Loading...
HomeMy WebLinkAbout0039 ZENO CROCKER ROAD - Health 39_ZENO CROCKED.RD, CENTERVILLE A= 170101 III J��ECYCLF�co y UPC 12543 p� HASIINOS, MN k/ F 1 No.Clw f —A9-�5 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphration for Bisposal&pstrm Construction permit Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 5 Z 4^C> Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address and Tel.No. DUigner'sName,Address and Tel.No. %CokA t"\ Geo✓� `'3 Oki Y0�r^-o" 1-)G%J\ j C,CV iXve\O ./ S s z.v CZ s Cv kA-4 r e. Type of Building: 3(y\( ® X" 4 Dwelling No.of Bedrooms Lot Size �{� sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3® gpd Design flow provided 2?D . % ( gpd Plan Date (aP 1 t k C C% Number of sheets "X Revision Date Title Size of Septic Tank t°uj5k C.pp {{;C7 Type of S.A.S. C,�G.(, t CL! A.%(,•-<S Description of Soil Nature of Repairs or Alterations(Answer when applicable):1P1_1k1Ak1 VA A C o G�1 X r C� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage Y disposal system in P 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. igned Date �'�f ci /f Application Approved by Date / Q Application Disapproved by Date for the following reasons Permit No. '— Date Issued ---------------------------------------------- ---------ri No.cam/( '_" 5 Fee C/v THE C6MM9NWE LTH OF MASSACHUSETTS Entered in computer: Yew PUBLIC HEALTH DIVISION'='TM1 N OF'BARNSTABLE, MASSACHUSETTS t gpplication for -MistlDkiAY.0tyBtrut Construction j3erinit Application for a Permit to Construct( ) . Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address oroLot No. 3 d Z.C^o c-row-Af rZj Owner's Name,Address,and Tel.No. Assessor's Map/Parcel `ems (ram` C r 5 ICA Installer's Name,Address,and Tel'No. Designer's Name,Address,and Tel.No. sC-GkA M 1; 1��3 ��� y�C�Mn��'`2 pave C0V C—, 0 f CUPki't,CI Type of Building: �6 3 6 q `( Dwelling No.of Bedrooms Lot Size / 5—sq.ft. Garbage Grinder(I W Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ) gpd Design flow provided 7-�/1 , t C t gpd Plan Date (� 1 ��G Number of sheets Revision Date Title Size of Septic Tank i �5, c n nn f{ C� Type of S.A.S. �Z0 L E t �a Description of Soil Nature of Repairs or Alterations(Answer when applicable) r ��1 N O 1 )a �,� pr��x o Date last inspected: q 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. Signe Date Application Approved by Date! ` Application Disapproved by Date for the following reasons C" i ��y-��,� ? ��; Permit Noo_ C J 1 � Date Issued ----------------- ---- ------------------------------------------------------------------------------------------------------------- . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired L/I Upgraded( ) Abandoned( )by S C 1 nJ1 in r-r- V� at C'j 24 4C r• 0 r N br- ( as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No���lated Installer� r U -j/t Designer V t (� „r,,� % , f- #bedrooms Approvedjwlnctio w gpd The issuance of this perm t shall not be construed as a guarantee that the system designed. Date Inspector v t No. __ 1r, Fee ` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposat l6pstem Construction permit Permission is hereby granted to Construct( ) Repair(f Upgrade( ) Abandon( ) System located at c n (? 4l -e Ar .P ru/ Le and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must beompleted within three years of the date of this ermit. Date tI Approved Town of Barnstable Reguhatory Services Ricllaiq V.ScIali, Intei-irn Director Public Health Division Thomas McKean,Director 200 Main Street,1,1yannis..MA 02601 Office: 508-862-4644 Floc 508-790-6304 Installer&:Designer Certification Form Date: 7/2/19 Sewage,Permit# AssessoCs Nlapllarcel 170/101 Designer-: David D. Coughanowr RS I listaller: az Address: 155 George Ryder Rd South Address: r ot P-1-N Chatham, MA 02633 4� 4-Ott-1107i 11� —wits issued a permit to install a (date) (installer) .septic systell, at 39 Zeno Crocker Road (address) based,on a design drawn by David D. Coughanowr dated 6/11/2019 (designef) I cc)-tif-'y that the septic system referenced above was installed substantially according to the design, which tra y inc-hide minor approved changes such is lateral relocation of the distribution box and/or septic tank. Strip Out (if.' required) was inspected and the.soils were,fOLUld satisfactory. I certify,that the septic system referenced above was installed vvith nlajor chaliges ()x, greater than:10'.lateral relocation of the SAS.or any vellical relocation otany component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to fbilowi. Strip out (i if rcqtfired) was inspected and the Soils were found satisfactorv. I certify that the systern referenced above was constructed in.compliance with the terms of the INA appr val.letters(it'applicab)e) 'S o' "'c "I)"'. v' DAVID DOO, D� —, g (Installer's Signature) A) 6 COUGHANDPiR No,. 1 3 (Designer's Signature) miner's Start t PLEASE RE TUItNI TO BARNSTABLE PUBLIC H EAlJ H DIVISION. CE Wrl IFICATE OF CONTPLIANCE. WHA, NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVEDBY THE—BARNSTABLE PUBLIC FfEALTH DIVISION, THANK YOU. Q)ASeptie\Desig,tier Certificatik)II I-()nTj Rev 8-14-13j1()c TOWN OF BARNSTABLE LOCATION Z l) CrOCRUt r PCJ SEWAGE# / VILLAGE' ' -Cr%j 1 V C--ASSESSOR'S MAP&PARCEL O ~ /®( INSTALLER'S NAME&PHONE NO. S CO �cc�.yt, S'fjJF��i��F ®b L�J SEPTIC TANK CAPACITY' ( x[!� l b y 6 (..,,c,( P OO 0 a IS)c LEACHING FACILITY. (type) ;) R(O <-00 4-s L ;(size) Gj,c rv► 6-crS } ' NO.:OF BEDROOMS � s OWNER+€' }�TJk ck !t an G, 3--K a' PERMIT DATE: Ch�( �! ' I "" COMPLIANCE DATE: Separation Distance Between the: l t 'Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet k Private:Water Supply Well and Leaching Facility(If any wells exist on site or Within 200 feet of leaching facility) Feet Edge of-Wetland a 'Leaching Facility(If any wetlands exist within ' 300 feet of leaching facility),' Feet FURNISHED BY � 'V 3 02 a i w ;L-z sq.G 0 47� cki Z 144 Town of Barnstable P# -p 7- 11-4q- Department of Regulatory Services BAB:NSTAABLt Public Health Division Date MASS. t6Sq �� 200 Main Street,Hyannis MA 02601 Date Scheduled. ;Tum e- 16 , 20 9 Time Fee Pd. b. o _. Soil Suitability Assessment for .Sewage Disposal PerformedBy:DA-V1D Witnessed By: Disvic) U LOC"ATIO & GENERAL INFORMATION Location Address 2e 7 0 C i oc—(Ice r Rd Oii tar's?Name I I h .100111101 Ce�+Pr v ; l� ll chr,iS+evSeh Address °i e e r R/ � Zeno C m k 4 Assessors Ufa �Parczl: p 170 G l D Engineer's Name G e n•t-Cl v, (1 e r m A 0263 IRh Q"V,Cl' ('00� BL✓�^ NIEW CONiSTRUCTION REPAIR Telephone r 57 0 T 3 6 4 O 4 y Land Use ����4P fit l Ci� L-q h/dl Slopes(Y.) D Surface atones \ NO n Distances from: Open Water Body ��� � ft Possible Wet Area �0 4 fi Drinkin.Water Nve11 I U d 4 ft Drainage W.., 90 ft Property Line `o fi ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes 8 pere tests;locate wetlands in proximity to holes) 5 A. V vy �y V-4 107 501 ZeK0 G�OG��'r 12o(tdx 1 Yl O h c° Parent material(geologic) i`0 ' / v / 1N G h Depth to Bedrock Depth to Groundwater: Standing Water in Hole: V�0 4 6- Weeping from Pit Face 116 Estimated Seasonal<High Grouruiwater V40 f e J—]L q-) 13 Z l V1 4.0 m $0,r1 gee DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Vq 01'h Depth Observed standing in obs.hole: in. Depth to soil mottles: ro me-°t+ 73 2 in. Depth to weeping from side of ohs.hole: in. Groundwater Adjustment ft. Index Well 4 Reading Date: Index'Well level Adj.factor Adj_Groundwater Level PERCOLATION TEST 'Time lU Ark Observation Hole 0 ,F Time at 9" V1 Depth of Pere Q O Time at 6` Start:Pre-soak Time v_oq/ Time(9'-6'') End Pre-soak 90"G _ Rate Min-Anch Site Suitability Assessment: Site Passed ,Site Failed': l' Additional Testing Needed(YEN original: Public'Health Divisrora ; OGsetvatiori'Hole Data-To Be Coiltpieted on Back----------- t ,y ***If Percolation test is to be conductedxw1thin-.1.00.1W wetland,you n1uSt first notify the Barnstable Conservation Division at least one (1)'week Prior to beginning. Q:\SEPTICtPERCFOR=VI.DOC DEEP,OQBSER�'AT I�\?HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulders. Consistency.°!$Gravel) p G AP 10�fz '/3 6ao►te- 'Fr•a We -27 e w l.oavhy 5,q44 toOCe, 27- t-S2 C t' kiVV-h 5CM 10KR 514- Leo DEEP OBSERVATION HOLE LUG ..._. Hole#% Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Vlunsell) Mottling ; (Structure;Stones,Boulders. Consistericv'�Io Gravel DEEP OBSERVATION;°HOLE LOG :x. . Bole Depth fiom Soil Horizon Soil Texture ,Soil-Color Soil Other Surface(in.) (USDA) Nuiisell) — `'Mottling (Structure_Stones,Boulders. `Consistenec_°lo Gravel) i j l l "DEEP OBSERVATION IIOI'E LOG ' -Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnicture,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Ajap: / Above 500 year flood boundary No— Yes V Within 500 year boundary, No V/ -Yes Within 100 year flood boundary No J 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" qe5 Ifnot,What is the depth of naturally occurring pervious material? Certification v ,�cH OF A jyss. I certify that on �0J, t j i 5 (date) p raluator examination approved by the Department of Environmental Protecti, than e aGo s lysis.was performed by me consistent with the rztluired trainin expert' ncl exp i,3�e�� � � h1R 15.017. #46� Signature Qa� m tIcgpzpdEo 2- -.Date 10, 2©i EVAl uP� Q:';S3 PTIC`,P1 RCFOR-M.DOC D AT E:__ ---- 9 -- PROPERTY ADDRESS: 39"_Zeno Crocker_B,QaLL___ —_ Centerville Mass 02632 ------------------------ On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 gallon septic tank, 120 /©/ 2 . 1—Distribution box . 3 . 1-1000 gallon precast leaching pit . Based on my Inspection, I certify the following condltl• /, , 4 . This is a title five septic system. ( 78 Code ) �, ./v�l ltok 5 . The septic system is in proper working order V j at the present , time . to*VoFe o 1gy4 6 . Waste water is 47 below the invertobftbhe leaching pit . AzQ'tgTq 7 . Septic tank should be pumped annually. Garbage disposf is present . 6.` e SIGNATURE: 1 Name:_,L �. e4���z.�7r------- Company: Jose.2h_P. Macomber_& Son , Inc . Address:_ Box-66_- Centerville , Ma . 02632-0066 -------------------- Phone:...508_775_3338_ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY FJOS�EIPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENvIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 39 Zeno Crocker Road NameofOwner Joanna Toth Centerville ,Mass . 02632 Addre"ofOwnw:23 Edward Go—Ty Lame Date of Inspection:11/8/9 9 South Weymouth ,Mass . 02190 Nameofirmpecta:(Pleasel'trint)�J— h P MacomberrJr . 1 am a DEPapprowed system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) �Pa+yN�: P.Macomber & Son Inc . Mailing Address: ox enterville .Mass . 02632 Telephone Number: S n R—7 7 S—1 3 3 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the Information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _i Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspectors Signature: , Data: /A47 The System Inspecto shall submit a c14Vaopy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department oKinvironmental Protection. The original should'be sent 1oVW system owner and copies sent to the buyer, if applicable, and the approving authority. . NOTES AND COMMENTS revised 9/2/98 Page Iof11 Printed on Recycled Paper 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:39 Zeno Crocker Road Centerville ,Mass . Owner: Joanna Toth Date of Inspection: 11/8/9 9 INSPECTION SUMMARY: Check A, B, C, or D: A. 'SYSTEM PASSES: 4111� I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was Installed within twenty(20)years prior to the date of the Inspection; or the septic tank, whether or not metal, Is cracked,structurally unsound, shows substantial infiltration or exfiitration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Al Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced - The system required pumpirtg-more than four-tmes is yeardue to broken or obstructed pipe(s). The system wi h ss—r inspection if(with approval of the Board of Health): - - broken pipe(s)are replaced obstruction is removed 7 revised 9/2/98 P2ge2of11 A � t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 39 Zeno Crocker Road Centerville ,Mass . Owner: Joanna Toth Date of 4upection: 1 1/8/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _wz� Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and 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.PRQT.ECT THE PUBLIC HEALTtLAND SAFETY AND.THE DiVE0NMENT: Cesspool or privy is within 50 feet-of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: .JLO 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance AML (approximation not valid).- 3) �O♦/THER f�/yA /✓� A /A revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM WSK-CTiON FORM PART A CERTIFICATION (continued) Property Address: 39 Zeno Crocker Road Centerville ,Mass . Owner: Joanna Toth Diu of Inspection: 11/8/9 9 D. SYSTEM FAILS: You fuust indicate either'Yes' or'No' to each of the following: I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The basis for this determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of*swag 9 Irtto4ecllity-or-"ttem component-dueqo an overloaded ormleg god'S:AS•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 e.distrib��box above outlet Invert due to an overloaded or clogged SAS or cesspool. Liquid depth Iri essepeel is less than V below Invert or available volume Is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(:). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for •►coliform bacteria,volatile organic,compounds, ammonia nitrogen-and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either 'Yes" or 'No' to each of the following: The following criteria apply to large systems In addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No / !/ the system is within 400 feet of a surface drinking water supply the system•ie-within 200 taeto!-N+ibutary-to esurfaoa drkilciwg water.su►ply• -_ -- - 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 39 Zeno Crocker Road Centerville ,Mass . Owner: Joanna Toth Date of Inspection: 11/8/9 9 Check if the following have been done:You must indicate either"Yes" or "No" as to each of the following: Yes No Pumping Information was provided by the owner, occupant,or Board of Health. None of the system compownts. n pua►wd+f�o atJeast-Iwo-aweaka awd the system hasbaaav�cai9iag wwsal tiow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components,=e+ecluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on:- Existing information. For example, Plan at B.O.H. _ Determined In the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)) _ The facility owner.(and.ocrupaats—H diffaraot fraaLz marl ware prmrided with InMcmat oaDn tha proper^+brans^A of SubSurface Disposal Systems. 7 I i t i revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreas: 39 Zeno Crocker Road Centerville ,Mass . owner: Joanna Toth Date of kupection:11/8/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow:IRg.p.d./bedro Number of bedrooms e igp Number of bedrooms(actual): Total DESIGN flow �V, Number of current residents: Garbage grinder(yes or no): Laundry(separate system) ( as Oro If yes, separate Inspection required --. Laundry system inspected ( e, or no) Seasonal use(yes or no): Water meter readings,if available(last two year's usage(gpd): %`1`f% 09-tg Sump Pump(yes or no):�/0 j 8= �'�mC� rya ,Eon' Last date of occupancy: COMMERCIAL/INDUSTRIAL: A� Type of establishment: Design flow: A) 4pd ( d on 15.203) Basis of design flow Baspt Grease trap present: (yes or no) Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no)A Water meter readings,if available: Last date of occupancy: A1;? OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of i formation: IL�7 14VRUA a System pumped as part of inspection: (yes or no)AW _ If yes, volume pumped: �/ gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool � Overflow cesspool XZ Privy kr Shared system(yes or no) (if yes, attach previous inspection records,If any) I/A Technology etc. Attach copy of up to date gperation and maintenance contract Tight Tank Copy of DEP Approval Other NA APPROXIMATE AGE of all components, date instaNed{if known)-and source of.Mformation: Sewage odors detected when arriving at the site: (yes or no) revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress:39 Zeno Crocker Road Centerville ,Mass . Owner: Joanna Toth Data of Intpection:1 1/8/9 9 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: cast iron 40 PVC_other(explain) Distance from private water supply well or suction line IJ Diameter_4 Comments: (condition of joints, venting, evidence of feakage,-etc.) - Joints appear tight No Pyidpncp of leakage qysi­ is xrented through the hou se vent . SEPTIC TANK: (locate on site plan) Depth below grader Material of construction:Zoncrete4i netal4oFiberglassA//QPolyethylene.5Qother(explain) NA If tank Is (natal, list aa)ge���� Js.aage.con_firmed by Certificate of Compliance (Yes/No) Dimensions:�t%Oy/1:Y1/L` fv r�r�ll Sludge depth:, r~� Distance from top o�,�judge to bottom of outlet tee orbaffie:�i Scum thickness: L - Distance from top of scum to top of outlet tee or baffle ..ss��tl Distance from bottom of scum to bottom of outlet t e or baffler I � How dimensions were determined: Comments: (recommendation for pumpin , condition of inlet and outlet tees or•beffle s depth-of liquid level in relation to outlet invert, structural-integrity, evidence of leakage, etc.) ump septic tank annual'Yy� _ . . Inlet & outlet teesaare in place Iiauid 1PvP17at the n„rlar invarr ; �q fifr_y nna of 1Pqkqge ar a e i Septic tank should be pumped . G-tEASETRAP: e. Heavy solids & scum layers are present . (locate on site plan) Depth below grade: AM Material of constructionMconcretetalFibergiass {Polyethylene.dother(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Grease trap is not�)present . revised 9/2/98 Page 7of11 .,7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddresa: 39 Zeno Crocker Road Centerville ,Mass . Owner: Joanna Toth Date of Inspection: 1 1/8/9 9 TIGHT OR HOLDING TANK:A&L(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: vA Material of construction-Aconcrete4lAmetaWAFibergl ass Wolyethylenq Aother(explain) A/$ .11R Dimensions: NA Capacity: gallons Design flow: WA gallons/day Alarm present�A Alarm level:_Alarm in working order:Yes4A No&,4 Date of previous pumping: Ly` Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tight or holdinQ tahks are notpresent . DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:�� Comments: (note-if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) — — istribution box has one lateral - No evidence of Gnlidg rarr:I� nvar _ No avi dpnrp nf—leakage into or out e€ the bem . PUMP CHAM8ER:L)d41Q, (locate on site plan) Pumps in working order:(Yes or No) 1 Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and ypurtenances,etc.) Pump chamber is not present . revised 9/2/98 page sorii l I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 Zeno Crocker Road Centerville Mass . Owner: Joanna Toth Date of Inspection: 11/8/9 9 SOIL ABSORPTION SYSTEM(SAS):�/ (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: 1 leaching pits, number: leaching chambers,number: 6 leaching galleries,number:7 leaching trenches,number,length: leaching fields, number,dimen hone: overflow cesspool,number: Alternative system: n , Name of Technology: i6a-;vS Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to mPdi um cnnrQP grand , NA signs g€ hydFat}j4e €e ' or =nndi nS, Sn; l S aFA dFy , Vegetati9 pipe . CESSPOOLS: e- (locate on site plan) Number and configuration: 6 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 (cesspool must be pumped as part of Inspection) Cesspools nrP npt presnpt . — Comments: (note condition of soil, signs of hydraulic failure,.level of pending,condition of,vegetation, etc.) esspools are not nrPSPnt _ PRIVY:.lJl. (locate on site plan) Materjals of construction: If� Dimensions: .1& Depth of solids:[} Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) Privy is not =rPCPnfi revised 9/2/98 Page 9of11 r } SUBSURFACE SEWAGE DISPOSAL SYSTEU INSPECTION FORM PART C SYSTem WFOR>.IAT10N(eorstinuad) Prop.MAddr.u: 39 Zeno, Crocker Road Centerville ,Mass . °~r"'(j Joanna Toth 11/8/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: . Include tlas to at least two permanent relsrence landmarks or benchmarks locate all walls wlWn 100 (Locate where public water supply comas Into house) �7' 9i revised 9/2/98 Pate 10 of 11 3 9 Z -e C /lock PAP 'IPA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddreu:39 Zeno Crocker Road Centerville ,Mass . Owrw: Joanna Toth Date of Impaction: 1 1/8/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record bserved.Site(Abutting property, observation hole, basement sump etc.) e Determined from local conditions Checked with local Board of health Checked FEMA Maps _zchecked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used,.,,Water Contours Map . Gahrety & Miller Model 12/16/94 revised 9/2/98 Page 11of11 I F. :•nrnr•..-n.•.-►*-rr�srnrmr•nssnn�.na�.rm+ri:'srt+�rrr�rre+r+Rn nrrnt+nr�+ataT .r.n-rr-.rr.+r•-:....,.r•} TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I•••TJ'1^T". ::f-T.IIT.^.T.TT1.1Sr11f'n.'1TI TI1riRt7nT1'7:T{Z�'ItRRl� 1-T�RI�iRf�lAl�t�'IR7 "MI, 'TI•T'TT+It� •^ -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 39 Zeno Crocker Road Centerville ,Mass . 02632 ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Joanna Toth PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber� & So-fF Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 1 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : System PASSED ' The inspection which I have conduc ted has not found any information which indicates that the system fails to adequately protect public heRlLh or the environment as defined in 310 CMR 16 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con acted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . "e V g Inspector Signature , Date ,•,�P- ne copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEAL1'ii. * If the inspection FAILED, the owner or.."operator shall u pgrade ' the system. within one ,year or the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 . partd .doc T,=4 TOWN OF ARNSTABLE jOCATION �1�dAe4l SEWAGE # _ VILLAGE ee&" !V% YA� ASSESSOR'S MAP & LOT 11VSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY At) LEACHING FACILITY: (tYPe) l/mi ) T r (size) EGA NO. OF BEDROOMS _ BUILDER OR OWNED 7 I�'��1 PERMITDATE: 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 fee o ac g facili ) Feet Furnished b �/ r i I .c Commonwealth of Massachusetts Executive Office of Environmental Affairs IF Dept. of Environmental Protection ,John Grid One winter Street,Boston,Ma. 02108 D.E.P. Title V Septic Inspector P.O. Box2119 Teaticket, MA 02536 (508)564-6813 WILLIAM F.WELD Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION API? 2 7 1998 Property Address: 39 Zeno Crocker Rd.Centerville Map 170 Lot 101 Address of Owner: w HEgFBgRNSTqg Date of Inspection: 4122198 (If different) LTHDEpT LE Name of Inspector: John Graci At Johnson:Box 71 Centerville I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) e ✓ Company Name,Address and Telephone Number: 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes This Inspection Is based on criteria defined InTltleV _ CondFmita ses code 310 CMR 16303.My findings are of how the system is performing at the time of the inspection.My Inspection does — Needaluation By the Local Approving Authority not tImplytic y any end any origts eompon nth userul of the vityofthe Fails Inspector's Signature: Date: 4i23198 The System Inspector shall sy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection If the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04@7H7) One Winter Street • Boston,Massachusetts 02108 a FAX(617)556-1049 • Telephone(617)292-5500 r l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 Zeno Crocker Rd.Centerville Map 170 Lot 101 Owner: Al Johnson:Box71 Centerville Date of Inspectlon:4122I98 _ Sewage backup or.hreakout.or hlah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health).Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D) SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to(lie surface of the ground or surfeco waloi s duo to an dvei 100ded 01 Clogged cesspool. SAS is in hydraulic failure. (rerleed 04r17197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 Zeno Crocker Rd.Centerville Map 170 Lot 101 Owner: Al Johnson:Box71 Centerville Date of Inspectlon:4127199 D]SYSTEM FAILS(continued) Yes No 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply — 1 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. trevlasd"271911 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 39 Zeno Crocker Rd.Centerville Map 170 Lot 101 Owner: Al Johnson:Box71 Centerville Date of Inspection:4122199 Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: . _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if dtfferent from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is — — unacceptable)[15.302(3)(b)] (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Add ress: 39 Zeno cracker Rd.Centerville Map 170 Lot 101 Owner: Al Johnson:Box71 Centerville Date of Inspectlon:4127199 FLOW CONDITIONS RESIDENTIAL: d/bedroom for S.A.S. Design flow: 330 g p Number of bedrooms: 3 Number of current residents: 1 Garbage grinder(yes or no): Yea Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: nia COMMERCIAL/INDUSTRIAL: Type of establishment: nia Design flow:a gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: nia Last date of occupancy: We OTHER:(Describe) rds Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Na System pumped as part of inspection:(yes or no)Ne If yes,volume pumped:a gallons Reason for pumping: nia TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no)_( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date Installed(if known)and source Information: 1986 Sewage odors detected when arriving at the site:(yes or no) No (revised 01127)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 39 Zeno Crocker Rd.Centerville Map 170 Lot 101 Owner: Al Johnson:Box71 Centerville Date of Inspection:4l22fg8 SEPTIC TANK: x (locate on site plan) Depth below grade: V Material of construction:x con create_metal_FRP_Polyethylene—other(explain) If tank is metal, list age nta . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L8'6"H6'7^w4'10" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 24" Scum thickness:6" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 13" How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage;etc.) Septic tank and all components us structurally sound and functioning properly.Recommend pumping now,then every two years. GREASE TRAP: (locate on site plan) Depth below grade: r4a Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nla Scum thickness:nla Distance from top of scum to top of outlet tee or baffle:rya Distance from bottom of scum to bottom of outlet tee or baffle: rva Date of last pumping;,,, Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) We BUILDING SEWER: (Locate on site plan) Depth below grade: ve,- Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction linetown Diameter: nla (�viimments:(conditions of joints,venting,evidence of leakage,etc.) (revised 0427)97J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) .Property Address: 39 Zeno Crocker Rd.Centerville Map 170 Lot 101 Owner: Al Johnson:Box71 Centerville Date of inspection:4122 S TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: Na Capacity: ns gallons Design flow: rda allons/day Alarm level:_pla Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: We Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) Na PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_ve. Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) rda 1 (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 39 Zeno Crocker Rd.Centerville Map 170 Lot 101 Owner: Al Johnson:Box71 Centerville Date of Inspection:4122199 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits,number: 1000 gallon leach pit leaching chambers,number:nla leaching galleries,number: nla leaching trenches,number,length: nla leaching fields,number,dimensions:Na overflow cesspool,number:nla Alternate system: nla Name of Technology:_n/a Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Leach ptt and all component,are structurally sound and functioning properly:System had v ofwater In tt at the time of the Inspection. CESSPOOLS: (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: n1a Depth of solids layer: We Depth of scum layer: Ma Dimensions of cesspool: Na Materials of construction: roa Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) He Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) nla PRIVY:_ (locate on site plan) Materials of construction: r0e Dimensions: We Depth of solids: n1a Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) We (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 39 Zeno Crocker Rd.Centerville Map 170 Lot 101 Al Johnson:Box 71 Centerville 4122198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) r der� 1 Nt 2� Page ! of 10 .(revived 04)27197) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 39 Zeno Crocker Rd.Centerville Map 170 Lot 101 AI Johnson:Box 71 Centerville 4122199 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revised04WI97) 19ge 10 0[ 10 1 No....... ......._...8 �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.. r�. `- Appliration for Biiposal Workii Tonitrnrtion ranfit Application is hereby made for a Permit to Construct (11') or Repair ( ) an Individual Sewage Disposal System at 1 ................t try � �.��J� � ���.��....... �- � Gn ��:�1`���l.............. ' Location-Address or Lot o. ,La ." ..-SIZ -�G.e� .�a....... '`a.�: ...._ "1f...._�� .. . .. l�+d �: _. %ill 5 ,--•-- ...._.. r •- ner Address - ---------------------- -- ----! /-.1./f..-----...------..... Installer Address em. Type of Building Size Lot... .. ;-�J.P 3.Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.........................--. Showers ( ) — Cafeteria ( ) Otherfixtures .........--•---------------------------•--------------.---•----•-•------.......---------------------•-----------•-----•--.....-----•--....._......---- w Design Flow............ ...................... allons er erson er da Total daily flow......... ....._ g `�-- g P P P Y• Y -- -- ---------------gallons. WSeptic Tank—Liquid capacity.ICKOgallons Length................ Width................ Diameter..--.---.------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-__...._I.......... iameter.-.... 2�-.-.-. Depth below inlet.... �1.... Total leaching area. •. ...sq. ft. Z Other Distribution box (:� Dosin tank Percolation Test Results Performed by ��1� ` _... � ................... Date.....--.-.��7� Test Pit No. 1... .. minutes per inch Depth of Test Pit..- ......... Depth to ground water-----`-.-----.--.--. L4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil....... � ' '-tea . .. w U Nature of 97a<or A s—Answer when applicable............................................................................................... ......................................................................................................................................... Agreement: The tindeFsWea agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI2 5 of the State Sanitary Code—The dersigned further agrees not to p/rnstem in operation until a Certificate of Compliance has be i ued y e b d of health. igned.•. ---. .-• . . -- - --- ..............................-----.... /Application Approved BY----•-----••.....--•._. ...�......_...-•----......-•-•..............•----........-- --••--... ....... ...... Da e Application Disapproved for the f of o in reasons:------•-------------------------------------------------------•-----------------•---------......----------...... ••••••-----•--•--•---•-•---•--•-••-----------•--•••------•-•-•--•-------....-•-----------------------•--••----••-----•-•-••-•---...------•---•-----.................................................... Date PermitNo......................................................... Issued.................................... .................. ti_ -- ---- - ---- — a------------- --- -- No....................... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , ..........................................OF..ro.�.,.F,t1�:?-,I-} j(„� .........---............-- Apli irFa#ion for Biopog al Workii Tons#rurtion 1hrutit Application is hereby made for a Permit to Construct (Z or Repair ( ) an Individual Sewage Disposal System at: c7----•G =-`-='-...=•_�!�- :✓...------ E r l l;� J t L LEE Location-Address _ or �r Lo wner ..---Address c . ...r.. y§�.......... Installer Address �- Type of Building Size Lot "1_Sq. feet Dwelling—No. of Bedrooms.......... ...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------•---•-------•----------•••-----••-•-----------••-••---- W Design Flow............. -T......................gallons per person per day. Total daily flow______-3. 92......................gallons. WSeptic Tank—Liquid capacity.)CC7.gallons Length................ Width.........._..... Diameter_______---_.____ Depth.............. x Disposal Trench—: o. .................... Width.................... Total Length----_............... Total leaching area..__-•--_-.•__-_-_-_sq. ft. Seepage Pit No...................�. Diameter.....L' :........ Depth below inlet... '�"-.... Total leaching area_Z.`��....sq. ft. Z Other Distribution box (✓) Dosin tank ( ) a Percolation Test Results Performed by &&014�.__ _....t .<< GG................. Date.........v -&7 1 �-- Test Pit No. I...�r..y_minutes per inch Depth of Test Pit...l.X:.......... Depth to ground water_.___...:..._.. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .•--•••-----•---------------------------•----•••••--------••------•••.T------------.••-•••-•---•----•-•.._......... ----•--•v----• ........•••••---•-. O Description of Soil........ `-- �- •-- --!-�_ �� 14_ 0 j : �-c... --------------------------------------- = ....... ._- --C7--=---- C,pl_[�1. ..t ? "�2+ C L. A—�_.-.!_l�? _.�; 1 --•------••-----------------•------------•-•----••---------•--------•••-•--------•-•-••---------•-••-------------•.......••--------•-------------------•---•---------••-- .............................. U Nature of airs or tions—Answer when applicable..............................•___----------------•------------•-----------...----.__...-_._... Agreement: �1 i. The_tinde;� " agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions'-of,TITLE 5 of the State Sanitary Code—The ndersigned further agrees not to place the ystem in operation until -a'Certificate of Compliance has b ssue by e rd of health. _ Signed -A—/. t.. .................. G ........................... - . Application Approved By......... ......... `�+----------------- D • Application Disapproved for the f o o ing reasons---------------------------------------------------------------------- --------------------------••-----•••--••-- .----•...............................................................•........................... ....•••------- Date PermitNo.......................................................7 Issued_............................ ........................... Date .. THE COMMONWEALTH OF MASSACHUSETTS BOARD/)yOF HEALTH oF......................�.... .................... Tntifiratr of Tontplianrr THIS I TO CE yIFY, That the Individual Sewage Disposal System constructed ( or Repaired by == ..................................................................................................- ............................ at ; _ staller has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as`described in the application for Disposal Works Construction Permit No........................................ dated...............__:.............................. THE ISSUANCE OF THIS CERTIFICATE SHALL_ NO,T`BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ ."Inspector.................................................................................... . �P THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALIti.. �... r ... - -......... NO......................... FEE........................ Disposal Vor noirndion rrntii Permission is hereby granted.. ----••------------------•----•-------•--........................................................ to Construct R7air ) Individual Sewage is sal Sys / at M Street as shown on the application for Disposal Works Construction Permit No.................... Dated...... __ _ ............... ................................. .... _.___ - .------------------ A. . _......._...._..._....._ I _ .. of alth DATE. ...... ------------------•-----•-•--------_... - FORM 1255 A. M. SULKIN, INC., BOSTON w SITE PLAN SHEEr I of 2 SCALE: l = Zo' Na X� 52 �2- PROP.:�3 � N 34,75 9 GOT a/8 74 I I ( to L w _ .LOT �/9 - • I W I I I � I -._,e5"No 14�>oC�, OF Mef1_ WILUAM ti M. -� R WARWICK No. 197710 - �c"s��ECISTER�� FOR- LEA EL SO 4-1-42 i REGISTERED LAND SURVEYOR i ZONE 6EA/7EV VILLE . /y4S-5_ PLAN REF. DATE BENCH MARK DATUM WM. M. WARWICK 8 ASSOC., INC. i DOMESTIC WATER SOURCE 7-atVI ! W,47-E25- Box 80/ - NORTH FAL MOUTH FLOOD ZONE. ND/�/-/-�r4Zf�/F'd� ��-�� MASS. 02556 - (6/7) 563-2638 { LEACHING 3ASIN SECT/ON NOT TO SCALE She•e� z e f Z 240.1.MH COVER EARTH . FILL BRICK AND MORTAR COURSES AS REOD• TO BRING i 4„ i COVER TO GRADE B FLOW LINE " / „ / INLET mil_ _ _ _ ,�: i 2 TO/" WASHED PEASTONE FREE. OF IRONS, ' PIPE '. FINES AND DUST IN PLACE l 3VZ4 +'TO I%2"WASHED CRUSHED STONE. FREE OF ��j1 •'�311 '• OPEN/NG WITH R +OUTER DIAMETER IRONS FINES AND DUST /N PLACE , AND 1314„INS/DE • ' DIAMETER I. CONCRETE TO BE 4000 PSI 28 DAYS € �� • ' : 2. REINFORCED WITH 6%611 NO. 6 GA. W.W.M. 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS 410" 3� 60, 4, NUMBER 'OF PITS REQUIRED aN � M/N• I tZ NOTE: EXCAVATE TO ELEVATION 4v-o0R ' EFFECTIVE DIAMETER (Nor To ExCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL WATER TABLE - LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED .MATERIAL WITH CLEAN TYPICAL PROF/LE GRAVEL TO DESIGNED GRADE. IB"STD. LT. WGT.. C.I.NH COVER , rj2.0 Z�o 4"8/T.FIBER PIPE OUTLET LEVEL DWELLING FLOW LINE T/CNT JOINT TO FIRST JOINT ��.(oD IO,r_ /4 A O 00 1 1 0 DO 0 1 1 - C.I. TEE 'T$ �-� [}7 S 1 I 0 I O 0 1 1 STD. PRECAST CONC. �7�8 �D/ST. BOX TO BE 14 O f 000 O 0 OOOGAL.SEPTIC TANK. INSTALLED ON LEVEL, 'G 1 11000 00 0 1 1 1 . STABLE BASE 1 11 000 00 5,1 11 sEPT/C TANK To BE 1 if 000 00 1 1 i I ; INSTALLED ON LEVEL, 1 I f 100100 1 1 1 ; STABLE BASE. 11 1 0 0 O 00 0 1 ' 111000 001111 : LEACH/NG BASIN i 1 1 Q O 00 0 1 , , BASE TO BE LEVEL ' i 1 0100 1 1 , ELey SOIL AND PERC. DATA - 00 Z TEST PIT N0. F'37�Co O�� TEST, PIT N0. 2 PERC. RATE MIN. /IN. 0 , �3 y Z Te-, -0,0 L 1- TEST BY SAN P/Gr2AVr--1, WITNESSED. BY: --(L0 17 { �o TEST LPIT GR. EL. y�' a --� g M eD. 5 A r-•►p GLe✓A.r-1 F l 1J e DATE: 10 �v sp.ti D E!^39•$ r-yo y.1zo v F-j D wpclvZy-� DESIGN. DATA. GENERAL NOTES. BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. DISPOSAL No SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD EST. TOTAL DAILY EFFL t2_'GPD• PRECAST REINFORCED CONCRETE UNITS. SEPTIC TANK I aoo GAL. ALL .SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE SIDEWALL AREAZ S GAL./SQ.FT.. TO .REVISED TITLE 5 - OF THE STATE ENVIRONMENTAL CODE, MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA •n.' GAL./SQ,FT. SANITARY. SEWAGE EFFECTIVE ON JULY I , 1977. LEACHING REQUIRED zoa SQ.FT• ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL LEACHING AREA OF HEALTH. ' 7-AfP Q•FT. AT -COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE i ►��wa�� 135.7sf xz 5• 43,V I BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. �h"?'oM i •I �f� ►•o = ► I ��I. PITCH ALL SEWER LINES. 1/4" / F.T. UNLESS INDICATED OTHERWISE. SEWAGE DISPOSAL SYSTEM aor , MAR7IN �G FOR'— Vj 5, v MORAN i , a ,p 123417� 1�o j" l01 � Z r=t�l c/sr�`�G�>��'�{► SCALE AS INDICATED DATE- I A 5 WM. M. WARWICK 8.ASSOC., INC. 8OX 801 - NORTH FAL MOUTH ` MASS. 02556 - (6/71 563 -2638 PROFESSIONAL ENGINEER t'ln-i o t }to..ts � '3 q O CA T. ON S WAGE PER IT NO. i V I L L A G E 49 _ a I N S T A LLER'S NAME i ADDRESS 6 U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �t �� r � 3 � � � � ,� �, �, �- �` LOCATION / �i� ----'-4Cf�'k' 1----- -- ENO. U �� VILLAGE VJ _ DATE/ vo APPLICANT o 7 d l X SI�IJO>�1� � FEE � ADDRESS -refundabl 19 / t � Z SJ�'N/'r J� TELEPHONE N0.7�] `- ENGINEER V-W Il--1 DG-- TELEPH NE NO _ J L 3•-� Q� DATE SCHEDULED ( p ant' s signature) O O O O O O . O .. O O O . . . . O. . . O O O . O O . . . . . . . O . . . O . . . O . . . . O ' SOIL. LOG SUB-DIVISION NAME r j 1�(,46- jVtjLjjZ DATE �jTO I TIME EXPANSION AREA: YES NO 6GVvjL(I l ENGINEER ` TOWN WATER ZPRIVATE WELL - `p! BOARD OF HEALT c EXCAVATOR ' SKETCH: (Street name,etc. ,dimensions of lot, exact locat'on of test holes and percolation tests,. locate wetlands in proximity to test holes ) NOTES : JOS t 1 4 � � J N o w ` I PERCOLATION RATE: Z-2 VVl I v\- )/ L, i TEST HOLE NO: ELEVATION: TEST HOLE NO: --ELEVATION: ! 1 1 2 : S� 2 - 3 3 - 4 ✓ 4 - 5 5 6 6 < .7 lr 7 8 Gc 8 9 9 10 L '" 10 11 w2 11 12 12 �Z 13 13 14 14 15 15 16 16 SU\ITABLF. FOR SUB-SURFACE SEWAGE : LEACHING FIELD LEACHING PITS LEACHING TRENCHES, UNSUITABLE FOR SUB-SURFACF. SF..WAC-'' . RFASONS : NOTE : I'N6I N1:}-:1,1 N6 I'LAN:; 1•il)ST SI}O1J NLII`11�1,A' A'S1Q,N!:I) '(-)N 1'}:l:C TI:S'1' AP}'I,1 CA'I' 1 0N l 1�; 1 N:\1 IN l;l AI'I,I. I :\t:'1' Ana OLD STAGE ROAD NOT TO II §IL— § 11 § SCALE QO V Q WATER LINE "'1�h� LEGEND V V V 4O GAS LINE SEPTIC COMPONENTS Q 2 Q ELECTRIC AND -� EXISTING J� TELECOM LINES 1000 GALE:3 O h� DRAIN® I SEPTIC TANK EXISTING ` O LEACH PIT/ f CESSPOOL CENTERVILLE• MA DISTRIBUTION BOX� L 0 C U S MAP e e TEST PIT • ee f EXISTING LEACH PI T TO BE PUMPED, FILLED AND �ARe ABANDONED IN PLACE. G R ` OT OWED / t i 12 in w HOLLY Ile ��l? �pplF OIS44 ELEVATION \ 61.71 i OF FOl1NDP��p PROPOSED SOIL ♦ ABSORPTION SYSTEM -SEE DETAIL / ON BACK 10 in LOOT (19 HOLLY AREA = 15089.sf+-. / GRarMirALI o 'T G PLAN BOOK 386, PAGE 90 PROPOSED rTy�L\ ASSR. MAP 170 'PCL 101ls c ot 60 PLAN �s ♦ �% �p q• G g Ay9 O 5 o SCALE:. I in = 20 ft G �. 20 40 ' G 4 r O ' m s 0 10 2 0 ♦� G `T, �e 1, 60 PRINT ON 11 x 17 in #s PAPER FOR PROPER SCALE NOTE d. THIS IS A INSTALLER MAY MOVE SOIL ABSORPTION' COLOR SYSTEM UP TO FIVE (5) FEET LATERALLY PLAN IN ANY DIRECTION. ELEVATIONS SPECIFIED,. USE COLOR PLAN ONLY ON FLOW PROFILE MUST BE MAINTAINED. , FOR INSTALLATION E FULL DETAIL IS BEST VIEWED IN FULL COLOR OF 414 H OF Mq �H SS9C ��� Ssq DAVID yGJ, p DAVID `yes SEWAGE DISPOSAL �-- D. .o COUGHANOWR v COUGHANOWR SYSTEM PLAN No. 1093 No. 461 -TO SERVE EXISTING'DWELLING �FGISTER�� s �PPRovEa BRIAN & JOANA CHRISTENSEN OWNERIS) OF RECORD 39 ZENO CROCKER RD .. 155 Goo Ryder Rd s CENTERVILLE MA c: PROPERTY ADDRESS Chatham, MA 02633 Davidcou®HotmaiLcom DATE: JUNE 11. 2019 508 364-0894 PG.1/2 JOE9a ETE-4388 �.BCDE I i SOIL TEST LOG DESIGN C A LC�UUL A T�9 HO SOIL EVALUATOR: DAVID D. COUGHANOWR, SE *461 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD WITNESSED,BY: DAVID STANTON. HEALTH DEPT. . SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS NO GROUNDWATER ENCOUNTERED { TEST PIT' 1 PERC AT.48 In - 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL CONDITION. IF NOT. INSTALL ELEVATION DEPTH - SOIL USDA SOIL SOIL COLOR SOIL OTHER, - - NEW 1500 GALLON SEPTIC TANK. - - INCHES HORIZON TEXTURE (MUNSELU MOTTLES 59.05 0-6 . Ap SANDY LOAM 10 YR 4l3 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 56.80 6-27 Bw LOAMY SAND 10 YR 4/6 NONE LOOSE SOIL ABSORBTION SYSTEM: 27-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE 48.05 1 SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. NO GROUNDWATER ENCOUNTERED THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY TEST PIT 2 MIN/INCH IN C SOILS DEPICTED BELOW CAN LEACH: ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER BOTTOM AREA = (24 x 12.5) = 300 sq. ft. INCHES HORIZON TEXTURE (MUNSELU MOTTLES 59.20 0-10 Ap SANDY LOAM 10 YR 4/3 NONE FRIABLE SIDEWALL AREA = (24+24+12.5+12.5)x2 =146 s ft. 56.70 10-30 Bw LOAMY SAND 10 YR 4/6 NONE LOOSE TOTAL AREA 446 sq. ft. 30-129 C MEDIUM SAND 10 YR 5/4 NONE LOOSE FLOW CAPACITY 0.74 x 446 = 330.04 gal/day 48.45 INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED BELOW. FLOW CAPACITY 330.04 goI/dog WHICH EXCEEDS THE 330 goI/dog REQUIRED FOR A THREE BEDROOM DESIGN. i I W S U RQBV T�O(1V �W UDB-3 lHSE 02Q'Y DIMENSIONS PIPES EXITING D78OX TO. RUN LsVEL AND DETAIL FOR 2 FEET BEFORE PITCHING DOWN ►2 in - C MIN � FROM N TANK h u) TO . 100000o GALLON SEPT§C� TANK sas EXISTING .UNIT = DIMENSIONS & DETAIL j e Ris b In STONE BASE TANK TO BE PUMPED DRY AT TIME OF INSTALLATION 21 \ `� CROSS SECTION VIEW AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL in 2 NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. REPLACE WITH A NEW I in 1500 GALLON TANK TTED TAPER r 7F CRACKED, OTHERWISE O §L G=d O� III T§>O�UV f S� ® COMPROMISED. N TRU TL .ON II _ I S YS TE(MV] CO S C O DETAIL C x c USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL NOT DRYWELL +. UNIT 24.0 ft TO { SCALE r 8 -ft w in N -6 l t= M INLET OUTLET I zl I' ( i i co COVER COVER STONE 3.5 ft 8.5 ft 8.5 ft 3.5 ft 3 IN DROP FLOW LINE FROM I' 10 in = 14 1 To I 500 GALLON DRYWELL BUILDING t� D-BOX DIMENSIONS & DETAIL INSTALL ONE INSPECTION 48 in �I � RISER TO WITHIN THREE LIQUID GAS / USE INCHES OF FINAL GRADE LEVEL 6 INDICATE LOCATION BAFFLE H-10 ON AS-BUILT UNIT t_ -. __ _- b In STONE BASE IF NEW , � n3 SEPARATION BETWEEN INLET & OUTLET TEES NO LESS THAN LIQUID DEPTH ODO, CROSS SECTION VIEW 102 /n -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE CROSS SECTION VIEW STARTING WORK. INSTALL AN APPROVED GEOTEXTILE -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM I FABRIC OVER STONE © REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). -INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND ® a UTILITIES BEFORE EXCAVATING FOR SYSTEM. 28 3/4In TO a 24 in a 3/4 In TO -ECO-TECH RAPID RESPONSE RECOMMENDS THE INSTALLATION I in 1-1/2 In GRAVEL a DEPTHEFFETlVE® 1-1/2 In GRAVEL E OF LOW FLOW FIXTURES & APPLIANCES. AND PERIODIC PUMPING OF THE SEPTIC TANK. _ hS -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. 46 in 58 in 46 in DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. f' 150 in V L O p O E - TOP. OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE -4 in SCH. 40 PVC EL 61.71 +- b in OF FINAL GRADE AND TO PITCH AT l/8 in/ft MIN 59.45 D-BO EXISTING MAX USE H-20 � 57.15 EXISTING 1000 GALLON °000�go 0 00- °0000°a PRECAST '� �°o°oo oo°o SEPTIC TANK 57.59 DRYWELL :00000°aQao 56,50 EXISTING REFER TO DETAIL BOX STONE in iSOL ABSORPTION 41 56.67 BASE 56.40 REFER TO b In STONE BASE IF NEW SYSTEM —REFER 11 S ll L�llyll O EXISTING DETAIL BOX SS ft 5-1�2 ft Lo NO GROUNDWATER BELOW 54.40 MOTTLING OBSERVED _ 48.05 I SEWAGE.DISPOSAL SYSTEM PLAN ° 39 ZENO CROCKER RD CENTERVILLE, MA JUNE 11. 2019 1ETE-4388 RG 2/2