HomeMy WebLinkAbout0039 SOUTH PRECINCT ROAD - Health ESouth Precinct Road, Centerville
I
�III� _ q 2J�PECVLIFD�Om
UPC 12543 o-
No. 5� °on.CoNS���
HASTINGS, MN
TOWN OF BARNSTABLE
LOCATION 3 _SEWAGE# .*?
VILLAGE C-rN�-&ry AIV ASSESSOR'S MAP&PARCEL 143
INSTALLER'S NAME&PHONE NO.�3c ,Pt
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) `i 0Q ! 1 C V6N C 1nr (y (size) �''y, 1 X '.5 X'
NO.OF BEDROOMS
OWNER 'Fa J J o,,i
PERMIT DATE: I a 13 COMPLIANCE DATE:
Separation Distance Between the: Nerve C�:vCc»NL FF'�
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility C rim '(C 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 , Feet
FURNISHED BY �� -1�
:Deck.
1
f
I
yNo. �.a� �" � Fee
4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for Misposal opsom CoYCompiete
ttlon VPrm
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) System Individual Components
Location Ad rpss or Lot No 2 S ,��/ 5r,��Lt �(�e.Nr t Owner's Name,Address,and Tel.No.
;ZJ Ce-vr.elat11 sae ��1/v
Assessor's Map/Parcel/Ef�j - /V 3
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
d7elv5�e�S 1�JfCOti Zi 4C 5OF,...1VC0.7fS S 5'05-V77--3-71-�;
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size %�,_/Z5 sq.ft. Garbage Grinder( )
Other Type of Building 1jay y•e No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided 35-7, '3 gpd
Plan Date �rl�y/� Number of sheets Revision Date
Title T�
Size of Septic Tank Type of S.A.S. 'Z 5 00 y�./fy�/ Leta,,,•f?r/s W ra �t j*,V
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) .�s
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.
Siorne. Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. B1 3,qq b Date Issued g-
No.:
Fee
THE COMMONWEALTKOF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYitation for Vsposal:,e* $t, Ylt �Constr ' ttion hermit
,.
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) Complete System Individual Components
Location Ad r ss or Lot No. S 3y F(eCr,vC r Owner's Name,Address,and Tel.No.
CeN l-elot 111- -Pq ., /I&"/
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Ovo14s A c3rc N a-Nc S00-4/a7- 7/5-S
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size S/2 sq.ft. Garbage Grinder( ) +
Other Type of Building hyv 5-G No.of Persons Showers( ) Cafeteria( )
a
1N Other Fixtures
" Design Flow(min.required) 3✓U gpd Design flow provided 36- • -3 gpd
Plan Date //Ar/Z. Number of sheets Revision Date
Title.
Size of Septic Tank 115 c /iNj Type of S.A.S. 5 ��-/Gv�✓ r!A k,-/S W 'v 5,�-,vr
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Z�5 fo N r'cJ
Date last inspected:
Agreement:
1) ders T heigned 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.
Si !y-_ Date
Application Approved by A Date /
Application Disapproved by Date
for the following reasons =
Permit No. Q I Date Issued !-1 1
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO-CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(" ) Upgraded( )
Abandoned( )by �..�6,y C,5
at 3°( 5 E VX e c Nc- CerV*Gi(y Ate
has been constructed inta/ccordance
with the provisions of Title 5 and the for Disposal System.Construction Permit No., I f-7 i dated
Installer'Do--?,,\ cS / Designer s,,r cr wj JAA, -/c s
#bedrooms !� / '� Approved des' n ow 7 30 gpd
The issu a is' e ' i all ot. : construed as a guarantee that the system wil ctio as d sig• d'
C.-� - U
Date Inspector ,%
- --- ---------------1-----
No. -I (U Fee uG�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Bisposal &pstP11�.Construction permit
Permission is hereby granted to Construct( ) Repair(�/) Upgrade( j Abandon( ) f
System located at 30/ .5&Vo,-,k p/,rcre•ct- d
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:Constructio must be completed within three years of the date of this permit.
Date I z 1 /� Approved by
Town of Barnstable
Regulatory Services
t Richard V, Scah,.Interim Director
16As9.. ]Public Health Division
�b Thomas Mclean, Director
200 Main Street,ayannis, MA, o26d1
Office: 508-862-4644 Fax: 508-790-5304
Installer & Designer-Certification Form
Date: At 13Sewage Permit# Assessor's1Map\Tarcel 1`{ 1%_{�
9�,�,
Designer: C XztstaIler: 'V. A , ' •�,. rc
Address: �� .C.�c�z ,�tS i Address:
v �
On UL �' - ��'v� �^� was issued a peznlit to install a
(date) taller)
septic system at `-` . Ir'� vim- er:rye "�b'ased on a design drawn by
to ', n-k2r. sL Owr � dated «__ � ( r �3
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relccation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major caanges (i.e.
greater than 10' lateral zelocauon of the SAS or any verdeal relocation of any component
of the septic system) but iu accordance with State & Local Regulations. Plau revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
were found satisfactory.
_ ? certify that the system referenced above was constru with the terms of
the 11A. approval letters (if applicable)
PE7'FR T.
� RRc�NTIrH
02z:
C1VI6,
NO.361pS
taller's Signature) dare
NAL
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION, CERTMCATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH TMS FORM AND A.S-;..
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC 1 EALTH DIVISION.
TRAM YOU.
Q-Septic\Desiper Cettificaticn Form.Rev &_14.13,doc
Town of Barnstable P#
. Department of Regulatory Services
: Public Health Division Date
KAM
p
200 Main Street,Hyannis MA 02601
Date Scheduled � $ "�� Time a i 'Fee Pd. �V
Soil Suitability Assessment for Sewa DAS saw
dn✓ ,,/^ iG,� J/l
Performed By: / 4—� Witnessed By:
LOCATION&GENERAL INFORMA ON
Location Address 1,S��� P(�:i�C Owner's Name�i
k 0111
L /►1T� Le. Address 'V E1 l-�-,� ��
,.
Assessor's Map/Parcel: /.� O '-' 3 Engineer's N e V
NEW CONSTRUCTION _ REPAIR 1 Telephone#
Land Use ? S-'ALA f-1�(`-� Map-M) 1 '- Surface Stones rJor a �e
Distances from: Open Water Body?3� ft Possible Wet Area_&jA It Drinking Water Well Z)eft
Drainage Way ft Property Line y fl— ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pcn;tests,locate wetlands in proximity to holes)
v
1, trgM1
Parent material(geologic) V Jay _�/4 Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: !� L Weeping from Pit Face � _ t
Estimated Seasonal High Groundwater
r� Z t
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: 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 Adj.factor Adj.Groundwater Level_
PERCOLATION TEST Date Time
Observation 2�
Hole# Time at 9"
r
Depth of Perc ` Time at 6'
Start-Pre-soak Time B �� `Oyj Time(9"-6')
End Pre-soak l
Rate MinAnch L Z
Site Suitability Assessment•.. Site Passed�_ Site Failed Additional Testing Needed(Y/N)
Original:Public Health Division Observation Hole Data To Be Cotnpleted 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:\SEPTICIPERCFORM.DOC
DEEP OBSERVATION HOLE LOG Hole#1_
Depth from u Soil Horizon Soil Texture Soil Color Soil' Other
Surface(in.) f (USDA) (Mansell) Mottling (Strucnae,Stones,Boulders.
Consisten Gravel
6 -4 f3 l.S to .
4-2y �, s co �!
z -i3 - C 5 2•S`f-N
DEEP OBSER TATION HOLELOG Hole# -Z✓
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Maasen) Mottling (Structure,Stones,Boulders.
Consistency-° Gravel)
0 —6 A `/
f3, t,5 kaya-fl&
z ssY E a
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA), (Mansell) Mottling (Structure,Stones,Boulders.
!- %Gravel)
l
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture r .Soil Color .Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
nsisten vel
Flood Insurance Rate May:
Above 500 year flood boundary No_ Yes,2C \\
within 500 year boundary No Yes_
Within 100 year flood boundary No Yes \
Denth of Naturally Occurrine Pervious 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?
If not what is the depth of naturally occurring,per material?
Certification
I certify that on ( �� (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�ertiis/ C_
e�and experience described in 310 CMR 15.017. '1 ^�
signature 04TOA 1�. o.—� Date i r I "1 (J
Q:\SEPTIC\PERCFORM.DOC
COMMONWEALTH OF MASSACHUSETTS
ET�!�
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner's Name: MR.RYLANDER
Owner's Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Date of Inspection: 4/6i01 RECEIVED
Name of Inspector: (please print);�;i:., JOHN GRACI
Company Name: ` SEPTIC INSPECTIONS APR 17 2001
Mailing Address: CO. BOX 2119 TEATICKET,MA.02536
TOWN OF BARNSTABLE
Telephone Number: 508-564-6813 FAX 508-564-7270 HEALTH DEPT.
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is ,;`M;',.'
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:
ti
X Passes
_ Conditionally Passes
_ Needs Furthe valuation by the Local Approving Authority
Fails
Inspector's Signature: Date: 4/6/01
The system inspector shall submit a opy 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 r.
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 1041 : l't
THE SYSTEM PASSES TITLE V IN.PECTION.RECOMMEND PUMPING SYSTEM NOW AND EVERY ONE YEAR
TO PROLONG THE SYSTEM'S USEFULL LIFE.
****This report only describesj:conditions at the time of inspection and under the conditions of use at that time.This
inspection does not address howjhe system will perform in the future under the same or different conditions of use.
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Title 5 lnCnP(tlnn Prnm rii
si�nnn
Page 2 of 11
r,
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER
Date of Inspection: 4/6/01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all.of Section D
A. System Passes:
X I 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:
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM NOW AND EVERY ONE
..
YEAR TO PROLONG THE SYSTEM'S USEFULL LIFE. .,
,f
B. System Conditionally Passes:
_ One or more system components as"¢escribed 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 determined"please explain.
n/a 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.
ND explain: n/a
n/a 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'br;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: n/a
n/a 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
?•q
1
ND explain: n/a
Page 3 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A '-
;lac. CERTIFICATION(continued)
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER
Date of Inspection: 4/6/01
t. +
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
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 surfa°cAvater supply.
_ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. Y:
.,�
_ 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 tia',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 n/a s
"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 ;E
of the analysis must be attached to this form.
3. Other:
n/a
T
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Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER
Date of Inspection: 4/6/01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into_facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/2 day flow '
X Required pumping more than 4 times in the last year NnT due to clogged or obstructed pipe(s).Number of times
pumped nLa.
X Any portion of the SAS,cesspool or privy is below high ground water elevation. A
X Any portion of cesspo6l.or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspogl;orprivy is within a Zone I of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 must 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 must serve a facility with a design now 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)
a+
yes no
X the system is within 400 feet of a surface drinking water supply
j
X the system is within 2001eet of a tributary to a surface drinking water supply v
X the system is located in a ni6bgen 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.
n
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER
Date of Inspection: 4/6/01
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
A
Yes No »
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection ?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS,located on site?
X _ 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? �..
s.
X _ Was the facility owner(an&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
X Existing information. For example,a plan at the Board of Health. q
X _ 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)]
]
1'
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Page 6 of 11
pit f
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER
Date of Inspection: 4/6/01
FLOW CONDITIONS
RESIDENTIAL
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
Number of current residents: 4
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available:(last 2 years usage(gpd)): n/a
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMI&15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(ryes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no):NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a
Reason for pumping: n/a
TYPE OF SYSTEM r
X 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)
4:
_Tight tank Attach a copy of theDEP approval ;
Other(describe): n/a ;r
i
Approximate age of all components,date installed(if known)and source of information:
20 YEARS
Were sewage odors detected when arriving at the site(yes or no): NO
F
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER
Date of Inspection: 4/6/01
BUILDING SEWER(locate on site,plan) r
Depth below grade: 8" :,
Materials of construction:_cast iron =4.0 PVC Xother(explain):20 PVC
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,Venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 2"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 1000G L 8' 6" H 5' 7"W 4' 10"
Sludge depth:0"
Distance from top of sludge to bottom of outlet tee or baffle:34"
Scum thickness: 2"
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: n/a
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.):
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING
NOW AND EVERY YEAR TO PROLONG THE SYSTEM'S USEFULL LIFE.
GREASE TRAP: _(locate on stite plan)
Depth below grade: n/a
Material of construction: concrete` metal fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related
to outlet invert,evidence of leakage,etc.):
n/a
is
�q,l w
Page 8 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFAC0SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER '
Date of Inspection: 4/6/01
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level:N/A Alarm in working order(yes or no):NO
Date of last pumping: n/a
Comments(condition of alarm and.float switches,etc.):
n/a
I;
DISTRIBUTION BOX:X(if presentirust be opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments(note if box is level and disthbution to outlets equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
THE DISTRIBUTION BOX IS StyRUCTURALLY SOUND.
r ,
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
I11 111
, ..
�t
R
Page 9 of 11 ,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER
Date of Inspection: 4/6/01
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' T leaching pits, number: 1
n/a leaching chambers, number: nla
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: nla
n/a leaching fields, number: nla
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT
HAD 6"OF LEACHING LEFT AT THE TIME OF THE INSPECTION.SYSTEM SHOWS NO SIGNS OF FAILURE.
BOTTOM IS AT 7'
CESSPOOLS: (cesspool must Wpumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
n/a
�i
Q
Page 10 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
4
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER
Date of Inspection: 4/6/01
4.~.
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.
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in
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 39 SOUTH PRECINCT RD CENTERVILLE,MA 02632
Owner: MR.RYLANDER
Date of Inspection: 4/6/01
SITE EXAM
_Slope
_Surface water
_Check cellar *•: .
Shallow wells
Estimated depth to ground water I 1 +feet
,zf
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
GR
OUNDWATER WAS DETERMINED FROM HAND AUGER- 11'NO WATER ENCOUNTERED.BOTTOM AT
7'---ADJUSTMENT TO GROUNDWATER IS 31211 FROM SDW 252 ZONE C
i
a,
COmmorwvevtth of Mossochusetts ,John Grad
Executive Office of Environmental Affairs D.E.P. Title V Septic h>spector
Department of P.O. Box 2119
Environmental Protection Teaticket,MA 02536
(508) 564-6813
8 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ^ 1
PART A O
CERTIFICATION ca RME'lVE®
[l r✓
Property Address: 39 Sourth Precint Rd.Centerville Address of Owner: MAY 3 0 199 `r
Date of Inspection:517197 (If different) 7
Name of Inspector:John Gracl Undse T OWNOF BA STgBL ti
FPT A�
Company Name,Address and Telephone Number: A
4*
E Z
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time,of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X Passes This Inspection is based on criteria defined In Title y
_ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is
Needs Furt er valuation B the Local Approving Authority performing at the time of the Inspection.My Inspection does
Y PP 9 ty not Imply any warranty or quarantee of the longevity or the
Fails septic system and any of its components useful life.
Inspector's Signature: Date: 518197
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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:
Aj SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
BJ SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair,passes inspection.
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.)
The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is
imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street 9 Boston,Massachusetts 02108 • FAX(617)556-1049 0 Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 39 Sourth Preelnt Rd.Centerville
Owner: Llndse
Date of Inspection:517197
Sewage backup or breakout or high static water level observed in the distribution box is due to a broken,
settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
_The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water
supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 11115195)
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 39 Sourth PreclntRd.Centerville
Owner: Llndse
Date of Inspection:517197
D) SYSTEM FAILS(continued)
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further Information.
(revised 11115195)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 99 Sourth Precint Rd.Centerville
Owner: Undse
Date of Inspection:517197
Check if the following have been done:
X Pumping information was requested of the owner,occupant, and Board of Health.
X None of the system components have been pumped for at least two weeks and the 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.
rVaAs built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,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.
X The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
� G 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 39 Sourth PrecIntRd.Centerville
Owner: undse
Date of Inspection:517197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 339 gallons
Number of bedrooms: 2
Number of current residents: a
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: nla
Last date of occupancy: 2 weeks ago
COMMERCIAL/INDUSTRIAL:
Type of establishment: rda
Design flow:9 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present: (yes or no) No
Non-sanitary waste discharged to the Title 5 system: (yes or no) No
Water meter readings,if available: n1a
Last date of occupancy: rda
OTHER: (Describe) nla
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped.
System pumped as part of inspection: (yes or no)No
If yes,volume pumped: 9 gallons
Reason for pumping: n1a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes, attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
18 years
Sewage odors detected when arriving at the site:(yes or no) No
(revised 11115195)
5
�I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 39 Sourth Precint Rd.Centerville
Owner: Undse
Date of Inspection:517197
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 2'
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions: L 8'6"H 5'7"W 4'10-
Sludge depth:12"
Distance from top of sludge to bottom of outlet tee or baffle: 25'
Scum thickness:0
Distance from top of scum to top of outlet tee or baffle:6"
Distance form bottom of scum to bottom of outlet tee or baffle:0
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
The septic tank and all components are structurally sound.Recommend pumping the system every two years for maintenance.
GREASE TRAP:
(locate on site plan)
Depth below grade: n1a
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: n1a
Scum thickness:nia
Distance from top of scum to top of outlet tee or baffle:n1a
Distance from bottom of scum to bottom of outlet tee or baffle: n1a
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
n1a
(revised 11/15195)
- 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 39 Sourth Preclnt Rd.Centervllle
Owner: Undse
Date of Inspection:5l7197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: n1a
Material of con struction:_concrete_metal_FRP_other(explain)
Dimensions: n1a
Capacity: n1a gallons
Design flow: n1a gallons/day
Alarm level: n1a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n1a
DISTRIBUTION BOX: X
(locate on site plan)
Depth of liquid level above outlet invert: liquidleyeIwithbottomofpipe.
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
D-box Is structurally sound.
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
n1a
(revised 11/15195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 39 Sourth Preclnt Rd.Centerville
Owner: Undse
Date of Inspection:5l7197
SOIL ABSORPTION SYSTEM (SAS):X
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Na
Type:
leaching pits,number: 1,000 gallon octagon leach pit
leaching chambers,number:nfa
leaching galleries,number: nfa
leaching trenches,number,length: Na
leaching fields,number,dimensions:n1a
overflow cesspool,number:n1a
Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
The overflow is structurally sound and functioning properly.It had V of water in it.Shows signs of being 112 full.
CESSPOOLS:
(locate on site plan)
Number and configuration: nfa
Depth-top of liquid to inlet invert: nfa
Depth of solids layer: nfa
Depth of scum layer: Na
Dimensions of cesspool: n1a
Materials of construction: nfa
Indication of groundwater: Na
inflow(cesspool must be pumped as part of inspection)
Na
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.)
Na
PRIVY:
(locate on site plan)
Materials of construction: nfa Dimensions: n1a
Depth of solids: Na
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
Na
(revised 11115195)
8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 39 Sourth Precint Rd.Centerville
Owner: Llndse
Date of Inspection:517197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
1 1
I [CollB
AC
6p
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9
E
--100-- EXISTING CONTOUR N Rd Ra
x 100.98 EXISTING SPOT GRADE Cedt`o G J\E°ta
Q�
—W—EXISTING WATER SERVICE Rd s
/ U UNDERGROUND WIRES pred"jO� Rd 5• preo'"O� dos �d
N 60'48'48" E TEST PIT N ��o reoE�et
0 " 104.00' x Q BENCHMARK
101,30 - LEGEND 5 precl�°t ad LOCUS �o
060 5
N 101 57 L 0 T 25 Merlh de w Z rd
101.51 M B L 148- 143 or o � ergo . . �o�<,�
x 13.2' x 101.05 r RoSer� �a
-� o
15,128 ��f—_ —
__ a
EXISTING LEACH PIT
II�.' TO BE PUMPED, FILLED WITH
TF'=2. :vim x 100,84 / SAND AND ABANDONED LOCUS MAP
10,1:,4. NOT TO SCALE
� :. D'� ��i� EXISTING SEPTIC TANK
+ L :' N.f TOP OF TANK, EL.=102.22
INV,(OUT)=100.89E
1 } GENERAL NOTES:
BENCHMARK SET
OUTSIDE COR.IBULKHEAD 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
EL.=102.82(ASSUMED DATUM) _ �� BOARD OF HEALTH AND THE DESIGN ENGINEER.
M w SHED 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
° _sl- C j OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
fn ,cz1 LOCAL RULES AND REGULATIONS.
x 101.35 101.35 M 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
3 O x0
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
BMA / b)1 DESIGN ENGINEER.
cV 10 ,40 1` CV ' 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
0 10 .82 DECK bh 102.60 102,21 N FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
a� � 101.87 I 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
N ( 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
Z I' THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
{t HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
102.0 `: EXISTING I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
1 HOUSE 39 /
(# � SHED a/ , ��1 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
/ T.O.F=103.8E 101,88'
102,01 102.32 Co.. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
/x �p2.. . AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
x OF Mgss9 DIRECTED BY THE APPROVING AUTHORITIES.
102,02 < x 102.5 � O y�cQ �yG 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
102,18 / a o PETER T. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
...
x 102,69 1 McENTEE In CONSTRUCTION.
CIVIL " 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
No. 35109 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
o / 1 ,OU-- R p REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3),.
—— / J i , opt EGl STE 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
�- �t01,99 15 ,ice INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
x 101,74 �r7 / / a" W 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
NOT CONSIDERED TO BE A PROPERTY LINE SURVEY.
99.67
CB / L�90;00 �i .�:. 98.67
102,12 'R=�o0•00' ��� - 9881 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
99,06
R 39 SOUTH PRECINCT ROAD, CENTERVILLE, MA
edge of pavement 99,76 CT
l d;o �"'�100.94 T'1 1�1I � Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
K E V OWNR OF RECORD SCALE DRAWN JOB. NO.
UT14 P FALLON, PATRICK Engineering by:Q En ineerin Works, Inc. 1"=20' P.T.M. 229-13
S � 39 SOUTH PRECINCT ROAD Engineering
CENTERVILLE, MA 02632 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
(508) 477-5313 11/19/13 P.T.M. 1 Of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL:99.0
FOR A DISTANCE OF 15' AROUND THE BACK OF HOUSE
SEPTIC TANK PERIMETER OF THE S.A.S.
INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX }
OUTLET AND SET TO 6" OF FI .ISH GRADE INSTALL RISER & COVER PROPOSE S.A.S. DECK
SET TO 6" OF GRADE INSTALL RISER & COVER OVER EACH CHAMBER AND
TLF.G. EL.=102.4±
3.8t SET TO 3' OF F.G. TO :SERVE AS INSPECTION PORTS
F.G. EL.-102.5t F.G. EL.=101.0t F.G. EL.=101.0t
N W
S9sr•69B' d" f
3'(max.) L = 27'
® S=1% (MIN.) ® S 1%5(MIN.) j\ 0)
4"SCH40 PVC 4"SCH40 PVC
2" LAYER OF 1/8" TO 1/2"
6" DOUBLE WASHED STONE
�o,. 14 6 ®®$aa® (OR APPROVED FILTER FABRIC) U" S• c0 �
EXISTING 48" LIQUID ®®a®®�® --3/4" TO 1-1/2" DOUBLE
LEVEL ADD INV.= PROPOSED 4' 5.2 4'
WASHED STONE Vi
98.77 INV.=98.60 I I
GAS BAFFLE INV.=100.89f D-BO EFFECTIVE WIDTH = 13.2' Q
1 vi
3 OUTLETS
EXISTING INV.=98.50 o I
EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS N I N
SURROUNDED WITH STONE AS SHOWN I o 1
H-10 RATED I of
o_
NOTES: TBREAKOUT ELEV.=99.00 a®ea S.A.S. LAYOUT f
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=98.50 as®a I--13.2'--I
INVERTS, PRIOR TO INSTALLATION. aaaaa eases
2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=96.50
GRADE ON A MECHANICALLY COMPACTED SIX 4' 2 X 8.5'=!1.0! 4'
INCH CRUSHED STONE BASE, AS SPECIFIED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0.
IN 310 CMR 15.221(2). PERVIOUS MATERIAL
5 (MIN ) ABOVE G.W.
3) INSTALL INLET & OUTLET TEES AS REQUIRED. . LEACHING SYSTEM SECTION ®®®® 0
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM OF TP, EL.=90.0 z ®®®®®® ® ®®®® 33"
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. (NO GROUNDWATER) w ®
Z ®L3_E@®®® ® ®®®®
SEPTIC .SYSTEM PROFILE
102"
SOIL LOG 4" KNOCKOUT
DESIGN CRITERIA
DATE: NOVEMBER 4, 2013 (REF#14,169) 20" DIA. COVER
NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE PE(SE#1542) /
WITNESS: DONNA MIORANDI R.S. HEALTH AGENT 4" KNOCKOUT 4" KNOCKOUT 62"
SOIL TEXTURAL CLASS: CLASS I (EFFLUENT LOADING RATE=0.74 GPD/SF) ELEV. TP- 1 DEPTH ELEV. TP-"2 DEPTH
DESIGN PERCOLATION RATE: <2 MIN/IN 0
101.0 q 011
101.1 q 0"
DAILY FLOW: 330 GPD LOAMY SAND LOAMY SAND
DESIGN FLOW: 330 GPD 100.5 g"10YR 4/2 10YR 4/2 4" KNOCKOUT
GARBAGE GRINDER: NO-not allowed with design B 100.6 6"B
LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF LOAM SAND
LOAM SAND 500 GALLON CAPACITY, H-10 LOADING
74 GPD/SF 99.0 24" 98.6 C 30° CHAMBERS
C 5
PERC
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY
42'/54" N.T.S.
PROPOSED D-.BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED
USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SURROUNDED BY DOUBLE WASHED STONE-ALL SIDES MED. SAND MED. SAND 39 SOUTH PRECINCT ROAD, CENTERVILLE, MA
SIDEWALL AREA: 2(13.2' + 25.0') X 2 = 152.8 S.F. 2.5Y 6/4 2.5Y 6/4
BOTTOM AREA: - 13.2' x 25.0' = 330.0 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
by: SCALE DRAWN JOB. N0.
TOTAL AREA:..............................................................482.8 S.F. 90.0 132" 90.1 132' Engineering Engineering nsby: Works Inc. N.T.S. P.T.M. 229-13
PERC RATE <2 MIN/IN. ("C" HORIZON)
DESIGN FLOW PROVIDED: 0.74 GPD/SF(482.8 SF) = 357.3 GPD NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
e (508) 477-5313 11/19/13 P.T.M. 2 Of 2
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VILLAGE CeN���__ ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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I N S T A ERIS NAME i ADDRESS
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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