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HomeMy WebLinkAbout0101 AUDREYS LANE - Health 101 Audreys Lane Marstons Mills 1 A = 028 080 r l COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS > d DEPARTMENT OF ENVIRONMENTAL PROSECT-IO- a RECEIVED M 5� DEC 0 3 2002 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 101 Audrey Lane Marston Mills Owner's Name: Bill Fenton Owner's Address: FAILED INSPECTION _ Date of Inspection:9/4/02 Name of Inspector: Timothy Lovell Company Name: Accurate Inspections Mailing Address:550 Willow Street MAP W.Yarmouth,MA. PARCEL _- Telephone Number.508-771-3700 LOT 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 x 'ls Inspector's Signa re: c Date: 9/4/02 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 system failed because of hydraulic failure,The leaching pit was full and no longer working. ****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. Page 2 of 11 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 101 Audrey's Lane Marstons Mills Owner:Bill Fenton Date of Inspection: 9/4/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _g_I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditional) Passes: y y _N/A 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. _N/A 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 infiltration 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: _N/A Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): Broken pipe(s)are replaced Obstruction is removed Distribution box is leveled or replaced ND explain: _N/A_The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system gill pass inspection if(with approval of the Board of Health): Broken pipe(s)are replaced Obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 101 Audrey's Lane Marston Mills Owner:Bill Fenton Date of Inspection: 9/4/02 C. Further Evaluation is Required by the Board of Health: _N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _N/A_Cesspool or privy is within 50 feet of surface water N/A 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: _n/a_ 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. _n/a The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _n/a_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _n/a_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: ' I Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 101 Audrey's Lane Marstons Mills Owner: Bill Fenton Date of Inspection: 9/4/02 System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections; Yes No _x_Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _x 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 day flow _x_Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _x_Any portion of the SAS,cesspool or privy is below high grounds water elevation. _x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _x_Any portion of a cesspool or privy is within a Zone 1 of a public well. _x_Any portion of a cesspool or privy is within 50 feet of a private water supply well. _x_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.] _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CUR 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: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ T The system is within 400 feet of a surface drinking water supply The system is within 200 feet of a tributary to a surface drinking water supply T The system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: P Owner: Date of Inspection: I Check if the following have been done.You must indicate`des"or"no"as to each of the following: Yes No _x _Pumping information was provided by the owner,occupant,or Board of Health x Were any of the system components pumped out in the previous two weeks? _x_ _Has the system received normal flows in the previous two-week period? x_Have large volumes of water been introduced to the system recently or as part of this inspection? _x _Were as built plans of the system obtained and examined?(If th y were not available note as N/A) _x_ _Was the facility or dwelling inspected for signs of sewage back up? _x_ _Was the site inspected for signs of break out? _x _Were all system components,excluding the SAS,located on site? _x_ _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? _ _x_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 _x _Existing information.For example,a plan at the Board of Health. x _Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CNM 15.302(3)(b)] i I Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property YAddress: 101 Audre 's Lane Marstons Mills Owner.Bill Fenton Date of Inspection: 9/4/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_3_Number of bedrooms(actual):_3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_330 Number of current residents:_2 Does residence have a garbage grinder(yes or no):_no_ Is laundry on a separate sewage system(yes or no):_no_ [if yes separate inspection required] Laundry system inspected(yes or no):_n/a_ Seasonal use: (yes or no):_no_ Water meter readings,if available(last 2 years usage(gpd):_Well Water Sump pump(yes or no):_no_ Last date of occupancy:_Current COMMERCIAIANDUSTRIAL n/a Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):_no_ If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _x Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 9/10/79 Were sewage odors detected when arriving at the site(yes or no):_no_ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 101 Audrey's Lane Marston Mills Owner:Bill Fenton Date of Inspection: 9/4/02 BUILDING SEWER(locate on site plan) Depth below grade: 1-1/2 ` Materials of construction:_cast iron _x_40 PVC—other(explain): Distance from private water supply well or suction line:_75' Comments(on condition of joints,venting,evidence of leakage,etc.): No evidence of leakage,joints look tight,venting is proper SEPTIC TANK: x (locate on site plan) Depth below grade:_10" Material of construction:_x— — 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: 1000 Gallon Tank Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle:—32" Scum thickness:_3" Distance from top of scum to top of outlet tee or baffle:_8" Distance from bottom of scum to bottom of outlet tee or baffle:_ How were dimensions determined: in the field tape measurements_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): No evidence of leakage liquid level is at invert out,tees are in place,structurally sound, GREASE TRAP:_n/a (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 top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 101 Audrey's Lane Marstons Mills Owner: Bill Fenton Date of Inspection: 9/4/02 TIGHT or HOLDING TANK:_a/a_(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_g (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): There is evidence of solid carry over no evidence of leakage, PUMP CHAMBER:_n/a (locate on site plan) Pumps in working-order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 101 Audrey's Lane Marston Mills Owner:Bill Fenton Date of Inspection: 9/4/02 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _x_Leaching pits,number:_I_ 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.): Evidence of hydraulic failure leaching pit is full and there is evidence of overflow,vegetation is very lush and heavy soil was damp dig out the cover. CESSPOOLS: z (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 inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_n/a (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 101 Audrey's Lane Marstons Mills Owner: Bill Fenton Date of Inspection: 9/4/02 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. Well 1 Back of Home Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 101 Audrey's Lane Marston Mills Owner:Bill Fenton Date of Inspection: 9/4/02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_20 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) _x Accessed USGS database-explain: Plate 2 You must describe how you established the high ground water elevation: Information provided by Cape Cod Commission Plate 2 well#Al W-230 shows water level is at 25.3 ft adjust to 20.1 ft TOWN OF BARNSTABLE � LOCATION 0/ UD kE Z_S ,Lei-V 1Z SEWAGE # aQZ Vl, ,LAGE, JrS oil/ )! ASSESSOR'S MAP & LOT" — INSTALLER'S NAME&PHONE NO.U�Z"-19,/ SEPTIC TANK CAPACITY fib LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER �.nLIT�C ice, PERMITDATE: COMPLIANCE DATE: tj—la o� 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 .Z 1 f /�` 73~ g® N-.2poz- 33 FEE 50 ,00 Board of Health, 3o c r s�a)Ae. , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) - ❑Complete System I(Individual Components Location �O\ VC��L �� Owner's Name aeor Vq-Acm Map/Parcel# Address %O ,--Y3- c Lo, Lot# A Telephone# SO8 1-4Z (® ig Installer's Name — Designer's Name Address 5' ® OV 49 Address 4Z,�, Telephone# $p Q _ 77/_ 4 Telephone# -5-08 HZ8 l S Type of Building Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinder( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) gpd Calculated design flow 44A40 Design flow provided 44ZAI Z(o gpd Plan: Date +VOOJ (¢e Z.00-L Number of sheets \ Revision Date Title Lor Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator \c Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS V-oCC 4Z�Xa5X\`c1C1 \0Cx-, g �-3n c L\snox N OF M i �o J E N R �LP n . The undersigned agrees to install the above described Individual Sewage Disposal System in accordance o I and further agrees to not to place the Sys in operation until a Certificate of Compliance has been issued e Signed a' Date e o /STS s'q ITAR\PN Inspections a« 3 .. i + a ;.:, FEE ®�d�// COMMONWEALTH.Of MASSACHUSEVS t Board of Health,4. 71a)o e rzA C&\C MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT � Application for a Permit to Construct( ) Repair( ) UpgradeX Abandon( ) - ❑Complete System KIndividual Components Location �� Vdt.� �� La Owner's Name (1ZOr �2\ Map/Parcel# o-ca _ Address `O �e-ej S L Lot# Lit) Telephone# Sob NJ 4-j(.V19 Installer's Name Designer's Name �'•'��� Address 5�,/1 r 1 — Address Telephone# 50 g _ 77/_ 4 V 0 Telephone# $pg HZB Is'17 Type of Building ' gals_ '; 'o- %\AEI Lot Size sq.ft.. Dwelling-No.of Bedrooms 14 Garbage grinder ( ) Other-Type of Building /,J/ No.of persons Showers ( ),Cafeteria,.()" Other Fixtures •ff Design Flow (min.required) gpd Calculated design flow 44440 Design flow provided Z(o gpd Plan: Date MO\,l (Q a7_0O7_ Number of sheets 1 Revision Date Title o, a '5;� Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation ZCO Z DESCRIPTION OF REPAIRS OR ALTERATIONS V Q Q yh 1 bOf�s co ya r\C� c, 3 ' IQ L X \\'vS X -X!N_�. �I The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with th .ro '§ions of T and further agrees to t to place the t^m in operation until a Certificate of Compliance has been issued by th o of e Signed Date r Inspections oZCK�-533 O° No. C®�'1[�9[ONWEALT14O MASSAC14US�ETTS FEE 50, Board of Health, nr, . Q MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed.( ),Repaired ( ),Upgraded ( /Abandoned ( ) by: �� �� nLa�o.r ?L,A at i has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) r^ Installer , Designer: ���� �, Inspector: �:v �. i��• Date: The issuance of this permit shall not be construed as a guarantee hat the system will function as designed. No.01OC —53 � � l� � FEE SO: 00 COMMONWKAFTII OF M SSAC14USETTS Board of Health, At�Ar,!A&6V11 MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade(s�Abandon( ) an individual sewage disposal system at 10 1 � 9"n , as described in the application for U Disposal System Construction Permit No. -53 , dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. ,,^� Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date ( ���c dd- Board of Health • IC t TOWN OF BARNSTABLE c LOCATION SEWAGE # Oc22 VILLAGE��' �� ASSESSOR'S MAP & LOT" QZ— INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L, (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: , _ COMPLIANCE DATE: Separation Distance Between the Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet. Private Water Supply Well and Leaching Facility on site or within 200 feet of leaching facility) ((If any Wells exist t Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) I Furnished by Feet � g i. ©' v 1 2� 13I - 2� 5-- - - 93 A 517 13-5 - 115' °�Tr,E► . Town of Barnstable P# ti Department of Regulatory Services a►aNareULK Date MASSh Division s � 200 Main Street,Hyannis MA 02601 I • 0 U:de Fee Pd. l o t . ' e Date Scheduled 2 Tt n U Suitability Assessment or Sewage Disposal Soil Sut y f _ Witnessed By: Performed By: Uer 'I 't It.� h � Location Address /D� A,`l� I Owner's Name .) S Address AA.IIA Assessor's Map/Parcel: v z g 0 V Engineer's Name �t+c�Re, NEW CONSTRUCTION REPAIR Telephone# 5-08 y ZQj� t S lZ (P Land Use %) es Slo i Surface Stones '" � Distances from: Open Water Body tit ft Drinking Water Well WA P ft Otherft Drainage Way ,1.t/A ft Property Line I O t SKETCH:(Street name,dimensions of Blot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) j + , f Q 1 N �C) 4 i JIS- I Parent material(geologic) xss Depth to Bedrock /J,A Depth to Groundwater: Standing Water in Hole ,V1,4 Weeping from Pit Face A11A - Estimated Seasonal High Groundwater I4L-I paw•I"•I aN Ib6, !1 �. i S f n R, y u ';b l axT'A�WdBHI�OiKd'9f°�l�'quavc� ' k6"ati ��OYti� Method Used: in. Depth Observed standing in obs.hole: in. Depth to soil mottles: NlR Depth to weeping from side of obs.hole: - in. Groundwater Adjustment ,444 ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level + v r• t ' tps•: Ullijiffil Win V.11. R '': •�' fi i Observation Time at 9" Hole# --�--- Time at 6" Depth of Pere i -Start Pre-soak Time Time(9"-6) End Pre-soak H Rate MinAnch Ccnm hC 41 Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(YM) Original: Public Health Division i Observation Hole Data To Be Completed on Back--------- ff Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders. Consistenev.%Gravel -Z.9-S4 C. So, Z•s`� s M4.c)IIjrA IC. Rs� oL teOZ J'-1-1L14 C Sc,� NG\.0E 4 !:: IN Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders. Consistency,%Grave tt' a�"fptk +'° �" r'•', a, A C' (!1 !�. '! Q .pe!t� _ ..FF tAl anStilMFef@fiiFi. Y'J' .. 9.: . . :. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) 6''yyryryyy��� 'NHy I! !!^e iy�, �!�'�'..il' t�„4.1� �I!��.In�IY� YI'u,lSi n .�•Fe_..T 1.�F ...- : 1 Y , Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders. Consistent %Gravel Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring 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? If not,what is the depth of naturally occurring pervious aterial7 N Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protecti n and that the above analysis was performed by me consistent with the required training,expert an xperience describ 310 CMR 15.017. Date Signature LlMassachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1 Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 5.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.417. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address forms on the computer,use N/A only the tab key Name to move your 101 Audreys Lane cursor-do not use the return Street Address key. Marstons Mills Massachusetts 02648 City State Zip Code 2: Owner Name and Address: Af (( � Felton, George P& Helen B 101 Audreys Lane I t Name Street Address Marstons Mills Massachusetts City State 02648 508-428-4619 Zip Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Four-bedroom single family dwelling 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): Existing 1000 gallon tank, d-box, and one leaching pit 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): One leaching pit t5form9aaudry's-rev.5/02 Application for Local Upgrade Approvals Page 1 of 4 I Massachusetts Department of Environmental Protection L7Bureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440 gpd Design flow of proposed upgraded system 440 gpd Design flow of facility 440 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ❑ Voluntary ❑ Required by order, letter, etc. (attach copy) ® Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Use existing 1000 gallon septic tank, add d-box and 5 concrete leaching chambers with stone. 3. Local Upgrade Approval is requested for: ® Reduction in setback(s)—describe reductions: Setback from drinking water well. (This is a local regulation)Setback to be 126'vs. the required 150'. ❑ Percolation rate for 30 to 60 min./inch: min./inch ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft. Percolation rate min./inch Depth to groundwater ft ❑ Relocation of water supply well (explain): t5form9aaudry's•rev.5/02 Application for Local Upgrade pp pg Approval*Page 2 of 4 Massachusetts Department of Environmental Protection �' Bureau of Resource Protection —Wastewater Management Program 1 Form 9A - Application for Local Upgrade Approval pP P9 PP Required by 310 CMR 15.403(1) ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: N/A If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: Unable to meet 150' setback to drinking water well under Town of Barnstable's local regulations. Well[will be 126'from the proposed soil absorption system. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: N/A 3. A shared system is not feasible: N/A 4. Connection to a public sewer is not feasible: N/A t5form9aaudry's•rev.5/02 Application for Local Upgrade Approval•Page 3 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified'i pursuant to 310 CMR 15.405(2). ® Other(List): As-built of 87 Audreys Lane showing drinking well is located >150'from proposed leaching facility. D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." I Facility Owner's Signature Date Print Name I Jennifer M. Dalrymple, R.S. November 7, 2002 Name of Preparer Date 438 Cap'n Lijah Road Centerville Preparers address City/Town Massachusetts, 02632 508-428-1512 State/ZIP Telephone NOTE: 310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Division of Watershed Management, upon issuance by the local approving authority and before commencement of construction. ,I it i t5form9aaudys-rev.5/02 Application for Local Upgrade Approval*Page 4 of 4 i Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 913 -Local Upgrade Approval Issued Pursuant to 310 CMR 15.404 and 15.405 B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater. Separation reduction ft. Percolation rate min./inch Depth to groundwater ft ❑ Relocation of water supply well (explain): List local variances granted not requiring DEP approval per 310 CMR 15.412(4): Setback to private drinking water well. The drinking water well is to be located 126'from the proposed leaching facility vs. the required 150'. List variances granted requiring DEP approval: N/A Approved by the Barnstable Board of Health: Print or Type Name and Title Signature Date t5form9bavdreys•rev.5/02 Local Upgrade Approval*Page 2 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 913 -Local Upgrade Approval Issued Pursuant to 310 CMR 15.404 and 15.405 This form is to be completed by the local Board of Health and a signed copy provided to the system owner. The system owner shall provide a copy of this local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Division of ' Watershed Management, upon issuance by the local approving authority and before commencement of Ll construction. A. Facility Information Important: When filling out 1. Facility Name and Address forms on the computer,use N/A only the tab key Name to move your 101 Audreys Lane cursor-do not use the return Street Address key. Marstons Mills Massachusetts 02648 City State Zip Code 2. Owner Name and Address: Felton, George P& Helen B 101 Audreys Lane Name Street Address Marstons Mills Massachusetts City State 02648 508428-4619 Zip Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Jennifer M. Dalrymple ❑ PE ® RS Name 438 Cap'n Lijah Road Centerville Massachusetts Address Cityrrown State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ® Reduction in setback(s)—specify: Reduction to local regulation which requires 150'setback from private drinking water wells. The drinking water well will be located 126'from the proposed leaching facility. (this is a local regulation) ❑ Percolation rate for 30 to 60 min./inch: min./inch ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction t5form9baudreys•rev.5/02 Local Upgrade Approval*Page 1 of 2 LO ,� A- T q N �O I S W A G E PERMIT NO. o b VILLAGE INSTA l ER'Sl NAME & ADDRESS �� B U I'L D E R OR OWNER DATE PERMIT ISSUED . DAT E COMPLIANCE ISSUED �� `o—t� !. tb�'� .M ry2'�. n ��9 `R` ��' '� ,2 y . . � . v ,'; .�. °` �.�,, . 1 ' �;� (� . -, No..q:y-...... Fim_- iS..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ... ....... --._.--------OF............... ledrYl Apphration -fur Bhipuiittl Workii Tomitrurtiutt Vert tit Application is hereby made for a Permit to Construct (M or Repair ( ) an Individual Sewage Disposal System at: V Q F Location- ddr� Leo o. or Lot No. G l ��v� ••-••-- . . . .. 0....... r_..... Owner Address . .. ...� S T, � Installer Address Q- Type of Buildin Size ---Sq. feet U VDwelling 2No. of Bedrooms------------ --------------------------Expansion Attic ( ) Garbage Grinder (/�O Other—Type of Building ..... No. of persons---------------------------- Showers — Cafeteria Other fixtures . - --------------------------------- W Design Flow............ . ........`..........gallons per person per day. Total daily flow.._.._.......0__0------------------gallons. Septic "Tank—Liquid capacityLQodgallons Length________________ Width............._.. Diameter__.__....-....__ Depth.--..-..--.----- xDisposal Trench—No. .................... Width.................... Total Length............._`... Total leaching area....................sq. ft. Seepage Pit No-------/........... Diameter......... Depth below inl t---... `__ _ Total IAe ing area__-_.-3--�__sq. ft. Z Other Distribution box (� ) Dosin tank ( ) a, V' � 'G ��""' Percolation Test Results Performed by. GW/(/--4RI=____._�f��///2V_? ADate........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..-----_-.--.-..--..---- rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ ------------------ ------------------------------------•------•••-------•----•------..._...-----...................................................... 0 Description of Soil---------------------------------------------------------------- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig ed...... -- ---- �f 7 7 Date Application Approved By........ �s lL�lyd.l !_•... .. r_ - ------------- Application Disapproved for the following reasons:............................................................................... ............Date ....-----•--- ---------•-------.--•----•------------------------------------•-------------•---------------------------•-----•-------------------------------------------------------------------- -------------------- Date PermitNo......................................................... Issued........................................................ Date .......0­0.0.000.00­.....-•.000 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ..........OF.......... a. 5.....................---................ Tertifirate of "WIT",ampliattre THIS 6 E FY, Th t the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ------------ staller has been installed in accordance with the provisions of le XI of The State Sanitary Code as described in the application for Disposal Work s Construction Permit N .:.._.. _z__ ---------------------- dated.... :_._ac .'.7..._;7................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector.................................................................................... THE COMMONWEALTH oF MASSACHUSETTS BOARD uxx . T�-- ^^ � =� ----']� ----'.. ------------'--- Appliration fo Uhip« iia Vorks TotwArurtion Vantil Application is hereby made for,a Permit to ( D�» or � , ' ) an Individual 6o~uge Disposal System at: Ys 4-4..414c---------- ......... �P.�Jn -ow . _. ]�4� Address Me Installer Address w Other 9 Septic Tank-Liquid capacityJAWd � Other Distribution box (�) Dosing tank � Icst Pit No. ] --minut6s perinch Denm`uf, Test Bt. ` Depth tn�ro ud water 0 � ~~ ``` / �' ' Ueacr�t�oofSo�.''---�'----- ` --_-_ ........................' �_' 'i /' --'`r--'---' ` --� --.` --_� � .�!. -�_ ~ � --_-'--' --.-'--'' -----' � � �� Nature of, xep�rs.nr'z�/�rr�uoos--Apswer, when upp�am�'-._-'-_^.----'--._--._----------'_- ` The undersigned agrees to install the. aforedescribed Individual Sewage Disposal System in accordance.with the provisions of Article XI of the Stat'q, Sanitary Code--The;qn.'dersigned further agrees not to place the system in ' operation until a Certificate of 7 Date Application Approved Dv-- - Date ` Application Disapproved for the /o�onoin7reasons:ji_-..���_---_-_.'�--_----.-�-------'_.----- | .............................................. ..................................................................................................---'---'�,--'----_'---' | um° | Permit No.................. ' ' 1auu�d__-------_��-�_____' | "w ' o"te . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH THIS 'EA�O�FY Th" 'the—Individual Sewage Disposal System constructed or Repaired has e6n installed ` , `- . ` . ` of"' I r, ------ - - -------- at.--'- ------?9�----a� State Sanitary Code as described in the ' provisions ~0��' applicition for Disposal Works Construction PermitTHE ISSUANCE OF THIS CERTIFICATE S' "U"NOt BE CONSTRUED AS A GUARANTEE THAT THE ƒ . 1 SYSTEM. | . ~^^^ .-'___-_---.---_................................. Inspector..................................................................................... � � . '~- THE ussr�s _.- - -�_-_ ` | H by [>F~ /�5 °�°~ _ -_.'__-- F M Al N f ' i a z. ti l � o o , x { t �. 0 A14 ol +: �J ` 0� 992 Y-' • - tai F z LOCA0TAOA.1� ;'z ` Elf,^. ; ,/ n n _.... 'fr�,f=��_� ,�;i C7(,?J4'.`' r '�."=' 1:� M'•'''/.C!.�•C)%`.<'e','7r.! t,,,, 1;.;� ;ie! �i d •rj, t !i _ AV900043Y C94,BT/FY TNRiT T'NEf 49UIi-,DIVA ` SAOCWA./ OM TiVIS vL,Q" iS 4OCo97"EO Opt/ Ti✓E DOES �;ONROGJNI 7'40 7I SO.V/Jt/G BYEL�glN6 Of� rwe Tow" OF "�,E`.,t/u7. ARFNE f N/A./OA✓ CO,V9TQC/CT�a. OJAL.A s "An CO)DO a 7►jq&7CCI'A174? � 9fCIST civet e,vG�Jva►��s /' �aD S RA:'� L,Qrva aveVgproera E30G/TE+ 4ZOQ -YP9'MOLol7-", "A755. =197-t= ASSESSOR'S MAP NO. 2- PARCEL L LOCATION SEWAGE PERMIT NO. i,o- L/)— A u D L—A P 30(-/ VI L L A G E -- - �nST ,07J �/�� I N S T A L L Ejt4 NAME i ADDRESS wY� co & aC�1 1111 UILDER OR OWNER ,2+ nl, DATE PERMIT I SA U E D DATE COMPLIANCE ISSUED 2_S y A Lu C� U ! �Got c) NGT A6 •� '- Ct// /oGcztiof'iS Showr-� A.rG a..; \ proPoS�d ors/y \ / u,i � 0 V 25�/3 �� \ C of 38� � w NO vel \ � quo y �; . ` Z F LoT 39, \ eon © c / 5 0(fl�iLl 17, oI i r. yo v r- v.q 7-� � 7-& s T-- s f , FLOW GAS IcSA./ r,. %it/✓E•,oE'.T EL. E- 1/�9TiONS � c 410/ 77 Su�oGrvised bc�.• c./OHAJ eELLEY� ASSESSORS MAP : Oz�-" X-C)-' O�bo TEST HOLE LOGS NOTES: 4U 7 PARCEL: 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD ZONE: 1j/A SOIL EVALUATOR : �, a�r.l.., �� THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF Tom,. :.•�ads. BOARD OF HEALTH REGULATIONS. a � �e WITNESS : c7f� r' 6 REFERENCE: -Et44tt, oV "c,� DATE: �o-��-zcx�z_ 2 ) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, r prcyv-tb by T".'tt' PERCOLATION RATE: L Zm�1h SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO f rnuj i,i913. on}�+• 0A 6o�t� �+ « •) INSTALLATION. TH- 1 TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION Ate# �oq� ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE ! DETERMINATION. �o ndy l cur> 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS SPECIFIED OTHERWISE) 5/'-ALOCATION MAP 1� z�sy y,� �& Zq 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A G+ Coo._,_ roar ¢v 5/ a GARBAGE DISPOSAL. Z,r . /Go � 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) C-L MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON �u rti�l A BASE OF 6"OF CRUSHED STONE. e-AMM,94* t.E.P<-.k-9%-V s%Nik" �m4Ero A+V'U T% .Ev �.iCa.v�� CLEAN JwN� Si3 AK'.+C.oR"R;>Rr,3C.i:. W'<TH '4aY�GMR 15.256(,i,. S?� THE 4'��C. TRNr. 1b To SSE PvrKQGl7 AIJD AFL Sot ti7`m REwtid3ED. "J GovER.�o Azc 'co $6 wvT14W \' or-4RA6OE.Avev r w tS-"Fvt_6 'Rz SEPTIC SYSTEM DESIGN + 137.487 - •.' -'�'pu>N. S�-"t S 't'ktfe'��•`�Rb�-1�v'tb�c.Ct� tsf"r'Cl��' �n1'.'a'C1i1_1Z'CO GW FLOW ESTIMATE I14 BEDROOMS AT Ilo GAL/DAY/BEDROOM tiro GAL/DAY *Locate AuOA 3 -K%tkC- d��w�iNa�'YTti-°-s� Ex�Sz�NCa�'sR.�N��I�1t, wRTr✓R. w6u."'C0"�� `"ue I SEPTIC TANK t � ._ 'F�toM"CHE�'��.£.� S•AS. �lS, 'CN'�'CZ�Q.a��EC7 L-lqo GAL/DAY x 2 DAYS SSA GAL f 1 USE Imo GALLON SEPT I C TANK Ex��'Ctnrta SOIL ABSORPTION SYSTEM / ,/ S ContCCZE"CE L '< CA -A% x 3'1 SIDE AREA: z( �-�+�ti'�z _ �gz x .1y - i4-L,o% GAD BOTTOM AREA: xj� &1o7 x -ILA 0) co ' SEPTIC SYSTEM SECTION ,y- / 0 (J) so.00R� Mt:� 0�055--e�- CTIONJAL PETAL- To c-kAl I , 5c., i°7 Rss�rnEt] .._.._____ TWO sNsPEc.�eo*t curs Q�ER�t,w~ZS wmtCnt. oFC,szwoE _�-4.... r— _� kN---L- 1 SE 11/01 4 7.4? GAS^ _DVS+\l "kia6Mt D 6tvt1E 41,Ue D-BOX �- CT E ECItdR �.__.__.i i 000 GAL '13A0 oNCK S '"� yb. :•e �1S.Oto v i 45Z3 tl~-- • �yZ 4�OCs1DdlE: w�, - •. . I Yl q� 8, %7` -- ;;.� G�,s t�,�c� SEPTIC TANK HRt ''P.S hVC-'KECA'4 T Lo'x 3.0k&.oO LC-+b og EQosL �- .r_.���..i � •�' rE i G7 C! = t� ` i 1 JENNNIFER ran al "C��3. 55.y �__._ L = ' e 113 LE ,.o+ SITE AND SEWAGE PLAN :J7 (r7 j ('1 �1,�8T ,110t l THII U 1'1�ECA'�,T Corr U\F- 7E CH LOCAT ION : - too Av �;>✓� L Ili / A UL)Hi- � � ��S L..17,.'s � YYl 14 --- L A I II HffZE5`t CE9 TIDY T --IAT' THEIKC- AXE NO WP:LL �, PREPARED FOR : G rHE -T�-{.AN -THOSE �t-IJVJ?�I, KNOWN OR REFO?\*TEU TO ME WITHIN 160 FC-E T OF P'K0p0'5ElD 4�)Y�5 . SCALE: JENNIFER M. DALRYMPLE, R.S. 0 438 CAP'N LIJAH ROAD DATE: 11 -6-Zoo Z CENTERVILLE, MA 02632 W DATE HEALTH AGENT 508-428-1512 >R _ Z ASSESSORS MAP : OZ� Lc)-' 08� � Z' TEST HOLE LOGS NOTES: PARCEL:, 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH LAN, 1995 MASSACHUSETTS TITLE V & TOWN OF 3�' ! FLOOD ZONE• �/rlhl SOIL EVALUATOR : �. ,G�ry..," t� THIS P BOARD OF HEALTH REGULATIONS. sack�a o� WITNESS: REFERENCE: Wt�.K.LY�� EakokGS Sabd\�,�o�a�n �� L.a�� DATE: , l o'»-z '-I- 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, -pr,-vNmta by To""c5 �uh?tzts ck�k¢� PERCOLATION RATE L �, ., 1 SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO N ay I t►913. on 4 tts. cx4 �a�t�4s�c.btiR- �• � INSTALLATION. 1 f oG t,� -'1or,�,� v)-z -� °t2 TH- .�` o W-►,�( TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION A ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE DETERMINATION. Ir 4) ALL PIPING TO BE 4" SCHEDULE 40 nn 1/8 "! FOOT. (UNLESS V SPECIFIED OTHERWISE) LOCATION MAP � Zq _ zsy 5/w �,y,�s Coor .S 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE DISPOSAL. L4 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) C-L MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON rM1 r td-- A BASE OF 6"OF CRUSHED STONE. IUVR-5r3 ,,�y __..__..._.____-._ _._ --- ��.�' •'-t '� TF1C EXIg'C\lata LE.PK.14'P\T 6HALt.. 'B� '4um4Et7 AN'o Ftct.Eti w�•t,� Ct,EA�.►�N� �N tt.C.t.oR.'t>Asc.�- W'+lLt1 3tQ cr.nR t5,25s(;��. N�vsE �j 'tt4b �4n'�C. 'T'RN+" ,b To'F3�."�3tvc?GO P.1•.TG Hu..SaL.�'Cy`s`k�woca6D. GuvE'K.tu A¢,rm•Cc9 $6 wtYµ�f.1 �' of CsQAo�•Q'� GR�'$�*ff,,.6 'R� SEPT I C SYSTEM DES I GN 9� "8oAR0 of ttFMi�TN SNCP�cTtO�.�•"�a'4�. !M�PCC& AS Q.Es�sJ�iGEd 'icy -To.,w. S4-'rg 'C1i�'Q&.SPb�a6oRS�Ltty oPr'Yt't ��15CN.� TO Gwc--, ! •�._........ �oJ ' Nerc t<\t..Pk'C 1,0� '�xtJ:�'l.C,.''C\4.�'�"ia 1 FLOW ESTIMATE l �- F4 BEDROOMS AT I I o GAL/DAY/BEDROOM - ti4o GAL/DAY - 1_ocA� �taR�aNcE - caU��E -cc, PkwoswO 'C+ I Aix LoGgtiol{ - n� s t-�s-r Ex�St�NU zsR�NK\rJG wPTi�R W6L .Ta' ,E �Zlo' I t5E s�kit'e�t 7 SEPTIC TANK.-., � - •-�`` '��L.onti TKE '�+a�E.T3 S.RS. �lS. Tt�E'R�Q���� tyo'jAL/DAY `x 2 DAYS - SS3y GAL / USE 1coo GALLON SEPTIC TANK SXMT�Nc, SOIL 'ABSORPTION SYSTEM t `I1 t �\Nccwmmr eyn, . T S I DE AREA: ' m _ t9z_ x i4-t 0% Goa ' ' ' ' BOTTOM AREA: si x1k Lin x -iLk c-AWD C� ` ► � �' SEPTIC S YSTEM SECTION I r)g.cc so.ot�As "aEp � o -fir CTIONI .L PETAL �- NO T TO 'Z_;�L .5F-E=1A�3&ts*s / 54,t7 AtsSVrRE j Ls C D-BOX �caEsEC ' yb ; T --�---- ., (000 _ I GAL c �t5,'L3 ;.-= , '•.1 vt"a1��Er��rc�E:..._... .•� ;'•' � ,.•. ysv8' I IIiI I 38, 'I7' — .-_ �, *-wic, SEPTIC TANK Kt; hFC-'KECAS r La'x 3•0')c b.o`LC-b OK E.O%jr.t- ` 'Da�n►�,t 4� I 1 3 a -- rsaisR u J vi i j N ofM 1 '1 115s' ...-.__. O�S� A`SS�,y tm tz 1=G7 CJ C2 -,-� N c W S. `t40MOX j o� E NNIFE , toy n rya t __,_, Z� Z b5.�{ \ L ra i t i I `` P N 25 i L. - gO .4 I - ---- f � � SITE AND SEWAGE PLAN NrfinW� 00 5E*C_ 'tOQ THKU PRECAST Cc>�,JC.�E TE CH l�M�EQ`� LOCATION --1o\ A UL)HIC, _ . , A (� Maw STo r.5 nos�t,.�s rn,� HEKIE5 t CER TtFY THAT THERE AXE NO WP:LL 5, PREPARED FOR : THER -THAN JHO'::�C ' t) TOWN, KNOWN OR FE?0?.TED TO 0 ME W►THIN 150 FCE T OF TI- I5 F OPOSE0 '�)YS TEM. JENNIFER M. DALRYMPLE, R.S. SCALE: �'' = z6 W ' _ 438 CAP'N LIJAH ROAD DATE: 11 -t_zooZ W CENTERVILLE, MA 02632 Z DATE HEALTH AGENT 508-428-1512