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HomeMy WebLinkAbout0062 WHIDAH WAY - Health 62 Whidah Way --- Centerville A = 230 — 195 S M E A D No.2453LOR UPC 12534 smsad.com • Made In USA — F89tU5EDNhLSPIE00lKTlrE SF� #MHSOF Tl*SR OCK sausaens So IRON(O WWWS PROMAMARO 1._ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for -Misposal *pstrm Construrtion Vennit Application for a Permit to Construct( ) Repair(✓rUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � Owner's Name,Address,and Tel.No. C eva-esw}\'C C f c�M Assessor's Map/Parcel 3 D 0 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. tIS\C.S �T N2 C947 1NC �sC�1? `71Y/ �N �NC•�,iar INC✓✓IDS Type of Building: Dwelling No.of Bedrooms 3 Lot Size 20170 sq.ft. Garbage Grinder( ) Other Type of Building {/)0%.>%r No.of Persons Z Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3® gpd Design flow provided 3'0,7 gpd Plan Date 1 3o I t( Number of sheets "L--- Revision Date Title Size of Septic Tank s 5 f i� Type of S.A.S. 2 5-cx.5 !fl 4 , ,-j C Lnca-,10 e rS Description of Soil Nature of Repairs or Alterations(Answer when applicable) i NS Hta. 1 tV LOF.o S.A . S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 1 Date rZ i/ Application Approved Date OZ. Application Disapproved by Date for the following reasons Permit No.Q_ 7 y�� Date Issued No. / I v - Fee�Q THE COMMON . ALTtiH OF MASSACHUSETTS Entered in computer: • - Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS 4 ftplicatlon for ;Disposal 6pstetn Construction 3permit Application for a Permit to Construct( ) Repair(L//Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Addre s or Lot No. 2 G011 t u0c y Owner's Name,Address,and Tel.No. C�v ��vv�1(C C cur\ Assessor's Map/Parcel a3 O� g fr 1 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. l��s\c,S As �(c�v�aZiv� cC7�-�1CX�-7/S7 �.v ��.,r-r•-:-�1 l.Jrii'f[5 . Type of Building: Dwelling No.of Bedrooms 3 Lot Size ,2 v.50 y sq.ft. Garbage Grinder( ) t Other Type of Building V)yv5r No.of Persons 2. Showers( ) Cafeteria( •) - - .< Other Fixtures Design Flow(min.required) '3 30 gpd Design flow provided 3'-to,-7 gpd Plan Date 1 Number of sheets '1-- Revision Date ' .'i Title Size of Septic Tank P I 1 �.•� Type of S.A.S. 2- 5-CX5 cl 4 /),,-a C kc^10 e r$ Description of Soil Nature of Repairs�fr Alterations(Answer when applicable) t NS t r_ \ N F r o S.A Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of y Compliance has been issued by this Board of Health. Sign !�'Z Date ApplicationApproved Date Application Disapproved by Date for the following reasons i Permit No o/ty T U Date Issued 2 r s I -------=---------------------------------------= ------- ----------------------- ------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS t 9 w f , BARNSTABLE,MASSACHUSETTS ' (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by c,% A fCn.y.a v c r at G (.✓h C)u k has been constructed in accordance c� / with the provisions of Title 5 and the for Disposal System Construction Permit No.`s G/-1 C9-?dated Installer DI0 '4 5 Designer t"5 I've "le S #bedrooms Approved de is n ow 3 110 Al gpd The issuance of thi per i sh/)noybt construed as a guarantee that the system wil nRio r esi i Date Inspector � - ---- No. Q —2 Fee d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH-DIVISION -BARNSTABLE,MASSACHUSETTS I MIsposaf 6pste onstrnctlon Vermlt Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at �, 2 Gc/�1 ,Ja (,t om Y �+o•i a P/U I 2' i 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. i Provided:Construction st b co 'pleted within three years of the date of t1fis permit. }Date � �� Approve�b�e E } t; �r TOWN OF]BARNS TBLE . LOCATION fp;&,'-WVNj`" UQUIy `3t;S.EWAGE# a,1 y —®Z `j �ULAGE( &r.:J tip ASSESSOR'S MAP&PARCEL .2_10_Y Iq INSTALLER'S NAME&PHONE NO:Q"4- 5N_�(t'AAjN 4-NC S'PTIC'TANK CAPACITY of w LEACHING FACILITY (type) (size)' NO.OF BEDROOMS ti OWNER !+ t �`�PERNIIT DATE: COMPLIANCE.DATE: �L (; ' Separation Distance Between the: N FPf Pd Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility t�T":i�ee IC Feet Private Water Supply',Well'and Leaching Facility(If any.wells:exist on site or within 200 feet of leaching facility) Feet Ed'g e of Wetland and Leaching n'( Y Facility If an wetlands exist within 300 feet of leaching facility) , ` Feet y FURNISHED BYq` 1�5 u �.D^.J A 40iG o� .� YJAeRN°S 1 �T15 02/06/2014 14:24 50e4775313 ENGINEERING WORKS PAGE 01 'down of Barnstable Regulatory Selrviees Richard V. Scsli, Interim Director '$ Public Health Division Thomas McKean,Director 200 Main Street,'Ayannis,MA 02601 Office: 508-862-4644 Fax: 508-790r6304 Installer & Designer Ce ti-ication Form I�! gAssessorl 4 Date: ``1 Sewage Permit# 'a s Map1Parcel rPs6�!"'teEni-et �� Designer- Installer: P-1,• Y-vtw-4,n kv, C *Adc3ress: !2. W. ss�e 14 Address: - )14* On y / ` ro"q, it ra J"`C was issued a permit to install a (date) (ir4tall=) septic system at t!o W h�dc'�` J&J aced on a design drawn by (address) A,Fe,. & -f-e lar- dated f r y (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 comp lan ith the terms of the NA approval letters (if applicable) N oP �--- PETER T. �l�i'" Mc�NTEE (Lustaller's Signature) CIVIL �1yo.381A9� : At esip is Szgnatuze) X Designer's iCATE PLEA E TURN TO ARNSTABLE PUBLIC HEALTH DIVISION. CERTI OF T CART] ARE R CETD BY � BARNS.ABLE PUBLIC HFAI. II VISION. H HANK YOU. Q:19epti0l1)esigner ceitifioaion Form Rev 8-14-13.doc Town of Barnstable P U Department of Regulatory Services Public Health Division Hate ( z-- 3 ibsq �� 200 Main Street,Hyannis MA 02601 o � , Date Schediiled B f a cJt r - Time Fee Pd. (. Su Soitability Assessment for S e Cj A o Z Performed:By ���1 `L��'i�" #"lam 'Z Witnessed By.- LOCATION&.GENERAL INFORMATION Location Address � // ff h 2 1/lfdl c pt�. Owner's Name 6 e..1`yjd,0, PR 4c,.1c.� Addmss C-e,�-Vdl Le a26CA, Assessor's,Map/Parcel: 'L-3 Q —I CLS Engineer's Name �f} �' �6,, � T. - M NEW CONSTRUCTION 11__ REPAIR x Telephone# Land Use .�,-d�t OUJ Slopes(%) � Z— Surface Stones Distances from: Open Water Body Possible Wet Area; d ft Drinking Water Welld ft Ud Drainage Way �3 ft Property Line Zx,J/"''ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes) �( S,,, be Parent material s "U�"J� W"pI� (geologic) )to'Bedrock(�olo i ) Dep Depth to Groundwater Standing Water in Hole: �0-L - . Weeping from Pit Face U>tiC . tl Estimated Seasonal High Groundwater l 3 Z DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Death Observed standing in obs.hole: ,. .in, Depth to sc ott!cs: irf. Depth to weeping from side of obs.hole in, Groundwater Adjustment fr. Index Well#"''t" ` Reading Datei `--"Index Well level Adj,factor r Adj,Groundwater Level , PERCOLATION TEST Date Thne.� Observation Hole# e Time at 9" Depth of Pere ?? Time at 6" Start Pre-soak Time @ Z Time(9"-6") End Pre-soak G C q Rate MinJInch. Site Suitability Assessment: Site Passed -,4 Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be.conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPT10P8RCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture: Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones;Boulders. o to v.l � 5 . w DEEP OBSERVATION HOLE LOG Hole# z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) w� (USDA) (Munsell) Mottling (Structure,Stones,Boulders... Consistency,% rav io. (Ly/z 6 -36 I- 510V& �f3z C plat "Ixt'a Z 5-Y6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon -Soil Texture Sail Color >.'Soil Other Surface(in.) (USDA) _(Munsell) >Mottling (Structure,Stones,Boulders. ConsWe e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,`Stones,Boulders. Consistency, Flood'Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes ,...� Death.bf`Naturally occurring.Pervious Material Does atleast four feet of naturally occurring pervious material exist in all areas.observed throughoutahe area proposed for the soil absorption system? G S `'If not,what is the depth of naturally occurring per ious material? Certification . ri 5 I certify that on 1�1 (date)I have passed-the soil evaluator examination approved by the . Department of Ettvironmental Protection and that the above analysis was performed by me conststent with .T the required tra` ing,expertise and experience described in 10 CiV13t 15.019. Signature Date _ 6 y Q;\SEPTICVERCFORM.DOC Town.of Barnstable P#_/ � .Department of Regulatory Services a rtarne e f .; Public Health Division Date ( _ 3 • 200 Main Street,Ilyannis MA 02601 Date Scheduled .:` '. l 1 i 6'�� �. Time / Fee Pd. So ' Suitability Assessment for S e Di o. l Performed-By:__ 0 f f✓ G.L�tn�-t' #I�l f Z �' Witnessed By: LOCATION& GENERAL INFORMATION r Location Address / Z �f� /`4 ���t: J Owner's Name �v`Y44, p c. t�e,1-d-Q 'GJ`i I l e V Address (R Z G( t t,&� "V644 Assessor's Map/Parcel: '2-3 0 --1 Engineer's Name Po;�xlit.NEW CONSTRUCTION 11,w, REPAIR X Telephone# �� s Land Use �:dk lea 1 Slopes(90) ' '�Z Surface Stones r (cc Distances from: Open Water Body ft Possible Wet Area:>3C%d ft Drinking Water Well d ft U� Drainage Way �3 ft Property Line Z��� J ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes) v � vU w�al�c� way Parent material(geologic) "y Depth to'Bedrock 0E v yr.l. Depth to Groundwater. Standing Water in Hole: Weeping from Pit Faceal~C tJ Estimated Seasonal High Groundwater ! 3 Z DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _ .__ _In. Depth to SG p: sDttlds;--- In, Depth to weeping from side of obs hole _ - - ln. ©tnuttdwatef Adjustment, ft. Index Well# `'. Reading Date. ° "Index Well tevel Adj,fact-r..., - AdJ,dtouflawoterl.eve) ,e PERCOLATION VEST Date, Thne,�_._ Observation Hole# d1A Time at 9" Depth•of Perc C.� Time at 6" Start Pre-soak Time® Time(9"-6") Z End Pre-soak L C tyvL Rate Min./Inch. Site Suitability Assessment: Site Passed -,4- Site Failed: Additional Testing Needed(Y/N) original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\S EPT[C\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole#_— Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure Stones;Boulders. Consistenty, v 1 0-39 L S z. r"�QeQ ►.Q 2i 5 DEEP-OBSERVATION HOLE LOG Hole# .2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% 10 ,f3 z A z-s Y� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color ".,:Soil Other Surface(in.) (USDA) -(Munsell) Mottling (Structure,Stones,Boulders. Consistency Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Flood Insurance Rate Map: Above'500 year flood boundary No_ Yes2�._ Within-500 year boundary No— Yes Within 100 year flood boundary No Yes Depth,of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in ail areas.observed throughout;the area proposed for the soil absorption system? GS. If not,what is the depth of naturally occurring per ious material? Certification I cent n icl C S' , (date)I have passed the soil evaluator examination approved byi tfie Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tra' ing,expertise and experience described in 10 CMt 15.0,17. Signature Date _ ( � y Q:\$EPTICAPERCPORM.DOC AsBuilt Page I of 1 TOWN OF BARNSTBLE LOCATION ( U)" `;:SEWAGE# `a101 `O)`T VILLAGE( J ASSESSOR'S MAP&PARCEL �L3 T INSTALLER'S NAME&PHONE NO. ;L�C S1 PTIC TANK CAPACITY e1,15hN� LEACHING FACILITY(type) e A( raA riP (size) NO.OF BEDROOMS OWNER Gft r.A o r PERMIT DATE: COMPLIANCEDATE: 11-161+1— Separation Distance Between the: '17t' t"h-01i N i�?(ed Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility WT W(C 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 Of any wetlands exist within 300 feet of leaching facility) Feet i FURNISHED BY qT( A t�yb,,j^ r rA alT 4�1 o�--- http://issgl2/intranet/propdata/prebuilt.aspx?mappar=230195&seq=2 9/14/2015 } S COMMONWEALTH OF M-ASSACHUSETTS EXECUTIVE.OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION yt' V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 60 } ? Owner's Name: RECEIVE® Owner's Address: 'J , �" ooa Date of Inspection: .� FEB 2 8 2001 _ 6 a Name of Inspector: please print '- ti%� rw TOWN OF BARNSTABLE Company Name " . ,L HEALTH DEPT. y Mailing Address: Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant7toSetion 15.340 of Title 5(310 CMR 15.000). The system:. ses Conditionally Passes . eed Further Evaluation by the Local.Approving Authority ail � Inspector's Signature: L ._ . . Date: ��U 3. The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 P gpd or greater,the inspector and the system owner shall submit the report to the.appropriate regional office of the DEP.The original should be sent to the system owner_and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Y„ Page 2 of.]1 v OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: AA 11,Ahte Owner: ��7� Date of In ection:' Inspection Summary: Check A,B,C,D or E/ALWAYS'c.omP lete all of Section D A1.1 System Passes: have not found any information which indicates that any of the failure criteria described in,310 CMR 15.303-or''in31'0 CMR 15.304 exist.Any failure'criteria not evaluated are'indicated`6e'low Comments:. ; B., System Conditionally Passes: One or more system components as described in the"Conditional Pass".section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health;.will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or hig} stafic water level in the"distribution box due to broken or obstructed pipe'(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of.Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The.system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 101-1-4 Owner Date of In ection: 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. I. System will pass Lin less Boa,rd„of Health deter.pnines in accordance with 310 CMR 15.30'3(l j(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The.system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the.SAS is less than 100 feet but 50 feet or more from a. private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from.pollution from that.facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided.that no other failure criteria are triggered:A copy of the analysis must be attached to this form.. 3. Other: 3 .Page 4 of 11 OFFICIAL INSPECTION FORM NOT.FOR VOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: G . a, Owner: Date of 4ection-:: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections:. Yes N� L: 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 ty 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 ''/z day now _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number / of times pumped v 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 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 theanalysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health.to determine what will be necessary to correct the failure. E: Large Systems To be considered a large system the system must serve a facility with a design flow 0 of 10 000 d to 15,000 g Y Y Y g � gP gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) .yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in.a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone.1I 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 systeme owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of I spection _ yz Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No -P,0�_ Pumping information was provided by the owner,occupant,or Board of'Health v'Were any of the system components pumped out in the previous two weeks? I_ 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? _bZ Were all system components,excluding.the SAS, located on site? h'' _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,.dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the.facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the toil Absorption System(SAS)on the site hag_been determined based on: Yes no 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(3)(b)J 5 Page 6 of I I OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner Date of In pection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design). Number of bedrooms(actual): DESIGN`flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewagesystem (yes or no): f yes separate inspection required] Laundry system inspected(yes or no : QZU" Seasonal use: (yes or no) T- Water meter readings,if available(last 2 years.usage.(gpd)): Sump pump(yes or no) — Last date of occupancy:: 01- COMMERCIALIINDUSTRIAL./900Y Type of establishment Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.):. Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):_ Non-sanitary waste.discharged to the Title 5 system (yes or no): Water meter readings, if available:. Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records t� Source of information: j`� Was system pumped as part of the ins ection(yes no) If yes,volume pumped: gallons--How was quantity pumped determined? _ Reason;for pumping: TYPE OF SYSTEM 1,7eptic 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): Ap ro imate age of all components,d to ins. lied(if known)and soprce of information: Were sewage:odors°detected when arriving at the site(yes or n� 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) P `) Property Address: alih V GuGG Owner: Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron 40 PVC other(explain): Distance from private water supply well or suction hne: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:Zoocate-on'site plan) 1� Depth below grade: Material of construction:je!'�concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) _ Dimensions: Sludge depth: �� ! b P Distance from top of sludge to bottom of outlet tee or baffler Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined:40A a41 h (" � ,l. l.�'(i Comments(on pumping recommendations let and outlet tee or baffle condition,structural integrity, liquid levels As related to outlet invert, vidence of leakage,etc.): � J rl GREASE TRAi �vate on site plan) Depth below grade:_ Material of construction:_concrete metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of i I . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM•INFORMATION(continued) Property Address: Owner: Date of Ins `ection: . TIGHT or HOLDING TANK/(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: e Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm.present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION.BOX: I (if present must be opened)(locate on site`plan) Depth of liquid level above outlet invert:&2,Z/a,04 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of �aka-e into or out ofbox, etc.): " _.t 01,7 azo ii PUMP CHAMBER o"cate on site plan) Pumps.in working order(yes or no): Alarms in working,order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.)! 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM: PART C SYSTEM INFORMATION(continued) Property Address:bQ 1, )J AI A/t2 Owner: Date of Inspection irl SOIL ABSORPTION SYSTEM (SAS): e'(Iocate on site plan,excavation not required). If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number;length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation; c.): �. , . CESSPOOLS/Yzncesspool 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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,cond fition o vegetation,etc.): PRIVY4cate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 1Uof l I OFFICIAL INSPECTION FORM—..NOTYOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: r Owner: Date of In 'ection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. a'' ' 10 Page 1.1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of In pection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high groundwater elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: _'becked with local.excavators, installers-(attach documentation) y" Accessed USGS database-explain: You must describe how you established the high ground water elevation , O1 11 No.qs- 71 F��Sa:.0.0........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .....................OF....... ............................................ � ' Appliration for Disposal Works Tonstrurthin Urrutit Application is hereby made for a Permit to Construct (/Or Repair ( ) an Individual Sewage Disposal System at: .k ' �Z 3 r ... iLH 1 W±�1X...1 � -------------------------------------•---------------.........................-•-•------- Location-Address or Lot No. .........-� . .......�..�................................. ------------•.................•-------•-••---...------ Owner --------------------------------Address Installer Address UType of Building Size Lot_�v5.04..........Sq. feet Dwelling— No. of Bedrooms.._...�r..................................Expansion Attic (ap) Garbage Grinder (NP) aOther—Type of Building ............................ No. of persons_......................... Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------•.-.--___-___ W Design Flow......SS.............................gallons per person per day. Total daily flow---------530.......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._-_-_-_-.-_--_-- Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (/) Dosing tank ( ) `" Percolation Test Results Performed by------------------------------ -------------------------------------- to ground water--- �VM....... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ••-••----•--••••------------••-•---•-----•--•-•-•--••••-----------------•-------••--•.........•••---......................................................... 0 Description of Soil......offZ�--;•L ..f..S � PZ ---•-----•-•---•-------------------------------------•------------------------•------------•-•---------- V .........................................................l'� ��' oix�-:, At 'Ql�ll? �1k'E'.�k��'------................................................ ---------------------- ` •... ...ct, ---------------••--•--------------------------------------------------------------•--•----•--------------------------------••-. 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 TITIZj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by t and of health. Signed �lrl..l85 ................. Application Approved By..... ----- --- --- ` ................ .......... ......... ------ ApplicationIt Disapproved for following reasons----------------•----...----------•-------------------------------------------------------------------........... ..................•--••-•-•--............-•--._.....-----•---...----•----•----•----•--------•-----•-----•--•------------•-•------•-----------•-•------•••-••--•---•------•-----••---•-•---•-••----.-•-•- Date . �s Permit No............... --------------...--------- Issued....................................................... No...... ......... Fes ..� ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4d✓Ar....................OF...... e�# a��, '" ?« �............................................. Appliration for Disposal Works Tonstrnrtinn thrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at w 1 "" i Locationddress or Lot No. f .°�s�5s.e44: _.O .-. .......n__. ..................^---......... Owner Address a . ..........4&mvs.....,�,�..k_ 1519�s'&4......................................... --------..............-----•-•----••-•--.......................................................... Installer Address UType of Building Size Lot. =.. ' ..........Sq. feet Dwelling—No. of Bedrooms___---' ..................................Expansion Attic (o) Garbage Grinder Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria a' Other fixtures .............................................................. Design Flow....... ..............................gallons'per person per day. Total daily flow......... _. Q.._....................gallons. WSeptic Tank—Liquid*capacity............gallons Length-----------_-- Width-_____--___._--- Diameter................ Depth................ x Disposal Trench—No................:.... Width.....--------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------_------------- Diameter------__.:------------ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (A Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date............. ,1_4j Test Pit No. 1.>;- ......minutes per inch Depth of Test Pit-----/- ....... Depth to ground water.. Test Pit No. 2..............._minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---•-•--•--•-----------------------------------------------------------------•-•-••-.....-•-.---•••........................................................ D Description of Soil-----. ................ ---••-------------- U W ---- ----------------- ------------�:..".?A........ 0..4,V.n>............................................----------•-•---------------------------------------•--•----------•-•---•--....... 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasjxw issued by t board of health. Signed ---------------------•••---•. l t t. . Application Approved By..... --- --- -•- - ---• --------------------------- . Bate Application Disapproved for h following reasons: --....-•-•-•-----------------------•---------------------•-------•-----•--------------.....----•--•-------•••.................--•-••--•••-••••-••-•---•--•------••----•-------•-----••--••-•-•--•••••-•. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH Gisa. `_"r A�,.. ...... .ter.....................O F... .......... .. .. 4�e.�. ......................._.............. Tntifi.ratr of f omplianrr ,r THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by............. ...:.bw.............................................................. -.......................................... Install atA _._. 41 :Q...-._..._ +M t ? ,.---•------................................................................ ._ 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 ' I ...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NO�1: CONS R9,@�® AS UARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. . `. �� ......................................... Inspector DATE........................... THE COMMONWEALTH OF MASSACH ETTS BOARD OF HEALTH ...................OF...z ov« "q" 4. ....................................... No.�........... FEE Disposal Works Tonotrnrtion= "permit Permission is ereby granted......."`°-: _........... to Construct ( ) or�Repair ( ) an Individual Sewage, Disposal System at No. .2c :" .................................................................... Street as shown on the application for Disposal Works Construction Permit No...............____. Dated• -- 1__--!_QS-•-----•--------- -..................................... . b. • ............- Boar of Health DATE..-- -----------------------•----------•---- FORM 1255 A. S LKIN, INC., BOSTON L,JCATION WAGE ,? MIT NO. PILLAGE eei,9 kt/w Me INSTALLER'S NAME & ADDRESS �j 'g U I L D E R 0R OWNER a 61-e-ep 1-1 er DATE PERMIT ISSUED DATE COMPLIANCE ISSUED `Y Goy a 3 /2t4c to e 'f3 AsBuilt Page 1 of 1 W ATION WACEI �P RMIT NU. a-, ILL AC INSTA LLER'S NAME A ADDRESS �J f1.SC_o`f /jrlri� SD rl �j 8UILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED jC � sou t��r u � �m'1 "sc 3�` I http://issgl2/intranet/propdata/prebuilt.aspx?mappar=230195&seq=1 9/14/2015 1v 5- 76 °.S3 ' z` E 1 S 7G � Gl0 r Z-!� 61 2-41 I I ;a r 'A'c-N el A �iR SErh(-A"T /3/b �3 r� t7 ti *., iT! R9gS 30 /V0/fce .�.;��, .��._--_ ��G�� l' a 1 . f i 1_-0 r plQoT�cT�vN PCrZ /-b2T Ll kGy , " t J SECT -LL G. To �✓ �'Yl.,�i :.i s v <.. , ALBERT \" LEGEND (.'' n EXISTING SPOT ELEVATION 0,t0 -�r�o. �a.�3 ; ,/,- � T A EXISTING CONTOUR --- 0 --- ` c�vi : CERTIFIED PLO PL N F'11KISHED SPOT ELEVATION (� , `�\,;` Y = ,;<4i � FINISHED CONTOUR 0 a� ' ' ` L /N a 7 23 NOTE: The location of any- existing undergi-ound sewerage, 1 N ;wells, or other utilities shown on t;is plan is approx- imate only as determined from records and/or verbal ♦ • information. The contractor is responsible for the SA , �'.1�.3 .r, �.��t1 � I, verification of the existing locations in the field. SCALE, 1 � � DATE LOREDGE ENGINEERING CO. IN 5 CLIENT. 1 CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB NO.92 29 / BUILDING SHOWN ON THIS PLAN CIVIL LAND ., CONFORMS TO THE ZONING LAWS t ENO NF�ER Rv DR. v.```':_..r OF BARNSTAB E , MASS. ... 712 MAIN STREET CH. By •�-� *� .•� w HYANN I S, MASS. SHEET_L. OF "= A E REG. LAND SURVEYOR z 7W4eAr 7'A1 r7 C TANK.P� C-R alC�A DE ..PO-,O1AAlF7-,Se CO A7 7-.,C- CO wArAl ./0 Pr. *W 710 ISJrA DAF. '4 N,,, -RA.OF B M004SH 7 &� --X7 P.,Pz" r/'e.4 V Y CA S 7-IRON CO V4L-.JR' -T/yl,4 I-L- SE USED 0 : -1jO'-lN jC>.lq1V,6WAY 2 A; i A co $114=14r CLEAN SAWO OA C-Ae)=1 4 L 'q SCHED UL . . .77 2 I-AYER .4 40 WIN.,Pj CY WA SHED 57 D157.' !IO'PAFM r7. SEPTIC 7A' A OV< GNE BOX IF WASHED STONE # 41 10 4 0 # : : pjeEcA5r sz.e,��' 6 f 73 ► a.I's 0 0• : 0 0 0 0 a 6 P17 ,OR ZV411V lWVCXr P/7' CAI",--1-7-Y 5-4,9 1:57"f 4- 7 INXERT AT 01111-DIMCy 4,9,0 FT. 04 /0 FT PIAM. C(SEE W-W11-A-r)OAl) INLET .SEPTIC TANK7..5 .1cr _47.3 4C7' ou7,L&-r SEPTIC TANK /)VL*-r,p,,.57,T/j5j,7/.OAf 80,y 4-7-1 &T GROUND HATER7,-IWZ-,C SECT/ON 1OAl O)C 007ZAE70157-RZO&MION" 16,9 FT, INLET I-CA CH ING 7- 46.7 Fr .5,6WACH AOISROSAJ. SPP-S7`&/K I.ASACH11V6 Cl/7' JCAL-4C DiMFN510*V A 7. D,FS1S,V CM17*E-ICIA 's 6 4FT- FT SOIL LOGGA'q&A'G-= AMISROSAL awn �lv *5NO11- 7,E57 AlUMAER Of Z,.-.ACV1,Vr. P/73� I-l-Z DATE OF SOIL TEST $0, RESUA.7-5 PVIrA'ZSSZd> JYPM 40 _19 0 7'rO/W 4Z4 CHIN& jP--R P1r $o. AM I-,-,Ot COLA riOPV II Af' 707AI -6 f- SQ ,Frr. -5-0 135 0 L 4Z4CH1^lCr AREA --?- . AWA-CO I-A-r/0 N *A7F 'y mesEmVE LEACNINCFAREA SP. 7. ¢ 21 v p?, -i OF Pw Z-07- -2-3r /�Nl"!- 'rV/!/ ar ALBERT ROBIERT MFPI :57t,Iv I, N?jc'.RSE ELDREDGE A;L:) tqo. 193F7 rVCmE.XWWA.(AWRI*U C4?VJ I"C- V, lei-PjR4 -7 tZ AlA ^4A,57S. FL 3(S.7 IN -S'r, "YANA115 1&C'4> _-.4 -FA17'-*a,.Z - / .1>-1 .5 kV.Ar&ff &7VC041Al7--`-11� 4f-AE�Y.3 Osf!�.. .1040 AfO- 9 3 O 9 -99--EXISTING CONTOUR P' egva uet ' x 100.98 EXISTING SPOT GRADE m Laake 97 PROPOSED CONTOUR e� W EXISTING WATER SERVICE ec G EXISTING GAS SERVICE =o Qo a pP 4P Dr -jGUI UNDERGROUND WIRES Ci A TEST PIT o�g�d to 28 Great Marsh Rd �' ; Rau BENCHMARK PG 91 gas LEGEND PB 31 Route 28 er'cc LOCUS West Mofn St LOCUS MAP NOT TO SCALE Y N 13°48'50" E 124.98' LOT 23 MBL 230-195 _ 04 20,584 ±SF oZo to \� 103.56 M zo 12.8'�I 103.25 r z 20' -_ . . . �� + edge °f c!e°rin9 + 103.52 to C I }'0 5 103.03 choinlink fence 102.53 Ln 1" :m,{ 103.29 x o. 03,39 102.14 x TP 11: 0 .�+ 102.61 TP 21'.:.• N 101,90 EXISTING LEACH PIT _ 103.17 TO BE PUMPED, FILLED j \ INGROUND W/SAND & ABANDONED SWIMMING x 100.88 EXISTING SEPTIC TANK 100:60 it I POOL TOP OF TANK, EL.=101.68 x U'_' -7' IN V.(OUT)=100.35f BENCHMARK SET 101:6 / 102.58 OUTSIDE COR./BULKHEAD BM EL.=103.96 x 100.25 _ DECK 103:96 �C(ONC. PATIO;'`.' 25' 1 3.35 w 101.58 + o :3 103.24 103,17 N 04 x x 103.3 0 Lp :0 (o(o I ® EXISTING x HOUSE(#62) 102:63 z .� / GARAGE / T.0.F.=104.86f 1-0 1 103.53 103,82 c / 1 00 ::�i 102.06 o / C 103.22 x Lij C0 Qi 3 '- DRLI%EWAj'.*' Q DRIVEWAY'. .' + 10 .36 \ :o _ i x 101.51 0 101.87 101.80 125.00' ELEYBDX 101: 7 S 13'48'50" W x 100.27 ,. 99,97 edge of pavement 99.46 100.51 100,29 99.29 catchbasin 99.19 WHIDAH WAY Mgss9��G o PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN i MCENTEE CIVIL K 62 WHIDAH -WAY, CENTERVI LLE, MA o. 35109 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 F EUSZER `�� Engineering by: SCALE DRAWN JOB. NO. S EN OWNR OF RECORD CRUMP, RICHARD M & JOAN M Engineering Works, Inc. 1"=20' P.T.M. 263-13 3lD 62 WHIDAH WAY 12 'West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. 61 CENTERVILLE, MA 02632 (508) 477-5313 1/30/14 P.T.M. 1 Of 2 r NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:99.7 FOR A DISTANCE OF 15' AROUND THE SEPTIC TANK PROPOSED D-BOX PERIMETER OF THE S.A.S. INSTALL RISERS & COVERS OVER INLET & OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER PROPOSED S.A.S. SET TO 6" OF GRADE INSTALL RISER & COVER OVER EACH CHAMBER AND T.O.F.=104.86t SET TO 3' OF F.G. TO SERVE AS INSPECTION PORTS F.G. EL.=102.4t F.G. EL.=102.9t F.G. EL.=102.0t F.G. EL.=103.0(max.) 3'(max.) L = 40' M ® S=1% MIN. 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" 6" DOUBLE WASHED STONE 11 10"1 " B BB $ BB (OR APPROVED FILTER FABRIC) 14" BBB Bag BBBBBBB EXISTING 48" LIQUID BBBBBBB --3/4" TO 1-1/2" DOUBLE LEVELWASHED STONE ADD PROPOSED #4'/ 4.8' 4'GAS BAFFLE INV.=99.47 INV.=99.30 INV.=100.3zm BOX IVE WIDTH = 12.8' EXISTING 3 OUTLETS INV.=99.20 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=100.0t NOTES: BREAKOUT ELEV.=99.70 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=99.20 jaa = INVERTS, PRIOR TO INSTALLATION. aaaaBaa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=97.20 GRADE ON A MECHANICALLY COMPACTED SIX 4' 1 2 X 8.5'=17.0' 4' INCH CRUSHED STONE BASE, AS SPECIFIED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' IN 310 CMR 15.221(2). PERVIOUS MATERIAL 3 INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. ) LEACHING SYSTEM SECTION 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM OF TP, EL.=91.2 AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. (NO GROUNDWATER) SEPTIC SYSTEM PROFILE It=12_81 SOIL LOG 4$ 736 DATE: JANUARY 24, 2014 (REF#14,268) SOIL EVALUATOR: PETER McENTEE PE(SE#1542) o chainlink fence WITNESS: DONNA MIORANDI R.S. HEALTH AGENT O Q ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH ClillIn 50�'�$fp 102.5 A 0 102.2 A 0 11 U LOAMY SAND LOAMY SAND 101.7 B 10YR 4/2 10" 101.4 B 10YR 4/2 10" LOAMY SAND LOAMY SAND 10YR 5/6 10YR 5/6 -99.3 38." 99.4 36" - O C C CP O? v MED. SAND MED. SAND 2.5Y 6/6 2.5Y 6/6 O 91.5 132" 91.2 132" PERC RATE <2 MIN/IN. (ON FILE P-4517, 5/16/85) "C" HORIZON SAND IS CONSISTENT WITH PERC NO GROUNDWATER ENCOUNTERED DECK GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. O 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR GARAGE TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF S.A.S. LAYOUT THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. DESIGN CRITERIA 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS NUMBER OF BEDROOMS: 3 BEDROOMS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY DESIGN PERCOLATION RATE: <2 MIN/IN THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. DAILY FLOW: 330 GPD 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS DESIGN FLOW: 330 GPD IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND GARBAGE GRINDER: NO-not allowed with design REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. .74 GPD/SF 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND EXISTING SEPTIC TANK: 1000 GALLON CAPACITY NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 62 WHIDAH WAY, CENTERVILLE, MA SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:............................................ ................. 471.2 S.F. Engineering Works, Inc. N.T.S.. P.T.M. 263-13 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD (508) 477-5313 1/30/14 P.T.M. 2 Of 2