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0109 ZENO CROCKER ROAD - Health (3)
r 109 Zeno Crocker Rd. A = 170- 142 Centerville h v OPsndafleY"' k s 4210113 ORA 10°10 M. 6 i 1 fh rf_ L , No. -11 1 `F� _� Fee O < THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for Disposal �6pstrm Construction permit Application for a Permit to Construct( ) Repair O� Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. /09 � rj�(' Owner's Name,Address,and Tel.No. 91S4 �1`�Yt��'NW_ er- huh 8 Assessor's Map/Parcel P26 JS/� vov-A Installer's Name, ddress,and Tel.No.my�5b tf-7�1•- 9 3?9 esigner' Name,Address,and Tel.No. �tt�;C Gor-6 )Ss rvA-iw c qs i'+�J�s P6 iewad_i v- s Type of Building: r Dwelling No.of Bedrooms 3 Lot Size �� 106 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) J 3 O gpd Design flow provided 3 y / gpd Plan Date Zp_�p�(a Number of sheets Revision Date Title w ill Size of Septic Tank e yg's 1 m joEo Type of S.A.S. o? v /-['IU 6cog d Icy.,A ah",�S aS)( IQ 93 Description of Soil��e o—ei 1pq 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 t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. a�r Signed A Date l v431 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �� Date Issued .. No. U 1 �P 1 Fee NO— io THE COMMONWEALTROF MASSACHUSETTS Entered in computer: PUBLIC HEALTH.DIVISION - TOWN OF-BARNSTABLE, MASSACHUSETTS `' es Y Application for Misposat *pstrm, (Construction Permit I Application for a Permit to Construct( ) Repair 0� Upgrade( ) Abandon( ) ❑Complete System 4dindividual Components Location Address or Lot No. zeno(�r6cAa t Owner's Name,Address,and Tel.No. 9/j4 5D;,2 - -L//'">/j Assessor's Map/Parcel 00 ee.n kq-U t l Jr_ -5a T_;& er 9 h t/S r)Ui�f oPe Installer's Name,Address,and Tel.No. ,SvFS-7�(- 9 3 esigner's�Name,Address,and Tel.No. - - v -Y/ �jor�v vac,Cvnsfr�,� m,1y r- g5Sly ,"Sv rLj pj � eG'YJinecrIR ,_ilc q/39A42t4,c Sf 1JVVUrs p r Type of Building: Dwelling No.of Bedrooms 3 Lot Size !US -- sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3.30 gpd Design flow provided 3 7`/ 9 gpd Plan Date DC'Ce m LP r 90.�r(D!( Number of sheets r Revision Date Title i I� S fates PIlt�n! /! G'J X� rr"DCP/t/f �L°i7-9li�/�P ,ti`I/� , Size of Septic Tank L Xl S�I r / Type of S.A.S. /flo 50094 /Pnr�"..q' 25X lo?•83 Description of Soil . J , 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"t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. s Signed Date Application Approved by 141 V 17 R Date Application Disapproved by Date for the following reasons Permit No. o l 6 L/ Date Issued } / --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by /�i' ( �„,51tr'��s�ii9� r�C at/O F n [ l nej� n ,,4 lie has been constructed in accordance with the provisions of Title 5 and thefor Disposal System Construction Permit No. �_�n� "V6 dated e / 6 Installer ," .�. � '6n 1 Jd`� Designers�sx i Vi of�or'l�F�� I ��C #bedrooms Approved design flow I- �f g gpd The issuance of this p rmit hall not be construed as a guarantee that the system will fun Lion as des gned. Date Inspector �„/ --------------------------/------------------------------------------------------------------------------------------------------------- No. d I L/6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction permit Permission is hereby granted to Construct ) Repair(� Upgrade( ) Abandon( ) System located at /D 9 7enc, rDG �r t='a Z!zII P and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. I Provided:Constructs n must be completed within three years of the date of this permit. Date �1 Approved by U I � . JAN-14-2017 01:31 From: To:15087906304 Pa9e:V 1 ry Towns Of Bar �(_ ` Hatable lRegulatory Services maw Mug, Thomas F.GeifEr,Director Asa a Public Health Division Thomas McKean,Director 2W h1s"k Sheet,HyanAls,MA 02601 Office: 503-962-4644 Fax: 508-790-6304 _liastallei Desicur Cer ' tea 'on m m Date: Sewage Permit# C"4J�- `f , Assessors Map\parcel Designer: 9,d h. Clap,. Address: .� p l�'l�tr+� � Address: t_1 toot, On was issued a permit to install a (date (installer) septic system at P-rI v based on a design drawn by (address) G�+tir dated A / / esi ex) 1 certify that the Septic system referenced above WAS installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with ma or changes (i.e. gre tl>a ater n l0' lateral relocatlon of the SAS or any verdlcal relocatioi o�any compost of the Sept' but in accordance with State& Local IZegulatio ns. Platt revision or ce ' as-built designer to follow. ' nANIEI.n f, nJALA `; (Installer's Signature) dull. <� No 46607 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNHARLE PURMC REALTH DIVISION- CER1319CATL OF COMPLIANCE YM,,L NOT BE ISSUED UNTIL BoTh irftJIMM AND AS-30VT CARD ARE TOWN OF BARNSTABLE LOCATION 10!I ZU1110 C(ZG1GK,Lsk_F-h. SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: 1 A- �-9' COMPLIANCE DATE: 2- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility '+" 5 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) h( Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ZZAO l 01 A- y- �l ° Postal CERTIFIED MAILTM RECEIPT (Domestic Mail Only;No insurance Coverage Provided) � a t CO Postage $ Certified Fee C3 Postmark � I= Return Receipt Fee Here C3 (Endorsement Required) LA C3 Restricted Delivery Fee C3 (Endorsement Required) O Total Postage&Fees Is rq ru Sent To v l K a"+ /a(/� BO D r- rq w - ------------------�-----------------------Boqe�r- rq w / _ Qh _____Ti = � ar PO Box No. Ciry,State,ZIP+ &ulor�-h �L 33LIO:�- PS Form 3800,August 2006 See Reverse for Instructions Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. ■"Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a"postmark on the Certified Mail receipt is,desired,please present the arti- cle at-the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2;�(tl 3.Also complete A. Signature item 4...4striCtedtDe�lPuety is desired. X Agent ■ Print your,.name and•:ecldess on the reverse- ❑Addressee so that we can returttrthercard to you. B. Received by(Printed Name) C. Date of Delive ■ Attach this card to fhe`fiackrof the mailpiece, S' © ^t b or on the front if space permits. t b 1. Article Addressed to: D. Is delivery address different om item 1? ❑Yes If YES,enter delivery address below: ❑No J'huarf Fay y� 97- g Seel? 1�i 4-f�re . al�e (/Uar- iJ FL 3. Service Type Certified Mail® ❑Priority Mail Express'" ❑Registered J;PRetum Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Ar� 7012 1010 0000 2847 8155; PS Form 3811,July 2013 Domestic Return Receipt 5C. UNITED STATE _A First-Class Mail Postage&Fees Paid I LISPS ;FT4 2 I. Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box* I I l�vr� 07'13aMS-Vh1e fl h I � abb /YJai� Sfi��2� I y e:i - 4 Ci=e:2:Ci_.: -� /R, -_0 oe- ' Deparfineaat of RegWat®gy.SerNAM vli�es te Da Public Realth.Dl u 200 Main Stree[,Hyannis MA 02601 t-• Date ScheduJ.ed Fdl, 6. D� v�w o a .n q •� W 11 is OS PerfunnedBy: G("1, e l y '7 Cc I y�� Witnessed By: r Location Address / /f� Owner's Name 601e- C�+� N y1p Address Assessor's Map/I'aroel: 70 l ];nginaer'S Name NEW CONST/R.UO"I'ION REPAIR Land Use; �' U//t Slopcs(%) G— Surface Stones Distances ftm: Open Water N ody >too f Possible Wet Asea>[00 fi Drinking Water Wcll >�a2 Drainage Way y� ft Property Line �t/ ft Other ft SEE'T`CH-P(Sacet name,dlmemlons of lot,exact locations of test holes&pert tests;locate wetlands•tu Pxonla ity to holes) N 33� w ®1� C N Parent material(geologic) I�C,� O u/Q.S Depth tq 13edrga% Z�0 P �/ , Depth-toGmuudwater: StandingWaterinHale: -/ / -_ f Weeping from PltFaca /" / 1 - EstiMated Seasonal high Groundwater NIA If f JJ a 1C�17JU11 9 AAO.I'4 Jl's R SEA �.A'.�'ltAL Jl aGEE 4'V A Jl E rJ AR L•t•ND Method Used: LV E Depth Observed standing in obs.hole: Depth to wccpingirom side of obs.hole: ln, GrtluiltlwdirAdjudtlii nk j• Index Well i# Reading Date: ' Index Wcll 1pVa1-,:— A6 factor,.,.,._,_..-.Adj.givundwntariivai Observation Bole# _l� 'Pluta•at. " , . w ,., DepthofPerc. ` Tl=At6" S[artPxc-soaltTima @ _ -- Time.(9�,_6„) - - End I're-soak Date Min.iluch L. ✓�'1/ J '; - .. -- ; tiltp Suitability,A,samsmcut: Site Passed. V SitA Failed: Additional Tosting Needed(YIN) JOriginal: Public health Dlvlslon CbSazYatioA HoZt;Data TO Be Completed oA BaCk-----••••--- ***Tf percoiata®an test is to be emadaacted witbat 100' of wetland,YOU must-fl staaotzt'y the. Barnstable Conselpv2taon Division at Fast one(1)'week prior to begunzdng. Q.,5SUTICIPE,P,.CPOR.M.DOC f ` Depth from Sail S-Iorizon Soil.Texture .Sd11,Color Soil Otlicr '� Surface(in.) , (irSD'A} (MunselI) Mottling (Structure, Stones;Boulders, ravoi) ova - 30 30-W IDyR /S� Depth from Soil Horizon SbilTexture 'Soil Color Sall Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, ansis en C/o Grave -3� g . 5 L iavA41/y 3y-11(° G MI5 10�� 7/ ]BEEF OBSERVATION HOLF,LOG W,. Depth-froni SoilHorizon SoiITexture Soil Color Soil Olhar' Surface(in.) (USDA) (Munsell) Mottling (Structured,Stones,Boulders. Colisigtorgy,%G e Depth from Soil horizon Soil Tcxturc soil Color Sail Other Surface(in.) (USDA) (Munsell) Mottling (Sfructura,stouesw Boulders, " Ca si Eatt 6 , �Iaod Yns•tsranci;�.ate'1VYa.�.. ._ Above 500 year;flood boundary No Yes v Within 500 year boundary, NO 'Yes- Within IdOyearfloodboundary No. Denth.of ntar—al I n.0c cu.rrinf-Per,v10-as 1Y1at8rIaY Does at least four feet of naturally occurring perwlous miterlal axist in all areas observed throughout the area proposed fbr the soil absoi ptibn systeml y 2 S If not,what is the depth of naturally occurring pervious materlal7 (oRWcafioxg S. ( ( �C x certify that on (date)Y havepassed the sail evaluator examination approved by the Department of Environmental Protection and that°tho above analysis was perrormed by me consistent with . 'the required training,expertige and experience described in�10 ClVM 15.017. Signature �iJG � --- haft; I�/ Y� • 4 ' ' �.:�s>✓r~ric�r��.cra�.M.noc . Town of Barnstable Barnstable Regulatory Services Department AlAmer,caC j IA MAS&LE 9 Public Health Division Fp µAl A 200 Main Street, a e , Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8155 November 1, 2016 BOYER, STUART V & FAY 9748 SAN VITTORE ST LAKE WORTH, FL 33467 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 109 Zeno Crocker, Centerville, MA was inspected on 10/16/2016 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: 0 Distribution box and chambers staining above invert. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Th a cKean, R. ., Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\I09 Zeno Crocker Centerville.doc i Town of Barnstable snRrrsr�a�.e, � • 6� ,�� Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Officer 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA if ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any-portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER X l_ o n^� .1 � Ali` CAJOVer 1Avef Repair deadline: ,Z QASEPTIMDEADLINES TO REPA4 FAILED SYSTEMS.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v e � 109 Zeno Crocker __ -- Property Address Fran Boyer Owner Owner's Name }� �} information is Ma Centerville __ _ required for every 02632 10/16/16 page. City/Town State Zip Code Date of Inspection rN.3 .. r%2 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:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono _ use the return key. Name of Inspector - - DiBuono Sewer and Drain lge Company Name — -- -- --- -- — 8 Johns path — ---------------------------------------- ------------------ -------------- -----------...------- Company Address S Yarmouth Ma 02664 _ City/Town State Zip Code 508-364-9587 S103522 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 - El Needs Further Evaluation by the Local Approving Authority ----�— --- �� 10/21/16 l pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system 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 report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l5ins•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page of 17 Commonwealth of Massachusetts U3 Title 5 official Inspection Form i — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Zeno Crocker Property Address Fran Boyer_ -- Owner � — Owner's Name information is Centerville Ma 02632 10/16/16 required for.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: 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): 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 109 Zeno Crocker Property Address Fran Boyer Owner's -- --------_— — wner's Name information is Centerville _ Ma _02632_ 10/16_/16 required for every — page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ 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).- El obstruction is removed ❑ Y ❑ N El 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 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts Title 5 official Inspection Form _ Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments �r a 109 Zeno Crocker Property Address Fran Boyer Owner ------ -----------------------------__------------------Owner's information is required for every Centerville _ — Ma _ 02632 10/16/16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates.absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %. day flow I5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Zeno Crocker _ Property Address Fran Boyer Owner ------ ------- Owner's Name information is Centerville Ma 02632 10/16/16 required for every ------ ---------— ------ -- ---.._._.. - - — ------ - -- -- ._._.. page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of'a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ 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. 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 5 of 17 IfX Commonwealth of Massachusetts W Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 109 Zeno Crocker Property Address Fran Boyer Owner Owner's Name information is Centerville Ma 02632 10/16/16 required for every _ -- — page. City/Town 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 ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® 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. ® El approximation 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•3113 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 109 Zeno Crocker Property Address Fran Boyer Owner ---------------- -- ---- Owner's Name " -- information is Centerville Ma _ 02632 10/16/16 required for every _ _ ---------- page. City/Town State Zip Code Date of Inspection D. System Information Description: System is in failure. Distribution box shows staining 1" over bottom of out flo pipes. Staining is also visible in the leaching chambers over invert pipe. Water usage was over 335 GPD over the last 18 months on record. There is 1 ft of standing water in leaching chambers and the home is vacant. System is only 8 years old. — — — Number of current residents: Vacant 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 ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 335 Gpd 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date 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: — ----------. ..------------------------ ------------_--__._-. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \ ,y 109 Zeno Crocker Property Address Fran Boyer Owner Owner's Name information is Centerville Ma _02632 10/16/16 required for every _ _ — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping p g Records:c ds• Source of information: pumped in August 2016 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): 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts _ Title 5 Official. lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments „a 109 Zeno Crocker Property Address Fran Boyer Owner -------------- --------- ----- --------___.__._._..____------------------------- Owner's Name information is Centerville _ Ma 02632 10/16/16 required for every -- -__ —_------- ------_.-- --- _ --------- --------- page. City/Town State Zip Code Date of Inspection D. System Information- (cont.) Approximate age of all components, date installed (if known) and source of information: 8 Years New Dbox in 2016 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 1.5 -- ----------- - -- --- _._._. - 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: --- ------ feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: --...- -- - — ----- - ----------... - years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: ----- --- --- --- -- -- - Sludge depth: ------ --- ----------.._. - - t5ins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form } -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \. 109 Zeno Crocker Property Address Fran_Bo er Owner Owner's Name information is required for every Centerville Ma 02632 10/16/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24 -- Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 42 Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of Ieaking,Tees and or baffles in place at time of inspection., Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness — — Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins•3113 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 a 109 Zeno Crocker Property Address ---- - -- --- -----_--- Fran Boyer Owner's -- -------- wner's Name -------- -......--- --'-------------- requir required is Centerville Ma 02632 10/16/16 required for every -- --- - ----__— - ---- -- ------ -------------.. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and levels are normal. 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: -- --------------------- — s 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•3113 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 o 109 Zeno Crocker Property Address Fran Boyer Owner Owner's Name information is Centerville Ma 02632 10/16/16 required for 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 New in 2016 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.): 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: 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Zeno Crocker Property Address Fran Boyer Owner ----._,_---- --- Owner's Name information is required for every Centerville Ma 02632 10/16/16 page. City/Town -- — State _ Zip Code _ Date of Inspection — D. System Information (cont.) Type: ❑ leaching pits number: ---------- --- 2 ® leaching chambers number: ------=-- - ❑ leaching galleries number: -- -- ❑ leaching trenches number, length: - ❑ leaching fields number, dimensions: --- ------ - --- ❑ overflow cesspool number: —--------------- ❑ innovative/alternative system Type/name of technology: ----- --- ----------------- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ---------------- 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts --= W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ( °/V 109 Zeno Crocker Property Address Fran Owner's r e Boy Owner -Namm- .-e.._..--------- — Owner' information is rewired for every Centerville Ma 02632 10/16/16 page. City/.Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No ponding no break out 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.): 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Zeno Crocker Property Address Fran Boyer Owner ------------------------------ --------- Owner's Name information is Centerville Ma '02632 10/16/16 required for every _ . __--- -- -------- --------------- - --------------_— ---- --- ----- page. CityrTown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts _ w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10_9 Zeno Crocker Property Address Fran Bo er Owner -- —y-------------- --. Owner's Name information is required for every Centerville_ Ma 02632 10/16/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope a ❑ Surface water 2 ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft 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: 2008 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain.- El Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test hole data on plan_ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Assessitig As-Built Cards Page 1 of 2 TOWN OF BARNSTABUK LOCATION t6q Ga � P SEWAGE N C�- * VILLAGE_ -CeA-(,1 I(Q ASSESSOR'S MAP&PARCEL __/-A3 /y.;) INSTALLERS NAME&PHONE NO, i.v .e�,Jf,6 :e c Ah r c•.t i�r S pt 77r SEPTIC TANK CAPACITY _ 1 rw LEACHING FACILITY:(type)_.-1 11111 01( tt j{ (size)_9V_x- NO.OF BEDROOMS 3 OWNER�3v_ PERMIT DATE: 5 1 D b COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility IS �! Feet Private Water Supply We4 and Leaching Facility(If any wells exist on site or within 200 feel of leaching facility) _ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED 13Y D43 c 1. Pl<,. 5 1 T-i ��AE px t-IOVSE 133-r; 37'J' - 93 A-d: A-3= �b A,4^ 3T)„ -� Ns' httn //�uww t�wnnfliarnctahlr>.nc/AccFecinv/NTvlrli.rt�lav a.cti`)m�nt�at=17O14�X,.mci=1 1(1/14001 A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Zeno Crocker Property Address -- -- ---------- -----—---- Fran Boyer Owner O --- wner's Name - ----------------------- information is Centerville Ma 02632 10/16/16 required for every _ page. City/Town 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P# r (o Department of Regulatory Services s" ,,RNUMB i Public Health Division Date 144 y BIAS& 039.��� 200 Main Street,Hyannis MA 02601 —Date,Scheduled_ L� Time Fee Pd. ' Soil Suitability Assessment for Sewage Disposal I.a 1 Performed By: O�y 1� ►J �O�G�PrU�W +`J Witnessed By: }LOCATION& GENERAL INFORMATION Location Address Z2�oe CIlOc(�C �o( Owner's Name<W t 4 cemi ery l i l e Address j0/C �.9,9 U �`t/� Assessor's Map/Parcel: 7 Q / 42 Engineer's Name 1 W C©// 4C(40WF NEW CONSTRUCTION REPAIR w- ~/Telephone# Land Use F` I b C N T I i-L Slopes(%) D Surface Stones Distances from: Open Water Body O D t ft Possible Wet Area lw t ft Drinking Water Well U(/ ft Drainage Way 50 ft Property Line ft Other ft i SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 5"13133 �'1 1 II ff n 1 GROUNDWATER ADJUSTMENT k �I Im EXISTING GROUNDWATER LEVEL l 4 a n �. BASED ON TOWN OF BARNSTABLE 0 - Im GIS DEPARTMENT RECORDS. of I �t _ INDICATED` GW 33.00- -1 i I i' INDEX WELL SDW-252 ZONE T; z 0 READING DATE AAPRIL. 2006 I / READING 46.9 ADJUSTMENT 2.5 O ADJUSTED GW 35.5 t5t.B3 Ft r Parent material(geologic) R 0 6 L 4-61 A L ` OV IV RS(-f Depth to Bedrock „SON F— Depth to Groundwater. Standing Water in Hole: lV©N L Weeping from Pit Roe Im E Estimated Seasonal High Groundwater �E L 1T B OV-C DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: See Ghav-r Depth Observed standing in obs.hole: In. Depth to soil mottles: in, Depth to weeping from side of obs.hole:. in, Groundwater Adjustment fr. Index Well# Reading Date: Index Well level— Adj.thetor— Adj.Groundwater Level,, e PERCOLATION TEST Date SNd 4 Thne q A M Observation Hole# Time at 9" EL/ .Depth of Pert � 1� Time at 6" Start Pre-soak Time @ Time(91141) End Pre-soak Rate MinJlnch Imp f Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To'Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICVERCFORM.DOC 'SOIL TEST LOG DATE OF TEST: MAY 10. 2008 APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. iPERC NUMBER: 12226 NO TEST PIT I PAARENOTUNDWATE MAATERIA RNCOUNTE ED L OUTWASH PERC AT 64 in - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING Q I 55.55 0-6 FILL } B-14_ Ap SANDY LOAM 10 YR 3/4 NONE FRIABLE 14-30 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 53.05 30-132 C MEDUIM SAND 10 YR 6/3 NONE LOOSE j i. 44.55 C 5 . ( NO TEST PIT 2 PAARENTU MATERIAL: PROGLAC ALD OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 55.65 0-10 FILL 10-16 Ap SANDY LOAM 10 YR 4/4 NONE FRIABLE 16-32 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 52.98 32-144 C MEDUIM SAND 10 YR 6/3 NONE LOOSE - 43.65 - • ""'-`__-" IJJLf1 -.._._ - IYIUIIJGII .. 'Luu u..w.v,uwuw, Cnitec Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consi e Flood Insurance Rate May: Above 500 year flood boundary No •Yes Y _ Within 500 year boundary No-r- , Yes / Within 100 year flood boundary No� Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? p 5 If not,what is the depth of naturally occurring pervious material? _.. �. Certification I certify that on NOV (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 it_ the required training,expertise eaandd experience described in310 CNN 15.017. yjH OF titgss� Signature ") �cJ �.""�r" LS Te Date irna y L 2, d oo� D D. U � COUGHANOWt< • `�O "C E N S 10 QASEPTIGIPERCFORM.DOC ,� VA t U PLO 44 No. Fee q /V p, o� XHEALTH THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYtcattou for Mtgozal 6p5tem Cougtruction 30ermctt Application for a Permit to Construct( ) Repair N Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 5d `LA 40—q 1 D I i®q meenc fur ; CPa� 'vi �l�— t5 t-oclj* -EN40'r Assessor's Map/Parcel 1-7 0 1'LM q C r Installer's Nam�edress and Tel No Designer's Name,Address and Tel.No. 1 1�l?M Ntlboin1 r` r S L E-CQ-Ted Type of Building: Ij Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (_q Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) s sO ,o gpd Design flow provided 3 jd Q gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Natu a 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 Board of Health. , Signed 4, v Date Application Approved by E Date _S�— /�P— Application Disapproved by: Date for the following reasons Permit No. �O�i" I Date Issued � �'S�F--.+.. .- '�`,,, .,_1 . - . r -��.C.r,:-..-r^.,.�„--.. 4'"•a•,S""aJi'Hr"-."ye.,'. .-,...n..a=-�"":... ,�._, ,..:...�.�..- .. ..--' 1---- No. Z 4, ..'a Fee r /00, '' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 0_7C HEALTH DIVISION - TOWN�OF BARNSTABLE, MASSACHUSETTS Yes Zfp'rication for ]Diooal *pgtem Cott truction Permit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components t Location Address or Lot No. Owner's Name Address,and Tel.No.'50 _L4 r 0- 1ogmenoCf -�,O��,r Assessor's Map/Parcel 50 "7?(0 Installer's Name ddress,and Tel.No g�-�7�5 i Designer's Name,Address and Tel.No. 1C ►n NCO -T Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder > � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) Q O gpd Design flow provided ! �0 a�'� gpd Plan Date i Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil _ Nature of Repairs or Alterations(Answer when applicable)7( �J .� eQ-\ it. C-Tt - Q q 31, 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. . .Signed �L� "/"�..-, Date Application Approved by a // Date 4 `'7 Application Disapproved by: Date r' for the following reasons r Permit No. Z00 Gi" 9 y Date Issued = d —————————= ——————————————————————————————THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 3auerz- , Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by M \��r)`rl �Y S at)QCJ 7e,r'C C'S C)OC.eSL.. � l,, Q� ��Y l ,�Q has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Cl}R--IgO dated 5//91 Installer N"C-G1l b P-gey`! Designer G^cm�wcqNf2 #bedrooms Approved design flow gP d The issuance of this permit shall w Qc nstrued as a guarantee that the system yste ill function d gned. Date 5 ,, U Inspectors 1 4 —y—————————————— ___—_———————————————————————— No. O� Fees THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 3ovf� oqaY *p6tem �Congtruction hermit Permission is hereby granted to Construct ) Repair ) Upgrade ) Abandon ( ) System located at A Oq 1 r) OC�t(..�t�f' , (22x�Aex-V t ,CSC._ and as,described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date �� �y" 2 O d Approved by l Towle of Barnstable Regulatory Services } Thomas F. Geiier,Director * EAE.4SPASM y MASS. . Public Health Division i639. 1� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date:j�";-c- 0 Sewage Permit# �'if'��� Assessor's Ma p\Parcel Resigner: -C-D e.(J''1 Installer; U)(Y\"G T�i(�wn sc S �L Address: Address: SCAM. IC..Pn �'i! On X- C �i c�S�MS lk -was issued a permit to install a (date) (installer) ,P 1 ►C _ septic system at ZDC-CQ based on a design drawn by (address) e-c-� dated J- I -C)37 (designer) I certify that the septic system referenced above was installed substantially according to the design, which.may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. .I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but ui accordance with State-&Local Regulations-:-Plah revision-or - certified as-built by designer to follow_ i _ T Y N OF MgSS�o DAVID yes o D. X,4 !r1 COUGHANOWIR N (Installer's Signature) ��No. Tea G�STE�1�O LSgNITAR,P- (Designer's Signature) (Affix Designer's Stamp Here). PLEASE RETURN TO B-ARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WELL NOT..BE ISSUED UN7M BOTH THIS FORM AND AS-BUILT CARD. ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DI-VISION. TILANK YOU. Q:Health/Septic/Desiper Certification Form 3-26-04_doc TOWN OF BARNST ABLE LOCATION loci `2., ,, Cr c."l Ed SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. sed*c Service S'M '775' SEPTIC TANK CAPACITY ! rd0; LEACHING FACILITY:(type) R YC-t-gj Qj-y,,J[S (size) NO.OF BEDROOMS 3 OWNER 3a,U•ee- PERMIT DATE: Ja 1 Df COMPLIANCE DATE: �fdc3 0� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /s- 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 +�$5 c y.. 401c.- S id7- tA-� r QfP Ag a .f� �3�4 f A_5o Eft °° s� 4 /- \� THE COMMONWEALTH OF MASSACHUSETTS c) BOAR® OF HEALTH ............ ........ ..............OF.-- :} f .I -- 1 -I',�.�� J—•------•----------- D�i ApplirFation for Dispati al lar�) or Cann trurtinn amit Application is hereby made for a Permit to Construct Repair ( ) an Individual Sewage Disposal System at: �� 1 � `� .� G t ..............._......... .. -..... .............. . -- ----- ............. Location-Address ® ` or Lot No. A e� .'� ..... ..1�- fie. ' ^'-�---------------•--�---.•� ..1 �.1- ..... .1�.. ` —��._..... Owner./ ` Address -----------------------------------------------••---•-••-•-•--•---••-- Installer Address d Type of Building Size Lot...� feet Dwelling—'No. of Bedrooms............................................—, Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building ............................ No. of persons___--_-._--_-__-_-._-_____ Showers ( ) — Cafeteria ( ) Otherxtyes --••--••••-•-••-•---••----•-•••-•-•••••-•--•-•-•----.-•-----••--••••••••----•-•••-....--•-------•-•--•-••-•----•-•----•--•--•--••----•-•••-•--•----- W Design Flow.......... ........................gallons per person per day. Total daily flow--___-_-- --------_............gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench—No..................... Width ....... Total Length__.... ..............Total leaching area....................sq. ft. Seepage Pit No...._j-----_____.. iameter....... Depth below inlet. ........ Total leaching area.. 9...sq. ft. Z Other Distribution x ( Dosing tank ( ) _ Percolation Test Results Performed _. ............... Date....... Test Pit No. 1....4� inutes per inch Depth of Test it------ '..... Depth to ground water....... .............. GL, Test Pit No. 2................minutes per inch Depth of Test Pit__-_____----_____ Depth to ground water........................ --------------- O Description of Soil------------------�� ..:.. .. . . .. a_ j -Cam- t J ►� �.,2I u: .. V W U Nature of Repairs or Alterations—Answer when applicable................................................................................................ .-------•--•------....-•----•----------------------------------------------------------•--------•••-••-••-•--•--------------------•---------•-•--••••-•--•...---------••---------••-•---.............._. Agreement: The undersigned agrees to install the aforedescribed IndividuA Sewage Disposal System in accordance with the provisions of 1IT11 5 of the State Sanitary Code—The and g ed further agrees not to place the sy tem in operation u '1 a ertificate of Compliance has been su y t e r health. Signed.......... . •--•-- ...... •... .... ............. ................... _ Acation Approved By-•-•-•--•--•-•-••-•---••-•••-••-•-••-••..... .... .•.... ••••• ......... e Application Disapproved for the following reasons:. • •-••-----••-----••--•-•--•-----•--•---------------•---••-•-••----------•-•--•••----._...--••••............. ••-••--•-•-•-•-----•••-••------•-•----------------•••••-•-•--......-•-••-----••-••-......----•-.........•-•-----••---•••-•-•-•••--••--•-•-••......•--•--, ------------------------------------••------- Date Permit No.........IRS=4 � Issued Date No................_....... Fizs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................:..•.---------......OF... - ..? ... 1-. ..l...L' ..�' ..... �... ApplirFation for Diipuial Worka T. ustrnrtiun runfit Application is hereby made for a Permit to Construct l" ) or Repair ( ) an Individual Sewage Disposal System at: _ .............. - •---..............--•--...--•--•---............---......_._..._....... .-•-•-•-•----------••..............•-----••---•-•-----••--•••••------•--•----••--.....--•---...... Location.Address or Lot No. •_.. ....... Y.................................. _ __... Owner W —-'- 5...........................Address1 .........-- ! .- Installer Address d Type of Building Size Lot__—_ -' .... •_•!__i_ .Sq. feet Dwelling—No. of Bedrooms.......:�".................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............_--------------- Showers ( ) — Cafeteria ( ) aI Other.fixtures ------------------------------ - - w Design Flow_.......... ..........................gallons per person per day. Total daily flow............. -__�••'�_-_............_..gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__-_____-____ - Depth............_... x Disposal Trench—No. .................... Width.................... Total Length..... .. Total leaching area....................sq. ft. Seepage Pit No........ ........... Diameter.____._ .---- Depth below inlet. _�.��______ Total leaching area_ �...sq. ft. Z Other Distribution box Dosing tank ( ) ` `-' Percolation Test Results Performed b �.....,.2 �. . 4- ._.�___�_`� ........................ Date___.___!.?__ - yJ..... ` ' Test Pit.No. L__./_� inutes per inch Depth of Test Pit....... .._._... Depth to ground water_....................... Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_____.________•........ a ---------------------------------•-----------------•--•-----•---------------•-•--- D Description of Soil-----------------�• �" I `� '�C'` �� ��`� 1`' ........................... ✓f -�?• �i -L... ---- -- w ----•--- -•-•---- -•...--•--••-------••- x . U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..... ..-•--••-------------•-- Agreement: The undersigned agrees to install the aforedescribed Individu Sewage Disposal System in accordance with the provisions.of TITIE 5 of the State Sanitary Code— The and gned further agrees not to place the system in operation u l a ertificate of Compliance has been Ts3 dr y the �tr iealth. r r Signed. . .' .".... • ... Kea- v4a �-� A cation Approved By............................................ . •-- ..... -------- ......... Application Disapproved for the following reasons:. . ........................................-----•-•-•------•-------------•----•---•---•----•--•-------,..--•- - - - ------ -- ----•----•-----------------------------•-----------......_..-••••-•---. Date Permit No........ ". ............................ Issued , Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 9 HEALTH ......O F.... .. ... ... ('11rdif irate of Tompfiatta THIS S ® CERT . , That e Indivianal 5ewagA.,Disposal System constructed / r Repaired ( ) �/I v ` Installer has been installed in accordance with the provisions of TIT,IE 5 of The State Sanitary Code as descrikqd in the application for Disposal Works Construction Permit No.__ `"'_ "' ' _.__.__ da.ted__ .-�3' ------ IRS ------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.CO RUE A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. a DATE................. ---- ....... ... .................... Inspector-••---- .. -- ---ALA. THE COMMONWEALTH OF MASSACH ETTS .'•' BOARD OF HEALTH /................. �i���a�n1. n ��ann Sinn .ernti� Permission is/ereby granted... ,_..f�`._r'- �:. ®;I= --- to Construct ( ) or Repair ( ) an Individual Sewage Disposal. System ' at No..............................................' ....................................................................................................... Street as shown on the application for Disposal Works Construction Permit No M. t�¢____ D'ated...�_: - ._ ............... 9 ........................... --•----------------•-•• ••... ......------..._......••-•-- � �rd of Health DATE............. -..--- 7------.?-5....................................... ..............•---------......----- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS __. SITE PLAN SHEET] of 2 SCAL E: I = Z®' 6000 G A L, L Ks A C,AA (fit-r ?)I p. D " slKg A7rr, 1'lG '(AlJK O 5 I xL N C�zj to¢r�per17 (7 v%/L - F�- � I m !I s SZ)e � NI s M. �1 _ o WAPVV I(. II o No. 1977, �£GISTER��J��� L t P,aL- 'ram REGISTERED LAND SURVEYOR FOR � - ' ZONE ylL-L.s M A► PLAN REF. DATE BENCH MARK DATUM _- jr� ► L,.-2 WM. M. WARWICK 8 A530C., I,NC., DOMESTIC WATER SOURCE- 80X 80I - NORTH FAL MOUTH �O tJ - t—E �2!� FLOOD ZONE. �� G. MASS. 02556 — (617) 563 -2638 LO CATION / SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS &;ras r ca,ovT-rrcC) d UILPDIR OR OWNER e eL rv-ja-..f 6,"Lf -r'—DATE PERMIT ISSUED h /, 49 -DATE COMPLIANCE ISSUED %� ` _. ���� ��� w P��� `�R `Q 1 C ��d _ ` LEACHING BASIN SECT/ON NOT TO SCALE shce a7Z Z 24"C.I MH COVER EARTH FILL'la BRICK AND MORTAR COURSES AS R£OD• TO BRING 4„ 4"• ._ ._ COVER TO GRADE 8'FLOW LINE INLET 1_ _ __ __ _: 2 �8'' TO!1z..WASHED PEA STONE FREE. OF IRONS, FINES AND DUST/N PLACE OPENING W/TH 4%8" l ' 4 TO /k2"WASHED CRUSHED STONE. FREE OF �� ��• ' OUTER DIAMETER IRONS, FINES AND DUST /N PLACE ANO 1414" INSIDE • DIAMETER • ' I. CONCRETE TO BE 4000 PSI 28 DAYS 2. REINFORCED WITH 6%6° NO. 6 GA. W.W.M. X ` •' 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR I GREATER DEPTH REQUIREMENTS 4'0" —Iso ---�— �1 —� 4. NUMBER OF- PITS REQUIRED ONL MIN. EFFECTIVE DIAMETER NOTE: EXCAVATE TO ELEVATION 41 •A. OR (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL WArER rABLE - LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN TYPICAL PROFILE GRAVEL TO DESIGNED GRADE.. /B"STD. LT. WGT. C.I.MN COVER y3.o ..• 2.0 SI.a 5t:5 •'` 4"BIT.FIBER PIPE ,:: 4"C.GP/PE TIGHT ✓0/NT OUTLET LEVEL i OWEL L/NG _ FLOW L lNE 0 TO FIRST JOINTN� � C./. TEE /4 49' 001 I0 I /',, I If Q00 00 11 1 I '$r0. PRECAST CONC, y��q-I 1 1 I 0 00 00 1 1 1 1 000GAL.SEPTIC TAN : D/ST. BOX TO BE 49,0 I 11100 0 0 0 1 1 1 INSTALLED ON LEVEL, 1 1 0 0 00 1,1 1 1 STABLE BASE 1 I 1100 00 1 1 1 1 SEPT/C TANK TO BE 1 if 000 00 1 11 1 INSTALL D 0 LEVEL I I 110010 0 1 1 : 1 STABLE BASE. I logo 0 0 0 1 1 1 1 111100 001111 LEACH/NG BASIN Q BASE TO BE LEVEL i 1 0 0 0 0 1 1 , , SOIL AND PERC. DATA `'4' .4 '• �,� TEST PIT N0. f374,d 011 TEST PIT NO. 2 :.PERC.RATE : MIN. /IN. L1. -roll• /Sua5d1L :TEST BY �fLuc h�ELfl Sb•► JP/6•Tzav�(. . '.WITNESSED. BY m le"9Lu/A TEST PIT OR, EL._.`�x' SA V;7 DATE: I o z'07 /$ No G�.ovetDv.1 A�TF�S�Q,/ DESIGN DATA GENERAL NOTES BEDROOMS 3 .. NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. DISPOSAL No SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD EST. TOTAL DAILY EFFLt2_aGPD. PRECAST REINFORCED CONCRETE UNITS. SEPTIC TANK , aaa GAL. ALL .SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE SIDEWALI AREAGAL./SQ.FT. TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE, MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA _GAL./SQ,FT. SANITARY SEWAGE EFFECTIVE ON JULY 11 1977. LEACHING REQUIRED �� SQ.FT.. ANY -CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL,LEACHING AREA OF HEALTH. 7-4SSQ.FT. AT -COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. ' PITCH ALL SEWER LINES I/41 / FT. UNLESS INDICATED OTHERWISE. rpm, SEWAGE DISPOSAL SYSTEM moo`' • .MARTIN E. FOR' v MORAN 'Z Tc rJ O G 1p23417�Q 1Zoc-k-ir,-� CZ D ' �i��O,rE, G/S'i'i"c.�'G\�akk' �!V'1��V lLl. /Vl fc$•S . SS/DRAT EN SCALE AS INDICATED DATE- . WM. M. WARWICK 8.ASSOC•, INC. • BOX 801 - NORTH fAL M0vrH ` MASS. 02556 - l6ITl 563-26J8 PROFESSIONAL EN61NEER } CENTERVILLE. MA _ .. . CONTOURS , . .. Z —�\ \ m p EXISTING - - - - - - - 50 --/-- MINIMAL GRADING PROPOSED �° STONEY c LIFE RD o z W U —/— LOT 624 \ N o z + E5 2 J owe ' w --/ AREA = 18106 sF+- �pM W iN m m J CD m m --/ GAS ` AMES WAY -/ GARBAGE GRINDER 1 /- IS NOT ALLOWED ' GATE \ 55 z w> -- WITH THIS DESIGN. LINE �O 00 oS M A P GAS , O SCALE o mLn O w 1 ~ W J a+� ;i`+a`'i:c:i i` Ul N 3 1 15-P W (n z 1 o / m n L EGEND O(L d uJ, c , m d60&12-0 \ ❑ ~o _juz; �J z 3 �° I �/ ID m EXISTING <cn<- �W = w W Z ,, cn� 1 1 1000 GALLON U 3 j 0 �= 1 o f 1 O SEPTIC TANK w W} U � L, ° Z JIl 41 �� < _j O Z N o= 1B-D I 1� IO EXISTING LEACH I �� O CD z m m 0_° W < W w 1 7 O Q M X ���/ ll PIT/CESSPOOL jW w mm twn ° 1 �-� /'� I WATER m w= ❑ ?T ;:: w COO m m is) � / 3 U Q = w00 LINE ��GATE �\ TEST PIT ® D-BOX O CLl U W m f)_}: m I ���15-0 W A Z cc c� ° "' i co m �''—' p J w Q �, :;_:..,._y>; -I DECIDUOUS CONIFEROUS W rn_z `—' Q z I TREE Oo TREE >e Q z J CD m z , Z� + Z QQ 1 I I 1 d �12-M *2-P W W Ljj LL O Q X jLn �+ 1 4 -NUMBER REFERS TO DIAMETER IN Ln 41 0 Z ry��-y� (V N 1 y I I I INCHES. LETTER DENOTES TYPE. p~p (n ILL W N m 1 12 P I O-OAK M-MAPLE P-PINE C-CEDAR W Z I w LL i U] o 1 I vw z o I G�R�GE ® TP-2 _ � � I p� x _T F�o 55 1 CO TP-1 ® Lp,B I NON I �cNOFiygs jHOF1y� (n Cn U w Zzw 0`' DAVID you, o`' DAVID 'ems OU D. = F p 3 ?z 1 O I <ti\ �\ I COUGHANOWR " COUGHANOWR W z O T �, * O 1 Q No. 1093 15-P �f1� \ QF �O SO 4/CENSER W W Cn 03 + c� ri 0o{J / G13TE� / �O T (Y Ln Z m 1 15-0 \\ S N 4 E V U P a W > (o N m 1 / NI Ln W ff w w z Z 151.83 fr ---4�--- -- ®e ��� SEWAGE DISPOSALRVE S NSYSTEM S E M PLAN J � (� 24ftX12.5FLX2fil << z J I— LEACHING GALLEF?Y EST. STUART AND FAY BOYER 0 p C7 m < U OWNERS OF.RECORD ° LL i,, � FLAN �°� 1995 109 ZENO CROCKER ROAD X r ( CENTERVILLE. MA (� � � W A D_ SCALE.- 1 20 F t 11 Z + � Y �®�01�� PROPERTY ADDRESS O BENCH MARK '0 0 20 40 43 TRIANGLE CIRCLE ASSESSORS MAP 17 0 PARCEL 142 SANDWICH MA 02563 PLAN BOOK 386 PAGE 93 O Ln c, TOP CORNER OF DECKX 0 10 20 z z ELEVATION = 58.�4 508 364-0894 Ics DATE: MAY 12. 2008 z W X W BARNSTABLE GIS DATUM -joe #ETE-2931 PAGE 1 OF 2 VERSION: I- W w THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. r e _ SOIL TEST 'LOG � . . v . DESIGN CALCULATIONS DATE OF TEST: MAY 10. 2008 APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461, DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT, SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS PERC NUMBER: 12226 USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL 1 CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) TEST PIT 1 PARENT GROUNDWATERENCOUNTERED AL OUTWASH DISTRIBUTION BOX: USE 3 OUTLET D-BOX. PERC AT 64 in - 2 MIN/INCH IN C SOILS SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft. LEACHING GALLERY CAN LEACH ELEVATION AboL = ( 24 x 12.5 ) = 300 sf DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER A s d w = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sf (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING At-ot = 446 sf 55.55 0-6 FILL Vt- 0.74 x 446 = 330.04 GPD 6-14 Ap SANDY LOAM 10 YR 3/4 NONE FRIABLE USE A 24 Ft- x 12.5 ft. x 2 f't GALLERY. Vt = 330.04 GPD > 330 GPD REOUIRED 14-30 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 53.05 44.55 30-132 C MEDUIM SAND 10 YR 6/3 NONE LOOSE LEA CHING GALLERY 1000 GALLON SEPTIC TAW USE SHOREY PRECAST 500 GALLON NOT TO DIMENSIONS AND DETAIL NOT TO LEACHING DRYWELL (H-10 LOADING) SCALE USE EXISTING H-10 IIVIT SCALE TEST PIT 2 NO GROUNDWATER ENCOUNTERED PARENT MATERIAL: PROGLACIAL OUTWASH CONSTRUCTION DETAIL SEPTIC TANK IS TO BE PUMPED DRY 2 MIN/INCH IN C SOILS DRYWELL UNIT AT TIME OF INSTALLATION AND IS TO S T O N BE EXAMINED FOR STRUCTURAL ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 24.0 Ft INTEGRITY. INSTALL NEW PVC OUTLET (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING TEE EQUIPPED WITH A GAS BAFFLE. 55.65 m 0-10 FILL � TAPER 10-16 Ap SANDY LOAM 10 YR 4/4 NONE FRIABLE m,, L Lq 16-32 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 4 v N N - 52.98 32-144 C MEDUIM SAND 10 YR 6/3 NONE LOOSE 4 �0 43.65 0 � 3.5 f t B.5 ft 8.5 ft 5 f t Lo GROUNDWATER ADJUSTMENT 24.0 Ft- EXISTING GROUNDWATER LEVEL BASED S DEPARTMENT RECORDS. 500 500 GALLON DRYWELL B >^�_6 In A �� DIMENSIONS AND DETAIL INDICATED GW 33.00 INLET OUTLET • INDEX WELL SDW-252 USE H-10 l9VIT INSTALL ONE INSPECTION COVER COVER s ZONE D z .z zz.A z.z z.z.z....... z z.A...<w.z a .... READING DATE APRIL. 2008 RISER TO WITHIN THREE 3 IN DROP READING 4 6.9 INCHES FINAL GRADE —► �l FLOW LINE + AND INDICATE LOCATION = ADJUSTMENT 2.5 ON AS-BUILT PLAN FROM 10 14 TO ADJUSTED G W 35.5 BUILDING in D-Box 4s in LIQUID GAS N O TES,E'S LEVEL BAFFLE �0 33 00 00 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. o0000000000 00�00 In 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED o0000000o DO FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 00 0 0 i� CROSS SECTION VIEW 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 1021 OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. CROSS SECTION VIEW SEWAGE DISPOSAL SYSTEM PLAN 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND REMOVED. 2 in PEASTONE 2 in PEASTONE 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. -TO SERVE EXISTING DWELLING 0 0 Zl ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES z41^ STUART AND FAY BOYER AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. 28 1iz�, vTz TMr1vE 1-112inGRAVn 26 8) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT In 109 ZENO CROCKER ROAD CENTERVILLE, MA . PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 46 In 58 in 46 in ECO-TECH ENVIRONMENTAL 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 150 in STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH APPROVEDTITUTE AN EXTILE 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. FA13RICLINR MAY B PLACE OFSTHE 2 1 PEASTONE LAYER SPECIFIED. ETE-2931 I MAY 12, 2008 212 ALL SYSTEM COMPONENTS SHALL BE NOTES SYSTEM PROFILE �t MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88 Gr\ o ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE pr a� a 2. MUNICIPAL WATER IS EXISTING FILTER FABRIC OVER STONE \\ \ TOP FOUND. EL. 53.8 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. D io \ 52.0' 2% SLOPE REQUIRED OVER SYSTEM 51.0 MINIMUM .75'�OFCOVEROVER PRECAST WATERTEST D'BOX FOR LEVELNESS BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST e p PRECAST H-10 MIN. 2" WALL THICKNESS PRECAST RISERS UNITS TO BE AASHO H-L 51 .4' 4"OSCH40 PVC COMPONENTS �rQ Locus ,:. PIPES LEVEL 1ST 2' �ENDS INVERT IN 47.54 (TYP') SIDES 48.33' S. PIPE JOINTS TO BE MADE WATERTIGHT. cue Chopp4 IN ACC DANCE " EXISTING 14" ���� ®�0 �[��0- �00 >o°o°g°o° 6 CONSTRUCTION DETAILS TO BE OR o U' n 10 WITH 310 CMR 15.000 (TITLE 5.) TEE SEPTIC TANK** TEE 50.Ot'* a o 0 6" MIN. SUMP ;og00000 a 00000000000o O >°oo°0000 ,�00000�000� 12" MIN. INT. DIM. ° ®®�®�®®®®®® �C.��(]O�0®®�® ° ° ...,Cc a ;0000a000 m=!Imm��0��� :000000007. THIS PLAN IS FOR PROPOSED WORK ONLY AND GAS BAFFLE::` 47.77' 47.6' °o°o°oog 45.5 ° ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY a �� OTHER PURPOSE. Q S uio H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. d 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Rome 28 Fuller R ALL AROUND PRECAST STRUCTURES 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [21) o CONCEALED WITHOUT INSPECTION BY BOARD OF 6 HEALTH AND PERMISSION OBTAINED FROM BOARD (5•`}% SLOPE) ( 1 % SLOPE) OF HEALTH. FOUNDATION- EXIST. SEPTIC TANK 41' D' BOX 12' LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FACILITY CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & ' BOTTOM TH-2 * SEPTIC TANK SHALL AT 1 LON 00 GALLONS NO GROUNDWATER FOUND WORK LOCUS MAP LOCATIONS UTILITIES PRIOR TO COMMENCEMENT OF THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL AND ITS SUITABILITY FOR RE-USE. 11. ANY UNSUITABLE MATERIAL ENCOUNTERED NOT TO SCALE BUILDING SEWER OUTLETS AND REPLACE WITH 1500 GALLON SEPTIC SHALL BE REMOVED 5' BENEATH AND AROUND THE ELEVATIONS PRIOR TO INSTALLING ANY TANK APPROPRIATE TO SITE PROPOSED LEACHING FACILITY. PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE ASSESSORS MAP 170 PARCEL 142 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. LEGEND- 99 - EXISTING CONTOUR X 99•1 EXIST. SPOT ELEV. 131 .33 -[991- PROPOSED CONTOUR BENCHMARK COR BULKHEAD LOT 624 SYSTEM DESIGN. 198.41 PROPOSED SPOT EL. EL. = 52.8' 18,105f SF GARBAGE DISPOSER IS NOT ALLOWED TH1 TEST HOLE ° 52 EXISTING 3 BEDROOM DWELLING 2� SLOPE OF GROUND G DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD G -- G G USE A 330 GPD DESIGN FLOW (D UTILITY POLE V FIRE HYDRANT GO NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING N � SEPTIC TANK: 330 GPD (2) = 660 **RE-USE EXISTING 1000 GAL. SEPTIC TANK LEACHING: HOLE LOGS I r� r�� / SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD TEST _ ; ; EXISTING 1 I r DWELLING / Q BOTTOM 25 x 12.83 (.74) = 237 GPD ENGINEER: DANIEL E. GONSALVES, SE #13587 I TOF = 53.8 / O TOTAL: 472 S.F. 349 GPD W w DECK D STANTON, RS W W f -� o WITNESS: DAVI Z � _ _ _ _ USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 12/20/16 � DATE: 0 o / < 2 MIN INCH � GARAGE / � WITH 4' STONE ALL AROUND PERC. RATE = I �� \`, 3 .4' SLAB it � W CLASS I SOILS P# 15224 I _ j ELEV. ELEV. H F MA �J 4 , d 1 TH2 F STONE C) APPROVEDDATE BOARD OF HEALTH opt 51 .0' 0" 51 .0 o _ EXISTING LEACH DRIVE A A PIT FOUND DURING -7 51 \ SL LS SOIL TEST 10YR 3/2 10YR 3/2 / �o o TITLE 5 SITE PLAN 7" 699L _ w SL LS 5� 83' _� N 109 ZENO CROCKER ROAD 30" 10YR 4/4 48 5, 3410 10YR 4/4 48.2 CENTERVILLE, MA \ PREPARED FOR C C BORTOLOTTI CONSTRUCTION PERC BOYER MS MS DATE: DECEMBER 20, 2016 10YR 7/4 10YR 7/4 N of � M � s N OF Mgss off 508-362-4541 gssy fax 508-362-9880 ,P�. ,o ��, � DANIELA �� Asa q�y o DANIEL DANIEL..A m\ downcope.com OJALA a DANIELA G A. OJALPI =� CIVIL o OJAtA � , OJALA No 409ft0 own cape engineefinB ift. No.46502 q " CIVIL No.40980 �, q �r l 126" 40.5' 126" 40.5' o F p � � A � o- � �- �55\0 civil engineers ,o GrSI � � �' Op, �q OQ'� }. > s NG T� Grs F �� q S RJR y F o �c { -SS\ d V WATER ENCOUNTERED Scale: 1 = 20 ° land surveyors NO GROUND N� ° ss �_; SURv V Y T 939 Main Street ( Rte 6A) �w ��w � � ANAL �`� �,�, , �_ ®� o 0 20 30 40 5o FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 16-402 BORTO-BOYER.DWG