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HomeMy WebLinkAbout0056 THOREAU DRIVE - Health " 5G T— reclu giveIF ' Centerville P ' LA = 191 185 a a I Iy s 4 0. 0)x7ford, NO. 1521/3 ORA N.14 10% i I Fee �NorT� Alpo THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN,OF BARNSTABLE, MASSACHUSETTS Yes ftpfiration for Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.S6 �� ,��4(mot Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Z tj 91- Installer's Name,Address,and Tel.No. tm 3.,4 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures u Design Flow(min.required) 3-76 gpd Design flow provided /!� ° gpd Plan Date Number of sheets Revision Date l Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 16 joz* > C1t r q 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 Healt Si ed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No, l Date Issued 7 TOWN OF BARNSTABLE LOCATION ED T��LA Oc, SEWAGE# 9 �) VILLAGE Cet'C tS \R ASSESSOR'S MAP&PARCEL AH M� v INSTALLER'S NAME&PHONE NO.p,bV�OnO SeuQr-k Dca.n Sfl�6 3(aHgS`67 SEPTIC TANK CAPACITY 1300 ��� qeofon LEACHING FACILITY:(type)'a, �SO G (size) NO. OF BEDROOMS 3 OWNER 1ZO no-c S PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Q a } No!.T" 1-7 Fee AID THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�,f'- PUBLIC HEALTH DIVISION -1T�OWNo,OE B�2NSTABLE, MASSACHUSETTS Yes 01pplitation for Bisposal ,pstrm ConstrUttion Permit Application for a Permit to Construct Repair( 'e Abandon Com lete S stem Individual Components PP ( ) P ( ) U�p�a ( ) ( ) ❑ P Y ❑ P Location Address or Lot No. / U Owner's Name,Address,and Tel.No.S 4 r, AD d Assessor's Map/Parcel Installer's Name,Address,and Tel.No. /f Designer's Name,Address,and Tel.No. �� yt 3.1 7 CtN-f/ IC-✓� Oral G 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) 3-76 gpd Design flow provided ' 7 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank �a 00 Q Type of S.A.S. J Description of Soil j Nature of Repairs or Alterations(Answer when applicable) ,401.6 C4-C/y 1/41-1 -„ 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 Bo d of Healt ) / Sig ed Date Application Approved by Date } � Application Disapproved by Date for the following reasons Permit No. ram' r) ( r Date Issued -- - - ------- ---------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS eeftifitate of Comphaftre THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by ,� /A_v IZ© 1 — n - ---- at � /� q (e&V4L D A has been constructed in accordance ff with the provisions of Title 5 and the for Disposal System Construction Permit No.:�/7-.9 1 dated Installer �� w�)r+l� -S�'/+N ✓ P,�f�,C 01-0-i Designer #bedrooms Approved design flow ^r� god The issuance of this permit shall not be construed as a guarantee that the system w l>fancti^ojasdiesjIg& Date } } % Inspector l•--�r . -_-----_,_-_____.______.___.___.-___-_-._____________________._________I_ _________---___ No. }-7 _ 11 Fee / 0 V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Vsposal 6pstem onstCUttion 3p fmit Permission is hereby granted to Consstcuct( ) Repair( v) Upgrade( ) Abandon( ) System located at ! g 1.4 e,- &a Q(Z- 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 must be cog�pleted within three years of the date of this permit. Date I �� I 1 -7 Approved by RrV uia o ry servic�es RioardX S'cali,Interim Directtrt' R'BARN5TA[�'L. w g PI ;HeaU4 d�vas�€tj�a 'I'hotfias lvlcl<Ojib,DIfectoar Z{}ti'tYi�arxrStreet,]FT:���tixrxis,.:ilT4..(l�Ui.)1 ©S ee: 5t7 562 �1:Ci 1} !ax '50 -'%-G30 4 'mta ler DcslZner Qrti'Iication Forte Date: t1 ) Sewage Permit# 0 t`7 ��_ �1 .Assessoi•7s.PNIap\P.:vrcel 1 Designer � e .. lnstaller x s�✓l�S- � �'t.' �1 Gs �e ( Addr•t*ss: 3SK,� e;�, rgwt i 66 P C}n. k=as.issued a Oerrnit to install a s'lJ c syst n Glil Mfg `" � �^e �y � �; EQaas d oil a j s'Igjl dra vri b- ter i';,M-c G,. e t, (addrers�... Al c elated-_ Ct I critify,that the septic,systern re efe' ced above Was i rstalle 3'substantially ace ord ng to the-design;Which Inay in ucle r-runor approve d ehancyes;such as lateral relcacatiora of the dis'Giibuifox bCxx.axd!or sclarrcR tank. Stlip, octt ("if recicjraeti) was insp cted and the soils werE fottn�l satts'fae"tor}: 1,°certify that.the,scptrc;sy'stern r-efe fenced ubo e. was r'nstat:ted w4h''rna or chanbc`s (i.c: greater than ]V-lateral re;l'ocatiar -of the &AS,«r any Vertic,!,L r l'txca t,ion of any component aE'th4 septic''system) Bert in aeccirdance kvith Stitt;R Local, R gulations. Plan r vis'ion or ce'x t fiecl <is lxtrrlt C} desig xrr to foltorv. Str•i}i o tt(if recluifed) was inspected and the,soils v�ci�c'fotrixtl sltrsf��.tory, l ce ti:fy that the swtern referenced above was Ctrrxstrt ct� N-ith the te-rins. - -- o1'tl e I�,r� al)prova3 letters r pplir;tible} Rm flhsta°ilea s Stgn�atur }" t ' (1)es itcr s.S°� rtatLIE (Nllix-Designer . Strop Here) PLEASE ETU'RN 16 I3� ONSTABLE PUBLIC I I,7�ALTH U:IVISI01'. CERTIFICATE' 4F CC?1I1'I Irk`CE \h"lI L. >rtfJ t" 6F [SSt;ED UNTIL BOTH THIS FORTI ND AS BUI ARD ARE RECE14IT B THE'BARNS`IABLE,PL'-i3.LTC 1IE; I.T.I"I l)lVrlSION. THANK YOU. r:' ' lat ctl�clencr Cerkcfir itictn E.=orK>a Rr� l-1 ..I i, uc Town of Barnstable P# Y` Department of Regulatory Servicies Public Healfth Division ` wtxereat.e, � Date ��"s"ss ---�----- i6J� �� 200 Main Sn-eet,Hyannis MA 02601 Date Scheduled / _T k C)a oltJ / Time_ _� Fee Pd. Soil Suitability Assessment for !)ew Disposal Performed By:p,�e.� RC.E {-e c S(��� C{2 Witnessed BY: — LOCATION & GENERAL INFORMATION LcKation Address j� Owner's Name; 5_(1 —MCJ r"Qot V Pe Address is $ea,%0 Cep �P 1 e i �c�l�t` © Assessor's Map/Parcel: e— `�s� Zd�z Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 50 9 - 4-7 3 Land Use " pp' , 1� IrA2 :rn � Slopes('Yo)�Z � Surface Stones Distances from: Open Water Body-3 ad ft Possible Wet Area �_M_ ft Drinking Water Well (S-Oft Drainage Way�rl_A� ft Property Line [ rZd ft Other _ ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands fn proximity to holes) i 1 � Z Parent mate rial(geologic) V Cf�'uI'Q:f t� . f; ) _—_ Depth to Bedrock:r� Depth to Groundwater: Standing Water in Hole: Weeping from Pit Nce i1�6i2e T Estimated Seasonal High Groundwater DETERNUNATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing;in obs.hole: F_u-- in, Depth to soli m(tttlo,...-..a,-.rr-..o....,-.._-..--in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# _ Reading Date:__—_ Index Well level_..m Adi,factor—_ Adj.Oroundwater LeveI PERCOLATION TEST Dole.�.,,,_..�, Thite,_,m,� Observation � Hole# 1 )O—f Time al:h" Depth of Pere �� rr(t Time at 6" 2 q C, j Start Pre-soak Time @ — —. Time ff'-6") End Pre-soak Rate Min./Inch ?' Site Suitability Assessment: Site Passed ✓ Site Failed:_ Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back------------ ***If percolation test is to be conducted within 1.00' of wetland,you must first notify the Barnstable.Conservation'Division at least one (1) week prior to beginning. Q:\SEPTfC\PERCFORM.DOC r DEEP OBSERVATION HOLE LOG bole#T�'— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% ravel DEEP OBLSERVA TION HOLE LOG Z I Depth from Soil Hor izon Soil Texture So il Color Soil Other Surface(in.) (USDA) (Munsell) Mottli:ig (Structure,Stones,Boulders. Consistent % ravelL— I U�� gyp, S � �.oyt2`IIz DEEP OBS5ERVATION 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. w Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistent,°k Oravel]� Flood Insurance Rate Map:, Above 500 year flood boundary No— Yes_ Within 500 year boundary No r� Yes Within 100 year flood boundary No Yes, Depth of Naturally OccurringrPervious 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 pervious material? Certification I certify that on 1( c1Q,5 (date) I have pawed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was pe:r,-formed by me consistent with . the required training,expertise and experience described in 310 CMR 15.01" . f Signature. Date_ Q:\S EPTIC\I'ERCFO RM.DOC COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Cgmplete items 1,2,and 3.Also complete A. Signa '* b item 4 if Restricted Delivery is desired. ��. y •❑Agent ■ Print your name and address on the reverse Ix A7 `'% y Mcidressee so that we can return the card to you. B. Received by(Arke amp O. gate of.Delivery ■ Altach thi$card to the back of the mail iece, or on the#rout if space permits. p D. Is delivery address d �nt frorTrfem 4 7 es 1. Article Addressed to: If YES,enter deliv4.5ddd?bss-below: [3 No 2®r q e i^ 3.' se �e Type ertifled Mail ❑Express Mail I ❑Registered 1Aetum Receipt for Merchandise d-V ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ,4 , (Transfer from service label)t 7 O Q,6 !0 81 p; 0 0 0'�� 3524 7,16 8 j PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 1 I UNITED STATES POSTAL SERVICE wu • .,.r ,,.� o """�:;,v,w„�:�.�: �ir �-°Ofas Mail,. g��aid �.w. A.: Pe • Sender:.Please print your name, address, ana"NP-�fr6 this tiox �• « = I I i � I 1 %'��� \ Town of Barnstable id J. Health Division 200 Main Street Hyannis,MA 02601 I I ��'t'�1�1'i'li'i!„I„i�11,1l11�11111„III�I111111�1,11'11'i�'�'I�� I I U.S. Postal Servicew CERTIFIED MAILTM RECEIPT (Domestic Mail Only;No Insurance Coverage Provided) For delivery information visit our website at www.usps.corn • 73 ��® i PS Form 3,800,June 2002 See Reverse for Instructions Ce,illfied Mail Provides: a A malti ng receipt (—anaa)Zooaaunr'oosE-odSd 11 A unique identifier for your mailpiece to A record of delivery kept by the Postal.Service for two years Important Reminders: • Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. • Certified Mail is not available for any class of international mail. • NO INSURANCE COVERAGE IS PROVIDED with. Certified Mail. For valuables,please consider Insured or Registered Mail. •For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for I a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. •For an additional fee, delivery may be restricted to the addressee or addressee's authorized a ent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. 'IMPORTANT:Save this receipt and present it when making an inquiry. tnternet access to delivery information is not available on mail addressed to APOs and FPOs. Town of Barnstable Barnstable �pINE r Regulatory Services gyp`' o Thomas F. Geiler, Director mericaCity Public Health Division EARNSTABLE, *. 9 MASS. Thomas McKean,Director 1639, �0 2007 Ar f 200 Main Street ' Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 I� I Sent Via Certified Mail: 7006 0810 0000 3524 7168 June 18, 2013 George.Papps P.O. Box 123 Dedham, MA 02027 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. .According to our records, you own the rental property at 56 Thoreau Drive, Centerville, MA. Enclosed is an,application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.bamstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2012 fees included. This must be completed within (14) fourteen days of your receipt of this letter. 1 Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Karen Herrand Division Assistant Public Health Division Direct#508-862-4072 i I ' ' Y COMMONWEALTH OF MASSACHUSETTS ` z EXECUTIVE OFFICE OF ENVIRONMENTAL.AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECT T% ISM Sy,J. J 1 TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY:ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 7`7(�nn l�2� oC///w��(� MAP I I Owner's Name PARCEL : a r Owner's Address: �[(� LOT Date of Inspection:\--IC PA Name of Inspecto (ple• se rint) — Gv Company Nam Mailing Address: _ Telephone Number: 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 15.340 of Title 5(310 CMR 15.000). The system: /Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fail / Inspector's Signature: Date: 9 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 ar�r� irk. ad� Y ""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 6/15/20.00 page I Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: �� Date of Inspection: UQ Inspection Summary: Check A,B,C,D or E/ALWAYS complete.all of Section D A. •/System Passes: V 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. 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 oraank 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: r Owner Date of Inspection �- 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 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR V + LUNTARY ASSESSMENTS SUBSURFACE`SEWAGE DISPOSAL SYST M INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 4 uL1 Owner. Date of Inspection: o�O D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ _ �1 Backup of sewage into facility or,system component due to overloaded or clogged SAS or cesspool 1/ 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 9 j Liquid depth in cesspool is less than 6"below invert or available volume is less than %z day flow V Required.pumpmg more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within 100 feet of.a surface water supply or tributary to a surface water supply. .Any portion of a cesspool or privy is within a Zone 1 of a,public well. Any portion of a cesspool or privy is within 50 feet of a:private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no'acceptable water quality analysis. [This systern 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 A 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 corredthe failure. E. Large Systems: To be considered a large system then stem must servea•facilit with design Y y a g flow of I000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the.criteria above) yes no the system is within 400 feet of a surface 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. '4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owne • Date of Inspection. a Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes o Pumping.information was provided by the owner, occupant,or Board of Health vl' 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? V _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no ./ — Existing information.For example,a plan.at the Board of Health. LZ- 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)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: ff/g MuL&4 Owne Date of Inspection - 00 FLOW CONDITIONS RESIDENTIAL kl� Number of bedrooms(.design): :2 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (fo example: 110 gpd x#of bedrooms):. Number of current residents: Does residence have a garbage grinder(yes or no Is laundry on a separate sewage system (yes or no):ag[if yes separate inspection required] Laundry system inspected (yes or nokl� Seasonal use: (yes or no)V. z4f� Water meter readings, if a ailable.(last 2 years usage(gpd)): aO� Sump pump(yes or no)/ p p Last date of occupancy: COMMERCIALIINDUSTRIAL—,4t& 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: 1 =%� Was system pumped asp 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 _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 _�cAttach a copy of the DEP approval , Other(describe):�L.2'a"'::':� g� Approximate age of all components, date installed(if known)and source of information: C&O .7=d A Were sewage odors detected when arriving at the site(yes or nol:L—/&. 6 II I i Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY_ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: ��1c ®A Owner: Date of Inspection: Z,P� pppri 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:j/'(locate on site plan) Depth below grade: f� 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: � k Sludge depth+ � x nt - 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:c 1�i a"e /tr Comments(on pumping recommen ations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert:,qvidence of leakage,etc GREASE TRA�.. 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.): 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: 2. Owne Date of Inspection 0 f a(�v a TIGHT or HOLDING TANK (tank must be pumped at time of inspection)(]ocat:e 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 BOCK (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 CHAMBEkt. - 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.): 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: 1 ZQ2Q .� Owne Date of Inspection: (�d SOIL.ABSORPTION SYSTEM (SAS):JL(locate on site plan,excavation not required) If SAS not located explain why: ........... Type eaching 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.): � 1� - ���� CESSPOOLS: JW(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.groundwa.ter 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.of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 Page 10 of]1 OFFICIAL INSPIECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner• Date of Inspection 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. 10 Page I 1 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address., Owner. ��— Date of Inspection. ��OC�o� 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 150 feet of SAS) Checked with local Board of Health-explain: Checked with.local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: , 11 Penm.i'c umber: Date: Completed by:. Hrl'GH; Gi O-UNrD-VV-L T'cR L-VeL C.OMRU T A T ION C;� r Site Location: (9 1_?_11,1111e Lot N'o•. Owner Contractor:_ �d� Address: Notes:. Measure depth,-Lo.waier-,able. to nearestA/i0-;.ftL_ ._.._................................... .,........_.............. .Date . •_ � - mbntn/day/year I - S T=? 2 Usina.Water-Level.Range Zone i and Ih.dh.x Weill:Ma.p-locate site an.6determine: O".Appr•o.priate.index well.".............................�1.................._.. �J. L B Water-level ,:anaezone:._............................. q STEP:;:3: Usinc�monthi•y.report:;"'Gurr�nt -�. "� �- '. Water Resources Conditions" determine current-de:oth to water revel ror•Inderz wel•I ............................ monti/Year S,••EP• ''. Adjustments .or index'well (STEP 2.5:),,curnent death I' to water•le.v'el ios•index well ('STEP 3')., I. and water-level zone (STER28) det=_rml•na•wa srdevel sejustmem .......................... _ ---•_-- S7EP: 5 -stimate depth to:hiah water by subtractia th.e water• level adjustman.t"(S:T•EP 40 rom measured-.death to.water (e ite.level at s (STEP'1)' _............._.............:................................................................. :.. ! JZ Igurc '3,— 8i}s.0du0ible- om;; -a. i i LTt: s I t_O C QT N 5EW&CAE P ER MIT U O. Ihl p E 1JNNlE RESS BUILD R 5 �A/lE _ ADDRE S DATE PERMIT ISSUED DATE COMPLI &KICE ISSUED ; _ _ _ ��a� ao� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF tHEALTH d..... ..Yv ----- -----------OF............ ............ Appliration -for Biipgiitti Workii Tomitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -- - : 19 1 ., rl+p(Z l V-------------�......1_UL----------------------- ------------------L ° Locatio Address or Lot No. Ow Address -------------------------------- --------------.......----------- Installer Address �3_ o�� Q Type of Building Size Lot---------------!__---------Sq. feet U Dwelling—No. of Bedrooms------------------------- -------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ._r_ Design Flow......... .................... Mons er erson er da . Total daily flow--------------------- 0...._..........._gallons. W gg� P P P Y Y ---- g� WSeptic Tank—Liquid capacity/ ltP__gallons Length................ Width................ Diameter---------------- Depth.__.___-_..._._ x Disposal Trench—No-________' __.._.. Width___ ___ ___ _____ To�t L.en h--- .-_--_______--- Total leaching area--------------------sq. ft. Seepage Pit No..6_�_-__i7__ lame e _ Deptlr f owow ................. Total leaching area........--.---__.-sq. it. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY......-................................................................... Date.--------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-..-_-.-.---.--.-_---. - (14 Test Pit No. 2................minutes per inch Depth of Test Pit---------_---------- Depth to ground water...--. -_--.--.-_------ 9 - ....-------•- .. -------- ------------- 0 Description of Soil----l�C�,- / ifh!� -•-•-------•-------•--•---------•-------------- --•- ----._-- - ----------------------- I x ��!--'-------��j ----/�Jd-��------------- W x ------ ----------------- -------- ................................................ -------------------------------------------------------------------------------------------- --------------------- UNature of Repairs or Alterations—Answer when applicable---------------------__----.---..-__-__--_.-_-----_-._.-..---_.-.-._-----..-.___-__.--..--:__... -----------------------•-•-•------------------------•----------•----•-----------------------------•-----•------•--------------------------------------------------------------------------------------.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees'not to place the system in operation until a Certificate of Compliance has been issued by the boAd of health. ,� ................ ' Date ApplicationApproved By............... - / ......---'-•------•-------------------------'•-••-•'----'--'-••--••-- 6/17 Date Application Disapproved for the following reasons:................................................................................................................ '••••------"--••'-----'-••.....--•-•-------------------------••-•....-----------•-------•--•--•---•----••••----•••-......----'-------'-'---'•-'-----------••••.......-'•-'•......---•---•--------- f Date - Permit No.----� ._/..................................... Issued.... =( Date No.---yWT...... Fw&..).. .....`:.Li.e, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF....-. : '. ....�� -( �.+�.- --------------- Appliration -for Uispuiitt1 ' larks (onstriirtion Prrutit r f, Applicaon is hereby'' de for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . `�.. J o �., ;4 11 .. Location_-Address or Lot No. ��`'�y� 4� 4S r`..:----•----� rf `s( ...................... --------- (� 'T✓ A S OW`�+�.9 .. �R — Address = =' Installer Address .. Q Type of Building Size Lot...... feet Dwelling—No. of Bedrooms-----------lc�_'---------------------------Expansion Attic ( ) Garbage Grinder ( ) per-, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures •------••------------------------------------------------------------------------------------------------------------- gFlow ... U --g(-_--._- P P P Y Y . ` ----------------gallons. W Desi n __......_:_!___ _______________________gallons per person per day. Total daily flow.._.._._.._.._..._ WSeptic Tank—Liquid capacityr4i -----gallons Length................ Width................ Diameter---------....... Depth..-.__._____---- Disposal Trench—No... __,..Width-_- Total Length___ _______________ Total leaching area--------------------sq. ft. 2 _ ,.._o Seepage Pit No._?------_____ "__. tairieter�6--- y`____------ D pth`b"e'low let-------------------- Total leaching area.....-.----_____-_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................... ------------ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water---_____---..-_----.---- �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.._--_-_______-----..-. D Description of Soil----"`�' �� k�"" _..._.- j-t# . f x ------------- U ---•-------•------ Z -------------------------------------------------------------------------------------------------------------------------------------••-•---------------•-------------------.... 1 U Nature of Repairs or Alterations—Answer when applicable.---------------------------------------------------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------------------------ -------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. -7 Signed.. ---- . ••. . _...................... ... Date ` Application Approved By...................:.../....f� --------•------------- -------------- ,l Date Application Disapproved for the following reasons:----••----•----.......-•--•-----•-----•-----------------•--•---•-----••----•-•--••---................--•-••••••- ..................------------------------------------------------------------•--•----------•-----------------------..._-•---------------•----------------••-•-----------•---•-------------------.----- _ Date PermitNo...... �� �__._••-••••------...--•-•••-••-•--_. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. !. ✓ti`'..........OF............��qlz r Ti �e& ` .. ............................................... IVETrrtifirate of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................ Zt ....�......--�1?�6�--- ---------------------------------------------------------•--------_-------•---------------......---...------ Installer at- < _t.-. = = T ----•- --- has been installed in accordance with the provisions of :Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......44a r9....................... dated_-------_...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F................................................................................... No......................... FEE........................ us % v-ml WorkiiZanstr4wfian rrrmit Permission is hereby granted_._ .l=&-=- f �� �¢ t=� �o ---------------------------------- to Construct ( or Rmair ( �,Ap iIrLd+.ydual Sew ge(DisposaY s�ysterfi �t� f atNo......................................................................................................................... ---------•-••-- Street as shown on the application for Disposal Works Construction Permit No..................... Dated_._�F.�-_ ----------------•----------------------------------------....._--•---••--•-••-_•••-•---•••--••.•--•----- Board of Health DATE_ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1C.19 ISFI l'967 PIC min iT oy . 'DUI fiRS A)4 l� T E P F'1? - T /Ss° �'���� �� �-- �� . F -� „ �-��, ,Cr AD Pond+ �z '.1 z I S T-o e Y G L V � r� J i A ——gg—— EXISTING CONTOUR N x 100.98 EXISTING SPOT GRADE —W EXISTING WATER SVC. a —G EXISTING GAS SVC. y .z —&.H.W OVERHEAD WIRES �c TEST PIT BENCHMARK ° O LEGEND w v 4 ti . N o m o U C 99.31 99.48 o o LOCUS o Storey WpOd s 99.55 R LOCUS MAP NOT TO SCALE R=30.00, —, 74 48 T 99,72 \ 99,55 CATCH BASIN 99,99 ® 99,38 N r mm / f, - / OD a ! / x 100.90 irri x 100'80 x 101,48 � �� 99,61 J 99.61 O y LOT 19 15,585 ±S.F. b PARCEL ID: 191 -18LO 5� QP / x 101,88 S BENCHMARK o`` 101,71 vrP K rn OUTSIDE CORNER / o� OF BULKHEAD Off' / 101.61 EL.=102.22 99.24 / EXISTIN x 1015 0 HOUSE(#56) T T.O.F.=102.22f � � � 1 101.72 GARAGE �I 1X(D ` 1 �1 1,79 1 H � 1 l B SCREENED ( 1 98.78 / 102,220 PORCH 1 / TP-1 TP-2 ��' w l00,3 i 101.66 101,74 G 0.25 1 TE 1 101.49 101.61/ N f�. .- _ : ?� fENOE x 00.21 10!0,24 O 1 ` EXISTING SEPTIC TANK S TOP OF TANK, EL.=100.13 101.65 `57' INV.(OUT)=98.80t(VERIFY) \SSA F \;,..yj\ / , �0' CP o' y 0. { 1 � S 65 �x 100,21 1 o i 1�ti t PROPOSED S.A.S. ✓ 2-500 GALLON CHAMBERS x 100,94 SURROUNDED W/4' STONE OF Mgss EXISTING S.A.S. • ���� 9cyG TO BE PUMPED, FILLED o PETER T. F, W/SAND & ABANDONED McENTEE CIVIL No. 35109 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 56 THOREAU DRIVE, CENTERVILLE, MA ` l Prepared for: DiBuono Sewer & Drain, 35 Content Lane, Cotuit, MA 02635 OWNER OF RECORD (,\ l Engineering by: SCALE DRAWN JOB. NO. LEONARDO HOLDINGS, LLC Engineering Works, Inc. 1"=20' P.T.M. 281-17 c/o ACETO, BONNER, & PRAGER, P.C. ONE LIBERTY SQUARE, SUITE 410 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEEP N0. BOSTON, MA 02109 (508) 477-5313 11/4/17 P.T.M. 1 Of 2 r i NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=36.50 FOR A DISTANCE OF 15' FROM THE EDGE SEPTIC TANK PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F.=102.22t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=101.8t F.G. EL.=101.7t F.G. EL.=101.7f F.G. EL.=101.6t MAINTAIN 2% SLOPE OVER S.A.S. 76' L = 19' L = 5' ® S=1% (MIN.) p S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" il DOUBLE WASHED STONE i0"1 6 as pe as (OR APPROVED FILTER FABRIC) 14" BBB BBB aBBBBBB EXISTING 48" LIQUID aaaaaaa -3/4" To 1-1/2" DOUBLE LEVEL ADD PROPOSED 4' 4.8' 4' WASHED STONE GAS BAFFLE INV.=98.72 INV.=98.55 INV.=98.80= D BOX EFFECTIVE WIDTH = 12.8' (FIELD VERIFY) 3 OUTLETS INV.=98.50 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=99.3t BREAKOUT ELEV.=99.00 INV. ELEV.=98.50 aaaa NOTES: aaaaa aaaaaaaaaaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.=96.50 aaaaaaaaeaa INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. 4' VARIES 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH VARIES- SEE SKETCH ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED 310 CMR 15.405(2). 5' (MIN.) ABOVE G.W. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION BOTTOM OF TEST PIT, EL.=90.7 =_ 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. SEPTIC SYSTEM PROFILE GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL EX/STING . BOARD OF HEALTH AND THE DESIGN ENGINEER. HOUSE(156) S�0 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS T.O.F.=102.22f Chi OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: IGARAGE -310 CMR 15.405(1)(b): 1) A 7' variance, S.A.S. to cellar wall, for a 13' setback. BH I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE SCREENED DESIGN ENGINEER. PORCH rn 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 6+. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF �� ` 4 PROPOSED pc HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. s, - / 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. S.A.S. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE �+ DIRECTED BY THE APPROVING AUTHORITIES. SEPTIC LAYOUT 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS SOIL LOG 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). DATE: OCTOBER 27, 2017 (REF#15,513) 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE SOIL EVALUATOR: PETER MCENTEE PE(SE#1542) INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 101.7 A ° 101.7 A 0 SYSTEM COMPONENTS NOT SHOWN ON THE PLAN SANDY LOAM SANDY LOAM 101.2 10YR 4/2 101.2 10YR 4/2 B 6„ B 6•' DESIGN CRITERIA �21 3'-� SANDY LOAM SANDY 5%6M 10YR 5/6 NUMBER OF BEDROOMS: 3 BEDROOMS Tr 00 BOTTOM AREA 99 7 C PERC 99 6 c 2s SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) 04_ I ' 320.0 S.F. 1 cO 30"/48" DESIGN PERCOLATION RATE: <2 MIN/IN J�L- DAILY FLOW: 330 GPD 3.7' _--J1 DESIGN FLOW: 330 GPD [: 1 2.8'---1 MED. SAND MED. SAND GARBAGE GRINDER: NO-not allowed with design 8.5' 2.5Y 6/6 2.5Y 6/6 LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF PERIMETER=75.6' 9° .74 GPD/SF SAS DIMENSIONS .7 132" t32" PERC RATE <2 MIN/IN. "C" HORIZON EXISTING SEPTIC TANK: 1000 GALLON CAPACITY SKETCH NO GROUNDWATER ENCOUNTERED PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 56 THOREAU DRIVE, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25:0') X 2 = 151.2 S.F. Prepared for: DiBuono Sewer & Drain, 35 Content Lane, Cotuit, MA 02635 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:.............................................................. 471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 281-17 „ DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 11/4/17 P.T.M. 2 Of 2 i