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0007 VICTORIA STREET - Health
7 VICTORIA STREET Centerville A = 148 - 039 S M E A D No.2-153LOR UPC 12534 smead.com • Made in USA AEC-% 2 a MUS®NIMPROOUC�U!E SFI �� CERiiFlED SOURGNG NANWSFFROGRAIKOkfi Commonwealth of Massachusetts P/- 6-63 [ r� Title 5 Official Inspection Form ral Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Victoria St W Property Address r1j 0 Marcio Martoso Owner Owner's Name 1:, information is X. required for every Centerville V11 MA 02632 7-26-18 ' page. City/Town State Zip Code Date of Inspection t-r Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information �1; (31 R0 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification 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 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further I ion by the Local Approving Authority 7-26-18 Inspector's 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 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. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of'Massachusetts ;w Title 5 Official Inspection Form i.'i. Subsurface Sewage Disposal System Form Not for Voluntary Assessments a � r. .> 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 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: ® 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: System is in good working order with no sign of failure. 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y ❑N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form ! �iCi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a , 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville . MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y El ❑ ND (Explain below): ` ❑ obstruction is removed ❑ Y El ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ 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 ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts r� 3 Title 5 Official Inspection Form i i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Victoria.St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 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 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form } K,I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private 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- 1 0,000g pd. ❑ ® 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts r� p Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments FZr. 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection C. Checklist „ „ Check if the followinghave been done. You must indicate es or no as to each of the following: 9 Y 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? ® El information 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: i ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 sue, Commonwealth of Massachusetts �,. Title 5 Official Inspection Form ! r11F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments T y 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) El Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 7-2018Date 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: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' r�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code- Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Town--pumped 2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: New leach field 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts r� t� Title 5 Official Inspection Form C. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2014 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 42"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 36"feet Material of construction: ® concrete ❑ metal ❑ 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: 1000 gal Sludge depth: 12" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form • i�i Subsurface Sewage Disposal System Form Not for Voluntary Assessments �c1r. ,a 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts f;. Title 5 Official Inspection Form ! �IC-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments T., 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 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.): Tight or Holding Tank (tank must be pumped at time of i nspecti on)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 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 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form w. ' i4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts ,. Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments T, 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 15 biodiffusers ❑ 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.): Biodiffuser field in good working order with no sign of back-up. 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 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F1,, > 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is Centerville MA 02632 7-26-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): r a Disposal System•Page 14 of 17 t5ins.doc-rev.6/16 Title 6 Official Inspection Fo m.Subsurface Sewage D p y g Commonwealth of Massachusetts Title 5 Official Inspection Form ! hl Subsurface Sewage Disposal System g m Form Not for Voluntary Assessments p Y rY 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately en �- f t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 c Commonwealth of Massachusetts 3 Title 5 Official Inspection Form i)i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � �. 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 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: 12 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: Date ® 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments T, 7 Victoria St Property Address Marcio Martoso Owner Owner's Name information is required for every Centerville MA 02632 7-26-18 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth'to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. &030 Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered incom uteri Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitatioii for Mispo8Af 6pstrm Construction Permit Application for a Permit to Construct( ) Repair(k) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7 &-',#c�D ego 4 ��"' OwnQ Name,Address3 and Tel.No. e an{6G%vG'Ile— Assessor's Map/Parcel lelvlo7r SCe 4-�e Installer's Name,Address, d Tel.No. esigner's Name,Address,and Tel.No. � u®sfc fcp 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 .7 a gpd Design flow provided 3 �3 gpd Plan Date a7�/3"�l Number of sheets 2 Revision Date Title Size of Septic Tank /ppa Type of S.A.S. Description of Soil 7—osasG - A.n/ Nature of Repairs or Alterations(Answer when applicable) 7 rfp fl /fin Y 3- —Wee,,5 5 ,S— fG " / v� e'vs, la-zg,�L, -emu 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. n m ate Fl �-- Application Approved by ate Application Disapproved by Date for the following reasons Permit No. Date Issued No. % Fee D THE COMMONWEALTH OF MASSACHUSETTS Entered in co uter: Yes. . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS .Application for Mieposal .pstem Construction Permit Application for a Permit to Construct( ) Repair(k) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.,� v.'c�p��'� j'g7" Ownee Name,Address,and Tel.No. c`//G , �, e7v .4, /e" r Assessor's Map/Parcel 6 3 -S 4---C Installer's Name,Address, d Tel.No. 2Designer's Name,Address,and Tel.No. /id�iluU� yc�.• Type of Building: A.)G Dwelling No.of Bedrooms Lot Size >4 ,78,f-- sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required) 3 3 d' gpd Design flow provided _7 3h' gpd Plan Date �'� -�J t/ Number of sheets Revision Date j Title Size of Septic Tank Type of S.A.S. ,,, Description of Soil ►-,. " Nature of Repairs or Alterations(Answer when applicable) ?4� Date last inspected: f.. Agreement: " y /%- I ne.undersigned'agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provi ons of Title 5:of the Environmental Code and not to place the system in operation until a Certificate of a �� Compliance has been issued by this Board of Health. p gne _ ate Application Approved by / ate / l Application Disapproved by Date for the following reasons 4 '.wGlpniytis� Permit No. Date Issued TH E COMMONWEALTH OF MASSACHUSETTS } BARNSTABLE,MASSACHUSETTS Certificate of Compliance ,f THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed'(—Y*- Repaired( k) Upgraded( ) Abandoned( )by at 7— has been const cted i acccar with the provisions of Title 5 and the for Disposal System Construction Permit No.w��t d Installer /--�� �-- -�� ; Designer #bedrooms Approved de//sign ow -7 ^ �, gpd The issuance of this pe 't s 11 n f b constr ed as a guarantee that the system vSiII n ass designed. ry Date Inspector % / l 1 / -- - -- - - ---------------1------------------------------------------ /- - _ - - > 1-7 No. Fee ��— /v THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS MIsposal bpetrin Construction i3ermlt Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at !J,`r ar r� S' /'r-�7�r r��.✓'/ 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:Consftuct must be c mplet d within three years of the date of this permit. Date Approved by �... Q'1 SEP/08/2014/MCN 09:53 Ali FAX No, F. 001 Town of Barnstable Regulatory Services x 'Richard V. Scali,Interim Director BARN r tm.e, t �A Public Health Division roc s° Thomas McKean,Director t 200 Main Streek Iffyinnis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form t Date: Sewage Permit# Assessor's MaplParcel t —LA Designer: "e el(� � Installer: Address: Address: � ti '� <3- on was issued a permit to install a (date) (installer) 1�, septic system at 7 A LIM Ak ST , " +based on a design drawn by (address) MP" ew- 1 dated , f — designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the RA approval letters(if applicable) °F D RRE M. (Installer's Signature) .4. .. GISTD (Designer's Si—�lature) PLEASE RETURN TO B TAHLE PUBLIC HEALTH DIVISION, CERTIFICATE OF COWLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD AUX RECEWED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. - -— Q:1Septic\Designer Certification Form kev$-14-13.doc Town of Barnstable Regulatory Services ti °,► Richard V. Scali,Interim Director iY s Public Health Division . a`� Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for.Alternative Svstems Property Address: �/ 1 �-l 0 R-1�`� S 11t sT Assessor's Map\Parcel: t� 0 39---- Property Owners Name: %�.-� �a ����/ In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an "x" in the applicable box next to each line certifying the information. Yes N\A El I have been provided a copy of the Title 5 IlA technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) ❑ LL I have been provided with the Owner's Manual ❑ Li" have been provided with the Operation and Maintenance Manual ❑ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by '-3 10 CMR 15.287(10) and the Approval ❑ LS For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) If the design does not provide for the use of garbage grinders, the restriction is understood and accepted warranty, I understand the requirement to repair, replace, modify L, Whether or not covered by a q P or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303 agree to comply with all terms and conditions above. ��1Property Owners minted name 1JI&LC 1 as ►y gro...e owners signahire Date Note: This form must be submitted along with the septic system disposal works permit application for all I\A systems including new construction, repairs\uparades, with and without agoregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\LA homeowner certification.doc AsBuilt Page 1 of 1 LOCATION SEWAGE PERMIT NO. 127)- < L/,-'7n«i�f VILLAGE INSTALLER'S NAME A ADDRESS SIJILDER ' OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i t r T� http://issgl2/intranet/propdata/prebuilt.aspx?mappar=148039&seq=1 6/19/2014 1_.T€?WN OJFF BiRNSTABLE LOCA'�'i0N If A G7 y CC J% SEWA09 e -�----.�. A$SESSOR S MAC' Lpx . 1NSTA�.:�R'S NAAliE 1k i't�t?ME NO. $El�'I'YC T.mk CAFACX't'Y .. t�� CHi1�1G'tyACII.iET . ("e) 'a`D �'�`�� kr3 �1��G�QDZ C3'9Vl�i? �f3RNdY'��ATE CpllllA�iCE 1pA"ICE777, ...._. ._...., ._,.,y,, {Sepam- don testirn c between. vies Maxlmuml djusttrcl.GtaUudwtttev'&bla 6 tw 061tom ofLeaGhing Pi'ly ,Water SupA ty .Of any.wells exist ' a�eitc�ar wit�an�.Qp feet:of IancEi�►S factUty) .: .._,�, �ca9 }EciSas.;iyf wiii,nEl snit uis l tpg>~ac ty([Esixty wetlands a isE thiti 00 foadf 10011149.,!uc sty} r i ae W �urnlsbad by .:: ,..... c ol r , r TOWN OF BARNSTABLE LOCATION 7 V I C,CIZ/A cl.'r SEWAGE# OI O VILLAGE I aw 1 I ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. � i eew Le- SEPTIC TANK CAPACITY' K-X%Sri P S `Kb--0 LEACHING FACILITY:(type) ADS 14e40 NO 0 i (size) X 321 A NO.OF BEDROOMS 3rowS 0� g" -t�sedge. BUILDER OR OWNER,�f r:Ah% PERMIT DATE:DM I COMPLIANCE DATE: (—q' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ����—� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 3 _ � A A 6 C D E o 4 18.6 4„ 6 133' I vErrf 6 233 L0C A'T ION SEWAGE PERMIT NO. , L- �,�off'" !,y/f+�c�r►�',1.� S''� �w� "a`�''�` VILLAGE V INSTALLER'S NAME i ADDRESS S u 1l DE o: OR OWNER Dols OATE PERMIT . ISSU-ED DAT E CO_MPLI- ANl:E ISSUED _. • ,�- - -.",�,� �� Pf .�, 4,.�i ��' �� f , 2-6 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH - 10 l yg o �9 —0.441ocJ..............OF............ :-.................._.. Applira#ion for Diipnsal Workii Tomitrurtion ramit rA plication is hereby made for a Permit to Construct 04J or Repair ( ) an Individual Sewage Disposal ystem at�: ................r i-�'"Ta .,C.lam__.....� •----------------- -- L..�_Q.T -`�..... - Location--Addressy (✓t .or. Lot-No. Owner Address a _...----•-------... .......................................... --•--•--------••-----•------•----._..........•---•----....---------------------•-----•-----------• Installer Address i Type of Building Size Lot__/561__4S__..Sq. feet Dwelling— o. of Bedrooms.................___________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons__________________________._ Showers ( ) — Cafeteria ( ) a' Other fixtures __________________________________ W Design Flow............._J�__-�.....................gallons per person per day. Total daily flow.......... ...._____.________gallons. WSeptic Tank—Liquid capacity/ ®gallons Length___._�__'_ Width........ ----- Diameter................ Depth____- I...... x Disposal Trench—No.__.................. Width.................... Total Length.................... Total leaching area_________-_______�__j_sq. ft. r.� Seepage Pit No----------/--------- Diamete o�.__`. Depth below inlet__=-:..1�___...._. Total leaching area..t.. �-Ast.-4t. Z Other Distribution box (14' Dosing tank ( ) '-' Percolation Test Results Performed by.._G-d.�__-_ _. fAkf,Date_.__�12_�_ ..1 Test Pit No. 1_7�� '..minutes per inch Depth of Test Pit_/114`... Depth to ground water �---�!v. Test Pit No. 2___.............minutes per inch Depth of Test Pit.................___ Depth to ground wate ..7'C2 .....--•--•---------------------•------.....--•--•-•-•-•-----•-•--•-•----•••---••--••-------------•- ........----•...... O Description of Soil-•-------------•- �---------- T: !9 .1 l?---------P.4--� --------•-------------------- x x --............. ----------------------------------------------------------------------------------------- -•-•••--------•--••-----------------•-•--••••••••--••---------------•--•-•--•-••---•------•-- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLYHE, 5 of the State Sanitary Code—The unders urther agrees not to place the system in operation until a Certificate of Compliance has b ssue the b r iealth. gne - --.. - ------- - -• ••.- t Application Approv = ------------------• ............................... --•----•-•--- Date Application Disa pro f o the following reasons------------------------------------------------------------------------------------------------------•......._._ Date PermitNo......................................................... Issued....................................................... Date N01.2` ? Fxs...3. ................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH qTb. ............OF............. S i ........................ Appliratiun for Eliipos al Works Tomitrurtion thrmit Application is hereby made for a Permit to Construct (1\4) or Repair ( ) an Individual Sewage Disposal System at: • !�.l........................../a........��.. T.:....-•-•-----•...... ........... . •. . -T..---- .....-----------...--•----•-------.............----•-. Location_Address or Lot No. ..............•-------»......................................................_.._........._._.... .............._.......----..............._.....----....._......................................... Owner Address W Installer Address Type of Building Size Lot....l ._Zg .Sq. feet 1-1 Dwelling—No. of Bedrooms............✓...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..........--•--•-•--•-•----•-••--•-•--•----•--............-•---•-••-•-•-----•---------._...........---•----•-------------------••--•------------------• Design Flow..............�.��.................._.__gallons per person per day. Total daily flow.........._ •_-��_..��._..® ...............gallons. WSeptic Tank—Liquid capacity./O U4allons Length...... . Width.......... Diameter_______________ Depth....... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------/------- Diameter... �..... Depth below inlet........2�;_....... Total leaching area.5�./Aq:-Fr C Z�, z Other Distribution box (/k)- Dosing tank ( ) '-' Percolation Test Results Performed b �-� ``J �'`fE.L L ... � Date..... .. ?_ _ .�.:'f-�Z" a y..-. :-•--- 1 Test Pit No. 1.....�''° ._minutes per inch Depth of Test Pit..�.r- . _"__. Depth to ground water-JO 7—_.,E�N 0-4 GCJ c.,AJ 7"r=:r2 e;-D Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-...______-___.--.-___- Q+' --------•------•----••--••-•-•-----------•------•-••------------------•--•----------•-•-- 0 Description of Soil---------•--------Sk.a............ ...%..��./ f� ............................1 - -- W 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 TITM 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. . ,r Signed. ---------•--....--•------••-•---•...........................................•-•-•-•- D e Application A rove .dB, ...................................................................... Z' Application Disa pro for the following reasons-................................-•---------------------------------------------•...............-------•--•----- ................................ ------.........---- -•------•-•-•---•----------------- ------------------------------------------------------------------- Date- PermitNo......................................................... Issued------------------------ ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOA OF H A H ......................OF.1 ... . . . . . ........................................... (9rrtifiratr of * ontpliaanrr TH S TO CER a the Individual Sewage Disposal System constructed r�or Repaired ( ) ..by �r .... -------------- - ---------------...----------------------............•••--••----••-•-------••--•••---•-- �j Instaue ._ ..- has been installed in accordance with the provisions of TI"' 7 5 o �}ie State Sanitary Code s dfibed in the application for Disposal Works Construction Permit o..___ _____________ dated_-_/.� -.f _ __- 2 ......_..... �' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS D AS A GUARANTEE THAT THE SYSTEM WIL F CTION SATISFACTORY. �/ DATE..1 ... ' -- Inspector... .:_-.-.----•-•-•-------------•-------•---•-•-----------------•------ THE COMMONWEALTH OF MASSACHUSETTS BQA D HE � OF T....�w`I.. ................... � ................................._..... No................... FEE ........ Dispos al o *w �onitrttrtion nutit Permission is hereby granted----- -- --- •----------------------------------------------•---------------......--------.......-•----......... to Cons tu /`or epair a�n�l--n. viat ,dTfal Sevt €e posalySystem -------- -•-••- ----•---• ................ Street .as shown on the application for Disposal Works Construction Permit No................... �Datgd-..4'. ... f1......Z_......_.... ----------- --------------- �--�4�'1=�=` - ... Boarji'of Health DATE Z� ------------------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ' LEGEND ' CENTERVILLE LOCUS: PROPOSED CONTOUR 7 VICTORIA ST. I PROPOSED SPOT GRADE pQ-' EXISTING CONTOUR BENCHMARKTOP CORNER OF STEP + 96.52 EXISTING SPOT GRADE ' ELEVATION = 105.11' W— EXISTING WATER SERVICE Z TEST PIT m Y N89 444'20"E 191.34' /--�— ti G.O. J O l �� AMES WAY 106 �� J MILL RD Ld G G Cam, LOCUS MAP LOT 039 2 �� m� LOCUS INFORMATION 18,285f SF p 0) I Ems+ PLAN REF: see plan 0.42f AC 7 O TITLE REF: 7795/323 Y z 00 W ) PARCEL ID: MAP 148 PAR. 039 W z"to I j II 11 W_ FLOOD ZONE: "X" Q X � Li \ , vent COMMUNITY PANEL: 250001-001 5—C DATED:08/19/85 3 Lv C] O T e} 0 0 ���1(� T 'i o SEPTIC SYSTEM o �� NI) `� REPAIR PLAN W Z i e Wv, LOCATED AT: 1°2 01/ 01 Q W-- 7 VICTORIA STREET CENTERVILLE, MA PREPARED FOR 185 - ------- NEIGHBORHOOD N7941;38.,w EPAVED ' y WASTEWATER /41 DRIVEWAY 'c� i c� 4 AUGUST 15, 2014 REV. AUGUST 21, 2014 EXIST. I ,000G / o SEPTIC TANK , o ,� OF Mqs� EXIST. LEACH PIT DAR NOTE 10 `.! M � = v EXISTING DRAINAGE EASEMENT1140 GENERAL NOTES: SNITAR\a� 1Ll 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED BOARD OF HEALTH AND THE DESIGN ENGINEER. TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 9, IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 11 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK.LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. ' MEYER & SONS, INC. - 310 CMR 15.405 (1) (B): t) A 5 2.6 r. (MAX)E FROM BELO GRADE VS RE7) TO ALLOW AL (LE OWLEACP LEACHING 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION �\ P.0. BOX 9 TO BE12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY rA 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE 13ACKFILLED PRIOR AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY TO DESIGN TI NEER D APPROVAL BY THE BOARD OF HEALTH AND THE 13. NO KNOWN PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING EAST SANDWICH, M A. 02537 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW (5 0 8)3 6 2-2 9 2 2 ENGINEER BEFORE CONSTRUCTION CONTINUES. FOR THE USE OF A GARBAGE GRINDER t 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 16. NO WETLANDS WITHIN 150 FT. OF PROPOSED LEACHING i 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 17. INSTALL 40 ml POLY LINER AS SHOWN TO PREVENT INFILTRATION THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. TOWARDS EXISTING WATER SERVICE. SCALE: 1"=20' 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. SHEET 1 OF 2 J 1540 i NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:97.39 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=107.19 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. VENT F.G. EL.=105.3t F.G. EL.=105.0t F.G. EL: 103.0t F.G. EL: 103.0-101.0(MAX.) �N OF dlgss9�� o DA EN 9" MIN COVER/ 0 S=1% MIN. 36" MAX COVER L�=150' L = 1O'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) N 1�0 (MIN.) 6.1 EL. - 42.42 0 S 1% (MIN.) ® S=1% (MIN.) 1 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 10" t4 s t1.3" TO NITAR��`� \INV* 103.04 �"uowD INVERT LEVEL kNV.=102.79 INV.= 97.0 PROPOSED GAS BAFFLE D-BOS INV.=9, 3 ROWS OF 5 UNITS AT 6.25'/UNIT + 0.75' WEDGE = 32.0'/ROW INV.=99.0 (toe of SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1.000 GALLON SEPTIC TANK SLAB RESTORE VEGETATIVE COVER EL.=99.69 EXISTING SEWER OUTLET INV.=103.44 TO TO LL WITH CLEAN PERC SAND 75� TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT=TOP ELEV.=97.39 PIPE INVERTS PRIOR TO CONSTRUCTION INV. ELEV.= 97.0 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.= 96.06 EXISTING SUITABLE GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 2.83' MATERIAL 5' MIN. ABOVE BOTTOM OF r� 76.. -I 310 CMR 15.221(2) T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 3 x 2.83' - 8.49' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK (5.16' PROVIDED) USE 3 ROWS OF 5-HIGH CAPACITY PROFILE WITH 1500 GALLON SEPTIC TANK IF FAILED, BOTTOM OF TESTHOLE EL.=90.90 - ADS 16208D BIODIFFUSER (H20) UNITS-NO STONE DAMAGED, OR UNDERSIZED. W/ CONTOURED WEDGE 4) INSTALL INLET & OUTLET TEES W/ GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE TYPICAL SECTION 16" N.T.S. N.T.S. J_ rN _i SOIL LOG P#:14446 DESIGN CRITERIA DATE: AUGUST 7, 2013 (--- 34" -� NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 SECTION END CAP SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. Elev. TP-1 Depth Elev. TP-2 Depth 16" HIGH CAPACITY 1620BD �H-20� BIODIFFUSER UNIT GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 102.70 0" 101.9 0" FILL 0. MODEL 16" HICAP SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXISTING 1,000 GALLON SEPTIC TANK 100.20 30" 99.65 27" A LOAMY SAND A LOAMY SAND LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT 10YR 3/2 10YR 3/2 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 99.70 36" 99.15 33" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. B LOAMY SAND B LOAMY SAND SIDE WALL HEIGHT 11.3" DISTRIBUTION BOX: 3 OUTLETS MINIMUM 10YR 5/8 10YR 5/8 OVERALL HEIGHT 16" (MINIMUM) 98.55 50" 97.98 47" 4640 TRUEMAN BL l/D C C OVERALL WIDTH 34" PRIMARY S.A.S. MED-COARSE MED-COARSE 13.6 CF Em. HILLIARD, OHIO 43026 USE 3 ROWS OF 5 - 16" ADS 1620BD BIODIFFUSER H-20 UNITS-NO STONE PERC TEST 2•SAND 2�D/q CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. AND EXTENDED 0.75' W/ CONTOURED WEDGES 0 97.25 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF BIODIFFUSER) PROPOSED SEPTIC SYSTEM/SITE PLAN (BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.73 SF/LF = 443.43 SF 91.70 132" 90.90 132" 7 VICTORIA STREET CENTERVILLE, MA (CONTOURED WEDGE) 3 ROWS x 0.75' x 4.73 SF/LF = 10.64 SF TOTAL AREA = 454.07 SF PERC RATE <2 MIN/IN. SOILS IN ("C" HORIZON) Prepared for: Neighborhood Wastewater DESIGN FLOW PROVIDED: 0.74GPD/SF(454.07SF) = 336.01 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Engineering and Surveying by: SCALE DRAWN DATE: • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 Meyer&Sons,Inc. NTS D.M.M. 08/15/14PO BOX 981 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA02537 R� DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil EvaL Exam in October, 1999. 508-3622922 08/21/14 D.M.M. 2 Of 2 AsBuilt Page 1 of 1 LOCA'1ION SEWAGE PERMIT NO. 9 VILLAGE INSTALLER'S NAME i ADDRESS SUILDER OR OWNER DATE PERMIT ISSUED Cb DATE COMPLIANCE ISSUED t 1 Lt I 7y ' http://issgl2/intranet/propdata/prebuilt.aspx?mappar=148039&seq=1 6/19/2014 Sou of C-.EF"i�f-y' l�/T� EXC'i9 i/r4TE /G•�n 1 7-0 - a A 1 E U 4,Jl4e ' o F TO E t_Ev -- --- — -- - e X 154-•;n , qr�c. -,d Profs ?� !0' 7- OA / V S F .E' T CX9 (_E .. _ `� 2" f iB - %z " wasi ed s — 14fo., �- _ _ -- - - I , D�_SCT B.CX o eLAG- e � rryf � D C J l /x�/02 0/ \ '001? �a0L = 7 TEST HOLE r -r-E ST d4-10L- E- #� + 13. - 1 �4 _ , i �� 4 S `c- d•vH c.� '`�" _�s r �� � ) -7- 1 G4 G P p `3 ; j --oP o 9. 3 a 101 E k-F T F Y AT THE £3 lJ/L £)/A!G � � � � �� — S C� (/lJ /�7 � � G� C._._ � /v - r',�'000SED oAv �'HE G�eoun/n .9s �rtiO (Ntit 0AJ ?/H1S PLF?A-1 D0F_ S 147n,� "- Cc7NFOiEM 0 TNF_ BUILDIAAS 5E7-- v CTo2i f} 7- Tot�1nJ ©F -fL GCS./7•E ,C- t/i "54 �\w (IF pNy ' ,yN OF'kaF3. T''^\ S C,9 L ` fa S S t-1 O lam//v T�F-i E EJ€RC;' 0 13- O OO / .r7L i Y.� A2 t"� O u T H !VI �7 S _-3 o p p ro P oS e d e r e va-t/a r--> E C�U/A2 E /`�J E N 7-5 � - -- -- -- -y-- ._ ..-_ e x /$f/ �9 G• O n t O u r S "�r` O n� = G U -�'f' .