e �•{
,1
Needs Further Evaluation by the Local Approving Aumppty
Fails i
Inspector's Signature: &.4 Ali
cp� L,gl �h, 1-1
Date:
00 rn
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.
Notes and Comments: ` / /1 U i 4-PoQ / vv 14, O7
t,Q ti c P l I- / A Ie,-f P ��- S T-)}(A) Lj At 'P U-e h bt1 I
I" t l t . WrgV//C- e /ci a 0/
****This report only describe conditions at the time of insp
ection 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.
s Page 2 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: -7 Sc/�u bat0/ 6;v /JR A
Owner: r1
Date of Inspection• 0
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of on D
A. System Passes:
I have not found any information which indicates that y of the of
criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist Any failure criteria evaluated are indicated below.
Comments:
B. System Conditionally P
One or mores em 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.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.If`not fined"please
explain.
The septic tank is metal and over 20 years old*or the septic ether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank 1h* is imminent System will pass inspection if the
existing tank is replaced with a complying septic tank as ap ed by the Board of Health.
*A metal septic tank will pass inspection if it is sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is a ble.
ND explain:
Observation of sewage bac or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a bro ,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
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
obstruction is removed
ND explain:
4'
Page 3 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address bG / W✓N C!!M A/
Owner:—44A •-7 4
Date of Inspection:
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of H lth in order to determine if the system
is fining to protect public health,safety or the environment.
1. System will pass unless Board of Health determi m accordance with 310 CMR 15.303(l)(b)that the
system is not functioning in a manner which protect public health,safety and the environment:
Cesspool or privy is within 50 f a surface water
_ Cesspool or privy is within 5 of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank an
cyst p d soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
T The system has a septic tank and SAS and the SAS is within ne 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS' 'thin 56 feet of a private water supply well.
The system has a septic tank and SAS and SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used t etermine distance
"This system passes if the well w analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic ands indicates that the well is free from pollution from that facility and
the presence of ammonia en and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are tri .A copy of the analysis must be attached to this form.
3. Other:
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: jkboa?/ Clen 4w111l
r• v/ .L
Owner. rK, Ejr •�
Date of Inspection: t2od 7
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
oe clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_✓ _ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/Z day flow
_ tIi Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
_ �,,fo�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 coliform bacteria and volatile organic compounds:
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis most be attached to this form.]
(Yes/No)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 most serve a facility with a design flow of 10,000 gpd to 15,000
gpd-
You must indicate either`yes"or`no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinkin ter supply
the system is within 200 feet of a tri to a surface drinking water supply
_ the system is located in a ogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone H of a public supply well
If you have answered" es"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section 94bove 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.
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
/ CHECKLIST
��l Property Address: 7 y b 4 e// 6' r Aao,- JP,.,GJ_/1 60-lkp-alll-c A,#—
Owner• /7G/� r C �►
Date of Inspection: /8 .td d
Check if the following have been done.You mast indicate"yes"or ,nor 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
t✓ 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,evA ting the SAS,located on site
_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the Were
or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
_ Existing information.For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b))
Page 6 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
(�L L SYSTEM INFORMATION
Property Address: 7 �.J�1�)pQ,e l &v Lj4K. RAC r
Owner. rI C AS
Date of Inspection: 9 PS 1- d
O CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Number of current residents:0
Does residence have a garbagegrinder(yes or no): N 0
Is laundry on a separate sewage system(yes or no):h p[if yes separate inspection requiredl
Laundry system inspected(yes or no):6.<-tT
Seasonal use:(yes or no):_LJ 0
Water meter readings,if available(last 2 years usage(gpd)): /t(.2l Od v
Sump pump(yes or no):LV 0
Last date of occupancy:
COMMERCIAL/INDUSTRIAL C�G S �9lvn /✓'� cs 4 T S'YSltit
Type of establishment:
Design flow(based on 310 CMR 15.203): RDd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):—
Industrial waste holding tank present(yes or�n;Non-sanitary waste discharged to the (yes or no):—
Water meter readings,if avail
Last date of occu
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Py/n avi F{h�bo04 AM- j6W wT IO
Was system pumped as part of the inspection(yes or no): /lJ v
If yes,volume pumped: pllons—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)
_Tight tank —Attach a copy of the DEP approval
—Other(describe):
Approximate age of all components,date installed(if]known)and source of information:
Were sewage odors detected when arriving at the site(yes or no): INb
Page 7 of I l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
L Property Address: -7 __SAu
Owner:
Date of Inspection• ao to 7
BUILDING SEWER(locate on site plan)
Depth below grade: 2��-3 /
Materials of construction:vcast iron _40 PVC_other(explain):
Distance from private water supply well or suction line-
Comments
Comments(on condition of joints,venting,evidence of leakage,etc.):
,,c ct O!J a Q/17"t"
SEPTIC TANK: "'-(locate on site plan)
Depth below grade: .Z 0 11
Material of construction: ✓concrete metal fiberglass_polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate) Q x 'G k 7
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: oZ -7
Scum thickness: /(
Distance from top of scum to top of outlet tee or baffle: r�
Distance from bottom of scum to bottom of outlettee or baffle:
How were dimensions determined: ,�5r046w fed 47-7 eK C`"i Q Are--
Comments(on pumping recommendations,inlet and outlet tee or bale condition,structural integrity,liquid levels
as r lated to outlet invert,evidence of leakage,etc.):
v!nR/Al { o nz/Ih o� V C /�)l >L �•P•G /1P fir, '
/AVav
Pvt cd•t ftr{ o lecr ?
GREASE TRAP: (locate on site plan)
Depth below grade:—
Material of construction:_concrete metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of o top of outlet tee or baffle:
Distance from botto f scum to bottom of outlet tee or baffle:
Date of last p g:
Comment pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
i
Page 8 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFFORMATIO/N�(continued)
Property Address: sAt-461%ol A0V flair K �h ir✓/ In-f—
Owner• r it t C l^
nsp Date of Iection: t+0rJ
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 lyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/
Alarm present(yes or no):
Alarm level: Alarm in w ing order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: �(if resent must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
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.):
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
f
r
Page 9 of l 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) /�,,
Property Address: /C
--- �!�/V bQ�l �✓ �ar� � eer y�rAville
Owner: Pidli!C t se^
Date of Inspection: 'P/l ql 200
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type / (s'r'cc� �
_leaching pits,number:leaching _ X tD Sftn�e, /
leaching chambers,nu :
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/altemative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
/--I/ &v, L,P-eL s °mot— v-P G3'' AvaII4
1i o�
c-"A-c- is -a f P1'Of- inv's 40v, /
CESSPOOLS: (cesspool must be pumped as part of inspectionXIocate 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 o :
Comments(note condition of ,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, si raulic failure,level of ponding,condition of vegetation,etc.):
Page 10 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 7 Shubael Gorham Rd.,Centerville,MA
Date of Inspection: Hendricksen
8/19/2007
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
a
3
01
z_ a� �� _ 9,5-�
v
Pagel] of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner:Date of Inspection: 7 Shubael Gorham Rd.,Centerville,MA
Hendricksen
SITE EXAM 8/19/2007
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water ( '
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-if checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
N
Accessed USGS database-explain: 1 ��s Tjj,pd QqIIA 9'Q
You must describe how you established the high ground water elevation:
5 Cf ed.� = q, 0 9.s
3
2c,A q'S h4� te_ 9 z A 0,---1wwa-/�
C&�4vu vt Is 3
�; � rC/ C4
Town of Barnstable P I,
Department of Health,Safety;and Environmental Services
Public Health Dvsioin Date
367 MairrStreet,Hyannis MA 02601
t+u►sa. �i � .�- I
Date Scheduled � . f ime j Fee Pd. �
Soil Suitability Assessment for. Sewage Viyosalo
Performed By: ...............
Witnessed By:t�/V � �✓� ��� ,7
.:::.;:.>:;::::;:c:;::::.::.;:::.:: .............
Location Addres::::.:
s Owner's Name
7�H!/BAE� Gael1��I Sas�NT.H�v�I�iCKs�>Sf
Address
Assessor's Map/Parrel: 1 7///3 I Engineer's Name 7-C_)>JuMgS
NEW CONSTRUCTION REPAIR Telephone#Sa$38S;Z4RS
Land Use /C Slopes(%) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes 8c perc tests,locate wetlands in proximity to holes)
Lv
C=1 C
-11
•x�
Parent material(geologic) (�' $A r kCIAM Depth to Bedrock `
Depth to Groundwater: Standing Water in Hole: 09' Weeping from Pit Face
Estimated Seasonal High Groundwater
:;;«.:.::.:...............................:...:..:..: ...:t+'+t t : �. ; C� ::' ' Elt1 ::,_ E .::::,:.:::.:..:;:..:::::
Methodilsed .;:.::............................................................
Depth Observed standing in obs.hole: eA" in. Depth to`soil mottles: in.
Depth to weeping from side of obs.hole: _ in. Groundwater Adjustment ft.
Index Well#__-....,.... .Reading Date:__.__ Index Well level rli:factor�_ Adj.Groundwatei Level
:c;•>:.;:>:::•;r•:»s::;.::a::x�yy:.::
gum*
...........,,.
J.ate... L� ....
Observation
Hole# / Time;at 9" . -
Depth of Perc Time at 6"
Start Pre-soak Time® + l 3� Time ff'-V)
End Pre-soak 11,14r
Rate Min./inch
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-�
Copy: Applicant
Y: 1..!.....
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
' t c ° Gravel)
.:.::... .:...... : .:.....:::.;:. :.::;:.... .
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
%
lu
32-70'' &W �44 /V ykGfW 6?6 V 0 leg 4S
G_144
:.:::..:: . . ... . ......
:::::.
S
Depth from oH o So Texture Soil Color Soil Other:;.;:.;
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
nsistency.° Gravel)
Dun. H61
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,° el
Flood Insurance=Rate 1VIao:
Above 500 year flood boundary No Yes
.-Within 500 year boundary No. Yes
Within 1.00 year flood.boundary No_ Yes
t.
Depth of NV turally Occurring Peru dus Material
Does at least four feet of naturally,occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
i If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on I:� "i;tJ ! (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,exp rtise and experience described in 310 CMR 15.017.
Date
Signature I
No() ....... Fimis............. .......
THE COMMONWEALTH OF MASSACHUSETT!§
_rl I
BOARD OF HEAL M
1 .
.:.....OF.......
.................. 13
pplira -on for Uispasa Works Apu
"rn'
4' rin
-vm Application isN�ere y 10?ad�qir 4a =itto'Constl U or Repai'' nV I&nSewag(Z�f
System ap:
.................. ..................................
&,w F4
..... ....... ........ ........... .. .................... ........................................
cation-Address dr
I.A '0:----,
........ . ..... . -------- -------- ---------------------------- -——-------------- ........Z
... ..............
.
—,%Owner Address
.................. ............. ...........................................................
Installer
Address
Type of Building Size Lot___.. 0......Sq. feet
U Dwelling—No. of Bedrooms.____..11-7.............................Expansion Attic Garbage Grinder (lVf
�--4 ........
yp Other—Te of Buildin g --------.................... No. of persons.__..______.___..._______.__ Showers Cafeteria
Otherfixtures ......... ............................................................................
Design Flow.......
........................A,5_,....gallons per person per day. Total daily flow......S
W . ................................gallons.
P4 Septic Tank—Liquid capacity. ......gallons Length________________ Width______..___._.._ Diameter_____._._____._. Depth_______._____...
Disposal Trench—No_.................... Width_....._.___..___.___ Total Length.____._..___.__.._._ Total leaching area....................sq. f t.
Seepage Pit No.... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Other Distribution box Dosin tank ank
P _g_1
Percolation Test Results Performed by..- ......44. Date....9- .1,67-2 .............
-_Test Pit No. 1. minutes per inch Depth ol��est Pit____________________ Depth to ground water_._._._._..__..__.__._..
'0
44 Test Pit No. 2................minutes per inch Depth of Test Pit__...__...___._..___ Depth to ground water.___.__..__.__.____._._.
A.. ............................ ---;.....................w
S a — ----------4�1_1
•
x
Description of Soil.... ........... .. ... . ----
............... ......... ........7..........................................................
------------------
....................................................................................................................................................................................................
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 TME 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is u 0 by the b,?,cprdjof health. 7
Sig d... .............. . .. ....................
.......... .......................
Date
Application Approved By..----. . ..................... Date
Application Disapproved for the following reasons:................................................................................................................
.......................................................................................................................................................................................................
. Date
PermitNo............................................... ...... Issued...
.Di;---------" ----------------
NoQ
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O�F HEALTH
Appliration for llhipos al Workti Tnnitrurtinn Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System
t_-.1r, Z
Location-Address /''� Br,rLoteNo
¢ ?
...i.......•---..._.»...................... --•-•-•-- ............ .---•----................................................ ... ._...........
Address
.........
-.--- e. ner -
Ow
.�..... .<
�%' Installer Address
Type of Building Size Lot... .?..................Sq. feet
►� Dwelling—No. of Bedrooms......`":.............................Expansion Attic ( ) Garbage Grinder (Alty
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other,fixture - ..
,.�------------------........---- -------.------------
W Design Flow.......' ...... -.gallons per person per day. Total daily flow......" z. .�" ...................gallons.
W Septic Tank—Liquid capacityt. �.gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No......... Width............. . Total Length Total leaching area....................s ft.
..� <; g g Q•
Seepage Pit No... �_ . ..�•Diameter.................... Depth below inlet.................... Total leaching area..................s ft.
r°`A•il" P g Q•
Z Other Distribution box W DAW tank ( )
Percolation Test Results Performed by.--_- '} ..".'�...... .. ._.. Date...-9`-_.a�.. 2 ...........
,.� Test Pit No. 1. e'1«c.._minutes per inch Depth o Test Pit.................. .Depth to ground water........................
f� Test Pit.No. 2...............minutes per inch Depth of Test Pit.................... Depth to ground water........................
x - -
r� �'�
Description of Soil....._ --- u¢ "" � � .�r..- - .:. '__::
J
x
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 TITLE E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in.
operation until a Certificate of Compliance has been i Xi
by the b. rdrbf health.
Sig d..._ .1.t I ° ` 'D� ..`I�---
Date
Application Approved By.....• �'= .. ...C..... 1 ..,.. -� .:.:.. .......
Date
Application Disapproved for the following reasons:----•-------------------------------------------------•-----------------------------------------------....--••--
--------------------•--------•-----------......--------------......------.....----------•--•-------------._...-•-••------•-•...I.....-••----•------•••----•-------••••-•-•------••----•......-•••-----_..
Date
PermitNo...........................:.:.. Issued-.......................................................
Date
y:>
THE COMMONWEALTH OF MASSACHUSETTS
BOARD,-,,OW
EALTH
y
(9,n ifirFatr of Tomph anrr
THIS S ER FY t t ndividual Sewage Disposal System constructed ( ) or Repaired ( )
Iystal
as been installed in accordance with the provisions of T The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. ..... C.., . dated-......
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WIL FUNCTION SATISFACTORY.
_
DATE........... `.. _�[ ..-.. 4'-s....................•------------ Inspector-- .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
7 t� ...........f...r! ..........OF........ !1 .�' .-----
I........J.....
FEE...---.a............
Dispnlittl IV inn prrmft
Permission is hereby granted-"•-• GGr "'
to Construct r Repair (. ) In�i dual. vage osal Sy
at No.." � /r�i� = ` mot " •-. �'. ........... ...
T� /`.`t
- Street
as shown on the application for Disposal.Works Construction e i No. _... ated.._ e d". ........
t ........... =
.......................
Board of ealt
DATE...... ........................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
LLo C-Alzs.ac-c- GRI 4��E:Z- 1 3 1
1~Low r- 110 -4 S t '33o G.P.D. 13 2
-�EPT1G TA+-I1G = 330V Imo % • 495 6.PD.
IJS�- IUOb 615.L. Z8//ct5a,,�
I-)ISPCK L.L PtT - I-JSE 10cx:> GAA-.
�IT.>`J�C�ALL �E-a = 150 1 �.3
ISo St= 9 2.S + :!,S7715 �. �. ��� �4�
S C�
15CrrMAA QtZt� = d SP.
SD Sri. K t .o = So s p.V. \ NCD
TOTAL 'p ESI6Q = .425 G..P.D. l
J
TbTQ t_ t7Qt L>-( FL.Otiv = 330 6.PD. � AT 24
�><g
PMlZGDL&TIOLJ �ZhTE U ZMIw OR 1845.
V.
/ V U - rAwvr A'
A/ o
AV f �'
Piro
9q, y Tor Fwo s loo.o
4.
luv• 97 0
r ioe I Ood 111V. ',A
S�> ,c711„ 4r IW GAL.
T-A0tK
Sht,Jtay l oOo 95,8 lwv IW.
4Le,4rA
1% ad
PIT
1
WASWILD
STONE 8 ci,
CE�'TtF1EL7 PLbT PL A.V-1
FlizoF•-ii LoCATto"
tL ►.Jo e,,-_ �'; CAL IIN 60rT tA.Ti` 17-13177
GG12T1F�j THAT TI4F-- I=otj*ADA.notA '5"0,.u►.1 P1--4tJ R�F�c�E�.tGE
GC)AAPL`!S W tT4A TWZ: ( 6�" t 17J/2
Quay SCTL��Ct< �C-4u1�Etit�uTS �1= TIC >.-
-(ow►J Or-- A '_iv S"f A. �� Cta F11 Ek=VILL(; �,I i
I •
va-rc . � �� (� - g a.XTLtiz. �`. u�E ►�.sc.
tZEGlS to IZGt� LAIW0 SuZuC�Yo�S
'['1-�15 ht-At-I 1 ►aoT �AScv vk.i A�1 o5-TEevtL-lC o MA.sS.
tiPP1-1 C-A.tiJT
r ' 1 .4 �j
nit �/) (.C_...
y
SiUGt� G;tanntL�l.'t �' izaoNc� � � — :-
l10
ii t&, ! FLOW %IC) x•3 S30 6,pt7. .
�E-PTIG,�TA�.11C �:37�O.r.ISC%+4�C7 6.P.D. 132 -
sIOOb 6A .. Z8�/G25p` r
�715PO�GL'':PIT uSE IOOo C-.AA-. [l1
4x4-.:�(�E1V4LL CI•Ea
dl N
7 ' -'k'8OT'lZ'�Nl.Q2F.G•c 'Gip 5T•.
[t1 cd
TOTAL �ESIGIJ=425 G.P.D.
TbTo I-` �ii of FLDtiv 330 6 PD. zi
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LOCATION S ON OF BARNS&dSEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL 1�7/ 43/
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS �4J--3 30
-Dal
OWNER Q,9 y`
PERMIT DATE: 112// a/75! COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
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) _A"� J Feet
FURNISHED BY- �,
LOCATION SEWAGE PERMIT NO•
71ot 132 S_huabel Gorham Ad. 79-805
VILLAGE
}
Centerville MA.
INSTA LLER'S NAME i ADDRESS
Alfred Faller
Cotuit Ad. Marstons Mills, MA.
R U I L 0 E R OR OWNER
Alan E. Small, Inc.
Bog 536 C _ntervi l l e, MA.
DATE PERMIT ISSUED 4/25/80
DATE COMPLIANCE ISSUED
1
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DESIGN CALCULATIONSg
I r4UM9ER OF BEDROOMS TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR OR CRAWL SPACE
GARBAGE DiSPOSA UNIT _ _ 10 FT. MINIMUM FROM SLAB
ELEV. = 100.00 10 FT. MINIMUM
TOTAL ESTIMATED FLOK -- CLEAN SAND
( 110 GAL/BR/DAY X fit.) ___ __ GAS./DAY (ASSUMED) CONCRETE
REQUIRED SEPTIC TANK CAPACITY _____ GAL. COVERS LOAM AND SEEC
i I ACTUAL SIZE OF SEPTIC TANK
4" SCHEDULE 40 PVC PIPE
SOIL CLASSIFICATION I MIN. PITCH 1/8" PER FT.
LAYER OF
DESIGN PERCOLATION RATE <_ s__ MIN./IN. ^"
EFFLUENT LOADING RATE -�!4_ GAL./DAY/S.F. �� �� 1/8" TO 1/2"
\, WASHED STONE N'
LEACHING AREA -_�_ SQ. FT. / 4' CAST IRON PIPE VET
LEACHING CAPACITY (AREA X RATE) GAL./DAY ��JJJ I (OR EQUAL) MINIMUM � NO REQUIRED
! P TCH 1/4" PER FT. \\ I z
I I �
RESERVE LEACHING CAPACITY _ ''"_ GAL./DAY
V Y ELEV. srr FLOW LINE
) ` FLEV o ` 1 ` I
WIN EV
LEVEL r � o ° DDT CDC ` . ... i
ELEV. GA` E.E _ - n`- -ELEV. s . , < !
^ t
t -
� / „ 1 BAFFLE
-- r
1 � . 7"7tj' _ �D« z ' DDCuD ^ D � CD ;�
LIG. ID
4 FE T TLET HES - - M _ r i
(TO E_ ;:LAC-D 0)\, FIRM BASE) ��• Trr % o
I i �: TG EL WATER T t R TES � L 3 ✓t?� 5 Gi,�l J,`r '�.5 M'' � � `j�., `� • 7�
FF�ET - lk.0 •':CS C'XI JCTI�y�C' IF WORE THAN ONE. GLITLET ';• � I
6 FcET y {�� i ire :_ n' kLiVrh' f0
FEC'T H e n1..4 �i (TO SE FLACCD ON FIRa: EASE) �' - _
3/4" TO 1 1/2- CLEAN'-!- I �.r P _"
\ 1 c ... R' AN DOUBLFREE E
NHS & SILT
STONE � �' • �• i.YAS`
\� ctib�i ... ► . t F t.
..:.. v r, USES PROL mac .L WATER TABLE ELEV. -
A "'` DISPOSAL c"�L�' '%R0 LEr, OBSERVED WA 1[1.- TABLE CLEV -
\\ t NOT TO SC BO'TON OF TEST HOLE ELEV.
I
I
/ NOTES:
/ SOIL TEST ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5
/ DATE OF SOIL TEST ____^_________ AND THE TOWN RULES AND REGULA11ONS FOR THE SUBSURFACE DISPOSAL
OF SEWAGE.
SOIL. TEST DONE BY _____�_-_� =- 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF
WITNESSED By
--------. FINISHED GRACE.
/ OBSERVATION HOLE ELEV.=_-____ 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
DERCOL;-TION RATE <_2 MIN./INCH AT _______ INCHES 10 FT. OF DRIVES OR PARKING AREAS H-2C LOADING SHALL BE
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS
G DEPTH I HORIZ TEXTURE COLOR MOTT. I CTHER 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE
MORTA.REG !N PLACE
` 5. NO DETERMINATION HAS BEEN MADE AS TC COMPLIANCE WITH DEEDED
O � 0 7` ���' �G OR ZONING REGULATIONS OWNER / APPLICANT IS TO OBTAIN SUCH
*i DETERMINATION FROM APPROPRIATE AUTHORITY.
9� T��`� + �, 41414
; 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR
_._ IS TO CALL "DIG-SAFE" AT 1-888-34a-7233 AT LEAST 72 HOURS
`Vt1' PRIOR TO COMMENCING WORK ON SITE.
/ 77 CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS
\ 4 '�� / NO WATER ENCOUNTERED AT _- � 1! .7 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE AN
96.4 ELEV' _ - - VARIA ION IS TC BE BROUGHT TO THE A7ENTION OF THE DESIGN
ENGINEER IMMEDIATELY.
t 97.4 G`l' / OBSERVATION HOLE 2 ELEV.= ��' _ 8. PARCEL IS IN FLOOD ZONE
a
PERCOLATION RATE _<� MIN./INCH AT --_____ INCHES LOT Is SHOWN ON ASSESSORS MAP AS PARCEL
1 _ I
+P
DEPTH HORIZ TEXTURE COLOR Mill OTT. OTHER
�9.5 r�
LOT 1,T2
- -� APPROVED: BOARD OF HEALTH
96.3 �, �� NC WATER ENCOUNTERED AT ELEV.
TANYA �`y��� , PROPOSED SEPTIC DESIGN
x 5" pAICNEA'JLT FOR
'�� 1095 0 �� OAK% NDRICKSEN
�FCI STE�'� /PIQrW
\ o �, --� j� f Jj ��, y•vim. l�Q^ ` PRO : 7 SHUBAEL GORH" RD.
� o - � . ,,fry•..
^ f ° ARN.STABLE, MASS
� ! - �'� QP /CE,�I TER `✓y �
9 \ 97.0 LOCUS
TADCO ENVIRONMENTAL CONSULTANTS
95.3� _�C*
9\8.0 2 COMPASS LANE, DENNIS, MA. 02638
�--- 98.7 � ,,�\� I ;508) 385-2425
LEGEND: 7. p '
EXISTING SIP', ELEVATION x0.0 / 96.4 / \\ —(98) j DAT ; SCALE ^ " - �.'
EXISTING CONTOUR ----00---- 95.6 �' - I -
FINAL SPOT ELEVATIO,�N //,j lam ► "T ( J
FINAL CONTOUR --LNJ-- 11p L 5,O
i��,._.
SOIL TEST LOCATION "B REVISED t., �` I JOB NO.
UTILITY POLE r ,� + ! a I
TOWN WATER —W ..60E—W
CATCH BASIN ��) \ QOAD
GAS LINE �G L G�RHAM 1e LOCATION MAP ; REVISED SHEET 1 OF 1
CESSPOOL �P E
CLEANOUT —� C.O. ����� C: I SB l PRO,' 6614-00 dw_o 6614-sas.Dh'v fo 2007 TADCO