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HomeMy WebLinkAbout0060 ZENO CROCKER ROAD - Health 60,'?euo Crocker Road Centerville A= 170-106 ,.1 UPC 12534 ' No 2..�3LOR '` ► MAYTININ 010 I :1 �i�� � �� '1 b No. c- Fee XPoa .011 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: P! PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPlication for Misposaf 6pstrm Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade)0 Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 60 ZePO GROC 4A;R 1R0Owner's Name,Address,and T 1.No. �'t c 0W1 Rk cQ 1CA A-rI C` NANk coo ze►®c ttoci�;R Assessor's Map/Parcel D ©( Ry4k) Noth,*s ,GV_JA1L) Ge,1W-G,I Installer's Name,Address,and Tel. o. 6Z`Wn -$811 Designer's Name,Address,and Tel.No. 5(7$�'J3 037� �;64PC-'WiP6 6-4j7 0JSL-S 1,(-C Zd_ bt�lGiltJC'�`2la'Gr Cu,y{Z�q�i}w�1a NiK1 l S3 Sr- dt,4ai-POE` MA X&S`-F CR�J®� N-� O D-5 3 9 Type of Building: Dwelling No.of Bedrooms b9 3 Lot Size 15 t sq.ft. Garbage Grinder( ) Other Type of Building G5 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -33o gpd Design flow provided 337,4 gpd Plan Date 9"(p (I Number of sheets Revision Date Title t-,b -Z G�jo cp2o evjqp_ Rj) Size of Septic Tank I �50o Type of S.A.S. / � 'L 3(,14Q, H -a p 6(0D 1F'Fo. c@ Description of Soil $'e— P(AN GL-y4pSc- SA-&JiD Nature of Repairs or Alterations(Answer when applicable) L)T( -2- Gj4&— (LC-., j5uo Gcgde_ TA:IUV To N el,�J D -90X Tn 19 ARO 3 6 kC' H -ao al0DIPFL) 6s6AS tk) F(aZ> CX&2 F'IGr Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea Si Date 0 Application Approved by Date L Application Disapproved Date for the following reasons Permit No. ��i - ��T Date Issued (o No. ZC(j v ,. Fee THE C�M ONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,"MIASSACHUSETTS 01pplication for,Misposal 6pstem Cons tr dtoh 3permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. !oO ZENO GROG*� RO Owner's Name,Address,and Tel.No:" c�TF.Jt kAR N A-rl C-*NAn1 Coo zmjo c Yzou 'R Assessor'sMap/Parcel O p RY00 'TgotkAS IEtt>`JA1U GeAJZ`V_VI C.45' Installer's Name,Address,and Tel. o. 56Z-q n -$$`('7 Designer's Name,Address,and Tel.No. 5 b$-o'�3 031-1 CA(le (pe e+JTuZ@wS6 S ( (.Cr xL tr tJCaliJt.�LJw(�- Cei/giZ Etl�� Mq l 53 Ga4wgtwee(44- 5 r- M, SWP6-15* M A 19-54 CQA&Jaq- v:-S 3$ Type of Building: Dwelling No.of Bedrooms Lot Size 15A b9 g sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 337+T gpd Plan Date 9—G—(I Number of sheets I Revision Date Title („0 7 QJ0 Size of Septic Tank �'{j 0 > Type of S.A.S. �Ak c 3(�H C, H-A O (3(Q'D I rFF >SGR ' Description of Soil 15Ct~ P( NY G&fASC c Ar&j;) fQ 4a" i Nature of Repairs or Alterations(Answer when applicable) " UT(L47-6 ISc20 cv�(- -( 4!41:� Ti0 N EL✓ D-GOX M 19 141E _ a .36 Re H -ao 131=Frwepts W F(4gz L°zue[an Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heap Signgd Date Application Approved by Date /q G Application Disapproved Date for the following reasons Permit No. - Date Issued (c -------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(x) ' Abandoned( )by Gt AP Ew(D g; C:NTd-,PQLSCS at (O Z G N O !d kQ G(Ce� Rn C fWJ_Q-XV(�as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nopj 1-Zqq dated Installer C,'AV CtytD G LC(Z_ Designer TC [�- #bedrooms Approved desi�. esign)d. fl 3 3 + gpd The issuance of this pe s all jot be construed as a guarantee that the system ill Date � %t Inspector ------------------------------------------------------------ No.20 I ( za! Fee oU THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(X Abandon( ) System located at (Q(5 Z C NU Ca OC C_tM Wb C,5Krr8QV/LLC 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. r Provided:Co struc ion must be completed within three years of the date of this permit j Date y zo l ( Approved by - 1 Town of$arristable Regulatory Services Thomas E.Geiler, Director • BARNdPA6LB, r Public Health Division 0�7° ►`� Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Officc: 508.862-4644 Fax: 508-790.6304 Date: �"!3_I Sewage Permit# °' l 2-'49 Assessor's Map/Parcel I 70 10(o Installer & Designer Certification Form Designer: NYC En.�tne�t��, TC)C Installer: C:iCewAL &1l-e.(Ct(se.5� LAG Address: 2t;.5y CroonbPU-(V� hU)!!J Address: 10 3. x 7 -3 east w0r0nAm h K 02�3& � , t-�"�lvt 6'lill4 o2jo3,t On 9 "6 ' Zo t► :c+� was issued a permit to install a (date) (installer) septic system at (o D Zee CCCOiCc'r Goad ^ based on a design drawn by (address) SG En9z�eerc� ) 74)c. dated 9- (" l ( (designer) __Z certify that the septic system referenced above v.,as installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. _ I certify that the septic•system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or anN/ vertical relocation of any component of the septic system) but in accordance with State &, Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (Wreq nspected and the soils were found satisfactory. ,HOFM4c. JOHN L_. k' CHURC.-II;L (I st ler's Signatt e) c'"IL No �.1Yb0�7 esigner s Signatur (Ai ix esig er s Xrnp Here) PLEASE RETURN O BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE__ISSUED UNU L BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTAELE PUBLIC HEALTH DIVISION TIJANK YOU. y 1ul'lice lilnl+5\d�slgncicCrlilir;rti+++l kmn.doc TOWN OF BARNSTABLE ALOCATION l enT-er v't (l .`60 2er+o Cro(, ,&2SEWAGE# Z G `1 - 299 VILLAGE ASSESSOR'S MAP&PARCEL 1 -7 O //0(. $_INSTALLER'S NAME&PHONE NO. e4lee.w�e- L n a-y p?3-S LL,'. SEPTIC TANK CAPACITY 1 � O 0 LEACHING FACILITY:(type) 666 nel-s s t�„2>-��(size) 4: - NO.OF BEDROOMS OWNER �i CRIr�l1✓� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: ee11 Z �� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Ivy V oC iZ 5 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY CaQeLo- i • � 1 �� 7•� a31 s, C3 Aa a3�o 8� ,5 cy 9710 B(I Cl(I I Town of Barnstable P# ILK' +' Department of Regulatory Services >iAUR Public Health Division Date t , 200 Main Street,Hyannis MA 02601 • �o raKt" / l Date Scheduled G [ �'� Time Fee Pd. 00 Soil Suitability Assessment for. Sewage Disposal Performed By: !'I Gy�'�-� ( i ��j, C,$ Witnessed By: 6 /_- LOCATION& GENERAL INFORMATION Location Address l� 2.P_yL0 e -,_L..eeZ 24\ Owner's Name i4Afe-" T-, evol' I y1 (/��-�•"' _ ��� J Address Assessor's Map/Parcel: d-20 0(A Engineer's Name C' i�A� &tfG>rP�.)<S .{ SC F119i�e1'i`�� NEW CONSTRUCTION REPAIR t/ Telephone# 'LZr -50..8-Z73-0.377 Land Use -2- S,� � 'm 41y �`�'ei��� Slopes(`�) Surface Stones Distances from: Open Water Body ft Possible Wet.Area - ft Drinking Water Well ___:__ft Drainage Way ft Property Line 710 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Sc�. aHar,4t� �\ate -4 C) no Parent material(geologic) BU�uxzS`� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater 7 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: PiceGE--O�PJ¢(0o%0/1 Depth Observed standing in obs.hole: 7(2,40 In, Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor Adj.Groundwater Level- PERCOLATION TEST >�ntp g Z�o-I TI ne to AH Observation Hole# Time at 9" Depth of Pero Time at 6" Start Pre-soak Time @ �0 /o f Time(9"-6") End Pre-soak /d'Z 3 0 Rate Min./Inch L Site Suitability Assessment: Site Passed t-5 Site Failed: Additional Testing Needed(Y/N) N original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conselrvation Division at least one(1)week prior to beginning. Q:\SEPTICNPERCFORM.DOC ' DEEP.OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Otl►er Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistency,%Graven a- 9 11 V 9-12 . 45 C-i C5' — 9� 126 -2 M S DEEP OBSERVATION HOLE LOG Hole# Depth from iSoil Horizon Soil Texture Soil Color Soil - ' Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. *' onsist %Grave GS LDYr3 1 I,-Y2 a L s J p Yt-5/4 2-76 c-1 CS 2,5 1�/6 qb-i26 C-2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%G e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. consistency. Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No '� yes --- — Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,exp 'se and xp e e described in 310 CMR 15.017. Signature Date Q:6SEFT MERCFORM.DOC Postal .v :l CERTIFIED g ECEIPT (Domestic Mail Only; ul Ln rU t I • I Al _ Ln m Postage $ _. eC M Certified Fee fl p Rostra Return Receipt Fee 22 1 (Endorsement Required) Here 0 Restricted Delivery,Fee rq (Endorsement Required) rI C3 Total postage&Fees�=J• J �U�� C3 Sept To o Kew cn. I.:�rilat.� . r�- street apr.1VO Tat �d - orPO BoxNo. lD o z e4 0 O'OC Ke)- City State,ZlP� PS Form :rr June 2002 Certified Mail Provides: 0A �esensalzooaeunr`ooae-o�sd ■ A mailing receipt W A unique identifier for your mailpiece N A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Maiia. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. s For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811�to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. s For an additional fee, delivery may be restricted to the addressee or addressee's authorized a ent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". k ` • If a postmark on the Certified Mail.receipt is desired,please present the art!- de at the post office for postmarking. If a postmark on the Certified Mail � receipt is not needed;detach and affix label with postage and mail. .IMPORTANT:Save this receipt and ppresent it when making an inquiry: Internet access to delivery ififormatlod is•not available on mail addressed to APOs and FPOs. Town of Barnstable Barnstable SHE pp THY Regulatory Services Department ;micaC'1 { Y { Y + BARN SrABLE, "Ass. 1679. Public Health Division m �0 ATE0 MAC a 200 Main Street, Hyannis,MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7006 0810 0000 3525 5378 June 21, 2011 Karen A. Tiernan 60 Zeno Crocker Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 1301 Old Post The septic system located at 60 Zeno Crocker Road, Centerville MA was last inspected on 6/8/2011, by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines _ of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Stain line observed up into raiser, 2" of scum observed in leaching pit You are ordered to repair or replace the septic system within 60 (sixty days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO RD OF HEALTH 4 omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\TEMPLATEl.doc T ' - F , Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the I computer, use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name � P.O.Box 763 Company Address Centerville Ma. 02632 Cityrrown State Zip Code (508)477-8877 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/8/2011 Inspector's SignatuW Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurfac4SewageD System•Page 1 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 60 Zeno Crocker Rd M Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): .F a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 s i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 60 Zeno Crocker Rd Property Address ' Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system Has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts 93 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ��M •'' 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ ® tributary to a surface water supply. r ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. P ® El criteria system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City[rown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 C M R 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is Centerville Ma. 02632 6/8/2011 required for every page. CityfFown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2009:86,000 g ( y g (gp ))' 2010:122,000 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �^M 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as art of the inspection? Yes No Y P p P P ❑ If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ^M 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: e611 Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage:System vented through the house vents. Septic Tank(locate on site plan): 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 gallon Sludge depth: 711 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ^M 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 25" Scum thickness 4 11 Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appear's structurally sound. } Grease Trap (locate on site plan): f 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 c a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has one late ral.Observed heavy solids in box.Soil was black around outside of box. a f 'r f 7 L y. fi Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No a Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 3 Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments , 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): System shows signs of hydraulic failure. =-111, at_time o� f in�Wl.Stain line observed up into reiser.2" of scum observed in leaching pit. 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 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ;M 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every.page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): �s Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 • Map Pagel of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® Zoom Out fl®In 7,14 i • " ` b J +h, t , y.. V.3 . 7.1 34 t , Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER .._..._. .. . . .. (.—,rinht 9MF_O(N!1 Troup of P-0.hlc AAA All rinhfe romnn http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=170106&mapparback=170l... 6/11/2011 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 32 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: As-Built ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 60 Zeno Crocker Rd Property Address Ryan Tiernan Owner Owner's Name information is required for Centerville Ma. 02632 6/8/2011 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r x t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i /? o - /3e ' LOCATION- v�# SEWAGE PERMIT NO. ,L.o �Q 2envo c9Zpe kM 7 3 1?ILLAGE \ I N S T A LLER'S NAME A ADDRESS N . B UILDER OR OWNER p. Al., I�dLA✓ q DATE PERMIT ISSUED ti DATE COMPLIANCE ISSUED __. _.. Ifs-.. 1 - 9-5 3��'= a I .. V No.--- .5...:..7 ' I /0 — 10 lU I EB..................... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................OF.....' '/ .tJ..` ` _ UC .XVp iration for UhipmFal Workii Tangtrnrtinn runfit Application is hereby made for a Permit to Construct ("") or Repair ( ) an Individual Sewage Disposal System at: Lo bo ��®�Y�. ....---GEC Location-Address or Lot No. Installer Address i J UType of Building Size Lot..!�.,�(2- __.�.�....Sq. feet J Dwelling—No. of Bedrooms---•----.......•..................•••-•••--•Expansion Attic ( ) Garbage Grinder i a Other—Type of Building ............................ No. of persons......._.................... Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------------•---.....---------------------------------.....----...----------------......_..•••-•-...........•••• W Design Flow........... .........................gallons per person per day. Total daily flow----------- ..................gallons. WSeptic Tank—Liquid capacitylu ..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.........?.......... Total Length.................... Total leaching area-__.-_-_•----••-----sq. ft. Seepage Pit No------------I------- Diameter..........LZ..... Depth below inlet..3y.JL,....... Total leaching area..?---9....sq. ft. Z Other Distribution box (✓) Dosing tank ( ��s a Percolation Test Results Performed by�!<`.!�!��'�.---•�._?�.......................................... ,.a Test Pit No. 1.... '._..minutes per inch Depth of Test Pit.... ..'........ Depth to ground. water........................ (X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - ;..... a.......................................................................... •- O Description of Soil.......... -..... �'��.. .. ...�t _ P ;- 5 ��----- �! �. x - 6......Wei?..s�.�.P.... �.. Vim....GL�-_X_�.....__�-��� W UNature of Re ' o Iterations—Answer when applicable.____........................................................................................... .. -• ••--••••••---•--•-•-•••-......•--•-•••••••••••••......-•-•••.............••- Agreement The undersigned a ees to install the aforedescribed Indiv' al Sewage Disposal System in accordance with the provisions of TIT E 5 of the State Sanitary C — The i ed further agrees not to place the system in operation until a Certificat f Compliance has be s e d of health. Signed•--. ... •. ...... ... ........................................................... .. ... .............. PPlicationA Approved BY..... ...•..... ... .. ...................................... . 1 ` 3�S / ate Application Disapproved for the 1lowing reasons:------•---------------------- ---------•-••-- -••-•••••-•-•••••••••--•••---•--•-•--•-•••--•-•-.....---•••-••-••-•••••--•-••••-••-•--......•-••••-•••-•.-••--•••-•-•-••••••••••-•--•-----•---•--......••-••-•-••••••••-•-----•-•--••---•••••--.....•--- Q, Date Permit No......-C? --... ...I--------•---------... Issued...------•-•------- -• �s Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH7 oF......i. ! . ' ^. .1 . '................ Trrt firatr of Tautpltattrr THIS IS CER I Y, That the Indp •dual SewMge Disposal System constructed (t--Y6`r Repaired ( ) _.. at �.... Installer has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... .-.. ...................................... Inspector-----------..: .: THE COMMONWEALTH OF MASSACHUSETTS BOAR , OF HEALT No...... ...... . ) ( FEE..... .............. kPermission is her by granted.............. -b lT`� t_.t_.�.._�_.._.�_._._$i�It r�Iltt� . ; ... .a. ,Y`' j............................................ to Construct ( or Repair ) an Individual Sewage Disp dal System Street — as shown on the application for Disposal Works Construction Permit No......._i......'� Dated......................................... joard of Health DATE............. - - e*'�-----`-----............................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS' 1 b° No......................... Fma.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............................_......--.....OF....... = A: ► - ' TA A t. E Allp iration for Uiiprr i ai Works Tnnstrnrtiun Prrutit Application is hereby made for a Permit to Construct ( -) or Repair ( ) an Individual Sewage Disposal System at: ............. ..... Location-Address or Lot No. -----•----..._----•-. .......-- ner � s a ............ �.i��, .-----.. %p t!�"1.fi± �G- .1 al' .1. � �...� ���.�F-------------------------------------------- ••- Installer AddressPQ + U Type of Building Size Lot....l.!o&^2.Sq. feet Dwelling—No, of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ,tX Other—T e of Building ............... No. of ersons.......-----............--.. Showers / a —Type g ------------- p ( ) — Cafeteria ( ) Otherfixtures ••-••••••--•------------•-•--•••-•••--•-•----••••-•--------•-••••-••-•----•-•--- -•-••--••••••••••••••••---••••••...•-••••......•--•-••-•-•---••--... W Design Flow.............��f.......................gallons per person per day. Total daily flow............ .................gallons. WSeptic Tank—Liquid capacity.A,0U gallons Length................ Width................ Diameter----..........-- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------I------ Diameter........... 7-. Depth below inlet...3•t•U..... Total leaching area...2. 9..sq. ft. Z Other Distribution box (✓S Dosing tank ( ) '-' Percolation Test Results Performed by..l�1 VV ,�_(_ &S 5 CC f a Date Test Pit No. 1................minutes per inch Depth of Test Pit-----M.1......... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit...----............. Depth to ground water----.........---........ O Description of Soil---------- ,.'_, -...- - 'l 13 S.�\�-' Z ...... nJ 15- -Cs �. ;.. - _ /-•-------------- U --•--------------------------------------A -1......_ .E_ 7_:.. S A --....'.� - C l_� 1. _ ... .. ?1 W -------------------------------------•••••••-----------------------••--•......•-------•--•-•-••-•••----•--•-•-•---------•-•............---•••-••----•-•••--•-----••----••••.....-•-••••.....--•-•-••--- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -••----•---------------------------------------••---------------------........................................... Agreement: The undersigned agrees to install the aforedescribed Indivi al Sewage Disposal System in accordance with the provisions of TITlL 5 of the State Sanitary Co?l — The u _er geed further agrees not to place the system in operation until a Certificate of Compliance has bee s e a of health. Signed . .. .......................................................... .. Application Approved By......... Int4,0........� ?.! �l --.....::�- �. . t�5.......mate Application Disapproved for the fo6lowing reasons:................................................................................................................ -••-••••--•-•--•-••-•--••----••-•----•---•-••••-....•---••-••......-•-••-••-----------------•----•••...-----••••-•---••-•-----••---•-------••--•--•------•--•••••-•----•-••---••--•••-••---•--•....-•--- Date PermitNo......................................................... Issued....................................................... Date y 7 SITE PLAN SHEET /OF 2 SCALE: / = 20 ' �0 • 5m��j � 4di x.Q, T- o � N o \ S 0 N � N p' �773 L '5 = Z� P✓�E.rJ ��4u�DIvtD�p- �Ivw�vEp� YN.- I-oGA'Tkor-j :!5 b►Cc.U C2ArC"� A 5 h N v tic.>►J Q u o I dN -rNe NI w \,o T 1 ZH OF 4f4s�o�y c WILLL4m s M. WARWICK 10* REG/STEREO LAND SURVEYOR FOR If L•I,� ZONE PLAN' REF DATE ,., `BENCH MARK DATUM 6\42t L) eE WM. M. WA RW/CK 9 ASSOC., INC. DOMESTIC WATER SOURCE-Tarim wo► BOX 80/ - NORTH FALMOUTH � F100D ZONE �Jo►J- �= - t> G� MASS. 02556 - (6/7) 563 -2638 .I AO' . I LEACHING QASIN SECTION NOT TO SCALE Shcel e o f Z COVER EARTH F/L L BRICK AND MORTAR COURSES AS REO'D• TO BRING c�r4• _,r.�_ M., COVER TO GRADE 4.. B'FLOW LINE _ l INLET �_ — _+ ,.. 2' "TO I"WASHED PEASTONE FREE OF IRONS, PIPE FINS AND DUST /N PLACE OPENING WITH 4% " �4 TO l 12 WASHED CRUSHED STONE FREE OF OUTER DIAMETER. IRONS, FINES AND DUST /N PLACE AND /314" INS/DE DIAMETER 1. CONCRETE TO BE 4000 PSI 28 DAYS 2. REINFORCED WITH 6%6" NO. 6 GA. W.W.M. 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS 4.0.. I--- '��--}- 6'0" I I 3� 4. NUMBER OF PITS REQUIRED J•AJ?i MIN. IZ ' NOTE: EXCAVATE TO ELEVATION 2�0•y OR EFFECTIVE DIAMETER (NOT r0 EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL I - WArER rABLE - LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN ' . TYPICAL PROF/LE GRAVEL TO DESIGNED GRADE. Z.O /B"STD. LT. WGT. C.I.MH COVER r" 51.0 0• 4"8/T.FIBER PIPE 4'C.LPIPE TIGHT JOINT OUTLET LEVEL DWELLING FLOW LINE p TO FIRST JOINT —— —+ti-, ,,_• �4, 00 11 0011 i C.I. TEE C7 t l "11100100 11 1I TD• PRECAST CONC. (i. Z DIST. BOX TO i 1 0 00 O 0 1 1 i I 'I I• To OWGAL.SEPTIC TANK. I I 1 0 0 0 0 0 0 1 1 1 INSTALLED ON LEVEL, I i 1 000 00 0,1 I STABLE BASE \SEPTIC TANK To BE I '1 0 0 0 00 6.11 1 INSTALLED 0 LEVF'L I it 0 00)00 1 1 ' ; STABLE BASE. G 0 1 1 1 1 t LEACHING BAS/N : , I I 1 p O 0 0 0 1 i BASE TO BE LEVEL_,.. 1000, 1 1 , SOIL AND PERC. DATA -PERC. RATE LZ MIN. /IN. TEST PIT NO. P -.3-7-7 - TEST PIT NO. 2 0 v e,z r��lsym6 L 0'� TEST BY 1�jzVc� N�L D 5 Ativ a 12av WITNESSED. BY: _Z670 AA D- S &►J } TEST PIT GR. EL. 1 DATE: 51 A NjP 3�.y j No �•��.�p w A-t->a� --DESIGN DATA GENERAL NO TES :BEDROOMS 3 NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. . DISPOSAL No 'SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD 33 0 PRECAST REINFORCED CONCRETE UNITS. EST TOTAL DAILY EFFL. GPD. SEPTIC TANK I��� GAL. ALL. SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE SIDEWALL AREAZ' S GAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA 1-52 GAL./SQ.FT. SANITARY SEWAGE EFFECTIVE ON JULY I , 1977. LEACHING REQUIRED 2�cc' SQ.FT., ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL LEACHING AREA OF HEALTH. I 'T 7'4 SQ.FT. AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE I BOARD OF HEALTH. SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES I/4" / FT. UNLESS INDICATED OTHERWISE. O> p SEWAGE DISPOSA L SYSTEM o� MARTIN oyG E. �.', FOR' L �L— w MORAN w •-�-.� �O GS— ra#i .p 123417�p �D 6-1�-_N- tay—v1�-1,� + AA A. . . ..� s/oran4�•N � I 4��5 - Q SCALE AS INDICATED DATE WM. M. WARWICK 8 ASSOC. INC. 8OX 80/ - NORTH FAL MOUTH .r MASS. 02556 - (6/71 5 63-2638 t, 'i PROFESSIONAL ENGINEER T.O.F. EL.= 55.7'± ? PROPOSED VENT WITH CHARCOAL PROVIDE EXTENSION RISER FINISH GRADE OVER D-BOX= 53.5 ± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FILTER TO ABOVE GRADE FINISHED GRADE OVER BIODIFFUSERS= 53.5 - 54.8 GENERAL NOTE S SLOPE @ 2% MIN. WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE INSPECTION PORT WITH ACCESS BOX TO METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 54.2'± F.G. OVER TANK EL. = 54.0'± 5"DIA. OUTLET(S) WITHIN 3"OF F.G. (ONE PER OUTER ROW) CODE AND ANY APPLICABLE LOCAL RULES. } } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE EXISTING 4" PROPOSED 4" 9"MIN. SEE NOTE 21 DESIGN ENGINEER. PVC SEWER PIPE 36"MAX. 4.37'MAX TOP OF SAS/B.O. - 0.43' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE _ �� ! 5 SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3" DROP MAX 3„ 9„ _ � � PROVIDE WATERTIGHT L - 32± 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2 DROP MIN MIN.SLOPE JOINTS (TYP.) ELEVATION = 50.43' FOR A DISTANCE OF IS AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4"PVC IN FROM 1.33' 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" °+ SEPTIC TANK 4" PVC OUT TO (TYP.) 16" THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE _ • LEACHING FACILITY 0.90' n10.75"(TYP) SPECIFIED DROP BETWEEN 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL ' MI 6" , 50.OQ' 49.10' laid flat " 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE I J' 0.37 MIN. 50.20 ( ) 2.875 (34.5 ) AND CONDITION OF EXISTING TEES 9 (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK GAS BAFFLE 6"CRUSHED STONE (TYP,) 5' MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY 5.75'TANK NECESSARY COMPACTED BASE REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH VARIES(SEE PLAN) AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX - - --- - TO BE LEVE 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 54.58'ESTABLISHED BASE. INSTALLED ON A OF L STABLE GROUND WATER ELEV= < 44.00' BIODIFFUSERS (END VIEW) ON TOP OF A REBAR AS SHOWN ON PLAN. FIRST:1 EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION (BY ADVANCED DRAINAGE SYSTEMS, INC.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT SEPTIC TANK PROFILE CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES 'CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. - 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING / • + ` ,r « • TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM i • ' / ' ` • PERC NO. 13391 APPROPRIATE AUTHORITY. 1 +` ' INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS * ` • LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE �• �+ * '``+ * fr i : : *s �,' EVALUATOR: Michael Pimentel, E.I.T. THEY SHALL WITHSTAND H-20 LOADING. • +� .� ` . • ) C.S.E. APPROVAL DATE: Oct. 1999 * • `' �+ " `( ` • ~, -�h DATE: August 26, 2011 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. «•' i ` . • . TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE `r # ; ` • ELEV TOP- 54.50' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. " : �• *'•• REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, I • • ,� • • ELEV WATER= <44.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). PROPOSED 4" PVC VENT PIPE; , ; . t • 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN EXACT LOCATION PER OWNER ; l� PERC RATE _ < 2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. N Benchmark LOCUS DEPTH OF PERC = 42"-60" 16. PROPOSED PROJECT IS LOCATED WITHIN: Top of Rebar MAP 170 f ,t� © �, „ � '* � � � • 1 TEXTURAL CLASS: 1 ASSESSOR'S MAP 170 PARCEL 106 rS / � i \ \ Elev. =54.58' PARCEL 250 •Approx. M.S. *• M OWNER OF RECORD: KAREN A. TIERNAN (LIFE TENANT) L. m �� \ ZONE 2 0 `a + ' „ ADDRESS: RYAN THOMAS TIERNAN / \. �C'� � 0 54.50 rL \ 11 * ` m e • t`►r8 ` Fill 8 D ZENO CROCKER ROAD 4 i A ACCESS BOX TO GRADE (TYP F12) a *�" • •• A" Loamy Sand 53.75' CENTERVILLE, MA 02632 OQ- �� ) ©$,. • ,� *+ * • . • 12" 10Yr 3/1 53.50' \0G,O �*�1/ M: , FEMA FLOOD ZONE C 13" \\FS I I .. s . B Loamy Sand COMMUNITY PANEL# 250001 0015 C 441- OJ �� 5" 13" ` \TONS PROPOSED TOTAL 19 ARC 36HC r�. " •+' 10Yr 5/6 (#3616BD) H-20 BIODIFFUSERS IN } ! � ` + ��, * .w � , 17. DEED REFERENCE: BOOK 24841, PAGE 141 u� SHRUBS / 14" \ e A FIELD CONFIGURATION I ,,/O a ... 42" 51.00' Ow / I ' y + `'� Perc 18. PLAN REFERENCE: P.B.403, PG. 26 s� Ln •. C 60" 49.50' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. o / \ cTP 2 PROPOSED DISTRIBUTION BOX _ • * • O ' Is ' • 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY GAS � c Ss • Coarse Sand MBtc Y i 55 W- GAS �A 54 5'\�, 7 76469 - ' " • • . C-1 2.5Y 6/6 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY W-_-�--W S C 86, F J!' •� FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. w y/M i' .v .� 21. IN ACCORDANCE WITH 310 R DECK I - CM 15.401 -15.405, THE FOLLOWING LOCAL UPGRADE 96" 46.50' APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): B/l oR,�E EXISTING (1.) A 1.37'WAIVER(3.0'-4.37') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. i 3-BEDROOM / 1 O % LOCUS PLAN C_ L Medium Sand Ln DWELLING 2.5Y 6/6 / TOF =55.7'± O ` LP SCALE: 1" = 1000' 126" 44.00' � z / No Mottling, Weeping or Standing Observed E " n EXISTING LEACHING PIT TO BE DESIGN DATA TEST PIT DATA LEGEND PUMPED, FILLED WITH CLEAN I -55- � '\ PERC NO. 13391 COARSE SAND &ABANDONED INSPECTOR: Donald Desmarais, R.S. 50xO EXISTING SPOT GRADE a r ` MAP 170 NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel, E.I.T. - - 50 - - EXISTING CONTOUR i J C.S.E. APPROVAL DATE: Oct. 1999 PARCEL 106 `/ DESIGN FLOW 110 GAUDAY/BEDROOM 50 PROPOSED SPOT GRADE 15,698 S.F. ± \ EXISTING 1if160GALLON SEPTIC TANK DATE: August 26, 2011 W r TO BE UTILIZED IN THIS DESIGN TOTAL DESIGN FLOW 330 GAUDAY 50 PROPOSED CONTOUR TEST PIT DESIGN FLOW X 200 % - 660 GAUDAY ELEV TOP 54.50' E/T/C EXISTING UNDERGROUND UTILITIES SWING-TIES SCALE: 1" =20' = r r�2,s�s'F �d`^ryo USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER= <44.00' C EXISTING CABLE LINE r �4 DESCRIPTION HC-1 HC-2 W PERC RATE _/ GAS - - EXISTING GAS LINE MAP 170 BIODIFFUSER CORNER(1) 23.5' 52.5' = PARCEL 250 BIODIFFUSER CORNER(2) 28.6' 54.9' INSTALL 19 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) DEPTH OF PERC W W - EXISTING WATER LINE MAP 170 TEXTURAL CLASS: 1 I TEST PIT LOCATION PARCEL 107 BIODIFFUSER CORNER(3) 41.6' 26.0' BIODIFFUSER CORNER(4) 42.6' 20.1' SYSTEM CAPACITY _ - O(TOTAL L.F. OF BIO'S)(4.8 SF/LF) (0.74 GPD/SQ.FT.)=GPD 0 EXISTING 1,500 GALLON SEPTIC TANK 7" 54.50' (95.0') (4.8 SF/LF)(0.74 GAUSQ.FT.)= 337.4 GAL. LEACHING/DAY 9" Fill 53.75' A Loamy Sand PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE " 10Yr 3/1 12 53.50 TOTALS: ' ❑ PROPOSED H-20 DISTRIBUTION BOX TOTAL NUMBER OF BIODIFFUSERS: 19 B Loamy Sand MAP 170 TOTAL NUMBER OF COUPLINGS: 0 10Yr 5/6 PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) PARCEL 251 TOTAL LEACHING AREA: 456.0 42" 51.00' TOTAL LEACHING CAPACITY: 337.4 REV. DATE BY APP'D. DESCRIPTION (4 PROPOSED SEPTIC SYSTEM UPGRADE NOTE: Coarse Sand PREPARED FOR: 450� EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE C-1 2.5Y 6/6 o cb DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER CAPEWIDE ENTERPRISES N 00, "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED HC-2 2) DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED 96 46.50 LOCATED AT Cy/M 40' JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. DECK o NOTES: 60 ZENO CROCKER ROAD #60 N 1) C__2- Medium 2.5Y 6/6 CENTERVILLE MA 02632 _ . -- ) SCALE: 1 INCH .-_-- --.-____-- 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH EXISTING 2011 SEPTIC SYSTEM COMPONENT. 3-BEDROOM 126" 44.00' = 20 FT. DATE: SEPTEMBER 6, DWELLING HC-1 j �r►V'V o 10 20 ao 80 FEET No Mottling, Weeping or Standing Observed V OF TOF = 55.7'± serve vy°� 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA RESERVED FOR BOARD OF HEALTH USE JOHN L. PREPARED BY: SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF CH CHILL JR. JC ENGINEERING, INC. SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. 7 , �. 2854 CRANBERRY HIGHWAY 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION ,�"6 EAST WAREHAM, MA 02538 OVERLAY DISTRICT AND THE ESTUARINE WATERSHEDS. SITE PLAN- _ 508.273.0377 SCALE: 1" =20' Drawn By: MCP Designed By:MCP Checked By: JLC JOB No.2052