HomeMy WebLinkAbout0184 EISENHOWER DRIVE - Health 184,Eisenhower Drive
Cotuit P
A 039 118 -- — --
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YOU WISH TO OPEN A BUSINESS?
Far Your Information: Business certificates (cost$4D.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not;give you,permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 0260-1 (Town Hall) and get the Business Certificate that is
required by law.
DATE: S1101i2 Fill in please:
APPLICANT'S YOUR NAME/S: 0
k ;!,;'+•••..ii �.j �r.;` BUSI ESS YOUR HOME ADDRESS:
_t I.S.t!FM1 •k!+J .i l..i�;Lj�n -
fr- TELEPHONE # Home Telephone Number y
OR E I N #: (� Z E-MA I L-. '`� 1 .SFa
NAME OF CORPORATION: h�� t-C
NAME OF NEW BUSINESS 00 TYPE OF BUSINESS Sv
IS THIS A HOME OCCUPATION? E NO `
ADDRESS OF BU51NES5. e �"� MAP/PARCEL NUMBER Ck5 - (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable, This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILOING CO MI S NER'S OFFI MUST COMPLY WITH HOME OCCUPATION
This indivi ua b e i or d f y rmit u*rements that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO
COMPLY MAY RESULT IN FINES.
u hors SI iTBture*
rVMFAT '
2. BOARD OF HEALTH
This individual h"thorizedSignat&e"
rmit equirements that pertain to this type of business.
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS
: . TOWN OF BARNSTABLE
LOCATION $y E2.SEN//oW6-R OR . SEWAGE# got)8- /Y2,
VILLAGE Co-ly,f ASSESSOR'S MAP&PARCEL 039 - //S
INSTALLERS NAME&PHONE NO. B i3 CX cAVA'T2orn/
SEPTIC TANK CAPACITY /o oo
LEACHING FACILITY:(type) _moo go) chawiA 1�z) (size) 13 x .7S x a
NO.OF BEDROOMS 3
OWNER
PERMIT DATE: COMPLIANCE DATE: y- IS-D r<
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
FURNISHED BY
A�-3S n
A Z -31
Cie-ai
i
C3 _ c//'
3y -.2& ' y
cy - 33 '
� d
OS• t y 5
cs-S7
n Frond Arcl!',�
No. of, Fee /dp
r
THE COMMONWEALTH OF MASSACHUSETTS, Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppricatiou for ;Digpo!9a1 *pftem Cou.5truchon j3ermtt
Application for a Permit to Construct( ) Repair ) Upgrade( Abandon( ❑Complete System Kadividual Components
Location Address or Lot No. 194 E i Sohhow er Dr tv a Owner's Name,Address,and Tel.No.
CoTu yr 'b,LL- OITee
Assessor's Map/Parcel O 3 q liq 194 E 15ow►o wee eD Co TL)i r
Installer's Name,Address,and Tel.No. 5 0 a`4 7 7— o&53 Designer's Name,Address and Tel.No.
RcbeeT 6 0b\,j -3t6 CULAY-4tiat4 EK41wim e1 K6 users 508-4 7 7-S 313
14 IMe" w TbefSTOALE1�.w• c2oSs F1 _
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 gpd Design flow provided �� f� � gpd
Plan Date 9—1 1—0% Number of sheets 2- Revision Date
Title Tro S\js-rrMP—L A Q //
Size of Septic Tank 2�Ci✓J�/aDU( r„' Type of S.A.S.(Z X y G LInar,�jp/r .�3
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 Board of Health.
Signed Date H— )4—d%
Application Approved by :` t'W_ Date
- —r--�
Application Disapproved by: Date
for the following reasons
Permit No. ��-(�/ Date Issued j _U
No. , ^ f Ir 4 4 Fee dd
TW 6bMMONWEALTH OF MAS AC'HUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
- 2pplication for 0igpogal.*pgtemc Construction Permit
Application for a Permit to Construct( ) Repair () Upgrade( Abandon( ❑ Complete System jf J Individual Components
Location Address or Lot No. 19 4 E \lJ(,`( LDC Owner's Name,Address,and TeL No.
()'f U IT 13 I L L ICU-n C e-
Assessor's Map/Parcel p 3 q `� 1 �t C I`�(->N i ic,vq l-e ziD (U-rw l I-
Installer's Name,Address,and Tel.No. S a S``)7 7- U(��3 Designer's Name,Address and Tel.No.
►` obej Ea Ilfo\f -u-1 6 CXCAVA1104 E 14� INCH 21r1(, 60(c)ZrS 509- Li '7- 5 313
14 `ti i\f3f V_F_ L)J -f0(Z 5vQAI..E 12 \N. Cl2t� act"ICi l� ` tU i
Type of Building:
Dwelling No.of Bedrooms . 3 Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures '
Design Flow(min.required) 3 3 gpd Design flow provided 3 �. 0 gpd
Plan 'Date_,7 ') 11 O s Number of sheets ,2 Revision Date
P"Title rdiaUSt-_ n CJ Dr I( 5r\1.rSl'r'A.4 JJ2,0ADC P1 A/j 1 ,
Size of Septic Tank -e-v,1A1 Ma r u,t Type of S.A.S.(�,?. X 6 C( &,,k i r f. ) , x 2 3
Description of Soil J g
b 1
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 Board of Health. ..
Signed Date ``• 1 ``I._U
Application Approved by �1 kw. ef? Date
Application Disapproved by: Date
for the following reasons
Permit No. nlJ� a Date Issued
_THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that ttbe`On-site Sewage Disposal System Constructed ( ) Repaired ( ►' ) Upgraded
Abandoned( )by
at 1CA L1 iE 1 S()N 1-1 R) -t)21 V L has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. Ooe_ /tI2 dated t//(t//[
Installer Roarz i E:y,C.• Designer E N/-r I IN-FTr P 1 I`I 6- \/LUQjL S
#bedrooms \ Approved design flow 330 , lA gpd
The issuance of this permit shall'no be 7nstr 'ed as a uarantee that the system w;i1 unction as designed.. �/� /J (,'
Date Inspector � f'I /04
---- —f/
Fee //fU -'
THE COMMONWEALTH OF MASSACHUSETTS
`- - PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Wigpogaf *pgtem Congtructiou Permit
Permission is hereby granted to Construct ( ) Repair (✓ ) Upgrade ( ) Abandon ( )
System located at 1 GIST N,H/1 y,i t=a -D 21\1 E t U T U 1—1
I
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 is pe it.!
Date /C/4,, Approved by 1
Town of Barnsta.ble P#
C�
Department of Regulatory Services
Public Health Division Date
i639.
e$ 200 Main Street,Hyannis MA 02601
AnrEDµA�a d
Date Scheduled
iJ Time Fee Pd.
So Suitability Assessment for Sewta e Disposal 17�
Performed By: `l am o 'J Witnessed By: Q ov, ���
LOCATION & GENE L INFORMATION r v
f �3
Location Address I y i 5�(1 h DUJIV « Owner's Name I I 70 >� c n
['OTV IT _ I Address 1 S t} l 6erlE1DLUP1 C�l v•,
CUTTV IT ✓
Assessor's Ma /Parcel: 0 a 9 I(Cl Engineer's Name ?Engin G3
p �n9 i n2•er�n l_c.� •r�S
Telephone# ^5 0 9— t-1'17 -531 � C�
NEW CONSTRU(tT[ON .�REPAIR
P
Land Use t "" l P ( ) L Surface Stones
Slopes `Yo
r �� ft Possible Wee Area Z� ft Drinking Water Well =tt
Distances from: Open Water Body_
Drainage Way ft Property Lined ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
-Z
��se�•he�e� ��
y �
Parent material(geologic) (
L��(�l t �cJ Depth to Bedrock / ^
Depth to Groundwater. Standing Water in Hole: �,��` - Weeping from Pit Face
(-A
Estimated Seasonal:I-Iigh Groundwater 2
DUTERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: Observed standing;in obs.hole: In. Depth to soil ntottl : ift
!-
Depth toiweeping from side of obs.hole: in. Groundwater Adjustment
A .factor......�_ Adl,druundwater Level
Index Well# Reading Date: Index Well level R�.a� dJ
PERCOLATION TEST Date,,,1 , Time. �J
Observation , Time at 9"
Hole#
Depth of Perc T r7 �( jTime at 6"
StartPre-soakTime.@ G _ i TSmc (9"•6") F __-
! h f�tiln s -
End Pre-soak
q
Rate Min./InchC.�j
Site Suitability Assessment Site Passed Site Failed: Additional Testing Needed(Y/N) -
Original: Public Heitith Division Observation Hole Data To Be Completed on Back-----
***H percolaAion 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:\.SEPTIC1PERCF�RM.DOC
DEEP OBSERVATION HOLE LOG Hole# _
Depth from Soil Horizon Soil Texture .Soil Color Soil i Other
Surface(in.) (USDA) (Mansell) Mottling (Struc' re,Stones,Boulders.
Consistency.% ravel
`l-y2 St,
:DEEP DEEP OBSERVATION BOLE LOG. Hole# Z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel)
PEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistent Gravel
'DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structute,Stones,Boulders.
onsistenc ra el
Rate Flood Insuran•e R te Map:
+ Above 500 year flood boundary No_ Yes 4
Within 500 year boundary No Yes„e
Within 100 year flood boundary No—C�11 Yes
Depth of Naturally Occurring Pervious Material
! f; Does at least fbOr feet of naturally occurring pervi us material exist in all areas observed throughout the
area proposed fbr the soil absorption system?
� rP
{ P Po.
J
us matorlal7If not,what is the de th of naturally occurring pervto
Certification ��
I certify that on. (date)I have passed the soil evaluator examination approved by the
t Department of Nnvironmental Protection and that the above analysis was performed by lie consistent with .
the required tra expertise and experience described in 310 CMR 15.017.
Signature _Date
Q:\.SEPTICIPERCM, RM.DOC
Town of Barnsta � le
Regulatory Services
Thomas F.Geiler,Director 4
• _ Public Health Division
Thomas McKean,Director
200 Main.Street, Hyannis,MA 02601
Office: 508462-4644 Fax: 508-790-6304
Date: Sewage Permit# z009 -141- Assessor's Map/Parcel
Installer&Designer.Certification Form �' -,•
Designer: Ag 1�t�r;n w lit?ter 1►l 3 . Installer: f� U ' ``
Address: 12 Vy . CCU S S'1-,'-e C.�LZd Address:
errs 1- 1�($ M4 024 Lly rt7 �6(O le , 1w
On "` was issued a permit to install a
(date) (installer)
septic s stem at `g� i S eit.kwu--e. ,Ps-, `q�'• r
p y based on a design drawn by
,^ (address) ,
-f{ P. J dated
(designer)
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. Stripout (if required) was inspected and the.soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical re f any component
of the septic system) but in accordance with State&Local 0ti'0j revision or
certified-as-built by designer to follow. Stripout(if requ' d the soils
were found satisfactory.
o PETER
McENTEE
o CIVIL
No. 35109
(Installer's ignature) q�oF RFc/stER``°��
F 10NAL C
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE "TURN 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:bffice fomBWesignemertification fo m.doc
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION.FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
TI CERTIFICAON
r MAP
Property Address: L PARCEL v_
Owner's Name: — LOT 1_ _
Owner's Address: ECE1VED
Date of Inspection:
Name of Inspector• (please print) J; rdr�IU -i SUN 0 1200�
Company Nam TAg�E
Mailing Address; J TpWN OF gA pEPT
C�QCf O HEALTH. I
Telephone Number: / �.
CERTIFICATION STATEMENT F.
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
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: Q
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.
Notes and Comments
****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.
Title 5 Inspection Form 6/15/2000 page I
Y
Page 2 of 11
OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURF ACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
e
Property Address:
Owner:
Date of Inspee n:
Inspection Summary: Check A,B,C,D or P/ALWAYS complete all of Section D
A. S stem Passes:
I have not found an information
y m ion 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.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
`-Observation of sewage backup or break out or high static watet level in tti6 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(§)are replaced
obstruction is removed
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:
2
i
Page 3 of 1'1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner: —
Date of Inspe on:
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which.will protect public health,-safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
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 SA is within 100 feet of a
surface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within Zone ] of a. public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100,feet but 50 feet or more from a
private water supply well**. Method used to determine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A�copy of the analysis must be attached to this form.
3. Other:
Page 4 of I l
OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE.SEWAGE.DISPOSAL SYSTEM INSPECTION FORM'
PART A
CERTIFICATION(continued)
Property Address: ��
Owner:
Date.of Inspe 'on:
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no".to each of the following for all inspections:
Yes Ng
V Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or
/ clogged SAS or cesspool
t/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
> cesspool.
t/I Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number '
of times-pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
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 froth 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 coliform bacteria and volatile organic compounds
indicates that the well is.free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen.is equal to or less than 5 ppnt,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)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•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
— _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat.under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
i
Page 5 of 11
OFI+ICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner:
Date of Inspe on:
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
Pumping.information was provided by the owner,occupant, or Board of Health
— (Were.any of the system components pumped out in the previous two weeks ?
Has the system received normal flows in the previous two week period ?
/Have large-volumes of water been introduced to the system recently or as part of this inspection?
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
,Z'— Was the facility.or dwelling inspected for signs of sewage back up
_(Z'_ Was the site inspected for signs of break out?
Were all system'components, excluding the SAS, located on site
l� 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?
c/_ 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)i on the site has been determined based on:
Yes no
✓- Existing information. For example, a plan.at the Board of Health.
v _ 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(3)(b)]
5
Page 6 of 1 I
OFFICIAL INSPECTION-FORM—NOT FOR VOLUNTARY:ASSESSMENTS
SUBSURFA.CE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property AddA
Jif
Owner:
Date of Inspec
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310.CI R 15.203 (for example: 110 gpd x#of bedrooms):
Number of current residents:
Does residence.have.a garbage grinder(yes or no):
Is laundry on a separate sewage system (y�s or tio): .[if yes separate inspection required]
Laundry system inspected(y s or no): 1U0
Seasonal use: (yes or no): . .
Water meter readings, if av i]able(last 2 years usage(gpd)):OZ—$��0,� �0
Sump pump(yes or no): (�J �J —
Last date of occupancy:
COMMERCIAL/INDUSTRIAL/9&
Type of establishment:
Design flow(based on 310 CMR 15.2.03): gpd
Basis of design-flow(eats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):—
Non-sanitary waste discharged to the Title 5 system(yes or no):-_
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of.information: �qf "ht kil ?J,�,%
Was system pumped as part of the i spection.(ye or no):
If,yes, volunie._pumped: � _ gallons.:--Hoiv was quantity pumped determined? -
Reason Tor pumping:
TYPXOF SYSTEM
_Septic lank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
Privy
_Shared system.(yes or no)(if yes,attach previous inspection records, if any)
_Imiovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank —Attach a copy'of the D) P,approval
—Other(describe):
A�mateageofall
ompo eats, d to its lie (if krto n)and source of inforination:
Were sewage odors detected when arriving.at the site(yes or no✓)
6
Page 7 of i l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date of Inspec n:
BUILDING SEWER(locate on site plan)/�&
Depth below grade:
Materials of construction:_cast iron _40 PVC other(explain):.-
Distance from private water supply well or suction line:
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK:Jo on site plgn � ��
7 �
Depth below grade: — '�
Material of construction:LZconcrete imetal_fiberglass_polyethylene
other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: .S
Sludge depth:—
Distance from top of sludge to bottom of outlet tee or baffle: Z5
Scum thickness: —p—
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom f outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommen ations,Anlet and outlet tee or baffle condition, structural integrity, liquid levels
related to outlet invert,evidence of Ieakage,.etc .
GREASE TRA;% cate on site plan)
Depth below grade:—
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom'of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or.baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
7
t
Page 8 of 11
OFFICIAL,INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION(continued)
62LProperty Address: AI
Owner:
Date of It Ve on:
0
TIGHT or HOLDING TAN1��(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: //
Material of construction: concrete metal fiberglass__polyethylene other(explain):
Dimensions.-
Capacity: gallons.
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working.order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches, etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
age int or Utf bo ,etc.): y� '
PUMP CHAMB)C% locate on site plan)
Pumps in working order(yes or no):
Alarms in.working order(yes or no):
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
8
L
Page 9 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date of Inspec nWTEM
SOIL ABSORPTI6` (locate on site plan,excavation not required)
If SAS not located explain why:
TYPe
eaching pits, number:
,. leaching chambers, num er:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number, dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,
a (7/
CESSPOOLS -(cesspool must be pumped as part of inspection)(]ocate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no): t`
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.):
PRIVY ocate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner
Date of Inspec n: Q�
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.
1 bc-0 Q000
� o
c oo gallor)S
10
Page I I of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C .
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date ofInspec n: ,�,po(�
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
11
Permit Number: Date '_.�.,r;•1 .:,fir-x�ei-,-.
� r7 s Completed by:
2 s.i,di•�Y� F
HIGH GROUND-WATER LEVEL COMPUTATION
�yRt,�r Ui
11 g iNE
i
«,ram ti Site Location: ,OW lved�l��GG/�/� ,i`'/ ce Lot No.
r,
.�k}�l'ira�spru r ;. wner: Address: �
=y ap d9fA/ �.Cd��� Address:
;;.,�,�;�, ;•�,�,� -Contractor: �
3`.4vut r 1}Y
tit 0
RR- Notes:
STEP 1 Measure depth to water table
to nearest 1/10.ft. ...........:............................................ ...... ..... .Date /
s,a..�.ya,.;.... ., month/day/y ar
.
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
site and determine:
OA Appropriate index well.................
OBWater-level range zone .....................................................
STEP 3 Using monthly report "Current .
Water Resources Conditions"
determine current depth to ®�� ��J
water level for index well ................:.........
month/year
STEP 4 Using Table of Water-level Adjustments
for index well (STEP 2A), current depth
to water level for index well (STEP 3),
and water-level zone (STEP 213)
determine water-level adjustment ..........................................................................................
STEP 5 Estimate depth to high water
by subtracting the water-
!' : level adjustment (STEP 4)
( from measured depth to water J
levelat site (STEP 1) ...................:......................................................................................... / •Z .
Figure 13.--Reproducible computation form.
15
i
LOCATION SEWAGE PERMIT NO.
�4 (31 ;S@t�i1ou., �j --g ZZ
VILLAGE '
g ec?-//,
1 TA LLER'S NAME i ADDRESS
r,6"'o-+- 0(at-- D:
w "C
GUILDER OR OWNER °
DATE PERMIT ISSUED &A go\ ,q ��'
DAT E COMPLIANCE ISSUED �` � � �-2
� o
�r�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HE WLT
............: .... ....OF. ...............................
ApplirFation for Disposal Works Ton' strnrtinn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
............� �:. o1 .v.r _ •___ w�: .1 s�•....................................4 .................
Location 9_ Location- ress or Loxy No. 9
....l t ...... 1 i� ....................................... ----VLZI w.Pl_:f���'i..._(./�64Y � `l7Dl�............
Owner e
Address
Installer Address
dType of Building// Size Lot........................ Sq. f�ept
U Dwelling.16V o. of Bedrooms_______________ .........................Expansion Attic ( ) Garbage Grinder
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
f1{ Other fixtures .....
W
Design Flow ) ._ _.__ ............... .gallons per person per day. Total daily flow..........................
WSeptic Tank Liquid capacity_LdO...gallons Length........:....... Width................ Diameter__-_:____._..__. Depth................
Disposal Trench—No_____________________ Width___ ............. Total Length..___.___I __ Total leaching area___._.________.____._sq. ft.
______ Depth below inle ......... Total leaching area. ��,�.sq. ft.
Seepage Pit No......../......... Diameter_______
Other Distribution box (� Dosing to
Z Percolation Test Results Performed by..______ �. �Vesit
Are ..._'_____________________ Date__ ..............................'
Test Pit No. 1._..�ti ___minutes per inch Depth of Pit____________________ Depth to ground water._______.__._.__..._._.-
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----_...................
a+ - --- _ --y------
Description of Soil a� :. .._.�(/. - it "� ... .�
x _-- -_.. --- Z
U -----------------------------------------------•---------------------------------------•-•.._..--------•-----------------------------------------------------.....---.........----•-•-------------------
W --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
..............................................=.........................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TI:'L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance- a been issue .the board of health.
n
Signe . .... ............................ ....IJ11.25..........
Date
Application Approved By.._... ,Lf % _..._.. ...... a
.'
Application Disapproved for the following reasons-------------------------------------•---------------------------------- ........................................Date
e
.....................•------...--•----------•----------------...-•---•-------------....•--------------------
Date
PermitNo......................................................... Issued........................................................
Date
No......... - ..� Fizz........ ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ZO HE LT
......OF.......
ApplirFation for Disposal Works Tonstrurtiun fumit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System jje�t
.._..---
L. .!..... .c`.. : .1'1. ?Cll.ar�.. �ar!'. `..t oral...-----•............................................... lo ......--•
•- Location• ress �+ or L44.4
No
....................................... '�G? ._.. :Ildw:tx. a...
Owner Addre s
i• �
6 , .. _.... .. . ----------------•---•-----------•--•------ ---..... a r=, ,i t j+ ....
_ d td ----
ess
Type of Buildin Instauer Size Lot............................Sq• f
U Dwelling-��`No. of Bedrooms.•..............3................._......Expansion Attic ( ) Garbage Grinder �rrf' ,
Other—.Type of Bidding No. of persons............................ Showers — Cafeteria04 ( )
� Other
WW fixtures .----•-•------------------------'---._...------------.•---•-'•----•---------•-------•-------.._........ G� dons.Ds d ily flo osPer ersonperay a aR Septic TankLq d ca a�it _�do.__gallons Len day.
DiameterDepth..........
x Disposal Trench—No ................... Width_.. ......._...... Total Length........._ ._ Total leaching area....................sq. ft.
Other Distribution ibution box Dosing to
Diameter........ Total area. l�s ft.
Seepage P g - .. q.
(� g__-- Depth below inlet ,
Percolation Test Results Performed by........ n..Alrll r�A0`4 ,.--':................... Date_.."'__'.f ___ * '_._..
Test Pit No. 1... ~_.minutes per inch Depth of r est Pit.................... Depth to ground water........................
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O .......................�.....___ _...__ .. �, d 1 .t -
Description of Soil-•----- .._..�.".. ....... __._... +� ..
x
.....
W -------------------------------------- !------------ ------- ----------------------
.---------------------------------------
----------------------------------------
-----------------------------•-•---------•-----•--------•--•-----------------•-------.......----------------••----------------•----•------.....--•-------•--•----...._..-----------------•---------•----
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
..................-......--....•--•----------••------•-------------•-•--------•'---......--------..............•-•••-•••----•---•---•-'•--------------'-•••----.......-•---•-----•------....._......---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal .System in accordance with
the provisions of TIT.!, 5 of the State Sanitary Code-The undersigned further agrees not to place the system in
operation until a Certificate of Compliance-has been issued�bX the board of health.,
Date
Application Approved By...... _: .....,,
Date
Application Disapproved for the following reasons:.......................... ._...__
............................
--------------------------------- '•-------•---•--•-----.-------•------.-------•------------._-------------------------------------------'•----...---------------------------------••------------------
Date
PermitNo......................................................... Issued.......................................................
Date T_
4�
THE..COMMONWEALTH OF MASSACHUSETTS
,u,»•A.. BOARD OF HEALTH
(Inrtifirate of (font liFanrr
THI. IS TO CE TIFY, ThaLtthe Indivi a wa e Disp, ` 11 Syste constructed or R�'�ed
by.. dGG�9.� .. ;ta4 G"
Installer
at ... --- = -------------------------- f..........'............................................................................
has been installed in accordance with the provisions of m j')tr 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.__..
------ ----j�-..................... dated.....2:.'".`..hF-y-7f=..............
THE ISSUANCE OF THIS_CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........��_.... .......--•....................................... Inspector........ ------..
te
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT rj
rt� :...... .... ...........OF............. '.4�A ...................
�4
No.............1 ' � ..�•�-
b�... FEE...l..':`.S„�.. ....
Disposal orkg. Tn 's#r tinUP r t
Permission is hereby granted.-"-"" '_.__1--}_: • [Aef..'
to Construct (' or R air ( n'Indivl ti Serra a Dispos S tem ` `
at
Street
,.
as shown on the application for Disposal Works Construction Perm> I,_ Dat ..
00
,�„ ^ „ � Board of Healthh
ff
DATE..': .., :......----•-------••--•----------------------•----._.---'--••••--
FORM-.-,i-1255 HOBBS & WARREN. INC., PUBLISHERS
t I �
u Ste: t Oocb 64,L_.
i - VS6- tOCX=l Gds.-- .}T�
r(T�;6C//,S.LI.. SEA - t�sf7 �ca•t^. � 7=��:..� rA�,w + �,� ?
'Olt
TOTAL -C;)ES16Q = 4-ZS G..Qn• �o
4410
T.�L.E4Gt;
i '-OTA L T>�4.t U`f F LD ut/ = 33D c�PD. ,� _' ' i''t _ f
rive
t !ZGDt pTIOtJ GATE ( � 2%4t�u'aR L�Y�.
Qj
a�
It 17
TOP ;,UUL"Le;
""feST I����9 .��z-��� � 4-
WCX-�
,r Ape
'd'Fip", Iaoo iu>r '
4r�PEs I7lSf. ".. 1W. GAL. +�' H'A
luv.
FIT A
W rna 'i
# C.r.t 't'I V:!-I E.L)
L aCA.T I O" -- -
C?C.A t,i=; )r i
't'�-(AT' T14t . f�Bo: SL r�i� 5"Of►.!
PA-AI t1= Q�+-sc��=�
AWC> 't<TL-,Ar-V V.'GQUiQC-.AAt%.f.1T[ ;
PA,IrG 1-J---1
t2Gf�lSi'E_t2�D Z�l..i-!�i �U�+1�'r.`t 4•t
{1}� A� pSTE.�ViI-t..C--_ c� 14rf lkS''a•
u•l,rk?J.�/1E;►J i ivc��tc��{ �- .r►�c. CsF� "f, 41' -toUrt..p -
� --
N
h
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL:87.8
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
PROPOSED TANK PROPOSED D—BOX PROPOSED S.A.S. 1 (3) 5" DIA.OUTLETS
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE CHAMBER AND
T.O.F.
OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE SET TO 3' OF F.G. TO SERVE AS INSPECTION PORT 15 5" 16 2.,�
F.G. EL: 90.5t
F.G. EL.=99.9t F.G. EL.=94.1 t F.G. EL: 100f
1 2"
15.5"
L = 33' L = 4' 2" LAYER OF 1/8" TO 1/2' 6"
C4 S=1iu (MIN.) ($� S=1% (MIN.) , DOUBLE WASHED STONE j
4"SCH40 PVC 4"SCH40 PVC (OR APPROVED FILTER FABRIC) 7 T
14" ���@ ®� H- 10 LOADING 2
EXISTING 48" LIQUID INV.=90.64t
LEVEL I V =8 1 7 = 4' 5.2' i 4' D_.B O X
N 8• INV.-88.00
GAS BAFFLE pROPO ] p D—SOX EFFECTIVE WIDTH 13.2'
W/INLET TEE INV.=87.00 N.T.S.
XI NG SEPTIC TANK 509 GA LI_ ON LEACHING CHAMBERS
R$I� ROUNDED JWITH STQNE AS SHOWN
H-10 RATED
TOP CONC. ELEV.=87,8
BREAKOUT ELEV.=87.5
laculam ®tea® ®®EI® 0 ® ® ICI ®
NOTES: 1) D—BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=87,00 ®®Q®ualagagal® ®®l�® EE
GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.=85.00 33
INCH CRUSHED STONE BASE, AS SPECIFIED IN �d W ®® ®®®® � ® ®®
310 CMR 15.221(2). 3' 2 X 8.5'=17.0' 3' N z ®�®� ®®
2) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 23.0'
3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OR G.W.
AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. 11 LEACHING SYSTEM, SECTION
4) MAXIMUM COVER OVER SEPTIC TANK, D--BOX & S.A.S. 'NO GROUNDWATER, EL.=79.0 = 102"
SHALL BE 36".
SEPTIC SYSTEM PROFILE
N.T,S. 4" KNOCKOUT
�.
R IA. COVER
20 D E
~�..'�•, SOIL LOG /
4" KNOCKOUT / 4' KNOCKOUT
62"
DESIGN CRITERIA DATE: APRIL 8, 2008 (REF#12,163)
DECK SOIL EVALUATOR: PETER McENTEE PE
WITNESS: DONNA MIORANDI R.S.
NUMBER OF BEDROOMS: 3 BEDROOMS ` �,� •,,4` HEALTH AGENT
`'ti" 4" KNOCKOUT
SOIL TEXTURAL CLASS: CLASS I ��\'�'� �\ ELEV. TP- 1 DEPTH ELEV. TP—Z DEPTH
—. . ....... . �.,
DESIGN PERCOLATION RATE: 5 MIN/IN ~ 90.5 A 0' 9Q.q A 0
� PA
DAILY FLOW: 330 G.P.G. Crl �j T SANDY LOAM SANDY LOAM
10YR 4/2 10YR 4/2
DESIGN FLOW: 330 G.P.D. o �. 'L`L' 90.2 B 4» 89.7 B 4"
500 GALLON CAPACITY, H-10 LOADING
GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY '�� 10YR.5/8 . 10YR 5/8
87.0 42" 87.0 36" CHAMBERS
� 1 �
LEACHING AREA REQUIRED: (330) = 445.9 S.F. w C C
PROP. S.A.S. iv 44" N.T.S.
11.
.74 PERC
USE 2-500 GALLON LEACHING CHAMBERS IN SERIES I---23'----I I 56" PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES MED. SAND MED. SAND 2.5Y 6/4 2.5Y 6/4 184 EISENHOWER DRIVE, COTUIT, MA, MA
SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F.
BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. Prepared for: William Potter, 184 Eisenhower Drive, Cotuit, MA 02635
TOTAL AREA:.... ......... ............ ---........—.......1.1448.4 S.F. 79.5 132" 79.0 132" Engineering by: SCALE - DRAWN JOB. NO.
S.A.S. LAYOUT PERC RATE <2 MIN/IN. ("C" HORIZON) Engineering Works
NTS P.T.M. 154-08
DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D. NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
(508) 477-5313 4/1 1/08 P.T.M. 2 Of 2
LEGEND - N
F
A, S 8*21'47" W S - 98 ........ ........ EXISTING CONTOUR e°T`Pf d'Pro oQ
�'— 90,11' 16'S'18' W x 100.98 EXISTING SPOT GRADE Q�c° A ° pay ", °�.
` 56.75' iL 99 PROPOSED CONTOUR a
. . . . .. ... . . . . .. . . .
j 99 PROPOSED SPOT GRADE °
{'
W EXISTING WATER SERVICE
EXIST11ING LEACH PIT a °+r0
N ,1 TO BL PUMPED, FILLED W/ ® TEST PIT �° ; a boy O^ Neck Rd
SANDI & ABANDONED BENCHMARK ° °
l a Nixo Ave
EXISTING SEPTIC TANK
ITOP OF TANK, EL.=91.97± LOT 16 Q
i INV.(OUT)=90.64t APN 039-11 $ - LOCUS
6 } 21,905t
LCR 36608C' LOCUS MAP
0
Ya �Lo,O x NOT TO SCALE
(Sheet 2)
GENERAL NOTES:
1, ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF HEALTH AND THE DESIGN ENGINEER.
—Ta 1 ) I. n: 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
DTP-2 j Q I ._ � ! t LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW:
N r r TP-1 I 1 ! Vn f 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
N c . 1 I BECK f-' PATIO w \t o G)l1 yn '�j TO DESIGN NSPE TI NEER D APPROVAL BY THE. BOARD OF HEALTH AND THE
N' �p 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
WALK Sidle D� FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
- F ENGINEER BEFORE CONSTRUCTION CONTINUES.
7771
-�... r S 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
/ ` !l r'` F'' W Ht� 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
i Ir ,/EXISTING'/ ����� N A1,, a F�� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
00 �' ' r �/ / / / ! , / SIq V I HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
�- I . HOUSE (#�84�/ , , %;,
1 :- r ,� // T.O.E.=99.1±/ j /�/ % / % ; : m� v P .2� WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
co, a /� /��/j/j�,� ////f/GAR E I f nST` (�W 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S.
N / / '/ / ' �:
'/ r F Sf 9, A REEDSAS UPON CLEARED
BYY OWNER ANDSCONTRION SHALL BE RESTORED AACTOR OR A AS
S OTHERWISE
9) g p ._.j I �s 1n. DIRECTED BY THE APPROVING AUTHORITIES,
0,9
!� t w 1 1 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION.
�.' ja 0� 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
PAVED j IN IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
DRIVEWAY ! �. Benchmark Set _ REPLACE WITH CLEAN SAND AS SPECIFIED IN. 310 CMR 255(3).
TO of Corner St0/7E 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
g a s P INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
EL.=92.65 (Assumed) 13, THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
y� PLAN REFERENCE: LAND COURT PLAN 36608 C - Sheet 2 (LOT 16)
ss'�y PROPOSED SEPTIC SYSTEM UPGRADE PLAN
PETE-�� T.
L=125.00' j _ ''f McENTEE G� 184 EISENHOWER DRIVE, COTUIT, MA, MA
R=1 i 74.91' ,.'.,�+�..�., CIVIL
�,• �' i � No. 35109 Prepared for: William Potter, 184 Eisenhower Drive, Cotuit, MA 02635
! /
54
C��E �� Engineering by: SCALE DRAWN JOB. NO., edge I of pavement 98 ,� --.. -... _: - / ��` Engineering War 1"=20' P.T.M. 154-08
12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
EI SEN H OWER DRIVE ,oa�`� i, o-� (508) 477-5313 4/1 1/08 P.T.M. 1 of 2
-