HomeMy WebLinkAbout0140 ACRE HILL ROAD - Health 40 -Q&e Till, R?pd 1
Barnstable P.
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TOWN OF BARNSTABLE
LOCATION 140 ACA6 4T,L.L. SEWAGE# Z•Q21 -ZO1
VILLAGE Aa,,3�1 o�a L6 ASSESSOR'S MAP&PARCEL `ZC11 -f-
'
INSTALLER'S NAME&PHONE NO. Oaese 6, ®w2 "S7OS
SEPTIC TANK CAPACITY SOCK o, .
LEACHING FACILITY: (type) C-4AW,6 (size) Z5
NO.OF BEDROOMS
OWNER lC_ t . 1e— F ► kL4'��
PERMIT DATE: (,e I Z-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 E - � la
�14a d�ke� fl�'I(
i
I 22�q 2s,s
30.E 30.3 3
m
o $
l _
No. v/—2 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppliLation for -Mispo8al *pstrm Construction Vertu
Application for a Permit to Construct( ) Repair( ) Upgrade(X) Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. I Td ARE AD Owner's Name,jkddress,and Tel.No.
Assessor's Map/Parcel 29-71&ci Ho C 14 fLL jbe}tiLV5'-4E$4jS-
Installer's Name,Address,and Tel.No. 50 9 -471~8,9 77 Designer's Name,Address,and Tel.No. 509-X7 3 0*377
166C-A rg 60ix co 4 ::- EA)C—_Wc490—t A.YG, xp<-
343 IT-- Pwrq 5, Maw L,-r&4 CRe4A6 N Ed
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 7] Sc�-1-rsq.ft. Garbage Grinder( )
Other Type of Building fZ1F6 l'0EfJ i, LL No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 3 L19 u gpd
Plan Date 5 ('3 — ;1,0 X I Number of sheets i Revision Date
Title 114 6 Ac-RL7 I4 l L�, R�D 6kW S;T *&C -
Size of Septic Tank 1 ®®^^ Type of S.A.S.(A) 500 eaki- CtAd`'LPa�
S
Description of Soil k co tNb l�36 5e-& PLA1V
Nature of Repairs or Alterations(Answer when applicable) T11 6-r*-L(.. 016W 14"16 oa a GA41 off+
W t!PkDate last last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o ealt .
Signed Date 5-1
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No._ 2,W f:2,0 Date Issued A
---------------------------------------------------------------------------------------------------------------------- -
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w No. ,./ Fee
=p' r THE COMMONWEALTH OF MASSACHUSETTS Entered in.computer: Ye��
.j, ' ra PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS
;g application for Zisposar'*pstrm' Construction Permit
4,
Application for a Permit to Construct.( ) Repair( ) Upgrade ) Abandon( ) Complete System. El Individual Components
k Location Address or Lot No. !qORA,A r. IL Ra Owner's Name„Address,and Tel.No.
Assessor's Map/Parcel 2 -1 1A JgO&A ii 14MLM 6h STiE9C G
Installer's Namepoeaar Address,and Tel.No. '$d 9 .1477.8�71 Designer's Name,Address,and Tel.No. !'p$-X13-O'3T7,
type of Building:
`
Dwelling, No.of Bedrooms Lot Size S67;sq.ft. Garbage Grinder( )
Other Type of Building QES' 1060ThAL No.of Persons - Showers( )'Cafeteria( )
Other-Fixtures
° Design Flow(min.required) 330 t, gpd Design flow provided 3 gpd
' Plan Date Number of sheets Revision Date a `
Title 1!46--A4.ag 141 L.Lt R M-N SiTAIV .�
Size of Septic Tank Type of S.A.S. 60 5j 00�{, eAAf-%C -1r
Description of Soil M 4S 0 S&Lb NA ri "
40/ -
Nature of Repairs or Alterations(Answer when applicable) 77tjs hw— mew 1`4-1b " 0`,) GA44.Od
l�
t` "DT°iG SIC - b Aj e%j rk r 17�c�1�. "mil >~�z
Datg last inspected:
Agreement:'.
41 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 Healt �
+,
Signed ;V�L �. Date
Application Approved'by ( Date
Application.Disapproved by Date
for the following reasons
Permit No: `, _��")�:� Date Issued tdi 2
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded
Abandoned( )by ''AeT' 6 V X
at A ck j.��,��.. ,p has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. �.t (dated
Installer (, Designer
#bedrooms Approved.design flow Rio gpd
The issuance of this permit shall not be construed as a guarantee that the system will fun V'on designed.
Date Date !_ //../") /'' Inspector A 4PI
�Y�� ---^.°_•� ='�.'"�...>:-`cs.'`x'"-'ss- -i'?-c'-=""c'r.�. c..�-a= a..•-7�_��---�"-_.,�q:.:,�._.'* "�'T` .-...7-x.-q."�.."' -=^,-�*- ..F , -ter."^.�
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstrm Construction Permit
Permission is hereby granted to Construct( ) _ Repair( ) Upgrade( Abandon( )
.Systen0ocated at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized.his/her duty to comply with ;
r
Title 5 and the`following local provisions or special conditions.
Provided:Constructi hot be completed within three ears of the date of this permit.
P Y .
Date CS/ ��r Approved by
Town -of Barnstable
P
Regulatory Services `-
Richard V. Scali, Interim DirectorBAMMUZ
MAM
Public Health Divisionw
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601 .,
Office: 508-862-4644 Fax: 508-790-6304
}
Installer& Designer Certification Form
Date: 6-11-21 Sewage Permit# .ZOV .' Z-01 Assessor's Map\Parcel 297/69
Designer: JC Engineering,Inc. Installer: Robert B. Our Co., Inc. (Rl3
Address: 2854 Cranberry Highway Address: 363 Whites Path
East Wareham, MA 02538 South Yarmouth, MA
On RBO was issued apermit to install a
(date) (installer)
s
septic system at_140 Acre Hill Road based_an a design drawn by
(address)
JC Engineering,Inc. dated 5-13-21 -
(designer)
X I certify that the septic system referenced above was installed substantially according
to the design, which may include minor.apptoved 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 constructed i lance with the terms
of the I\A approval letters (if applicable) `-� qc 4
s
3�0 L yGa
0 CHURCHI JR. Co
(1 sta er's natu CM!
41
O,r
(D ner's Signature (Affix De 1 p Here)!
PL SE RETURN TO ARNSTABLE PUBLIC HEALTH D SION. 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
. .
TOWN OF BARNSTABLE
LOCATION 4 C e 11I L'L ZZ SEWAGE # 9003
'VILLAGE�A A R N S`7'h f6G C ASSESSOR'S MAP & LOT 29'7—®69
INSTALLER'S NAME&.PHONE NO: A C d IM
SEPTIC TANK CAPACITY D O D Q L G
LEACHING FACILITY: (type) .2- /?RY W 2LL 5 (size) AS
NO.OF BEDROOMS
2,UILDER'OR 0 R
PERMITDATE: D3 COMPLIANCE DATE: I Z) 3
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 Wedand and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
�.
- - � � � ate,/'d'
� � � �� �� �
� r
,� � �
��� �
v
� � �•�:
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s
s
S ( '�
i :r
` - ��
No. y� Fee' 5 0. DO/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYitation for Zi!6pool *potem Construction Permit
Application for a Permit to Construct( )Repair(X X)Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. 140 4 C 2 e H.l..e.e Road Owner's Name,Address and Tel.No. Pat t i c k f i.t z y e z a-e
Bazn.6ta9 te, tla,3,s. 02630 140 Acae Kiii Road
Assessor's Map/Parcel B a 2 n b t a Q e, /�a b/�. 026 3 0
��
Installer's Name,Address,and Tel.No.5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—2 7 3—0 3 7 7
a. P. Nacomge2 & Son Inc, aC CngineeAing 2854 C zanf e22y R'L'ghw y
Box 66 Cente2v.i.eee, Na.6-s. 02632 Cae.t Nazeham, rla.6,3. 02538
Type of Building:
DwellingYXX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) U m i t t.i n y e e a c h i n g 2 i t. I n.6 t o.e.e.i n g
2 500 rgae.eon .Qeaching chamge2,3 /tacked in 4 ' oie z" stone.
25 'X92. 9'X2'
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 Certifi-
cate has been issue b this B of alth.
cate of Compliancey
Signed c�,�.. Date ell
10131103
Application Approved by 4j4 Date 11 /a D31
Application Disapproved tor the following reasons
Permit No. Go e�- S-17 Date Issued a
: 00/'
No. Fe
50
.,�
A �..--p""' � �' $rifeied in computer:
THE COMMONWEALTH OF MASSACHUSETTS
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
a.ppY%cation for ;D grog pelem Com5truction PlernYct
r"XX Upgrade( )Abandon( ) ❑Complete System El Individual Components
Application for a Permit to Constntct( _ )Repair( )-Upg ( ) p d y
Location Address or Lot No. 14 0 A c 2 e fl.i.2 e Road Owner's Name,Address and Tel.-No. %a t 2 i c k T i t Z g e 2 a-
13aansta9-eP, Maus. 02630 1.40 4c/1r_/1` e, Poad
Assessor's Map/Parcel, q117.
.1 Baant
026 3 0
�s a g.2e, MCl�iS%5.
Installer's Name,Address,and Tel.No-5 0 81.7 7 5-3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—2 7 3-0 3 7 7
a• 1). Macomaea. 9 Son Inc. �C Cng.inge ing 2854 Caange-zay llighw ,y
Box 66 Centeay.iete Mas-s. 02632 Cast I�laae�iam, Na6.6. 02538
Type of Building:
DwellingyAvX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder
Other Type of Building E No.of Persons Showers( ) Cafeteria( ) "'
Other Fixtures
Design Flow �t gallons per day. Calculated daily flow gallons.
Plan Date. Number of sheets Revision Date
Title M
Size of Septic Tank Type of s A{5 3
j
Description of Soil
Nature of Repairs or Alterationsfknswei when applicable) 0m.i t t.i n p i e a c h 4",n g ?.it-. I n s t a i i i n g
2-500 oatton ieach.ina chamk84z Racked .in 4' o,E 1#\atone.
25'X 12. 9'X2'
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 Certifi-
cate of Compliance has been issue by this B,ar of Health.
Signed'`_ Date 10131103
� t
' Application Approved by Date 1 IA w 3
Application Disapproved for the following reasons
f
Permit No. 7) 00 - Date Issued i i J,a
——————---——-- ———-
- ———————————--
THE,COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Coutpiiauce
THIS IS TO CERTIFY,that the On-site:Sewage Disposal System Constructed( )Repaired(XX)Upgraded( )
Abandoned( )by 2. P. flacom&ea 9 ~Son Inc.
at 140 4cze Hi..r i Road /3aAnatakle, Mae . has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. a 003 'S 1-7 dated} f i k 3
Installer 2. //0. MacoMReit 9 Son Inc. Designer X Eng.ingea-ing
The issuance of this p rmit t&11 not be construed as a guarantee that the system will •ia d�esi d,w S'.
Date / 1 13 Inspector
No. �003 - gN7 Fee:$50. 00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS w
30igpozat *pgtem Conztructiori ermit
J
' Permission is hereby granted to Construct( )RepairXXA)Upgrade( )Abandon( ) `
System located at 140 4c/te fl.i._O?e Road Baansta&-ee, Maaa. {
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�permit.q
Date:_ I 1 [do/o 3 Approved by ��•���% �.
` TOWN OF BARNSTABLE
LOCATION SEWAGE # 9003`'S
VILLAGE AlAR ST'A /31-C-� ASSESSOR'S MAP'& LOT Z97-00
INSTALLER'S NAME&PHONE NO: la A4 A C CAI d e R f 5 Q,41
' SEPTIC TANK CAPACITY O 4 y - C L G�
LEACHING FACII.ITY: (type ,,y e L-� �/e L ,� (size
) ) �►
y
NO.OF BEDROOMS .3
BUILDER OR O R
PERMIT DATE: *2- 03 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility an wells exist
PP Y g tY (� Y
on site or within 200 feet of leaching facility) Feet y
Edge of Wetland and Leaching Facility(If any wetlands exist %-
j within 300 feet of leaching facility) - - Feet_
Furnished by !
i
�.J
ys l S�
s�
Commonweofth of Mossochusetts )n_i retigr®
Executive Office of Environmental Affairs "APR 2 3 Job Grad
-R P. Title V Septic Inspector
KO.O. Box 2119.
r .Environmental Prate �s' n � Te t
Department �f
icket, MA 02536
WII amFF.Wald 8 (508) 564-6813
Trudy tyoxs �?
BrcnlW,EOEA
o
David B. Struhs
Cmmhafony .: �, '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A +�
CERTIFICATION ...
Property Address: I y O AL fie `\\ \'�� i�p (`S1p s� Address of Owner. ;
Date of Inspection: `i L4 gip : (if different)
Name of Inspector:
Company Name, Address and Telephone Number.
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site-sewage disposal systems. The system: .
Passes
Conditionally Passes n, "
_ Needs Further Evaluation By,the local ApprovrnS Authont� _
Fails :. x.
k
Inspector's. Signature:, Date. y ���.q�
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days ofcompleting,this. ,
inspection. If the sE-stem 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 Department of Environmental Protection'''
The onginal should be Bern to the system owner and cope, sell' to tile buyer, if applicable and the appro,irg au.,h,oritj }
INSPECTION SUMMARY: :.
CheA B, C, or D
Aj SYSTEM PASS S: - - •_ .. a ;� _ <c` -a:,, .rU .,: +,
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303..
Any failure criteria not evaluated are indicated.below,
BJ SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired.' The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe,basis of determination`in all instances' If"not determined", explain why not) '
The.septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltrat on, or tank failure is
imminent.: The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as. -
approved by the Board of Health.
(revised 8/15/95)
One VAnter Rest • Boston,Massachusetts 02106 • FAX(617)5ib-1 W! Talaphona(617)202-5600
0 Printed on RKVded Paper
e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM'
PART A '
CERTIFICATION (continued)
Property Address:
Owner: 1� ;
Date of Inspection
B) SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution..box. The system.will pass.inspection if(with approval of the
Board of Health): R
broken pipe(s) are replaced;,m,
obstruction is removed'
distribution box,is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed _
_ t ,
"
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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING-IN,A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
-2) SYSTE:N WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER'SUPPLIER,,IF AP,PROPRIATE)'DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT,THE_PUBUC HEALTH AND SAFETY AND THE
ENVIRONMENT � -
1 hp �vsien) rids a >epilc tan' anu'luii d'u�orption systen!ar�d Is Vr�t('ull ,uv fcci iy q�ulq:c Lai. $up,J�'� v" uuta'� tc a':
surface water supply.
The s%i!en- ha, a septic tank and soil absorption system and is within a Zone l of a public water supply well.
. , , ;
_ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
_ The syuem has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private,'water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is.equai,to,Qr less than S'
ppm 4
' � .. `? :f .f - 1,;. . =a t ip .f�i.`1,�' vy ,p.:ri v>
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in`310 CMR 15.303. The basis
for this determination is id below. The Board of Health should be contacted;to determine what will be necessary to correct.
the failure. rR. .. r,.�.
AVi, _
Backup of sewage,into facility or system component due to an 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. r ,
(revised 8/15/95)
-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART.A
CERTIFICATION (continued)
Property Address:
Owner: [�
Date of Inspection:�\1
D) SYSTEM FAILS;(continued):
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 1/2 day,flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).i
Number of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation
Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds,`ammonia,nitrogen and nitrate.nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design..flo"• of system is 10,000 gpd or greater (Large System) and the system.is a significant threat to public health and safety,
and the environment because one or more ot.the following conditions exist:
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.a
_ the system is located in a nitrogen sensitive.area (Interim Wellhead Protection Area (I,WPA) or a mapped Zone h of a
public water supply well.
The owner or operator of any such system,shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department.for further information.
(revised 6/15/95) 3
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property A ress:
Owner: f
Date of,Inspection: L,y`Q`p
Check if the following have been done:
�=P mping information was requested of the owner, occupant,and Board of Health.
mane of the system components have been pumped for at least two weeks and the system has been receiving normal Flow rates
during that period: large volumes of water have not been introduced into the system recently or as part of this inspection.
(\,V*s built plans have been obtained and examined. Note if they are not available with N/A.
L�—The facility gr dwelling was inspected for signs of sewage back-up..
_L-TiTe system does not receive non-sanitary or industrial waste flow
L.Jhe.site was inspected for signs of breakout.,
VAS system components, excluding the Soil Absorption System, have been located on the site. .
�he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for.condition of baffles or
tees,material of construction, dimensions, depth of liquid,depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based,on existing information or
approximated by non-intrusive methods
�e fay f t} o ^n' '?n .nrriinantc i(diffprPnt frnm owner) were orovided.with information on.the proper maintenance of Sub-
. _ - :•
Surface Disposal.System. :: ..
(revised 8/15/95) 4
1;
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Ad ress: (:\C.`(e \-\c\\\
Owner: �>l Cn -1(1
Date of Inspection:
t�1C 4 FLOW CONDITIONS
RESIDENTIAL:
Design flow,_ gallons
Number of bedrooms: 2
Number of current residents:
Garbage grinder (yes or no):-A-IL)
Laundry connected to.system (yes,or no):\-'Q S
Seasonal use (yes or no):-\1210
Water meter readings, if available:
Last date of occupancy:
COMMERCIAUINDUSTRIAL:
Type of establishment: ,.
Design flow:_____.gallonsJday
Grease trap present: (yes or no)_,_
industrial Waste Holding Tank present: (yes or no),_ w
Non-sanitary waste discharged to the,Title 5 system:dyes or no),_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupanq:
GENERAL INFORMATION
PUMPING RECORDS and source of information(: P
System pumped as pan of inspection: (yes or no)-
If yes, volume pLimpcd JDCJZ� gallons ,
Reason for pumping: NeJ02 0&°.�
TYPE OF YSTEM
Septic tank/distribution box/soil.absorptron,system
_._ Single cesspool
Overflow cesspool
Privy
Shared system (yes or,no) (if yes_, attach previous inspection records, if any(
Other(explain)
• x
APPROXIMATE AGE of all components; date installed (if known) and source of information: O
Sewage odors detected when arriving at the site: (yes or no)
5
(revised 8/15/95)
i,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued) .
Property Address: 90 A CAL V11
Owner:
Date of I6s LCct rii
SEPTIC TANK: Lim" 4
(locate on site Tian)
Depth below grader
Material of construction: _✓concrete _metal _FRP_other(explain)
Dimensions: � 't ' ' '► 11
Sludge depth: it
Distance from top of sludge to bottom.,of outlet tee or baffle; alal')
t, _ „.... ...
Scum thickness:_
Distance from top of scum to top of outlet tee or baffle: t
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping, conditi of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integri evidence of leakage, etc,) Ct
G l
GREASE T.RAP•.�
(locate on site plan t
Depth below grade:
Material of construction: concrete metal FRP other(explain)
Dimensions:
Scum thjckne,b.
Distance from top of scum to top of outlet tee or baffle:
Distance from borto" ni Cnom fn bottom of ou!le! tee or.bahle:
Comments: s .
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
_t .., ,
(revised 8/!5/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: '1 b r[►
Owner:
Date of Inspe to�rG
TIGHT OR HOLDING TANKA�1(�
(locate on site plan)
Depth below grade:
Material of construction: _concrete meta) _FRP—other(explain)
Dimensions:
Capacity: _gallons
Design flow:- gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX; '
(locate on site plan)
Depth of liquidleve) above outlet invert:
Comments:
mote if levei and distnuulwn i>r.yuai, rvidrilCr cif SUiid� Ca ( �'�'Er
r evidence of leakage into or out of box, etc.)
'UMP CHAMBER:�j'
locate on site plan)
'umps in working order.(yes or no)
omments:.
Tote condition of pump chamber, condition.of pumps and appurtenances, etc.)
wised 8/15/95)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
_t
SYSTEM INFORMATION(continued)
t
Property Address: AO C..tQ
Owner: �(G n
Date of Inspection:
SOIL ABSORPTION SYSTEM
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods).
If not determined to be present, explain:
Type:
leaching pits, number.-L-MO Q t^��\Cf1 L.eaCn (�►
leaching chambers, number:_ �J
leaching galleries, number.
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Commenj: (note condition of soil, signs of ydraulic fail ui level of ponding,.conditiorl of ve 'Qn,etc.) ��.QCh ' J. w CfS
CESSPOOLS:
(locate on site plan)
Number and configuration
Depth-top of liquid to inlet invert:
Depth of solids layer: a
Depth of scum layer, x
Dimensions of cesspool
Materials of construction:
Indication of ground,;atc•:
inflow (cesspool must be pumped as part.of inspection)
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.)
(revised 8/15/95) 8
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
1 SYSTEM INFORMATION (continued)
Property A dress: ` l.�0 [ (C
Owner: w
Date of Inspection:
Li
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
79
flt .
fi gaa �1
DEPTH TO GROUNDWATER
Depth to groundwater:_ feet
method of determination or approximation: 3 C-5S
(revised 8/15/95) 9
LOCATION SEWAC PER T N
1:o -7`""
` VILLAGE -
ol V,- &
INSTA LLER'S _ NAM i ADDRESS
BVILDE�R�OR OWNER /
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED j-- �4 _ �C
L�cl G^
r
�va sC�
oil-
� C
�� 3 1
No .....�y Fps....�. e...
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® pOF HEALTH
C---C�.._N............OF.........4] 2 J1rQ.S.I./Q. fit. ..............................
Appliration for Disposal Works Tomuur#inn Prrutit
Application is hereby made for a Permit to Construct (L-*) or Repair ( ) an Individual Sewage Disposal
System at:
,tQ (�.. ..... !1.. . _...2b....:.....ZRNR UTA.RjL .................L4.7......./.i�L..............................................----
ocatio md si o No.
. ..---- . .-:.....-•---•---•.._..._ c - -
......................
---•----.---- ...............................................----
Installer Address
Type of Building Size Lot.;7l..5_rL9_...Sq. feet
Dwelling—No. of Bedrooms........-�.............................Expansion Attic ( ) Garbage Grinder (NO)
Other—T e of Building No. of persons............................ Showers — Cafeteria
Other fixtures .----••--•----••--•---•---•-•••--•• .
- -- -- -- ------- ---------- ---------------------- -------------
W Design Flow.......//V..........................gallons per4 9r0%y. Total daily flow........:Y�.O....................gallons.
WSeptic Tank—Liquid capacit)MOV _�...gallons LengthR. .`.'.__: Width_ !!.k" -'w.. Diameter................ Depth... .e`..
x Disposal.Trench—No. .......... ..... Width.................... Total Length..........._d........ Total leaching area........:...........sq. ft.
r
Seepage Pit No....../----__.._. .1.iameter....&....__..... Depth below inlet.... ........... Total leaching area----.p.q....sq. ft.
Z Other Distribution box ('' ) Dosing tank ( )
'-' Percolation Test Results Performed /_3.�t.....&-F-r-...... Date.......
,al Test Pit.No. I.._.�.?_minutes per inch Depth of Test Pit.../a......... Depth to ground
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil--...0..ZY..A V.D_..._Slrs SQ Lt=
v --------------------- ,c� �'i9�u
W
VNature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of LILT:..E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed.......Y ----v,.......-- --•-• .�.---•-•-••----•--- ..........................
Date
ApplicationApproved By........ - ------------------•--...........------------------------•-•------•-..._•--_.._.
Date
Application Disapproved for the following reasons------------------------------------------•--•-•-----•--•-----------------------••---•--•---•-----•-•--------_...
-----------------•---•---.......-•-----------------•---------•-------------------•------...-•-------...---------------------•••-•---•-••---••--•-----••-------------•----•------•-•----•------•••--•....
Date
Permit No......!Y!...-•---•-------•....................... Issued--• .-------Date ...................•
11
No. 7 ."....� Fxs.....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.Ltm2.N------.....OF......... /1
Applira#ion for Disposal Works Tonstrnr#inn Vrrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sev age'"Disposal
System at:
1�.. ..... ?!l..l. ...... a ,......... �f2A) �"AR1_.e.-----------------4�t r.......� .............................................ocatio ,Address o Lo�j No
r Add
Installer Address
Q Type of Building Size Lot. /_S.. ,2 ...Sq. feet
aDwelling—No. of Bedrooms..........�.....:.........................Expansion Attic ( ) Garbage Grinder (A00)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( )
d Other fixtures ..................................... ----"-------------------------------------•-•------...........---....----
;ff
W Design Flow........t,/, .........................gallons per..pe en rlay. Total daily flow....... ....................gallons.
WSeptic tank—Liquid capacity/40#0...gallons Length*. _"_.. Width-'.''.:'>O".. Diameter_--- p "o'
x
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft.
Seepage Pit No....../.......... Diameter.... ........... Depth below inlet..... Total leaching area_A�_ O.jQ....sq. ft.
Z Other Distribution box () Dosing tank ( )
'-' Percolation Test Results Performed by. 0.NAz.,15..AA�IA.Batt_ ..:A. «...... Date.......MA57.1Y...1 �;
Test Pit No. 1.....4.1 --minutes per inch Depth of Test Pit.../3.......... Depth to ground water..A!,O.MA.....
LEI Test Pit No. 2................minutes per inch Depth of Test"Pit.................... Depth to ground water........................
a •--••-•• -------------••--...................-- ---•-•-•......--••-••-----------._....----••••-••••---..........._.....................•--•_----
D Description,of Soil.... f.. _ al.. ' --•--. v.�'_'T' azl,...---------•-
-----------------------
4 ......... A-V....--fit r�,t..........,>/ .........................
w
--•-•-----------------------••------•--•---•-----•--•-----------•-------•--••--••--••--•-••...._....----•--•-•---_....•-•--------•-••-•---••---••---••---------•••--------••-••••-...........-•-•••.....
U Nature of Repairs or Alterations—Answer when applicable....................................•.._......•.-........................_..................-_.
----------------------------•------••----.........-•----•--•------.....---......................... ---•-------•----------------•-•-----------•---•--------------------------------....----•--.........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TT 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
_•.. _...: -._ Signed .... t3f4leP. ............... ....-•••- ate........_ - -
ApplicationApproved By......._ = `�...............................................................................
Date
Application Disapproved for the following reasons-----------------------------•--------------------------•-----------------------•-------------------------....•--
•---------•••-•--.........•••--•-•----•-----•----•...•••-----------------•---••------..._....---•-•........--•------•-•.....................•-----........................-•-•---•---Date.........-•---
Permit No. :14 -7 Issued ------
Date
T.1 E=COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
0.4A.)..AJ.............OF..........#J�!'Q. .�1... .%r"�.a '!................................
. .� Trrtifiratr of TunapliFanrr
THIS IS TO CERTIFY, That e Inu vidual Sewage Disposal System constructed ("I-or Repaired ( )
_ Installer
at...Z O••'-`-•..... ..........�.C-4.0_'.........Kyle:c...........R_b*=-------. .-......................................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..-._:_.....2Y-7_ .....7t..._. dated---t-----�!l "--��.................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. `
DATE................. Inspector._...- - 'p
THE COMMONWEALTH OF MASSACHUStETTS
BOARD OF H1kALfTW1
c .......tQ W ............0F.......... "A A. .!' .i .................... t!r
r FEE....::..... ......P.J
Disposal�] .arks Chu i nnrtwi n � wrath
Permission is ereby granted............V. I." ... •.. .................
to Construct or Repair ( ) an Individual Sewage Disposal System
at No.._40 .. ' '.kt.......: ' " :.... .f'I-' �! 12 . 9. °
Street . 7417,e
as shown on the application for Disposal Works Construction Permit No................... Dated.............................
:i: __._....
,
DATE...1 C B Health
11 •-- •-----••---•----
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ,
s y.t LOT
17
PRQP s�Pric
TANK LEI9Ctt
s s Pik_ 5 �--�' �.e
M a rz �i a 3 79
.74
`,e.� RES ROE, fare Pl�UL r�UR/691 XNS P CTI R- m T
TESL
r ,�L jg4 d- L AM—' /41dl� SUBSOIL c
., N o LJ
' YYY
e)[J/c..D/ivG S.E7-0ACA:f A2 C>U`rR'e—^145l./75
�20 DO SE.L7
V _ . _ •. '. , . �_ B�D ROOMS
SE P T/C S y5 TE-M COA-45 T2 UGT/ON
.-.{.HR n✓F�2 O M T 55
MA
ES FL A
, G N- FLOW G �..
E'XIST T,4G .COL7E /fTL
VC/-•/
�; ZT,
'YEA Z-i�4 i21�tiLLa 7 0^IS- o'
TOP OF d20a5
' �� • Q, MAiVf-IOL� Co✓E�, /NIpC ✓/QUS COVE2
a 1fVf T�//n/ P OF.
�/ /
. s / �H'EDG1 ;a D
F2orN /n/F14:72,47—IAA
A r '� _ � r 4 s •' r n•r CV VGA
4'GA5r 'Mid Zf.'"N/iDE O
/MC/M 4
/.TGi�/
- rV p
T. G
or A2� ^'tn� r�ircf� P�1r DiA`. ;
/W�5HE4' 4
fNK�ZT r / t C STOn/E
' /.IVvser
�t7 �,
SE pT/G Tit.�%:� ,.•, .> F ( r y Y'.F�EV• ; A 2 O Un/O
�W4 TGIz.7"/G/iT�
: ., •
T �p GA�6AGE Ge/Nz _ 9,0
S/ TE AL N 0L 1
LDCA7T/p/�/ L
OF
ShDLGN I—A_-LK.l�<� rAiver 1�iSTrziBUT/O�v. �Ox
. i .�A�i7,.'. �'� S OG�T�:.ETS� AfVD 'LEACH•✓/.VG .�/T`
itrhJq` , t� ' 3E OF .T�Ei�/F42GED CO.VCT�ETE
('� . ' No 503 ONG`2ETE ST,2EAVGT,/ . 3000 ems/
�f K E ,.
i d. �q STE�'�`.��. STEEL. 20000.
1%✓A•Y n/O T TD BE L`7,_A;E J
? C>�.:.� 7' fi� O✓.ECG 5ySTEM ui�/: 5j
= C. RTIy THE• .E3�1 't JN FiUtQ.AT/OfV '� ZD S/.C>!V.. L OA LD/�v6 /� 1JSED:
Zf�CAT1c P� l5 Cf-Q R CCT A S SHOWN N .�No
Z r . L)ES GOM P Y. l c)17'Y `rl/C /3UiC.DING - —'
. .
SET L3ACK IT45,,6LUiR-EMCIN T S or. -rH i Low,J
HEALT7/
�'y UL �� ► y�3 4 Pi�,e01/�1 L
PROVIDE
EN CONCRETE GENERAL NOTES
TOP OF FOUNDATION ELEV. = 115.30 EXTENSION RISER
WITH 5"DIA. OUTLETS) � FINISH GRADE OVER CHAMBERS= 113.30' - 114.20'
ER
CONCRETE COVER TO WITHIN 6"
REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM
OF FINISHED GRADE ABOVE ' 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2"DOUBLE WASHED STONE TO CROWN OF PIPE 1• UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISH GRADE FINISH GRADE FINISH GRADE OVER D-BOX=113.50 METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE
@ FND. EL.= 1 14.50 OVER TANK EL.=114.50' - 114.25' OUTLET COVER 2"OF 1/8"TO 1/2"DOUBLE WASHED STONE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES.
2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
20"MIN.ACCESS COVER TOP OF SAS= 111 .58' PLACE RISERS ON ALL CHAMBERS OF HEALTH AND THE DESIGN ENGINEER.
(TYPICAL FOR 2) 36"MAX. 9"MIN. TO 6"OF FINISHED GRADE 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL
EXISTING 4" 1 10.75' 36"MAX. BREAKOUT EL =1 1 1.25' BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED.
_E7� F_- I i PVC PIPE 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN
2"
6" 3" 3" g" - PROVIDE WATERTIGHT ELEVATION = 111.25' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS
JOINTS P.
DROP MIN. o 0 0 0 o A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
0 3"DROP MAX. 4"PVC IN FROM " 0 0 00 O oo THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
\0
T 14" SEPTIC TANK 4 PVC OUT TO o 0 0 0 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM.
1 12.63 I LEACHING FACILITY T o00 0 0 00 0 o0 6 THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
111 .91 ±
11 1 .71 ± �0 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN
*CONTRACTOR TO 111 .00, MIN. 110.83' 2 0 0 0 0 0 C) 0 0 0 0 CD`D
*CONTRACTOR TO CONTRACTOR SHALL VERIFY SIZE 48" IFY oo oo CDC,
IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO
VERIFY AND CONDITION OF TANK AND TEES VER " o0 0 0 BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH.
AND REPLACE AS NECESSARY GAS BAFFLE ON 6 CRUSHED STONE j o 0 0 0 0 8. ELEVATIONS BASED ON ASSUMED N.G.V.D. DATUM OF 115.00'
BOTTOM OVER MECHANICALLY -
COMPACTED BASE 4' 8 5' OBTAINED FROM A NAIL IN A TREE AS SHOWN ON PLAN.
4.0' 4.0 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
5 OUTLET DISTRIBUTION BOX 25.0' (-YP) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE
TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= 28' * 12.9' AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY
EXISTING 1 OOO GALLON CONCRETE SEPTIC TANK BASE. FIRST TWO FEET OF OUTLET 108.75 DISCREPANCIES TO THE DESIGN ENGINEER.
�� �� �� PIPES TO BE LAID LEVEL. 2- 500 GAL. CHAMBERS 5'MIN. 10. ALL JOINTS WHERE 1IPE ENTERS AND EXITS CONCRETE
LENGTH 8-6 WIDTH 4 -10 DEPTH 1-
CROSS SECTION VIEW STRUCTURES SHALL BE MADE WATERTIGHT.
SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR
NOT TO SCALE ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH
NOT TO SCALE NOT TO SCALE DETERMINATION FROM APPROPRIATE AUTHORITY.
12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
C TEST PIT DATA LOCATED UNDER PAVEMENT,
DRIVES OR TRAVELED WAYS IN WHICH CASE
THEY SHALL WITHSTAND H-20 LOADING.
"SWING TIES" SOIL EVALUATOR: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND
Samuel Philos Jensen
FINES
DATE: August 27,2003
DESCRIPTION HC(1) HC(2) 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND
V.,
TEST PIT#: 1 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF
` f SEPTIC COVER IN 3 25.8' 15.8'
n O LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
ELEV TOP: 114.65'
COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN
SEPTIC COVER OUT(4) 20.6 20.5
ELEV WATER: 28' ACCORDANCE WITH 310 CMR 15.255(3).
D-BOX O 5 47.7' 36.2' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
0 PERC RATE: <2 Min./In.
a SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
r r t2 SAS CORNER(6) 41.4' 33.1'
DEPTH OF PERC= 37"-55" 16. PROPOSED PROJECT IS LOCATED WITHIN:
a TEXTURAL CLASS: 1
SAS CORNER(7) 56.0' 57.7'Vil Y ASSESSORS MAP 297 PARCEL 69
m
17 RECORD E A
a 0 114.65
� � ' OWNER OF FITZGERALD, PATRICK J 8 CATHERIN
ADDRESS: 140 ACRE HILL ROAD
A Sandy Loam 10YR 6/3 BARNSTABLE, MA 02630
FEMA FLOOD ZONE C
B Sandy Loam 10YR 6/8 AS SHOWN ON COMMUNITY PANEL# 250001 0005 C
t
18. PLAN REFERENCE:
1. "SUBDIVISION PLAN OF LAND IN BARNSTABLE MASS. FOR JAMES K. SMITH,"SCALE 1"TO
33 111.90"
100', DATED MAY, 1976,AND RECORDED IN PLAN BOOK 311, PAGE 11 AT THE
Perc. BARNSTABLE COUNTY REGISTRY OF DEEDS.
r
55. Fine Sand 2.5Y 7/6
C1 Massive,V. Friable DEED REFERENC •
,,. ..
5-10 O 102
/o
t ° Graobbles v. C
20. ALL DISTURBED AREAS SHALL SEED TO ORIGINAL CONDITION.
.`i�ESTOR,.
" - ' 2 50 100 106.32 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
LOCUS SCALE. 1 - 1000 N871 _
�' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
400.00 Med.Sand 2.5Y 8/4 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
\ ` 79c ~ 777 C2 Loose, Single Grain
\ No Standing Water,
\ 770 MAP 297 Weeping,or Mottling
O Observed
Wp Vj ~ � \ 70
9 PARCEL 62 132" 103.65'
OD �70 *SOURCES: USGS HYANNIS QUADRANGLE AND BARNSTABLE GROUNDWATER MAP
W C) /46 \ ` ��� N/F CAIADO
EXISTING 1000-GALLON SEPTIC TANK DESIGN DATA LEGEND
_- -' 0$-_ `- - -- NUMBER OF BEDROOMS: 3
_ DESIGN FLOW: 110 GPD/BDRM - - 50 -- -- EXISTING CONTOUR
TOTAL DESIGN FLOW: 330 GPD
_- �_ ` DESIGN.FLOW X 200 % = 660 GPD F50 PROPOSED SPOT GRADES
x EXISTING CESSPOOL TO BE PUMPED AND USE EXISTING 1000 GALLON SEPTIC TANK �0 PROPOSED CONTOUR
•�2 �i✓p�� = 11' - 770- - - 1 FILLED WITH CLEAN SAND
E/T/C --- EXISTING UNDERGROUND UTILITIES
INSTALL TWO 500-GALLON CHAMBERS -- ------- w ---- EXISTING WATERLINE
ARDEN7��
\ � � SIDEWALL CAPACITY
GAS EXISTING GASLINE
7
ICI #1�0 �� - (7) _ (LENGTH +WIDTH)(2 SIDES)(EFF. HEIGHT)(.74 GPD/SQ.FT.)=GPD TEST PIT LOCATION
U EXISTING O (25'+ 12.9')(2)(2')(.74 GAUSQ.FT.)= 112.2 GAL. LEACHING/DAY
3-BbRM (4) IV N 0 0 EXISTING 1000 GALLON SEPTIC TANK
GAS DWELLING 7r o '.. `77� 0 BOTTOM CAPACITY
GAS (3) (6 c9 �, p (LENGTH)(WIDTH)(.74 GPD/SQ.FT.)= GPD 4"SOLID SCHEDULE 40 PVC PIPE
`- TOP OF FOUND. O Oo
r v \ GAS �` GAS 32.1 \ - C:) (25)(12.9)(.74 GAUSQ.FT.)= 238.7 GAL. LEACHING/DAY
r J EL.= 115.30 ❑ DISTRIBUTION BOX
g (5) TOTALS: 500 GAL. LEACHING CHAMBER
a
INSTALL TWO 500-GALLON CHAMBERS TOTAL LEACHING AREA 474.1 SQ.FT.
to00
QO GRAVEL DRIVE TOTAL LEACHING CAPACITY 350.9 GPD
% a \' 1 11/10/03 SJ JC RAISE S.A.S.0.25'
O o f REV. DATE BY APP'D. DESCRIPTION
D ,',' TP �� ;, PROPOSED SEPTIC SYSTEM UPGRADE
� -�- _ p PREPARED FOR:
Qp`I� B.M. 114 65 _ ', - MAP 297 114 1 9 PATRICK FITZGERALD
EDGE OFr Nail in Pine 5
Elev. = 115.00' _ _ PARCEL 69
LOCATED AT
Assumed NGVD DISTRIBUTION BOX 115
71,507 s.F.# 140 ACRE HILL ROAD
BARNSTABLE, MASS.
RESERVED FOR BOARD OF HEALTH USE
SCALE: 1 INCH = 20 FT. DATE: OCTOBER 28,2003
�OF0 10 20 40 80 FEET
ROUTE 6MID.- =400. 83 � JOHNL. ° m
CtiURCHtLL w PREPARED BY:
C/gPE R=9850, 00 C,L JC ENGINEERING INC.
HIGHWAY ,
No. 4� 2854 CRANBERRY HIGHWAY
:• EAST WAREHAM, MA 02538
SITE PLAN
. ' 508.273.0377
SCALE: 1"=20'
li#3 Drawn By: SJ Designed By:SJ Checked By:JLC JOB No.538
i
T.O.F. EL.= 115.31± FINISH GRADE OVER D-BOX=1 12.2'± FINISH GRADE OVER CHAMBERS= 1 1 1 .0' - 112.2' GENERAL NOTES
PROVIDE EXTENSION RISER SLOPE @ 2%MIN.OVER SYSTEM 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION
WITH COVER OVER INLET& FINISH GRADE OVER TANK EL.= REMOVABLE WATER-TIGHT COVER OVER 314"TO 1-1/2"DOUBLE WASHED
OUTLET TO WITHIN 6 OF F.G. � RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS STONE TO CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISHED GRADE 114.0 {, o „ CODE AND ANY APPLICABLE LOCAL RULES.
FOUNDATION= 1 14.5'± 5"DIA. OUTLET(S) MIN SLOPE 1 /o BOX TO F.G. (SEE NOTE 21) 2 OF 1/8 TO 1/2 DOUBLE WASHED
STONE OR GEOTEXTILE FILTER FABRIC 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
21"MIN.ACCESS DESIGN ENGINEER.
PROP. SCH. 40
COVER(3 TYP.) 9" MIN.MIN.
36"MAX. 1
9"MIN. TOP OF SAS=109.33' PLACE RISERS ON ALL 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
PVC SEWER PROP. SCH. 40 36" MAX. 1 Q$•rjQ' 3 "M 9IN. CHAMBERS WITH SYSTEM UNLESS OTHERWISE NOTED.
PVC SEWER BREAKOUT EL= 109.00 INLET PIPES TO 4. TO PREVENT BREAKOUT THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
2" DROP MIN. WITHIN 6"OF F.G.
MIN. 6 „SLOPE @ 1% 3"DROP MAX. 3" 9" L=32't ELEVATION = 109.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
- MIN.s�oPe �� PROVIDE WATERTIGHT 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
13" T4" PVC IN FROM JOINTS(TYP.) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
CONNECTION 14" 110.50' PTIC TANK 4" PVC OUT TO 0 0 0 0 0 0 0 0 0
LEACHING FACILITY p o0 00Sb
p o 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM.
1 1 1 .7 ± INLET TEE 12" 6" CD- o o 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
110.75' 48" OUTLET TEE Of/ MIN. 108.83' 2 100 o� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
TEES TO BE CENTERED o 0 0 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
GAS BAFFLE 6"CRUSHED STONE b o 00 oo NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
15.T OFFSET TO FND DIRECTLY UNDER RISERS OVER MECHANICALLY
AND DESIGN ENGINEER.
COMPACTED BASE 4.0'
5 8.5' (TYP) -I 4.0' 4_0' 4.83' 4•0' 8• ELEVATIONS BASED ON ASSUMED DATUM. BENCHMARK ELEVATION OF 115.00'
6"CRUSHED STONE OUTLET DISTRIBUTION BOX A TYP) ESTABLISHED ON A NAIL SET IN A TREE AS SHOWN ON PLAN.
OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE 25'0 - < , ( 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET /106.50' GROUND WATER ELEV.- 100.00 12.83' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
PROPOSED 1,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
*CONTRACTOR TO VERIFY EXISTING LENGTH 10'-6'' WIDTH 6-8" DEPTH 5r-$11 (Dimensions per CROSS SECTION VIEW 2 - 500 GALLON CHAMBERS 5'MIN. CHAMBER END VIEW
TO THE DESIGN ENGINEER.
T T T DETAIL TYPICAL CHAMBER PROFILECHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
ELEVATION PRIOR TO ANY WORK& ACMEJShorey)
NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
�-�• /� REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
••I-
1 I A APPROPRIATE AUTHORITY.
74
* PERC NO. 21-130
12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED
INSPECTOR: Donald Desmarais (BOH) UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR
` ` "' �W • EVALUATOR: Michael Pimentel, EIT, CSE TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING.
� CSE APPROVAL DATE: Oct. 27, 1999 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINE
S.
_
1, � DATE: May 6, 2021
+ 11 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
' TEST PIT#: 1 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,,
ELEV TOP= 111.00,
FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
ELEV WATER= < 100.00' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
LOCUS r:
PERC RATE *<2 min./inch
SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
_
w ,,
� 16. PROPOSED PROJECT IS LOCATED WITHIN:
J, lk �tk DEPTH OF PERC= *37"-55"
a N87° 12' S0"E sa
e \ ASSESSOR'S MAP 297 LOT 69
7 7J TEXTURAL CLASS: I
400.00' A �i9� v 7 # .
e OWNER OF RECORD: PATRICK J. &CATHERINE A.FITZGERALD
co ADDRESS: 140 ACRE HILL ROAD
MAP 297
a �1r\ 7�O BARNSTABLE, MA 02630
�T�\ \ PARCEL 62 x 0" 111.00'
�709 N/F CAIADO "�'�1 A Y FEMA FLOOD ZONE X
�- :m
Loam Sand
106` \1 .- 61 10Yr 3/1 110.50' COMMUNITY PANEL# 25001C0558J
.- _ �
1t76, ��� . .
"' ��� � ��°� 17. DEED REFERENCE: BOOK 10209, PAGE 304
_ - -107-_ _-' \ , { Sand Loamy' ( {
I3
- PROPOSED 1,500 w. <}` ;. 10Yr 5/6 18. REFERS BOOK 11, PAGE 11
PLAN REFERENCE: PLAN 3
108, GALLON SEPTIC TANK -' `, "`" 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
30 108.50'
PROPOSED ^= C► 20. THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL
_ INSPECTION�., = h NOT ASSUME ANY LIABILITY FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
,
-
_ 9_ - PORT ' i ` ` I
C *o 70 21. A 4"PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A
mo `'/ `� �` � .� � . .. �,
DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A
Medium Sand
ORO 112`� TP 1 C 2.5Y 6/6 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
17 a (5 TP 2 10�_
'bGK_� 111x0 111x0 - _. "a .�.,.. :° �...z. 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL
�.
HC- GARDEN 1 12 25.p• 6) REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT.
` �, 77� 45.9' -O '-7 PROPOSED TWO(2) 500 GALLON LOCUS PLAN
12_ LEACHING CHAMBERS W/ N
140 S), SURROUNDING AGGREGATE SCALE: 1"= 1000' 132 100.00
✓ 3 ,
EXISTING 7,� ��v' \ >
J °D o No Mottling, Standing or Weeping Observed
D GAS 3-BEDROOM --- p - J� PROPOSED D-BOX m
o �J GAS �� G DWELLfNG DECK (1 (2 _, DESIGN DATA
*Perk test taken from plan entitled
AS T®F- Proposed Septic System Upgrade at LEGEND
o = � GAS 115.3'± 1 .� EXISTING SOIL ABSORPTION 140 Acre Hill Road"dated 10-28-2003
1 SYSTEM (APPROX. LOCATION)
prepared by JC Engineering Inc. 50x0' EXISTING SPOT GRADE
C-2 \ ! TO BE ABANDONED NUMBER OF BEDROOMS (DESIGN) 3 - - 50 - - EXISTING CONTOUR
GRAVEL DRIVE ,� DESIGN FLOW 110 GAUDAY/BEDROOM
O 1 el, , T PITDATAr-t PROPOSED CONTOUR
�``' TOTAL DESIGN FLOW 330 GAUDAY
DESIGN FLOW X 200% = 660 GAUDAY PERC NO. 21-130 50 PROPOSED SPOT GRADE
INSPECTOR: Donald Desmarais(BOH)
11 MAP 297 USE PROPOSED 1,500 GALLON SEPTIC TANK GAS EXISTING GAS LINE
EVALUATOR: Michael Pimentel, EIT, CSE
g
00/ ( PARCEL 69 ❑/H/W EXISTING OVER HEAD WIRES
.�� EXISTING 1,000 GALLON SEPTIC C.S.E.APPROVAL DATE: Oct.27, 1999
OF B.M. TANK TO BE ABANDONED (i.e: i __ - �114 71,507 S.F.# DATE: May 6, 2021 W EXISTING WATER LINE
4C PUMPED, BOTTOM OPENED/ -11g,
OG�. Nail in Pine � TEST PIT#: 2
`�- Elev. = 115.00' RUPTURED AND FILLED w/CLEAN -_,_ INSTALL 2 - 500 GAL. CHAMBERS w/ AGGREGATE TEST PIT LOCATION
Assumed SAND) PER 310 CMR 15.354 �115 ELEV TOP= 111.00'
116-- SIDEWALL CAPACITY ELEV WATER= < 100.00'
--� 116 O O O PROPOSED 1,500 GALLON SEPTIC TANK
(LENGTH + WIDTH) (2 SIDES) (2' -HIGH) (0.74 GPD/S.F.) GAUDAY PERC RATE =
(25.0'+ 12.83') (2) (7 ) (0.74 GPD/S.F.) =112.0 GAUDAY
PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
DEPTH OF PERC=
BOTTOM CAPACITY TEXTURAL CLASS: I ❑ PROPOSED DISTRIBUTION BOX
(LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY QO PROPOSED 500 GALLON LEACHING CHAMBER
ROUTE 6 - MID-CAPE HIGH (25.0'x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY HIGHWAY L=400.83
R=9850.00
0" 111.00,
TOTALS; A Loamy Sand REV. DATE BY APP'D. DESCRIPTION
TOTAL NUMBER OF CHAMBERS 2 K101-� „6 10Yr 3/4 110.50, PROPOSED SEPTIC SYSTEM UPGRADE
TOTAL LEACHING AREA 472.2 SQ.FT. '
TOTAL LEACHING CAPACITY 349.4 GAL./DAY 7��� PREPARED FOR:
g Loamy Sand
1oYr 5/6 ROBERT B. OUR CO., INC.
NOTES: SWING-TIES 30" 108.50'
LOCATED AT
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH DESCRIPTION HC-1 HC-2 140 ACRE HILL ROAD
SEPTIC SYSTEM COMPONENT.
SEPTIC COVER IN (1) 27.9' 27.3' BARNSTABLE, MA 02630
C
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE Medium Sand
PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SEPTIC COVER OUT(2) 34.5' 34.1' 2.5Y 6/6 SCALE: 1 INCH = 20 FT. DATE: MAY 13, 2021
SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF CORNER OF STONE (3) 77.0' 80.T tN of µ JOHN L. 0 10 20 ao so FEET
�+
SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. CORNER OF STONE(4) 52.3' 61.0' CHURCHILL JR. PREPARED BY:
3.) PROPERTY IS LOCATED WITHIN GROUNDWATER PROTECTION OVERLAY DISTRICT. RESERVED FOR BOARD OF HEALTH USE CIVIL JC ENGINEERING, INC.
4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY FOR THE CORNER OF STONE(5) 56.1' 70.6' No.
INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS IN THE FIELD CORNER OF STONE (6) 79.6' 88.2' 132" 100.00, 1 atso7 2854 CRANBERRY HIGHWAY
EAST WAREHAM, MA 02538
PRIOR TO INSTALLING THE SYSTEM. CONTRACTOR SHALL NOTIFY ENGINEER IF SITE PLAN
MEASUREMENTS APPEAR TO BE INCORRECT. No Mottling, Standing or Weeping Observed 50$.273.0377
SCALE: 1"=20' Drawn By: SJI Designed By:SJI Checked By: MCP JOB No.538-1
_ _ _ _ -- - -- - - ----- - -- -- _ - -, ------ - --_ - _ ---- - _ -- -- -- - -------- -- ------- - -- -- - - _ - --- -' - ---- _ - - -------