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0330 WHITE OAK TRAIL - Health
30 White Oak Frail Centerville 192-248 UPC 10259No.H1630R ' HASTIN0S.MN TOWN OF BARNSTABLE LOCATION .33C> e C� : tCSEWAGE# dO 1-4 -J,40 VILLAGE Ci✓"W,e1Z wtLLC--ASSESSOR'S MAP&PARCEL -Z1� INSTALLER'S NAME&PHONE NO. e o cat Tt Cc`_it SEPTIC TANK CAPACITY C-ki Y le -kf, 4�,,"— 'I�Q LEACHING FACILITY:(type) t Z-&-4C_ (size) oC t0• NO.OF BEDROOMS OWNER PERMIT DATE: , i!�E COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) _Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �-- Feet FURNISHED BYAwi/ E I 8,, I � � 7 3a y, E TOWN OF BARNSTABLE LOCATION —936 4 i�RZ4WSEWAGE# dO 1-e* - -ICU VILLAGE CC1q'7E�'1z v11_U_7-ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. cs SEPTIC TANK CAPACITY C-kI jk!! —i&e.y k5nn 4.4-L �® LEACHING FACILITY:(type) t��1(G P (size) 30,4 X, f0• �J4 NO.OF BEDROOMS � S'� OWNER eJ PERMIT DATE: 4,,}a-L t COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility }-4�, Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY / w✓ ��t. C"7Ji"'��s�/ f ��o Rr�� r >�- I i f i � ...-. :fir � 39` �3a'y" y9� � - -.._�. ti <<; �� J i � J T No. V L Fee 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -1°OWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System . ❑Individual Components Location Address or Lot No.336 W ` e Oak Owner's Name,Address and I Nq, & 0 r� Assessor's Map/Parcel , e3/�y 4 (.d�(�.� .06Mc.. ag&C 508 Xo 6'.10 I ller's Name ddress a d Tel.N Designer's Nam Ad ss,and Tel No. Yo� cG(1 • e 5044 77/9 mom r� 5aS'. � Type of Building: Dwelling No.of Bedrooms Lot Size v;?-Lt(40 sq.ft. Garbage Grinder( ) Other Type of Building o No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Design flow provided 3(4 1 gpd Plan DateZW)e! w_"0 f d4 Number of sheets Revision Date lOt Title Size of Septic Tank 1000 - r_ Type of S.A.S. (t=n Lol y jp.�. Description of Soil Q0e-C W L0a(D tf— 'erg S G. ' On Nfture of Repairs or Alteration (Answer when applicable) 3 LJ - 30 50 ©��� 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 Cod an no ace the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed _.__.__ Date ,/CJ/?1P, 17 Application Approved by Date O� Application Disapproved by Date for the following reasons Permit No. C>,?D' ® Date Issued oe No. V / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION=TOWN OF BARNSTABLE, MASSACHUSETTS Yes x 2pplication for_Misposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair(0110Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.330 W hl+E'06&7 #to Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1 13 3 l� y � I 66 k-La W 5 k J'i)•03�eCr 5U8 d 5'103 In Caller's Name,Address,and Tel.No. Designer's Name Add ss,and Tel.No. 1- O r �It��F ;(GC)S+( G 0/) - (K' - �} CGf5'E n6 i n,&ese`i�Ct `}a . (j/ M X 1 'xd« Type of Building: Dwelling No.of Bedrooms Lot Size rr, `1(p sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 �d gpd Design flow provided gpd qr Plan Date`}Jj')iP 1 c Q 114 Number of sheets Revision Date r' Title Size of Septic Tank y(o Type of S.A.S. -DE W1 L4 cJU Description of Soil Pec m(-C"b 1 e, r,. ``'r It - or fyi(l Nature of Repairs or Alterations(Answer when applicable) N G -30 T w t�rye 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 ace the system in operati'm-t6eff a Certificate of � g Compliance has been issued by this Board of Health. ' ` Signed/ Date_J Application Approved by �^ Date (' —cq Application Disapproved by Date for the following reasons Permit No. p�(�' 0 Date Issued e^ 0 3 --------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance �,, THIS IS TO CERTIFY,that the On-site Sewage Disposalsystem Constructed( ) Repaired( � Upgraded( ) Abandoned( )by ii ��olUy-�- (Glut j-UG'� [6,o T n e-. at_� �Rn h;t L TaI I Cpm c-'v,`I 1,e has been constructed in accordance ? with the provisions of Title 5 and the for Disposal System Construction Permit No.a-61</-210 dated Installer Designer #bedrooms �j Approved desi n flow - d The issuance of 's pe it hall of be construed as a guarantee that the syste wi J knco as d si il 4 Date Inspector 4 ----------------------------------------------- ----- ----------------------------- - ----------------------------------- No. 14 —1;1( o Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Disposal 6pstem Construction i3ermit Permission is hereby granted to Construct( ) Repair( jj Upgrade( ) Abandon( ) System located at �," > t e— ( l 1 l_.gr e-to ttF\,e R?t-. and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permi 2 � Date 7' Approved b PP Y .• JLL-26-2014 00:36 From: To:5097786611 Paoe:1I1 JLL-c5--2V14 09:57 From:6ARNST HEALTH 15087906304 To:91S024'289399 P.2'2 Town of Barnstable Regulatory Services J Richard V. Scali.,Interim Director BAE<l Public Uealth Division MOIS&¢ Thomas McKean,Director 200 Mniu Street,'kyanni9,MA 02601 OHicc: Fox: 309-7M6304 llotncownerlC'crtiftc►ttion Form for Altcrnatiye Systems Property Address: '��. tok(TC°02i ! l tom,_ Assessor's MnplPnrcel: ) -/ S� / SM,-! 1)' 9 Properh, Owners Norms: Lt) In accordance with ttilassachusztta DEP alternative system approval letters, the tollo ving certification information is required by t1ie Owner of record. The Owner of record must place an `�" 41 the applicable box next to each line certifying the information. Ycs MA ❑ 'I have been provided a copy of the Title 5 IIA technology Approval letters. (16 page Standard Conditions letter and the specific:tecltnolopyletter) ❑ 1 have been provided with the Owner's Manual (] I have been provided with the Operation and Maititenance Manual hor Systems installed under a Retncdial Use Approval,l asr+ee to fulfill my _ responsibilities to provide a Dccd Notice as required by 310 CMR 15.287(10) and the Approval n For Systems installed under a Remedial Use Approval,I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner,as required by 310 CMR 15.287(5) f` If the desinn does not provide for the use of garbage grinders, the reslrie6on is understood 1 ` and accepted (� Whether or not covered by a warranty, I understand the requirement to repair,replace,modify or Wke any other action as required by the:Dcpartment ur the LAA,it the Department br the LAA determines the Syst<:m to he failing to protect public health:and s tlhty and the environment, its defined in 310 CMR 15303 I r- L 3, ,� _agree to comply with all terms and conditions above, ."Property Owners printed name -:�L12-91201y roperty Owners Signature t Note., This Porto tuusc be st bndt-tcd along Witt, Ntc ac tics stem disposal works permit application for till I1A s •stem including new construction re airslu ewndeo with and without aggire etc stout and with e myentional design criter'tr or credited deli n t:ritcria. ' (�.15grticaA hu:nen.�ner ctrlili�aui��n.11ut; . FROM :down cape engineering inc FAX NO. :15083629880 Jul. 21 2014 04:24PM P1 A — /03 T. 0)_vvTff.I Of PSIRTUIS11,12ble 'y Tlow�n iaq F. GeRmir,Dir«C'10T K"9- Publk Health DivIsie'a 200 MAm St'vet, MA.02602 fpx 509Z)90-6104 lf� ve Dzilm, Inalanc r: /0 lnmo Irt- 13 o-,./- 70 4L &4�d ap�,�u=L to'inst'ill LL d a.6esi Fni.di awo-bY at'. 33. I ftltify tjTdL thc; -,eptic, Svg�f-m,T_e,fu,rc-,aced ahcyvc zva3 in aL[ed �,LibstrQafially a(,,aodi. 9 tee .}ucll s,s laf.f, -calioi of-L C, bo"T MCl/G.r ceutir Viit , . r s ystff i -1, V41. m4jo:� b,111,90,s (.1-0. g c)ve -is is talloc �h T 'atjo.tj 0,Lin -vCTdfRI).ej.U(., .f . G h - 10' hitulaI.Tejouation of t1le '-AS 01: Puy of tlic: sf-p-h.c,vstf,,-m) bat ba accm:danc,i;w.jjb_State. &; LocaIR('giJ.Ebms-, ?Ian.Ttvlgiol) fl)-f dj-Rf,J S-x' t ljy H.mi.guc"r to follow. Civil No,4(;`A' C)NI (A—ff F, au u A _LT -710TH 'T 81* K'T k Ty'-T) ijNyff, Ofs, F10TATY1. iiv*)�) 17 IE y(a!I'.(jCY3F MKID II-TA-I DIVISTIN. r-*r--lei./e,,..,+,'�frs,,;,,,P.rl'.rrrifir.Atinn PnT-ni 3-2604.dar. down cape engineering, inc. SIEVE SOILS ANALYSIS 330 WHITE OAK TRAIL CENTERVILLE, MA DATE OF REPORT: 6/6/14 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 330 WHITE OAK TRAIL CENTERVILLE, MA LOCATION: DCE TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 203.9 SIZE :WEIGHT RETAINED % RETAINED % PASSED (sum € € --------------:......................... ..........................:---------------------:..................................... 0.0% 100.0% 3/4" 0.0€ 0.0% 100.0% 1/2" 0.0 0€ .0%€ 100.0% 3/8" 0.0i 0.0%€ 100.0% --------------.......................................................:---------------------------------------- #4 0.0€ 0.0%€ 100.0% --------------I......................................................>-------------------- ..................................... #10 16.81 8.2%€ 91.8% --------------:.......................................................---------------------:..................................... #20 65.5€ 32.1%€ 67.9% --------------i......................................................>-------------------- ..................................... #40 145.5€ 71.4% 28.6% ....................................................... #50 175.2€ 85.9%€ 14.1% --------------.......................................................---------------------,..................................... #80 195.8 96.0%c 4.0% --------------:.............................:........................:---------------------,..................................... #100 198.4€ 97.3%? 2.7% --------------i......................................................>--------------------- ------------------ #200 202.E 99.4% 0.6% --------------:......................................................---------------------------------------- PAN: 203.2 100.0%€ 0.0% i------------------- -+--------------------�---------------- ------------ ------- -- SAMPLE: € 203.9€ NOTE:TEST ON PASSING#4 ONLY, 11.7% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b (GRAVEL &SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION ��jH of �� cy >99%SAND ° DANIELA. GJ, 0 RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MINAN. MATERIAL " CIVIL NONCOMPACTED Igo.45502 SOIL DESCRIPTION: COARSE SAND .81ONAL ECG TRAI'4S.NO.: APPLI[CAloiT- ADDRESS: DESIGN FLOW: � bpd R EVI]E D BY: DATE: ITT/A OK NO k.. !..0:fii ;.iu:. _' '.e^ .?dC; :n,+• a3I'r, 'h nrTT::•w;rc ...:: ..F � .•,�:, 'rl'.f::L''i+ ;'•4..i�?:.�:,.:`'l.i;':,`.•` 'S;. '.att::viia ,:G4,. '�JI: .,•i:.' 3.� r.i'i LL j' v_{y ,' _ Ft'eC'::n;Y a.70.a �{,707��.��(;•:y,'��.: �i��?i,.%°::r`.�T .i5�..'i...t',.•A-..,.-f;�:�. ,r .y., a1[h i,",h�' t '���m,,Y�.lzr'.cY.bnt�.:..P... n�+9'la�:}'r.�.,•,<�,1',.i.. }�;! !.il.V,,:1L?A-u,.-.a-;»'.,.a!f,rA��ei";.Jt,lir.a�r*kFh^�nd:u xu.lJ,3:.na'�snaL,•,(?aiY,�.:.1.Yi>r,'t1i',Y<'..r1.•,A+v:9'• .�aA'�'. •�' Legal boundaries denoted[310 CMR 15.220(4)(a)] Street,Lot,tax parcel number and lot number noted on plan [310 V CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CNM 15.220(4)] % Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 Ma 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow s septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 NIA OKz NO Location of every water supply,public al private, [310 CMR 15.220(4)(k)] wi�hin 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] - Water lines and other subsurface utilities located[310 CMR 15.220(4)(m)] (if waterline cross see 310 CMR 15.211(1)[11) �✓ Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction V activities within 5 ft. of lot line) [310 CMR 15.220(3)1 Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as f approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] / Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)1 Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] `® Materials specifications noted? [various sections of 310 CMR 15.000] System components not>36" deep (unless Local Upgrade APPy q roal or LUA requested) [310 CMR 15.405(1(b)] Sheet 2 of 7 Address N/A OK , No 1J11µWi ;'1L :: � :YY;a+";�r( � 'f..t- 1 a: .— 'M ., ` a �` rµ' '':5:; ..��!.a.Y .ns;�,:c•i?:.;.� Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" +5"per foot for increase ft depth[310 CMR J 15.227(6)], Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 Cl R 15.228 1 Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high.groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA[310 CNa 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have users on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] / Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access " o ade - one port for stems<1000 d t� A ss to within 6 f � p Y gP two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310'CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] / H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks fiomresources [310 CMR 15.211] ""i1 H;^'¢ia"r.?. �•"{kh iSF� 3bE-F"f'.`7E.S 1?�„"�3'XY9` i �i, i' �r�, f�,c��E'.� .�`{. Yt.daa:o.::'r.,:ec.�:1 Required when other than single-family dwelling or flow>1000 gpd[310 C1Va 15.223(1)(b)] I First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OIL NO q:. ¢ dam';i..:. .:4 4" e:�y�,;.x. :j;�:•`"f.'�i.cl".•. *;PPIN1HilH" Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18"below water line (when water and sewer cross, see 310 CMR 15.211(1)[11) Cleanouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches andbeds) [310 CMR 15.251(9) and 310 CMR I5.252(2)(c)] j Siphon problem/ (leachfield below pump chamber) �d Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] % Splash plate or baffle tee required on inlet/provided? (when / pressure sewer to d-box or steep pitch of gravity sewer) [310 V CMR 15.323(3)(a)] Riser if deeper than.9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CIVlR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working—design flow)? [310 CMR 231(2)1 Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, discomiects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag ' fe mode. [310 CMR 15.231(6) and� )] Stable Compacted Base [310 CMR 15.221(2)] 11a Buoyancy calculations needed?Provided? [310 CMR. 15.221(8)] Sheet 4 of 7 Address N/A OK NO f ,LL• g :li�Y!i l`�' 1.11YA ' 777777 I:Via. fir.1.+N�iilt�31F•'s�'Calculations correct?4 feet of naturally occurring material15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed[310 CMR 15.247(2)] System Venting requireNprovided? (system under driveway or >36" deep) [310 CMR 15.2411 . Inspection parts specified and within'3"final.grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[41 and Guidance Document] G 0m.M:at:a..�.•:n..�........i.9..�•:n•:wl...+� ..:: ......_.w..a..:. .1 .. . �... 11...�' i .F '.k.•--�. /�/.N,.t Chambers and Gal. in trench configuration supplied with inlet every20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum-4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] ,�¶'� ;,q�?pr�y�r��pr r.- h�ry�r99•�v y ;� S' ` ' nyll.•p. l.�y�r`:.�:.."«'�m:�r� ~�,I v �lZ����ti 6 cs, �i• S. 't Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length[310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 25l(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] t ^'T ZbSQ,u'€C ' - "ET' r_Ma.nx+0. n:4.c Q 4. rrrt. minimum 2 distribution lines [310 CMR 15.252(2)(a)] a Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 I CMR 15.252(2)(e)]- Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only[310 CMR 15.252(2)(i)] Address Sheet 5 of 7 N/A OIL IBC Y� .qkB .Pressin e D osec€Systems ? Provided pump and piping calculations as required [310 CMR 15220(4)(r)] alternative - stems>2000 Pressure dosing required on all systems �d of al systems under remedial approval [310 CNIR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to noto onpan[l 310 CNM i5.254(2)(d)] Construction in ill -Did the plan specify that the fill shall meet �'®fasts ,� the specification of 310 CUR.15.255(3)? Impervious barrier and/or retaining wall? [Guidance Document] Impervious barrier installation must be supervised by designer [310 Ma 15.255(2)(b)] Retaining wall must be designed by Registered Professio�ial Engineer[310 CIVIR 15.255(2)(a)] / Side slope not exceed 3:1 ? [310 Ma 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and e Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 Ma 15255 (2)(01 a; l`essj' ePpa;[ a;®��cal Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan? [310 CNR 15.220 4 i N thin five _ on ran if a component is vn RLS Stamp necessary p p feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.4141 Sheet 6 of 7 Address i NSA OK NO i1„7tl�d.t�oge�i.Sera��ztEve��a�el�r9r'�1,'" 1. i li �i A. 7 �.i� �����r�Fa3i �.� f+Lt`� a i.{ `�'� yI[t 'F.Yi�:..'�'�,''`•� .ii,;;' Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CNR 15.214, 310 CMR 15.215 and 310 CNR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CNR 15.214(2)] i Are the nitrogen loads proposed in compliance? [310 CNR 15.216(1)] k . vx - sra ' ,�;.vrp. ,�_ 7;;r•�" (v<,^.fit.n',"f:c t;�� A yyam+ t.• �, Sri 1 �: t- li,,�,e,F.;.�.(. Pumping to septic tank? [ 310 Ma 15.2291 Shared System [310 CNR 15.290] Address Sheet 7 of 7 We Town of Barnstable P� Departlinent of Regulatory Services > M 9 Public Health Division Date ran A 200 ain Street,Hyannis MA 02 01" Date Scheduled f Time e F e Pd. soiPSuitabzlity .Assessment for Se � e Disp® Z � Performed-By:_bg1--14( 6 0)S Gt'J e> Witnessed By: ` LOCATION& GENERAL MORMA.TION / Location Addre$s ? 1 Owner's Name a C�,�-��.✓) l� �-- ` Address Assessor's Map/Parcel: Engineer's Name NEW CONSTRUCTIO /N � REPAIR Telephone# (j'�J c�6 d �'s�. Land Use: Wooded Slo es % P ( ) J� ! Surface Stoacs Distances from: Open Water Body W #t Possible Wet Area >( ft Drinking Water Well c�ft Drainage Way �(Gy ft Property Line ft Other ft S��TCIK:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands•In proximity to holes) i7 O ro. r>1 C Parent material(geologic) y ((1 a T+ ` t Depth to l3edroclt `��0 Depth to Groundwater. Standing Water in Hole: Weeping from Plt Fnea ` Estimated Seasonal High Groundwater A/I A— DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Alta W 6 Depth Observed standing in obs.hole: la. Depth to soil mottles: lu, Depth to weeping from side of obs,hole: In, Groundwater AdjuAtment 1G. Index Well# Reading Date: index Well lovol Adj,fhetor ,. Aru,GroundwaterLevei q PERCOLATI.ON T +'S'T Date(0/2//<I Thum Observation Hole# Tlmn at 9" --- Depth of Pero Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Nlindluch A I Site Suitability Assessment: Sitc Fassed Sits~Failed: Additional Testing Needed(.YIN) 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 Consgvatiou Division at least one(1)week prior to begIDMIDg. QASEPTIC\PERCFORM.D OC DEEP-OBSERVATION HOLE LOG Hole# � Depth from Soil Horizon Soil Texture .Shcl Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders, • o i ten;y,96'Cravel) 0 -0 A ' L 5 3/2 C, S to 70-/SO CZ LAP, b (f1CIS%a t�r�ve l S=14'/c, 6rcc fve-�. DEEP OBSERVATIONHOLE LOG = . Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. -Consistency.%Grave 3A1 -zz �oyRy/I' 22-ga Ci S I0,M f 10 6rcve(2ra Ile DEEP OBSERVATION HOLE LOG hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i tc c p e ]DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color 5011 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Colisistmoy, Flo_od_Insurance Rate Map: Above 500 year flood boundary No A Yes Within 500 year boundary No i Yes ' Within 100 year flood boundary No.V Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y?- S If not,what is the depth of naturally,occurring pervious matoriall C_ertification I certify that on �/�Z (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in�10 CNM 15.017. Signature -'��'- ��— Datb (o/U/ F Q:1S•F-PT1aPEltCF0RM.DOC I,) COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS U �� Z DEPARTMENT OF ENVIRONMENTAL PROTECTION m � � � d ee i�M Sye v 4 ' TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION A4 Property Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 P ,l Owner's Name: M RUTH JUST / V Owner's Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 Date of Inspection: 9/4/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes ; _ Conditionally Passes _ Needs Fu Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 9/4/01 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING SYSTEM NOW AND EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes conditions at the time of inspection and under the conditions of use at that tinge.'Phis inspection does not address how the system will perform in the future under the same or different conditions of use. Titlo G Incnrrtinn Fnrm h/]V),Qo ft, 1 'Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE:SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 Owner: M RUTH JUST Date of Inspection: 9/4/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING SYSTEM NOW AND EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE. 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. n/a 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'of 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: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping rhore'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: n/a "� Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 Owner: M RUTH JUST Date of Inspection: 9/4/01 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,iof 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,Sq 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 t6idetermine distance n/a "This system passes if the well'water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds`ind sates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogeri'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. t 3. Other: n/a a< Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 Owner: M RUTH JUST t Date of Inspection: 9/4/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n1a. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool''or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for'coliform bacteria and volatile organic compounds indicates that the well is free from pollution from thatlacility 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.f.' (Yes/No)The system fails. (..have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.1The 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply ?tC X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone 11 of a public water supply well If you have answered Vyes"to—any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the Iargetsystem has failed,The owner or operator of any large system considered a significant threat under Section E or failed under'Secfon D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. n Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 Owner: M RUTH JUST Date of Inspection: 9/4/01 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period ? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? i X _ Was the site inspected for signs of break out'? X _ Were all system components, excluding the SAS, located on site'? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information. For ekample,a plan at the Board of Health. X _ Determined in the field(Pany of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 i Rage 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 330 WHITE OAK TRAIL CENTERVILLE, MA 02632 Owner: M RUTH JUST Date of Inspection: 9/4/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons-- How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1990 Were sewage odors detected when arriving at the site(yes or no): NO r. • Page 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 Owner: M RUTH JUST Date of Inspection: 9/4/01 BUILDING SEWER(locate on site plan) Depth below grade: 20" Materials of construction:_cast iron —40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 14" Material of construction: Xconcrete.(metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confi,nned by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: IOOOG L 8' 6" H 5' 7" W 4' 101''11 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING NOW AND EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE,THERE IS 6 INCHES OF EFFECTIVE LEACHING LEFT IN PIT GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 Owner: M RUTH JUST Date of Inspection: 9/4/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): DISTRIBUTION BOX APPEARS TO BE STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.DID NOT EXPOSE. PUMP CHAMBER: _(locate on site,plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a Y� i 1 1 11 1 .Q iPage9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 Owner: M RUTH JUST Date of Inspection: 9/4/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: nla n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a 4 innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT APPEARS TO BE FUNCTIONING PROPERLY.THERE IS 6 INCHES OF EFFECTIVE LEACHING AVAILABLE. BOTTOM IS AT 7 FEET. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a q Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 330 WHITE OAK TRAIL CENTERVILLE,MA 02632 Owner: M RUTH JUST Date of Inspection: 9/4/01 SKETCH OF SEWAGE DISPOSAL'SYSTEM i 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. UYU j I I l«eel A6 � AcfA II nl L Ib � a3l �� �c al 90 Ll I in Page I I of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 330 WHITE OAK TRAIL CENTERVILLE, MA 02632 Owner: M RUTH JUST Date of Inspection: 9/4/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER 1S AT 12 PLUS FEET BY PLANS.GROUND WATER ADJUSTMENT IS 2.4 FEET AS INDICATED BY SDW 252 ZONE B' i t'. SYSTEM PROFILE NOTES ALL SYSTEM COMPONENTS SHALL BE (NOT TO SCALE) MARKED WITH MAGNETIC TAPE OR APPROX. NGVD PROVIDE MIN. 20" DIAM WATERTIGHT COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS Stye ACCESS COVERS TO WITHIN 6" OF FIN. GRADE ak 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING o� s \ TOP FOUND. EL. 71.6' FILTER FABRIC OVER STONE PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE Three Wequaquet 3. MINIMUM PIPE PITCH TO BE 1/8- EROOT.P F MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE EOUIRED OVER SYSTEM 69.4' = Lake n74. DESIGN LOADING FOR ALL PROPOSED PRECAST PRECAST H-10 p RISERS (TYP.) UNITS TO BE AASHO H-1Q Locus 2'0 67 8 4"OSCH40 PVC c o PIPES LEVEL 1ST 2' 2" DOUBJ_� WASHED PEASTONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. o ) o OR GEOT ILE FABRIC o a ` o 66.4' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE10- �oke�+ Ot TEE EXISTING SEPTIC TANK** TEE *� WITH 310 CMR 15.000 (TITLE 5.) e oo 66.4E 0000�00000000 ogo � 0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND c o GAS BAFFLE::: no- 0 65.89 0 NOT TO BE USED FOR LOT LINE STAKING OR ANY �, o 4' LIO. LEVEL (ACME OR EQUAL) . 66.06' 65.89' �$ 2' og 63.89' OTHER PURPOSE. o/ o d o0 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. s MIN. SUMP 6" H-20 3050 INFILTRATORS oc 12" MIN. INT. DIM. 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL 2"1^I>y, wK }j' 3/4" TO 1 1/2" DOUBLE WASHED STONE CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 (2]) HEALTH AND PERMISSION OBTAINED FROM BOARD ePOP OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30.4" X 10.25' OF HEALTH. 6.7' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP VERIFYING THE LOCATION OF ALL UNDERGROUND & ( 1 % SLOPE) OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. NOT TO SCALE EXIST 34' LEACHING BOTTOM TH-1 & TH-2 11. ANY UNSUITABLE MATERIAL ENCOUNTERED FOUNDATION SEPTIC TANK D BOX 2 FACILITY NO GROUNDWATER FOUND 57.2 SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 192 PARCEL 248 PROPOSED LEACHING FACILITY. **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE AND REMOVED OR PUMPED AND FILLED WITH CLEAN PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE SAND. SYSTEM DESIGN: GARBAGE DISPOSER IS NOT ALLOWED 5' REMOVAL OF UNSUITABLE SOIL REQUIRED AROUND PERIMETER OF LEACHING FACILITY, DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD DOWN TO SUITABLE SOIL LAYER. REPLACE - WITH CLEAN MED. SAND, TO MEET USE A 330 GPD DESIGN FLOW SPECIFICATIONS OF 310 CMR 15.255(3) \ SEPTIC TANK: 330 GPD (2) = 660 167.50' lu RE-USE EXISTING SEPTIC TANK** ., LOT 70 _ r _ _._._ _ _ __ _ __ ______, LEACHING: . 15,246t SF - \ - - _ SIDES: 2 (30.4 -F 10.25) 1.85 (.74) 111 GPD (TH 1 TI 12 I , TESL" HOLE LOGS \ � i I BOTTOM 30.4 x 10.25 (.74) = 230 GPD �7 BENCHMARK: USE TOP FNDN. AT EL. 71.6 x 69.83 I I TOTAL: 462 S.F. 341 GPD ENGINEER: DANIEL E. GONSALVES, SE 66.07 0 60 9 I .6 3 USE (4) H-20 3050 INFILTRATORS WITNESS: DONNA Z. MIORANDI, RS w/ 69.91 69 o WITH 1' STONE AT ENDS AND 3' AT SIDES DATE: 6/2/14 W/ I < 2 MIN INCH I P' PERC. RATE _ / w/ PORCH 2�, � f1 / .99 - - -� CLASS I SOILS P# 14378 w 69.85 W� 1.12 EXIST. DWELL. ELEV. ELEV. TF = 70.22 ETI 69.7' 69:7' �` 71:6' MA 0" b APPROVED DATE BOARD OF HEALTH A A O 1.28 LS r1OYFR LS 0.68 70.89 10YR 3/2 3/2 "8.65 „ 70.44, 70.09 6„ 6 � B B 51 70 'i4 TITLE 5 SITE PLAN �LS �LS 7 OF 22" 10YR 4/4 22„ 10YR 4/4 8 x� _STOCKADE FENCEX�6.9 132.51 330 WHITE OAK TRAIL c1 c1 66.64 CENTERVILLE LS �LS//// x 66.63 PREPARED FOR 1OYR 6/4 10YR 6/4 , 90" 62.2 90 /////d/ 62.2 :✓; BORTOLOTTI CONSTRUCTION/LAW C2 C2 / C�� 1 JUNE 5, 2014 SIEVE 66.80 � x F r ?; ooA o /^�s � �tN or,an Cr M s off 508-362-4541 k "ts, y�� .� � rr <� S R fax 508-362-9880 x66.80 1 A 1 \ ni. � , ", t y,M/CS M/CSU1`a I c, �i .iv; 1_ rTYT ;t i q A, �W ,. downcape.com 'K 9 U I!1 (A ! C- �.� N! .4 �02 � � J � down cape engineering Inc • 150" 10YR 5/8 57.2' 150 1 OYR 5/8 57.2' `� " ' 1 � �, ,i,•,� � � - �^ � , �� civil engineers -Scale: 1 20 ; land surveyors NO GROUNDWATER ENCOUNTERED 939 Main Street ( Rte 6A) > 4- > 03 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675