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HomeMy WebLinkAbout0038 VICTORIA STREET - Health 38 VICTORIA STREET, CENTERVILLE A= 148 063 ' llll Nop21535 ORS HASTINGS,MN • I I No. 2 Zq-7 Fee �U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes_`� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 9ppliLation for 33ispoSal 6pStem Construction permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. '? V[e't`(jw A 5T- Owner's Name,Address,and Tel.No. , �`Vtr.� MtCt401---L *, dAi'mip kV0,Tk0LkjSK, Assessor's Map/Parcel 1 9 -3 3�g` if 1 L 7- C:-45vTGX,tJ! Installer's Name,Address,and Tel.No.5 VF— 1 f77_9 6"7 7 Designer's Name,Address,and Tel.No. 509r>ft ,--O3"T7 Type of Building: Dwelling No.of Bedrooms �� Lot Size 0 — sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided--- `i'-!!C„� gpd Plan Date ZrU I�4 ` )LU')L 1 Number of sheets Revision Date Title 9 V=(, R 1 A S7AE2;-r- GC6E b' Vf U-46 Size of Septic Tank ] & !� Type of S.A.S.(;t) ago Description of Soil M&-b lu," &6Lb tom) -2,!:: t� 1.6&W Nature of Repairs or Alterations(Answer when applicable) I/0o=Y -C—A"4p :*4srri e, Z4K _70 GG� t W f 714 4 E4T 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 i nmental Code and not to place the system in operation until a Certificate of Compliance.has been issued by this Board Hea v� Signe - Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. a e 3' ( — a Date Issued No. t3 kJ( f P ¢ �, - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: -- Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �-- 4plitation for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair( Upgrade.( ) Abandon( ) ❑Complete System `H'Individual Component -�Location Address or Lot No. 39 V(GTDW A ST— Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 13$ VN_Tt0RjA ST- CC�fJ(L41,5� Installer's Name,Address,and Tel.No. ��-C1L77 �'Y 7 Designer's Name,Address,and Tel.No. `""j0S--7,:,r j y`77 g*fnss P .51 04-d" LAT14 eAoW8&XA4 Hwj c'd 4w ate' Type of Building: ' DwellingNo.of Bedrooms Lot Size � (� QUO sq.ft. Garbage Grinder( ) Other. Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3,30 gpd Design flow provided gpd Plan Date ZTU LN I i DL[U1;L ( Number of sheets ' Revision Date Title AST V10_:f, i A 5TAfg;; ' _'%WZ 4 ,6, Size of Septic Tank ; I ,(yip 6Eik UAj C Type of S.A.S. Description of Soil M6btL,-,A4 b r-zZ 2K""_• 1 g6w P4j1,ffj 1 � Nature of Repairs or Alterations(Answer when applicable) ]I? lies D-150 - r�.� 4 r�,� s w -rt-4 F - 0NG-- Date last inspected:' Agreement: , r 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 1✓nVironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board Health./ Signed—,/ )1 a �l/' Date 'Illy Application Approved by k; q,,, ..�- Date S, • Application Disapproved by Date for the following reasons Permit No. t Iq -7 Date Issued / 4k-I THE COMMONWEALTH OF MASSACHUSETTS , BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned(,/)by :P0 Q 6K:_(! D tl R. d a ` at ✓l&rDA 114 '�'. QUX,72 L) t"6 .has been constructed in accordance . f with the provisions of Title 5 and the for Disposal System Construction Permit No. ,a 7 dated Installer 40�%�-- Z?, nor-L 00 Designer JC, #bedrooms Approved design flow:- -_, + gpd The issuance of this permit shall 111 not be construed as a guarantee that the system will function as designed.r —, Date ] / �/ < Inspector� No. o.2 - 1 ,7 , Fee la l �.-"'""� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 0 ` Zisposal 6pstem Construction 3permit w- - Permission-i§hereby granted to Construct( ) Repair(X Upgrade( ) Abandon( ) { System located at 39 Y 1027L A t 4 5 7z6Eis!r l r l-,l- 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 completed within three years of the date of this permit. f l' Date y/�/ Approved by ✓ 1 ! y Town of Barnstable Regulatory Services Richard V. Scali, Interim Director • anttxsraet.e, Public Health Division rEp► A Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 9-20-21 Sewage Permit# 2021 - 2k1 Assessor's Map\Parcel 148/63 Designer: JC Engineering, Inc. Installer: Robert B. Our Co., Inc. (RBO) Address: 2854 Cranberry Highway Address: 363 Whites Path East Wareham, MA 02538 South Yarmouth, MA On g5 4 v RBO was issued a permit to install a (installer) (date) septic system at 38 Victoria Street based on_a design-drawn by (address) JC Engineering. Inc. dated 7-18-21 (designer) X 1 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 i pllance with the terms of the I\A approval letters (if applicable) jn��8, ,a � I O �N L G°c� U CHURCHII,t.,�, C" (Ins alder s ure) CML .41 4 'p0 � (D ner's`Signature (Affix De p Here) PL SE RETURN TO ARNSTABLE PUBLIC HEALTH D ­ SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc E TOWN O�i7¢F BA.RNSTA.BLE LOCATION ✓�� Y�C'� SEWAGE # ` I VILLAGE AS MAP & LOT /?�y 043 INSTALLER'S NAME& PHONE NO. Q SEPTIC TANK CAPACITY f 00y Q LEACHING FACILITY: (type) (size) /000 NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: ✓r G Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facili ty (If any wells exist ! on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist I within 300 feet of leaching facility) Feet Furnished by - i 14A 2 J ti ,TOWN OF.•,BARNSTABLE LOCATIONS 0l-$EWAGE LLAG-j90 T2 1'i`�L � "ASSESSOR'S* MAP LOT * f L = , rINSTALLER'S NAME PHONE,NO SEPTIC TANK CAPACITY ` LEACHING FACILITY:(tyPe)_4**j_ 0 (size) ` NO:OF BEDROOMS _ ;PRIVATE WELL OR PUBLIC WATER rr 2Y BUILDER OR OWNER h uk DATE PERMIT ISSUED: 4 i DATE . COMPLIANCE ISSUED:, �f M1 a VARIANCE GRANTED: Yes No? `x . 1 _ - .t` = ors: '• ,� .�'�. x ,,,f 1� �.r `'' �{ta T rv . •r•nnnr e�nPf�r"e•,'r17fe'JwRges'w►,er'Rr, t�eY I,R'flr:!7i(TP.n"•••} TOWN or BARN�5TARLP I30ARD OF 118A1,T11 _.SUBSURFACR SEHA09 DISPOSAL AYSTF,M INSPECTION VORN - PART D•r CERTIFICATION «••rr•tR•srsTtnnw•srrrrrn,nn•rm+r,ew,rr�»s�-�rrrnr�aa ,AI�1,�'Ifl!'1t wa, v*o�•t'+•wr r -TYPE OR PRWT CLEARLY- PRO,PERTY IN•SPFOTFI? STREET ADDRESS 38 Victoria Street-Centerville 0.2632 i�.. e—�ra��e��—ice.,•. ASSESSORS MAP, BLWK AND 'PARCEL � OWNER's NAME Helen Grotheer PAliT'.' D C9RTIFI0ATX0N ; NAME 'OF INSPECTOR Ro9.itt Pa.o•Un.1 , COMPANY NAME 10.Wh Macomlea''` Son Inc COMPANY AUDRFSS Box 66 •Cen�gtv.ilta Mabb' 0263�2 . Stce �' Tolm-or City. 8ta t LIP COMPANY TEL&PHONE ( 508. Y�7.5 - 3338 FAX (' 508- 11'90 4 f 578 , CERTIFICATION. STATEMENT I certify that I have Personally .inspected ;:the sewage system at this ndd.ress and that rd* information reported .1i true,. a,00ura•te•� grid omplete as of the time .qfg inspection.,- The ingpeotiQn was performed and any recommendations regarding upgrade', .ma•intenance,' abd repair .are• eon$is'tent with my trainip,g and expe-rience in the proper fun•cti,•on• and maintenance of on- site sewage disposal. systems , • u I tl�i{►t. Check one: System PAS9*D ' The inspection which •I have conducted has ,,n'ot found any information . which indicates that- the system falls to ' adequately. protect .publi•o health or the envi.ropment as defined in' .310 CMR. 16' 30.3', mAny failure criteria not -evaluated are as stated in the FAILURL CRI'yMA s+eation o•f this, form. System FAILED* f The inspection whic}) I have ban 'ted 'has'.••found that the $yatem fails to protect the public Health ;tnd the environment • in acvo-rdemce with Title 51 310 CMR 15 , 303 , and as - specifically noted -on •PA•RT- C - . FAILURE CRITERIA of this insjoec'tion dorm, Inspector Signature* 'Date ne copy of this eertl f ioat•i•oh must •be rovided 'to : the .QWN99. t �9 BUYER where applkoe•ble) and thla UPARD or KEA Ti{, „ * If the inspection FAIL'Eb., the .owner' .or""operator 'a:hala, . upS.r.iade'•t'he system. within, one year of the date of the inspection, unless, allowed Qr• req 4,red n h.ho.rw{se as. Provided in' q;10 CMR 15 ,306 ,. DATE 3/17/06 PROPERTY ADDRESS 38 victoria street Centerville MA 02632 On the above date, the septic system at the address above was Inspected. This system consists of the following: 1.1 1-1000 gaiion zept.ic tank., 2.1 1-1000 gaiion 2each.img pit., Based on inspection, I certify the following conditions: 3.1 7h.i,3 .is a 7-i-Ue Five zapt-ic zyztem (78Cado) 4.1 Se/2t.ic hyztem 1,6 .in /2/jope/L Wo2k-iag o2de2' at the i22eaent time. r SIGNATUR \(. Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc_. Address: P. 0. Box 66 k Centerville. Mass 02632 Phone: 508-775-3338 or 508-775-6412 JOSEPH P. �IIACOMBER & SON, INC. Tan ks-Cesspools-Leachfllelds Pumped & Installed Town Sewer Connections r P.O. Box 66. Centerville, MA 026.32-0066 775-3338 775-6412 • jr COMMONWEALTH H OF MASSACHUSEM EXECLFnW OFFICE OF EN AL. AMS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM I'A UI A CERTMCATIO.N Prop"Addra : 38 Victoria Street Centerville MA 02632 Owaer-'sNawe: Helen arothPPr Ow=esAdd -game t3ate.oll 7 0 6 Nan dImpeewr.(please .Robert A Paolini Comp m►yNammue:�7 P man-ommber A--Eon Inc. MAfihzgAddnz= Box 66 � Centerville 1 e MA 02632 T&pliWNamher:508-775— 338 CERTIICATION 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 mplete as of the time of the inspection.The inspection was performed based on rimy training and experience in the proper f mmmction and maintenance of on site sewage disposal system&I am a DEP app vved sydem haspector F110110111111t OD Seed=15.30 of Ilk 5(310 CM R 15.6NO). The system: XZL Passes , Conditionally Passes Needs Furtber Hvahmation by the Local Approving AutixNity � • F' Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(hoard of Health or DIIP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 1 ,00® gpd or greater,the inspector and the system owner shall.submit the report to-the appiropriate regional office of the DID The original should be sent to the system owner and copies sent to the buyer,if applicable,and time�oRimtg authorlty. Notes and Comments o* JAC tlnmq otbqw4im and mid fte eqwMdm Of=at 69. thm Tires bapedi m does not addres hoow dw syslem wlil pairomem in;an fature under the same or dibsent Title 5Inspection Form 6/19200D page I I Page 2 of 11 OFFICIAL INSPECTION.FORM—:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION YORK PART A CERTIFICATION(continued) Property Address: 38 Victoria Street Centerv.ille MA 02632 Owner: Helen Grotheer Date of Inspection: 3/1 7/0 6 Inspection Summary: -Chock A,B,C,D or.E/ LA WAYS.eflmplete all of Section:D A. System Passes: YES NO I have not found any information which indicates that any of the failure criteria described in 3.0 CMR 15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Septic .system .iz-ia /2a0/2ea woak.ing o z idea at the /2aeheat time., B. System Conditionally Passes: . NO One or more system components as described in the"Conditional Pass'-'section need to be.replaced.o.r repaired.The system,upon completion of the replacement or repair,as approvedjby.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. No The septic tank is metal and.over 20 years old*or the septic tank(whether metal or not)is Structurally unsound,exhibits substantial infiltration or exfiltration.or tank failure is:imminent. System will pass inspection if the existing tank is replaced with a complying,septic tank.as;approved by the.Board.of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: NO 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: No The system requited 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)prereplaced obstruction is removed ND explain: .. ti. 2. r Page 3 of 11 OFFICIAL-INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 38 Victoria Street Centerville A 0 632 Owner:. Helen Grot-thePr Date of Inspection:_j 1 'Z1 n ti C. Further Evaluation is Required by the Board of Health: No 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 willprotect public health,safety and the environment: No Cesspool or privy is within 50 feet of a surface water No 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: No 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. UD_ The:system has a septic tank and SAS and the SAS is`within a Zone 1 of.a.public water supply. et a private.water supply No The system has a septic tank and.SAS and the SAS is within 50 feof p pp y well. No The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply.well"-Method used to determine distance visual "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 f Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ! " PART A ,. CERTIFICATION(continued) Property Address: 38 Victoria' Street centerviiie MA. U2632 Owner: Helen Grotheer Date of Inspection: 3/1 7/0 F: D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no".to each of the.following:for all inspections: Yes No X Backup of sewage.into facility or system component due:to overloaded.or clogged SAS.or cesspool x Discharge:or ponding of effluent to the surface of the:.ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in�cesspool is less than 6"below invert or available.volume is less than'/a•day flow _jL Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy,is below high ground water elevation. - _ X .Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water:supply. X Any portion.of a cesspool or privy is within a Zone-1 of a:public,wel.1 . X Any.portion of a cesspool or privy is within.50 feet of a private Water supply well. �. X Any portion of a cesspool or-privy is less than 100 feet but greater than 50:feet from a private water supply well with no acceptable water quality analysis. [This system.passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates.that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered:A copy of the analysis must be attached.to this forT-1 No (Yes/No)The system fails.I have determined that one or.<more;'ofthe above failure:criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner4ould contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a.facility with a design flow of 10,000 gpd to 15,000. gpd• You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X 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 _ _X 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.1SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 38 Victoria Street Centerville MA .02632 Owner: Helen Grotheer Date of Inspection: 3/1 7/0 6 Check if the following have been done.You must indicate"yes!'or"no"as to each.of the following: Yes No y Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X — Has the system received normal_flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X — Was the facility or dwelling inspected for signs of sewage back up? " X — Was the site inspected for signs of break out X — Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X — 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 n� — Existing information.For example,a plan at.�he Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] I 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM;INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 38 Victoria Street Centerville MA 02632 Owner: Helen Grotheer Date of Inspection: 3/1 7/0 6 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design) 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#ofbedrooms)3 3 0 Number of current residents:1 Does residence have a garbage grinder(yes or no): a Is laundry on a separate sewage system(yes or no):no [if yes separate inspection required] Laundry system inspected(yes or no): rz o Seasonal use:(yes or no):_n o Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): no Last date of occupancy: a n A p n COMMERCIALVDUSTRIAL M1 A Type of estab,ishment: Design flow(based on 310 Ci;Ui 15.203): gpd • Basis of design''flow(seats/persons/sgR,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, available:if Last date of occupancy/use: . OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 3118106 12umI2 7 ma.in.t macom&ea Was system pumped as part of the inspection(yes or no): c--Le.s. If yes,volume pumped: 1000 allons--How was quantity pumped determined?m e a u.3 2 e_d Reason for pumping: ma.irn.t .TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: unknown Were sewage odors detected when arriving at the site(Yes or no •no 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 38 Victoria Street Centerville MA 02632 Owner: Helen Grotheer Date of Inspection: 3/17 0 6 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X 40 PVC other(explain):. Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,a c.): Jointb ap/2ea2 tight., Sy,3tem vented though hourse vent. SEPTIC TANK:y e f locate on site plan) 1.000 g ai e o n h., Depth below grade: 12" Material of construction: X 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) Dimensions8' 611X5 ' 8"X4' 10" Sludge depth: 2" " Distance from top of sludge to bottom of outlet tee or baffle: 6 Scum thickness: 1" 5 , 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: m e a u2 e Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc.): Pum .tank eveay 2 yea/tz .meet .9 Out tees ate �n ��ace. 7ank is ztauctuaaM .3011n cqui eve , ate no2ma ., GREASE TRAP: no(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.): 2eaze ;tlLap iz not f4ezerzt 7 i Page 8 of 11. OFFICIAL INSPECTION FORM..—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 38 Victoria Street Centerville MA 02632 Owner: __Helen Grotheer Date of Inspection: 3/1 7/o 6 TIGHT or HOLDING TANK: IV (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: Qallons 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.): 7.igh.t oz hoid.ing t.ank.3 aae not /22ezent. DISTRIBUTION BOX:y es (if present must be opened)(locate on site pn) 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.): 13ox .iz. .eevee ha.6 9 2atelza'eo No zign's„ .off iekage .in oa. out o� E;_oz.1 No aoiid caa2yove2. PUMP CHAMBER: no (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.): l um1? chamge2 .i.b not. 121Lehenz.,, 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: 38 Victoria Street Centerville MA 02632 Owner:. HP1 Pn Grothe r Date of Inspection: A J 1 7.1 n SOIL ABSORPTION SYSTEM(SAS): .(locate on site plan,excavation not required) If SAS not located explain why: Located see Rage ' 10., Type X leaching pits,number: 1 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Tyjpe/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,,damp soil,condition of vegetation, etc.): —� Loamy .to medium zand.� No zzgnz o� oa ponding.�. Soi-P,6 ate daub., vegetation i,6 no2ma CESSPOOLS: NO(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 br no): Comments(note condition of soil signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Ce.6.s/2ooiz aze noZ /aze,6en PRIVY: NO(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.): l)ti.ivu .ins no.t 2aeeent 9 Page 10 of 19 OMCIAl,INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS / SUBSURFACE°SEWAGE-DISP.OSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 38 Victoria`Street Centerville MA�2632 Owner: Helen Grotheer Date of Inspection: i/1 7/n F . UTCH OF SEWAGE DISPOSAL SYSTEM Piow\de a sketch of the sewage disposal system including,ties to at least two permanent reference landmarks or. benchmarks.Locate all wells within lo0 feet Locate:where public water supply enters the building. t 1 � 1 l 0 .. .10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) Property Address: 38 Victoria Street Centerville MA 02632 Owner: Helen Grothee.r Date of Inspection: 3/1 7/n ti r SITE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to ground wateri�)U" feet 1 Please indicate(check)all methods used to determine the high ground water elevation: •N D Obtained from system design plans on record-If checked,date of design plan reviewed: yes Observed site(abutting property/observation hole within 150 feet of SAS) M Checked with local-Board of Health-explain:a s t a!,91 rt a2 no Checked4ith local excavators,installers-(attach documentation) t ez Accessed USGSdatabase=explainAttPrtown. 9aan taIie.�.mQ,-u.a You must describe how you established the high ground water elevation: /l,3ed. t Ca e Cod Comm.ia.ion !datea 7agie Contou4z And P ugiic Uatea SuPP4 Glee head /�aotect.io-n aaeaz map 1 Sept 9995 ldatea sehouaceh oeliee cag mm. e cod coesion Top of Cround Leaching Pit V : ;cet Groundwater: Feet Below Bottom•of Pit High Groundwater.Adjustment 1.8 ft per Frim ter Method ` & .} P P Tlferefore,the vertical.separation distance between the bottoin , of 1 he leaching pit and the adjusted groundwater table is feet. ll ,I t Y I 00 Commonwealth of MassachusettsJUN Executive of Environmental AffairsDEP Q 19g6 Department of �. Environmental Protection 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 38 Victoria Street. Centerville, Ma. Address of Owner: Alfred&Barbara K. Forman (if different) Date of Inspection: 06/01196 Name of Inspector: Michael DeDecko Company Name, Address and Telephone number: Atlantic Environmental P.o Box 2384 - M ashpee Ma 02649. Tel : (508) 4771420 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection . The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system -X-- Passes ---- Conditionally Passes ---- Needs further evaluation by the local Approving Authority ---- Fails n , Inspector 's Signature: Date: 06/03/96 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer,if applicable and the approving authority. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 36 Victoria Street. Centerville,Ma. Owners : Alfred Forman Date of Inspection: 06/01/96 INSPECTION SUMMARY: Check A,B, C, or D A)SYSTEM PASSES: X-- I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303.Any failure criteria not evaluated are indicated below B)SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate es no or not determinate ,N, or ND . Describe basis of determination in all y � ) instances. If "not determinated",explain why not. -- The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfiltration , or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. ---- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). ----- broken pipe(s)are replaced ----- obstruction is removed ---- distribution box is levelled or replaced ---- The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ----- broken pipe(s)are replaced ----- obstruction is removed SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : 38 Victoria Street. Centerville Ma. Owner : Alfred Forman Date of Inspection: 06/01196 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health, safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETYAND THE ENVIRONMENT: ---- Cesspool or privy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. ---- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. --- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ---- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analy- sis 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 notrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: -- I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 38 Victoria Street. Centerville,Ma Owner: Alfred Forman D ate of I nspection: 06/01/96 D) SYSTEM FAILS (continued) -- 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 over- loaded or clogged SAS or cesspool. --- Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. --- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). number of times pumped --- Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. --- Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. ---Any portion of a cesspool or privy is within a Zone I 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 ana- lysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. l m SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CE R T I A CAT 10 N (continued) Property Address: 38 Victoria Street. Centerville, Ma. Owner: Alfred Forman Date of Inspection : 06/01/96 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above : The design flow of system is 10,000 gpd or greater Large System and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist : --- the system is within 400 feet of a surface drinking water supply --- the system is within 200 feet of a tributary to a surface drinking water supply -- the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please, consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 38 Victoria Street. Centerville, Ma. Owner: Alfred Forman Date of Inspection: 06/01/96 Check if the following have been done : -x Pumping information was requested of the owner , occupant and Board of Health. --x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built plans have been obtained and examined. Note if they are not available with N/A. --x The facility or dwelling was inspected for signs of sewage back-up. --x The system does not receive non-sanitary or industrial waste flow. -•x The site was inspected for signs of breakout. --x All system components, excluding the Soil Absorption System, have been located on the site. ---x The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees, material of construc- tion, dimensions, depth of liquid,depth of sludge,depth of scum. ---x The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods -•-x. The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 38 Victoria Street. Centerville, Ma. Owner: Alfred Forman Date of Inspection: 06/01/96 RESIDENTIAL: Design flow : 33 U gallons Number of bedrooms : 0�:> Number of current residents:02 Garbage grinder [yes or no): Nv Laundry connected to system (yes or no): cif S Seasonal use (yes or no) : rvv Water meter readings, if available: N� Last date of occupancy : COMMERCIALIINDUSTRIAL : Type of establishment: Design flow : gallons/day 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 : Other: (Describe) ............................................................................................................ Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N.` .................................................... System pumped as part of inspection(yes or no):......ik..)Q......... if yes, volume pomped : .................... gallons Reasonfor pumping:............................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 Victoria Street. Centerville, Ma. Owner: Alfred Forman Date of inspection: 06/01/96 TYPE OF SYSTEM A 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) --- Other (explain)........................................................................................... APPROXIMATE AGE of all components, date installed(if known) and source of information .�0aan...��...�.�.y.............................................................................................................. ................................ Sewage odors detected when arriving at the site (yes or no).....N....... SEPTIC TANK: ...... (locate on site plan) D epth below grade: .. . ... Material of construction: A,.. concrete ......... metal ........ FRP ........ other(explain) .............................................................................................................. Dimensions: S o?x. S µ Sludge depth:....t"........ Distance from top of sludge to bottom of outlet tee or baffle:.......33.................. Scum thickness:....(;."............. Distance from top of scum to top of outlet tee or baffle: ...........1.0......................... Distance from bottom of scum to bottom of outlet tee or baffle :..:.�.`l.'.'............... Comments : (recommendation for pumping , condition of inlet and outlet tees or baffles,depth of liquid level in r ,1L on.. o!M outlet i ert, structural inte ity, evide.n.ce.of leakage, etc.).... ... fN �.�. ... . .. g... v�. : . . . : -. ........................................................................... J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 Victoria Street. Centerville Ma. Owner: Alfred Forman Date of inspection: 06/01/96 GREASE TRAP : a (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FRP........other(explain).... . .......................................................................................................................................... Dimensions:............................... Scum thickness:............... ........ Distance from top of scum to top of outlet tee or baffle:....................................... Distance from bottom scum to bottom of outlet tee or baffle:............................... Comments: (Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)........................ ................................................................................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:....0. ...... (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FRP..........other (explain).......... ................................................................................................................................................ Dimensions:............................ Capacity:....................gallons Design flow:...............galions/day Alarm level:............................. Comments: (condition of inlet tee, condition of alarm and float switches,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 Victoria Street. Centerville Ma. Owner: Alfred Forman Date of inspection: 06/01 l96 DISTRIBUTION BOX16. (locate on site plan) Depth of liquid level above outlet invert:...�I�U P� 'Cott Comment: note if level and distribution equal ev d nce o s lids carryover, vidence of I akage int� S 0 out of box c. ... .. x?K. .a,�v.C ao:. .d.0 !.. . ,. ..,..{.. ... .v.dp' -:o' .................. . ................................... PUMP CHAMBER:....N .... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.).................... SOIL ABSORPTION SYSTEM (SAS):....LV.5....... (locate on site plan, if possible; excavation not required, but may be approximated by non- intrusive methods) if not determined to be present, explain: ................................................................................................................................................ ................................................................................................................................................ Type: leaching pits,number: ..l. .4 �..�'� leaching chambers, number:........ leaching galleries, number:........... leaching trenches,number ,length:..................... leaching fields,number,dimensions:................... overflow cesspool,number:.......... Comments: (note on Wilionsol , s' nsQf dra is failure vel of pondin condition of v�geta . . . . . ............. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property address: 38 Victoria Street. Centerville M a. Owner: Alfred Forman Date of inspection: 06101196 CESSPOOLS:....0... (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: ..................... Indicator of ground water: .................... inflow (cesspool must be pumped as part of inspection) . .. . ................................................. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY : ....0...... (locate on the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) . ................................................................................................................................................ i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address : 38 Victoria Street. Centerville, Ma. Owner: Alfred Forman Date of inspection: 06/01/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100'. 0 DEPTH TO GROUNDWATER: Depth to groundwater: 3.. .5feet tt�ethod of deterrr nation or approwim tine: J . L1 en .......... U_ ................................................................................................................................................ �l2 ASSESSORS MAP f10: !` PARCEL NO.: -�— THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1 0 t ......................................... OF......................................................................................... - AliV irFation for Uhipmal Workii Tnnitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (Individual Sewage Disposal S stem at . .....� . i C a 2[/l •.fit` ��� -- --------------------------------------------- location-Address or Lot No. -- -•---------------------------•---------•-•---•- ---.._... 45�K.Q_alk -----••_... ... --- Owner n Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -----•-----------------•------------------------...--- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid" capacity............gallons Length................ Width................ Diameter_------------- Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to.ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 04 ---------------------------------- ••------------------- ------------------------- •------ •------- ••--- ----- ••------------------------------- •... •---------•---- 0 Description of Soil..............................................................................................................................................-......................... x w x = ------- ------.....--- ----- -- ------------- U Natur :p Repairs or Alterations—Answer when Dlicable.._____.. S�fz_____ ���'_i-__04........1_6................. a Qv -zy.---'r':to�....---- , AA4 Agreement:The undersigned agrees to install the afor edescribed In idual Sewage Disposal System ' accordance with the provisions of is .% 5 of the State Sanitary Code e-- rsigned further agre not to e the s stem i operation until a Certificate of Compliance has b iss e YA6 Si n Application Approved ---------- = n=-----•---••-•--••-------•-_•••••^------•--••• •lL�___ == -------�J ............... Date Application Disapproved for the following reasons:.............................................................................................................. --------------------•-----...._._...------------...----------...-•-------------------------•--------...---------------...--------••----••-•-•-----•-•-------------•-•••••---•---------•••------••------- Date PermitNo... �. .. ........... Issued....................................................... Date Noy �.L.?4 -� Fmc.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ...................OF............................._........-----------------•----...----------................. Appliration for Ubipasa1 Works Tumummin Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( )'an Individual Sewage Disposal System at: < `"Y�.... r. .;_rj ... _.5�..._..`:l"rz.�., `c L.,� i-c-........................l.............................................. Location-Address or Lot No Owner . Address/ W +• = t...'.l.-�{ ."'�'._,.� 1...................••............. ............. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _________________________- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Gd Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—Nlo. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. a •-•-••-•--••----------------••-•-••••••--••••••-•-••••----•........••-••--•-.........._..._.._...---......................................................... 0 Description of Soil................................. .........................•..---........•......._.........•..._............•...•............................................•............_............................................................... U W ................................................................................................................... .................... aJ Naturg�ofaRepairs or Alterations—Answer whenlicable..._..___ _�UE ---___•. /S_l_ -.-_-_-_ 1 -.. =--••••� _ ?.us-� 1 -r-- c� .....j4-�-G'-•-•----•---•---•••-••-------- ---------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syst accordance with the provisions of l m I-mz_,..:.;' ;of the State Sanitary Code e u rsigned further agre snot to ce the ystem i operation until a Certificate of Compliance has be-efi is e r 1J@ Sig f -----•-------•-•- . Application Approved ty-•`..................................................... =-=` " ' rllate "' .. ............ Date Application Disapproved for the following reasons:-•----••-----------------------•---------••------•-----•----•----•-------•--------------•-..................... ......••--•-•-••----•--•.....••-•------••-----••••....-•--••---........-•--•--••.............•-----•...•.••---------••-•----•-••-•-•••••••-•••-•---••----------•--•----•-••-••---------....-••---------. _ Date Permit No.. .__- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ::....:.....A....c::;.1. :.f ?......OF...............c......r- 1.:................................... Tertifirat a of Tompliatta THIS'•-S TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } b .. "�. .........................r c ti �� !�'2 i c: \ .. ---------------------••---------•--•----•-........................•... ----------- �) Installer �— at ..` I------•-- ...-..•---•-------.�-------------------------------------------------------------•--••--- ---------------- ----------------------------•--•............... has been installed in accordance with the provisions of TILT E j of The State Sanitary Code as Aescr ibed_in the application for Disposal Works Construction Permit No------ - f_,, _&. dated---.------ -.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YNE SYSTEM WILL FUKCTION SATISFACTORY. ­_ - DATE.............. ....r...-� -------------------•-•-----...•.•. Inspector.!�---•------.............------------•-••----.....------...........--•-•----- THE COMMONWEALTH OF MASSACHUSETTS - - -- - - BOARD OF HEALTH FEE r...... Permission is hereby granted...........' �ice_ ±:_:......................' ` ` �~- .............••-•--•••-•••••••......•••---•••••••••••-•--••••...•••••.........•••...... to Construcct ( ) or Repair�`/j; ) an_Individual Sewage Disposal System Street c _. as shown on the application for Disposal Works Construction Permit No��^__._.`)�.1&.,Dated....l k')... ..... ............... . , -- --- f Board o - Health � DATE .......•... E- l FORM 1255 'Ft. BBS & WARREN. INC.. PUBLISHERS a �— "LO CAT ION SEWAGE PERMIT N0. VILLAGE j 1. viiC I " LLER'S NAME i ADDRESS I GUILDER OR OWNER DATE PERMIT LSS-UE0 c� D,AT E COMPLIANCE ISSUED a j �Gh i TOWN OF BARNSTABLE LOCATIO14 ✓�� ��� �a SEWAGE # I d ILLAG //�� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 2GIa-`74" Ta � — SEPTIC TANK CAPACITY ( OOU LEACHING FACILITY: (type) (size) /OoD NO. OF BEDROOMS BUILDER OR OWNER =eyy PERMITDATE: COMPLIANCE DATE: 3 D 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 r , Q ', i �7 � � � . t i � � �' � � 1 �X � � � � 1 i,l�� 11 J //i�!� %�� �s . . , n _ _: ,:. ._ . ; . ;z -r. ,�:- TOWN OF BARNSTABLE LOCATION /yC: I Grp9; lA OtSEWAGE # VILLAGE qZVt `L `- ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO�,Fj uJ3 i Cn /.7 aj2 J SEPTIC TANK CAPACITY <�5 LEACHING FACILITY:(type) ' � (size) ( ` � L NO. OF BEDROOMS , PRIVATE WELL OR PUBLIC WATER A�- f , BUILDER OR OWNER DATE PERMIT ISSUED: l O DATE . COMPLIANCE ISSUED: Q. VARIANCE GRANTED: Yes No x I �� of ;LOCATION SEWAGE PERMIT NO. VILLAGE 2, i'l� L IN L':L`fR'S NAME i ADDRESS BUILDER OR OWNEA- DA T-E PERMIT US_S-U E D DATE C0MPLIAWC-E ISSUED /�/�� • �� ���h �� r �` ���,�� '® -�'�„T No...C92_= Fps.. .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ©v st-� ..............OF...... .��'n�� ----,-- t lirtt i�a� for i� u l rk Toutlrurtion amit Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal System at: (�I ery ess A r / _ytG /� '••• ®""oLoocatio .. l . �- ddress r:. a ........... ........................................ -. .................................................................... Installer Address d Type of Building Size Lot....` _}C?o®___Sq. feet U Dwelling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) C4 Other fixtures -------------------------------- - W Design Flow..............5.S.....................gallons per person per day. Total daily!flow------------- ®...........--......gallons. WSeptic Tank—Liquid capacity 1oOQ..gallons Length-------�.. Width........ . ..... Diameter---------------- Depth....'....... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------- .......... Diameter._ .._. Depth below inlet........G........ Total leaching area.. Z Other Distribution box (J Dosing,tank ( low welkex r>i r_ 5�?-ISI a Percolation Test Results Performed by_____________________ ,_.._..............._......}-------------._--__.- Date.... __.__._____ ____._ Test Pit No. 1..... z.minutes per inch Depth of Test Pit.....�'4. ._.__ Depth to ground water.__h� ..��?..... t e Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O �� e ca � ............�cart ---------- Descriptionof Soil P-- ------------------••------------------------------------••-----••------------------•--••----•---------•-- x W ----•---------- --------------------------------------••-•---------•••--•--------------•-•-••-•••••-----•-------....-•---•--•-•--------•-------•--•-•••-•••-•-•-•-----------------------•--.....-------- VNature 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 TITHE 5 of the State Sanitary Code—The unde ig urther agrees not to placVne in operation until a Certificate of Compliance has been is ed rd o ealth. Z_ Signed----••--•• ... •••------•-••• • ---....... --•.......----••---------------• ..... --... Application Approved By--------•-- / _.._.. Application Disapproved for the f ollowing reasons:................................................................................................................ ....................••--------•••-----------•--.....•----•••••------•---•-----•--•----.......•-•••-•-•------------------------•-----•••---•-•--•--•-•-•--•-------•-••••-----------------•-•••-•--------- Date PermitNo......................................................... Issued....................................................... Date No................_....... FEE............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....:........oF.-....�.a.._9Z+C-0\-ems ApplirFatinn for Bi_pas al Works Tomitrnr#inn ramit Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal Syst at: ;4ocation-A ress ` t ^✓ C o � / -- -�?--� - �• ! . cif' w '' ddress a --.........C�. �t. ��................................... r� � �' ................-•---.I..-•---------------- Installer Address Type of Building b Size Lot....k...... feet �-, Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________________________ Showers � YP g --------•------------------- P ( ) — Cafeteria ( ) dOther fixtures -------------------------------•-•-•------•--------•--._...-----------------------------.....---- --- W Design Flow_____________�J_ .....................gallons per person per day. Total daily flow_._________�_a'_ Q...................gallons. WSeptic Tank—Liquid capacity!!099__gallons Length_______ Width...... •...... Diameter________________ Depth.... '....... x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------).......... Diameter_'! _:_`J._..... Depth below inlet........G._...... Total leaching area___`-_e l_4_sq:-ft. � (� Z Other Distribution box (�_IQ Dosing,tank ( ) .. ov., itJelle �- It�c . S ZS Z a Percolation Test Results Performed by..... ------------...------•---=------•--------------- Date----•--•-------------------------••---- a Test Pit No. L._._< .minutes per inch Depth of Test Pit_____ _._. Depth to ground water...n-- __ 1�"`�I� I? Test Pit No:-2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------- ---•----••------------ •••-----•-----_----••---------------- •........ •------------------------------- D Description of Soil____ ..___a�a c1~�c: __:._. ` _. ------•----------------------------------------•.................................................. x W VNature 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 TIT!L- 5 of the State Sanitary Code— The undersig rther agrees not to place the system in operation until a Certificate of Compliance has been iss ed b rd fe�alth. Signed.......... _ --- -••--•••-••-•• ...........1............................... ........--- ' D Application Approved BY :- .. = " ";r '---------- Date Application Disapproved for the following reasons-.....................---........................................................................................ ......................................................................................................... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... .Trrtifirate of Tnmplianre THIS IS TO CERTIFY �atthe ,dividual Sewage Disposal System constructed ( ) or Repaired ( ) by--•----•-•....� '-....... _: -.....••-•----•-------••-- - ............................................................ Installer I at......................� -�- ------------••--- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code.as described in the application for Disposal Works Construction Permit No...... t_- _ ,.'-------- dated----._-____-__________________________________ m THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................-•-•......................................... Inspector.............................................. __________... ...-•-••- THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH ...................................O F.................-_.._.._.......--------•-----......___.....__....._.._._......---... FEE... S............. . � ��nn�a1 nrk� �n ,�trtnn erutit Permission is herebranted....... � _ ��''. �-__.._.. ---..-----_•_.- to Construct r:JZa air ( ) an�I. ividual Sewage Dispos ystem .. ----- .. _____-__� --�-W-. ................................................................................ Street as shown on the application for Disposal Works Construction P^Peer�mit No...................Al/at ,,._..________-...__._...._____-___._...___.._•.. ---------------- ••----___________ d of Health DATE...........................�7/ _-........................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS i 5uf Ll i I � I l r r ! ; - --t—' 1 - -- OR I Kr Tc _ I o Ld, CiraS. I ,a /G X 1�0 , CloS I FOOT I I i i i i Lifc I LItF ! I -SUP �E boy SJ_o.�2i3J_F�_ShELv1�.5 SKEW �J.f�LIC._S._ wx 7.wo_♦Z!�E2S_ _—[_ _ _ _� O CYIIL 11 ,,TIw i G+- o I90.a a3l:LocAie.. FmsT.IN. i F"I�._RaT4,. i D6t 2'66 -D�. ! 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L �7 Lti � f� ,��E 3 3 O--- G D�Y ... ....,..-. .. :- `]' C� . / / i � \ SOT S E f' , 7f�/�i k' 3C X / S = D�TC/M �a ' 4 9 TE57- HOLE- HOLE- #Z c i � p \ I SiJi,350/L /08 — o° �� �/ S r>c L /97. 9s / ( 2. 57 = g94.3G P D J Bow G= / 07 96. o f 14 4 " 7-E � / ,E/NCOU,• /TE,�ED / � /^_ / / cEeT/FY T�II�T THE £3U/LD/tiJG / -' C/V L.�1c::'12 o f'O 5 E D o nJ T-k-/E G�e o Un/D ,v S $f/ O !-/AJ 0 ti Ti-! AJ D O E S •- /=: f t S 0 -i?G E S 5 C.ON)=O,21-7 TO THE BU/LD/A,/G SET- B F�C E Q U I N E 1-M E ti TS 0 F T/--/ S T, -T' �E ,ASH OF,k4r c i9 L E r9 S S H O!�J /�J D f4 T E /`J,-H Y Q / /� / / EVERET7 . SG d �Y ,..�•, . / �/ V l [/�/ — ` Y rr-� ,QNo. 137 S C i9 L 4 O t t r Z Al rod ` '. .. E l� / n C . O 00 = exIS-t-/ nc/ e /evatlon BLDG• SETBA9c,� 0: D O = Pr-opoSed e /e v(a-t-/or- A2 2E�/`�lE ti/T-S — — — - -- -- — e x /S t/ r1 9 C o rn f o u r-S 40 r o r7� = 20 f+�r S / de = /o /9Po20 VE D -0—�-- -- ---- Pr-oPoSe� con-four-S B o��2D o� HEALTH re m r-- _ / o - - -T.O.F. EL.- 55.8'f - FINISH GRADE OVER D-BOX= 54.2'f FINISH GRADE OVER CHAMBERS= 54.1' - 54.5' 3/4"TO 1-1/2" DOUBLE WASHED r 1=N 1=R A I NI OT1=C SLOPE @ 2% MIN. OVER SYSTEM/ PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET & ' RISER TO WITHIN 6" OF FINISHED GRADE 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE OUTLET TO WITHIN 6" OF F.G. MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) N OF G OT XT DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. (r� FND. EL.= 54.7'± F.G. OVER TANK EL. = 54.1't r-5" DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC -- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE PROPOSED 4" 9" MIN. TOP OF SAS = rj1 .63 PLACE RISERS ON ALL DESIGN ENGINEER. EXISTING,4 ; 9" MIN. CHAMBERS w/PIPED 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE SCH. 40 PVC 36 MAX. 50.80 36" MAX. BREAKOUT EL = 51 .301 '< INLETS TO WITHIN 6" ' SYSTEM UNLESS OTHERWISE NOTED. 1­1SEWER PIPE OF FINISHED GRADE"" � 6" 3" 3" DROP MAX L-201f 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - - 2" DROP MIN 3 ga - MIN s�oPe @ 1 PROVIDE WATERTIGHT a o ELEVATION = 51.30' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A 4" PVC IN FROM f _ JOINTS (TYP.) (�� rr-�� o�� 40 MIL GEOMEMBRANE LINER IS PLAGE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 13" SEPTIC TANK 4" PVC OUT TO 0 0 0 O 0 u OOD0 O 0 (D THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE • LEACHING FACILITY o� 00 ��I o 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN ' � �c> �--� � � � � � `-J � � � INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL 12" 6" 00 00 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF \ OUTLET TEE 51 .17, MIN. 51 .00 2 0 0 0 0 °° o 0 0 0 0 0D0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES \-GAS BAFFLE 6" CRUSHED STONE °o 6 0 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY oQ °° o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE + I I AND DESIGN ENGINEER. f( 4.0' 8.5' (TYP) 4.0' I f 4.r3' ! q.p� j 5 OUTLET DISTRIBUTION BOX I 4.83' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. SEE BENCHMARK ELEVATION AS TO BE INSTALLED ON A LEVEL STABLE 25.0' (TYP.) SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET /48.80' GROUND WATER ELEV.= < 43.20 -12 83 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1 , 5' MIN. 000 GALLON CONCRETE SEPTIC TANK I CROSS SECTION VIEW 2 - 500 GALLON CHAN�t��l�� Li il"1iwiULi\ L-iou v Jkz. 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR 10 VERIFY EXISTING SEPT!�' T ^ "'°'' PROFIL � TYPICAL CHAMBER PROFILE ��.,�.�, �., �.�. TO THE DESIGN ENGINEER. � I ELEVATION PRIOR TO ANY WORK & D S I �ti i tL:r V i r« o.fri Li L-TA L CHAP AILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE - 11. NO DETERMINATION HAS BEEN MADE A5 TO COMPLIANCE WITH DEEDED OR ZONING / ♦ * • i :r' < "•' -•" ' TEST PIT nATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM .•.• 'f% ;� •�:Q x PERC NO. 21-185 12. ALL SEPTIC SYSTEM AUTHORITY. 2 ;f =,� f• •�• :! • "`=- TEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED PROPOSED TWO (2) I -- rC` ,. •�/• INSPECTOR: David W. Stanton (BOH) rET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR �, , ' • , • • r UNDER MORE THAN FEA 500-GALLON LEACHING I ti ► ,%� • -'• • EVALUATOR: Michael Pimentel, EIT, CSE TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. CHAMBERS w/STONE o 'j '' • f ! ti {' •J'• ' i C.S.E. APPROVAL DATE: Oct. 27, 1999 MAP 148 /� !1 ; • 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. LOT 64 MAP 148 ,° { ;'• ,�;'' (. �%' ��� DATE: July 12, 2021 FENCE I LOT 67 A i '' `r'1` fr 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE fA -X-X_X-�(-}�_- O t •i J TEST PIT#: 1 I , .'',ti!!' •;r • . 10 TEST MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ! x-x-x-X-X Y► - _ - ;, X54.8 I ►t ••'"� , ELEV TOP= 54.20 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, X54.1 x '3 ( ,�r _ �•. . •'JL, ONE O �/ FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). I I.�fl ELEV WATER = <43.20' N86° 13' 10"E �,ft� 15. ND IN 16 0 ``w CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND �,(( I PERC RATE = SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 00. 160-00' �� 18 ` • 16. PROPOSED PROJECT IS LOCATED WITHIN: . , ,_, � I \ � �. �� � •, DEPTH OF PERC= ASSESSOR'S MAP 148 LOT 63 . TEXTURAL CLASS: I - 1 FIRE PIT j� C rya r,t3erry �� �. OWNER OF RECORD: MICHAEL & CAITLIN WOJKOWSKI �, LOCUS WALK TP 2 /�X) `- /o ; 1 ,�' p" 54.20' ADDRESS: 38 VICTORIA STREET i \ / 54.3 / s 1 h g7pOP C-1 / PROPOSED / A y CENTERVILLE, MA 02632 - --- - � �_--- -•w�---- Loam and x54.1 INSPECTION PORT J __ _ -�,- 10Yr 3/2 TP1 ': FEMA FLOOD ZONE X (2 1Granberry Loamy Sand % \ `l t ''� µt" J B 10Yr 5/6 COMMUNITY PANEL# 25001 G0561 J TOF=55.8't x2' r I -PAVED DRIVE- I 1 `AIL �'�bc' ) 17. DEED REFERENCE: BOOK 21055, PAGE 230 I , o --�, . L?�,m be r rt; ,t '``' �� 36" 51.20' -PAV / I N , 1 cr I r Ponr� !' �» 18. PLAN REFERENCE: PLAN BOOK 350, PAGE 55 �, j ji •` • 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. II I I I ( \ x54.5 �_ ® �_ , *• �� 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY f I I \ Z �;• , f p i1 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY DECK \ 22.T N t ; ► ' • . �(_. FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 4) � f•. Medium Sand s4�` -a ,� � • • �/;, C 2.5Y616 \ - ; "` r-_ I ;.;,�-� � ! �• �l 21. A 4 PERFORATED SCH. 40 PVC PIPE SHA1_L BE PLACED IN A VERTICAL POSITION TO A ,x54.5 :,,, - . .- `-- 1,• �l` !_ a, , I DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A 1/ w x54.1 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. w / w!_w�� I #38 PROPOSED (1 22. OWNER /APPLICANT/ CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL LOCUS P LA N EXISTING DISTRIBUTION REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. f J S 3-BEDROOM / BOX GA \ DWELLING SCALE: 1" = 1000' x54.1 1 132" 43.20' G�< \ EXISTING LEACHING No Mottling, Standing or Weeping Observed DESIGN DATA _ � } PIT TO BE PUMPED, �� � -----"" � FILLED w!CLEAN� � � MAP 148 � �-� j �� � !_)%�, I /-� x54.7 ; SAND & ABANDONED , LOT 68 PERC NO. 21-185 N INSPECTOR: David W. Stanton (BOH) 50xO' EXISTING SPOT GRADE � �S3 �\ ,� NUMBER OF BEDROOMS (EXISTING) 3 fl \ EXISTING 1,000 , ' EVALUATOR: Michael Pimentel, EIT, CSE - - - 50 - - EXISTING CONTOUR C I \ \ / , /i C.S.E. APPROVAL DATE: Oct. 27, 1999 GALLON SEPTIC DESIGN FLOW 110 GAUDAY/BEDROOM I \ \ / � -o \ IN THIS DESIGN / w11 r-5� PROPOSED CONTOUR TANK TO BE USED 53 z TOTAL DESIGN FLOW ^ n J c 9 330 GAUDAY DATE: July 12, 2021 C) DESIGN GAL/DAY DESIGN FLOW x 200 % = 50 PROPOSED SPOT GRADE A : USE EXISTING 1,000 GALLON SEPTIC TANK Q o \ \ \\ r i � C:) TEST PIT#: 2 w \ m o C:) ELEV TOP = 54.20' Ua. EXISTING GAS LINE ? \ SHE / / o ' o 0 1 \ \\ % / . O P. j , / ELEV WATER = <43.20' C) U) EXISTING UNDERGROUND UTILITIES \ \ ////// / f / // INSTALL 2 - 500 GAL. CHAMBERS w/ STONE PERC RATE _ < 2 min./inch* W W EXISTING WATER LINE m m o � II I I \ � .,:. M 11 I E/T/C Benchmark / TREELINE // DEPTH OF PERC = "C" Soil Top Corner of B.H. i SIDEWALL CAPACITY TEST PIT LOCATION J 4y`5 ! TEXTURAL CLASS: I Elevation = 55.15' / �g`ti (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAL/DAY I 1 MAP 148 _ Approx. M.S.L. r (25.0' + 12.83') ( 2 ) ( 2' ) ( 0.74 GPD/ S.F.) =112.0 GAUDAY -- ® O EXISTING 1,000 GALLON SEPTIC TANK rn LOT 63 -,, - - -- -- - i h 1 011 54.20' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE G) II - --- 16,000± S.F. / , BOTTOM CAPACITY A Loamy Sand m -/ (LENGTH x WIDTH) (0.74 GPD/S.F.) GAUDAY 10Yr 3/2 11 DRAINAGE N86° 13' 10"E PROPOSED DISTRIBUTION BOX I (25.0' x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY 6" 53.70' EASEMENT 160-00' B Loamy Sand O PROPOSED 500 GALLON LEACHING CHAMBER < f \� 10Yr 5/6 rn m f TOTALS. 36" 51.20' Z _ f I TOTAL NUMBER OF CHAMBERS 2 TOTAL LEACHING AREA 472.2 SQ.FT. REV. DATE BY APP'D. DESCRIPTION MAP 148 TOTAL LEACHING CAPACITY 349.4 GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE LOT 62 PREPARED FOR: Medium Sanc ROBERT B. OUR CO., INC. C 2.5Y 6/6 LOCATED AT NOTES: 38 VICTORIA STREET 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM CENTERVILLE, MA 02632 COMPONENT. I SWING-TIES SCALE: 1 INCH = 10 FT. DATE: JULY 18, 2021 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING 132" 43.20' 0 5 10 20 40 FEET FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO "' DESCRIPTION HC-1 HC-2 DC ZN 6F Nq ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. c� No Mottling, Standing or Weeping Observed pa ssgc tl o yes PREPARED BY: CORNER OF STONE (1) 48-9' 26.5' 45.6 JOHN L. RESERVED FOR BOARD OF HEALTH USE *Pere rate taken from Application for Disposal o CHURC LL JR. JC ENGINEERING INC. 3.) ENTIRE PROPERTY IS LOCATED WITHIN A MASS DEP ZONE II, GROUNDWATER PROTECTION M U L OVERLAY DISTRICT AND THE ESTUARINE WATERSHEDS. , m CORNER OF STONE (2) 36.4' 42.4' 32.4' Works Construction Permit No. 82-283 on file N 41807 2854 CRANBERRY HIGHWAY with the Barnstable Board of Health. 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY FOR THE INSTALLER. a CORNER OF STONE (3) 48.9' 51.0' 44.9' ssl I EAST WAREHAM, MA 02538 INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS IN THE FIELD PRIOR TO INSTALLING THE SITE PLAN CORNER OF STONE (4) 58.8' 38.8' 55.2' 508.273.0377 I SYSTEM. CONTRACTOR SHALL NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. SCALE: 1"- 10' Drawn By. MCP Designed By MCP Checked By JLC JOB No. 5795