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0088 ZENO CROCKER ROAD - Health
8 Zeno Crocker --— Centerville A= 170-251 IN I 5 M EAD® No.2.153LOR UPC 12534 emad aom • Made In USA INVU 014 �, scan __ _ T i 3 Fee (. / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1V/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprfcation for 3h5potal �&potem Con.5tructfon Permit Application for a Permit to Construct( ) Repair("/Upgrade( ) Abandon O ❑Complete System U Individual Components Location Address or Lot No. $' �� C�� Owner's Name,Ad ress,and Tel.No. 17l 7—S— Assessor's Map/Parcel elf Ilegg, Z Coo /a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ley"0 Other Type of Building Wee No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min re aired) gpd Design flow provided ?ji gpd Plan Date Number of sheets / Revision Date Title Size of Septic Tank %� e Type of S.A.S. hp /1,5 A 52v Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B d of ea Signed Date 51--Z1_61!�2e Application Approved by - Date 75 ez-^C) Application Disapproved by: Date for the following reasons Permit No. 0 — ' .7 _ Date Issued $,A No. � _ Fee 16 MASSACHUSETTS THE COMMONWEALTH OF M Entered in computer: L.XPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for &ooal 6pgtem Cowaruction Permit Application for a Permit to Construct( ) Repair(/Upgrade O Abandon( complete System LJ Individual Components !cation Address or No. g' �D�® �/^� Owner'sn�,Ad9resand o. Assessor's Map/Parcel C�� i'l�/Ile g' Z Qo Clog.c Pr i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: / Dwelling No.of Bedrooms -3 Lot Size 6, D sq. ft. Garbage Grinder (_411t) Other Type of Building 5/ PWC'If No.of Persons Showers( ) Cafeteria(. ) Other Fixtures Design Flow(min.re ired) gpd Design flow provided 3 509i 5 gpd Plan Date Number of sheets / Revision Date Title 5/ O 7" ��� ��/1�p /Cl� �' C&A/ e" !ZJ/� Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bga�ealtha Signed Date s �"/ `!/ 24 Application Approved b �r PP PP Y 1, Q Date 75 - X 2 -C) Application Disapproved by: Date for.the following reasons r Permit No. /2 O Q ' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disp sal System Constructed ( ) Repaired ( j�Upgraded ( ) Abandoned( )by l' ���� , at �D 1001 A,1/' EG �/' ,i' Ce�rJ/�f�// has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. AC)061 - `3 I dated ' Installer Designer#bedrooms �j Approved de g,nflflow/ ?3J gpd The issuance of this permit sha11 not be construed as a guarantee that the system will function /as designed. Date �+ u 1 Inspector t% e` No. _/�g0 ( " 31 __--____.._ _ ___---- -- ------ - -- - ------_ --"--- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Mi.5pool 6p.5tem Con.5tructfon Permit Permission is hereby granted to Construct ( //)++ Repair ( ✓) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date 2`� Approved by ( � TRANS. NO.: CITY/TOWN: APPLICANT: ADDRESS: ze*40 DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO .aL kKCik::i.�t�a 4':ttii'ASS,x'�;.,<�.,�+.�'�: .��' .�;`�.e. :..P.�.'.��.M1�a/�. �6 ,�'r��:�"�'ah�F t .r..'d� •�r),x. Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CNM 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) ` [310 CNM 15.220(4)(d)] Location all buildings existing and proposed 310 CNM 15.220(4)(c)] Location and dimensions of system components and reserve areas. moo' [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] f- ' daily flow septic tank capacity(required and provided) Y soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.2421 Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] " Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CNM 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 s N/A. OIL NO Location of every water supply, public and private, [310 CMR ` 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located[310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[11) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(l) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR ' 15.0001 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address Sheet 2 of 7 N/A OK NO If S�1P ICrTAl�K,S�,�'.. Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers , on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] f Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] f, Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR �a 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] b Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] '"9 meY"f P sX.f�W a%M11 G3"19fdtilftD' +.r S4 � �� Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A. OIL NO rLI]Cl�I1GtsJC� Y2 ® YI1YY��gNR. Lo cated at least ten feet from any water line? [310 CMR R l5.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.21l(1)[11) Cleanouts required/provided ? 1310 CMR 15.222(8)] , Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? f Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) t15.232(2)(a)l NBO le compacted base [310 CMR 15.221(2) and 310 CMR pash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMM 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] MfCMR ump 6" [310 CMR15.232(3)(e)] Wover if<2000gpd); waterproof manhole if>2000gpd [315.232(3)(d)] Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating lll lead-lag mode. [310 CMR 15.231(6) and(e)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed?Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.2411 . Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[41 and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] V Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum- 4'maximum. [310 CMR 15.253(1)(b)] ' 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] E a rn m z6 o`� ed fie 5000 gP,Md) minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM RI5.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] , Bottom area used in calculations only[310 CMR 15.252(2)(i)] Address Sheet 5 of 7 R N/A OK NO Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by I designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance ar iarace �' :41 ` Are the variances listed on the plan ? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address Sheet 6 of 7 N/A OIL NO 1VifY®gars ,Setasatzve�A,reas n 'dk la a a i '{ rU 1. Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 FROM :down cape engineering inc FAX NO. :15083629880 , Jun. 11 2009 07:29AM P1 Town of Barnstable Regulatory Services 'Ehomas F. C'Feiler,Director '"" Putbgac Health Division Thomas McKean,Director 200 Maim Sptreei,14yammis,BIA 02601 0friee, 509-862-4644 Fax: 504-790-6304 instid1cr sec Desiggem Certification Form eU o3cttl Y)ta9:e: � . .�1� � Sewage P'eraait# /39 Assessor's M. ap1>F'ar'cel. � _ Designer*. 1!lsl�llee IJOr�o/,q Adclress: r. :,... ... 40,< '1 on .22 ®� D� O ^ eW6;1 was issued a permit to install a (date) n (irlstall.cr) septic system at 64 Ca based on a design drawn by (ad.dress) -- dated Riesigner) 1 certify that the septic system referenced alive was installed substantially am)rdinp to the design, which may include iniaz.or. approved changes such.as lateral relocation of the distribution box and/or septic tank.. I certify that the septic system refereaced above was installed witlr major changes (i.e. greater ti-mu 10' lateral relocation of the SAS or at1y vertical relocation of any component of the septic system)but in accordance with State Xt Local Regr�lati�nrs. Plan revision or cebtilied as-built by designer to follow. ;x uFF sac U�NIE (l,nstal r.'s Signatdire) Civu_. No.46502 �. ION Au 1 I (T)es.gi.er's Signature) � (A Ffii,Designer's Stamp Here) 1rLA°aL 18L'rU12N Y'(D E3A1t1VS'1'Al3Li= I IIfiT,I� HEALTH 1)MSION. (�ERTiFICATE OF (_Y):WtYL1ANCE WILL NOT BE !SgUFD YJtrlTB', 'I irtllil)•'I AND AEs-RUJIT CA ARE RECl±M1,I)lid TILL BA WNSTABL1 JE'0.1!3LIC W AT.TY1 DIV SIO N.'rHA21K VQ17, Q:Hcatthi cptk/Dcsigucr Ca-dfication Form 3.26-04.doc TOWN OF BARNSTABLE .. ll LOCATION 5f 6 �c� 611y I r". �U SEWAGE#a QV 9'137 VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /O0r LEACHING FACILITY:(type) 306 shy y (size) p.'V r),.f1Z �41 NO.OF BEDROOMS / OWNER �" r PERMIT DATE: COMPLIANCE DATE: �+ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching-facility) feet. Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet 1 FURNISHED BY d ,?76 �e i Town of Barnstable Barnstable P MMe icaCity Regulatory Services Department aA.EtNSCAB.IE, r MAS& Public Health Division 1639. ,0 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX' 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205009748 5/18/2009 Kerry Merchant 88 Zeno Crocker Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 88 Zeno Crocker Road was last inspected on March 31 2009,by James D. Sears, 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: • Backup of sewage into facility or system component due town overloaded or clogged SAS. 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within Sixty (60) 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 F THE B ARD OF HEALTH Thomas McKean, S., CHO Agent of the Board of Health Commonwealth of Massachusetts 1/ Title 5 Official Inspection Forte Subsurface Sewage Disposal System Form Not for Voluntary Assessments �. , 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name information is CENTERVILLE MA 02632 3/31/2009 required for 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. Important:When A. General Information filling out forms . on the computer, use only the tab 1. Inspector. key to move your t. . cursor-do not JAMES D SEARS y. 'A use the return key. Name of Inspector BLUEWATER ! Company.Name.. 350 MAIN ST Company Address p. W YARMOUTH MA '' 73 Citylrown State N �. Zip ode 508-775-2800 S-1623 0 ' 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 f#9l7gSS0,,,� ❑ Needs Further Evaluation.by'the Local Approving AuthorityJAMES :mom_ _o. SEARS 4/27/2009 t�'�' FRrIF�`- T Iry ector's Signature Date 4��i�F 5 INSp-�����`� ppnnuilttWU�� 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. MI.f TitlV Inspection Report.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal stema5 I Commonwealth of Massachusetts Ii rJ ill � I I� p Its tion Forte 1 u I>; Subsurface Sewage Disposal System Form - Not.for Voluntary Assessments ,i 3 y ' 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name information i e required for every CENTERVILLE MA . . 02632 3/31/2009 page. Cityfrown 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. Answer yes, no or not determined (Y, N, ND) in the❑ 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. metal septic tank will pass inspection if it is structurally-sound,-not leaking and if a — - Certificate of Compliance indicating that the tank is less than 20,years old is available. ND Explain: ❑ -Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will . pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed Title'V Inspection Report.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 c� Commonwealth of Massachusetts rJ Title 5 Official Ins F® 14;\ 'ow Subsurface Sewage Disposal System Form Not for Voluntary Assessments 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name information i e required for every CENTERVILLE MA 02632 3/31/2009 . page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ ` 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 ❑ obstruction is removed ND Explain: 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. .• 'I.- 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-- 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 k 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. -Title V Inspection Repo rt.doc sbxm Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts` � fJ Fite 5 Official lnspiection Fora tVl� - Ic' Subsurface Sewage Disposal System Form Not for Voluntary Assessments 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name information is CENTERVILLE MA 02632 .3131/2009 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation, is Required by the Board of Health (cont.): 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 coliform f ammon ia nitrogen and nitrate nitrogen is equal to or bacteria indicates absent and the presence o g g q 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 F,ailure Criteria Applicable to All Systems: X -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 FX El 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 pit is less than 6" below invert or available volume is less than'/z day flow 7 7 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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. Title V Inspection Report.doc+0X08'; Title 5 Official,lnspection Form:Subsurface Sewage Disposal System•Page 4 of 1.5. Commonwealth of Massachusetts I � I Title 5 Oficial- Ins"o ti n orm Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner. Owner's Name information is CENTERVILLE MA 02632. 3/31/2009 required for every page. City/Town State Zip Code Date of Inspection B. Certificatioh (cont.) - D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ 21 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ x❑. Any portion of.a cesspool or privy is within 50 feet of a private water supply well. ❑ Z.1 . 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.] X❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. Z, ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be -necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large-systems, you.must indicate either-"yes"or`'_no" to each of.the following, in addition to the ,_____-_ questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface.drinking water supply. ❑ Elthe 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"toany 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 shalt upgrade the system in accordance with 310 CM 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Official Inspection Form.Subsurface Sewage Title V Inspect16n.Report.doc•t73/OS � 0 p S, S w ge Disposal System•Page 5 of 15 ` Commonwealth of Massachusetts � , J Tit Official Is -Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name information is - CENTERVILLE MA 02632 3/31/2009 required for every page. Cityfrown 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 0, 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? 0 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) 0 ❑ Was the facility or dwelling inspected for signs of sewage back up?. x❑ . ElWas the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? FX1 ❑ 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: x❑ ❑ Existing information. For example,.a plan at the Board of Health. ❑x El 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)] Title V Inspection Report.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Ti � Uf icial I s ed n Forte` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 ZENO CROCKER RD. .' Property Address KERRY MERCHANT Owner Owner's Name information is required for every CENTERVILLE MA 02632 3/31/2009 ' page. City/Town State Zip_Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms (actual):` 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of.bedrooms): 220 Number of current residents: 2 Does residence have a garbage grinder? ❑Yes Q No Is laundry on a separate sewage system? [if yes separate inspection required] ❑Yes ❑X No Laundry system inspected? ❑Yes 0 No Seasonal use? ❑Yes l] No ,Water meter readings, if available last 2. ears usage (gpd)): NA 9 ( y 9 Sump pump? ❑Yes Q No Last date of occupancy:. - - .. . RESENT P 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 E No Industrial waste holding tank present? ❑Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑Yes ❑ No Water meter'readings, if available: Last date of occupancy/use: Date Other(describe): Title V Inspection Report.doc•03/08 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts. , 11 rJ Title 5 Official Inspection For m �-�4�i_ �✓ Subsurface Sewage Disposal System Form Not for Voluntary Assessments 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name information is required for every CENTERVILLE MA 02632 3/31/2009 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: : Source of information: 2-14-09/3-31-09 Was system pumped as part of the inspection? ❑Yes 0 No If yes, volume pumped: 2500 GAL . gallons How was Y uantit pumped determined? q Reason for pumping: SYSTEM FULL AT TIME OF INSPECTION 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): 'Approximate age of all components, date installed (if known)and source of information: 1985 PERMIT#85-1046 Were sewage odors detected when arriving at the site? ❑Yes 0 No ;.Ttle V Inspection Report.doc•.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15- ' i I Commonwealth of Massachusetts � Title 5 OffidaI Insp- ct� Forte . 4 �17W 1,1 Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name information is required for every CENTERVILLE MA 02632 3/31/2009 page. City/Town State Zip Code Date of Ihspection " D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 28 feet Material of construction: ❑ cast iron ❑40 PVC"_ ❑other(explain)`. NA Distance from private water supply well or suction.line: . feet Comments (on condition of joints, venting, evidence of leakage, etc.): UNABLE TO SEE LINES AS SYSTEM FULL TO COVER Septic.Tank(locate on site plan): Depth below grade: feet : Material of construction: 0-concrete ❑ metal:. ❑fiberglass:, :. _0 polyethylene - _ 01.other.-(.explain) If tank is metal, list age: years Is age confirmed-by a Certificate of.Compliance? (attach a copy of certificate)-7 --[]Yes ❑ -No - Dimensions: 1000 GAL PRECAST Sludge depth: NA Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness NA Distance from top of scum to top`of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? NA '.:.Title V Inspection Report.cloc•03108 - Title 5 Official Inslontion.Form:,Subsurface Sewage Disposal System•Page 9 of 15 Massachusetts Commonwealth of l�assac - � '� � � � #ion ' `4 u '�rJ (� I� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � r 88 ZENO CROCKER RD Property Address KERRY MERCHANT . Owner Owner's Name informrequiratifore CENTERVILLE MA 02632 3/31/2009 required for every page. City/Town State Zip Code Date of Inspection Do 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.): TANK FULL TO COVER Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene Elother(explain): Dimensions: Scum thickness Distance from top of scum to top of.outlet tee or baffle Distance from-bottom of scum to bottom of outlet tee or baffle --- Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, a.Y liquid levels.as,related to_outlet inyert,_evid.ence 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): -Title V Inspection Report.cloc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 15 4,\ Commonwealth of Massachusetts Title: 5 Official Inspectim Forte Subsurface Sewage:Disposal System Form Not for Voluntary Assessments 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name requiratiforon e CENTERVILLE MA 02632 3/31/2009 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont:) Tight or Holding Tank(cont.) 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.): a Attach copy of current pumping contract(required).-Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site -plan):X Depth of liquid level above outlet invert OVER Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of"leakage into or out of box, etc.): DISTRIBUTION BOX NOTED ON ASBUILT. DID NOT OPEN AS PIT WAS OPENED AND FULL TO COVER AND OVER COVER Pump Chamber(locate on site plan): Pumps in working order: ❑Yes E. No . Alarms in working order: ❑Yes ❑ No. Title inspection Repo rt.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 1;5, Commonwealth of Massachusetts� Jitle 5 OfficialInspect n Form ( = i Subsurface Sewage Disposal System Forma - Not for Voluntary Assessments , i 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name information is CENTERVILLE MA 02632 3/31/2009 required for every page,. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber;condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan,excavation not required): 1f SAS not located, explain why: Type: x❑ leaching pits number: 1 leaching chambers number: r El leaching galleries number: ❑ leaching trenches number, length: t_ __ __ _._ _❑ 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.): LEACHING IS ONE 1000 GALLON PRECAST PIT PIT&COVER AT 4' BELOW GRADE . PIT FULL TO COVER&OVER Title V Inspection Report:doc i 03108 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15. C Commonwealth of Massachusetts �, �r ,JTitle, 5 Official. Ins ectiOn for'"I' Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments � - 88 ZENO.CROCKER RD. Property Address. KERRY MERCHANT Owner Owner's.Name information is required for every CENTERVILLE MA 02632 3/31/2009 page. CityfTown State: Zip Code Date of Inspection D. System Information (cont.) '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 a Depth of scum layer I Dimensions of cesspool Materials of construction, Indication of groundwater inflow ❑Yes ❑ No t Comments(noteconditionof soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):,:. Privy (locate on site plan): Materials of.construction: 'Dimensions Depth of solids 4 Comments (note condition of soil, signs of hydraulic failure,.level of ponding; condition'of vegetation, etc.): _n. V 'v Tdle Inspection Repor aloe 03108 Ttle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 St Commonwealth of Massachusetts `Title Official Ins c j brm i ij, Subsurface Sewage Disposal System Form -_Not for Voluntary Assessments - 88 ZENO CROCKER RD. Property Address _ KERRY MERCHANT Owner Owner's Name information is required for every CENTERVILLE MA 02632 . 3/31/2009 "page. City/Town State Zip Code Date of.inspection D. � � �rr� �rafi rmation (cone.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building page In 6-5 - 3?` r Title V Inspection Report.dec 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 : I I I ' I I } t ! , I i I I ; i ' I i i I • I ' I 4 2- • TNI I , � � I � I i I I I ; I I ls� i l i A , I ! , I I 1 � I : I , { I I 1 I I t I I I I , i I i t I I I 7 I I i - - , _ 1 : •: � � i 1, ! j 1 + t -. j I i 1 [ 1 I iI f : j 1 I I• I ! ' 1 F _ t ( i I I ! r Commonwealth of Massachusetts _ .. c dot� `, y1-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 ZENO CROCKER RD Property Address KERRY MERCHANT Owner Owner's Name information is required for every CENTERVILLE MA 02632 3/31/2009 ' page. CityfrowD State Zip Code Date of Inspection D. System Information (cont.) Site Exam: . 0 Check Slope NONE x❑ Surface water NONE 0 Check cellar FULL x❑ Shallow wells NONE 11 Estimated depth to high ground water: 3515 feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record 1f checked, date of design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet.of SAS) Checked with local Board of Health -explain: ❑ Checked with local excavators;installers- (attach documentation)-- - — --— - Accessed USGS database-explain: USGS WELL SDW 252 ZONE B 1.8' You must describe how you established the high ground water elevation: USGS WELL SDW 252 AT 47.1 ZONE B 1.8 ti ADJ 35' 5 Title v Inspection.Report.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 _.A;)ESSOR-S MAP N ``ka PARCEL � G'CATION SEWAGE PERMIT NO. VILLAGE e INSTA LLER'S NAME A ADDRESS etc e U I L D E R OR OWNER DATE PERMIT ISSUED (Z D A T E COMPLIANCE ISSUED- t - i) i A cSSOR'S MAP NO.a`�Liao PARCEL Q, L0.-CATION SEWAGE PERMIT NO. Ln Ae A'S �VILLACE INSTALLER'S NAME a ADDRESS Y, • c ��- B U I L D E R OR OWNER Labs — Scn\\C) DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1 a � n, o0 ow 0 X y � �� -z-?d THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH_ .......... .O W.a....--....OF...... .1./...1.1;r'. ......................... Appliratiun for Uhip sal Works Cguntrudion Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at . 21) .............. I!?�.: Locatioi.«na�$L V. _.................._ ............��C 1.L..(. Lot No... ...............«.......«..... ltv[ Owner a ..................r.. ------------------.----- ..... ..��.... ----•..... ............. . 4fer .. Type of Building aarL //��',, r_ U YP g � Size L'ot...�!�:�//.r.tg.«�.....Sq. feet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) GartSage Grinder�'Vfr aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures . p1c6�177 ........ W Design Flow.........�-J. ii-�--. gallons pe pepse �r c#y. Total d_ply pow..._..._.--�����............ lonl.t WSeptic Tank—Liquid capacity-l_._60_gallons Length.�...a..4 Width:�,-'4.—... Diameter................ Depth. x Disposal Trench—No.......... ......... Width...... ............ Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No..........I.......... Diameter....... Depth below inlet......��..... Total leaching area Q.�.�.... ssq. ft. Z Other Distribution box Dosin (� �.. Percolation Test Results Performed by...... ` �h..l�.a..._. ._ 1 .:.......:. Date..... �� ,� -- .. .. 4 Test.Pit No. 1..G-��..�ninutes per inch Depth of Test Pit.... ....... Depth to ground w/ter .. ..... �� 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ........................................................... 0 Description of Soil................•-- ...................................................... -------.---- •. •- w -------------- t....... .. h ... .� '�}. — ,. ..---........ ....... UNature of Repairs or Alterations—Answer when applicable..................................:.............................. ......................••. .... ......- --.......-•------...-•.........................---------.............•--••••••........ ---•••-•••--•••......--••••...•--•..................... Agreement: . The undersigned agrees to install the aforedescribed In vidual Sew Disposal System in accordance with the provisions of LITL: 5 of the State Sanitary Code- :fhe i ersig e r agrees not to place the system in operation until a Certificate of Compliance has been issue o 1 Signed............... .... .. '--............---... ..C...`... Application Approved B Date Application Disapproved for the following reasons:................................................................................................................ ..---•.............................•---....-•--•----••----•--......---...............---.....-^-................................................................................... Date.............. Permit No.......«�—�_ .`.� ............ Issued...... ---•........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..... .. ........ (Irruttrtttr of Tontplianrr I` THIS IS TO CER�TJFY, That the Individual,Sewage Disposal System constructed (�-)-'ot epaired j ) _ ..... Installer ... 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........ .1D 6.... dated...........�Of1?/�_............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL-FUN,-CTION SA ISFACTORY. DATE--------------•--.......•...r----------•---•--......••--......-----........... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS, BOARD OF HEALTH,,,--'/ _ ..........................................OF.... /� %' a�/"7 -/�� ...---- 0...... ...� .... i/'/'� r r r 1V .FEE... ^�a........ Disposal Works Tonstrurxion f mutt Permission is hereby granted_......:y ,+.�'-;! ` '- ....... :!'.��_��._ to Construct ( /,) Repair (.�) an Individual Sewage Disposal System (f r^ j - r� -- o Street as shown on the application for Disposal Works Construction Permit No_____________________ Dated..........+.. ......................... ..........=•-... .........� C z Board of Health DATE.............. r } THE COMMONWEALTH OF,,MASSACHUSETTS BOARD OF HEALTH UJ ..........OF...... �q�.:,�TAP-75LE s ............................................... Appliratilan for Uispaoai Marks Tonstrnr#iun Vern it Application is hereby made for a Permit to Construct ( )y or�kepair ( ) an Individual Sewage Disposal System at.: �� d V....................................... .............. :� :. :� - .-at,- ............................ � Location•Address or Lot No. -_..... . . 1 -_ �.� - . ........... ............. ��' :�^i�i1` .----...................--•-•......_........ ... r Owner Address a .................. a- ��k' ;.,�... ................................ -•-•-••••------- ••-----•---��-- . ---•-•.. ......: ................ O _7t l i,staller Address /� Type of Building, �, Size Lot__.:1!Q:. ...!.....Sq. feet .. Dwelling,No.V of Bedrooms..........—•.................................Expansion Attic ( ) Garbage Grinder pa, Other=Type of Building ____________________________ No, of persons............................ Showers ( ) — Cafeteria ( ) a d Other fixtures Design\Flow.......*1 t .. gallons per person per day Total daily 4fi . ...._......_ lons.� Septic,�Tank—Lfiquid capacity� o.gallons Length.0_�.(,?... Width__ 'X:_. Diameter________________ Depth_,. x Disposal Trench=-No. .....,w............ Width_____________ Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..}._!_..-.1..---___.. Diameter-_._..__..,_-...... Depth below inlet...... ...... Total leaching area_ (1 A...!.sq. ft. Z Other Distributioit•box O� Dosing tank-( `-' Percolation Test Results Performed by.. .:'F" `�C,i .� I `� v— Date._...j2a !.. � Test-Pit No. 1._- ,7^.minutes per inch Depth of Test Pitj_�4i....... Depth to ground water.... ��t LX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............................. - .............. ._................................... 0 Description of Soil_....... i l , 1. C � ---__ - •_- W .................................................�--'--•-------•-----------•--•-----•-.._...._..... ---..._ ---------- __-------••---•--__........._�........ V Nature of Repairs or Alterations' Answer when applicable.......... ... .................. ......................................................... •••................ ........ ....... --........... .....-............---------------••---•---...---•----........ ...... .................. . Agreement � The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LImLZ 5 of the State Sanitary Code—The�pundersig6eV7.ther agrees not to place the system in operation until a Certificate of Compliance has been issued by,the oard,of health. Signed.............. .!•__l`// � �% .l.L;::?_'...._...._...._...... ... .. . .. .. .... r�GDate /�, Application Approved By. - //"r°-/ - ..... ....... .. ... .�_ .._...._.�.........._. .._............... 7 Date Application Disapproved for the following reasons----------------------•-----------------------------•-••---•--------•---..__.......••••-•-...•-•---•-........... ..-•-•--•••--•••••-•............................•----•--•---•----............---........._......_.__......-_.:..._......•--..._.....---._._...._...._....----•--.._....---.______.---.......__--......._ Date Permit No........ !za`1 .... Issued....................................................... Date F Y r. SECTION SEWAGE y . n y 2 -SEPTIC TANK- ��, -"D"BOX- S 1 -LEACH. _._ TOP OFF N (MSL)r . �F I18TO N*1 " 1 _. HED �va " N s OUT IN OUT F C7G 21& ✓r2,12 51:�7 - TANK ELEV. ELEV. ELEV. IC, ELEV. -77 ELEV. ELEV. y� / s. 'Y> t .. .. i .1. OF�4 -.11h s• r, d J 67 WASHED STONE (" �7(oa P.x�'i'T-FYI OF T-EF-) O' L p j TEST HOLE LOG _ TEST BY L� WITNESS d�z22�85 C BEDROOM HOUSE tE TEST DATE T— DESIGN T.N:�► 1 T.H. 2 - __�t ELEV. ELEV. LZ DISPOSER DISPOSER tl LOAF�I PERC RATE MIN/IN �1. _ FLOW RATE 33t7 (GAL./PAY) SEPTIC TANK E REQ'DSEPTIC TANK SIZE cJOO 1 a� Gi F4 � �; � -(� n L G��• �-7 5A A iTl"F T ZS _ _ . . V LEACH 'FACILITY. .. {; F . SIDE WAL ..BTf�' t21.� .....:377, C7 .G/D. a BOTTOM �8 Z P77=-��D 3 tl/�) . 5d:3 G/D. TOTAL rLp( i I SF _ LI27, 3 <o�Qr air - ff. . iy r T G , •." USE: I LEACHING �E�k WATER ENCOUNTERED. . I"• SL5 f� LT`� -7P-0 G1 NOTES: (UNLESS OTHERWISE NOTED) lL 51 DE-- 10, 1.DATUM(MSLU-TAKEN FROM'51& I"� QUADRANGLE MAP 2:"MUNICIPAL WATER . -------AVAILABLE � 1c), 3.PIPE,PITCH:W-PER FOOT OF - 4.DESIGN LOADING FOR�ALL PRE•CAST'UNITS:AASHO µ/c� .44 �" w�� U.M. CPS. �K�L�1KnLET �'tP� Z.t 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. 6:PIPE JOINTS SHALL BE MAOE WATERTIGHT ARNE H. 7:CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. aA� ^+ QiTC PLAN STATE ENVIRONMENTAL CODE TITLE 5 V '� SITE G g• •r�a.� p`�. >=4�c .rpT�� �. �,�rX o..��-c a�.o -5+- ,�'� ( No ?,� l 4i LGT- 2R. Z�T1C� G2pGkR. _` LOCUS: ' T[ '`t; � -• �'" ���p`tN Z6A D, CFI?FA V LLB'. lI A LS REG.PR �I INEER' ARNE �y� pp K 4 PA F' 2.7 ---- - _ ►, _. x EF c�►p@_ :en�in�@ti�►g _= , - - - --� - -- EPAR ED FOR:. �r TF ._ .... CIVIL ENGINEERS LANDSURVEYORS BOARD OF HEALTH �IA SI<w SUftY R. /n (EXISTING) SCALE GATE 6 �CONTOURS APPROVED a DAV T8 O( D ALL SYSTE LL SYSTEM PROFILE MARKED WITHCMAGNETICTTAPEO R BE NOTES PROVIDE WATERTIGHT MIN. 20" DIAM. (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1ake�0 1. DATUM IS APPROX. NGVD GIS SPOT ELEV.) ACCESS COVERS TO WITHIN 6" OF FIN. GRADE ) AS REQUIRED ° TOP FOUND. EL. 57.0' PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2• MUNICIPAL WATER IS EXISTING o o 2% SLOPE REQUIRED OVER SYSTEMZ 55.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. a MINIMUM .7_' OF COVER OVER PRECAST �c °o PRECAST H-10 8" MIN DIAM. 2" DOUBLE WAS ASTONE 4. DESIGN LOADING FOR ALL PROPOSED PRECAST get COVER UNITS TO BE AASHO H-iQ RISERS (TYP.) I ELEV, PROVIDE OR GEOTEXTILEP/RIC 2'0 i 4"0SCH40 PVC Locu i 54.9' TEE PIPES LEVEL 1ST 2' 52.5 5. PIPE JOINTS TO BE MADE WATERTIGHT.. 10" 14" o 00 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE ,mac a TEE EXISTING TEE * 6" SUMP TH o 52.0 310 CMR 15.000 TITLE V. y 1000 GAL H-10 53.5 f ( ) SEPTIC TANK o°°o°°o°°o°°o°o° 12" MIN. INT. DIAM. o0 2' o0 (RE-USE) GAS BAFFLE °°o°g ° °- oogo 000 0 0 0 0 0 0 0 ** o000 0000 50.0' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 3 52.17' 52.0' NOT TO BE USED FOR LOT LINE STAKING OR ANY 3050 INFILTRATORS OTHER PURPOSE. 3/4" TO 1 1/2" DOUBLE WASHED STONE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 8 DEPTH OF FLOW = 4 _ RoOR ue 2 TEE SIZES: 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30.4' X 10.25' 9. COMPONENTS NOT TO BE BACKFILLED INLET DEPTH = 10„ COMPACTION. (15.221 [2]) 5 7' CONCEALED WITHOUT INSPECTION D BOARRDD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OUTLET DEPTH = 14" - - OF HEALTH. ( 12% SLOPE) ( 1 7. SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION EXISTING SEPTIC TANK 1 1 D' BOX 2' LEACHING CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT BorroM TH-1 2 44.3' OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE No GROUNDWATER FOUND WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE ASSESSORS MAP 170 PARCEL 251 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. NO CONSTRUCTION PROPOSED (UPGRADE ONLY) 12. EXISTING LEACHING FACILITY SHALL BE PUMPED SITE IS WITHIN GP AND ESTUARINE PROTECTION AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND SAND. DISTRICTS 99- EXISTING CONTOUR .54 X 99.1 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR 67 198.4] PROPOSED SPOT EL. 54.67 FFNCt° 70 J), TH1 �k, x 54.73 SYSTEM DESIGN: TEST HOLE �2 6 Y l� 2> SLOPE of GROUND GARBAGE DISPOSER IS NOT ALLOWED UTILITY POLE 21 55. DESIGN FLOW: 3 BEDROOMS © 110 GPD = 330 GPD ' U � + yy0 FIRE HYDRANT :;4 67 TH1 , USE A 330 GPD DESIGN FLOW NOTE.- NOT ALL SYMBOLS MAY APPEAR IN DRAWING �� x 54.75 T TH2 x 54.89 SEPTIC TANK: 330 GPD (2) = 660 00 5 RE-USE EXIST. 1000 GAL. SEPTIC TANK ** TEST HOLE LOGS ,� L .12 5 .3 LEACHING: � ENGINEER: ARNE H. OJALA, PE, PLS BENCH MARK - CORNER SIDES: 2 (30.4 + 10.25) 2 (.74) = 120.3 GPD WITNESS: DAVID W. STANTON, IRS CONC. BULKHEAD EL. = 56.2 O SS x 54.71 5407 BOTTOM 30.4 x 10.25 (.74) = 230.6 GPD DATE: MAY 8, 2009 0 -4/ TOTAL: 474 S.F. 350.9 GPD < 2 MIN/INCH 2 PERC. RATE = N 55.93 � USE (4) 3050 INFILTRATOR UNITS CLASS I SOILS P# 12543 56.17 55.73 WITH 1' STONE AT ENDS AND 3' AT SIDES O GARAGE 55 5.90 5.64 ELEV. ELEV. 7.0 CONC. P A TI 0 0" 54.7' 0" 54.7' �o�� 40 EDWEWNGXIST. 3 R 55. 5.15 � MA S APPROVED DATE BOARD OF HEALTH A A O S,'�c4' 4.81 GGg�J�OR\�E / TOP FNDN. = 57.0' 54 �� SL SL w 4.6 3" 10YR 2/1 3" 10YR 2/1 V G 9 G--x 9-�G- DECK TITLE 5 SITE PLAN Y E G .41G`��G G---_ G 30 OF B B O Ex �4 3 E E---x-54E9-E PEE,55.88 LS LS 88 ZENO CROCKER ROAD 30" 2.5Y 6/6 52.2' 30" 2.5Y 6/6 52 2' 70 CENTERVILLE C1 C1 LOT 28 PERC MCS MCS 74 69' 16,161± SF PREPARED FOR �' BORTOLOTTI CONSTRUCTION/ 969' 5Y 6/5 969' 5Y 6/5 MARCHANT C2 C2 MAY 8, 2009 CMS CMS off 508-362-4541 ��'tNOF�yssgc y,�3�t�OFMgssgc fax 508-362-9880 2.5Y 8/4 2.5Y 8/4 ��� DANIELA. yG� �o� DANIEL ti�m I downcope.com z OJALA -� A. - • • 124" 44.3' 124" 44.3' CIVIL N OJALA down cope engineering, MC. -0 2 � ,� No.40980„ o civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' _ OFF sc�s ������ NpF R,o °� / land surveyors �� l 939 Main Street ( Rte 6A) 0 10 20 30 4o so FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 0 n p ,/ 09-084.DWG (SBO) (l-�U`i-