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HomeMy WebLinkAbout0018 SUNRISE ROAD - Health 18 Sunrise Road Centerville P A = 251 105 .10 llll UPC 12543 NO.�R `tis+mNS`���° HASTINGS. MN a olrnmonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 18 Sunrise Rd. Property Address Alexandre Naurath z., Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name r� P.O.Box 763 Company Address Centerville Ma.. 02632 rerun City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluatio the Local Approving Authority 12/21/2007 Inspectors Signature Date The system inspector shall submit a copy.of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 18 sunrise rd.,12/07 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts `W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 18 Sunrise Rd. Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more,system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits,substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health.. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval.of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 18 sunrise rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °w 18 Sunrise Rd. M Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.. 18 sunrise rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 18 Sunrise Rd. Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 18 sunrise rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , M 18 Sunrise Rd. Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a.private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ , ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 18 sunrise rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Sunrise Rd. Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health . ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption.System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at'issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 18 sunrise rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 1 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Sunrise Rd. Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State . Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑. Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readin s, if available last 2 ears usage d 2006:163,000 g ( y g (gpd)): 2007:114,000 Sump pump? _ ❑ Yes ® No Last date of occupancy: unknownDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date i Other(describe): 18 sunrise rd.•12W Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 18 Sunrise Rd. Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: System installed 2006 Were sewage odors detected when arriving'at the site? . ❑ Yes ® No 18 sunrise rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 7 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w 18 Sunrise Rd. Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 14feet Material of,construction: ❑ cast iron N 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence'of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal 'D fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 H2O _ Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured 18 sunrise rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 18 Sunrise Rd. M Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic-tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 18 sunrise rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 18 Sunrise Rd. Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ' Attach copy of current pumping contract-(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has two outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 18 sunrise rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 I . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 18 Sunrise Rd. Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers' number: 2-500 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No evidence of hydraulic failure.No ponding or damp soil. 18 sunrise rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 I , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 18 Sunrise Rd. M Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 18 sunrise rd.•12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Map Page 1 of 2 Town of'Barnstable- Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out j J j j j NIA In (�yq1 'M r R.r r e ge3 x r 0 - Feet F n � Set Scale 1" = 20 I Aerial Photos r'—,,inhf')OOr_7M7 Tn... of P.—tohlo NAA All rinhf.rncone http://www.town.bamstable.ma.us/arcims/appgQoapp/map.aspx?propertyID=251105&ma... 12/21/2007 r — - Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 18 Sunrise Rd, Property Address Alexandre Naurath Owner Owner's Name information is required for Centerville Ma. 02632 12/21/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LC 30' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2006 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database.-explain: You must describe how you established the high ground water elevation: USED:Gaherty& Miller model 12/16/94 ground water elevations.USED:USGS observation well data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. r 18 sunrise rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 i TOWN OF BARNSTABLE LOCATION SEWAGE# 200f6 VILLAGE ASSESSOR'S MAP&PARCEL g I /0-�— INSTALLERS NAME&PHONE NO. �— SEPTIC TANK CAPACITY t S 00 (�— LEACHING FACILITY:(type) ,9 ,50' 0 C Li- c')O(size) l Z X der NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility WO 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 eS � a 3a,0 3 q L4 a D 3 3..7 a 3Y cgr.° No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpphration for �Bigonl �§pztem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 1'2 Jv-t e-%S E ��� Owner's Name,Address,and Tel.No. Can �on� zpRmss N�M ftN Assessor's Map/Parcel SAM G Installer's Name,Address,and Tel.No. 02\-44�A (C-P! 1 Designer's Name,Address and Tel.No. tala- tOE EN�e f_LC 15";4y Et Svcs, 42 -402. 534-"+910� Type of Building: Dwelling No.of Bedrooms 3 Lot Size Zl ,& o +- sq.ft. Garbage Grinder Other Type of Building hi pie No.of Persons V Al k Showers( of Cafeteria( �) Other Fixtures LA V-A-r Qy KI TCAC- J :S- J1A)k 1 A1r13 Design Flow(min.required) 3 b() gpd Design flow provided ,331 ,S gpd Plan Date 4T1�tTt3(� Number of sheets Revision Date Title e 15>k6-ecr.� ccc� Size of Septic Tank K\ Type of S:A.S. 2— Description of Soil p\eve Nature of Repairs or Alterations(Answer when applicable) '\-b 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 Boar 1I alth. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 20 cc - �-( ———Date Issued —— -! No. , :, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ►Yes RpPlicatiort for �3i!5Po!5a1 ,pgtem Construction Permit Application for a Permit to Construct O Repair . Upgrade( )! Abandon O Complete System Individual Components a Location Address or Lot No. 8 SuN Q.NS C -ev, Owner's Name,Address,and Tel.No. _ �r�M1:S NYMflN � Cet��cw�\1C Assessor's Map/Parcel Z j (�S a t cJ� C Installer's Name,Address,and Tel.No. t 'f^r rat 4 w'ti De igner s Name,Address and Tel.No. CAPEW tOE ENT .LLt`� , � ..t �+' ,,� �'jN�lY E,.►�1t JCS, Type of Building: `"" Dwelling No.of Bedrooms Lot Size Z j 830 } sq.ft. Garbage Grinder Other Type of Buiidin ✓yp g N c ne No.of Persons U�(1� Showers( v) Cafeteria( ) Other Fixtures k . to v A_MD_y ki Tc N E,J ;;/Ajk / ca.aJ®P.Y Design Flow(min.required) gpd Design flow provided gpd Plan Date — `01r)" Number of sheets Revision Date t] Title �� O'�Qe` l G t Size of�eptic Tank (\�Q�,� Type of S.A.S. 2 ¢4hnrne5 lbt X ZS�tZ' Description of Soil �Co G>1 eJl i Nature of Repairs or Alterations(Answer when applicable) �rie *.'Z) t 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 Application Approved by _ Date -! �'' 5 t' Application Disapproved by: Date for the following reasons Permit No. 2n cy,� l `9 �� Date Issued � F i" THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS � 1 Certificate of Compliance x THIS IS TO CERTIFY,that the On-site Sewage Disposal SystemConstructed ( ) Repaired ( Upgraded ( ) Abandoned( )by C t�15 I LC_.. « _.W^ nn ,, _ at �K) QXSE (' LLB has been constructed in accordance with the provisions of Title 55 and the for Disposal System Construction Permit No. 7(�n rn g� dated ulx Installer �(.:l.�f�� D (_'.IVI GK�1 �.�S • Designer f'�� �. s�(/� #bedrooms 3 Approved design flow ,-- ' gpd The issuance of this perm't�jsh Il no+/bye construed as a guarantee that the sys��ill fuZt~ iorb aA ekigne�. Date ,/0 69 Inspector, --------------------------------------------- No. �-�1 ll'1 TJ Fee (a) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Merlito.5aY 6pgtem Con5truction Permit Permission is hereby granted to Construct ( ) Repairs"(�)4. Upgrade ( ) Abandon ( ) System located at (2,4, and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty _ to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed,within three years of the date of this permii. DateLll t- ���(o Approved by "'� Town of Barnstable F1ME T Regulatory Services Thomas F. Geiler, Director BMWSTABLE.Ds 9�A MASS. 1�0 Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 5/02/06 Designer: Shay Environmental Services, Inc. Installer: Capewide Enterprises Address: P.O. Box 627 East Falmouth Address: P.O. Box 763 MA 02536 Marstons Mills, MA 02632 On 4/28/06 Capewide Enterprises was issued a permit to install a (date) (installer) septic system at #18 Sunrise Road, Centerville , MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 4/19/06 (designer) XX 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. F, I certify that the septic system referenced above was installed with major changes (i.e greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. pit , ��4�N OF MgSVc9C�", o` CARMEN G� (Installer's Si ature), E. SHAY co No. 1181 Fcis TV.: S (Designer's Signature) (Affix tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form i TOWN OF BARNSTABLE LOCATION (2<j SEWAGE# VILLAGE• ASSESSOR'S MAP&PARCEL 2S / INSTALLERS NAME&PHONE NO. ��,,��_ ��� �g e4oat SEPTIC TANK CAPACITY Sw. {-1— j LEACHING FACILITY: (type) C+ 10(size) Z k d NO.OF BEDROOMS OWNER--�;'e.vhQ 5 i ►,n 4 PERMIT DATE:. COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted,Groundwater Table to the Bottom`of Leaching Facility +NO I Z 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 i�zs � it�sg I tqr .� 3 �g 40 at4 61 q :p, � � a 43aa 4 r 43 3 1. a �{ ar.® as MAGNETIC / Cre9or1, yi /y/F' / C�2626�o l000 +l _ \ OD O Ln 1 V O ,Q, �AO9*O)ddd 4 Q Q 1 1 T A m 2 n Cu T lb o ti \ lOp 69, _ o \ \ l Loney . N/F Prior & C,y p ~ _ 1 375g0/6 otston �5 Overview 2 KU gg gi 55 fit' �,-+r iSta 7 41'- F t.. 'i P � .�`. *�� s c ��,,� ila�'�,�•• ' ��y �" '��. 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Cash Company Name: Straight Flush Septic Inspec MAR 04 2004 Mailing Address: 27 Osprey Lane E.Sandwich, Mass 02537 TOWN OF BARNSTABLE Telephone Number: (508)833-0873 1 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 true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and expeiience 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: xx Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date. 2/23/04 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and:-finder the conditions of use at that time.This inspection does not address how the;.system will perferm;.hkhe future under-the same or differeliit conditions of use. i= Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 18 Sunrise Road Centerville, 02632 Owner: Nyman Date of Inspection:2/23/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: xx 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: 'I have found nothinq to fail this system under the provisions set by the state and local qovernment. B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the_for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 18 Sunrise Road Centerville, 02632 Owner: Nyman Date of Inspection:2/23/04 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 surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for 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. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:18 Sunrise Road Centerville, 02632 Owner: Nyman Date of Inspection:2/23/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No xx Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool xx Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Xx Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool xx Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow xx Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped . xx Any portion of the SAS,cesspool or privy is below high ground water elevation. Xx Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. xx Any portion of a cesspool or privy is within a Zone 1 of a public well. Xx Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Xx 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 cotiform 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.] kd (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 flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no n/a the system is within 400 feet of a surface drinking water supply n/a the system is within 200 feet of a tributary to a surface drinking water supply �/` the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 18 Sunrise Road Centerville, 02632 Owner: Nyman Date of Inspection: 2/23/04 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No xx _ Pumping information was provided by the owner,occupant,or Board of Health xx Were any of the system components pumped out in the previous two weeks? xx _ Has the system received normal flows in the previous two week period? xx Have large volumes of water been introduced to the system recently or as part of this inspection? xx _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) xx _ Was the facility or dwelling inspected for signs of sewage back up? xx _ Was the site inspected for signs of break out? xx _ Were all system components,excluding the SAS,located on site? xx _ 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? xx _ 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 xx Existing information.For example,a plan at the Board of Health. xx _ 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)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 18 Sunrise Road Centerville, 02632 Owner: Nyman Date of Inspection: 2/23/04 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: ,t Does residence have a garbage grinder(yes or no):_N�L��� Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no):yvi Seasonal use:(yes or no):&D Water meter readings,if available(last 2 years usage(gpd)): 2002-80,000 2003-78,000 Sump pump(yes or no):No Last date of occupancy: 2/04 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Owner sup. Septic pumping info Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system xx Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: House was built in the 60's Were sewage odors detected when arriving at the*site(yes or no):No Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Sunrise Road Centerville, 02632 Owner: Nyman Date of Inspection: 2/23/04 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from,bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Sunrise Road Centerville, 02632 Owner Nyman Date of Inspection: 2/23/04 TIGHT or HOLDING TANK:_(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal_fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Sunrise Road Centerville, 02632 Owner: Nyman Date of Inspection: 2/23/04 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located why:explain : P Y Type leaching pits,number:_ leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number:_ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1/6X8 cesspool Depth—top of liquid to inlet invert: 20" Depth of solids layer: 5" Depth of scum layer: 1" Dimensions of cesspool: 6X8 Materials of construction: Concrete Indication of groundwater inflow(yes or no):_ Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): No sign of any failure under the codes set by the state and local government,qround dry, veq. normal no siqn of any break-out or pondinq. PRIVY:_(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Sunrise Road Centerville, 02632 Owner: Nyman Date of Inspection: 2/23/04 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. My Fro&A 6use / 1 1 °i 1 Title 5 Inspection Form 6/15/2000 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: 18 Sunrise Road Centerville, 02632 Owner: Nyman Date of Inspection: 2/23/U4 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 17.0 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 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) xx Accessed USGS database-explain: Cape Cod Commision You must describe how you established the high ground water elevation: Augered down 17' no water encountered, not next page %'' `` Title 5 Inspection Form 6/15/2000 11 Permit Number: Date: Completed by: .� 1.11GH GROUND-WATER LEVEL COMPUTATION Site Location: 18 Sunrise Road, Centerville _Lot No. Owner:Nyman Address: 18 Sunrise Road,Centerville Contractor. Straight Flush Septic Inspectors Address: 27 Osprey Lane, E.Sandwich 02537 Notes: No water encountered STEP 1 M rastrre depth to water tab le to nearest 1/10 ft. .................................. It!.............. Da2/23/04 17.0� rnonrh/clay/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: ( Appropriate index well................. ..................... Sdw25:- © Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to 2/04 50.5 water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 26) _ 6'9 determine water-level adjustment .......................................................................................... 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Sdnedule 4d PVC w/Charcoal Odor Titer SECTION A A ALL OUTLET APES FROM THE �house 10' min. from Amass cony Mostb° PROFILE PIEII OF LEACHING SYSTEM MISIRW1101e emc SHALL K tr CONCRETE COVERExisting Foundation to septic tank O7inBOX �� be grads SET tEvaT FOR AT LEAST 2 FT ° e z Win 6" of fN>Tslned GARAGE, FLOOR SLAB ELEV. 100.00 (ASSUMED) septic tank covers must be 6" of finished grads vrtiH Riser COVER I Jf+ a within 6 Nn o1 fknlsinedRISW k H-20 River ,r-: 3-r OUILET •� :s s 1 1 Orals afar Septic Tank-9950 -20 R COVER Orods ever D-Box-9950 mer SAS- ELEV-90.50 �•a f f/1r;�vI ameh s sew #/lAr-11r�i -w- �� a �' !! 1 CT1aN cover mwt �}�_ ( j o within 6 in. of finishedFA prods < OUTLET !' ` �•�•A rs.� s�+vea�yy S 0.02 3 OLE H 20 3 Maxknun Cover Top Of SAS-Bev.=96 00 ,,.� ,e: ff 46 ! NEW S-0.01 or Oreoter S- 0.010•per foot j . tf15" loOSL e� $ �• g 1,500 GAL 10' 1 0 0 o Oo 0 0 0 4" - SCH. 40 FROM EXM.FwroATiw A m SEPTIC TANK �. ,�, • EffaoU,e o pth o C3 o 0 o PLAN SECTION CROSS-SECTION c o jo 0 2 Units H SS = iT € Kra911 H-10 e. 4, 8' 4+ a ` b rIL,/ ±l CONCRETE FUI1 m rn i 3.5'-- ri'- 3.5' a o "ml A-1 ri 3 HOLE H-20 DISTRIBUTION BOX SYSTEM PROFILE 6 b.a1 3/4"-1 1/2' EffeettvfLerngth NOT TO SCALE 1sm e compacted atone Tii o 87Db1 AlnHlya K*A* I t e � G7 Effect'hre Vklth � 1 1 I Not to Scale - - o SOIL ABSORPTION SYSTEM (SAS) c 1. 500 - C H-20 LEACHING UNITS / WIGGINS PRECAST GENERAL NOTES 6 in of 3/4"-1 1/r BOTTOM OF TEST HOLE a ELEV 87-W m conripacted stone Not to Scale 1. Contractor is responsible for Digsafe notification NOTE; ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE and protection of all underground utilities and pipes. 2. The septic tank and distribution box shall be set level on 6" of 3/4 -1 1/2' stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. �r TR T \ \ 4. This system is subject E inspection during installation W�,Sf T GL O W .l �` � by Carmen E. Shay - Environmental Services, Inc. PERCOLATION TEST t 5. The contractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan MARCH 31, 2006 t t and Local Regulations. Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 100.00' t, tt 6. If, during installation the contractor encounters any Results Witnessed By. WAIVER (BARNSTABLE B.O.H.) soil conditions or site conditions that are different SHAY ENVIRONMENTAL SERVICES, INC. t t from those shown on the soil tog or in our design Percolation Rate: Less Than 2MPI ® 48" t tt installation must halt do immediate notification be tt ; made to Carmen E. Shay - Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the Test Hole Test Hole septic system unless noted as H-20 septic components. No. 1 No. 2 t 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. � i t 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. DEPTH SOILS ELEV. DEPTH SOILS ELEV t D 99.50 0 99.50 10. All solid piping, tees & fittings shall be 4" diameter Schedule 40 NSF PVC pipes with water tight joints. Sandy gavel dr Loam Dena Grade .. , t 11. Municipal Water is Connected to ALL OF The Residence and Abutting t t Properties Within 150 Feet. ------ t 1 • .00 t -----�_- ---I08 Sandy sandy I i THE PROPERTY LINES ARE APPROXIMATE AND LOOM LOOM SURVEY�,,,, = • t COMPILED FROM THE SURV PLAN GENERATED BY ta 10 rR 5/6 04 i ED KELLOG OF OSTERVILLE, MA ENTITLED 6"- 48' Be 95.50 6"- 4r Be 99.50 O i PLOT PLAN OF LAND OF in CENTER'VILLE, MA' Mod. AND �O t DATEDDEC. 1956. IT SHOULD BE USED FOR NO PURPOSE 2� � /3 Ste`. LOT #2 & LOT #4 i OTHER THAN THE SEPTIC SYSTEM INSTALLATION. 50 46"- 144 7.50 ��` l 48- 144 �\ 21,890 Square Feet t/- ; Y = i EXISTING CESSPOOL TO BE PUMPED OUT AND REMOVED TO FACILITATE INSTALLATION OF NEW SAS. . i NOTE: ANY STRIPPED OUT SOI ATE E%ISTIN ; FROM THE EXISTING CESSPOOL TO BE DISPOSED SHED ; OF AS PER BOARD OF HEALTH SPECIFICATIONS. 1 ; NO WETLANDS ARE "PRESET,T WIT ilN 200' OF THE PROPERTY Perc #1 ASSESSORS MAP 251, PARCEL 105 Depth to Perc: 48" to 66" LEGEND Perc Rate= Less Than 2 MPI Assumed \ i i t Observed ESHWTA - NONE OBS.- 144" �`� �� tt � i t DENOTES PROPOSED Design Calculations 104X 1 SPOT GRADE �,,\ .� \ � �t Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 GoL/Day Min. per Title v e ) X Garbage Grinder. No `� �` DECK ; t 104. DENOTES EXISTING SPOT GRADE Leaching Capacity Proposed: 330 Gal./Doy Minimum (Min. Per Title V) ` t Septic Tank : - 2 x 330 Gal./Day = 660 USE NEW 1,500 GAL. Septic Tank. \� \� , i .� , .` ; � PL PROPERTY LINE SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Bottom Area: 0.74 gal/sq. fL x 300sq. fL = 222.00 gallons os ; i - 96 PROPOSED CONTOUR Sidewall Area: 0.74 gal./sq. ft. x 148 sq. ft. = 109.50 gallons i 1 EBISTIIVG Providing: = 331.50 gallons 3 BEDROOM - ---- -97 EXISTING CONTOUR i i Use- (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, HOUSE t I TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND EXISTING DEEP TEST HOLE & 4' OF WASHED STONE ON THE ENDS. AGE DECK PERCOLATION TEST LOCATION J• � I 3-2-C MAIL ACCESS MAWMLES o� --- CONCRETE SLAB j 6 FOOT STOCKADE FENCE try PROJECT BENCH MARK FOUNDA"ON 1 GARAGE SLAB FLOOR ELEV. = 100.00 (Assumed) 0 ° ------- --_--- ASPHALT -^�t� DRIVEWAY , PLOT PLAN INLET 1 Failed t c `� f { GRAVEL _�---- INtFr = / CESSPOOL g' J�: ------ I f q3 RIVEWAY m 3 -_�. THE ACCESS COVERS FOR THE SEPI C TANK. -- ;t a OF PROPOSED SEPTIC SYSTEM UPGRADE DISTRIBUTION BOX AND LEACHING COMPONENT l �5^ s ;;\ a L ` SHALL BE RAISED TO WITHIN 6' OF � i \ ` �; PREPARED FOR f� �� t �f STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE ,�, 1 �` �` / `` r�ti'� - ✓ PLAN yIEw T EG S OR EQUALS o ;� :, i JAM ES A. NYMANON ALL /- NDS NEW c500 gal 3-W REIMVI COHERs Septi o - , � �T'E5�-HOLE#2 ' ``. : of3' AT a ELEV.- 99.5- 18 SUNRISE ROAD r .,. - _ a -"" r;,• TEST HOLE1 4" PVC �j0 corn.d�arenee mM-t- r Min.Inlet to eua t r:' ••r T ELEV.= 99.5 Vent Pipe �y . �4,_ , % ;� C E N T E RV I L L E, MA 10•as ,� t �r` 115.00, ; �� s-r e-r E§ 98- -f _ �`� i �0 `(N�=MASS PREPARED BY: r-W mb. ------------. 10 RNEW SHAY 00 E. fs U1 tT.R I,S.E .R OA I� � S Y � � NVIRONMENTAL SERVICES, INC. CROSS SECTION END-SECTION 0 20 40 50 P.O. BOX 627 (40 FOOT RIGHT Of WAY) EAST FALMOUTH, MA 02536 TYPICAL 1500 GALLON SEPTIC TANK 84N1TAR�Pa TEL/FAX : 508-548-0796 NOT To SCALE SCALE: 1"=20' NOTE: REFER TO ATTACHED FLOOR PLAN SCALE: 1"=20' DRAWN BY: CES DATE: APRIL 19, 2006 (H-10 LOADING) F PROJECT#SD896 FILENAME: SD896PP.DWG SHEET 1 OF 1