HomeMy WebLinkAbout0038 STONEY CLIFF ROAD - Health 38 Stoney Cliff Road
189-01.6 Centerville
No. 4210 1/3 ORA
rendaf lexo
1000
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No. d�"v(_�� J Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
application for 3Disposal *pstem (Construction Permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. -319 Shy l MAd Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel (' (1Z�. \L '� VGL
Installer's Name,Address,and Tel.No. /13 old X4r My V esigner's Name,Address,and Tel.No.
ob 7
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) y
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.
Signed_ Date 0 I -7 //
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. _ (J ' VU Date Issued �� 1
� S I
No. 4"�+(. ` t 3 1
Fee /U +
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
Rpplicatiatt for Misposal 6pBtem Construction Permit
Application for a Permit to Construct Repair k/UPgrade Abandon Complete System /�Individual Components
Location Address or Lot No. 3e C k M aZ Owner's Name,Address,and Tel.No.
Assessor's Map/Parceli (� �!� �� !
Installer's Name,Address,and Tel.No.//3 old X4.f^"v U esigner's Name,Address,and Tel.No.
'lope of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
1
Other Fixtures
Design Flow(min.required) gpd Design flow provided Air gpd
Pfau; Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) _ 6 r A r
� - k AtsL� dj � � � ��
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 2
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. l!,
t Signed / Date -7 // ,
Application Approved by / Date
Application Disapproved by Date
for the folloyng reasons
/ s
i
Permit No. �.d O C/ ) U Date Issued /1. " /
c
I
THE COMMONWEALTH OF MASSACHUSETTS
no BARNSTABLE,MASSACHUSETTS
Certificate of Compliance 1
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
r Abandoned( )by ( cZrA
rt"�V_
at Qram,.`/ C\� \C (� een constructed in accordance
With the provisions of Title 5 and the for Disposal System Construction Permit No,?61 -Y�6 dated ( 1- - / -
Installer C.V r1 �-r-c,-J Designer
#bedrooms [t Approved design flow /,` gpd
The issuance of t 1 is p.rmit shall not be construed as a guarantee that the system w' 1 fun ho as des'gned.
, Date Inspector try,,, )
--------------------- ---------------------- --. - -- ---- .
No. 2b i ' U Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction 3permit
Permission is hereby granted to Construct
��( ) Repair( ) Upgrade( ) Abandon( )
System located at y kC\.A , ySc 0-d C Uk_(r_1jl
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction m•st b�(0)
mpleted within three years of the date of this permit. 1 r
)- 77 -Date � Approved by
TOWN OF BARNSTABL-E
LOCATION NC�I C\ �� SEWAGE# a 01'3 , 13'7
VILLAGE ASSESSOR'S MAP.&PARCEL -16k--OI G
INSTALLER'S NAME&PHONE NO. A �ra.sa I.�� -�/�o-�ls� y
SEPTIC TANK CAPACITY P Il S t t NC
LEACHING FACILITY:(type) L fe sr.N c H Ao (size) 60' -frc-&x�
NO.OF BEDROOMS,
OWNER� ILG
PERMIT DATE: 0 I2 2-1 IT_ COMPLIANCE DATE:
Separation Distance Between %a 5.1k.5 GoTT = 28.30
fi. 4 Co.cJ s
Maximum Adjusted Groundwater Table to the Bottom of Leachin acility Feet
Private Water Supply Well and-Leaching Facility(If any wells exist Orr
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
411
3 - ND t S
52- h - 30 0
R
0
w
A ti V-ON
ee—5TOAXy C h 4 R�) -�
J
Fee (j V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for his "sat 6pstem Construction permit
pplication for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 34e 5 l o ae/ c l�� l� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 15 C(.» 0 1
I taller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
�l&s a13Eow�j-i:oc
SOO- N@O-71 r^+SfNr-PdiNs W J5 Spa_a 3/`3
Type of Building:
Dwelling No.of Bedrooms Lot Size S sq.ft. Garbage Grinder( )
Other Type of Building �\p joke No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) :3!3 C) gpd Design flow provided gpd
Plan Date 2 ►I) Number of sheets Revision Date 5 IM
Title
Size of Septic Tank e-A)5f- Type of S.A.S._ LC -G Lec.,Arti,,.,
Description of Soil 152d e 11.4
Nature of Repairs or Alterations(Answer when applicable) LAr,'Wl ey" S k 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.
Date
Application Approved by Date c�
Application Disapproved by Date
for the following reasons
Permit No. 1 3 / 3 7 Date Issued "/ as - 1
3 / Fee
No . ."
THE COMMO, EARTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION.-'TOWN,OF BARNSTABLE, MASSACHUSETTS Yes
1pYitatiOYC for IN 08aY *pBtPtl1 COttBtrULtI01IPrlllit
Apphca ion for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 30 S7a 4L 1 c 1,4 -%ZJ Owner's Name,Address,and Tel.No.
0f`a Cp l o�o15 ica.
Assessor's Map/Parcel I�c( — 1'
Ir,�staller's Name,Address,and Tel.No.,/ Designer's Name,Address,and Tel.No.
s k�u71�s A G(ou0-)�r4 e
Soo- t-100-71 rtiS�Nrr✓�%�S l•V�5 5" -t/ 7- 5313
Type of Building:
Dwelling No.of Bedrooms Lot Size I S 71 sq.ft. Garbage Grinder( )
Other Type of Building �\OJSY No.of Persons 1�+ Showers( ) Cafeteria( )
Other Fixturest
Design Flow(min required) ) gpd Design flow provided gpd y.
Plan Date-2 ► Number of sheets IL- Revision Date 511 /3 V _ All,v��
Title ivp �
. Size of Septic Tank ifX I')f l;+ Type of S.A.S. LC -L L PacLt <ha... obe/,; Jv,1,Xv
Description of Soil :�e r ►U d
Nature of Repairs or Alterations(Answer when applicable) l NSi-a1i /UeW S.A
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.
igned /2-- Date .
Application Approved by Date y / 7>
.Application Disapproved by Date
for the following reasons
Permit No. sDz/ 3 Z 3 7 Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliartre
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( � Upgraded( )
Abandoned( )by :!:�V�A g,, A ZAo,_u ► -Y--Nc
at-_3¢� 1,ION j-_r e',, ( &0 ke l,0 1e has been constructed in accordance /
with the provisions of Title 5 and the for Disposal System Construction Permit No.c� '3 O� %.3 /dated
Installer ,_��� ?a—) r-N< Designer �•va r�.,r Y i,.� L✓� S
#bedrooms Approved design flow 3O ,f gpd
U c
The issuance of this permit�sdll no a construed as a guarantee that the system will ectiV/1
esig/ned. �Date i � Inspector ✓/l�t/�
/ Y
No. /,3 — 13-1 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
misposat *Pete .�t onstrUrtion Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at 313 snrjej, C 1114 C/ ""YN4YY/di Lip
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction mus a comple/l'ed within three years of the date of this permit.
y Date / 3 Approved b
i
05/02/2013 07:27 5084775313 ENGINEERING WORKS PAGE 02
Town of Barnstable
Regulatory Services
Thomas F, Geller,Director
$ F Pubic Health Division
` Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office- 30&9 - Fax.: 508-79"304
Date: Sewage Permit# � Asst es Map/Parcel
laftlier fi DesisueX Ce�ggg Forte
Desiper: IE�q0. war4s, lne . Installer: 9,ft,` kl4c
Address: 1 z W. Crn :r •`slat izd. Address:
M A.
On 1 ,A &b w'i Wi c.. was issued a permit to install a
(date) --- (installer)
septic system at 3E pert Clig 141 based on a design drawn by
(address)
leyLe V&-AkS 6L dated 2r1111 13 —AojJ413a-J1�
( esigcter)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State& Local Regulations: Flan revision or
certified as-built by designer to follow. Stripout(if required) wa ted and the soils
were found satisfactory.
�s PETER T.
u` WENTEE
Ier's Signature CIVIL
No.58109
(Designer's S�i.�gnature) (A �x Design
D-W9WffTT1W91PWUTO 1RARTNTRTAL111 E P11TRIJC DM ION. CL4= ATE
CE WILL NOT B ISSUED, U AS'
BUILT CARD ARUFCFE11MD BXjHE BARNSIABLE_PUJ1L1C.HEALTJJ DIVISION.
M A a MU.
q;loffiee%MU\dosigmerca ification folm.doc
Town of Barnstable P# "
r Department,of Regulatory Services
i { Public Health Division DateMAIM
22 I
sbJy �� 200 Main Street,Hyannis MA 02601
_Date Scheduled JSJ 1) C.� 6U , Cd
Time Fee Pd.
Soil Suitability Assessment for a e Disposa
Performed By: / ��� `G f`'��� Witnessed By: S
LOCATION&Q7ENERAL INFORMATION
Location Address 3 Shy yt� f Owner's Name ,G/, � �Lw G
(�
` Y
t`e✓t tczv, )r0 Address 3S
Gea!¢rV,)Iz ✓VU+ o21o3Z
Assessor'sMap/Parcel yl �Fc/ —61 - Engineer'sName '�y'��e;jS (Y
NEW CONSTRUCTION REPAIR Telephone# e.SO Z -7 3-7 ly-7(o b
Land Use Z_s�G�yt]�d c t' Slopes(%) 2-1 Surface Stones A)/4--
Distances from: Open Water Body;:'/Oc✓ ft possible Wet Area-;N 00 ft Drinking Water Well ft
Drainage Way /� / ft Property Line ��— ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations ofxest holes&perc tests,locate wetlands in proximity to holes)
Cr�cvt L-1 .
r s
�n
Lz
540
(N u
Parent material(geologic) 4-J% Depth to Bedrock �
Depth to Groundwater. Standing Water in Hole: AVA- Weeping from.Plt Face 'vf�
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: ____in. Depth to soli mottles; in.
Depth to weeping from side o`obs.he3e: y M. Croundwater Adjustment - ft.
Index Well,# Reading Date: Index Well level�— Ad),factor— Adj.Croundwater Level .a
PERCOLATION TEST Date- Thne_
Observation
Hole# t Time at 9"
Depth of Pere �� Time at 6"
c�q 1(4,U
Stan Pre-soak Time® _ ! Time(9".6")
End Pre-soak
Rate Min./Inch L Z
Site Suitability Assessment: Site Passed- . — Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be.conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTICIPERCFORM.DOC
DEEP OBSERVATION HOLE LOG Hole#I
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA). (Munsell) Mottling (Structure;Stones,Boulders.
Consi Gravel)io
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
:Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
h ,
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes --
.. Within'500year'boundary No Yes
Within 100 year flood boundary No Yes
Death of Naturally Occurring 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 sous material?
Certification l
I certify that-on J (date)I have passed the,soil evaluator examination approved by the:
Department of Environmental Protection that the above analysis was performed by me consistent -
the-required,trai ' ,expertise and experience described in 310•CiYM 15.017.'
r�-- Date
Signature �.
Q:\SEPTICIPERCFORKDOC
COMMONWEALTH OF MASSACHUSETTS
F�
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
d � .
TITLE 5
s. a
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSMWS. ) _
SUBSURFACE SEWAGE DISPOSAL SYSTEM F�OMI ZV
PART A
CERTIFICATION
Property Address: 38 Stoney Cliff Road REC��V
C'_Pnt-Prvi 1 1 P E®
Owner's Name: M-n j ,aP lnlest
Owner's Address•
JUL Z 6 2004
Date of Inspection: %— 4 T- Tpw
EAR H DEPRNS7-
Name of Inspector:(please print) W i 11 i am E_ .Robinson Sr
Company Name: William E. Robinson Septic Service
Mailing Address: P 0 Box 1089
Centerville, MA
Telephone Number: (S08) 77S-8776
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 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 15340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: �a 6 J / , n Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health-or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design now 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
"This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2ofII '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued).
Property Address: 38 Stoney Cliff Road
Centerville
Owner. Dent e E t
Date otlaspetnf
Inspection Summa heck A,B,C,D or E/ALWAYS complete all of Section D
A. Syste Passes:
1 have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B.J System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced
.p d or
repar` d.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answe yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
e septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound, xhibits substantial infiltration or exfrltration or tank failure is imminent.System will pass inspection if the
existing is replaced with a complying septic tank as approved by the Board of Health.
•A metal�,eptic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating hat the tank is less than 20 years old is available.
ND explain
Obs ation of sewage backup or break out or high static water level in the distribution box due to-broken or
obstructed p pe(s)or due to a broken,settled or uneven distribution box. w'System
y will pass inspection if(with
approval of oard of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The lystcm required pumping more than 4 tunes a year due to broken or obsutxted pipe(s).The system will
pass inspect on if(with approval of the Board of Health):
broken pipes)are replaced
obstruction is rtmsoved
ND explai,:
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t Page 3 of 11
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_ 38 Stoney Cliff Road
Centerville
Owner: Denise .WEst
Date of Inspection:. 9—p
G 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
y , less the Board of Health(and Public Water Su tier if an determines that the
PP Y)
system is functioning in a manner that protects the public health,safety and environment'.
_IT a system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a
surface water supply or tributary to a surface water PP Y �ry r supply.
— The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply.well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a
private water supply well** Method used to determine distance
•*This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is Gee 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.
3. ther:
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 38 Stoney Cliff Road
Centerville
Owner: Denise West
Date of Inspection: 9-6 "
D. •stem Failure Criteria applicable to all systems:
You m st indicate`yes"or"no"to each of the following for all inspections:
Yes o
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
es clogged AS or cesspool
Static liquid level in the distribution box above.out let 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'h day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the 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 rater
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. arge Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd-
You in st indicate either"yes"or"no"to each of the following:
(The fo lowing criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
I - -
If you h ve answered"yes"to any question in Section E the system is crosidcred a significant threat,or answered
"yes"id Section D above the large system has failed.The tmmcr ar operator of arry large system considered a
significaant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
iS.304 he system owner should contact the appropriate regional office of the Department.
4
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7
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:_38 Stoney Cliff Road
Centerville
Owner• Denise West
Date of Inspection:
Check if the following have been done.You must indicate`yes"or"no"as to each of the following:
Yes No
_ umping information was provided by the owner,occupant,or Board of Health
— v Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection?,
Were as built plans of the system obtained and examined? If the were ere not available note as /— Y ( Y N A)
Was the facility or dwelling sewage inspected for signs of a back up?
P g g— Was the site inspected for signs of break out?
✓. Were all system components,excluding the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baftles 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
_ /�Existmg information.For example,a plan at the Board of Health.
Pam_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance.
is unacceptable)(310 CUR 15.302(3)(b)J
5
Page 6 of 1 l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 38 Stoney Cliff Road
Centerville
Owner• ---
Date of Inspection: 7- "0
FLOW CONDITIONS
RESIDENTIAL.
Number of bedrooms(design):. 3 Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms):
Number of current residents:
Does residence have a garbag grinder(yes or no):Ae
Is laundry on a separate sewage system(yes or no):T [if yes separate inspection required]
Laundry system inspected(yes or no):��
Seasonal use:(yes or no): , /
Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 3 — 36, 0 0 0
Sump pump(yes or no):,A-0 2002 — 39, 000
Last date of occupancy:
COMMERC IANDUSTRIAL
Type of estab ishment:
Design flow based on 310 CMR 15.203): gpd
Basis of de gn flow(seatslpersons/sgft,etc.):
Grease tra present(yes or no):_
lndustria waste holding tank present(yes or no):—
Non-s tary waste discharged to the Title 5 system(yes or no):_
Water eter readings,if available:
Last to of occupancy/use:
OT ER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: 9 2 2
Was system pumped as part of the inspection(yes or no): n
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping: w 4
TYPOF SYSTEM
L/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/Altemative 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:
iSEQ �-
Were sewage odors detected when arriving at the site(yes or no):/
6
I
.]'age 7 of 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 3 8 StonevQI;f f Road.
Centerville
Owner: Denise west
Date of inspection: —®t2�
BUILDIN SEINER(locate on site plan)
Depth belo grade:
Materials f construction:_cast iron _40 PVC other(explain):
Distance orn private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: '
_✓(Iocate on site plan)
Depth below grade: `l ,
Material of construction:_concrete metal fiberglass_polyethylene
_othcr(explain)
If tank is metal list age:___ Is age confirmed-by a Certificate of Compliance(yes or no):_(attach a copy of
certificate) ► ,
Dimensions:
Sludge depth:_ y— S'
Distance from top of sludge to bottom of outlet tee or baffle: .101F
Scum thickness: Z--o
Distance from top of scum to top of outlet tee or baffle:_ Y ,
Distance from bottom of scum to bottom of outlet tee or baffle:_J�,
How were dimensions determined: C R�w
Comments(on pumping recommendations,inlet and outlet tee or baffle conditicn,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
GREASE TRAP _(locate on site plan)
Depth below gra e:_
Material of con ction:_concrete_metal fiberglass_polyethylene other
(explain): —
Dimensions:
Scum thickne s:
Distance fro top of Scum to top of outlet tee or baffle:
Distance fro bottom of scum to bottom of outlet tee or baffle:
Date of last umping:
Comments(on pumping recommendations,inlet and outlet ice or baffle condition,structural integrity,liquid levels
as related o outlet in
evidence of leakage,etc.):
i
7
Page 8 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 38 Stoney Cliff Road
0en7Fervi1 > e
Owner:
Date of inspection:
TIGHT or HOLDIP G TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construct n: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity- allons
Design Flow: allons/day
Alarm present(yes r no):
Alarm level: Alarm in working order(yes or no):
Date of last pump: g:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present mu
st 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 CHAAIBE (locate on site plan)
Pumps in workin order(yes or no):
Alarms in%worki g order(yes or no):
Comments(not/ condition of pump chamber,condition of pumps and appurtenances,etc.):
{
8
Rage 9 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 38 Stoney Cliff Road
Centerville
Owner: nPni GP WPRi
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,ezcavation'not required)
If SAS not located explain why:
Type
,,;ea'hi pits,number:_
ciac chambers,number:
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.): >
CESSPO LS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and onfiguration:
Depth—top f liquid to inlet invert:
Depth of soli slayer:
Depth of scu layer:
Dimensions o cesspool:
Materials of c nstruction:
Indication of oundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials o construction:
Dimension
Depth of lids:
Commen (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
I
Page 10 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 38 Stoney Cliff Road
Centerville
Owner: Denise West
Date of Inspection: t
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.
v
10
- Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 38 Stoney Cliff Road
Centerville
Owner. Denise West
Date.of Inspection:' d O�Z
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
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 I50 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
it
AsBuilt Page 1 of 1
TOWN OF BARNSTABLE
L.00AnON_ faxes, Gt, SEWAGE 7 i�
VILLAGE CL- /
ASSESSORS MAP & LOT
INSTALLER'S NAME & PHONE NO. )?off, �.S6 �✓ 7 5--� t
SEPTIC TANK CAPACITY
S
LEACHING FACILITY:(type) �--
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER J cl/ o 7
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED�C,."�-- S&
VARIANCE GRANTED: Yes No
_ --�
i
a
Ihttp://issgl2/intranet/propdata/prebuilt.aspx?mappar=l89016&seq=1 1/22/2013
TOWN OF BARNSTABLE
LOCATION SEWAGE"# 7 --JC
VILLAGE CL:h- j
ASSESSORS MAP & LOT61
INSTALLER'S NAME PHONE NO. Ro wsd t-, I? 'J`�,
SEPTIC TANK CAPACITY L 6 p
LEACHING FACILITY:(type) �d (size) L/
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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CJ �' i�/f �. .l
{Lryn� 4/ I �� "1 1
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No.._.r�.a-:I- .6 Fes$ 30 00...........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
'~ - TOWN OF BARNSTABLE
Appliration for Disposal Works Tonstrurtiun Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at:
..Denisex..: 9bR1k�......................•-------------••-•-
38 Stoney Cliff Igtion-Address or Lot No.
........................... . - ....
3$:_Ston yCl .f _Id---_Qmteryille.......................
Owner
Address
aW.E. Robinson_Septic-_Service P•tQ.._Bo__x 1089 C_•._e_rvill_e_.NIA__••_•_-_--_-
Installer
3 Address
U Type of Building p ( ) Size Lot..-. Sq. feet
DwellingNo. of Bedrooms...........................................Ex anion Attic rGai'g7 -cinder ( )
aOther—Type of Building ............................ No. of persons..............--........---- Showers ( ) — Cafeteria�
dOther fixtures -------------------------------•---------------------------------------------------------------------------•----
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter-----------_-- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--.
40 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....--..................
P4 ----------------------------------------••------....----....---.....-----------------••-•--•----•---.........................................................
ODescription of Soil......graMel..........•"-----•-------------•---------•------------------------------------------------•---------------------------••----------.......----------
x
U
w _ --- --�
UNature of Repairs or Alterations—Answer when applicable........................................................."..--.-.------.-.-.-._---------------
..i nstallaf.i.on..of..a...-,.OII4--gal--sepl i�--t;a Ilc-►---D4DGX,--2--stom- packed -galli-e&I...............................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has bee issu�,l by bo rd of�hera .
Signed ...... ..------� ---- h
....-�-------
Application Approved B ...-------_--------------------------------------------------------- ---�..-
eS.�%'l�4�'�C.� Dace
Application Disapproved for the following reasons: -------_---------J-------- ---------................
.............................................................................
.............................................................. .............................. ...................... .......................................... ........... ......................
qqss Dace
PermitNo. ....... .3. ..................... Issued ...-----------------------.........--- --.....------.....---------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for UWposal Works Tnnifrttrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at:
Devi.e C
38 Stoney Cliff J?fition-Address or Lot No,
......................--.......................................................................... z .i lP........:.._._........_
Owner Address
a __W.E...Robinso..... t c_Sexvie . ........ �'-eO=-Box..1Q$9_.Centeav .«A.
Installer Address
Type of Building Size Lot........t..................Sq. feet
►� Dwelling—No. of Bedrooms..._3.....................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons.............--............. Showers ( ) — Cafeteria ( )
PA Other fixtures ....
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter...........::... Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.----_-----...... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f]:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -------------------•----------------------------•----------•--------•----•------....--------•--•.............................................................
O Description of Soil.-----c_rramel.....................................................................................-----------•-•---............................................
x
U ------------------•-----•---•---------•--•---------•-------•--------------•--•------•----•-•------------••--------------•----------••-----------•-------•--•------------------------------.....-•-......
W
-------------------------------------------------------------------------------------------------------------------------- ----- --------------•-----------------------------------•--•............
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
? sa.L l�t�Ox� f sCl�� R1A ?^,•t ?�, ' � '� tnma ? .. 1i i a ..................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has
�beee issu by lit bo rd of�hea',h.
Signed -- .lam/ -- -- . .----. - ----------- ------� ..J--`----------2
Application Approved B
..---.. .: --' Date
PPpP Y -... -. -•r%C-t---------------``-......------------------------------ �^= �
JDate
Application Disapproved for the following reasons- ---------- ---- ------------------------------------- ------------------- --------...........................................
- ----------------------------------------- ---------------------------------
c�r Date
PermitNo. ....... -3-..�..................... Issued ------------------------------------------. -- ------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
CEex#tf rate, of Tompliart re
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X )
b -W E-- Robinson Septic Service
Y-------- ---- -------......--------------------------- - - ---------------------------------------------------------------------...-----------------------------------------..........------------------.....-----------------------------------
Installer
at ------38---S-toney..Cliff---1d---------Centerville— ------------------- ------------ ------.......---------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..----.. 01 -----23--?1?..... dated ...............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ---------------------------- ------------------...... Inspector . `... ~....... ........:
Ll
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�� TOWN OF BARNSTABLE $30.00
No...... ..._ FEE.
Diaplasal Works Tunnstrttrtion anti# � 1
Permission is hereby granted..t2t4 F—Rohi?� .......................................................................
to Construct ( ) or Repair ( X) an Individual Sewage Disposal System
at No...........38..,St,?nem.M.J.f_f_Rri,iCPntan7 D.In..................................... --•-----------------------•-------•-------------------............••..
Street q -4 2
as shown on the application for Disposal Works Construction Permit No.la" ✓ Dated..........................................
........................................I'�+_
......................
Board of Health
DATE..................... ---,-�--��-
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS
r
ENVIRMECH �,AB��T�� � � �
Mass-Cert. #:MA063 a
449 Route 130 Sandwich, MA 02563 - (508) 888-6460
X r r
CLIENT: Larry Nickulas LOCATION: Lot 57 Josia's Patik
ADDRESS: W. Barnstable, MA
COLLECTED BY: L. Wile SAMPLE DATE5-15-93 TIME:
DATE RECEIVED: 5-15-93 SAMPLE ID: Z958
JOB #: New well WELL DEPTH: 160' 4"PVC 15 Gal./Min.
RESULTS OF ANALYSIS:
Parameter Units Recommended limit Result
Coliform bacteri a/100 ml (MF Method) ` 0 0
pH pH units 6.0-8.5 6.12
Conductance umhos/cm 500 101
Sodium mg/L 20.0 11.0
Nitrate-N mg/L / 10.0 0.12
Iron mg/L 0.3 0.31
Manganese mg/L 0.05
0.06
Hardness mg/L as CaCO3 500
17.8
Sulfate mg/L 250
5.9
Potassium mg/L 20.0
0.7
Alkalinity mg/L 200
16.2
Chloride mg/L 250
16.5
Turbidity NTU 5.0 13.5
Color APC units 15.0
<1.0
Background bacteria
Volatile Volatile Organic Compounds (EPA 601/602) see attached. None detected,
(EPA 601/602) see attached. None detected
COMMENT: Iron level is not a health hazard.
I
M NO WATER IS SUITABLE FOR DRINKING PURPOSE OR PARfETERS TESTED.
D
C DATE �� }
?`L r
em
$—mo5-93 12: 39 ?M ;GROUNDWATER ANALY'LLCAI; 6:08. 759 4475;9 2/ 3
J
smuwwATER
ANALYTICAL EPA METHODS 601 and 602
Volatile Organics (6C/PID/ELCD)
Lab ID: 5171-01
Field ID: Z958 .
Protect: Batch ID: YHA-0146-A Nickolas-Lot 57 Josias Path Sampled: 05-15-93
Client: Envirotech Received: 05-18-93
Cant/Prsv: 40ml VOA Vial/HaHSO4 Cool Analyzed: 05-19-93
Matrix: Aqueous
PARAMETER CONCENTRATION REPORTING LIMIT
(ug/L)
Dichlorodifluoromethane 8RL 5BRL 1
Chloromethane BRL 1
Vinyl Chloride BRL 5
Bromomethane BRL 1
Chloroethane BRL 1
Trichlorofluoromethane BRL 1
i 1,1-Dichloroethene 1
Methylene Chloride 6RL 1
trans-1,2-Dichloroethene BRL 1
1,1-Dichloroethane BRL
1
cis-1,2-Dichloroethene * BRL 1
Chloroform BRL 1
1,1,1-Trichloroethane BRL 1
Carbon Tetrachloride BRL 1
Benzene BRL 1
1,2-Dichloroethane BRL 1
Trichloroethene BRL 1
1,2-Dichloropropane BRL 1
Bromodichloromethane BRL 1
2-Chloroethylvinyl Ether BRL 1
trans-1,3-Dichloropropene BRL 1
Toluene BRL 1
cis-1,3-Dichloropropene BRL 1
1,1,2-Trichloroethane BRL 1
Tetrachlorcethene BRL 1
Dibromochloromethane BRL 1
Chlorobenzene BRL 1
Ethylbenzene BRL 1
m+ppXylene * BRL 1.
0%l ene * BRL 1
Bromoform - BRL 1
1,1,2,2-Tetrachloroethane BRL 1
1,3-Dichlorobenzene BRL 1
1,4-Dichlorobenzene BRL 1_
1,2-Dichlorobenzene
QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS
% 87 - 113
a,a,a-Trifluorotoluene 30 30 32 1 99 99 % 83 - 117
1,2-Dichloroethane-d4 30
BRL - Below Reportinq Limit. * Non-target compound. Method References: Method 601 - Purgeable
Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986).
ry
--98 -- EXISTING CONTOUR m
X 100.98 EXISTING SPOT GRADE N F
98 PROPOSED CONTOUR Nouset Ln
-W EXISTING WATER SERVICE Q Tomahawk O<
-G EXISTING GAS SERVICE 0
- Powderhorn yyo �
0.H.K-OVERHEAD WIRES y
TEST PIT Stoney
Cir LOCUS
Dee
BENCHMARK ;r
OLEGEND N gachm 0
P35.50 Route 28
0
35,9s LOCUS MAP
1I C �35.6 i NOT TO SCALE
`1Q � 36.00 � \\ � �
36,87 \\ ANT
4 �/ 36.92
c� 91 \ EXIS77NG 12" CORRUGATED ALUMINUM
/ e�k 37.55 6 r►, DRAINAGE PIPE DISCOVERED
/5 O
o{ o4e� h gyp_ 15 34,5� 35 MAINTAIN 10' MINIMUM SETBACK FROM S.A.S.P � J \/h6
�
6a96 � -31f 8 ��a�
� Q 3757 ice/ Zc� \\ � EXIS77NG S.A.S.
38.69 \ TO BE REMOVED
39.11 1 pp 38.61 + 38,4N \\ (SEE NOTE 11-SHEET 2)
U yprL x 37.55 32. 4 \\32,23 35.1
\ TP 1
\
by %'o,. 8.57 + 38.71 37.60 \/�r� TP 2 ,
38.5 1 4 \ A
3 .00 O \ 33.05 • > >•
C4.61 \\ \\ •/ s9�
38.39\ EXISTING \\ "'000' S" `s PROPOSED SEWER
HOUSE(7f38) p CONNECTION
--x1 T.O.F.=39.3 36\f 0 1 \\ 31.58� TIE IN AT, OR ABOVE,
B IN V.=30.00±
-✓ 37,90 1 x ) .00000 \186 \ \
O AL \\x 31.65 .x 3119 32
/ \\
/ SPIKE2 \\
_ DECK x 36.60 / 34.1� +31.32
10
i
34.09
�,� j/36,57 30.14 LOT 3A,�
S� 33,74 / \\\ 15,71$±-S:F.
O -1x /x 56 -A-PN f89-016/
�O. O.x 34.72 3 •;'� ��
9.94
✓�' 33.90 x
EXISTING SEP77C TANK - / /29.56 2-8 1 / 26.87x \ - ---2-6-
(TO REMAIN) \j
TOP OF TANK, EL.=33.58
INV.(OUT)=32.25f x 2 9,63� /X 2 7.6 2 �' \W4.19 ---'2-4
�i
.0000,
213IN �\ o 0 EW22.55
x26,38
23.40 x�
` 24.11x � W
.� 21.68
• � I
23.92 �1tGh
9 BENCHMARK SET
OUTSIDE COR./TOP RET. WALL
/�� ,fie EL.=34.44 (ASSUMED DATUM)
0
eqe
\� OF Mgss 23.07\V-10
21,45
o PETER T. r,
M cENTEE
CIVIL N PLAN REVISION - 4/30/13
No. 35109 REVISE S.A.S. DUE TO DISCOVERY OF EXISTING DRAINAGE PIPE.
.gp R£GIS[
PROPOSED SEPTIC SYSTEM UPGRADE PLAN
38 STONEY CLIFF ROAD, CENTERVILLE, MA
Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
OWNER OF RECORD Engineering by: SCALE DRAWN JOB. No.
TOBOJKA, RICHARD B H & REBECCA J Engineering Works, Inc. 1"=20' P.T.M. 108-13
38 STONEY CLIFF ROAD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
CENTERVILLE, MA 02632 (508) 477-5313 2/11/13 P.T.M. 1 of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL: 30.1
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX
S
INSTALL H-20, WATERTIGHT PROPOSED S.A.S.INSTALL RISERS & COVERS OVER INLET & CHARCOA
OUTLET AND SET TO 6" OF FINISH GRADE RISER, FRAME & COVER INSTALL INSPECTION PORT OVER END UNIT VENT
T.O.F.=39.3 SET TO FINISH GRADE
EXISTING F.G. EL=34.Ot PROPOSED SEWER CONNECTION F.G. EL.=32.0t F.G. EL=36.0(MAX.) II
• INV.=30.00t(FIELD VERIFY)
MAINTAIN 2% GRADE (MIN.) OVER S.A. .
L = 4' L = 4'
@ S=1% (MIN.) 0S=1% (MIN.) INSPECTION PORT
4"SCH40 PVC 4"SCH40 PVC
s^
10"1 6
14" 10.75" TO
INVERT
EXISITNG 48" LIQUID INV.=32.25 EXISITNG ROPOSED
LEVEL INV.=29.70 1 TRENCH W/12 ADS Arc 36HC UNITS 0 5'/UNIT = 60'
P
GAS eAF> E D-BOX INV.=29.70
INV.=29.87
H-20 RATED SOIL ABSORPTION SYSTEM (PROFILE)
EXISTING SEPTIC TANK UNITS MUST BE STAMPED H-20
ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
NOTES:
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE
INVERTS, PRIOR TO INSTALLATION.
TOP ELEV.=30.13
2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=29.70
GRADE ON A MECHANICALLY COMPACTED SIX
INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=28.80
310 CMR 15.221(2). 4' OF NATURALLY OCCURRING 2.83'
3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W.
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. EXISTING SUITABLE
ESTIMATED HIGH G.W., EL.=22.4 - MATERIAL
(MOTTLING) ADS Arc 36HC UNITS TO BE INSTALLED IN
SEPTIC SYSTEM PROFILE TRENCH CONFGGUUIRATI SEC ON WITH O STONE
N.T.S.
GENERAL NOTES: SOIL LOG
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: FEBRUARY 8, 2013 (REF. P#13,859)
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL EVALUATOR: PETER MCENTEE PE, (SE#1542)
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: Elev. TP- 1 Depth Elev. TP-2 Depth
-310 CMR 15.405(1)(b): 32.1 0 32.1
1) A 3', variance to the 3' maximum cover requirement, for up FILL FILL
to 6 max. cover. S.A.S. shall be H-20 and vented. 31.8 (DRIVEWAY STONE) 3„ 31.8 (DRIVEWAY STONE) 3"
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR A SANDY LOAM A SANDY LOAM
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 1OYR 4/2 10YR 4/2
DESIGN ENGINEER. 31.4 8" 31.4 8"
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING B SANDY LOAM B SANDY LOAM
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10YR 5/8 1OYR 5/8
ENGINEER BEFORE CONSTRUCTION CONTINUES. 29 8 C1 PERC 30.1 C1 24"
PE
5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 48"/54"
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. FINE to VERY FINE to'VERY
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE FINE SAND FINE SAND
8. THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE PROPOSED S.A.S.
2.5Y 7/3 2.5Y 7/3
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS ADJUSTED GW ADJUSTED GW
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 22.4 (MOTTLING) - 116" 22.4 (MOTTLING) - 116;'
DIRECTED BY THE APPROVING AUTHORITIES. 22.1 120" 22.1 1 120"
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY NO GROUNDWATER OBSERVED
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PERC RATE: <2 MIN./IN. _
CONSTRUCTION.
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 63.25"
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND ts"
IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
34.5"
DESIGN CRITERIA TOP VIEW
NUMBER OF BEDROOMS: 3 BEDROOMS 60"
END CAP END CAP
SOIL TEXTURAL CLASS: CLASS I FRONT VIEW SIDE VIEW
DESIGN PERCOLATION RATE: <2 MIN/IN END CAP
DAILY FLOW: 330 GPD REAR/TOP VIEW ^
DESIGN FLOW: 330 GPD NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
TO CHANGE VITHOUT NOTICE. PRODUCT DETAIL MAY -
GARBAGE GRINDER: NO-AND NOT PERMITTED WITH THIS DESIGN DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY ==B.4640 TRUEMAN BLVD
HILLIARD, OHIO 43026 Are 36HC DETAIL
LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF ADVANCED DRAINAGE SSMMS,INC. UNITS MUST BE STAMPED H-20
.74 GPD/SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SOIL ABSORPTION SYSTEM 38 STONEY CLIFF ROAD, CENTERVILLE, MA
USE ADS Arc 36HC UNITS IN STONELESS TRENCH CONFIGURATION Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
(GENERAL USE APPROVAL FOR 7.88 SF/LF IN TRENCH CONFIGURATION)
Engineering by: SCALE DRAWN JOB. N0.
1 TRENCH WITH 12 UNITS @ 5.0' PER UNIT = 60.0' Engineering Works, Inc. NTS P.T.M. 108-13
60.0' x 7.79 SF/LF = 467.4 SF 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(467.4 SF) = 345.8 GPD (508) 477-5313 2/11/13 P.T.M. 2 Of 2