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HomeMy WebLinkAbout0264 TREE TOP CIRCLE - Health 264 Tree Top Circle '�- tA=='IY6 arst6ns Mills -025 I` 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 264 Tree Top Circle Property Address W Ed & Ruth Cook Owner Owner's Name information is Mills s required for every Mars MA 02648 2-9-16 page. City/Town State Zip Code Date of Inspection Q� 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. Important:When A. General Information , filling out forms \`o��a�tttOF Mq&. on the computer, �������..•• M' c use only the tab 9 ' y� key to move your 1. Inspector: o: ••N cursor-do not James D. Sears JAMES R,n use the returnsE" C6 key. Name of Inspector Capewide Enterprises, LLC •.�F _ °. Company Name ��\' tJ'�o.` 153 Commercial Street ntitN StpE```p�`� Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 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 2-10-16 nspector'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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ,,(V edrs Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 page. Cityrrown 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: The system is a 1000 Gal. Tank D Box and 12 Chambers. 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 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 page. City/Town 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 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 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 awapod is less than 6" below invert or available volume is less than 1/day flow rC fib C111.v t- 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 .° 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 page. Citylrown 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. ❑ ® 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 15,000 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 ❑ ❑ 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 page. City/Town 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? ® ❑ 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): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and 12 chamber. Number of current residents: 2 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 2014-47,000Gais g ( y g (gp )) 2015-45,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: 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 s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 Zi Cit /Town State page. Y p Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2012 -2014 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 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: New leaching 2011 permit # 2010- 135. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 20" 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: 1000 Gal. Precast H-10 2" Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 page. Cityrrown 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 28" Scum thickness 2" 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 16" How were dimensions determined? Asbuilt-Tape Sludge Judge 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 at working level. Tank at 20" below grade w/both covers at 6". Inlet baffle,outlet tee. No sign of leakage or over loading. tank should be pumped. Grease Trap (locate on site plan): Depth below grade: feet 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 L i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 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: Material cf construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 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 �,M s 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 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 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 is 16"x 16"-40" below grade w/cover at 22". Box is clean and solid w/two lines out. No sign of over loading or solid carry over. 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.): * 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 12 ❑ 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.): Leaching is 12 biodiffosr. Two rows of(six each ) stone less chambers. Ck D box and camera out to chamber's. Clean w/no sign of over loading or solid carry over. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-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 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 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: 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 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 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 /3-1 A .p -� / U 93 - 0257 r r) o o G7 r S t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells AID Estimated depth to high ground water: 10, 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: 2010 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: T.H. on Design plan 2010, no G.W. at 10'. Bottom of chambers at 4'-6" below grade. Bottom of chambers at 5'-T above T. H. Depth. 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 264 Tree Top Circle Property Address Ed & Ruth Cook Owner Owner's Name information is required for every Marstons Mills MA 02648 2-9-16 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 cr- TOWN OF BARNSTABLE LOCATION *Y lnat -P (,rc U_ SEWAGE# Z010" i3S VILLAGE n/I 124, ilf ASS/E�SSOR'S MAP&PARCEL iZ(O INSTALLER'S NAME&PHONE NO. C J 4'aZJ SEPTIC TANK CAPACITY loonn ij iG Z xrA i; LEACHING FACILITY:(type) %Aie ,3(01(y (size) ��?).,�- 30 NO.OF BEDROOMS OWNER t (200�c PERMIT DATE: 3-11 -Z o ►o COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility OTO if 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 C,FURNISHED BY 4a,e ;,l a. t1't 1"If fri*S e i L L c 1 f 2 14 tee/ A3 S3 3g<v s PH y A 5 yr:f Sr to@�o � t✓ No. �" t"3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipprication for Mioogol *pgtem Cou6tructiou permit Application for a Permit to Construct( ) Repair YI Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Z(0L 1 lct.l TS� X C�(t tOwner's Name,Address,and Tel.No. vw� ACQ to Assessor's Map/Parcel Z� Z � Installer's Name,Address,and Tel.No.Ca �n J e� �t 1G pr� Designer's Name,Address and Tel.No. � e 1 g L C i1.` �(� v `�Orc ion 293z( r� I� �''i C.�s�J ov, `-(2� did Type of Building: Dwelling No.of Bedrooms Lot Size 20 Op I ' sq. ft. Garbage Grinder ( ) Other Type of Building L. re No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 -6-0 gpd Design flow provided 73 (4(a . gpd Plan Date lc. -.OIQ Number of sheets Revision Date Title Zfn-{ \rta-4 119 Size of Septic Tank ,{I Type of S.A.S. (2 $"R9,,y ( Description of Soil It Nature of Repairs or Alterations(Answer when�appplicable) �,/�'b 1 d�.Q,,,! 1 7 OD 1.2- A71C $J(o N C_ Date last inspected: _1p 1,3 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board otJ44q1th. Signed Date o t o Application Approved by Date S 70 r­�to(C) Application Disapproved by: Date for the following reasons Permit No.. � / S Date Issued '"� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. t' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes w, Rpprication for Migloal *p!9tem Construction permit Application for a Permit to Construct( ) Repair Y.) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Z b(.( t le T� c Owner's Name,Address,and Tel.No. v (o b l L Assessor's Map/Parcel � �1 '►' Installer's Name,Address,and Z� Tel.No.C✓,f( .w� C)l i'(0,$f-) Designer's Name,AddressC_ and Tel.No. C -7 I r���,►,�� ()A t t� �? �K -7 Zy 3 -- 0 37-7 Type of Building: Dwelling No.of Bedrooms �'� ) Lot Size 7-p,©p 1 sq.A. Garbage Grinder ( ) Other Type of Building S t. •e No.of Persons Showers( ) Cafeteria( ) Other Fixtures , t E Design Flow(min.required) 3'0 gpd Design flow provided -3 k4 G . r. gpd r Plan Date Number of sheets I Revision,Date Title 2.(oH 1�1( Itii Size of Septic Tank loco 0 S 1—bS, Type of S.A.S. (Z S i(�..c_1-��S (J�•rt�ntl Description of Soil q I , IV Nature of Repairs or Alterations(Answer when applicable) CJC' ^k") \1 l3a F ti 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 o Ith. Signed Date ���o 2.b 10 Application Approved by —e� Date '5 74 -20 f U Application Disapproved by: Date for the following reasons Permit No. ( Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance v THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired� ) Upgraded ( ) Abandoned( )by T �,,Q 0,t,,J,tL 1 at Poq C e- v C.,%vt.k'c IM&i&rA 14 116 has beeenPalogn trgc1gd ig accordance �` with the provisions of Title 5% and the for Disposal Syst m Construction Permit No. // � dated Installer ,PGal-rcv ��f-c 'll _� �- Designer S. C. • 6ht V,.A" . #bedrooms Approved design flow ////���� 3 �t 3 gpd The issuance of this p it s'all not be construed as a guarantee that the system will'uh tion s designed Date Inspector - - M1 ------------ - No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS x1i6poal *p!5tem Construction Permit Permission is hereby granted to Construct ( ) Repair O Upgrade ( ) Abandon ( ) System located at 7i(a-( j( j a n�� c,o 1 A, )j and as described in the above Application for Disposal System Construction Permit.The applicant recognizes 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-"1�1- VQ� Date _ i/0 Approved by Town of Barnstable Regulatory Services Thomas F. Geiler, Director t CARNbfiABIR, 1 Publics Health Division MA88. Thomas McKean, Director 200 Multi Street, Flyannis, MA 02601 Office, 508.862-4644 Date: 5�I`I 1 r'7_ Sewage Permit# 'Z 4 r v 1 3,�� Assessor's .Map/Parcel Installer & Designer Certifleation corm Designer: Installers �c��;C)'@. Gd1�cc �tSt1 Address: Z6511 Cra0be;; Nt(hwai Address; 02(,3 Z Un 7'/�^Z oto._.__. ..� •1�__ .._...�.1=. _.was issued'a permit to install a te) (InstaIIer) septic system at_ 26 K Tce-e- TO C4-Ci t, _ based on a design drawn by . �L Enait'�.8-e c ivj :�"r�G, -- _.,,�� _,_..._._._._ - - �............. _ I ccrtifj-that the septic system referenced above was installed substantially according, u-) the design, which May include minor approved changes such as lateral relocation ot'thQ distribution box and/or septic tank. Stripout (if rcquired)`.zwas inspected and the sioil's 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 accordanec with State.& Local Regulations. flan revision or certified as-built by designer to fellow. Stripout (if required) was inspected and the soils were found satisCuctory, TH O�y, �Un nv C. CN (;,yil -- lnst�rlicr's Sign turcj ,ire t v1t. S1 esigner`s , igntltiirc .- (A tp Here) _ PLEASE REIL1RN TO BARNSTABLE PUBLIC AL`I'! VISION. CE r CA'TC OF COMPLIANCE WJLL .NOT BE .ISSUED UNTIL JJQTH THIS M,EM AND AS- B ILT CARD ARE RECEIVED BY THE, BARNSTABLE PUBLIC HEALTH DIV,Itq,.ION, THANK YOU. c,"ulliae fohns\ddslgnetecrtil'icauun I,rn.dc,c Town of Barnstable P# 1 Z 2/U Department of Regulatory Services Public Health Division Date MAM 1639.6 200 Main Street,Hyannis MA 02601 �f0 MA't Date Scheduled �$ Time _ Fee Pd. 00 Soil Suitability Assessment for Sewage Disposal Performed By: tj f G64-( Pi 4Y,£01 W ELT C S t Witnessed By: 1 r�,rr/'W: LOCATION& GENERAL INFORMATION Location Address 2� Owner's Name�( T✓�oP ��Y�(e Address Assessor's Ma /Parcel12, — P p �/OZ J - / Engineer's Name li�,�esz�.o l'!�k'cf +')'c SLn5tnQe(i NEW CONSTRUCTION REPAIR ✓ Telephone# L 6 Yoe SUf3 272--6 377 Land Use 5eQ12frl�j Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line 7 to ft Other g SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) s c,e_ a�ao�ed �I cv� Parent material(geologic) ouTus� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: 7 i 20 dog s Weeping from Pit Face 7 12G ''D3s Estimated Seasonal High Groundwater 7 1 20a,6_5 S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Dtrec -6bsef uQ{tm-i Depth Observed standing in obs.hole: _ 7 i 2__— in, Depth to soil mottles: 11 G in, Depth to weeping from side of obs.hole: 7 t � in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level a Adj.Ihetor, Adj.Groufldwater Level PERCOLATION TEST bate v-28 to xlme ii aN Observation i Hole# — Time at 9" . u u Depth of Perc Zy Z Time at G" Start Pre-soak Time @ l I:2 G PtM — Time(9"-6") End Pre-soak l 1:3 6 A% Rate Min./Inch Site Suitability Assessment: Site Passed ��'S Site Failed: ` Additional Testing Needed(Y/N) .ti Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole#_(_ Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% ravel i tJ 2 y L S 2y"- 101 C-j C S 2,51 b/c, �c-2a 1 !6y-120 c-2 lS 2. Y4. / ucSe. DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) is-yy 3 �S �0Yr �l� - 2'I-l0y C-1 C.S 2,5 `f b/b 10-2-0E1" 5<ovza to y..r20 G-Z rt S Z b/e ups DEEP OBSERVATION HOLE LOG Hole# Depth from .Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi to c Gravel DE EP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten � l Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes _. Within 500 year boundary No Yes Within 100 year flood boundary No,v� 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? Ye S _— If not,what is the depth of naturally occurring pervious material? Certification I certify that on 1°_ -7—`��l (date)I have passed the soil evaluator examination approved by the ` Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise a experience described in 310 CNIR 15.017. Signature Date Q:\S BPTIC�PERCFORM.DOC r LOCATION _ SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS B U I L D E R OR OWNER V6r-U C e.44- DATE PERMIT ISSUED r DATE COMPLIANCE ISSUED 7\\ \ O� No...11 ........... Fss.... �(/.5� THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH S� !.(�.L 7 U. '• Appliration for Uiupusal Works Tonstrnrtiun rumit Application is hereby made-for a Permit to Construct ( ) or Repair (li�an Individual Sewage Disposal System at: ...... la ... re .. ...... r..CA!:........................... .................................................................................................. do Add .. ^ �C✓�'1.... C�° ice..----•-- - - ,E'S� . )./.-s.. or Lot O n Ad ress •--•- nstaller ddress Type of Building Size Lot............................Sq. feet v Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—Type of Building No. of ersons____________________________ Showers g --------•----•-•------------ P ( ) .— Cafeteria (----). dOther fixtures ..---••-•---------------------------------------------.----_....._...-•---.._..---------------•-_..---•------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 . Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1­4 Percolation Test Results Performed by.......................................................................... Date......................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ---------------------------- - ............--...................... ../ - O Description of Soil (_----•-------------------•--•-.............................................. x c.> w x --------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable...___ )_ 1Q. L1._. Cj-/___.!/�,/- '`'---------------------•-•••--• •---------------------•-----•---•-----------------•-----.__.__..-...------------•--.....-----•-•----..._.....---....-•--•--•---------------•-•-------....----/--•-----------•--._......--....------•••-=-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be94 issued by the bo rd of health. tgd-- ,�=' -- ................ ...... ----- --- Application Approved B ..... . � Date Application Disapproved for f o owing reasons:............................................................................................. -------•----•-- ••-----•----Date-•------•-- PermitNo........................................................................................••--•-........ Issued...................................... - -....._ ----------- Date �_ _ No ....�.�...... FEs...> �1 :(1Lt THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ).&.�)f'' OF....,c.. � �.. f1 jf�° ..................................... Appliratiun for Eliiposttl Workii Tonitrurtion rrmit Application is hereby made for a Permit to Construct ( ) or Repair (L,-r an Individual Sewage Disposal System at: f �l ..� .�r_.... •I•(i...... r�J 1 ............................................ .............. .. ........_............. jeation-Address ,� or Lot�1 . . ,, s�..... j r.. %_ ........ ................. :..... . � s..........-----..._........._. y� Owner Address a :� € J �f� f `•���, l ?°` - �r`/'�......... t yl�r - !�'! '. .............................................. nstal er Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------•---------•-------•--------------------:..------••-•:------•-- ............................................................. Design Flow.............................. .............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results. Performed by..................•-------•--------••-------------------••---•--•......... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....................... 0-4 fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... _-------------------------------------------- ------------------•--......................................................... Descriptionof Soil....................................... ............................................................................. x U ••••••••-•--•••-------------•------------------------------------------------......------......------..............-----•=----------•-......------------•-----------------............•--•---•-••-...... W U Nature of Repairs or Alterations—Answer when applicable...____'_ _..:,l l�iC;1_. " .1...�il /................................ ------------------------------------------------- _--------------------•---••-------••---- -------------------------------•-•--•-•---------------------------- ....... ---------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the/bbord of I ealth� - Application Approved By.... r ........................................ a� r Date Application Disapproved for t�h of wing reasons:.............................................................................................................. --------------------------•-•----••---•-•••-•-- --•••---••-••--•-•-•--•-••--•-•-•--........••-•-....--•----......._.........•-•-•---••---•.......................................................... ` Date PermitNo......................................................... Issued------....-----------------•-----..._..........._•----- Date +4; THE COMMONWEALTH OF.MASSACHUSETTS _,. BOARD ' OF HEALTH ...........) :`'.......0F......... � k•%•`mil �1. .. ....................... (9rdifivar of Toutpliattre THIS IS TO CERTIFY; That the Individual Sewage Disposal System constructed ( ) or Repaired )- �. ................. -----................ d � 1 ... , ... rtaller J r _ ! at has been,installed iri accord nce with the provisions of TIT F• ..5 off he State Sanitary za ibed in the application,€or Disposal Works Construction Permit No.____ .�.6t�_�.............. dated...�0�; __..._..........._..... THE ISS AN E"THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM L NOTION SATISFACTORY. DATE..l.....�. ... --------------•-•-•---------.........----••-------•--_. Inspector...... ..... .......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . Biupouttl Works Tlanu#r _ ion VFrmft Permission is herebyranted.........- =f l f _ �'- ......... ....... to Construct ( or Repair a Individual Sewa Disposal System r , at ;� J/ /�/`J�'/1 !fJI J/y yG 5 iee� -C.... .....-- -. as sfiown on the pli ion for Disposal Works Construction Permit N ... ..._ ....... Dated.......................................... Board of Health FO -M 1255 A. M. SULKIN, INC., BOSTON {' T.O.F. EL.= 82.7'± PROVIDE EXTENSION RISER FINISH GRADE OVER D-BOX= 81 .0'± GENERAL NOTES WITH COVER OVER INLET& 4"SCHEDULE 40 PVC MIN. SLOPE 1% FINISHED GRADE OVER BIODIFFUSERS= 79.7' - 81.0' OUTLET TO WITHIN 6"OF F.G. SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION INSPECTION PORT WITH ACCESS BOX TO METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE REMOVABLE WATER-TIGHT COVER OVER WITHIN 3"OF F.G. (ONE PER TRENCH) CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= $1.T± FINISHED GRADE OVER TANK EL.= 81,6± . . RISER TO WITHIN 6"OF FINISHED GRADE 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE �+ C � DESIGN ENGINEER. ' PROPOSED 4" 9"MIN. „ EXISTING 4" " 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL 36 MAX." 36"MAX.ITOP OF SAS/B.O. = 78.13' SYSTEM UNLESS OTHERWISE NOTED. 3 1, OUTLET PIPE _ - PVC SEWER PIPE 5 DIA. OUTLET(S)! is 4. TO PREVENT BREAKOUT THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6" 3-- 3"DROP MAX 3" 9" PROVIDE WATERTIGHT , 2"DROP MIN MIN.SLOPE61% JOINTS(TYP.) STONELESS SYSTEM ELEVATION =78.13' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" I.. 4"PVC IN FROM (CLEAN SAND) 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" I \* °`m SEPTIC TANK 4"PVC OUT TO 1.33' nl-NP 6"TYP THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY 0.90' (TMP12" IN HNIE W -) 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. CONTRACTOR SHALL CONTRACTOR SHALL i OUTLET TEE 78.50' MIN. 7$,33' I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. VERIFY SIZE AND 48" VERIFY CONDITION OF ; 77.70 \-76.80' (LAID FLAT) 2.875'(34.5")--1---5.75'� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK CONDITION OF EXIST. EXISTING TEES 6"CRUSHED STONE 5 0� (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS SEPTIC TANK AND REPLACE AS GAS BAFFLE OVER MECHANICALLY NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH NECESSARY COMPACTED BASE (TYP.) 5'MIN. 11.50, AND DESIGN ENGINEER. 5 30.0'(TYP FOR BOTH TRENCHES) OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 82.00'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN UTILITY POLE#4H AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV= < 70.50' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 12 ARC 36HC ( 3616BD) BIODIFFUSERS TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE. TEST PIT DATA 11 REGULATIONS. OW ER/APPL CANT IS O OBTATION HAS BEEN MADE AS TO IN SUCH DETLIANCE ERMINATION NATH D ON FROM ED OR ZONING APPROPRIATE AUTHORITY. PERC NO. 12910 INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE EVALUATOR: Michael Pimentel, E.I.T. THEY SHALL WITHSTAND H-20 LOADING. zS C.S.E.APPROVAL DATE: Oct.27, 1999 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. DATE: Aril 28,2010 ���'��' TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE r _` MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. a K ELEV TOP= 80.50' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY ' C FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). i • i'= ° ELEV WATER= <70.50' \ � .;;ter s;,� • � • �! 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN r Yk, r r PERC RATE_ <2 min.�nch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. Ill O 3 t df. R ¢ a' FpC� � :. DEPTH OF PERC= 24"-42" °- UP `OF L +► >r � , ��rt �� = � 16. PROPOSED PROJECT IS LOCATED WITHIN: Yy°iH, pgVFM�jV� rR�� �„ TEXTURAL CLASS: 1 ASSESSOR'S MAP 126 PARCEL 25 m j� w w (40, Up C�p r x /'�'� HI '� OWNER OF RECORD: RUTH A. COOK ��TT i� Benchmark#1 \ 1, Z Nail Set in U.P.#4H \o,N, F-AV C�Ft �' /# ADDRESS: 264 TREE TOP CIRCLE a Elev. =82.00' S68°3 \ e��C) 0'4 - f • on 80.50' g'lo" i1v * �� _ ry Fill MARSTONS MILLS, MA 02648 Approx.M.S.L. F \ 10" r 79.67' ` Loamy Sand 78.50 FEMA FLOOD ZONE C MAP 126 \ 4 Perc _ COMMUNITY PANEL# 250001 0015 C \ yew\ \ = A 42" 77.00' PARCEL 24 MAP 126 87 New ZONE 2 17. DEED REFERENCES: 1.) DEED BOOK 23134, PAGE 31 / PARCEL 25 i 2.) DEED BOOK 1509, PAGE 354 1 oy V p :.' PROPOSED DISTRIBUTION BOX / 20,001 S.F.± 3 '� #�1 r . �, xt Coarse Sand 18. PLAN REFERENCES: 1.) PLAN BOOK 198, PAGE 43 / 631 4 A- ■ Y' C-1 2.5Y 6/6' 2.) PLAN BOOK 293, PAGE 93(ROAD LAYOUT) 19 ALL DISTURBED AREAS SHALL BE-RESTORED TO ORIGINAL CONDITION. f �" 20. PROPERTY LINE INFORMATION=IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY cod ' II FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY o - #264 �'�' � FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. o � EXISTING �.�� � � � " 3-BEDROOM °M c� .- 104" 71.83' DWELLING �O I LOCUS PLAN Medium Sand TOF = 82.7'± C-2 2.5Y 6/6 PROP.TOTAL 12 ARC 36HC BIODIFFUSERS 82- ' SCALE: 1"= 1000' (loose) (6 BIODIFFUSERS EACH TRENCH) o \ 120" 70.50' PROPOSED INSPECTION PORT WITH \\ No Mottling, Standing or Weeping Observed ACCESS BOX TO GRADE(TYP OF 2) \ \ TEST PIT DATA TP 1 © ---- -------- �p--------- " -- EXISTING 1,000 GALLON SEPTIC TANK TO BE 80.5 -- � � DESIGN DATA PERC NO. 12910 LEGEND UTILIZED AS PART OF THIS DESIGN INSPECTOR: David W.Stanton, R.S. 3390 NUMBER OF BEDROOMS(DESIGN) 3 EVALUATOR: Michael Pimentel, E.I.T. Benchmark#2 \ �c DESIGN FLOW 110 GAUDAY/BEDROOM Stake and Tack p4 TP 2 / C.S.E.APPROVAL DATE: Oct•27, 1999 50x0 EXISTING SPOT GRADE TOTAL DESIGN FLOW 330 GAUDAY Elev. =78.95' s°TREE �� `3 � � �,, 18^TREE / DATE: April 28, 2010 _-.. Approx. M.S.L. \ `r 80.5 1 2� j tv DESIGN FLOW X 200 % = 660 GAUDAY - 50 - - EXISTING CONTOUR �a �w MAP 15O TEST PIT#: 2 5 PROPOSED CONTOUR FLAG `� %c 4� PARCEL 41 USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 80.50' �9 ❑/H/W EXISTING OVERHEAD UTILITIES \ i ib ELEV WATER= <70.50' SHED \ �--EXIST. LEACHING PIT TO BE PUMPED & FILLED WITH PERC RATE= -W-W EXISTING WATER LINE CLEAN COARSE SAND &ABANDONED '(TYP. OF 2) INSTALL 12 -ARC 36HC (#3616BD) BIODIFFUSERS DEPTH OF PERC= TEST PIT LOCATION \ o / SWING-TIES SCALE: 1"=20' TEXTURAL CLASS: 1 Sg9° " LP -, °N "� SYSTEM CAPACITY FQ a EXISTING 1,000 GALLON SEPTIC TANK 36� 0 MAP 126 �3 o HG1 HG2 DESCRIPTION PARCEL 20 �94' 2 (TOTAL L.F.OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD BIODIFFUSER CORNER(1) 22.6' 45.3' (60.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING,/DAY 0" 80.50' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE Fill �L \6' k BIODIFFUSER CORNER(2) 30.8' 41.4' 10" Loamy Sand 79 67' 13 PROPOSED DISTRIBUTION BOX 7 / \ \ / BIODIFFUSER CORNER(3) 54.3' 71.0' TOTALS: B 4" 10Yr 5/6 78.50' `l \ /� � PROPOSED ARC 36HC(#3616BD)BIODIFFUSER Apo\ BIODIFFUSER CORNER(4) 50.1' 73.4' TOTAL NUMBER OF BIODIFFUSERS: 12 k\ TOTAL NUMBER OF COUPLINGS: 0 MAP 126 TOTAL LEACHING AREA: 468.0 SQ.FT. REV. DATE BY APP'D. DESCRIPTION TOTAL LEACHING CAPACITY: 346.3 GAL./DAY' PARCEL 19 C1 Coarse sand PROPOSED SEPTIC SYSTEM UPGRADE 2.5Y 6/6 (10-20%gravel) PREPARED FOR: #264 EXISTING NOTE: CAPEWIDE ENTERPRISES 3-BEDROOM EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE DWELLING DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER HC-1 TOF= 82.7'± "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO LOCATED AT ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003t(LAST 104" 71.83' 264 TREE TOP CIRCLE NOTES: MODIFIED FEBRUARY 18, 2010). TRANSMITTAL NUMBER=W000052. Medium Sand MARSTONS MILLS, MA 02648 z C-2 2.5Y 6/6 m HC-2 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE 1 (loose) SCALE: 1 INCH = 20 FT. DATE: MAY 10, 2010 OF EACH SEPTIC SYSTEM COMPONENT. 120" 70.50' 0 10 20 40 80 FEET 2) No Mottling, Standing or Weeping Observed ���jH OFMc 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF BUR �G� PREPARED BY: THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH RESERVED FOR BOARD OF HEALTH USE � c"",�`'''LL m� JC ENGINEERING, INC.. TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL (4 N �1 2854 CRANBERRY HIGHWAY BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 3. ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHED. SITE PLAN (3 508.273.0377 SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1807 _rtm r