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HomeMy WebLinkAbout0079 NOBADEER ROAD - Health 9 lqobadeer Rdad9 Hyannis A= 4 I No. / '-- Fee c�J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pplitation fDr-Misposal *pBtrm ConstCULtion permit Application for a Permit to Construct( ) Repair( �) Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.7 fd iE Jeer PoA�� Owner's Name,Address,and Tel.No. S'00-77G G y(V Assessor's Map/Parcel �® �V(,Y "'Po G11�1U� , / ®d j�rr Installer's Name,Address,and Tel.No. goic 7p4, lllft Designer's Name,Address,and Tel.No. ,rob,, 13 C4y) Type of Building: Dwelling No.of Bedrooms ��le Lot Size 9O 6 C/L sq.ft. Garbage Grinder( ) Other Type of Building KIC L 4.' ) No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requ'red) 3540 gpd Design flow provided AY a 3 3 gpd Plan Date 00 17 /A Number of sheets Revision Date Title Size of Septic Tank ®®® Type of S.A.S. �2 X X619 6?,g � �� rc✓e Description of Soil re _ k C'C . It r Nature of Repairs or Alterations(Answer when applicable) -ZI S J - Y ,j00 /411 ,x 11 1 *Sr'C DIG n 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 H S' ed Date d I Application Approved by Date Application Disapproved by Date for the following reasons L— -- --------------- ------ t Permit No. `� Date Issued 4 No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION . TOWN OF BARNSTABLE, MASSACHUSETTS Yes. y �lpYication foi wosal 6psteru Construction 3perutit Application for a Permit to Construct( ) Repair(� pVr e t( )} Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. 9 ,/ Lad«,f.' aAII Owner's Name,Address,and Tel.No. fV g;- 771,G y(V Assessor's Map/Parcel �f0 (, t tJ alp L° ,,4o4hc_ ;7 .(�0 6gJrcr eA Installer's Name,Address,and Tel.No. Designer""''Name;Address,and Tel.No. fv&f 13 09y) )�;kel- LGA L A M4 jVq 6 6k,4 ed. Type of Building: , Dwelling No.of Bedrooms d<C Lot Size O 4/L sq.ft. Garbage Grinder( ) Other Type of Building K15,- c,4o, No.of Persons Showers( ) Cafeteria( ) Other Fixtures .,,�'" ,•,,,,,* "_..w." "" J .r.;'�' ..r':'t'` a"'-' ''` r Design Flow(min.required) :J°,3Q gpd Design flow provided Ay9. 3 gpd Plan Date-'O'i /7 41A Number of sheets Revision Date Title Size of Septic Tank V d oa Type of S.A.S. X s60 401 4,, a/xsle if Description of Soil # PC Ar 4 r Nature of Repairs or Alterations(Answer when applicable) 7n.S- p` fIJG 4f411,,, P/ ,�1l , 9 144�/ �,i,s'�G,�� i �rX A A S_,rG a 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 He S' ned Date Q I'V7.01(961'e /.Application Approved by Date 1 , Application Disapproved by Date 4 for the Tollowing reasons Permit No. Date Issued X --------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFLY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) ! Abandoned( )by f�i�C y^ L�i•d ['cam j�j� at 79 yn ba Nre — ft-A has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nor ^ dated Installer ^(�� r Designer H rl ,' i _1 oc., #bedrooms %h Approved-de-si. flow 10Q gpd The issuance of this perrpitsh not be onstrued as a guarantee that the sy\stem will fim do as esigned. Date `� �) Inspec£or No. r T% Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct"( ) Repair( ) Upgrade( ) Abandon( ) System located at9 ,��,, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe , it. Approved by Date i Town,of Barnstable Regulatory Services Richard V. Scali,Interim Director snxtasrast.�• • . MASS. Public Health Division s6gq. �0 °i Thomas McKean,Director 206 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790=6304 Installer& Designer Certification Form Date: lo Sewage Permit# .20 �P-Assessor's Map\Parcel.�Ol Designer: Installer: aw!w c/;/V71 . Address: 4W Address: I�Q, ✓Ox �� On __ �/�1,4a L�"C/T0^as issued a permit to install a (date) (installer) septic system at 7 9/ jPk A�� based on a design drawn by (address) dated 9—/7- (designer) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or-septic tank. Strip out (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 any 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. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the RA approval letters (if applicable) A kOFMA8 AW (Installer's Signature) t N VON HONE v #1068 o y q \A Designer's Signature) (Affix p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE. ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc 79 nlbarkrr ��w/ I— si 0U I sf Nr�K w i � I j `ii • i �� /j� S �►R i C `a TOWN OF BARNSTABLE LOCATION �lA' 910 i+tDE1@�. SEWAGE# VILLAGE Q gWAe ti"-ASSESSOR'S MAP&PARCEL S® 146 INSTALLER'S NAME&PHONE NO. ?,tkA4, lta�UCo,attfuc'C�t�i '�°� �g� SEPTIC TANK CAPACITY 1 ` (7AQ. 1-1-1 01 LEACHING FACILITY:(type)(:;I> 50b UAL lei$ (size) _13X2�15, NO.OF BEDROOMS �C,� �l OWNER..] i PERMIT DATE: ` s. COMPLIANCE DATE: kb Separation Distance Between the: ��� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility t*-30 bT0-VJZt Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) I(fit Feet Edge of Wetland and Leaching Facility(If any wetlands exist within. 300 feet of leaching facility) Pt Feet FURNISHED BY will Or., Z. Town of Barnstable P# Department of Regulatory Services ': ,,, ,s Public Health Division Date cf!{ MASR 200 Main Street,Hyannis MA 02601 ia gild" � ` Pw� Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sqwage Disposal w //�y�Qy7{� PerfOimed By: '//�c_i[/•iS//` �//Vi/` WlfrieSSed By: LOIPATION& GENERAL INFORMATIUeje�, Location Address ® �� 's Na Ownerme Assessor's Map/Parcel: Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 47 V 7 Q v Land Use R 4 Err Q/ Slopes(%) .2 -Surface Stones ' Distances from: Open Water Body a�(. ft, Possible Wet Area— fI Drinking Water Well R 1 Drainage Way�ft. Property Line 2ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) ` 7 / Rt37. E off"" �} lei Parent inateo$1(geologio 6k1(Q1 t/� � Depth to Bedrock Depth to Groundwater: Standing Water in Hole: ���( Weeping from Pit Face Estimated Seasonal High Groundwater � c -r DETERMINATION FOR SEASONAL HIGH WATER TABLE Method used: s ' Depth Observed standing in obs.hole: 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 r PERCOLATION.TEST Date 1 f 7 l�[Ime Observation T ' Hole# - _ Time at 9", Depot of Perc• � ' � Time at 6" Start Pre-soak Time @ Time(9' End Pre-soak �• �'��� �/ G ��a Rate Min/Inch 1"1 d r ► f,� e' E it A Site Suitability Assessment: Site Passed • +ti .Site Failed: r Additional Testing Needed(Y/N) Original: Public Health Division �� Observation Hole Data To Be Completed on Back------ ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC 1 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ¢ Consistency %Gravel) rr 4 A DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structurc,Stones,Boulders. Consistency,%G*uvel) r' U y r R Al A'l ' e 19*r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. �onsi encv.%GcavelL DEEP OBSERVATION HOLE LOG Hole# Depth fiotn Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No Yes Cl Within 500 year boundary No c_/Yes Within 100 year flood boundary No Zl Ye, Depth of Naturally P_Mu_rring Pervious Material Does at least four feet of naturally occurring pervious rjal exist in all areas observed throughout the area proposed for the soil absorption system? > If not,what is the depth of naturally occurring pervioik material? Certification I certify that on ' idate)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 requi/traimmin ,exxerUse and ex hence described in 310 CMR 15.017. Si ature (. CO A � Date � / Q:\SEPnCTERCFORMDOC L O CATION `�` WAGE PERMIT NO. VILLAGE &44 I N S T A LLER'S NAME 6 ADDRESS K< 3h2A) 0 U I L D E R 00 OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED . W Lv J n . / r / OTA!DWEAOF MASSACHUSETTS ` BOAR® OF HEALTH YJ T4e-'2...............OF.........3 .J'_X�?r le--------------------------------- AIVp iration for Uiipnaal Warkfi Tonstrnrtinn ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: f . �i11 � Cer. r. l r ..�1.---.1 . 5 .......... ... ........ .c Location-Address or Lot No. Owner Address ---G®. s... ._... .... zj......... ••-------• --------------- W Installer Address U Type of Building Size Lot_.a.42.4�5_._..Sq. Dwelling—No. of Bedrooms.................0.........................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ) Otherfixtures -------------------------------•----------------•-------------------------------------------------------------------.........---------....----..----- � Design Flow................. .................gallons per person pe5 y. Total daily flow-------_.__:_....334�..............gallons. WSeptic Tank—Liquid"capacity.. M?gallons Length__. _ Width________________ Diameter________.__.___. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........./.......... Diameter.........AAO'.... Depth below inlet.......:4....... Total leaching areagS/_.S�.sq. ft. Z Other Distribution box ( ✓j Dosing tank ( ) ,�n�r_6 aPercolation Test Results Performed by..,�g �..f' AA9d V_—%P- )Date......�� Cd �3....._..... Plfg"! Test Pit No. 1....�.Z._minutes per inch Depth of Test Pit------/Z........ Depth to ground water.._.l�/�'?Q_�__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•---------------=---------------•-----------.....---•-----------.._.....----------....-----•-- ---•-•----------•- O Description of Soil........................... � ,�.r U ----i t s - "� 1 -. t - ....77—�r 4�= W --------------------•------------------------------------ ------------------....-------------------------------------------------. /" -!ice --------------------------•------- U Nature of Repairs or Alterations—Answer when applicable .......___..........._........._......_.._._...._.........___. .............................................-.......................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI,z. 5 of the State Sanitary Code— The un sin further agrees not to place the system in operation until a Certificate of Compliance has been 'ss d by e a f Health. ined-- :== ..... . .. .... .............................. Application Approved BY . --- --�'- ----• -- --------- �� Date Application Disapprove or t e following reasons----------------------------•----------------------------------...------------------------.....-------:.......... -•------------------•-•----------------------•----------------•-----------------------•--•---------....----------------------------------------------------...---------------------------------•-------- Date PermitNo...............................••---•----......---------- Issued_....................................................... Date No..- ...._.... Fim........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ToGv/I................OF........1 sue...... Appliration for Disposal Works Tontrurtion JIrrmit Application is hereby made for a Permit to Construct (✓S or Repair ( ) an Individual Sewage Disposal System at: 4 .& .... r�/� � ...... . L�calion-Address t Owner Address Installer Address Type of Building Size feet r., Dwelling—No. of Bedrooms...............O..........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers � YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------------------------------------••-------------------------•- - WDesign Flow................,56......._......__.-gallons per person pefj�ay. Total daily flow-__-------------.f. d...._..._.....,gallons. G4 Septic Tank—Liquid'capacity./ gallons Length__ ......t.. Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........I.......... Diameter......... Depth below inlet.......- ....... Total leaching areaZ.a/5A .sq. ft. Z Other Distribution box (&"� Dosing tank ( ) '-' Percolation Test Results Performed by--- Date_..._S1lo1.?3........._.. Test Pit No. 1...4.Z._.minutes per inch Depth of Test Pit______L�._..._... Depth to ound':water.._ - P P P bn' � •-- -- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a+' ................................................... .............7-------•-------------- -------------••--- - -- ---------- O Z.....!� .. z > A Description or Soil G7 �r .` �' r�� t .__ cu1 � .c�--! °; ----•-------.._...._._...--•---------------------------------•--•----•-............................................--------•-•- ram- ...... ................................. 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 TIT r p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. i ed_ ..................APPlication APProved By••••• ... .�...... ................•---------•--------------------...........-- ------------•---•-••--••-•--••-•-------- Date ingApplication Disapproved f h` reasons: ----•---------------•-------•-----•------...........------------------------..._......-----•---......-•------------......-------•----------------------------------------------------------...........-- Date PermitNo....................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... r . �rrtifiratr of Tompliaurr THIS IS CE Y, That thAIndV,; dua Sewage Di-s-po.� I S- tem constructed ( ) or Repaired ( ) by---•---------------F----�4=--- .................... i . at-•---------------•-------•;--•--•-------•------••--•----•-••.........•--•-•••••--------••-••---••••••----------•-•••--- ------------------------------ ......... has been installed in accordance with the provisions of TITLE 3�'l� qe Sanitary CoVas>d'" cl�g _ the application for Disposal Works Construction Permit No----------------------------------------- dated-............................................... THE ISSU NCE F THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL�FU TION SATISFACTORY. DATE.....°� . ......-`?----------------•---•-•--•--------•---•----•--- Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / ..........................................OF..................................................................................... �1 G No......................... FEE........................ Disposal r ons riir#' rrniit Permission is her ,cl an --•-•........... ....••---• ..................................................... to Construct ( or R ( ) % Indivi osal atNo...........................................,................-•-•---��---......--••---•--•---•--.------......---------------....._........-•------•- --�/--_. .............. Street �r� as shown on the application for Disposal Works Construction Permit No........... ....... x _______._.__._..._..................... . -•------------------------- -------- 4 .r �Z � oard Health DATE(((.���.°°°..�-,-J/ -----•-------------�-.�_�.. .:�..................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS if a& Commonwealth of Mossochuseffs ,John Grad ExeCumie Office Of EnvlronmerYtai AffairsD.E.P. Title V Septic Inspector Department of P.O. Box 2119 D Environmental Protection Teaticket 6 (50 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1!� RfCEIU, R PART A ;,,. Ap/� CERTIFICATION T �FC s 199? Property Address: 79 Nobadeer Rd. Y ry e Address of Owner: e STge1; ~ Date of Inspection:4121197 (If different) Name of Inspector John Gracl Swanson:ll LinwoodAv.DerryN.H.03038 e _v Company Name,Address and Telephone Number: t t CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: e X Passes This inspection is based on criteria defined In Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needibmit her aluation B the Local Approving Authority performing at the time of the Inspection.My Inspection does Y PP 9 tY not Imply any warranty or guarantee of the longevity of the Fails septic system and any of its components useful life. Inspector's Signature: Date:.4/21197 a The System Inspector shall sa copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: . Check A, B.C,or D:' A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or.repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.), .. _ The septic tank is metal, cracked,structurally unsound,'shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195). One Winter Street • Boston,Massachusetts 02108 • ,FAX(617)556-1049 • Telephone(617)292-5500 1 tl i G SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 79 NobadeerRd.Centerville Owner: Swanson:I I Linwood Av.Derry N.H.03038 Date of Inspection:4121197 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board.of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a'surface water supply. The system has a septic tank and soil'absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. (revised 11115195) p SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 79 Nobadeer Rd.Centerville Owner: Swanson:IILlnwood Av.Derry N.H.03038 Date of Inspection:4121197 D] SYSTEM FAILS(continued) Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: „ The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 79 Nobadeer Rd.centervllle Owner: Swanson:11Llnwood Av.Derry N.H.03038 Date of Inspection:4121197 y Check if the following have been done: X Pumping information was requested of the owner,occupant;and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. n1aAs built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected for condition of baffles or tem.material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. s . (revised 11115195) . 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 79 Nobadeer Rd.Centerville Owner: Swanson:11 Linwood Av.Derry N.H.03038 Date of Inspection:4121197. FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: 3 Number of current residents: 0 Garbage grinder(yes or no): Na Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yes Water meter readings,if available: nla Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: n1a Last date of occupancy: n18 OTHER: (Describe) nla Last date of occupancy: GENERAL INFORMATION• r PUMPING RECORDS and source of information: System has not been pumped In the last year. System pumped as part of inspection:(yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: nla TYPE OF SYSTEM X Septic tank/distribution box/soiI absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) ti APPROXIMATE AGE of all components,date installed(if known)and source information: 1984 Sewage odors detected when arriving at the site:(yes or no) No .f (revised 111115195) y g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 NobadeerRd.Centerville Owner: Swanson:I I Linwood Av.Derry N.H.03038 Date of Inspection:4121/97 SEPTIC TANK:X (locate on site plan) Depth below grade: 3' Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L 8'6-H 5'7"W 4'10- - Sludge depth:3' Distance from top of sludge to bottom of outlet tee or baffle: 24 Scum thickness:2' Distance from top of scum to top of outlet tee or baffle:6' Distance form bottom of scum to bottom of outlet tee or baffle: 16" Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance. GREASE,TRAP: (locate on site plan) Depth below grade: Na Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) n1a (revised 11115195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Nobadeer Rd.Centerville Owner: Swanson:I I Linwood Av.Derry N.H.03038 . Date of Inspection:4121/97 e TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n1a Material of con struction:_concrete_metal_FRP_other(expIain) Dimensions: n1a Capacity: We gallons Design flow: n1a gallons/day Alarm level: n1a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nla DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: Liquld level with bottom of pipe. Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) D-box is structurally sound PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) n1a z , (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 NobadeerRd.Centerville Owner: Swanson:I I Linwood Av.Derry N.H.03033 Date of Inspection:4121197 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may approximated by non-intrusive methods) If not determined to be present,explain: nla Type. ; leaching pits,number: 1,000 gallon leach pit leaching chambers,number:nfa leaching galleries,number: nfa leaching trenches,number,length: nfa leaching fields,number,dimensions:nfa overflow cesspool,number:nfa Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) The overflow was empty at the time of the Inspection CESSPOOLS: (locate on site plan) Number and configuration: nia Depth-top of liquid to inlet invert; nfa Depth of solids layer: We Depth of scum layer: nfa i Dimensions of cesspool: nfa Materials of construction: n1a Indication of groundwater: nia inflow(cesspool must be pumped as part of inspection) nla Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) nfa PRIVY:_ (locate on site plan) 4 Materials of construction: nla Dimensions: nfa Depth of solids: nfa Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) nla (revised 11115195) - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Nobadeer Rd.Centerville y, Owner: Swanson:11 Linwood Av.Derry N.H.03039 Date of Inspection:4121197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 3 rx rc ?I� DEPTH'TO GROUNDWATER' Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) NOTE: Recommend breaking GENERAL NOTES: x s2.5o through Cl layer to C2 layer below / red _ .leach chambersj(2 holes) to / 1. VERTICAL DATUM: _--ASSUMED _____ S provide access to C2 soils. ;x 2. MUNICIPAL WATER AVAILABLE. 1.91 Removal of Cl Layer, is not / 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT required. / SYSTEM UNLESS OTHERWISE NOTED. N . 4. ALL PRECAST UNITS TO CONFORM TO s2.47 ,2" 6�319"W / AASHTO: H_10 & 20-- 301 10 y "62.45 15' 5• PIPE PITCH-1 4" PER FOOT UNLESS OTHERWISE NOT 7, 62.90 /. ED. / x 66.06 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA ENVIR. CODE (TITLE 5) AND LOCAL -2 63.56 64.71 REGULATIONS. ` e3 O Lot 11 7 20,044 sff CONTRACTOR TO VERIFY LOCATIONS OF' ALL UTILITIES � . 5 �3 10b �s_3.01 PRIOR TO CONSTRUCTION. 0 Oak N r 5 4 O -64.78 65 es p o € 3.99 :'`- -x 5.22 / 6., LEGEND. 6.1 Qo 39• o PROPOSED CONTOUR ;. 65.53 / x s4 TH-1 Exist. Tank r, ro`O X rn 9s PROPOSED SPOT GRADE s.10 L 12" P.Pine t0 remain - 40 EXISTING CONTOUR ' Bunny 64.31 1°� >>, f f 0 .r X 30.23 EXISTING SPOT GRADE H tch rA H2 y ® TEST PIT u 64.44 ��.� 8 Garage 3 u 4.8 4.90' ' 66.06 64.32 drove g;.61' I 64.89' �' \ 66a6 :•�, 6g O a EXISTING WATER SERVICE 15.60 64.84 Q X o WORK LIMIT LINE ' 6s.7 65 5A2 A a �; 65.965.94 w 65.&9 ; ¢S.s> ,J.,sr 64 92 ,, 6A. 4.69 7' Exist. Dwell. I ` 1...1 S �4.75 4.97 = Waterline �' 9 1 ;, `` Or Mgs9 %4.96 Top Fndn. 65 2 fi5: S Firepit Elev. 66.6' W _ ' 65 { "� AMY L. �e $ �� O s64. 9 n \ VON HONE in64. 7 4 w ' Y 08 Q) c -+ x i .� y <n a x 65.95 3 . ` 90 rn No. 1068 k x 65.28 •.. Gasline 6S 94 J O I � 4.64 76 -C i I O6 Benchmark: Top of 64.66 Gosline 6, J r I o 6g 64.88 Bottom Step at e, Elev. 65.7' 1 O NOTE: This plan -is to be used for septic S64, � m o ss. 3 system purposes only and is not to be 1 4,3 j9" 65.75 used for any other purpose. x 65.61 LOCu Y x65.8 f -- 79 NOBADEER ROAD NOTE:' Pump and backffll 65 64 99 Vy CEN TER VI LLE, MA failed. leach pit. - is ,z � � •XsS.s, associates PREPARED Jeffrey & Melinda 5 CD }4:9++ Inc SYSTM aESICNS FOR: y p 664.85 64.80 78 320 Cotuit Road 0 _ Sandwich, MA 02563 L a m o t h e r R m m avel Dri Septic System Q °&`sset x64197. -._xrO��y (C)5082740074 Design Plan 79 Nobadeer Road � ASSESSORS MAP: 250 Centerville, MA 02632 PARCEL: 146/H0o & Too RB9 64.78 Surveying tor X � StraWberr REFERENCE: LCP 40592-C/CTF 1449233 64.69 AHpjalaSurveying Y Hill FLOOD ZONE: Zone X Town of Barnstable I Arne MA 0266 DATE REVISED SCALE SHEET N0. x 65. 6 west aamstable, MA 02tt88 �� _ Locus MAP N.T.S. #25001 C0562J (07/16/14) 508-362-0934 09/17/18 1 = 20 1 .of 2 . } X 64.61 Install risers w covers over "inlet and Provide Riser over D-box_ NOTE: All components to be marked with T.O.F. Full outlet to within 6" of final grade ma netic to NOTE: To prevent breakout, final (Full) � to within 6" of final grade � 9 tape or similar prior 'to final cover. EL. 66.6 (Access Covers min. 20' diam. per Code) 9 grade of EL. 59.73 to be carried (Cover",to be watertight) : out a minimum 15' beyond edge F.G EL: 65.8-66.25 F.G. EL: 64.75 Maintain Min. 2% slope over leach facility to • 'ExistingF.G. EL: 63:5 1. ere vent ondin F.G. EL: 62.5-63.6 of leach facility. Regrade to maintain maximum 3' cover. Exist. invert Min. 2" of 1/8" - 3/4" Washed Stone or Ins ection Ports within 6" to grade 4" Pipe L=11 i Geotextile Fabric Top 3.50 „ 'EL: 63.77 4" SCH 40 L=25' r Tee L L=10' 3/4" - 1 1/2 Double Washed Stone (Top of Unit EL. 60.6) • 4 SCH 40 PVC 4" SCH 40 PVC Top of Peastone or Geotextile Fabric EL. 59.73 io ®S=9:8% 19' a®. as ,> e u s 12,, 0S=1% 1 .MIN eaa$aaa 24 Eff. Depth EL. 62.4 Install Gas Baffle EL 62.15 EL. 59.67 EL. 59.5` a®a®aaa Bottom EL. 57.4 - PROPOSED DB-3 EL '59.4 Use 2 - 500 Gallon Precast Chambers H-20 DISTRIBUTION BOX (H-20) with Double Washed Stone 9.4' A. Watertest for levelness 4' Ends, 4' Sides (Install PVC Inlet & Outlet Tees) • EXISTING 1000 GALLON if more than one SEPTIC SYSTEM PROFILE (25 x 12.83' x 2') H-10 SEPTIC TANK outlet - EL. 48.0 SOIL LOG N.T.S. Bottom of TH-2 ADDITIONAL 'NOTE-S DESIGN CRITERIA 1 Contractor to confirm soil suitability prior( to installation. Contact BOH and SOIL EVALUATOR: AMY VON HONE, R.S. ' S.E. #2517 Design Sanitarian in" the event of varying ,soils from original soil test. Number of Bedrooms:Existing 3 .Bedrooms INSPECTOR: . DONALD DESMARAIS, .R.S., 'BOH DATE: SEPTEM#15777BER 17, 2018 10:00 AM An contaminated materials within 5' of proposed Leach Facility to be Soil 'Type: Class I PERMIT: #15777 2. . Y P P Y _ , removed. Replace clean fill per Title, 5 specifications. Percolation Rate: <2 -min Inch', PERCOLATION -RATE: <2 MIN/INCH IN C1 _ - P P P - / - Dail Flow: f TH - 1 TH - 2 3. Contractor -to . verify location. of water line prior' to construction. Y 110 G.P.D./Bedrm x 3 =330 G:P.D. Design Flow: 330 G P.D.` (Min. Required), ,EL. 64.0 EL. 63.0 4.`•Distribution Box to be placed on 6" crushed stone or compacted, level . Fill base. i Garbage Grinder: Not Allowed Fill t Leaching Area } Required: (3301)/0.74 = 445.94 S.F. 44" 60.4' 207 61:4 A (' A O , 330 G.P.D. x 200% 660 G.P.D Sandy Loam Sandy Loam c c Septic Tank Required: 10YR4/1 SEPTIC TIES Minimum 1000 Gallon (Existing) 10YR 4/1 ti 24" . C" 46" 60.17 61.0 Use 2 - 500 Gallon Precast Chambers H-20 with C1 sr. Loamy Sand .Sandy Loam Double Washed Stone: 25' x 12.83' x 2' 2.5Y6/4 10YR6/4 12 , (Mix of Stones 44' 59.4 83 & Sand Pockets) C1 391 Sidewall Area: 2(25' + 12.83')2= 151.32 S.F. Perc Loam Sand .� , Bottom Area: 25' x 12.83'= 320.75 S.F. ® y • • .,„ Total Area: 472.07 S.F. 72" Bottom 2.5Y6/4 � , 0.74(472.07 S.F.)= 349.33 G.P.D. (Mix of Stones � H f Desi n Flow Provided: & Sand Pockets) Garage ' r 79 NOBADEER ROAD 108" 54.0 1 `. C2 Coarse sand CEN TER VI LLE, MA ` PREPARED 2.5Ys/s I associates FOR: Jeffrey 8c Melinda 126" 53.5 180,' 48.0 No Groundwater Observed i +' SEPnc SYSTEM DESIGNS y <8 inches 0 11: 30 minutes Presoak i Exist. Dwell. sandwich,MA 20 ssa Septic System Larnothe Top Fndn. _ ' Site Plan (o)508.833.0041 PERC RATE:' <2 MIN/INCH C1 Horizon Elev. 66.6' :4 (c)508.274.0074 79 Nobadeer Road *. I, Amy L. von- Hone, R.S., hereby certify that I am currently approved by Centerville,' + MA 02632 the DEP pursuant to `310 CMR 15.017 to conduct soil evaluations and Surveyingar••• ,;^. Terry A. War neerr .P.L.S. that'the above analysis has been performed by me consistent with the F22 requirements of. 310 CMR 15.017. I further certify that I have �'` Harwich, MA 2"5 DATE REVISED SCALE SHEET NO. successfully passed the Soil Evaluator's Exam on November, 1994. (5D8) 432-009 09/17/18 1 = 20' 2 of 2 r SITE PLAN T YPICAL PROFIL E SCALE — / = NOT TO SCA L E „ �1. , �L u -r• , 18"STD. L T. WG T C.I. MH COVER — , W 4"C.l. PIPE 4"BIT. FIBER PIPE TIGHT JOINTS 01!/TL E T LEVEL L/NE FLOW �- 0 TO FIRST ✓O/NT 4� .n DWELL 14'1 o 0 — REE . c.1. r C./. TEE _ I STANDARD PRECAST t44- -- r ;� �• '' c, , CONCRETE A�Z GALLON DISTRIBUTION BOX SEPTIC TANK TO BE INS TA L L ED ON LEVEL , STABLE BASE. a .r SEPTIC TANK � TO BE INS TA L L ED ON I r <;..- LEVEL , STABLE BASE • . .f� eL . 55,0 2 //B'" TO 1/2 WASHED PEA STONF LEACHING PI + P J ALL AROUND FREE OF IRONS FINES BASE TO BE LEVEL AND DUST IN PLACE _ BRICK B MORTAR COURES 3/4" TO I-1/2" WASHED CRUSHED AS REOU/RED TO BRING STONE ALL AROUND FREE OF COVER TO GRADE 24"C.I. MH COVER 4. IRONS, FINES AND DUST /N PL 4CE AND FRAME r---- - --- It • �va.tc. IUQO 'rr 4 ' ___ ---- 1 LEACHING PIT SECTION- ` -- _ INLET 8' FLOW LINE T_ _ -,-_-_ P/PE I -L I. CONCRETE TO BE 4000 PSI 28 DAYS GL Af...t OUT 3oD!a• T, 2. REINFORCED WITH 6" x 6" NO. 6 GA W.W.M. To 5 p �PTN + �AcK�tt� i� 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER �r'RpP ~� DEPTH REQUIREMENTS. s;- '>0R 1 ' 1 hTP' Pt�EC,�'ST C.vNL. OPENING W/TH 4 1/8" 4. NUMBER OF PITS REQUIRED G a L Fc b.G I-1 te5 A 5 I!�.! _ _ +': _ ? OUTER DIAMETER Q LOT I I DwL ~��/ / 1-3/4 INSIDE DIAMETER I NOTE: EXCAVATE TO ELEVATION `-'t'� OR LOWER AS " �O, J 4 5 ; [LIFE tity 11 _i 3" REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH 1,44 PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN 71 GRAVEL TO DESIGNED GRADE g, + Lu ar VL ,r 41-0 MIN. ` EFFECTIVE DIAMETER � (NOT TO EXCEED 3 TIMES EFFECTIVE DFpTH) I <, c-�A� _. -�-� WATER TAQL E D {r wA - � T SOIL AND F 4 RC. DATA GENERA L NO TES T NO HEAVY EQUIPMENT TO RUN OVER SYSTEM PERC. RATE z MIN. /IN . I I � S Co F T t u G 1r N L.- [7 WM• kV AIzt.CJ lL {K /_�<j5o�, SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD EST @r __ r . _ _ PRECAST REINFORCED CONCRETE UNITS WITNESSED BY . N N .l A G O t3 t ( to, 1p� . N , ) ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORCANCE CCjv ' w A �� O TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE ,TEST PIT GR EL _- DATE : 5 MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF TEST Ptt' NG. I TEST PIT NO SANITARY SEWAGE EFFECTIVE I JULY 1977. O 0" ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE z, ToP/ 5U13gviL BOARD OF HEALTH. �i' cvMp�,GTEp 5A1J(7 AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, 7HE GOA9 C- '5AL1 D - BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. TKAGaC.PEAVC-L. PITCH ALL SEWER LINES 1/4" /FT. UNLESS INDICATED I eL 51•0 OTHERWISE. ILIo �izouA.lbWArEt� DESIGN DA'T.4 - BEDR00MS _. .__._ _ DISPOSAL EST. TOTAL DAILY Et•F. _.._ 33o GALS. L EGEND -` SEPTIC TANK GAL SIDEWALL AREA _. 7-S-...GAL.,'S0. FT. EXISTING GRADE EH AREA _____.1' GAL./SO FT SEWAGE DISPOSAL SYSTEM LEACHING RE vUIREi7i.___._.. � S0.FT ZONE V o oc Ai•'_AL � E �;C+„NCI AREA ?`�t SZ- SOFT. FOR FINISHED GRADE _ = � Tz t) L_ 5 T �2, UsT DOMESTIC WATER SOURCE E V ' ° ''� n • o0 j INVERT ELEVATION zuGc i-©T r-- r2 t-2,o A o OZ - PROPERTY LINE &JT E� VILIII, L iVA10- U -rA � lt,& PLAN REFERENCE : --- _,� MEAN HIGH WATER 1 r ,. ] ; R••t I n. J SCALE AS INDICATED DATE AUK S, ' a•,p tI I y.� • BENCH MARK DATUM L) 4? C-i `% T y h , - �i� MARSH V ff� � WM. M WARWICK 8 ASSOCIATES ? 1 �� ' SOX 801 - NORTH FALMOUTH A4ASSA111-HUSETT5 02556