HomeMy WebLinkAbout0153 TANGLEWOOD DRIVE - Health Usterville P r
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TOWN OF BARNSTABLE
LOCATION
��Il� i T , �'P.z, ��� `IVP SEWAGE# �V 14
VILLAGE 0 ,eir f, ASSESSOR'S MAP&PARCEL I U
INSTALLER'S NAME&PHONE NO.�,pe t,_JV,4,e_ &
SEPTIC TANK CAPACITY A000 C5e,
LEACHING FACILITY:(type) Cj)d JeeJ (size) & ,F, u x o?j,
NO.OF BEDROOMS 3
� C U-2-0- � / L e to KOWNER ✓ 9 4, R
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY c4y Gt, O b et,T.,4_,.,s L LC—
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No. aZ16
Fee ti
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppliLation for bisposal 6pstrm Cunstrurtion Vermit
Application for a Permit to Construct( ) Repair(w Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. l 73 -TAVG�Cuk-o�b Owner's Name,Address,and Tel.No.
dS_taL '1 LGC twou,LtA4%t,k) --r" PL4A,l'K
Assessor's Map/Parcel I a j DCL O t I—j
Installer's Name,Address,and Tel.No. J d& -L!T 7 g 8 7'7 Designer's Name,Address,and Tel.No.562-oL`7 037 7
Type of Building:
Dwelling No.of Bedrooms Lot Size l s, �I "� sq.ft. Garbage Grinder( )
Other Type of Building Q [2 No.of Persons Showers( ) Cafeteria( ) .
Other Fixtures
Design Flow(min.required) 3-3 0 gpd Design flow provided 3 , gpd
Plan Date - 'PQt 4 Number of sheets I Revision Date
Title aST8LVtLkX5
Size of Septic Tank OQO Type of S.A.S. ;;- j p 0 (5:y_C#_6J (,p�G1-�ll�G G EYiS
Description of Soil PLAN
Nature of Repairs or Alterations(Answer when applicable) USG C:�C`sZc�- 1i(l8� &o Ll <807
`l'Z Nd6W b-1;)O?E 111- (a) Snap l- k L0&) LC-t����-�b4�fr���2� U>C-I
4-' or—
Date last inspected:
Agreement: f
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 Healt
S' d Q Date
es
Application Approved by Date
Application Disapproved by AV Date
for the following reasons
Permit No. ' Date Issued
No. / Fee
li! THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
M
PUBLIC HEALTH'DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppfication for Disposal i5pstem Construction permit
Application for a Permit to Construct( ) Repair(J Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. l 53 -TA0"57t.()�b b72 Owner's Name,Address,and Tel.No.
65T1Lv i L.G t /14AA 4wt. hsQS0Jr� --f" Wt�AJ K
Assessor's Map/Parcell j 3 T)( V o-- ps l Gar
Installer's Name,Address,and Tel.No. $o$-477..88 7? Designer's Name,Address,and Tel.No. :0_'R-X73 03T 7
6�o �ac ev7lapusm u.c. S� c-N��Ntr�i,Cz=N -
1 S Nk MAISNPEE_ -295q G204IJ —M t+" t;, " 6(1-C
Type of Building:
Dwelling No.of Bedrooms Lot Size A5,j Q 1 sq.ft. Garbage Grinder( )
Other Type of Building Q. t D�-t F .L No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3.3(5 gpd Design flow provided 3 , gpd
r
Plan ; Date a-a( o�'Ol Number of sheets Revision Date
Title
Size of Septic Tank (�O yp Gwk_(_Q0 Type of S.A.S. ;L J O O <&j4_LL ON L O�Gb±rIIUE�G ((��S
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) USG ire lSz(A. - �,(��-! 15;,801 <1 "T3'41J(L
4-1 or—
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 Healt
si ed Q Date
Application Approved by / / Date
Application Disapproved by Date
for the following reasons
Permit No. r Date Issued / 1
i Z
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( )
Abandoned( )by
at I s 3 TA ti %j c_ p DQ. orrem)l LLB has been cons cte/d�'n acc rdance
with the provisions of Title 5 and the for Disposal System Construction Permit No /"/ dated
Installer FAJ rinWUS Designer rN G
#bedrooms Approved design flow ,J 3 0 gpd
The issuance of this permit
shall n t be construed as a guarantee that the systet4willfim��cttde 'gne .
Date �J` 1 Inspecto
------- ---------------------------------------- --- _ -------------------------
No. %%^(/ / Dl awn., Fee
THE COMMONWEALTH OF MASSACHUSETTS f
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction 3permit
Permission is hereby granted to Construct( ) Repair( Y� Upgrade( ) Abandon( `)
System located at 153 T�,jur=>!�,QJ o&D b Q i Vif b_ 't V/u L=-
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.
-.1
Provided:Construction must he co pleted within three years of the date of this permit.
D II ate Approved b �
Town of-Barnstable
r, Regulatory Services
Thomas F. Geiler,Director
• " Public Health Division
161:9. Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: 3- 5- 1 Sewage Permit# �41 -Oq6 Assessor's Map/Parcel t 2 l �3
Installer &Designer Certification Form
Designer: 3C engiwlzecfnq , Tnr Installer: CnQe�. G,iI�cr�,oy, LCG
Address: 285N Gcoo6".-� W t6w" Address: I S 3 C_n�� t 1, S�
Cask W0Cdnc,n Ha 026LB yy , +�
On a_ZA " 1 ea;GQz C�Iti�e� Qt�eS was issued a permit to install a
(date) (installer)
septic system at 153 Tan!�ie wood 4, _ based on a design drawn by
(address)
-XG En�jtrle�cirly , rnc•, dated relormr r� 21. 201N
(designer)
y 1 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 relocation of any component
of the septic system) but in accordance with State„&Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout(if required) was inspected and the soils
were found satisfactory.
�6µTN OP
{ JOH
` CHUB HILL ��
Installer's Signa', e) 'n
t.
<ye >
es 's ignatur (A iffip Here)
PLEASE RETURN TO BARNSTABLE PUBLIC ALTH 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.
gAol ice fomiAdesignercertitication form.doe
Town of Barnstable P#
Department of Regulatory Services
MAM
Public Health Division Date
i�sfl 200 Main Street,Hyannis MA 02601
e Pd
Date Scheduled (. �011
Time
Fe O
- .
Soil Suitability Assessment for Sew g s al,
2 f d
Performed By: -041 YY �p o f_ Y CS C Witnessed B : �
t Y
LOCATION& GENERAL INFORMATION
Location Address Owner's Name W t[-(_f4A t D L SO u S4
C>PtU6- . rkoY MAL.)W ,
QS-C&-z_tfi t.( Address i S 3 � �.( >> iZ - R V 1 L-C..L.
Assessor's Map/Parcel: a( G(�8 Engineer's Name ELil?5: p?el S Ur L.0 C 4
NEW CONSTRUCTION REPAIR X 2 Telephone# 6C��i SC &Y15t�1e2:in5
7-7 7,—�� 50�273.,6377
Land Use Res�.!n I a I Slopes m 3` S Surface Stones A oh e_
Distances from: Open Water Body ft ,Possible Wet Area ft Drinking Water Well ft
' Drainage Way ft Property Line _Oft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
.z=4
Parent material(geologic) ��'W G S Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: / . . B G S Weeping from Pit Face V
Estimated Seasonal High Groundwater I R 0
DETERNIINATION FOR SEASONAL HIGH WATER TABLE
Method Used: btrea d1cse.f uaktort -
Depth Observed standing in obs.hole: 13 Z __ _ __in, Depth to soil mottles: �a in.
Depth to weeping from side of obs.hole: in, Groundwater Adjustment
Index Well# Reading Date: Index Well level Adj.fl ctor, ,. Adj.droundwater Level R;__
PERCOLATION TESL' Dgtea Tittle// BAJ
Observation x
Hole# Time at V
Depth of Perc I 1 t' = Time at 6" — r
(� _
Start Pre-soak Time @ 11d0 arA 'Pima(9"-6") `
i
End Pre-soak
Rate Min./Inch __Z,- - CLY
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
a
***If percolation test is to be conducted within 100' of wetland,you must first notify the,
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:ISEPTIC\PERCFORM.DOC
DEEP-OBSERVATION HOLE LOG Hole# I + 2-
Depth from Soil Horizon Soil Texture .Sdil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders.
onsistency.96 Gravel)
1a-qa. B LS /oyR5 6 - -
�a-�N a C, rl a_a Y((3 0 lay
No�1 �vl5
DEEP OBSERVATION HOLE LOG Hole#
Depth from r Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
DEEP OBSERVATION HOLE LOG Bole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,
DEEP OBSERVATION HOLE LOG Hole# .
t_ Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
o ' ten
4
Flood Insurance hate Map:
Above 500 year flood boundary No— Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurrine Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? Ye.s -
If not,what is the depth of naturally occurring pervious material? ._.�..�
Certification
I certify that on a 0 (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,expertise and experience described in 310 CMR 15.017.
%� J ate
Signature ill D
Q-WEl`TiC\PERCFORM.DOC
L0CAT61
N -�- SEWAGE PERMIT NO.
' Z I-� ✓.
VIL AGE / Ile-
IZ)R ��CJc N.STA LLER' NAME & ADDRESS
BUILDER R fR
�� A
IZ,5
DATE PERMIT ISSUED
?6 V:.
DAT E CO-MPLIANCE ISSUED ` 7 �
P
.,� � y,�t
,r
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9
.:,F,
No.... yr2......... y r Fus..........J�................
THE COMMONWEALTH OF MASSACHUSETTS q
BOAR® OF HEALTH
Appliration for Di-quiff al Workfi C ontitrurtion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal `
System at:
................_... 4� ? �c.7 om..... -?.4d ..�...4�__-_`.......---.....----........ --...... -------•-------........---------
Location-Addr s or Lot No-
.... _( '.----•-••. ......------D3� .......�'n-------#-WA . ... er.. i.,l� ......_
Owner Address
...........................t�-----•---��:L��---_____---_------____-_-__ .......�...<..._.�?'� f..
...
----------
Installer Address
d Type of Building Size Lot..... ...Sq. feet +
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder
'_lPL4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Pa Other. fixtures -------------------------------•--
W Design Flow............. ........ ..........gallons per person pier day. Total d�ily flow..................... •.........gallons.
� Septic Tank—Liquid capacity_' .gallons Length..8_�._. Width_._.-jV__ Diameter---------------- Depth.. -�...
Disposal Trench—No. .................... Width.....i.............. Total Length........_... ...... Total leaching area....
...............sq. ft.
Seepage Pit No........I------_.... Diameter.._.....4....... Depth below, inle ...... ......... T tal leaching area..!%Q!:A...sq. ft.
Other Distribution box ( Dosm tank ( )
i
Percolation Test Result Performed by-. -- ••.•- $ -- °-�� Date.__..'�. I�.� '..............
aTest Pit No. 1................minutes per inch Depth of Test Pit._.....L.___e...... Depth to ground water........-®._......._.
(i Test Pit No. 2....... ....minutes per inch Depth of Test Pit........11...... Depth to ground water........................
Rai ------•---••• ......._...I-•-•-•-------••------•------
® 1�._-p r
Description of Soil----�----�-----.. .�ri_.�.--- �..---------�-~--�'�----M -�°�--*�---------------------------------------•------
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 IT 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 by the board ealth.
igne --- ----------
Date
Application Approved BY---- ----- - ---- ------ = I �._--._----------------_ ...-7` Date 7a...
Date
Application Disapproved for the following reasons:................................................................................................................
..................................
-•--------••-••--••-••--•--•----•-•-•-•-••--•-•-•-•------•--•-•--•----..----•------••----••-•--•-•---•-•••-•-----•••-••••-••-•••-•=-----•-----••---•••••-
....................No......................................................... Issued_..-__..... /J 7 8 -ate
Date
No. ....._....... Fss...........
...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
I ................._OF...-...1 AJZ.6d r.rm
App iratifa t for Uisplraai Works Tonstrnrtintt Famit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..... _ . ��. _4�9� ..... _4>. ..... � a ----•------LG� _.__.. ................................
Location-Add ,s or Lot No. /� / ff
..... ? .5 �.-.�:`---....... ku:" � ..---- ,� � LI�:S...--`� .._�(,.1`�-�`�l �l..d!.!.t�---•---
Owner Address
........................... :.�.......... _l-'�__14............................ ........
Installer Address
UType of Building Size Lot..... ---Sq. feet °
Dwelling—No. of Bedrooms.....................
.......................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons......................._.... Showers ( ) — Cafeteria ( ),
dOther fixtures ._...____________________________ _ ,
W Design Flow_____________"� _________ ` ..........gallons per person per day. Total daily flow.......................
_____.__.__._______._ �` _______ .gallons.
R; Septic Tank—Liquid capacityACWgallons Length.__-(,___ Width. :_-1P._ Diameter________________ Depth__!�.'!:-.s_'.�
Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area__�':__________....sq. ft.
a e
Seepage Pit No________ ___________ Diameter......... Depth belo role ._.._.C-_____.___,T tal 1 Ching area__' C�_._sq. ft.
Z Other Distribution box ( ') Dosing tank �� lr w
'-' Percolation Test Results Performed b ? ,_ _ a �a__. _ � Date__._____..��_ : ____.____..
y- ---- 2
a Test Pit No. 1.... .....minutes per inch_ Depth of Test Pit------- •------- Depth to ground water_________' ............
Test Pit No. 2..____I:__._minutes per inch Depth of Test Pit........ Depth to ground water------__—r_............
------------I - -•-------•---------------•--••---------------------------------
O- Description of Soil---- I �� --- ) 31R..------ 9 - 1 ----•-----------
U ----------------------------------------------------- = _..._.._... ......
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 TITLE 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 by the board 9jhealth.
igne - --=--------- -----•-
�APPlication Approved,By----------- -•- &4'r 4-X ------------------•--- .... Date
Application Disapproved for the following reasons-----------------------------------------------------------------------' ---------------------------------------
----------•-----------•----...---•---------=--------------------•-----.._....._._.__.._._._..--------------..-.------------------------------------------(-----------------------------------------------
. ISSued_.. .. _._-� _. Date
PermitNo-------------------------------------------------------- ....-=------• •
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/.. �` 1.................OF.... :' ' 'y ' ................._-..-......._...
Trr$ifirate of Toutpliattrr
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (v j or Repaired ( )
by_ .c;r..�._....44C.f_ % --------------------------------------------------------•----.....•---•-•-
p^ j / staller ,1
at..........!_-4.! le�dein
(°�d1 ?L =:: �':� Srr G.r '`?` �:✓'�� j- 5
has been insta accordance with the provisions of T 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. :::_��_�_______________ dated_._.._7._"-�k_-__� `___.______._
THE ISSUANCE OF THIS CERTIFICATE: SHALL NOT BE CONSTRUED A A GUARANTEE THAT THE
SYSTEM W1 L FUNCTION SATISFACTORY..
DATE........ �� Inspector_.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................OF..... -�..1 ............................................... FEE..s2 _..............
Disposal Works Tnntrudion Vamit
Permission. is hereby granted----.-..---- / _Ccy-7------------................-................................................................
to Construct ( 6--� or Repair ( ) ;n Individual Sewage Dis osal Syst%•
Street
as shown on the application for Disposal Works Construction Per o :.______._.._.�
-'' jj 'd;— --- ------------•-------------____--------
tsoard of Hea -
DATE.... ........................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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• CONONTiTEALTH OF ASSACH'vSETTS
EXEcuTIVE OFFICE OF ENVIRONMENTAL AFFAIF.s
v> DEPARTMENT OF ENVIRONMENTAL PROTECTION
Y
FEB 15 2005
TITLES TOWN OF BARNSTABLE
HEALTH DEPT.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSE-SSM]ENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A _
CERTIFICATION ARCEI. �Q3
Property Address: 6- Gt �Tito� LOT 2 y t-
Owner's Name: Czbw
Owner's Address:
Date of Inspection: f
Name of Inspector: I print) iGiide E t`e�T ��
Company blame: Aej
Mailing Address: 095Ts Cl) M
Da6�J
Telephone Number: _,S-VA.-,8
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 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: W zi&z
Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent.to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
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 6/15/20M page I
Page 2 of I I
OFFICIAL INSPECTION FORD-�NOT FOR VOLUNTARY ASSESSMENT'S
SUBSURFACE SEWAGE IISPOSAL`SYSTEM INSPECTION FORM
. PART A
�-�' CERTIFICATION(continued)
Property Address: f � J ow tvoJ T�i V e
S ✓r av
]Date of Inspection: _1,20 ® "
Inspection Summary: Check A,B,C,D or E!ALWAYS complete all of Section D
A. System Passes:
I have-not found any information which indicates that any of the failure criteria described in 310 CMR
15.�03 or in 310 CUR 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 n to be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by th oard of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following sta ents.If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic (whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank a is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as app ed by the Board of Health.
*A metal septic tank will pass inspection if it is sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is av le.
ND explain:
Observation of sewage backup break out or ingh statue water level in the distribution box due to broken or
obstructed pipe(s)or due to a bro settled or uneven distortion box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)az rephced
obi isvemoved
disft box is kveied or replaced
ND explain:
The system 94uired pumping more than 4 times a year due to broken or obstructed pipe(s).'Me system will
pass inspection approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
4 -
Page 3 of 11
OFFICIAL INSPECTION FORM a NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORS
PART A
CERTIFICATION(continued)
Property Address: 1�, a c3� t.�
I —
Owner:_DpSay5ct.
Date of inspection: _ T
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require fiuther evaluation by the Board of He h 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 at rdance with 310 CMR 15.303(i)(b)that the
system is not functioning in a manner which will prote public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface ter
_ Cesspool or privy is within 50 feet of a bord ` g vegetated wetland or a salt marsh'
2. System will fail unless the Board of Ith(and Public Water Supplier,if any)determines that the
system is functioning in a manner that otects the public health,safety and environment:
_ The system has a septic tank soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary a surface water supply.
— The system has a septic and SAS and the SAS is within a Zone i of a public water supply.
The system has a septic and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septi 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 i e well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile® ganic compounds indicates that the well is free from pollution from that facility and
the presence of amm is nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are ggered.A copy of the analysis must be attached to this form.
i
3. Other:
3
Page 4 of 11
P_
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S
SUBSURFACE SEWAGE D Pt G'SYSTEM INSPECTION FORM
I'ART:.A
CERT MCATION(continued)
Property Address: /a (ew
Owner:
r
Date of Inspection:
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or.cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
1 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.
cC Any portion of a cesspool or privy is within a Zone 1 of a public well.
j Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.(This system passes if the well water..analysis,
performed at a DEP certified 3aboratory;for coMorm bacteria and volatile organic.compum ads
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
ko (Yes/No)
are triggered.A copy of the analysis must be attached to this form.)
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 convect the failure.
E. Large Systems:
To be considered a large system the system�nst se e.a facility with a design flow of 10,A00 gpd to 15,000
YYoou must indicate either"yes"or"no"to each following
(The following criteria apply to large sys addition to the criteria above)
Yes no ;
the system is within 400 of a surface drinking water supply
the system is within feet of a tnbutary to a surface drinking water supply
the system is I d in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone fI of a lic 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.
significrnt threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CM R
15.304.The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEwAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CRECILIST
Property Address: dl � is- V
PI
Owner.
DIP 30,3sa—
Date of inspection:! �
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 NIA)
Was the facility or dwelling inspected for signs of sewage back up?
_ Was the site inspected for signs of break out?
�+ Were all system components,excluding the SAS,located on site?
_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
_ Was the facility owner(and occupants if different from owner)provided with information on the proper
mainte_nance 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 CUR 15.302(3)(b))
II 5
f
Page b of I 1
OFFICIAL!NSPEC'TION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: / .3 1 AsJl o `er
crt i P
Owner: S�ySrc
Date of Inspection: ( ( Q '-
F1,OW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): _
DESIGN flow based on 3I0 CMR 15.203(for example: i 10 gpd x#of bedrooms):
Number of current residents: 0
Does residence have a garbage grinder(yes or no): Ala
Is laundry on a separate sewage system(yes or no): / f if yes separate inspection required].
Laundry system.inspected(yes or no). /UD
Seasonal use:(yes or no): RX - f�/
Water meter readings,if available(last 2 years usage(Gggpd)):
Sump pump(yes or no): /Il
Last date of occupancy:10S
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15203): ggpd
Basis of design flow(seats/persons/s c.j:
Grease trap present(yes or no):
industrial waste holding tank sent{yes or no):
Non-sanitary waste disc aed to the Title 5 system(yes or no):
Water meter readings ' available:
Last date of oc cy/use:
OTHER scribe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no): Ajo
If yes,volume pumped:!gallons—How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
_Single cesspool
Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/AIternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank Attach a copy of the DEP approval
_Other(describe):
App7!7 e�of allcompot ents,date m stalled(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):
6
page 7ofII
OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSWNIN T S
SURSURF ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 0t G �f df
Q.
Owner: �� 6u eev
Date of Inspection: 4 l 7� C14
BUILDING SEWER(locate on site plan) ,
t'
Depth below grade: a3�
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: 1( (locate on site plan)
Depth below grade:
Material of construction:-t concrete metal—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: /L900 5 OE i
Sludge depth: ,S tt
Distance from top of sludge to bottom of outlet tee or baffle: <.2
Scum thickness: eg 4. - it
Distance from top of scum to top of outlet tee or baffle: IS3 t,
Distance from bottom of scum to bottom�of outlet tee or e: `
How were dimensions determined: eGa6 u"bil
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,eta):
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction:__ concrete_metal fiberglass,polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to t/oftlete or baffle: .Distance from bottom of scum outlet tee A'affle.
Date of last pumping:
Comments(on pumping rec9dimendations,inlet and outlet tee or baffle condition.,structural integrity,liquid levels
as related to outlet invert, idence of leakage,etc.):
t
L .
Page 8 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: !tc 4 'PI-{
Owner: a
Date of inspection:
TIGHT or HOLDING'TANK: (tank must be at time of inspection)Oocate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain):
Dimensions:
Capacity: allons
Design Flow: allonsfday
Alarm present(yes or
Alarm level: Alarm in working order(yes or no):
Date of last pumps
Comments(cond oon of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: eVcUt
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage or out of box,etc.): r1
PUMP CHAMBER: (locate on site lan)
Pumps in working order(yes or
Alarms in working order{yes no):
Comments(note con diti f pump chamber,condition of pumps and appurtenances,etc):
8
I
f
Page 9 of i l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSUk FACj SE*AGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:— / 4 V 4
V
Owner: P y or��_,Q�-
Date of Inspection: / J_
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
leaching chambers,number.
leaching galleries,number.
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number.
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): . �
,` s ha-5a 6 re c �au vrwv-(W 61 gam .
Is �be. 'v ,e iAvcn c4,v& ic-,vY
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater' flow(yes or no):
Comments(note conditi of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on si/pI
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 I l
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 0 — � �'t,��
0,5i
Owner: �DQ g
Date of Inspection:—�2 QS�
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 ehters the building.
i
.Page 11 of 11
OFFICIAL, INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
tt
Property Address: 3� �t� 1,�, Dr t tJe
Owner: Ja)eSov.-,o:-
IDate of Inspection: a
SITE(EXAM
Slope ems.
Surface water No
Check cellar et%
Shallow wells V.)o
Estimated depth to ground water o0 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 higp ground water-ele tion:
Y
{
T.O.F. EL.= 40.4'± FINISH GRADE OVER D-BOX= 36.0'±
FINISH GRADE OVER CHAMBERS = 35.0' _ 36.3 GENERAL NOTES
f PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED
REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION
WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS
OUTLET TO WITHIN 6"OF F.G. ° 2"OF 1/8"TO 1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISH GRADE F.G. OVER TANK EL. = 4O.q± 5"DIA. OUTLETS) MIN SLOPE 1 /o BOX TO F.G. (SEE NOTE#21) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES.
@ FND. EL.= 39.8 ±
�- - --- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
PLACE RISERS ON ALL DESIGN ENGINEER.
PROPOSED 4" 9"MIN. TOP OF SAS= 33,33� CHAMBERS WITH
EXISTING 4" g6"MIN. 9�MIN. 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
SEWER PIPE �`�-j SCH.40 PVC 32.50 36 MAX. BREAKOUT EL= 33.00' INLET PIPES TO 6 OF SYSTEM UNLESS OTHERWISE NOTED.
SEWER PIPE � FINISHED GRADE
6" 3" 3" DROP MAX 3„ 9" L-_98'+ 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
2" DROP MIN MIN.s�O �� - PROVIDE WATERTIGHT o o ELEVATION =33.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
10" T4" PVC IN FROMJOINTS (TYP.) � 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
4" �*37.6'± PTIC TANK10 4" PVC OUT TO 0 0 O 0 0 0 0 0 0 O 0 0 o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
96
CONTRACTOR TO PROVIDE LEACHING FACILITY :1 Top 00 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
SPECIFIED DROP BETWEEN " oo
INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL , 12 6 po °° 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 32.90 MIN. 32.73 2 0 0 0 0 0 0 0 °° � 0 0 0 p� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE o 0 000 op FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o0 0 0 0 0 0 o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY COMPACTED BASE
AND DESIGN ENGINEER.
L
4.0' 8.5'(TYP) 4.0' 4.0' 4.0'
5 OUTLET DISTRIBUTION BOX 4.83 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 40.00'
TO BE INSTALLED ON A LEVEL STABLE 25.0' (NP') ESTABLISHED ON CORNER OF STEP AS SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET
PIPES TO BE LAID LEVEL. 30.50' GROUND WATER ELEV.= 25.00' 12.83
9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
EXISTING 1,000 GALLON CONCRETE SEPTIC TANK 2 - 500 GALLON CHAMBERS 5'MIN. CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS TO THE DESIGN ENGINEER.
CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT, NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
'00 \ (�j� PERC NO. 14288 APPROPRIATE AUTHORITY.
-• �� INSPECTOR: Donna Miorandi, RS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
EVALUATOR: Bradley Bertolo, EIT, CSE LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
THEY SHALL WITHSTAND H-20 LOADING.
� C.S.E.APPROVAL July uly 2003
--y
-�- �.c DATE: February uly 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
' S0 Ii r '.4 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
~
- MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
r �
`. ELEV TOP= 35.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
* ELEV WATER= 25.00'
• „ 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
PERC RATE _ < 2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
co O Q • r DEPTH OF PERC= 92"- 110" 16. PROPOSED PROJECT IS LOCATED WITHIN:
rn kv IL m ASSESSOR'S MAP 121 PARCEL 83
MAP 121 °' `n o TEXTURAL CLASS: 1
Co
BLOCK 15 J U.P.#1278/1 M </- ,r*, O LOCUS � OWNER OF RECORD: WILLIAM P. DeSOUSA
PARCEL 1 (1j J + :/ I "
a 35.00 TROY L. MAUK
MAP 121 r 0
/L � � �! ADDRESS: 153 TANGLEWOOD DRIVE
PARCEL 83 \ � 4- 1 Fill OSTERVILLE, MA 02655
15,597±S.F. T Cho ��� �� ( • Q
��, / '� ' * ! r '' t 48 31.00' FEMA FLOOD ZONE C
EXISTING 1,000 GALLON SEPTIC TANK \�'o I- ' • . ZONE 2 ='" • " Loamy Sand COMMUNITY PANEL# 250001 0015 C
72 29.00' 17. DEED REFERENCE: L.C.C. 182276
TO BE UTILIZED IN THIS DESIGN ���Pj / \�G�,�c� OG� ��� �! ,' `• �/! \� A/E „ 10Yr3/2
�t�,Q` / . • �c�� o * Loamy Sand
EXISTING LEACHING PIT TO BE ' �' B 10Yr 5/6 18. PLAN REFERENCE: L.C. PLAN 35801-B (SHEET 3 OF 4)
-�O � oi,-
PUMPED, FILLED WITH CLEAN 5 BIT. DRIVE \ " _rf j 92" 27.33
COARSE SAND &ABANDONED Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
`\� �` l " • . • • 110" 25.83' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
\/ ,� +• FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERJNG WILL NOT ASSUME ANY LIABILITY a '' ,' r 1 '�' ,' a FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
MottLn 1120"
Oz xi- ff 1 1 21. A 4" PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A
xw I kO �� Medium Sand DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A
P U "' Benchmark C REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
tp DECK I � C131,
Comer of Step " 2.5Y 6/3
vo / x / Elev. =40.00 LOCUS PLAN 132 Standing a�132" SI 24.00'
X-X- .A FLAGPOLE,
j0 O I • Approx. M.S.L. -
��
#153 CHERRY / SCALE: 1" = 1000' 142" 1 23.17'
40 EXISTING LSA
3-BEDROOM
BH I DWELLING GAS
TOF =40.4'+ DESIGN DATA TEST PIT 14DATA LEGEND
,� qs PERC NO. 88
oFc� STOOP/ / - - - 50x0' EXISTING SPOT GRADE
LSA 1 NUMBER OF BEDROOMS (DESIGN) 3 INSPECTOR: Donna Miorandi, RS 50 EXISTING CONTOUR
LSA / PR. D-BOX / c9� / ^ I EVALUATOR: Bradley Bertolo, EIT, CSE
i DESIGN FLOW 110 GAUDAY/BEDROOM
r�
TREE (TYP) = / � / cV CO ! C.S.E. APPROVAL DATE: July 2003 PROPOSED CONTOUR
16" �� �� TOTAL DESIGN FLOW 330 GAUDAY DATE: February 18, 2014
50 PROPOSED SPOT GRADE
1l'{a.:, �,._- O j \ DESIGN FLOW x 200 % = 660 GAUDAY TEST PIT#: 2
MAP 121 ` SWING-TIES SCALE: 1"=20' LSA EXISTING LANDSCAPED AREA
{• $„ 3'CHERRY cqs ' USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 35.00'
PARCEL 84 ' ' / O TP 1 \/ DESCRIPTION HC-1 HC-2 ELEV WATER- 25.00' GAS - EXISTING GAS LINE
35xOM ' CORNER OF STONE(1)/ 22.2' 46.7' ❑/H/W - EXISTING OVERHEAD UTILITIES PERC RATE _
\ 35xO-- i CORNER OF STONE(2) 31.9' 30.2'
� INSTALL 2 - 500 GALLON CHAMBERS DEPTH OF PERC = W W--- EXISTING WATER LINE
PROPOSED 2 - 500 GALLON LEACHING 1 �� CORNER OF STONE (3) 41.8' 42.1'
CHAMBERS WITH AGGREGATE cs? " �' TEXTURAL CLASS: 1 fk TEST PIT LOCATION
12.. u LSA
CORNER OF STONE (4) 35.0' 55.2' SIDEWALL CAPACITY
• (LENGTH + WIDTH) (2 SIDES) (2 HIGH) (0.74 GPD/S.F.) = GAUDAY
REMOVE ALL UNSUITABLE MATERIAL Q �� EXISTING 1,000 GALLON SEPTIC TANK
c�;. g �� (25.0 + 12.83')(2 ) (2' ) (0.74 GPD/S.F.) = 112.0 GAUDAY F7P
DOWN TO"C"SOIL& REPLACE w/CLEAN �lb 6p 0" 35.00'
COARSE SAND PER 310 CMR 255(3) GUYWIRE / �j DECK BOTTOM CAPACITY Fill OOQ J(1 PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
PROPOSED INSPECTION PORT ! �./ ��vvp��.PyO (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY
I #153 II (25.0 x 12.83) (0.74 GPD/S.F.) 237.4 GAUDAY �E Loam Sand PROPOSED DISTRIBUTION BOX
48" 31.00'
U.P.#1276/8/T �P y' C_1 72„ 10Yr 3/2 29 00' Q PROPOSED 500 GALLON LEACHING CHAMBER
EXISTING TOTALS: B Loamy Sand
10Yr 5/6
H BA 3-BEDROOM
I� DWELLING TOTAL NUMBER OF CHAMBERS 2 92" 27.33' REV. DATE BY APP'D. DESCRIPTION
TOF =40.4'± TOTAL LEACHING AREA 472.2 SQ.FT. PROPOSED SEPTIC SYSTEM UPGRADE
TOTAL LEACHING CAPACITY 349.4 GAL./DAY
occc'� STOOP PREPARED FOR:
120„ _Mott)nn @120"_, ,5 00, CAPEWIDE ENTERPRISES
/ (2
HC-2- 8 Medium Sand LOCATED AT
C 2.5Y 6/3 O 153 TANGLEWOOD DRIVE
Sanig a�132"
�i3) 132° t d-n - _ 24.00' OSTERVILLE, MA 02655
MISCELLANEOUS NOTES: O
SCALE: 1 INCH = 20 FT. DATE: FEBRUARY 21, 2014
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC �„�`'i 142" 23.17' 0 10 20 40 e0 FEET
SYSTEM COMPONENT. (4 _ _ _ _ _ O�a�p Or 1,1,q �n
_ PREPARED BY:
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED 9 JOHN L.
LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. RESERVED FOR BOARD OF HEALTH USE CHURCH ILL JR. JC ENGINEERING, INC.
REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH 0 INC 07 2854 CRANBERRY HIGHWAY
TEST PIT DATA.
F EAST WAREHAM, MA 02538
3.) ENTIRE PROPERTY IS LOCATED WITHIN THE WELLHEAD PROTECTION OVERLAY DISTRICT SITE PLAN 508.273.0377
AND THE ESTUARINE WATERSHED. -__ _
SCALE: 1"-20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.2668