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Home My WebLink About1035 SHOOTFLYING HILL RD - Health 035 Shootflying Hill Rd Centerville A = 191 235 0mr,ford, NO. 1521/3 ORA ;:�. 10% Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F� 1035 Shootflying Hill Road w o r Na n Address nUU1Cs5 Marc Boulay Owner owners Name information is req red for every C Centerville MA 02632 12-5-19 page. y Town State Zip Code Date of Inspection s 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 No�tr OFPr.7;�q�� filling out forms A. Inspector Information ! /cp3 p� ,,��,,, .•' q�y on the computer, use only the tab James D.Sears = JAMES key to move your Name of Inspector :rn cursor-do not Ca ewide Enterprises use the returnW 0 p :'� Company Name 49 key. C , •.•,� \� 153 Commercial Street /y/��`yls INSP�G��`�� I Company Address �� Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1• ® Passes 2. ❑ Conditionally Passes 3• ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails r -Ij 12-5-19 pector's Signature Dete 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.726/2018 Title 5 Official nspectlon Forth;Subsurface Sewage Disposal System-Page t of 18 abed RJ dH W90 6 WE 60 Oa0 Commonwealth of Massachusetts -� Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1035 Shoofflying Hill Road Property Address Marc Boulay Owner Owner's Name information is Centerville required for every MA 02632 12-5-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary:Complete 1,2, 3,or 5 and all of 4 and 6. 1) 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: The system is a 1000 Gal.Tank 0 Box and three chamber's 2) System Conditional) Passes: y y ❑ 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, NO)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 exfiftration 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 ❑ NO (Explain below): t5insp.doc•rov.7/26l2018 Tale 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 2 of 18 Z a6ed xed dH Z0:90 6 WE 60 Da(] i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1035 ShootFlying Hill Road Property Address Marc Boulay Owner Owners Name information is required for every Centerville MA 02632 12-5-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: Mnsp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurtace Sewage olsposal System•page 3 DI 18 £ a5ed xed dH 20:80 61.0Z 60 Oa0 Commonwealth of Massachusetts Title 5 Official Inspection Form 1.Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owners Name information is required for every Centerville MA 02632 12-5-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 5insp.doc•rev.712 612 0 1 8 711le 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Lt 8 abed xed dH Z0:80 6 1,0E 60 OaQ c Commonwealth of Massachusetts t I Title 5 Official Inspection Form �ISubsurface Sewage p sal System Form-Not for Voluntary Assessments �V 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owner's Name required on is Centerville MA 02632 12-5-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in his less than 6"below invert or available volume is less than 'Y2 day flow /_ 9 ❑ ® 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 tributaryto a surface water supply. ® Any portlon of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 I I of a public water supply well i5insp.doc-rev.7/262018 Title 5 officia.Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 5 a6ed aced dH Z0:80 61,0E 60 Xl0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1035 Shootflying Hill Road L Property Address Marc Boulay Owner Owner's Name information is Centerville MA 02632 12-5-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered".yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)1 151nsp.doc rev.71262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 9 a6ed xeJ dH Z0:80 6102 60 O-Q Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments VV � 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owner's Name information Is required for every Centerville MA 02632 12-5-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Description: 1000 Gal. Tank D Box and three chambers, Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2017-56,000Gals g ( y g (gp ))' 2018-40,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5lnsp.doc•rev.712 612 01 8 Title 5 Dfhcisl Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 abed xed dH £0:80 660E 60 080 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1035 ShootNying Hill Road Property Address Marc Boulay Owner Owner's Name information is required for every Centerville MA 02632 12-5-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/personslsq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes,discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ ❑Yes No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7126,12018 Title 5 official Ir.spectlon Form:Subsurface Sewage Disposal System•Page 8 of 18 9 a5ed xed dH £0:80 6l•02 60 380 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments .� 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owner's Name information is Centerville MA 02632 12-5-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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) ❑ lnnovative/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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: 2002 - Permit #2002-551. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 28"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.); Pipeing is 4" PVC 'SCH -40. t5lnsp.doc•rev.7126/2016 Title 6 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 6 a6ed xed dH E0:80 6 XE 60 0@0 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owner's Name information is required for every Centerville MA 02632 12-5-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 18" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal.Precast H-10 Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 14 11 How were dimensions determined? Asbuilt -TapeSludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank at working level. Tank and covers atc18" below grade. Inlet tee w/outlet baffle. No sign of over loading or leakage. Note:Tank to be maint pumped after inspection. 15insp.doc•rev.7128l2018 Title 5 official Irspection Form•.Subsurface Sewage Disposal System•Page 10 of 18 o l, abed xed dH E0:90 61.0Z 60 080 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owner's Name information is required for every Centerville MA 02632 12-6-19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cost.) 7. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7126/2018 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 11 of 18 6 6 abed xed dH t,0:90 61.0Z 60 Da(] y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owners Name information is required for every Centerville MA 02632 12-5-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is H-20-22"x22"-32" w/one line out, Box is clean and solid w/no sign of over loading or solid carry over. 15insp.00c•rev,7/26:201e Title 5 Official Irspection Form:Subsurface Sewage Disposal System•Pape 12 of 18 26 a5ed xe� dH b0:80 61,2 60 MCI Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owners Name information is required for every Centerville MA 02632 12-5-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology: t5insphoc•rev.7126/2018 Title 5 Official Inspection Fvm:Subsurface Sewage Disposal System•Page 13 o118 £ a5ed xed dH t,0:90 6 602 60 Xl0 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owner's Name information is required for every Centerville MA 02632 12-5-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . 11. Soil Absorption System (SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is three 500 Gal. dry well chamber's. Chamber's at 3' below grade.Wet bottom w/no sign of over loading or solid carry over. 12. 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.726/2018 Title 5Of8dal lnspection Form:Subsurface Sewage Disposal System•Page 14 of 18 {,t a5ed xe:1 dH b0:80 660Z 60 �aG i Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owner's Name information is required for every Centerville MA 02632 12-5-19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5lnsp.doc•rev.7l28/2018 Tine 5 OfAclal Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 �� a5ed xeJ dH b0:90 660Z 60 Oa0 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u— 1035 Shoolflyinq Hill Road Property Address Marc Bouiay Owner Owner's Name Information is required for every Centerville MA 02632 12-5-19 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 A ' /3 A-3 13-3 9� a I t� -�r tNrtsp.doc•rev.7/28/2018 Title 5 official Inspection Form:Subsurface Sewage Olsposal System•Page 18af 18 gt a5ed xez! dH VOW 6We 60 DaG Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owners Name information is required for every Centerville MA 02632 12-5.19 page, City/Town State Zip Code Date of Inspection D. System Information (conQ 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells �✓� Estimated depth to high ground water: 10+ 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health- explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Auger T.H. 10'no G.W.. Bottom of chamber's at 5-6". Bottom of chamber's at 4'-6" above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. *6 sp.doc•rev.7126)2018 Title 6 ONcial Inspection Form:Subsurface Sewage Disposal System-Page 17 of IS L 6 abed xed dH b0:90 61,02 60 OaG Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,f 1035 Shootflying Hill Road Property Address Marc Boulay Owner Owner's Name Information is required for every Centerville MA 02632 12-5-19 page. Cityrrown State Zlp Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification; Signed &Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included " f^�fnMg£es 41 Nd Gw t t5insp,doc rev.7/26,12018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 gt abed xeJ dH 90:90 660Z 60 080 TOWN OF BARNSTABLE LOCI.TIO.N fJ�S� �140/ / �� i" , SEWAGE# VILLAGE C /IiPUr lie— ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. isE e V SEPTIC TANK CAPACITYOV LEACHING FACILITY: (type) (size) 1..4 NO.OF BEDROOMS 7 BUILDER OR OWNER 08,24 A®lll g Z PERMITDATE: t Do- 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 I aching facility) Feet y .Furnished b __ - -� �� 1 ,, r �°�(' _ � �� . . �, .�°� �: � � `'•� �- �' `s -�. ��//�� cam` r No. GUD �`�' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mioponl 6potem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /633-_%06r17jr>hj A, Owner's Name,Address and Tel.NA. S�O d ) Assessor's Map/ParcelC'e/t m-✓t He 1 /'?� dT K V ,�- (Gy IZL Installer's Name,Address�and Tel No. Designer's Name,Address and Tel.No. e,(Le�o 3� Y�SG r �, e�►��r173-01 °7 Type of Building: Dwelling No.of Bedrooms _ Lot Size�. sq.ft. . Garbage Grinder( *16 Other Type of Building No.of Perso s Showers( ) Cafeteria( ) Other Fixtures Design Flow Y yd gallons per day. Calculated daily flow �� gallons. Plan Date Sl!!,Q /G_200 Z Number of sheets l Revision Date Title I Size of Septic Tank /.D7jo Type of S.A.S. o Description of Soil 1'd� Lr/� de- >O 3 5!� ' 40^,0 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this and of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. ZOQ 2 -SS-I Date Issued C�Z r �No. !�O ' Fee �� L E.: THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 21pplication for Mi.5paar *paem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.fp. Assessor'sMap/Pazcel �e''t t�f✓ 1 ( /'� � ��K � 1JPj�„ QpcJ Gy Installer's Name, /IA/Iddres ,and Tel.No. Designer's Name,Address and Tel.No. 141 C/Q E'/ CEO W C ►�.Q(\kt•ti 3S-, Y2 w L Type of Building: Dwelling No.of Bedrooms LottSize ` sq.ft. Garbage Grinder'( `P G Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow k/ gallons per day. Calculated daily flow s&O gallons. Plan Date Se01~" /G 200 Z Number of sheets Revision Date Title Size of Septic Tank &yc, Type of S.A.S. tZ t,_-tllj _J Description of Soil I o'� r G./ �� C 3 y 0 n.0 k, 2 f �P✓Q Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Aoard of Health. Signed _ �G.�.e? Date / t " o Application Approved by Date LI-18—0 2 Application Disapproved for the following reasons Rermit No.� ZOO?- -S S( Date Issued ' ' g 0 2 t --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (compliance ✓, THIS IS TO CERTIFY, t -st at the Onte Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by C40 S r- at d S)i of 6 7- i has been constructed in accordance with the provisions of Title 5 and the for Disposal System onstruction Permit No. 2qp Z`SS( dated 11-17-0 2 Installer 14101.k-If ri (16 e/s V- Designer C h"iof *V-*v I h m The issuance of this permit shall not be construed as a guarantee that the syqW will function=di ed. Date l�� 7��'2 Inspector c>+..l' 4, Q-t --/�------------------------------------- No. `6 2 --S-5-1 Fee SU ..__. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi!6po$al *rae Con!5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon ) System located at D 3 S�,oa7- .. 1, /& C�Qti >-fr./4 Ae _ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this - Date:_ I t- (R-D l_ Approved by TOWN OF BARNSTABLE LOCATION 10 3.r SEWAGE # VILLAGE ��/l it /� ��' ASSESSOR 'S MAP& LOT - INSTALLER'S NAME&PHONE NO. /�`�is Ae V SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type)-7'S d!9 (size) /.I f X —7—?- , NO.OF BEDROOMS 7 BUILDER OR OWNER 0,0,-4 ! 0111,s1/ PERMITDATE: COMPLIANCE DATE: I I/d7/0- Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) JZ— Feet Edge of Wetland and Leaching Facility(If any wetlands exist Ut within 300 feet f 1 Ching facility) Feet Furnished by ZL 1 � � 1 PROVIDE PRECAST CONCRETE EXTENSION s,DIA.oun ET(S) /TOP OF FOUNDATION=56_02' RISER AND COVER TO VATHIN 6'OF FINISHED REMOVABLECOVER GRADE OVER OUTLET 4"SCHEDULE 40 PVC T@J rTWSH GRADE OVEii Dsax=50.40' FINISH GRADE @ FWD.EL" 54.50" FINS,GRADE OVER TANK EL.= 53.60'-54.20' f ((rYPICAL MK��v� 48_28 36" EXISTING 4- PVC PIPE Y DROP M01 PROVIDE WATERTIGHT 3' 3"DROP MAX. r 9" 4"PVC IN FROM .ttXNfS(TYP.) -SEPRC TANK 4"PVC OUrTO o 14' 7FI�� ' LEACHING FACILITY Y go 51.28' (COR o0 ( - FY) C C SHALLVERIFY) 48.53' 1r 48 36' r CONTRACTOR TO VERIFY 4ir E 10.0 EXISTING SIZE OF TANK AND FILTER B"CRMEaCHONE A ICAL OOMPACT HAMC:ALLY VARIES EXISTING TEES 1801 HIP COMPACTED BASE LE ON 5 OUTLET DISTRIBUTION BOX TO BE INSTALLEDON A STABLE BASE.flRSTTW FEET OFOUTLEf Z46.2'8'- EXIS TIN 1000 GALLON CONCRETE SEPTIC TANK PIPE$TO BE LAID LEVEL 3- LENGTH 8r WIDTH 4.10" DEPTH 57 CROSS SECTION VIEW TYPICA SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL NOT TO SCALE NOTTOSCALE 'tom_ CB(F I s MAP 191,PARCEL M9 WF DUNNETT B.M. Caldl Bain EXTERIOR LIGHTS Elev.=S0.00f . CONTRACTOR TO VERIFY Atsume0 684 ar LOCATION OF BURIED POWER 1�3 W � / New 20'x 30' GARAGE l KHchen Addition c � h m g MAP 191,PARCEI-235 0.SPN;y T GA)V= N' _ 30,913 SFt HSE 51035 I � , BEDROOM •:i_._. / L DWELLING TOF=56.ar • I 'V -TP1 v 'O SU-327WE 31ZOg h DtsTweunoN- //�� h J �.I�P f�(ISTING LEACHING PIT B� AND FILL WATH CLEAN SAND-1 r /1 (,✓ V INSTALL THREE 5004AL INFILTRATION CHAMBERS-- .I MAP 1 EL026 N/F WIWNS i-- -- -- - SITE PLAN SCALE:1"=2V - LOCATIOtl.l : 5EW&C;E PERMIT 1J0. VILLAGE 1NSTQLLERS U&ME 6 ADDRESS - tea _ C /113-RA �- - - - - BUILDER 'S Q &MF- ADDRESS OQTE PER"VT ISSUED D A►TE COMPLI &MCE ISSUEC) : g--2-�'-77 C`�R�GL n 37f No..........._%y ._ FES......� -..... THE COMMONWEALTH OF MASSACHUSETTS BOA!RD F' HE T .......... - l..°.. . ------..OF......... .... ...'✓r ...lv Appliratiun for Di,ivuual Works Tonarn.rtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: l �Q. r�.yr. l -- �c nd w - ----------------•------ Location--�ddress Q.A. .�. !---•. ......... :....... o_ _! ...... °.� � - -. �l..s Owner Address /� Insta ler Address � u UType of Building Size Lot. ..t00.0.....Sq. feet Dwelling—No. of Bedroo s-__-.----._,�..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ......... --......•-----•-------•-------...-•--•---•-•---------•-••-•---•-------------•------------------------•--••--•••......--•---..... W Design Flow .. .... .... ........ ......gallons per person per day. Total daily flow........3. .. ...................gallons. WSeptic Tank—Liquid capacityl.Ogallons 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 (` ) •--O/— W Percolation Test Results Performed by....( -a: l.-1., i'2ti.... ...7. .................... Date.._,_. Test Pit No. 1---- .......minutes per inch Depth of Test Pit.................... Depth to ground water--_______--j�a.`- rXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... ....... water........................ .... ... ........... ... .....................c( .... V -------------------------------------------- .--•------------------ •---------------- .-------------------- .------------------------------------------------------------------------------- .------------- W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ......................................-................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI L LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issue by . e and of heal tl Signed,, ... ..:.•... ........-•----.... --•• ............. ....... Date Application Approved BY ��'i ,L � f: .............. �_`" ............ Date Application Disapproved for the following reasons: -----------•--•-----•------- ..............•---•-••.......••-•-•-•--••••-••---•---•••-----•--•--••-•------•••-•------•-•••------•...--•••-•••-••---------•-•--•---- --------•-••---•----•---------•-•-------••............-----••---- r .7 Date Permit No..... Issued_... _ --�----� ................... Date FEs......f.................... e, THE COMMONWEALT ;OF MASSACHUSETTS BOARD 9F H E T .....oF...... wQ ppliration l ar BWVnii al Workfi Tomitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or.Repair ( ) an Individual Sewage Disposal System t .... -------- ----------------- .................................. r �Lo a n ,y 11 r Lot No r d- - : caner Add s �J .-___ O Installer Address Type of Building Size Lot...Z40v4 _0....Sq. feet U Dwelling—No. of Bedrooms........... -•--_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .....i__•-_-_•I______________ No. of persons---------------------------- Showers ( ) Cafeteria ( ) dther i to es --------•--------------------------------------------•--------•-----------------------------------•-------•--••-•--•----••-•-------------_---_----_-_. Desi n Flowr. ___: allons per person per day. Total daily flow........' ..................gallons. w { g - --- ------=ObtVg P P P Y• Y �--�- W 3 '"Se ptic Tank—Liquid capacityJ.-•_-__-_gallons Length................Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below filet..................... Total leaching area_.................sq. ft. Z Other Distribution box (: ) Dosing tank ( ) '-' Percolation Test Result Performed by.. 1. --__lhr _-.__ .` .__....__.•........ Date._ F � aTest Pit No. 1................minutes per inch Depth of Test Pit—------------------ Depth to ground water............ 4t__. Test Pit No. 2................minutes,per inch Depth of Test Pit_::_;..._..._..___.. Depth to ground water........................ - R D Description of Soil---•- ... -•-------- /---- --�"+� `�'' G�r� U 6... P _ _, ... a x w x U Nature of Repairs or Alterations—Answer when applicable______.:. ................................................................. Agreement: The undersigned agrees to install_'-the aforedescribed.Individual,Sewage Disposal System in accordance with the provisions of-,YffI 5 of th&State,.Sanitary.Code ' The undersigned further agrees not to place the system in o 'eration until a Certificate of'Com liance has be iss e b e ard•of healK. P � P � Y� P f_'• Date - e Application Approved BY--•-- yy! �' `'' ` .... ? -. . ..77 ••... Date Application Disapproved for the following reasons------------------------- ------------------------........................................................ 3, Date Permit No........................:..... Issued ------------------------•--•-------•----•--- r„ :. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ALTH -�+.- O F.........:.:...... ......... t (Infifirtttr of Tour rlianrr THI IS TO 13IFY a* the Individual,.Sewage Disposal System constructed ( ) or Repaired ( ) by •--••----.... ,.r � In 11 --------- at-•••------•- - f .._... ....�_...._ AWL f� ��•- ••. --• .................................. >. has been installed in accordance with the proviions of T�� r7 5 o The State Sanitary Code as described in the application for Disposal Works Construction Permit No� 1______________ da.ted_... _ ..._ '....�.�......_._._....._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS7U AS A.GUARANTEE THAT THE SYSTEM WILL FUNCTION-SATISFACTORY ...................................DATE . Inspector . ' THE COMMONWEALTH OF MASSACHUSETTS 7y BOARD HEALT_- No......................... FEE...1 ....:......... - Permission is hereby granted--• 0•---•---------- ---------- ------- ........... .......................... to Constr ep )` a I I ual Se age Disp „S s � atNo.._ ;.,'� !��-.- x� ..�.-- ---- - --•-•-• .......................... Stree ".� as shown on the application for Disposal 4�or s Cons ruction Per o ted..` ?~ ---- -•- - ------ -- _ s. Board of ealth DATE........-----=----------••••....--••••-•-••-••---•--•---•---•=-•--•---•--•--• FORM 1255 HOBBS & WARREN, INC., PUBLISHERS i i P.T �,y r+-�. L Q "� / i 1-• Y �7(tom. ` + ra..r., I i eh i . � I I u i r CEZT17 GMtZ Tt 1=Y T"AT TNt= 5"ow►J 4 t-- �•i.! ��i�RE�.1G t 162 M V, .J COAAPL-eS WIT" T"S 311D'G U WE-- Aua SE'r)BAGV V?CQOtiZEkAEflTS bF TNT -TO VJ LI OV= 42-s,� p. Lam. ' . - g!!-+5,. �3 A.XT T"ts VLAi,•.f le.,- UOT tbA51rn A.a! C?STEQV�L.0 ca r4CASS. 11+f5�1'i�t,J1L1�.l.i �jl1i�'Vi;.Y �'T1�t Cu��Ltrr ;tic-lr.f1S7 APPt..t (:.�..!-J'T' o a:r --et4 04l:;. L.oT 1. -4,2_ �4 N Q�Ti�t T No 61,9R43 r4GE' 6"/'/NIA E,Q SE�TiC T•9/1',Ca 3�o x'/,�'a,%= Usc ir�Qr G.4�. S/Dps WALL /5?E'EfJ = /.SD.5 r. To 7',-7 L DES1G/Y = S'C f?0, To r. L .1;W14 y W -•; .3 4 G, R.A • ELEV. ►o o.o0 F le F �,t nJg. Ola TO a ot'1. Ll OL7 •9G.6vu. gG.oz ly.t • Laas q 7.00 %, 006 ant,. day,= 94,:30 `A�r TAN VL GERYt ,000 t'aAL 1 q a,do LO a p a too L� � �'stoNw L O `T b 4 potToM GJ-1.5' ao wn T e.R ND 5'C19L. r TOP OF FOUNDATION = 56.02' PROVIDE PRECAST CONCRETE EXTENSION 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS= 50.40' - 49.70' ��,��RAL NOTES RISER AND COVER TO WITHIN 6":OF FINISHED REMOVABLE COVER ' SLOPE @ 2% MIN. OVER SYSTEM GLADE OVER OUTLET FINISH GRADE OVER D-BOX= 50.40' 4" SCHEDULE 40 PVC MIN SLOPE 1% 3/4" TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE . FINISH GRADE @FND. EL.= 54.50" FINISH GRADE OVER TANK EL= 53.60' - 54.20' 1 UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION 2" OF 1/8"TO 1/2" DOUBLE WASHED STONE - METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN. ACCESS COVER � TOP OF SAS= 49.11' PLACE RISERS ON ALL CHAMBERS (TYPICAL FOR 3) 36"MAX. TO 6"OF FINISHED EXISTING 4" � � 9 MIN. GRADE 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE D _ -c 48.2$ 36"MAX. BREAKOUT EL = 4$.7$' OF HEALTH AND THE DESIGN ENGINEER. ,;--PVC PIPE _1..-_ � 2" DROP MIN. PROVIDE WATERTIGHT 3. 4' SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL - ___---- 6.. 3., 3,t DROP MAX. 3tr 9�t i BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. -_ -------1 i JOINTS (TYP.) o o p 10 0 0 0 0 000 �oCo o � � 4" PVC IN FROM o � � O C� � o0 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN 14" ' 5 O3' SEPTIC TANK 4'PVC OUT TO o 00 00 0o ELEVATION =48.78 FOR A DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. UNLESS �'! .2$' T LEACHING FACILITY o0 0 o A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF I (CONTRACTOR o � 0 � 0 0 , 0 0 0 � � r o C� THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. (CONTRACTOR SHALL VERIFY) 48.53' 12 2 �� 0 0 0 0 1 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SHALL VERIFY) �-- OUTLET TEE MIN. 4$.36' � � 0 � 0 � 0 0 �� o I CONTRACTOR TO VERIFY 48 � � o o �I C� o 0 0 E.� 0 6, THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 10.0' --� EXISTING SIZE OF TANK AND 22"ZABEL FILTER o 6' CRUSHED STONE', Qo 0 o L o VARIES EXISTING TEES MODEL#A1801 HIP OVER MECHANICALLY (GAS BAFFLE 1 COMPACTED BASE 4'/ - -1 - 8 5' I 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED 4' 4' PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND BOTTOM) 5 OUTLET DISTRIBUTION BOX 33.5' 4.9' READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED I --- _----- --- _ �� (TYP.) TO BE INSTALLED ON A LEVEL STABLE < 39 5' 12 9, _ WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. GROUND WATER ELEV.- EXISTING 1000 GALLON CONCRETE SEP-'FIC TANK BASE. FIRST TWO FEET OF OUTLET 46.28 I PIPES TO BE LAID LEVEL. 3 - 500 GAL. CHAMBERS 5'MIN. 8. ELEVATIONS BASED ON ASSUMED DATUM OF 50.0'MSL OBTAINED LENGTH 8'6" WIDTH 4,10„ DEPTH �'.7" CROSS SECTION VIEW FROM NAIL IN POST AS SHOWN ON PLAN. SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER [ �(',,C�� L CHAMBER END VIEW CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION NOT TO SCALE NOT TO SCALE NOT TO SCALE THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY I - - I ,� I Fes ^ Nos TEST �-y� DATA DISCREPANCIES TO THE DESIGN ENGINEER. qN" w €- L�T`t 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE ji STRUCTURES SHALL BE MADE WATERTIGHT. INSPECTOR: SOIL EVALUATOR: Samuel Philos Jensen 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR 1 *: * ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN j DATE: August 26, 2002 q I "� � `by � � IT SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 1 N. + ;�*` d' TEST P #: 1 -. I _ 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UN ELEV TOP- 50.48' LESS f LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH ELEV WATER=_ >1 V BGS CASE THEY SHALL WITHSTAND H-20 LOADING. PERC RATE = < 2 Min/In (Assumed) 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND W. E. � I, yam . � , �' �* FINES. CB/FND -' re' � I DEPTH OF PERC N.A. j t, 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND F f i TEXTURAL CLASc': 1 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN i COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN * * ACCORDANCE WITH 310 CMR 15.255(3).0 50.48' I ,» Lo�imy Sand i A 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES 10YR 4/3 FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. MAP 191, PARCEL 029 # * » , �,;� ",;,j * 4t. 50.15' 16 PROPOSED PROJECT IS LOCATED WITHIN: N/F DUNNETT a. Loam Sand B Y ASSESSORS MAP 191 PARCEL 235 1 G Y R 5/8 44 * 28" 48.15' 17. OWNER OF RECORD: NARDONE, ROSAMOND C 'i�, _ B.M. �'' �.. * '^^;e;; t �� , � ,:�` �, ' ADDRESS: PO BOX 732 „„ * ► ' 101 EAST OCEAN DRIVE#403 _ Catch Basin * . r "' / +� * � '�� ■ KEY COLONY BEACH, FL 33051 EXTERIOR LIGHTS Elev. = 50.00' #'" MEd. Sand CONTRACTOR Assumed * '' „ .,. .. �� , ,, 1� R 5/6 I t TO VERIFY � . ...:;., . , ,. _ _ , s��... ,,:..... fl .. II TPI L1 i C 7 _. -ID COURT rl �2F,-__RF�I�E. __4654.2 ! FN S84'°32'20"E LOCATION OF BURIED TOWER ': _ 9 !� 306.13' a x � 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. i No Groundwater 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY LOCUSI c D I n n' Encountered FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY i V �.J y 1 L/"l' V 132" 39.5' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. SCALE: 1" = 1000' i W EXISTING GARAGE co DECK v' � DESIGN DATA00 LEGEND M LEGEND t- MAP 191, PARCEL 235 j 'ate x ._ ..,. 30,913 SF± I � `�'�-� ' �I-!�:I „Rb,,v., �� _,t�, EXISTING SPOT GRADES HSE#1035 I ata EXISTING CONTOUR EXISTING 4 NUMBER OF BEDROOMS PROPOSED T GRADES lei4 50 SPOT NUMBER OF PERSONS 4 BEDROOM DWELLING 4� �� ,� y y""may" DESIGN FLOW 110 GAUDAY/BEDROOM 0 PROPOSED CONTOUR "° s� 4.,' .. L.._ l „` r �.. TOTAL DESIGN FLOW 440 GAUDAY TOF = 56.02' �' N - , Eli - --- E/T/C EXISTING ELECTRICAL UTILITIES ;TP 1 - _.__- �;' <j DESIGN FLOW X 200 % = 880 GAUDAY EXISTING GAS LINE USE EXISTING 1000-GALLON SEPTIC TANK " 48 cr? "~W Cn � Y �-� __.._... _ _.._._w.�. EXISTING WATER LINE y �r qxs � 1rt - [t Q 5r - w r"7 TEST PIT LOCATION --� <C INSTALL 3- 500 GAL. CHAMBERS -- N O O EXISTING SEPTIC TANK �! o L� SIDEWALL CAPACITY --- -- i S84°32'20"E 312.09' --� 4" SOLID SCHEDULE 40 PVC PIPE �`c (LENGTH + WIDTH) (2) (2' HIGH) (.74 GPD/S.F.) = GAUDAY , J ❑ DISTRIBUTION BOX (33.5' +12.9') (2) (2') (0.74 GPD/S.F.) = 137.3 GAUDAY >- �O 500 GAL. LEACHING CHAMBER DISTRIBUTION S BOTTOM CAPACITY F'UivlP EXISTI�►C:; L&hCH!NiG p f- BOX `}Z� f11l`f 6..% Fig.L_�'Vl yl 1-1 �.LL./'ZIV V/t'Yt.ti ..•, / J L (LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY 1 9/26/02 JLC JLC NAME AND DRIVE LL (33.5'x12.9') (.74 GPD/S.F.) = 319.8 GAUDAY REV. DATE BY APP'D. DESCRIPTION �r INSTALL THREE 500-GAL INFILTRATION CHAMBERS MAP 191, PARCEL026 OQ PROPOSED SEPTIC SYSTEM UPGRADE N/F WILKINS TOTALS: PREPARED FOR: _ MARC & DEBRA BOULAY TOTAL NUMBER OF CHAMBERS: 3 _ TOTAL LEACHING AREA: 617.7 SQ.FT. LOCATED AT TOTAL LEACHING CAPACITY: 457.1 GAL-/DAY 1035 SHOOTFLYING HILL ROAD CE NTE RVI L LE, MA 02632 SCALE: 1 INCH = 20 FT. DATE: SEPTEMBER 16, 2002 IHOF 0 10 20 40 80 FEET r JOHN L. - g CHURCHILL PREPARED BY: Na J4t8G7 JC ENGINEERING, INC. CI`9L 5 ROUNDHILL BLVD. SITE PLAN ___ _------ ---- EAST WAREHAM, MA 02538 508.273.0377 SCALE: 1"=20' Drawn By. SPJ Designed By: SPJ Checked By: JLC JOB No 274