HomeMy WebLinkAbout0091 WHIDAH WAY - Health 91 Whidah Way
Centerville
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
u Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C
a
wM '` 91 WHIDAH WAY '
Property Address NZ
PENNY '
Owner Owner's Name "a
information is 3>
required for CENTERVILLE MA 02632 9-20-17
every page. City/Town State Zip Code Date of Inspection «/st
lbw
Cn
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: A. General Information /
When filling out
forms on the l�
onlycomp the tab key r, use 1. Inspector:
to move your DOUGLAS A BROWN
cursor-do not Name of Inspector
use the return
key. D.A.BROWN INC
Company Name
4 P.O. BOX 145
Company Address
CENTERVILLE MA 02632
Cityrrown State Zip Code
508-420-4534 S14297
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper�function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
9-20-17
nspeXrsg ature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report-to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This repgq only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
/0 td vs
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
GSM , 91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
AT TIME OF INSPECTION SYSTEM MET ALL PASSING REQUIREMENTS. THIS REPORT DOES
NOT PREDICT THE FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USAGE.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M0 91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5. Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
9 p Y rY
91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9720-17
every page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000g pd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°,M 5 91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ E Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
2 ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
❑ ® Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the.Soil Absorption System(SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Citylrown State Zip Code Date of Inspection
D. System Information
Description:
SYSTEM CONSISTS OF A SEPTIC TANK D-BOX AND BIODIFFUSERS IN A 11.3X25 FT AREA.
THE ORIGINAL PIT IS ALSO IN PLACE.
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes Z No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
2015----306 2016---408GPD (PROPERTY HAS IRRIGATION SYSTEM) SYSTEM IS NOT
DESIGNED FOR USE WITH A GARBAGE DISPOSAL.
Sump pump? ❑ Yes ❑ No
Last date of occupancy: 2016
DECEMBER
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: DECEMBER 2016Date
Other(describe below):
General Information
Pumping Records:
p 9
Source of information: OWNER PUMPED EVERY 3 YRS
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
S.A.S INSTALLED IN 2009 PER AS-BUILT
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: , feet
Material of construction:
❑ cast iron ❑40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 2.25
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500
Sludge depth: LIGHT
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM , 91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17 .
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness TRACE AMOUNTS
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? WOODEN POLE
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
TANK LOOKED FINE AT TIME OF INSPECTION. I RECOMEND PUMPING AT TIME OF
TRANSFER AND EVERY 2-3 YRS THERE AFTER DEPENDING ON USAGE
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
=BOX WAS FUNCTIONING PROPERLY AT TIME OF INSPECTION.
I�
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: biodiffusers
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Observation port was opened and was dry at time of inspection.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9 20-17
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
I
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: greater than 5
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 9-2017
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
design plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 91 WHIDAH WAY
Property Address
PENNY
Owner Owner's Name
information is required for CENTERVILLE MA 02632 9-20-17
every page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Assessing As-Built Cards Page 1 of 2
11 rr
TOWN OF BARNSTABLE
LOCATION_7111N Jj,LO,w SEWAGE 9Mq-02.
VILLAGE �P���U4��P ASSESSOR'S MAP&PARCEL
11-1.1 INSTALLER'S NAME&PHONE NO. C
SEPTIC TANK CAPACITY 1 S-M X/Sf/n/G
LEACHING FACILITY:(type) Iio�7, lr�'fS (size) (1.'3 i1L —
NO.OF BEDROOMS 3
OWNER __--,,
PERMIT DATE: 1� _ COMPLIANCE DATE: n
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 ofjoaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
db5 por+`ueNt
3-x11
`RDat �
A 2'x?
3-��'3`'
IAa�ve 9
C.
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1�.erc.wr�♦ tN.Qkce
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http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=230201&seq=1 9/21/2017
No.C�D61 _z�A I ' t Fee l CCU
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s/
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
12i"Plication for �Diopooar �&p!tem Cootruction Permit
Application for a Permit to Construct( ) Repair(4pgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. g l 6Jhid4 A (,xi CeA*e✓V1 j1e1 Owner's Name,Address,and Tel.No. 'Ptwrjy
Assessor'sMap/Parcel 2-30 �(g
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
'00o,,ias R �so�sN F,vgr•,e i,..g w�� 9
5_0 " 00- 1 WO-11, -57313
Type of Building:
Dwelling No.of Bedrooms Lot Size oZ 0 jG0 sq.ft. Garbage Grinder ( )
Other Type of Building Vwq-oe No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 3 t E S gpd
Plan Date _ 2-11010 a Number of sheets 2 Revision Date
Title
Size of Septic Tank j0a') Erp� 4$,, Type of S.A.S. `�jj�at � Le,
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) (
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Bo rd of Health.
Signed (/" Date
Application Approved by Date
Application Disapproved by: Date
for the following reasons y�
Permit No. b ` l/Q�f Date Issued v
yS�No.�D 61 —0,� t't> ,4 ' Fee 1 DO
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t/
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
` Application for Oigpogal i§pgtem Conotructfon Permit
Application for a Permit to Construct( ) Repair(416pgrade( ) Abandon( ) ❑.Complete System ❑Individual Components
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Location Address or Lot No. 9 f WA;dr h we,, �p elJ,.r✓illy Owner's Name,Address;and Tel.No.
Assessor's Map/Parcel I
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Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�UJSIG', A TSIUwNNSi^+t°t/1^'S
/525 SCV-977-5-313
Type of'Building:
Dwelling' No.of Bedrooms ] Lot Size .20 :kG® sq. ft. Garbage Grinder ( )
Other V Type of Building g V10JSe No.of Persons Showers( ) Cafeteria( )
Other Fixtures
'r
Design Flow(min.required) �) d Design flow provided t
gpd g P 3 �7. 0 gpd
Plan Date /. 010 lob Number of sheets:;,';L ) Revision Date
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Title *'
Size of Septic Tank fM%Tj�;)A1 TypeofS.A.S. 7')(n ,�� ��
Description of Soil
4 cM1'
Nature of Repairs or Alterations(Answer when applicable)
i
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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. l
Signed Date
i
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. J Date Issued
--------- ————————————
——— — ----------
THE COMMONWEALTH OF MASSACHUSETTS
-, BARNNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired r U raded
r,, ) P ( ) Pg ( )
Abandoned( )by �lC/�i yf�r,✓r✓
at >�( ��� G /�/►J� has been constructed in accordance
with the provisions of Title and the for Disposal System Construction Permit No. 0/ dated
..Oq
Installer 4 .4 N Designer f1 11.11rielee
#bedrooms Q Approved design flow 1),y 4 / gpd
The issuance of this permit shall nbt be construed as a guarantee that the system w"il f ction as design d)
�. P ..
Date �� Inspector
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
I PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
lwigpool *pgtem Con5tructfon Permit
Permission is hereby granted to Construct ( ) Repair ( 0 Upgrade ( ) Abandon ( )
System located at 4 f A/A m4 A A-
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date - r] Approved b
P,
®2;'10/2009 08: 36 5084775313 ENGINEERING WORKS PAGE
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Town of Bgrjastabje
Cory Services
T"homap F. Gefler, JD1r d,)r
hubfic Health
2001d��v�s Str"t,Hb'gmml#9,lbw.0201
5' Fax: 508-790.-(5304
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E i` - 1 ' l to l r®loar�tion f e SAS or auy v�ical relocation and,.
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HW'tW4d4�*Per.COf6fc8tion Foln 3-26-04.doc
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Town of Barnstable rOF
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Department of Regulatory Services
a : Public Health Division Date
200 Main Street,Hyannis MA 02601
�Fo M1x r
Time �� _ Ye e Pd-
+.Date Scheduled ;
i
oil'Suitability Assessment or Sewa a Dig oral
.f g P
.� Performed Bye. L � Witnessed By: 'v t` " �' -�
,
LOCATION& GENERAL INFORMATION
Location Address G� (N Owner's Name
�. w 1n.of /��.� `
�' •�."1 J C`•evt�-�!'.���� Address �.� wLl�Ck6.v\ vyc�
i Assessor's s Map/Pqicel: i , Engineer's Name � (" `C �
NEW CONSTRU0ON REPAIR i Telephone#
Land Use ��`� S`c' k V\, �o` Slopes(i) Surface Stones /V
Distances from: Open Water Body 3Cfz:l ft Possible Wet Area AoZ�ft Drinking Water Well l .ft
,.._Drainage Way� toe) ft Property Line � r "ft Older fr
SKETC$.($treet name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes).
i
Parent material(geologic)
�t.l�/ -� i Depth to Bedrock
Depth to Groundwaler: Standing Water in Hole: ��A_ ! Weeping from Pit Face
AU A
U '
Estimated Seasonal T jigh Groundwater j
D�TERMINtTION FOR SEASONAL HIGH WATER.TABLE,
Method Used:
Depth dbserved standing in obs.hole: in. Depth to sgil mtittlest. Jtt.
Depth tolwepping from side of obs.hole: in. Groundwater Adjustment fr
r Index Well# Reading Date Index Well level .a.. Adj.
factor A .Qroundwnter i evel,,s
i �
PERCOLATION TEST Date . 3C .
Observation 1 Tune at 9"
Hole#
Depth of Perc ` z ^(�1 rime at 6"
Start Pre-soak'ISme.Ce�; 1 Q. _ lime(9"-6„) R"
End Pre-soak o A i Zy y
i/J ,
Rate MmAneh �i1 t 0VL,
Site Suitability Asse$sment: Site Passed Site Failed: Additional Testing Needed(YM)
Original- Public He*Ith Division Observation Hole Data To Be Completed on Back---------
***If percolalign test is to be conducted within 100' of wetland,you must first notify the
Barnstable C4#servation Division at least one (1) week prior to beginning.
DEEP OBSERVATION HOLE LOG Hole# 1_
Depth from Soil Horizon Soil Texture Soil Color Soil ! Other
Surface(in.) (USDA) (Munsell) Mottling (Strucore,Stones,Boulders.
Consistency, vet
DEEFOBSERVATION HOLE LOG. Hole# "L
'Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) I (Munsell) Mottling (Structure;Stones,Boulders: .
y. ConsistencL%Gravel)
6 ram,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon - Soil:Texture Soil Color Soil Other
Surface(in:) (USDA) (Munselij' Mottling `(StnrctUre;Stones;Boulders.
onsl tenC -`ora
'DEEP OBSERVATION HOLE LOG Hole#
Depth.fmm Soil Horizon Soil Texture Soil Color Soil other
Surface(in.) (USDA) (Munsell) Mottling (Structule.Stones,::Boulders.
onsi t n . 1
Flood Insurance Rate Man:
Above 500 year flood Boundary NO— Yes r
WitAin soo year;boundary ; .No. Yes
Within 106 year flood boundary No/� Yes
. . : .,.;.
De th of Natultall .Occurrin Pervious Material
s�,1'``r
ervious.material.exist�in all areas observed.throughout the.
Does at least fo feet of naturally-occurring p „r
area proposed-for the soil absorptionsystem?
If not,what is the depth of naturally occurring pervious material?
Certification x
I certify that , 1% - (date)I have passed the soil evaluator examination approved by the
Deptirhnent of nvironmental`Protection and that the above analysis was performed`by Me consistent with
the.ret)uired ,expertise and experience described in 310 b 15:017.
ra
f�:/ Date �.
• . Signature :.
Q:1SEl'17C1PERCFbRM.DOC
r�T�OWN OF BARNSTABLE
LOCATION Il WWII ( y SEWAGE#
VILLAGE ��sJ,i—er�w1���ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. '—&cXAj.-J tiDL
SEPTIC TANK CAPACITY i_X 1,;"IV
LEACHING FACILITY:(type) (size) t(, 3 X 2Z S—
NO.OF BEDROOMS
OWNER N
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on a ;
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
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C�5 �o l ve
4P�g�G
��iSNNs�1�'
��nc�,a w e tw ptcc e
wiFh Jew\�y�
LOCATION/ SEWAGE PERMIT NO.
VILLAGE
cull. C-UAC
11NSTA LLER'S NAME i ADDRESS
Jj- �)C-/5co y �"5oA
R U I L D E R OR, OWNER
0-L'i,e it,kh ce
Q. zCl*,� Cc/1//C
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
L' i+�n
® �
NI o�yt
��
��°
U`
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ago ,�S M:y
No.-- :�'..:-•••-`3 Fps. ......._.........
THE COMMONWEALTH OF MASSACHUSETTS
y_. BOAR® F HE/.
......L.¢/ ......OF... ./..(<C. ..................
Applira#ion for Uhip at Workii Tamitrurtinn Prrmit
Application is hereby made for a Permit to Co struct or Repair ( ) an In ividual Sewage Disposal
Sy at
....... . ...._..JI-71,dzeq, ...... ...............................
Locion-Ad ess r ' Lot N e
...... . .-J c7r � --...-•-.-•-••-•..--- � s........_ ��. .................
ner p r Address
..-14e.��1 .5.. 1.�- •{.................... .........S ..............................................................
Installer Address
Type of Building Size Lot. a .C7.Sq. feet
U Dwelling—No. of Bedrooms...... .................................Expansion Attic (146) Garbage Grinder (11C)
Other—Type of Building No, of persons............................ Showers — Cafeteria
P4 Othe�_4xtures -------------- ------------- • .
W Design Flow......S...S......................gallons per person per day. Total daily flow--.--.. ...................gallons.
P: Septic Tank—Liquid capacity �Ogallons 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.............
....s ft'
Z Other Distribution box ( ) Dosing ) e
''" Percolation Test Results Performed by... 4 _�.._ .. 1 �� ate... ... _.. c.........._S
P
. Test Pit No. 1 G' J`.....minutes per inch Depth of Tit Pit....>.. ... Depth ground water........................
GL, Test Pit No. (.�tlt.I.-minutes per inch Depth of Test Pit.......�.._._. Depth to ground water`1��c..
a ......-- ••- ....... ........ ---------------
------•------------------
•--------
---••.....
....
•-----•-----
O Description of Soil..--- �� ....... b` ��
x _
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 iITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the bo d of health.
a
igned---• •• -----•-••• 69
.-- ._...! -_.
Application Approved BY ....... a ��
1.`'�- ate
Application Disapproved for the f ollo ' g reasons-------------•--------------------------------------•--••--------------------------....---•---•--••......._.....
...........................•-•--.......-----•-----•-----••-•----•----------•-----------•--......----•----•-------•------•---•••-•---•-•-------------••-----•••--•----•--•---•--...•--------......_._..._
Date
PermitNo....... ...�.� ..................... Issued.......................................................
Daft
j .r.
No...--.................... Fas.............................
THE COMMONWEALTH OF MASSACHUSETTS
--.-,., BOARD I PF- HE L
.. .........OF... ,, ..
Appliratiun for MWO' ial lVarks Tong ru0inn rumit
Application is hereby made for a Permit to Construct ( or Repair ( ` ) an In ividual Sewage Disposal
Sy at
............................
Loction-Add ss !*-- t N
ner
Address
¢ ...........
__
Installer Address
U Type of Building +'�; "
Size Lot.-_.: -6-Sq. feet
Dwelling—No. of Bedrooms___... .............. Attic ( Ctj Garbage Grinder (IC)
Other—T e of Building ....... No. of persons............................ Showers
a YP g --------•------------ --•-••--------- .... ..........................................................
( ) — Cafeteria ( )
dOther fixtures .•----•--------------••--•------- ••------••--•--------•-••----•----• ------• -- -••-•--•---.............
W Design Flow...... ..... .._._gallons per person per day. Total daily flow.........„ ..................gallons.
WSeptic Tank—Liquid capacity9A _gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.._...• ....._....sq. ft.
3 Seepage Pit No..................... Diameter.........__......... Depth below inlet.....,.............. Total leaching area...."-_---------s ft.
Z Other Distribution box ( ) Dosing
Percolation Test Results Performed by.... �1s '_ '_.. '?1`;" ate... _::a'" ?..._ .. .
1.4 Test'Pit No X1Z,415X.minu
--__-minutes per inch Depth of T Pit. t ground water _
.�i ---
4.1 Test Pit No. , . tes per.inch Depth of Test Pit....f. ...... Depth to ground water.;?70.�-t.- _.
a ------ ......_....
D Description of Soil....
_.
x ---------------------------------------•••-------•••••--•.......------
l ................................... e -_ ..�V .................................. ...........................
W ..............................
............................................. ..........................................................................................................................................................
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 has been issued'by the bo d of health
r
Igned.... ;. `
Application Approved BY...................•. . . •-- .....I--•-•---------...... a�--�".....
ate
Application Disapproved for the follow reasons:-----•------=-------------------••----------•-•-----•-------•--------'........................................
. ..... ......................
f Date
PermitNo......... ------------------- Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEATH
...............OF..... 5 l.!F. {
.............................
Trrtif rate of (Item rlittnrr
TH S IS TO TIFY, That t e Individual Sewage Disposal System constructed ( &Ielor Repaired ( )
M �' "
by..... / .:x _--------
••- ............P ------
•---------------------------
•---• ---------
I � Inst 1
-•------------------------------•---
. .. .......
has been installAd in accordance with the provis,iV of TITLE 5 of The State Sanitary;Code as de cribed in the
application for Disposal Works Construction Permit No........... .a.....��,._..'StO.... dated- :)�._. .. ��...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A`GUARA, T E THAT THE
SYSTEM WILL FU CTI N SATISFACTORY.
PATE................ . .............. Inspector.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD PF HEALTH
} OF......" ... /i ... :. .............................. ..
.. .. '. .. .....................
No..................� � FEE... ... ........
Bispou urku onpi7 n prru it
cic
Permission is herebyranted....... Ct
to Constru t or epai ( ) a�} In�pvidual S wage isposal Sys em
at No.... � Gs. : Le......... ' C - �'1'411� ^P --
Street
as shown on the application for Disposal Works Construction Permit No. 1 }`'Q. Dat d..
_
DATE..........._�. ....•..... .... ... oa d of ealth
F,,r.
FORM 1255 A. M. SULKIN, INC., BOSTON
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- �_
s, ' ' 1: r
,' LEGEND /.,._ .
. a
EXISTING . SPOT. ELEVATION Ox0 ,k 4'°� .
k CERTIFIED PLOT PLAN
EXISTING: GONTQUR_-- 0 -;
�f1HISHED_.;SPOT ELEVATION . ( � ¢ `off:, N i p9 r1 w/�
Y
PIN1lNED °,CQNTOUR- �' 0 r,,, - , `1`Y x' /- T °�9 _
/,/, - c V/ 'L ` ` -
.. E E,.
NaTE The .location of:any�•'exis Ling _nder round sewerage, `' IN
wg11. 'or other 'utilities. shown ..on tl: $ plan is approx ` ,, 2Dts� , .Z��86
.�,I,"!-"o 4,'.1,.;.I...��.....,,,�,�.I�-,1w;�__�.,._,!R*�,-,-!,,.I..-z--',l?I:��1,.._.�.-,".1�A���_,:1l�,:�"��—.,",!_",.3..,-,:,,11h I�i�.�,:,f.,�l.i,.,�"�,.,II..--.-_,s�-�--,'.',:,,_I.�,��1,1I,I i T-0_.�-i.""1.-,,,,21i��(j,�-.�I��'�,�,.N,-�,,,e-..,:,"-�"I 1,_k�4-�',�I;,_%�;_,_.11.,,',��!�,1.��,I`..'-,;-:�;,,:..�.:,`,;�,�,,"L,,;__�,;-,:1�''�I,,"I�41
t mate':anly as det_ermined from xezords and bx<<verbal 6 J,�1. �� •�'1a; 3 _, , `a
infarmatjon`.'.The.contractor is xes ansxble`",fox. the ..'', , ,,, , R v, � is /a 8s+
t
we ificat. - of the aexist ng locat'ion'$r �n ache: field;, gCALE� = 4� DATE Z:s;� s
f
— > Ma
s, . .DREDGE EN.G/NEER/NC CGl IN JF - -* # 1 `CERTIFY THAT THE PROPOSED
!> .,� r
�r .EelsTERE, REGISTER D ,T', �QS?NQ.v DU,ILDINQx SHOWN .ON : THIS . PLAN
LAND`-,?; -' A;'j `'� , E NINO LAWS
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9 .
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_ . 'a; �
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4 C /1(OTE /F Er TNL•� TNE.SFPT'iC TANK OR
r_ 2 .JOR& rNA/CtvG t .A /20 FT. t "�ELDIV
: 1R/4OE��► 24'1?/'�METFR GoN�R.+ETE COYE.�r
/rf/N s/,r,•ILL:OF BRDUGHT TO GRAOE._�i4/v,EXTRA
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'pe►n 1r SEPTIC TANfC
%4
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We
a ► fEl=FEC7 • • • !. WASNED STG.h,E
} •'f 5./ x Z,S = 3?7 • • • • • • -_ . • ao.. wPREC,gST SE&.PA6z
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JNYERT lT,dL// —1� T. I2- FT. O/�Q/rl -
TANK 48.S AT -
413,3 r
J'�T.�R TI�DLE r
/NLE7'.D/STR/D�/T/ON'60X 48. FT. SECT/OJV CF } -r ' a t 1
4?s SEWAGE O/SP05A.L'SY.STEM Tip L�ITION
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LEACH/NG PlT vrME/vsioN 'A 4 FT
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N
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l RESERVE LEAC/+tLN6 ARE/ SG. F T. S U I L, TEST, - 4S Z3
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Wequaquet -—99 ——EXISTING CONTOUR
Lake ® x 100.98 EXISTING SPOT GRADE
c�yP 97 PROPOSED CONTOUR
w EXISTING WATER SERVICE
i Qo BP�4e Dr G EXISTING GAS SERVICE 5 PG 91
'P o i —+JGW-- UNDERGROUND WIRES BK
'_ 39
�' TEST PIT PL•
00 �� � Zg
Great Marsh Rd _ R°ate BENCHMARK
RO1 Qr`c° Locus w LEGEND
est M°i� 3t
LOCUS MAP TRAIL
(Private WaY—NO Access)
NOT TO SCALE ������ �' p" E
N 07'00 p
180.00'
c�-
I ^\ Ul
rn \
LOT 29
20,260f S F. °j 68
Map 230 I 96.43 x
Parcel 201 I 97.23
ITP-1 .73
97.63 x �� \ NT k
\TP-2v-
Oo IN
o DECK whiskey arrel
95.98\
/ \ x 9 53 Op
EXISTING x � 48
8 992 `�� 1b"r°r
99 HDUSE (#91) x 98. 8 °`
i TOF=100.42±1
99.
98.93
x 8.85 98.08 .94
-03
i
/ EXISTING SEPTIC TANK
TOP OF TANK, EL.=95.73.t
�� A
99.2
INV. OUT)„�L. 4 40f
EXISTING LEACH PIT j
8.2 I TO BE PUMPED,' FILLED WITH
N SAND AND ABANDONED98
( ,
rn
96,65
< ° n ,
Benchmark Set i 96.98 I
OUTSIDE CORNER/BOTT. STEP 99.03 1
EL.=100.00 (Assumed) I 1
/ 'O
SOIL LOG \/ R'Sj�s, II ��`� °f MAssq
of
�P Cy
DATE: OCTOBER 30, 2008 (REF#12,404) // edge 9°96 e�ie 1 0� PETER T• G�
SOIL EVALUATOR: PETER Mc ENTEE PE CSE �� �t McENTEE
CD
WITNESS: DONNA MIORANDI R.S. a,^ CIVIL
HEALTH AGENT gg 9a I o. 35109
ELEV. TP— 1 DEPTH ELEv. TP—2 DEPTH I °p �£GISA_
96.8 ASANDY LOAM 0 97 0 SANDY LOAM 0" WhIIDAH WA Y
96.3 10YR 4/2 96.5 10YR 4/2 1 i > 02J
6" 6" 96.04 � /
SANDY LOAM SANDY LOAM OWNER OF RECORD
94.3
tOYR 5/4 30" 94.0 1OYR 5/4 36" RICHARD PENNY
C 42„ C 91 WHIDAH WAY
CENTERVILLE, MA 02632
PERC
54" F-c SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN
F-C SAND 2.5Y 6/4 91 WHIDAH WAY, CENTERVILLE, MA
2.5Y 6/4
Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
86.3 126" 86.5 126"
Engineering by: SCALE DRAWN JOB. NO.
Engineering Works, Inc. 1"=20' P.T.M. 249-08
PERC RATE <2 MIN/IN. ("C" HORIZON) 12 West Crossfield Road, Forestdale, MA 02644 DATE
CHECKED SHEET N0.
NO GROUNDWATER ENCOUNTERED
(508) 477-5313 12/10/08 P.T.M. 1 Of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL:94.0
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT
T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE CHARCOAL
EXISTING F.G. EL.=98.4t F.G. EL: 96.8t F.G. EL: 98.0(MAX.) VENT
ff MAINTAIN 2% GRADE (MIN.) OVER S.A.S.
' a L = 54' L = 8'(MAX) INSPECTION
S=1% (MIN.) p S=1% (MIN.) PORT
4'SCH40 PVC 4'SCH40 PVC
6"
s 11.3" TO
14"
EXISTING 48" LIQUID INVERT
LEVEL 1 _I
cAsADDFftE INV.=93.86 PROPOSED INV.=93.69 f 4 ROWS W/4 UNITS AT 6.25'/UNIT
INV.=94.40 D-BOX 11_:1 iINV.=93.61
4 OUTLETS (MIN.) SOIL ABSORPTION SYSTEM (PROFILE)
EXISTING SEPTIC TANK
ESTABLISH VEGETATIVE COVER
BACKFILL WITH"f.EAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
NOTES: BREAKOUT EL.=TOP EL. _.
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP ELEV.=94.00
INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=93.61
2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=92.67 III�►IIIIB►IIII�I
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF
3) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3' !1
EXISTING SUITABLE
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL=86.3 = MATERIAL
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL.
4 ROWS OF 16" (H-20) ADS BIODIFFUSER UNITS WITH,
NO SEPARATION BETWEEN EACH ROW & NO STONE
TYPICAL SECTION
KTS
SEPTIC SYSTEM PROFILE
N.T.S.
a
_. -DESIGN ,-CRITERIA-
NUMBER OF BEDROOMS: 3 BEDROOMS
SOIL TEXTURAL CLASS: CLASS I GENERAL NOTES:
DESIGN PERCOLATION RATE: <2 MIN/IN 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
DAILY FLOW: 330 G.P.D. BOARD OF HEALTH AND THE DESIGN ENGINEER:
DESIGN FLOW: 330 G.P.D. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
GARBAGE GRINDER: NO OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS EXCEPT AS'REQUESTED BELOW:
LEACHING AREA REQUIRED: (330) = 445.9 S.F. 310 CMR 15.405(1)(b):
.74 1) A 1' variance to the 3' maximum cover requirement, for no greater
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY than 4' of cover. S.A.S. shall be vented and H-20 Rated.
PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
USE 4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS DESIGN ENGINEER.
WZ NO STONE FOR AN S.A.S. WITH DIMENSIONS 11.3' x 25.0' 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
HIGH CAPACITY INFILTRATORS MAY BE SUBSTITUTED FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
) ENGINEER BEFORE CONSTRUCTION CONTINUES.
SIDEWALL AREA: NOT APPLICABLE
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
16 UNITS x 6.26 LF x 4.7 SF/LF = 470.0 SF 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
DESIGN FLOW PROVIDED: 0.74 x 470.0 = 347.8 GPD THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION,
75" 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S.'
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
DIRECTED BY THE APPROVING AUTHORITIES. y
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
76" - THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION.
PROFILE 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
16" 12. ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC SYSTEM
11.2" + COMPONENTS NOT SHOWN ON THE PLAN.
13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
-34" � IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
SEC11ON END CAP
16" HIGH CAPACITY (H-20) BIODIFFUSER UNIT PROPOSED SEPTIC SYSTEM UPGRADE PLAN
MODEL 16" HICAP 91 WHIDAH WAY CENTERVILLE MA
LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT • •
EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
OVERALL HEIGHT 166"" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCEp
SIDE WALL HEIGHT , Engineering by: SCALE DRAWN JOB. NO.
OVERALL WIDTH 34' 4640 TRUEMAN BLVD Engineering Works, Inc. NTS P.T.M. 249-08
13.6 CF Raffor%ow. HILLIARD, OHIO 43026 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
CAPACITY (101.7 GAL) MWAN n DROVAE srMM W_ (508) 477-5313 12/10/08 P.T.M. 2 of 2