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0016 FOXGLOVE ROAD - Health
16 Fo .UQ #Marsto;N ills ,,-A—� 149 fi 130,�031; - *�"` .a3 d `i"'.s g{ :Jc- § :y kid., e . r ►i t . Town of Barnstable Barnstable �pF THE Tp� f MWinnticaM Regulatory Services Department 111111 v MASS i634. Public Health Division . �i°�Far +A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012 1010 0000 2847 8513 March 3, 2017 JAMES A HELGERSON 16 FOXGLOVE ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 16 Fox Glove Road,Marstons Mills,MA was inspected on 02/24/2017 by Matthew Gilfoy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH `-- Tho-- cKean, R.S., CHO A of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\16 Foxglove Road Marstons Mills.doc. I • �T�ram, md Town of Barnstable iwRxsr.►si.e, 6 ,�$ Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA•02601 Office:.508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007. Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge:or ponding of effluent to the surface of the ground w F. ❑ Pumping more than 4 times during the last year not due to clogged or obstructed Pipe ❑Backup of sewage intothe house due to an overloaded or clogged SAS or cesspool O 1 YEAR DEADLINE CRITERIA Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 16 Fox Glove Road �M Property Address James Helgerson CA V Owner Owner's Name -J information is ,A, �,,,�,���Qs required for every � ��/jY�s D/�(� Ma 02632 2-24-17 page. City/Town State Zip Code Date of Inspection a-� CA Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. fm :When fillingng out A. General Information out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. Excavation Company � Company Name 374 Route 130 Company Address Sandwich Ma 02563 Citylrown State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification 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 ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 2-24-17 Inspector's Signature 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. ****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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ��0&w1/s Commonwealth of Massachusetts v Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'GSM 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed . ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 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 fecal coliform bacteria indicates absent 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: 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. E] ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. CityTTown State Zip Code Date of Inspection C. Checklist 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? ®NA ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, 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 maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 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): 425gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2016-49,000gallons 2015- 57,0009allons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- last pumped 6 months Was system pumped as part of the inspection? ❑ Yes ® No 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/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Fox Glove Road M Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1978/plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 6 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1'6" . Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000gallons Sludge depth: 4 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NAfeet 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: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): ,I Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): D-box was in working order but liquid level in D-box was high due to failed SAS. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located., explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (1) 6'x6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: I ❑ 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.): Leaching was in hydraulic failure at time of inspection and will need to be replaced. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 ❑ No l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Fox Glove Road Property Address I James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately FRONT GARAGE A1-31' 1-2T6". - ' " -271, 3 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW 13' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Feb-1978 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 16 Fox Glove Road Property Address James Helgerson Owner Owner's Name information is required for every Centerville Ma 02632 2-24-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION It, G SEWAGE# 1 2 VILLAGE. C ASSESSOR'S MAP&PARCEL ►y9- 130.31 INSTALLER'S NAME&PHONE NO. S3 EXQQ V0,A;oA 4` -I. 0&.53 SEPTIC TANK CAPACITY /o00 90.1 LEACHING FACILITY.(type) 500!gm) Wc- (2� (size) 13x2S X 7- NO.OF BEDROOMS 23 OWNER cr o PERMIT DATE: fnctrc_k 2 o 1`1 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 Al- 30fq" 81 AZ- 30' 1Gt' A.3a Ay• 3q ' 3 _ 0 0 No. © / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLAtion for Dispo�at * �/ Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I rp fo X 41,PVt En wner's Name,Address,and Tel.No. Assessor's Map/Parcel _'M I�q Lot 1�o,3( J_Grne5 6 (C en ,5'Qg-3(, _ 9V In taller's Na ,Address,and Tel.No. Designer's Name,Address,and Tel.No. ��� ��CGcNt�:fra �- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Ye 5 t 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) \330 gpd Design flow provided gpd Plan Date Number of sheets O� Revision Date Title Size of Septic Tank 1OO() eX 1-.4111C Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 2U d ( ( (2 ) N 10 sLln 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 He th. Signed Date „� -�17 Application Approved by Date d o—/ Application Disapproved by Date for the following reasons Permit No. on-0 I uy 1 Date Issued No. i i I Fee �- rI 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` ` . Yes PUBLIC HEALTH DIVISION - TOWWOF BARNSTABLE, MASSACHUSETTS 2pplitation for Vsp aY trm Construction Permit 1� o-;,� V7 Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I�p T O x it/P V PED 4=9 towner's Name,Address,and Tel.No. Assessor's Map/Parcel j q q L.o f 5 0 8 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. n 4 �`� ��cLCr�tc�frdn 57�k -477- ,01953AL99�t-l1 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building !°5 ((,C.W l No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 19 gpd Design flow provided 3 gpd Plan Date Number of sheets O� Revision Date Title Size of Septic Tank 1000 ex 15{t jC Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �V �U d 1�j /J (2 /O S07 n/" a-Li M be! s ' I - 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 KHe th. Signed Date 3 21) A lication A roved b PP pP y Date 3 'r1�"�� Application Disapproved by V Date' for the following reasons Permit No. go ^ 07 1 Date Issued ------------------------------------- ------------------------------------------------------------------------------------------------ �THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ecrtifirate of Compliance THIS IS TO CERTIFY,thar-&-osiolinn e On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( by . at ( ' has been constructed in accordance with the prews'ons of Title 5 and th for Disposal System Construction Permit No. dated Installer Designer ___1r`n q I #bedrooms { Approved design flow 3() gpd The issuance of this permit sh 11 not be onstrued as a guarantee that the syste will ctio as designed. Date I DZ /� Inspector --------------------------=-- ----{-------------------------------------------------------------------------------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal �6pstem Construction permit Permission is hereby granted to Construct( ) Rep air( ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within/three years of the date of this permit. .��Date � �O f�"" Approved by . ' M Barnstable August 4,2009 uxamg BAWWABM Revised January 12,2016 ANAMM 61dA� , 1110.1 2007 Counter Variances, Approvable By a Health Inspector Listing of Blanket Variances Granted by the Board of Health 1)�—FOR ALL 0 STE�!IS T=-HrAT HA� ENO I1 TCREA SE IN F�LQ-= Septic system component to foundation setback- but in no case, no more than a 50% reduction in the required separation distance. A future reserve area shall be shown on the plan for proposals'to increase or change foundation size on parcels when, in the opinion of the health inspector [or, if the health inspector is not able to make a determination, after consulting with the Director or Acting Director] the proposal appears to provide very limited space for the proposed construction, septic system, and a future reserve area. 2)FOR ALL SYSTEMS THAT HAVE NO INCREASE IN FLOW- System component installations proposed more than three feet below grade with proper venting (piped to the atmosphere) and with H-20 loading, but in no case shall the SAS be located more than six feet below grade. 3) FAILED SYSTEMS ONLY— SAS to private well separation distance variances, if located in the same general location as the old SAS and more than 100 feet separation is proposed,both from the on-site well and any and all wells on adjacent and neighboring parcels.* 4) FAILED SYSTEMS ONLY— Septic tank or pump chamber proposed to be located less than 100 feet but more than 75 feet away from wetlands or a water course.* 5) Additional seating at existing food establishments, if no more than 25% above the maximum grease trap capacity. 6) Proposals for six or more bedrooms, without any variances, are no longer reviewed by the Board. *NOTE: If there are two or more variances requested from#3 and/or#4 listed above, the applicant shall instead seek variances from the Board of Health at a public meeting. Wayne Miller, M.D. Paul Canniff, D.M.D. Junichi Sawayanagi C:\Users\decollik\AppData\L.ocal\Microsoft\Windows\INetCache\Content.Outlook\CBNGQ 123\CounterVariances.Jan2016.doc Town of Barnstable Regulatory.Services Richard V. Scah,Interim Director • snaxsrnaM v„ M� Public Health Division 1�° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: - ZI - I`? Sewage Permit# Zot`I -o41 I Assessor's Map\Parcel 149 130 31 Designer: Svc.TloL:�,cr4q Installer: _XCmvaA%0^ Address: �,p. Qp�c 81 Address: crt- A. LjQ �oc moy-4�oo�� Foresi�lo..l� On 3-Zo• In CXC0.V o.J i O A was issued a permit to install a (date) (installer) septic system at 1& Fo x g 1 o y c R c- based on a design drawn by (address) .Do y c cr-lc{ dated 3-1 • 1*9 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructs pliance with the terms of the M approval letters(if applicable) ��'�N OF 4f4 DAVID yGs D. a FLAHERTY,JR. (Installer's Signa No. 1211 GISTS / J S'9NITAR\PN esigne s Si ature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Torn of Barnstable. e y 0 Department of Regulatory Services Public Health Division MI 14ain Street;ilvannis MA 02601 Date ^� Date Scheduled 7 � Time: lid UJ t7'y Soil Sgi1abilit 7;AssessMent for Sew ge Disposes. _j Performed By �r 0 ✓" -y W'itnessedby: LOCATION-&GRAL INF,Ol21ilATION tit Location Address //� {' /�` J - -} ftlf ! o C�ZVtJ � Ovner`sName l Y+Yr9 Iw & AddressG Assessors Ma Pareel: Engineer's Name NFW CO\SIRUCTMN � --__ REPAIR 'felepfxine',r' .L Land Use_ 116t Slnpes(%) ___ Surlace Stones DisLtncrs from: Open Water 13.cid >' h Possible,We..Area -,��_(/_k.ft Dnnkm�.N•';tter 14�e1' o r l _fi Dtan:i x Way �_�tl Pro er•, p,:}Line -- 0 Ottrxi. fl. SUTCO:(Sheer nan,,dimcttsions of jot;exact locations af'tcst has&perc tesis;locate wetlands is in proximity to holes) ILA Parent material(geolp�iei;V '(wv(�(/K/�/�"'+ NO)to Bedrock %.Al Depth ro L'rwenduyier StandingWater m Ftotc LVecping from Pit Face £•stirrtated Seasanall-hgh Groiindwaier � qqq � DETE"11NATIOiy F®I2 SEASO NAL HIGIi WATER TAB Method Used:_ . Depth obse pfir standing in ob's hole ra. Depth to soil mottles.Depth.towxepnglornstdeofobs.hole _ — ' n. IndexWeilP - Readm ug-, m Cn'oundwaterAdjustment_ - . il.�: trade WWeil.?eve!' Adj.:factor, Adj.Groundwatert_e:+el PEI2MQ A;'TION TEST unre Observation Hole g" [nneat9" Depth of Pere, lime atfi" - S{nrt Pre-soak Time y�, •r- . ire 19••..5•.1; End Pre-soak � '�_.... Raiein.r'Incf ti Site.Sdiiabiliry Msessment:.SiAupassed... Site fai3od:_ Addrhonai Test ng Needed(YifJ). Original;Public.Health Division Observation Hole Data To fie Completed otf-Clack _____.._ *.If percolation testis to be Conducted within 1.00'of wetland you must lrgt notify the Barnstable(Conservation Division atleast'One(l j week prior to beginning. Q:LSEPTICAPERCFORNL DOC y 'DEEP"OBSERV.A`ION noLE LOG .:. Depth from SoifHorizoit Soil Texture II©Ae# ' Surface(in.) SoitCalor Soil Oiher " (USDA)' (h}unseff) \goUlingr :(Snurture,Sznnes,Boulders, ± C nsi tencv% ve DsoEP i'mo 710MI-101 LOc.. "". Hole#" Depth fran' Soil tiori:.nn. Sail Texture t Sar.Go]or Other " Surfacetin:) USDA Soil - ( ) (I�Suitsetf) iltottlin--- g; ($inrrture,Stanes Boulders. ' ons s enc ^/Gras De DEEP OBSERVATION HOLE E UG Hole#pth from Soil Horizon Satf Terturc - Surface,(in;). Soif Cofar soil Other (t;SDA) 0munsefl) Mottling, (Struc„ure,Stones Boulders. CO11M eii ',%Grdvef DEEP OBSE.RVA'TION HOLE LOG Bole# Depth from Soi!i-lorar)n Soil.Texiure - - . .Soil Color Soil Ofhcr Surface(in.) (USDA -- - ) :(Ntunsell) Mottling (Structure,Stories;Boulders. I'loii(j�nJilfanCe}7atE"s'i9r!' AbnvO: Q year fload boimdary Iva . Yes _Within_500yeorboun&, -iVo .— 'Yes Wahin looyear'fiiixlboundary::No' Yes_ DeAth of::M1atnr�tllv'Oceurr•;no iJPrvions Material Does at[east tour feet of naturall}roccurin;_perviat Is-materialexist in all observed throughout the area proposed for die soil absorption system [f t at what is the depth of naturally.occurring per faits material? s _Certification I certify that on (date)1 have passed the soil:eva:luator esanuttation approved by the Department of Env"on rental protection and that the above analysis was performed.by tnc_eonsishnt with the required traintn perttse and nc descri in 310 CWIR 15 017 Signature __ Date f � Q:SEYTICIPEkCFORM:DET�. �I ^ - ~ ^ � ~_ F��-`=� .�----- THE COMMONWEALTH orwAssAo*ussrrs U���� ��K� ������" ~�� /QF HEALTH ----'OF-' ----------.. ~~v-vr---~~---~- for --~-vr--~--1 ---`-r~~- -~~------~-r~~-~- nr~~-~--- Aoolicudoo is hereby made for u Permit to Construct X) or Ilcnuir ( \ an Individual Sewage Disposal system - 4_4 ~~ ~ '~~'~`'�~~~'~�'.- ' --ex-- _---~_..........................Or t,_ L r&s. ......... , y 0. ���m�� ��^� �J ____ ~ ~ _ fter Address --_-.�-���--'--'��������t'��-----'_------'--__- -------------------'---------------------'---_---' znsmoer Aares s -_ ��w� Type of o3 --�� . Size Lot feet I)w�l' �~9�. of 8edr000�s-'-------'^��--..--.-'-'Expansion Attic Grinder & �~ (}dzer--T`m* of Building ............................ No. of persons............................. Showers ( ) -- Cafeteria ( ) Otherfixtures --_-------_-----_-.-.-----.___________________________ Dea6o� ��n�------'�-_---��-��--�ul000 y . Iot� .�� Septic Tuok--Go���capacity- looa �cue��-�����-' \���b..���§��. 4- Dcy�b�����_ / Total ft. ~~ Percolation 7cut Ieoo�o-�- Performed by D ' ---- - 0.4 Test Pit No. l.��----------minutes per inch Test Pi -- Depth to ground =m Test Pit No. 3................minutes per inch Depth of Test Pit.................... Depth to ground water........................ � ^ ----'�-- . ---��- '� -'�_ �0 D of Soil � ----------------- ----------------------------------------------------------------- `------------------------------------- --------- --------------------------------- ------`-`--`----- .--_-----------__-.-.-_------_._--_--'-----_----'_--_-----'_.---'_----'_____ U Nature of Repairs or Alterations--Answer when applicable ---_-_---_'-_.--_-----.--'..__'-_- ''----'------------'-----'-------'-'----''----------'-'---'------'---------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with Fmc.... . .........._ THE COMMONWEALTH OF MASSACHUSETTS �. BOARD OF HEALTH +/J(,t).,��.............OF..........� f..wLl. J '_I ............................... ... Appliration for Dwposal .'.Yorks Tonarurtion Vamit Application is hereby made for a Permit to Construct (, ? or Repair ( ) an Individual Sewage Disposal System f �- �2 r- oll. �• f y /r1 t. �• Location-A44 en 1�.�. EM L.....`_K��� .���...._. .1......... �.............. ... ••"••" . Address (S� �•�+"• 11J a' Installer Address Q Type of Building Size Lot....... a.:.6(__�_`_... Sq. feet a Dwelling—L1 `o. of Bedrooms.........................................___Expansion Attic ( 3 Garbage Grinder p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures .........----------------------•.----------••------------------ .............................. Design Flow............................��... _..•..gallons per person e day. Total daily fio . ....... onsw W •gn -� � g P P P�fr/ Y t 1tY N'----•----------------_ . �� Septic Tank—Liquid capacity allons Length.. Width fl-� Diameter_ '. Depth - Disposal Trench—No. -------------------- Width.................... Total Length............... Total leaching area....................sq. ft. Seepage Pit No---------I......_. Diameter.......:2.1...... Depth below inlet......_1:........Total leaching area.....!?�?..sq. ft. Other Distribution box ( ) Dosing to ( ) Percolation Test Resulps Performed by.......................... ... . ff;.----- Date.---------------------------------------- Test Pit No. L.....-..�:.minutes per inch Depth of Test Pit_�L-••j 3... Depth to ground water..�r!.!'!°: i, Test Pit No. 2...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ a '. _. Descriptionof Soil........--• -3..........................•-•--• ....... , _.-•l_�--'— ..........--•�------•............... V ......................................................:.-•-------•-----------..•.........-•---•-------•--•-•-------------------------.--------------------------•.......•--------------- :.. UNature of Repairs or Alterations—Answer when applicable...:.............................................................................•......._...__. �. Agreement: ` '',..., The undersigned agrees to install the aforedescr' ed Ind' idual Sewage Disposal System in accordance with the provisions of TILT':,=. p S of the State Sanitary C :Th dersigneA further agre not to place the st in operation until a Certificate--of Compliance has be sued by and o lth. Signed ----- -- - ----------------------•--- ----- i Application Approved By............... • •... ' `.. :..: _ .........-----------•• ---•-• .... tprove ` following ;" --•---......... Date Appllcato3� Dap rovethe ollowm reasons:_._._._ °' .___._ .......... Date JPermit No......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Irrfifiratr of Tontplinnrr THI Te RTIFYATha,Lt$ ndividual Sewage Disposal System constructed ( r Repaired ( ) by ... .- .. .....--- .....K....` ...................... --------------------.......------------------------------------ .............................. at----•---•-----------�3------..... `....- ---•---v�....------. has been installed in accordance wit Mlle provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-..---.......................................... ar THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WtLL FUNCTION SATISFACTORY. DATE. .9. --...... Inspector.. ............................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF..........---.............................__..._..................................... No...f��-. ��..� FEE... ....... Diapoli i Toni#rttrfion rrntit �j Permission ilsAereby granted......... .. f ......�................. to Constru V) or air anite�,STa e Disposal System JG.y atNo.- -.. g .P--•-------y--------------------•---....----------------------------•-----•---•---....... Street as shown on the application for Disposal Works Construction Permit No..................... Dated_.___._____.__........................... // ��.......................•--...--.----..•...• Board Health DATE.----------f-.'------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS uo GAfZ:saGC- G ZI14- DFlL 1 ..1 ?'�d►L-( FIA,w = 110 -4 3 t SSO 6-P-V 1 r:CPS-lC T i1C = 33��t (r70 % • �J Es.PD. ( ��7 Ia' U S� l 00Ci 6A L. ! o` 1�oo��P� l/ 0 71o* � ISPOS DL riPIT - USE 1000 GQL Wao • sue. 1 .0 So C�.PD CPU 1 1 TOT, L 'V ESIGN = 42S G,P•D -rc)Tn t_ 17 2GD1DT10 U z&-rE : t"11.,1 SM I Q*,o¢ L".' a l..or 3 3 N' �^ E .,cat` � f!4' O.;t�� e .•+ � \,p.�' �htll� > y�, i l � i • NAL �UU•,(� 1 �- � .. • rP .: I ,AI �Q • ' �t'P� loco iuv f, t ,¢'p,Pb1 IN^aT. Iw• Geet.. �c1 EIMC IOOO 5�.0$ twK tw. •t• ' E 'f LsAaA ?; p PIT e �f i{ W� '+ i.... i ' WAflet) ii s CEQTIFIED Pl.b`f' P1-,4A-] L0CAT1Ot-4 CJEVJXEPV I U-C- I�l� b'AT M �I b•-��;� Lt.::t2TtF�( Tti-AAT T14a PQ0p DVJ L, Stu ��-"A�.l RtFEc�E--= •a-lFa;t_bt,1 :':Gc�vt,Pt_�l5 W 1TF� T1•ac: 51 OE..L1►-16 l-.GT 3-� , AI.1D SETL�AGLG �C-Qc.)IREMc1••lTS OF T1-+� �. o w w or- �3 P�1,JS`i 'C i PL JP U Fve q I OAL- .,D 0 I.�G�!_. �K-- igen [7A-rr `` -- .1 BQXTEtiZ 4 WYL 1�e. • REGIS•ttRED LA1JG SUZVEYo�•S ; ' OSTECVtLLr= `I W I S 01-A w Is L-1 OT E'„O�S EL7 0�.� A�•1 a I�rCAS�i• 4• T14L IQPPt_1GAti.1T r•k�r f�'.0 u•:',�n ru UL%-•TGCM1►4E: APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION Loa , 3 f�"O lov c eo 1.w NO. VILLAGE C DATE Z�/�- / APPLICANT DrVI�/1 P�I�I- FEE IS _do ADDRESS p0. b.OtC rI)U �n,- p` 1� TELEPHONE NO. (Non-refundable) ENGINEER �� -r-�� �� YE _TELEPHONE NO. DATE SCHEDULED �2s��9�j (Applicant' s signature ) • • • • • • • o 0 0 0 0 0 • o • o 0 o e o • o o s • • o 0 0 0 • o • o e • e • o • o • e • • e • • o • o • • o • ♦ • • • e • s e • o o • • e • • • • o • • • e o SOIL LOG SUB-DIVISION NAME DATE_ G �� 4' TIME EXPANSION AREA: YES i/'NO `5 ENGINEER ?: TOWN WATER k/PRIVATE WELL BOARD OF HEALTH EXCAVATOR SKETCH: (Street name,etc. ,dimensions. of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES: aC L_GvE �C9 c,� 35 UV1 r PERCOLATION RATE:_ Z V-% !lam TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 1 1 _ 2 Go ! 2 3 4 4 5 AN 5 7 6 8 5' 8 9 C1 9 10 10 m' 11 11 12 12 13 13 ,- 15 tiVct, l 15 ` 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD _ EACHING PITS_ LEACHING TRENCHE S UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS : ,f NOTE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED 0 PER TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURN 0 BOARD OF HEALTH COPY: RETAINED BY APPLICANT TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC�`SYSTEM PROFILE `BROUGHT TO WITHIN 6" OF FINAL GRADE - FlahertyEnvironmental Services EL. 56.0' EL. 54.0' (not to scale) _ INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. BOX 81 T 2"of 8" to b" DOUBLE WASHED Yarmouth Port, MA 02675 4" CAST IRON or EQUIVALENT PEAS`�ON�OR GEOTEXTILE EL. 54.�` MIN. PITCH 1/4" PER FOOT FILTER FABRIC 774.994. 1166 4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE :•;,,,,,,�;, FLOW LINE ENT IF REQUIRED �nrsr2'r_ obe ,ievBn Q a.• 'oo �` :oeeooeoee a 000eeoo... '..� a;.• °.• EL.49. 'f •,�. . f , L. EXISTING C� Q •p as coc00000e EL. EXISTINGT '� _�- i 0000000000� ° �� p p p 60000000� EL 51.6' r�o ® 00000000c LOCAL UPGRADE APPROVAL: EL, 51.03' °o°°°° o 0 0°0°0° p O p p Qp�Op`p- ® O o000o0o0c _MAXIMUM FEASIBL COMPLIANCE- ... EL.51.2' o 00000000°0°° �D ��Q��. E ::;a• GAS BAFFLE EL. 51.0' 000o00000°°000000 p C7 O O p'O•C= O Ipl p. 0°0°0°0°c Z--D 310 CMR 15.405(1)(b) •.: .� O°O°O°0000 °00000 'd' `•—!° 000°0000C H-20 o 0 0 0 0 0 0 °. o 0 0000 DECREASE IN SETBACK OF SAS 4 '•' °0°o°0°Oc EL.49.0' TO FOUNDATION- ° 6"CRUSHED STONE OR �D-BOXJ �: SOIL ABSORPTION SYSTEM FROM 20'TO MECHANICALLY COMPACTED 18' (2' REDUCTION) (DATUM: ASSUMED) Ex1sTING 1000 GALLON SEPTIC TANK (2) 500 GALLON H-20 CHAMBERS 8.0' (SEE T.O.B. COUNTER POLICY#1) 3" to 11" DOUBLE WASHED STONE WITH 4' STONE AROUND IN A —Y 12.83'X 25'X 2' CONFIGURATION 0 54 EL. 41.0' BOTTOM OF TEST HOLE EL. 41 0' LOCAT/ONMAP �a ® USGS ADJUSTMENT' N/A QeKSt• /— GROUNDWATER ELEV' N/A N TH Rs�Z \RIVEWAY 01yS.49eRd. EXISTING WATER SERVICE / �13 °O � TH-2 �a. TO BE RE-ROUTED $ SLEEVED WITHIN 10' OF SAS }�LOCUS O ` GARAGE ! P 54 TH-1 18' 54 LP O O� EXIST. S,T, EXISTING NTS 3 BR � ZH • DWELLING �� OFAf4O DAVI o D. " F ER J -' BENCHMARK. 1 No. 11 TOP OF FNDN LOT 33 EL. 56.0' FG/s T E�� J, 15,000 SFf �/'. SgN�T tpN MAP 149 LOT 130-31 sOpO 55 p0- DATE.'311712017 REVISED. SITE AND SEWAGE PLAN FOR . B & E EXCAVATION, iNC./ JAMES A. HELGERSON FOXGLOVE ROAD SCALE : 1 " = 30' 10ENTERVILLE, MA REF.PB 326 PG 29 PAGE I OF2 .............................................................................................................................................................................................................................................................................. ....................................................................... f -..................................................T................................................... ' t , GENERAL NOTES DESIGN CALCULATIONS { SYSTEM DETAIL Flaherty Environmental Services P. 0. Box 81 1. ALL PRECAST COMPONENTS TO BE H-10 Yc'i//)70Ut17 Port, MA 02675 RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 3 774.994. 9 966 DISTRIBUTION BOX(ES)AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW ALLOW FOR THE USE OFA GARBAGE (110 GAL/BR/DAYX 3 BR) - 330 GALADAY _ GRINDER. 3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL, 4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION 1 CODES AND REGULATIONS. — ..`•.:w y.`.::: i :; .`:.;`' 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MIN./INCH 1 VERIFY ALL ELEVATIONS AND DETAILS O 12,83' EFFLUENT LOADING RATE 0.74 GALADAY/FTz AND REPORT ANY DISCREPANCIES TO '•>~. :. DESIGNER PRIOR TO CONSTRUCTION�OR LEACHING AREA ASSUME ALL RESPONSIBILITY (2)x(25.0'+ 12.83)(2) = 151 SF ' 6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SFx 0.74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE 25, (1-888-344-7233) 72 HOURS PRIOR TO IN A 12.83'X 25'CONFIGURATION AS DIAGRAMMED CONSTRUCTION. 7. ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY N/A THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL -- SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN. 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION FILLED WITH CLEAN SAND OR REMOVED TESTHOLE#1 P#15298 rEsrHOLE#z P#340 AND REPLACED WITH CLEAN SAND. Evaluator.• David D.F/ahertyJr,ITS,REHS Evaluator: ' Baxter&Nye,A.Jones �(N OF MgSs�c i 10.ALL COMPONENTS TO BE PROVIDED SE#2755 BOH Witness: Ron Clifford BOH Witness: David Stanton,RS Date: June 26, 1981 D G� t WITH WATERTIGHT ACCESS PORTS Date: March 17,.2017 g� WITHIN 6"OF FINISH GRADE. o H R cn 11.ALL SEPTIC TANKS, DISTRIBUTION TH-1 ELEV.54.0' BOXES AND PIPING TO BE INSTALLED TH-1 ELEV.54.0' 1 0 0"-36" Loam&Subsoil FG/S T ERA WATERTIGHT. o"-14" FILL Sq 'rn \P� 12.N0 KNOWN WETLANDS OR WELLS 14"-22° A LS 10YR3/2 WITHIN 100 FEET OF PROPOSED 3 / LEACHING. t I 22"-36" B LS 10YR 5/8 4 13.THIS IS NOT A CERTIFIED PLOT PLAN 36^-156" Med Sand AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR f - BUILDING PURPOSES. i SITE AND SEWAGE PLAN 14.LOT IS SHOWN AS ASSESSOR'S MAP 149 36"-126" C MS 2.5Ysi4 �� l certify that on November 12,2002,l have passed FOR LOT 130-31 . B & B EXCAVATION, INC./ the examination approved by the Department of 15.LOCUS PROPERTY IS LOCATED WITHIN Environmental Protection and that the above analysis JAMES A. HELGERSON G.W.ELEV.N/A AN AQUIFER PROTECTION DISTRICT G.W.ELEv.N/A has been performed by me consistent with the 16 FOXGLOVE ROAD required training,expertise,and experience described (ZONE 11). BOTTOM TH-1 ELEV. 43.5' BOTTOM TH•'2 ELEV. 41.0' in 310 CMR 15.018�2)." CENTERVILLE, MA PAGE 2 0F2 ............................................................_._.............................................................--._._.............................................................................. ................................................_..-......,. t . _ .............................