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HomeMy WebLinkAbout0028 PINE RIDGE ROAD - Health ^ 28 Pine Ridgi Road " 0 18-057 C®tuit i s TOWN OF BARNSTABLE LOCATION SEWAGE# '20 n VILLAGE C.® ASSESSOR'S MAP&PARCEL 60 d< 7 INSTALLER'S NAME&PHONE NO. ��I�jP '•� �'�`"'"'� �l� SEPTIC TANK CAPACITY // 6 vJ LEACHING FACILITY: (type) 2 s 00 ize) 12 v< NO.OF BEDROOMS OWNER n��C�c/,y� ® PERMIT DATE: l 2 y 2 t COMPLIANCE DATE: ,2 2 2 Z 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 %/� "'� j�v%— �y�. �Z� ��� n�s� _ � - � � �� �� � 5 No. Fee �/v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rlpfltation for Disposal 6pstem Construction 3pErmit Application for a Permit to Construct( ) Repair( ) Upgrade(-k-Abandon( ) ❑Complete System Individual Components Location Address or Lot No._ZT l/ "r,7,f dyc Owner's Name,Address,and Tel.No. f u li F Assessor's Map/Parcel � s`r-k, .;/-Ij � ��tt Yr' Install�ller's Name,Address,and Tel.No. , l4 Y Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ` gpd Design flow provided 3Z47' 7 gpd Plan ), Date ' Number of sheets Revision Date Title Size of Septic Tank 1X0 0 C /� a p ► D�t Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �-Ca�✓ ���"� j� �J-fir %l 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 hem in operation until a Certificate of Compliance has been issued by this f _ Signe Date Z--/Y' �✓ Application Approved by Date h- J Application Disapproved by Date for the following reasons Permit No.�J��-� Date Issued f No.c'� ir Fee t uter:THE COMMONWEALTH OF MASSACHUSETTS Entered in com p Yes ^� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS _ 4plicatlon for Mlsposal bpstetn Construction Permit-, � Application for a Permit to Construct( ) Repair( ) Upg ade( $�bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.23- Pitn(.- rc/9C 1,eD Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1�" r7 GG �, iejC tE wt Install�ler's Name,Address,and Tel.No. 4 3of S f7 Designer's Name,Address,and Tel.No. ��d��� � ����� D ram,t� •? i//�c✓'�rg d J�✓,�f �y C � Type of Building: 'Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures .,rp Design Flow(min.required) •1''a gpd Design flow provided �;, gpd 1 Plan Date / 2'�� ? / Number of sheets Revision Date Title Size of Septic Tank l� � •`S kc, Type of S.A.S. '2 710 Description of Soil ' x•'''`� ..�.�- Ili Nature of Repairs or Alterations(Answer when applicable) 0'�—ZA ®`'1'� /� 7-0 2 ;f-/ZO 15;'6o 6r_110VL 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 yste n in operation until a Certificate of t Compliance has been issued by this�oard_of Health. l Signed Date ,�71 Application Approved by Date , 1. `_l q/ t Application Disapproved by Date t for the following reasons _ Permit No, ;Z0 / / �i+� Date Issued-------------------------- J � - ------------------- -- _ THE COMMONWEALTH OF MASSACHUSETTS r' BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(zuPgr aded( ) Abandoned( )by D ��/�u..!^n �es,w�-✓ OLJ �/C at ' .tdi ti'l: �� has been constructed in accordance t f with the provisions of Title 5 and the for Disposal System Construction Permit N 1 ` 4d e / './l�q Installer r`L`-l'�/ 124 4-0 "V Designer Cp�'I A t,tJ� ;r, Zv d,/-Xt �L #bedrooms d Approved design flow gpd The issuance of this permit shall not be construed as a'guarantee that the system will : ctio as desig/ned. Date 1 —f �.JG Inspector No _.-��" / . ..._.,.• L� !/ __ _. _...._.,_.. .•. .... _ . ,. ..._._.:. ..._ _..,_ � .:- ---�------._.----_.. Fee / (J C, ----- - .�-�.. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -Misposal 6pstem Construction Vermit 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 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 permit. Date �� 44 .�. Approved by�„ oF Town of Barnstable IME Regulatory Services Richard V. Scali; Inter i1n Director BARMABLE, - - - MASS Public Health Division �jp iG39• t0 Thomas McKean,:Director 200.Main Street,Hyannis,MA 02601 Office: 508-8,6274644 Fax: 508-790=,6304 Installer&DesioerCertifcation Form Date: r` t2 t'�I Sewage Perilnit# �'��, t$ rs b Assessors Ma:a Parcel C C,i+e-e Designer c r.nee{-:.tom txJc c s 141.E Installer 1 LUC Address: Cr;ssA P_1d 214 Address: `s- Co A fn LA ro-i-tJ 1 dcrr 2,M/ tKh was issued a permit to install a (date) (installer) septic system at 2'b P<—a A%e V as - based on a design drawn by (address) dated ll (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. Strip out (if required) was inspected and the soils were found satisfactory. T certify'that,the septic system referenced above"was :instalaed with major changes.(i;e. greater than I0' 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 with the terins of the I\A appro�ral letters(if a licable) ��, ACy " (Installer's Signature) CIVIL 00.35 09 FF (Designer's:Signature) (Affix Designe ere) PLEASE RETURN TO.BARNSTABLE PUBLIC HEALTH DIVTSION. "CERTIFICATE OF COMPLIANCE FILL NOT BE ISSUED UNTIL BOTH.,THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE'PUBLIC HEALTH DIVISION: THANK YOU. Q:1SeptictUesi;ner Certification Form,Rev 8-14-13.doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfill The engineer did not supervise construction of the system.The installer assumes responsibility for all materials,workmanship,backfilling to specified grades with proper compaction and setting riserstcovers as.shown on the design plan. wr .j LJCQTIOPI '� �� 5EW&C,E PERMIT O. IMSTQLLER•S W&ME 6 ADDRESS k ko r�i akt - LQaj-. —m AAc-5To-A5 t��S BUILDERS Q &MF- ADDRESS DNTE PERKA T 155UED DATE COt%APLI WdCE ISSUED : _�� ? CIE`. is�(a %o'� )coo �c�l DWG 1000 GAL- F r.� No.......�................ A-4)'THE Fimx COMMONWEALTH OF MASSACHUSETTS BOARD ,H EAL.T'H f1�� ...... ... ...0 F........... ......... t ...................... oAppliration for Disp sal Marks Tvu,51rudiott Prrmit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal Sys at ,{ /a � ocatio - ddress f Lot ............ --- :r Z................ 7 ow Address W Inst ler Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............Z.........................Expansion Attic Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers (. ) — Cafeteria ( ) a Other fixtures ---------------------------------------------•••-. W Design Flow......... ..........................gallons per person per day. Total daily flow.....___Z-V .......................gallons. WSeptic Tank L Liquid capacity/d!e�4;?_gallons Length................ Width................ Diameter---------------- Depth-----_-------- - ICA. x Disposal Trench—No..................... Width_......_.___ .._- Total Length.................... Total leaching area....................sq. ft. To Seepage Pit No......./........... Diameter./'.��_��epth below inlet.......... ........ Total leaching area..................sq. ft. C} Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.......................................................................... Date.................................. ------ C1 a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----__---_____-______-. l%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------- ... �, ...............................r� % -------------•.------- ODescription of Soil...........��! ............i--- . - ---�'�----------------------•---------•----- U ............................................................. ... ----------------------------•------------------- W --------------------•---•-••-••..•••--•-•••------•---•-•-•--------------••----•---•••••--••...•-•------•-------------------------•••-----•--•---•-•--••--•---••-•--••-•••-••.........--......._-•-.•••-• �. VNature 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 Article XI of the State Sanitary Code—The unders' d further agrees not to place the system in operation until a Certificate of Compliance has been ' s by he of health. Sid--- --- ---•------- ---- - ------ --------•• ................... ................................ /DaA lication A roved B --•-••••.. PP PP Y �..� Application Disapproved for the following reasons----------------------------------------------------------------•-----------......-----------•-••---......-_..... .....................•------...---....---...--------•-------...----•-------------••-------...-•-----------•----•----•-•----•---------•-•----•--•-•------------------•-----•---••----------••-•------•--- Permit No. .. Issued.... --�--� e•.-•--• Date r No... .. ... FEE.......40.............. THE COMMONWEALTH OF MASSACHUSETTS IN.VVfiratijan for Disposal Lurks Tanstrudion rnmit Application is hereby made for a Permit to Construct (. ) or Repair ( )'an Individual Sewage Disposal System at: }¢ , ................................................................................................. --•-••......-•-- ••••.......... •• •... ••--••-•-•--..................---•••......••-- Location-Address or Lot No. ....---•---- .... ......^................•....._........-----•.............................................................. ...... ......................-............................................................... Owner Address W Installer Address Type of Building Size Lot.*..........................Sq. feet K aDwelling-No. of Bedrooms..................:::.......................Expansion Attic ( , ) Garbage Grinder ( ) 0-1 Other—Type of Building ...................-------- No. of persons............................ Showers ( ) -- Cafeteria ( ) Q" Other fixtures'--•-----------------••-••............................ De W sign Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width_--------------------- Total Length.................... Total leaching area...._................sq. ft. Seepage Pit No....................: Diameter.__.....:_..._._..__ Depth below inlet___.___. .. .. Total leaching area........... ft. z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by------------------------------------ -----------•-----••-••---•---•------• Date........................................ ` Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................... ......................................it---- --- --- ....................•- jV '........................................................... " •. . .. i �/Description of Soil----------------- - ----. " . --' _ .. , ......----___... ^--------.........--- _. 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 Article XI of.the State Sanitary Code—The unders rd further agrees.riot to place the-systerri in operation until a Certificate of Compliance has been s y he of health. Dat Application Approved BY ••-- ate Application Disapproved for the following reasons-............................................ •--•---------------•--------•------------------••-•-----------._.... Permit No.....................................••••. Issued... S-------7.s�!!_.. Date _ y THE COMMONWEALTH OF MASSACHUSETTS BOARD R HEALT .. .... OF... ..... r 10rr�i�ir�f�e THIS,IS TO CERTIFY, That the Individual Sewage�Disposal System constructed ( or Repaired ( ) by....:---- ................• . ............... -- •-- ----- ---.. .. Installer �yid /(,�1//� �� � ... at ...---•••-•._........ s a, has been installed in accordance with th provisions of Article I of The State Sanitary Code as described in the PP P nit NAM;). dated._._ 1, " S"'"` a lica.tion for Disposal'Works Construction Permit � THE ISSUANCE OF THIS CERTIFICATE S�BALL NOT EE*CONSTRUE® AS A dated.... THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ' I DATE................. -- Ins ector------- .................................. ��� 1`•HE COMMONWEALTH OF MASSACHUSETTS k. .BOARD ® HEAL H o F..... ... Y T. N .. 4.• :FEE ... S .,Apa1MIles (111ons1r fivi gruff Permission is hereby granted............ =------- - ------------ .. ..... .... •••• ._.... ............................................. 'bb to Construe ( qr Repair an Individu Sewage 7 issal Syst - �: .. E Street 0 - as shown on the applic!•tion for Disposal Works Construction it No. ..... ...... Dated..... / .`........... ar of HealV " DATE ----- - -•-•--•.............K:-............_••--......_..... - FORM `1255 HOBBS & WARREN, 114C.}`-OUBLISH,ERS. SEWAGE INSPECTIONS LOCATION 28 Pineridge Road DATE 4/23/03 VE-LAGECotuit,Mass. 02635 ASSESSOR'S MAP & LOTO1 8-057 -INSF?ECTOR Joseph P.macomber Jr. SEPTIC TANK CAPACITY 1 000 gallons LEACHING FACILITY: (type)I-T.p 1000 (sizc)1 900 gal 1 nns NO. OF BEDROOMS 3 BUILDER OWNER 0 R Richard F3oden OWNER MAILING ADDRESS •46 Pineridge Road. Cotuit,Mass . 02635 a,. IN y _ ®�� `T ' \ i COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION s V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:28 Pine Ridge Road Cotuit Mass 02635 Owner's Name: Richard Boden Owner's Address: 46 Pine Ridge gr)arl rnt lit Mass 09635 Date of Inspection: 4/21 /0 3 Name of Inspector: (please print) Joseph P. Macomber' Jr. Company Name: Joseph P. Macomber & Son Inc Mailing Address:_Box 6 6 Centerville Ma 02632 Telephone Number: 508-775-3338 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 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;S�etion 15.340 of Title 5 310 CMR 15.000 The s stem: P ( ) Y Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails A Inspector's Signature: Date: The system inspector shal bmit 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION,(continued) Property Address: 28 Pine Ridge Road Cotuit Mass Owner: Richard Boden Date of Inspection: 4/21 /0 3 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D �A �SystemPasses. I .( 1 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: ,The septic system is in proper working order at the present time. 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. V&4 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: 4'd(/L�iObservation 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 distribution box is leveled or replaced ND explain: ,69 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: it 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 28 Pine Ridge Road Cotuit Mass Owner: Richard Boden Date of Inspection: 4/21 L03 C. Further Evaluation is Required by the Board of Health: 4)1) 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(I)(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: XQ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but, 0 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: i �I 3 f Ti , a� DATE: 4/23/03 PROPERTY ADDRESS:28_Pine-Ridge Road Cotuit------------------------ Mass 02635 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: 1 -1 000 gallon septic tank :REEIVE D 1 - 1000 gallon leaching pit ,i _ 0 6- 2003Based on my inspection, I certify the following conditions: TF BARNSTABLELTH UEPT. 1 . This is a title Five Septic System. (78 -Code) 2. The septic system is in proper working order at the present time. 3. Waste water is 37" below the invert pipe of the leaching pit. 4. Replaced cover on the leaching pit. I SIGNATURE: Name:-J.P. Macomber Jr .______ l Co.mpany: JosePh_P. Macomber-& Son , Inc . Address : Box 66 Centerville , Ma . 02632-0066 -------------------- Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTES A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 • Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 28 Pine. Ridge Road Cotuit Mass Owner: Richard Boden Date of Inspection: 4/21 /0 3 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No !//Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool v. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Ji f & Static liquid level in.the distribution box above outlet invert due to an overloaded or clogged SAS or /cesspool -„d.P-,eca G39 11 ? eLiquid depth inQt==vJ is less than 6"below invert or available volume is less than 'h day flow Required pumping Snore than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number _ Af times pumped d . - �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. l/Arty portion of a cesspool or privy is within a Zone 1 of a public well. _ f/ portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.] VD (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 SPd• 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 ! tthe system is within 400 feet of a surface drinking water supply th 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 Y g (_ ) PP Zone 11 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 Page 5 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 28 Pine Ridge Road Cotuit Mass Owner: Richard Boden Date of Inspection: 4/21 /0 3 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? y p p nod . Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components, luding the SAS, located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no ;-"'Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 28 Pine Ridge Road Cotuit Mass Owner: Richard Boden Date of Inspection: 4/21 /0 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3F t/ Number of current residents: r�� Does residence have a garbage grinder(yes or no):�d Is laundry on a separate sewage system ( es or no):� [if yes separate inspection required) Laundry system inspected(yes or no):AI Seasonal use: (yes or no): ,0,9 Water meter readings, if available(last 2 years usage(gpd)): 2 0 01 =21 , 0 0 0 .ga 11 ons=5 7. 5 4 GPD Sump pump(yes or no): 00 = , gallops=1 06. 85 GPD Last date of occupancy:A COMM ERCIAL/INDUSTRIAL Type of establishment: A/,q Design flow(based on 310 CMR 15.203): j/44 gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):yid Industrial waste holding tank present(yes or no):�liQ Non-sanitary waste discharged to the Title 5 system(yes or no): Al/l Water meter readings, if available: iU/9 Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 10/27/98 Maint. Tank Only Was system pumped as part of the inspection(yes or no): If yes, volume pumped: 0 gallons--How was quantity pumped determined? iLlr'� Reason for pumping: 101;� TY E OF SYSTEM Septic tank, di ,soil absorption system -p Single cesspool ,jQ Overflow cesspool Al'o Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) ,II)Innovative/A Item ative technology. Attach a copy of the current operation and maintenance contract(to be obtained from syst m owner) , •f�I Tight tank ,UO Attach a copy of the DEP approval V00ther(describe): Apphoxim,ate aoe of alll components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):.r/d 6 Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 28 Pine Ridge Road Cotuit Ma Owner:Richard Boden Date of Inspection: 4 21 0 3 BUILDING SEWER(locate on site plan). 4" Sch. 35 PVC pipe Depth below grade: /f Through out the system Materials of construction: cast iron .4/340 PVC t other(explain): Distance from private water supply well or suction line:/D Comments(on condition of joints,venting,evidence of leakage, etc.): Joints appear tight.No evidence of leakage.GystPm ; s vented through the house vents. SEPTIC TANK: locate on site plan) /dChf f'-40446w-� . Depth below grade: /,z Material of construction: &-concreteA/AnetaWdfiberglass��olyethylene /V&ther(explain) ZT19 If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):•��(attach a copy of certificate)Dimensions: Sludge .T. Distance from top�of�sludge to bottom of outlet tee or baffle:/ � Scum thickness: �.,� Distance from top of scum to top of outlet tee or baflle:./ ' Distance from bottom of scum to bottom f outlet tee or affle: How were dimensions determined: � Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump the septic tank eyer)4 2-1 ypars_ Inlet & outlet tees are in place.The tank is structurally sound and shows no evidence of leakage.Liquid level at the outlet invert is 51 " GREASE TRAH( Ae locate on site plan) Depth below grade:AZ4 Material of construction itl�concretemetalA��4 fiberglassil/�/ olyethyleneil/jother (explain): J 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: 41M Comments(on pumping recommendations, inlet and outlet tee or baffle condition,'structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present. 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C " SYSTEM INFORMATION(continued) Property Address: 28 Pine Ridge Road Cotuit Mass Owner: Richard Boden Date of Inspection: 4/21 /0 3 TIGHT or HOLDING TANKAbNe,(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: /VA Material of construction: concrete WA metalA1,4 fiberglass NA polyethylene�U�other(explain): A)A Dimensions: Capacity: allons Design Flow: gallons/day Alarm present(yes or no): Alarm level: �4 Alarm in working order(yes or no): Date of last pumping: .644 Comments(condition of alarm and float switches,etc.): Tight or hr)1 di ncl tanks ara not nrPGant DISTRIBUTION BOXCI—(if present must be opened)(locate on site plan). Depth of liquid level above outlet invert: W11 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 is not pr_espnt PUMP CHAMBER41y,(locate on site plan) Pumps in working order(yes or no): 41.4 Alarms in working order(yes or no): .04 Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump chamber is not present 8 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: 28 Pine Ridge Road Cotuit Ma Owner Richard Boden Date of Inspection: 4 21 03 / SOIL ABSORPTION SYSTEM (SAS): +� (locate on site plan,excavation not required) 1_-1000 ctallon precast leaching pit. If SAS not located explain why: T or`a t e.Cl• S e k—aQ A l (l Ty ✓ � leaching pits,number: .if a leaching chambers,number: O ,a leaching galleries,number: O leaching trenches,number, length: a 41t) leaching fields,number,dimensions: �(J!! overflow cesspool,number: a , 6 innovative/alternative system Type/name of technology: ��� s�•� Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand to coarse canrl Nn ai T c of hzdraulic failure er pending. Sni1c aro dr1r.Vegetatirm is normal Waste t.,Xater is 37" belew the n i yert pipe. CESSPOOLS!de-(cesspool must be pumped as!part of inspect ion)(Iocate 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): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Cesspool c ara not resent. PRIVYd-b0°(locate on site plan) Materials of construction: rU/tt Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Pri vv i c nntp resent. 9 Page 10 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Pine Ridge Road Cotuit Mass OwnerRichard Bod n Date of lospection: 21 03 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. 28 V��nx 1Ztd5e �oa� Co-}v:-�- j • ;fir 4 10 `` R11T--..I T'l�T.�1TR:JRf•/TnfffTlT'ST.IRR t`.T7TR►!1T•TIT�TRL 17nll.ellnl �1 TOWN OF BARNSTABLE BOARD OF HEALTH 0 SUASURFACF SEWAGE DISPOSAL SYSTF,M INSPECTION FORM - PART D •- CERTIFICATION +•s'1-T••••.'e—T.11R-.TT't.�SI�II'R.'1TtTT/'{9tR'�TT.r—S-f T�11�'\i1'RAI-1TTt0����7 r�nntmr.rfT�TTT.+rf�.•.—Sr-rT'r-.�. �. A -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 28 Pine Ridge Road Cotuit Mass ASSESSORS MAP, BLOCK AND PARCEL # 018-057 OWNER' s NAME Richard Boden PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME,Joseph P. Macomber & SCfi ' Inc COMPANY ADDRESS Box 66 Centerville Mass 02632 Street Town or C1ty State COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 1 578 cIP _ !T CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal s st this address an Y em at d that the informati on reported is true , accurate , and omplete as of the time of -inspection . The inspection was recommendations re ardir: u Performed and any g g upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : System PASSED; The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh 'or Lhe environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* \ The inspection which . I have con acted has found that the system fails to protect the public health and the environment in accordance with Title 51 3.10 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 7""✓7 �d DFne copy of this certification must be provided to the OWNER, the BUYER where applicable ) and the BOARD OF IMAL711. * If the inspection FAILED, the owner or"*Operator shall upgrade ' within one ,year of the date of the inspection, unless allowedortayete he requiredm otherwise as provided in 3.10 CMR 15 . 305 . partd - doc Page 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Pine Ridge Road Cotuit Mass Owner-Richard Boden Date of Inspection: 4 21 03 SITE EXAM Slope Surface water Check cellar Shallow wells t Estimated depth to ground water,�rJ^ feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-if checked,date of design plan reviewed: NA YES Observed site(abutting property/observation hole within 150 feet of SAS) (_Q_Checked with local Board of Health-explain: NA YRS Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain:http: //town,barns table.ma.us . You must describe how you established the high ground water elevation: Used: Gahrety & Miller Model. 12/16/94 Ground water elevations ahovp Spa level Used:USGS: Observation well t3ata .Tuna 1992 USED:USES- Tprhniral h>>llatin 42_n00 1 Plate #2 Annual—rangias of ground wa}A.rj� ;ns January 1992 Leaching Pit 1 eet Groundwater: Feet Below Bottom,of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the botto Of the leaching pit and the adjusted groundwater table is feet. 11 24'47 DECK 1 2,•.12' I . IY MNIAGON MO G I _ q-r 6'-10 9-5 4'+A I5'-2 1/r+A 16X 7 1/4' +A 6=10 r-r y b I USC Elfl3T SUD[A flx wDW flMF MOw• EXISTING mmDow = O 9 lG I F I • EkPANGFD I I t� EXIST. Sw N RE-ME EMT.N NDOW — --------------J DINING I�IY SITTING EW 7� eRGM onsT.uv lG p4 I 118 M.BATH m .n Iz-s•,me . ON , - wEw I IT.1 r-c I I� LIVING ROOM 5 31/4•REooAE 1 I s N,•RED OAG s•-c•.T Q QD io I 31/4.RED WAS w s m MASTER a © 1 I cw5n BEDROOM 0:: . VA TED wuw 1 R—EDcgMrFe f I1 1 4'-10 1/2- IT-s- -- W U�El O = - I OnST.B4t ABWC PANTRY 1 iV I' 4. ,� .._- �: QVAUITm CEILING 8 EXPANDED 3 q sMc -O KITCHEN xEw r Iv-c•,n-T - STUDY — — — — D n I Posy // 1 I Pmi m a� ® s N4•Iav oAx Rv.� — —— a 5 ss.Io 1 �^ 1 O C '^ TRA 3P INLIW ® N / .• N I O D PAx I I F / LAV. N - '^ Tom•.T-G O 0 c FdYER...� 1 n G'-I 1/2• IG'-112' ;" dewwe rainbow Trgs va•REDpu �- 3 I OB 'v 8'-31/2' 5'-I' 6'-IP T-r 4'-0' 1 2•-3' 4'-O' S'-T 3'-O' — ST 13 ---- - -- 1 As ilr s a 1a'o 11/2'wooD sTEr S2 5 20-3' 8'-T +A 12'-3' 1 5'-r+A FIRST FLOOR PLAN KEY NEW WALL5 O EXISTING WALLS TO REMAIN ...... ..: EXISTING WALLS TO BE REMOVED _ N Z N Q W CA O 4'-5 1/2' N u2� N Re-used nnG wwoow Z t RUUse d nnc WINDOW MT.WcW WINDm R T ROOK WWDOMR FLOOR (� I tv -------------------- —a O © a r---- i- • exLST. I ---- --------I O O w © BATH I ----- 1 �ui x I ; m 1 _ 1----� ❑ FW- onsTmu 1 ensTwG BEDROOM 1 < O I I BEDROOM_ I 1 2 a I I S SO4 I � o if I — ----------- __ ----- —-- I W TMG I - O1OT - I . I ensT.a0sTs_ _---_--- I -----J L---- I I 1 1 •'------------ I `BaoT I I I I I I L—— SECOND FLOOR PLAN W OUTDOOR SXONER _ JI1TH BnR9®Z'O.G - 0.y G POUND.WnLL F 5'-C7 RRseCDONs-M. p09nNG WORD PRPMe WN1 Raffia nil om a co FULL BASEMENT N[W Q W FULL BASEMENT I " 3 Z g I ,•TX10T•fWRCDCAMR 01 91AB FLOOR 9 M4—fOLY Ya a W V=HG6T-GINT t00`VA9L` _ 11 _ VAfDN DPRWe�FO — - - TTT11l CCMfAQED GRANUUVt BfSe 0 11---mil 0 O M I I r 1 1 2 X 10 FLOOR JOISTS !L B•n11CR, nlGn fD1AR0 cONOieR POI1NOPnON U) Q � I I ww.L GN� icconnNuwsconcv[T2 roonNG Y, IS'O.C. I I PROMO[2 s ones TOf.DOTTOM ar fND-wall W U w - --- as ur r Z Z DRILL a GROUT I,.BRR9®?•O.O I - W A 0 r» i e� HI1 IA' o+a •'i' a IIa a r--------------I�,I a iiii qi o I &-AGE 8tA8 I fommllaNAlk I.I -I I eae:.ee,:u�aww�il.ee 1 I � :.;.� • I I I'I - oIo ar .r c•r nw ew car ara e FOUNDATION PLAN FLOOR PLAN I N'•1'O I4'•i'tl r . lao � Izo 1 I y MPtCo«gmevert � q � �{ oral W I I � b •.,�.- 87CRAGE 1 z u amoa •m ou .. 44 1 1 w ara OARAOE b 1 I Q � , 1 1 1 0 ms�•°m`� rw°,L`���q�9"�d8a"A°4"gweue 1 � wuee.gr,«.Na+« 1 '• � r C r V WALe 1-0- ISM tl�ue�.�w.e.oc R"«„&o �aggq I aae Ilnwam SECTION AT GARAGE la••ro• �� SECOND FLOOR PLAN °tuwlroe In••Ia Ili - 2 A _ t:3dC ) l I 4 � I 1 1 I 1 I f t 4-1 f Q Orl • \ t r IV � � 7 WELL i �i✓.va. ,ei v.4a ,a Flxltif' �: 4.T TtitE FUu�lS�TI L,tJ 4�Jr �7 Y SCAB-� I„' GAO APeIL I, � I� IS +� A �JC-l_L 5�if��.JN Gil T►�l� 1 'l h!� neE LOGATGD B AXTER 1 2 '14r.^ c� Tt•lt= �1ZQu►.t°J AS S►1nwkv NErcUtJ AUK •`�c`'`STs�s�pi C Tt-`E OF TL)E=- V-EG.I s 7 E Le G-Vz> L-A k i r `)u f?.0 E.'` (a Z5 c lei/ To tAd 1•y © L:-I+JS.T to L G CST Ee-\; i�_c % AAA 5 , Ap2.1 L 1-11 t 9-?S ZEGt'STEiZv,=� L,4wr> r ——gg—— EXISTING CONTOUR �n I X 100.98 EXISTING SPOT GRADE 04 W EXISTING WATER SERVICE Z o G EXISTING GAS SERVICE J < I —UGW—UNDERGROUND WIRES CL Q ��_,_'_•_• AI I, TED WETLAND TEST PIT W o \ ,., _ — — �•���•�� $ BENCHMARK Q L) LEGEND F= _ _ _ •_ 0 J 8 14— 10_ \�• 'c` 16_ _ i 2� \ \` -AIL }' 18— _ Ld 20— LOT 2LLJ 1°�\ �•�; Q o �' W p cV 24, 2� PORCH � � ` \ � \\ 18� \� � � \ � 1�� \\ �� 0 N / �4. DECK \. �". ._ ',•, � a�i BENCHMARK \ COR,/CONC, APRON 25.36 � x 1EX/STING \ \ EL.=29.15 + 26,90 -a� 30.07X HOUSE(#28) 2k�: FF EL.=32.Of \ \ Z I z o W EXISTING 6.23 � \ \\ 18 z W t27,60 GARAGE T.O.F=31.Of l' � \ \ o N 26.30 2 29.61 V W 30.08 T \ \\ \ \\ \ w N 30.2.1 \ \ 3 p G� 30.8 ® / �'� \ �'c� •- \ \ 29,15'` ;29.60:..;. •� �� 10 10 \ \\ \ p N i N - r " TP 2TP-1 `.I' .t• .i :,j• .•.� „�•:• � � 30.12 .� � �\ � �4� � � r- � N 29.46 1 \ c� a x 28.77x 2.9: .'9' s' r:rl".::: 0,18 _ \ \��_-' `� EXJSTING LEACH PIT / r ,• \ ` 27,85 ••= ;;'.;�.� �y> 31.34 \ ^.. TO BE PUMPED, FILLED o VENT , . :.'25 J 31.02 f';. '.::.:G�• ;!: :', N 30.00 �'� \ -W SAND & ABANDONED Q STONE:.• `` x 28�0 SLEEVE SEWER FOR 10' ON :•:. ` 33.26 x \\ DR/VE Y EACH SIDE OF CROSSING { 379.V . \ \ \ S 71.29'30" 30.39 edge of pavement 31.371 31.84 _ ��• � 4,0 26.29 27.58 29,52 30.36 9 32,39 _ ��6U,�­32F�� ���,� OF Mgs�9C PROPOSED S.A.S. EXISTING SEPTIC TANK '`• �;' p o� PETER T. ti 2-500 GALLON CHAMBERS BENCHMARK PINE RIDGE ROAD , S MCENTEEcr MAG, NAIL SET (TO REMAIN) 32• o N 0)v SURROUNDED W/.STONE EL,= 29.78 TOP OF TANK, EL.=2934f 32.99 " CIVIL C w M No. 35109 .� � M INV.(OUT)=28.00f STD O oto c C N o W W .- J y f L I t1 l ,_t..y...,.^Nufl.Ln N (c) 04 I. o Cl 28PineR"dgeRd ?' `--`r "GD'•'= Q '0,CoWIt,MA02635 e1dPd 0 L.I Cl Li 0 a o L�j V Id 8i tf , t „sCo1o`.st,rY I V L_-- •42'20" W 13- f Loek ! N 71 I r r T*'- 3 & �0 __ f 'r.�! !!lJ rJl ] NI ke° ... ��) '.. 71/ •....11 —mot' t._..•. I 0 r 0 LOCUS MAPAL I o C- WETLAND I zz cn w w0 AllL I 4 o 1 i � w Of N � ,� o ^ V) Z 0 - - - - - - - - - - - c� W a m F LOT 2 1 A I cn s �� �---=--- 87,145±S.F.' cL N o w '�_ � PARCEL ID: 18-57 a o S 73-27'35" E a -\ r 28.31' N o Z to Ili o CO iI o �• Z � Y co � MW o a 0 n GARAGE HOUSE#28 O N N i I FII a N DRIVEWAY04 I �' 0 i 379.12' I vo ��� OF Mgss9c a edge of pavement S 71°29'30" E z r7 N o PETER T. yam, o N McENTEE V °' to ,M 0) CIVIL00 PINE RIDGE ROAD � � 4w L - SEE SHEET 2 - _ - - _ _ _ - _ _ _ 18.16' � 0 LO 1 20 SCALE WINDOW S 72°23'30" E 2111 t 2 l C-o M NLO OWNER OF RECORD N BODEN, RICHARD M & PAMELA G .0 P.O. BOX 691 , C 3 0 COTUIT, MA 02635 U.1 w NOTE: TO PREVENT BREAKOUT, THE PROPOSED M FINISH GRADE SHALL NOT BE < EL. 26.5 FOR A DISTANCE OF 15' AROUND THE C4 PROPOSED SEPTIC TANK PROPOSED D-BO PERIMETER OF THE S.A.S. Z 0 X PROVIDE RISER & COVER OVER INLET & OUTLET INSTALL RISER & COVER . GENERAL NOTES: MANHOLES AND SET WITHIN 6" OF FINISH GRADE SET TO 6" OF GRADE PROPOSED S.A.S. 0-INSTALL RISER & COVER OVER ONE CHAMBER AND 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL Q '= T.O.F=31.0f SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT BOARD OF HEALTH AND, THE DESIGN ENGINEER. W o F.G. EL.=30.0f F.G. EL.=309t- ` F.G. EL.=30.0f VENT 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 0 U F.G. EL.=30.Of OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE MAINTAIN 2% SLOPE OVER S.A.S. LOCAL RULES AND REGULATIONS. ? J 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR �-- L = 82' L _ 5' TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. c SCH4 (MIN.) © SCH4 (MIN.) 2" LAYER OF 1/8" TO 1/2" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 4"SCH40 PVC 4"SCH40 PVC U 6" 11. 1 1 DOUBLE WASHED STONE FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN io^t 7IINV.=28.00± s a®asses (OR APPROVED FILTER FABRIC) ENGINEER BEFORE CONSTRUCTION CONTINUES. Q M 2' EFF. aaaaaBa 0 aaaaaaa 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. EXISTING 48" LIQUID DEPTH _ �3/4" TO 1-1/2" DOUBLE � LEVEL ADD GA WASHED STONE 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF PROPOSED 4.8' 4' o BAFFLEINV.=26.27 _ INV.=26.10 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF D BOX EFFECTIVE WIDTH HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. W (VERIFY) 3 OUTLETS INV.=26.00 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. V 'EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. 3 SURROUNDED WITH STONE AS SHOWN 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS W N H-20 RATED AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE W W DIRECTED BY THE APPROVING AUTHORITIES. Z c TOP CONC. ELEV.=27.0t { cl 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY � NOTES: BREAKOUT ELEV.= 26.50 W a" m ease THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & INV. ELEV.= 26.00 eases V) 0 a®aaaaaaaaa CONSTRUCTION. INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. aaaaaaaaaaa 0 00 L BOTTOM ELEV.= -24.00 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS a, N o 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' 2 x 8.5' = 17.0' 4' IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 0 ON A MECHANICALLY COMPACTED SIX INCH CRUSHED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' REPLACE WITH CLEAN, SAND AS SPECIFIED IN 310 CMR 255(3). STONE BASE, AS SPECIFIED 310 CMR 15.221(2). PERVIOUS MATERIAL 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE a o 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. , INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. a A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE LEACHING SYSTEM SECTION 4 a� BOTTOM OF TEST PIT, EL.=17.2 4 13, THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND a AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 14• THE SYSTEMGINEER IS COMPO ENTOST NOT SOHOWNL ON OR ANY HE PLANNDOCUMENTED SEPTIC z 1 o SEPTIC SYSTEM PROFILELr) o N 17 0 SOIL LOG Z Y 3 N w � DATE: DECEMBER 10, 2021' PERC# 21-313 DESIGN CRITERIA SOIL EVALUATOR: PETER McENTEE PE, SE-1542 N WITNESS: DAVID STANTON. RS HEALTH AGENT ui F- '- NUMBER OF BEDROOMS: 3 BEDROOMS ELEV. TP- DEPTH ELEV. TP-2 DEPTH Z SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) 28.8 A 0"SOIL 7 A 0" EXISTING N DESIGN PERCOLATION RATE: <2 MIN/IN LOAMY SAND ; LOAMY SAND GARAGE DAILY FLOW: 330 GPD 28.0 10YR 4/2 z7 9 10YR 4/2 0 B 9„ B 10„ DESIGN FLOW: 330 GPD LOAMY SAND LOAMY SAND GARBAGE GRINDER: NO-not allowed with design 26.3 10YR 5/4 30" 26.0 1 10YR 5/432" 0 l,$ o v LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF C PERC C 2 24"/42" .74 GPD/SF N T --- N � 0 EXISTING SEPTIC TANK: 1000 GALLON CAPACITY cfl 0oN�1 �j, - PROPOSED D-BOX: 1 INLET, 3 OUTLET (MIN.), H-20 RATED I _ "0�' `SO• O MED. SAND �MED. SAND 1 + �- 1111 \ USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 2.5Y s/s x z.SY s/s SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES •� y M 'n Q) o SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. o, � � r BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. 17.3 138" 17.2 138' .� y TOTAL AREA:.............................................................. 471.2 S.F. NO GROUNDWATER ENCOUNTERED SEPTIC LAYOUT 01 c 3 0 DESIGN FLOW PROVIDED. 0.74 GPD/SF(471.2 SF) = 348.7 GPD PERC RATE: <2 MIN./IN. "C' HORIZON uj C W 04 LO