HomeMy WebLinkAbout0379 MIDPINE RD - Health 379 MIDPINE ROAD, BARNSTABLE
A= 349 030
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� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftplication for Misposal *pstem Construction permit
Application for a Permit to Construct( ) Repair(X Upgrade(X Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Y)cl M WPI Ill E k> Owner's Name,Address and Tel No.,
Assessor's Ma /Parcel DAROSI — t(�W E Zv7��-Zf�JS I
p 3� P-OJ,4,0 GvmmA ut A
Installer's Name,Address,and Tel.No.501'—4 77 —8c8'-1 Designer's Name,Address,and Tel.No. j®g 63'71
CO�Pcw00C Et. ,f7iSES t�G �� CNC�[r�E1�1i�Cr�xfC
Type of Building:Dwelling No.of Bedrooms 14 Lot Size 612f L113 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures LL
Design Flow(min.required) q 0 gpd Design flow provided T�2�7> gpd -
Plan Date C?map( NumberAl of sheets ( Revision Date
Title 3 77 cl M I DR/iVe A(, &Dt ,4
Size of Septic Tank ( ,o0o cmocc Type of S.A.S. "500 Q4L K4Aa:i`
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
/=SET- 01P
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Si Date =p� a o
Application Approved by Date W &
Application Disapproved Date
for the following reasons
Permit No. Date Issued�z� r
- C• r•r. - ,}� .,t: .. � .. a t" �T - � .
• ` �� 4 rrx I
rd uZ
f.Z
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Fee o
w= —THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC.HEALTH DIVISION =TOWN.;OF,,BARNSTABLE, MASSACHUSETTS Yes
` ,.ftp1iLAtibn,for'MIB't' al *ps tem.Cone.trUttlon Permit
Application for a Permit to Construct( ) Repair( Upgrade l/`I Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 311 M�-D-P(N e k' Owner's Name,Address ,,and Tel No.,
Assessor's Map/Parcel 349/036I3�4�t*�5T�€ P 0� � uCUrM Alc u(
Installer's Name,Address,and Tel.No.509 SS''7 Designer's Name,Address,and Tel.No. Q$ C-PL73+1>3-0
I e.owewetXc?t S'T' MA&4Pam" 12154 QuWafiWIfJ Et kgrZ4AM
Type of Building:
Dwelling No..of Bedrooms 14 Lot Size p , ( sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( `) Cafeteria( )
t
14
Other Fixtures
Design Flow(min.required) l gpd Design flow provided _ a gpd
Plan Date '] �� 1 Number of sheets f
Revision Date
Title _,,�`
Size of Septic Tank tp y Type of S.A.S. j(fib 04L e�.�0�
Description of Soil L Q o4 Sig A l� (ttg/ 4/1)" P L4 AJ
e�
4
Nature of Repairs or Alterations(Answer when applicable) U.SC ( `�Lj& I j G& StorI �1 1
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date °- o�O
Application Approved by ,G =_ Date
ff '
Application Disapproved>2 Date
-' for the following reasons
t Permit No. C__ Date Issued g/el_za
` THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS -
Certifitate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded X)
Abandoned( )by (,AF9_Uj%1D 1± EIJ7e0,q S6'C 4,44
at �1'9 M IJ)P[Iy6� fRO RAPJ J has been constructed in accordance
with the provisions of Title 5 andd the for Disposal System Construction Permit No`Zn16-�Z- dated g17-1 /6
Installer CA,REW I T)4 KE< L.LC. Designer J C.
#bedrooms 44 Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system will 'ctidas designed.
Date ( � _1 Irn Inspector Tj, ,� ,
' _ - ------------------ --_---------- - --------------- ----------- ----------,,--,-��----------
No (5& Fee$f 0)d
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal lbpstem Construction permit .
Permission is hereby granted to Construct( ) Repair(x) Upgrade(k ) Abandon( )
System located at � m 1 r)P l lirm
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
r
Provided:Construction must be completed within three years of the date of this permit.
Date / ��(�!�i Approved by
�.; TOWN OF BARNSTABLE
LOCATION 3'7 9 N k b P( fl)�-: Rb SEWAGE#
VILLAGE
ST � ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. 7� Ta��@JS��C 4Z��7-�R7
�P�i�� C7�9 7
SEPTIC TANK CAPACITY I ,QOO C*Lt.00J
LEACHING FACILITY:(type WAacB (size) f�4 fC
NO.OF BEDROOMS- 4
OWNER EU C—%k -5 OLI LL 104 0 =V gai d j�C
PERMIT DATE: P 2—gyp 1 COMPLIANCE DATE: 9—4—;L O 1 6
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility NIA Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) N A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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mo-VO/VJ/4V 10 14.JJ JVOLIJVJOI K404L r. VV 1/VV 1
Town of Barnstable
Regulatory Services
' Richard V. Scali,Interim Director
t annMsTULL d
MAMPublic Health Division
Fowu�' Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
office: 508-862-4644 Fax; 508-790-6304
Installer& Designer Certification Form
Date: 6"5_1 Sewage Permit# a® �y d ,y Assessor's MaplParcel l :5G
Designer: SC C0g14ce.,'M5 70C. Installer: Ca�Zwicle- rnF�cPcis�
Address: 2S.51 Cranbercy Kgi iwaT 5 y,Address: 1 3 Co,y,( exci a l S-4(�CA
a Sk U)acc. um}N r1 6 z 53 $ p 2 (o y 9
On _$ a-—((v C-Qeew�cl(_ r=0terertseS was issued a permit to install a
(date) (installer)
septic system at 37 9 M�a�h�' ��` based on a design drawn by
(address)
SG 1;�lglncectn� , Toc" dated 7-29-1b ( Ceu,( 8-Hfiv)
(designer)
_AZl certify that the septic system referenced above was installed substantially,according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
were found satisfactory.
1 certify that the system referenced above was construc nce with the terms
of the IAA approval letters (if applicable)
o ti
c� JONN L. GsA
CHUR ILL JR.S=", r -+
VIL
(L stalle ' Signatu N •41 7
signer's Signat (Affix igne s St mp Here)
PL ASE RETU TO BA STABLE PUBLIC HEA 1I D IS N. CERTIFICATE
OF COMPLIADiCE WILL NOT HE
USSUED UNTIL BOT T411S FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU,
Q;1SepticTesigner Certification Form Rev 8-14-13.doc
Town of Barnstable P#
Department of Regulatory Services
>i a�nrterAer�o B Public Health Division Date G�i �(a
MAM
ieJ9 200 Main Street,Hyannis MA 02601 C:
Date Scheduled y _ A
Time Fee Pd..
SOU Suitability Assessment for Sewffie. isposal46
Performed-BY: ►'h i—
_. t t 1 Q� �l CG witnessed By: V' �•,
LOCATION&.GENERAL INFORMATION
I.ocadon Address
Owner's Name 6(fC_;exj6 ZQ11Z.�n/SKi
Address D9 PAtDP1N6 •RD RjAP,,lJ.
Assessor's Map/Parcel:` `® I , /�✓b Engineer's Name G NTCW�� LL C"
NEW CONSTRUCTION I REPAIR X Telephone#
LandUsa-. �QY�►I/� vQlIiYIQ Slo es %
ct J P ( ) Surface Stones
Distances from: Open Water Body > ' o ft Possible Wet-Area i ft Drinking Water Well i I m ft
Drainage Way i ft Property Line >La ft Other {t
SKETCH:(5trect name,dimensions of lot,exact locations of teat halos&•perc tests,locate wetlands I'n proximity to holes}
II ;
SC PICI)
C
i
i_ (� „
Parent material(geologic)OAl T�i(�s f) Depth to Bedrock � � 7 �. � 65 r
Depth to Groundwater. Standing Water in Hole:_ /`�/' Weeping from Pit Fnee � ,�y7 t
Estimated Seasonal High Oroundwater �,Y�)7/� B65
DETE ATION FOR SEASON•AL'HIGH WATER TABLE
Method Used: L?if PC i 0 .(efV4i01\
Depth Observed standing in obs.hole: >I y� • In, Depth to soil mottlest
Deilth to weeping from aide of obs,hole: (n, Groundwater Adjustmont .
Index Weil-#,+ Reading Date: Index Well level r..,, Adj,3hCtor ,�. � Adj.Groundwater Level„_—
PERCOLATION TEST Ugie'12-1E T1„tu ' , M
Observation
Hole# Tinto at 9" _
rr 0
Depth of Pero Q'� y Time at 6"
Start Pro-soak Time @ Time(9"-6") --,
t
gg
End Pro-soak
Rate Mtir./Tnch �a. '• '
Site Suitability Assessment: 51to Passed 51tp Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observdtion Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conselrvation Division at least one(1)week prior to beginning.
Q:ISEPTICIPERCPORM.DOC
DEEP-OBSERVATION HOLE LOG Hole# I
Depth from Solt Horizon Soil Texture Shcl Color Soil• Other
Surface(In.) (USDA) (Munsell) Mottling (Stnuetum,Stones(,,Boulders.
. tsistency.96'Otavoll
Uu 13 L04rp` fYc
>�
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in:) (USDA) (Munsell) r Mottling :(Structure,Stones,Boulders.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soll Other
Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders..
Consistanah
I
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Sall Color Sell Other
Surface(In.) (USDA) (Munsell) Mottling (Structure,SRopes',Boulders.
t
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes . ____
Within 500 year boundary Nov, Yes '
Within 100 year flood boundary No.V_._ Yes
Depth of Naturally Occurring Pervious Ma erlal
Does at least four feet of naturally occurring per�(1 us material exist in all areas observed thrpughout the
area proposed for the soil absorption system? 1
If not,what is the depth of naturally occurring pervious material? .,
Ceftification
I certify that on�o"� ' 9 (date)I have passed the soil evaluator.examination approved by the
Department of Environmental Protection nd that the above analysis was performed by me consistent with .
the required training expertise and e e once described in 10 CMR 15.017.
Signature Date T 2 9 A ' ,
Q:Wl3PTIC\PBRCPORM.DOC
Commonwealth of Massachusetts
Executive Office of Envirol<unental Affairs
Dept. of Environmental Protection ,John Gil-Ad
One winter Street,Boston,Ma. 02108 D.E.P. Title V Septic Inspector
P.O. Box2119
Teaticket, MA 02536
(508 564-6813
WILLIAM F.WELD
Governor l®
ARGEO PAUL CELLUCCI
Lt.Governor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO
PART A
�8 �H
CERTIFICATION 8561'
9 W
Property Address: 379 Midpine Dr.Cummaquid Map 349 Lot 30 Address of Owner:
Date of Inspection: 618198 (If different)
Name of Inspector: John Graci Kevin Choi:379 Midpine Rd.Y a art +
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000)
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:
x Passes This Inspection Is based on criteria defined In Title V
code 310 CMR 16.303.My findings are of how the system is
_ Conditionally Passes performing at the time of the Inspection.Myinspectiondoes
Needs F the Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the
septic system and any of Its components useful life.
Fails
Inspector's Signature: ��� Date: e18lg8
The System Inspector shall Ibmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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 Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C,or D:
A] SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B]' 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of
CoMpl)ance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection,or
the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfillralion, or lank
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 007197)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 379 Midpine Dr.cummaquid Map 349 Lot 39
Owner: Kevin Choi:379 Midpine Rd.Yarmouthport
Date of Inspection:619199
_ Sewage backup or.breakout or high.static water level observed.in.the distribution b.ox is due to a broken,
or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if
(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled 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
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) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must Indicate either"Yes"or"No"as to each of the following:
1 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 identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage in 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
cesspool.
SAS is in hydraulic failure.
(revised MUST)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIOWFORM
PART A
CERTIFICATION(continued)
Property Address: 379 Midpine Dr.Cummaquid Map 349 Lot 39
Owner: Kevin Choi:379 Midpine Rd.Yannouthport
Date of Inspection:619198
D]SYSTEM FAILS(continued)
Yes No
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).
Numbers 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.
s
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. 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.
E] LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 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 of the following conditions exist:
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)
_ 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 04127197)
y.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 379 Midpine Dr.Cummaquid Map 349 Lot 39
Owner: Kevin Choi:379 Midpine Rd.Yannouthport
Date of Inspection:619199
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
_c_ — Pumping information was requested of the owner, occupant,and Board of Health.
x None of the system components have been pumped for at least two weeks and the 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.
x As built plans have been obtained and examined. Note if they are not available with N/A.
x — The facility or dwelling was inspected for signs of sewage back-up.
x — The system does not receive non-sanitary or industrial waste flow.
_x— — The site was inspected for signs of breakout.
x All system components, excluding the Soil Absorption System, have been located on the site.
x The 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.
x _ The size and location of the Soil Absorption System on the site has been determined based on
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal Systens.
x Existing information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is
unacceptable)[15.302(3)(b)]
(revlsed 04117)97)
u ..
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 379 Midpine Dr.Cummaquid Map 349 Lot 30
Owner: Kevin Choi:379 Midpine Rd.Yannouthport
Date of Inspection:618199
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 440 g•p•d./bedroom for S.A.S.
Number of bedrooms: 4
Number of current residents: 2
Garbage grinder(yes or no): Yea
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available:(Iast two(2)year usage(gpd):
rda
Sump Pump(yes or no): No
Last date of occupancy: n1a
COMMERCIAL/INDUSTRIAL:
Type of establishment: n1a
Design flow:0 gallons/day
Grease trap present: (yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: rda
Last date of occupancy: We
OTHER:(Describe) We
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Na
System pumped as part of inspection: (yes or no)No
If yes,volume pumped:0 gallons ,
Reason for pumping: nla
TYPE OF SYSTEM
x Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) ( if yes,attach previous inspection records, if any)
I/A Technology etc.Copy of up to date contract?
Other:
APPROXIMATE AGE.of all components, date Installed(if known)and source Information:
1984
Sewage odors detected when arriving at the site: (yes or no) No
(revised 04127197)
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C'
SYSTEM INFORMATION (continued)
Property Address: 379 Midpine Dr.Cummaquid Map 349 Lot 39
Owner: Kevin Choi:379 Midpine Rd.Yarmouthport
Date of Inspection:6/8199
SEPTIC TANK: x
(locate on site plan)
Depth below grade: 2'
Material of construction:x concreate metal FRP Polyethylene other(explain)
If tank is metal, list age na . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions: 1_e16^H67"W410"
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle: 24"
Scum thickness:0
Distance from top of scum to top of outlet tee or baffle:6
Distance form bottom of scum to bottom of outlet tee or baffle:0
How dimensions were determined: measured
Comments:
(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.)
Septic tank and all components are structurally sound and functioning property.Recommend pumping every two years.
GREASE TRAP:
(locate on site plan)
Depth below grade: rda
Material of construction: concrete metal -FRP Polyethylene— other(explain)
Dimensions: rva
Scum thickness:rda
Distance from top of scum to top of outlet tee or baffle:rda
Distance from bottom of scum to bottom of outlet tee or baffle:Na
Date of last pumpingnt.
Comments:
(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.)
rda
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 2V
Material of construction:_cast iron x 40 PVC_other(explain)
Distance from private water supply well or suction line?own
Diameter: 4"
Gdomments: (conditions of joints,venting,evidence of leakage, etc.)
(revised 04127197) x
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 379 Mldpine Dr.Cummaquid Map 349 Lot 39
Owner: Kevin Choi:379 Midpine Rd.Yarmouthport
Date of Inspection:618199
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: nfa
Material of construction:_concrete_metal_FRP_Polyethylene—other(explain)
Dimensions: nla
Capacity: n1a gallons
Design flow: Ma gallons/day
Alarm level:_nra Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
r'da
DISTRIBUTION BOX: x
(locate on site plan)
Depth of liquid level above outlet invert: liquid level vAthbottomofpipe
Comments:
(note if level and distribution.is equal, evidence of solids carryover;evidence of leakage into or out of box etc.)
DBox Is structurally Bound.
PUMP CHAMBER:
(locate on site plan)
Pumps in working order.(yes or no)No
Alarms in working order(yes or no) Yes
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
nla
(revised 04127)971
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 379 Mldpine Dr.Cummaquid Map 349 Lot 30
Owner: Kevin Choi:379 Midpine Rd.Yannouthport
Date of Inspection:618199
SOIL ABSORPTION SYSTEM(SAS):x
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
rda
Type.
leaching pits,number: one 1000 gallon leach pit
leaching chambers, number:Wa
leaching galleries, number: n1a
leaching trenches, number,length: Wa
leaching fields, number, dimensions:Wa
overflow cesspool,number:n1a
Alternate system: n1a Name of Technology:_rd
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
Leach pit and all components are structurally sound and funcdoning property.There Is 6"of leaching Iek
CESSPOOLS:_
(locate on site plan)
Number and configuration: n1a
Depth-top of liquid to inlet invert: n1a
Depth of solids layer: nla
Depth of scum layer: Wa
Dimensions of cesspool: Wa
Materials of construction: Wa
Indication of groundwater: We
inflow(cesspool must be pumped as part of inspection)
n1a
Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
n1a
PRIVY:_
(locate on site plan)
Materials of construction: Wa Dimensions: Wa
Depth of solids: We
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
He
(revised 04127)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
379 Midpine Dr.Cummaquid Map 349 Lot 30
Kevin Choi:379 Midpine Rd.Yarmouthport
618198
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
n 151 A
Q
r QA fLc
A R
Rc 31
VA �(L
0
(revised04)27197) Page f of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) .
379 Mldpine Dr.Cummaquld Map 349 Lot 30
Kevin Choi:379 Midpine Rd.Yarmouthport
618199
Depth of groundwater 12.
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting property,observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators, installers
X Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS maps and charts
(revlaed04127197) page 10 of 10
-SN&--T Z of Z S�/E�Ts
e..
TOP OF FOUNDATION
CONCRETE COVER
CONCRETE COVERS
4"CAST IRON 1I2"MAX. 7'm7z7r
OR SCHEDULE 40 12 MAX. •
P.V.C. PIPE 4"SCHEDULE 40 P.V.C.(ONLY)
1J, PITCH 1/4"PER.FT PIPE - MIN. LEACH
PITCH 1/4 PER.FT. PIT
PRECAST
INVERT LEACHING
%•, EL..7.8.•34.. INVERT INVERT p w c: PIT OR
�.o INVERT SEPTIC TANK EL 777/ DIST. EL7B6 ,_ ,
BOX ' ' EQUIV.
. . . .. .. GAL. INVERT INVERT ^i "a O'
a; EL..77•.88.. w w p :�: 3/4"To I I/2 EL77.o3 u.a M.o EL.�/r..?o a'.' w WASHED
o w r.
STONE
6'D I A.17
PROFILE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
r NO. SCALE
SOIL LOG WITNESSED BY
DATE TIME./ :3o A+/, 2o•v CiF�'o ep ,2,S,
�. BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 Lo,•v d� W�Z� Z /C.. , ENGINEER
ELEV. ELEV. . .•So. . ..:
S✓a son- s B o/e- � DESIGN DATA
4 FN4- sicry ,3
FiNdr N -smy0 NUMBER OF BEDROOMS
S%t TOTAL ESTIMATED FLOW . . 3.30 . , GALLONS/DAY
BOTTOM LEACHING AREA �j3.9. . . SO.FT. /PIT
SIDE LEACHING AREA . . . . . . SQ.FT./ PIT
GARBAGE DISPOSAL
FN� S/4wD (50 /o AREA INCREASE)
Sy,�o TOTAL LEACHING AREA j�7• �. . SQ.FT
PERCOLATION RATES.?�9?�. / MIN/INCH
,No. .WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .`.f3 74. SQ.FT�C.RD.
NUMBER OF LEACHING PITS . Pr.J-V-17 /
APPROVED . . . . . . BOARD OF HEALTH !' • - of S7v.v.— o.v AGL SiD�S
DATE . . . . . . . . . .
AGENT OR INSPECTOR
��PVtH Of �N OF�i1gS` c
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o KELLEY
i`li�,0in/� 20,E No.26100 Z
O
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PETITIONER °suevE
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LOCATION . f-jA?2ivsT�r3l�E J. /Iq ss,
SCALE PATE
►'LAN REFERENCE �37NG LoT ��o
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IZ7�! .774.
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KELLEYrnr TCJ.13E � q.
No.261op
00
�Gl P I CERTIFY THAT THE
�4# sT E�o� $FLOWN ON THIS PLAN IS LOCATED ON THE GROUND
SU AV AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
. . . . WHEN CGNSTRUCTED.
DATE , , . . . . .
JZoW -Z6 le',ov.TJ,t4---T/o�v �'p — P&-77-10n/ ftE01STEREO LAND SURVEYOR
ey 3 3 � 4Vl
L0C TION SEWAGE PERMIT N-0.
VILLAGE
INSTALL 'S MA & IDDRESS
R U I L D E R OR OWNER
DATE PERMIT ISSUED s
DATE COMPLIANCE ISSUED 3® /
\ ko
._� 'y
_AP1-1-UrI,CATI0:+ FOP, PEt2C0LAT. 0Zj TEST AND-, OBSrERVATIO:a TITS
LOCATION_ Lo T 140 v / ���,�}A Lfj NO. n-
VILLAGE DATE C /
APPLICANT CV",1Acs?1,p HILI-S Oe• T . FEE zt;, _
ADDRESS47?x4,41 V S?; y�42l�Io cJi�{/�O.eT TELEPHONE NO. (Non-refundable)
ENGINEER Lo to 6 J&_z Le-R_ I N C _TELEPHONE NO,36 Z -6F
DATE SCHEDULED_ D,6G 3 :30 44
' (Appl cant' s signature)
• • • • • • • w • • o • • • • • • • o 0 0 • • • • • • • • o •'• o • • • • • • • o o e • • e • • • e • • • • o • • • • • • • e • •o • • • • • • • o o e • s • e •
SOIL LOG .
SUB-DIVISION NAME c/,v.y�yt ����----��y DATE Z ,3 .�/ - TIME 16
EXPANSION AREA: YES NO �c� uJs`c C�? ,� ENGINEER --�
TOWN WATER_ZPRIVATE WELL szz":nj BOARD OF HEALTH
EXCAVyTOic
SKETCH:' (Street name, etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes)
NOTES:
2/7.6g'.
n
yV
o
\a�
PERCOLATION RATE: ��-'•-f r gJ�.S!
TEST HOLE NO: / ELEVATION: TEST HOLE NO: Z- ELEVATION:
� 1
2 • 2
3 o� a.r ,sv So i cs 3
4 4
7 7 7 '
8 8'
9 9 Cc,c�9-J i--j F'
10 , 10 J�
• 11 11 ,��
12 12
13 13 XG _Z
14 , 14
15 15
1616
SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD L
T_L'Ar`T-ITrT� TPI`KTI`gFlC.
UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS :
NOTE: ENGINEERING PLANS MUST SHOW NUIHBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: CO,'•IPLF.TED IN F.NTTRF.TY BY P . F . AND RFTURNF,D TO BOARD OF FIF.ALTH
COPY: RETAINED BY APPLICANT
A'
l
is
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
............. w.........0F.......1-74121 ,�,
ApplirFation for Biipaaai Works Tomitrnrtinn Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
i1,C�fr�1.jE:...� ........... .. ras 3 G.e) /�c�
Location-Address or Lot No.
W
.�' & -_Owner •---------- Address
Installer Address
Type of Building t Size Lot____-_--------------------Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
04 Other fixtures -------------------------------- -
W Design Flow...............s'S'�..................gallons per person per day. Total daily flow............Tf ....................gallons.
WSeptic Tank—Liquid capacity/ ..gallons Length Width. �'_ Diameter________________ Depth-.6-..W.", \'
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------/.......... Diameter.....14......... Depth below inlet.���_�_.._. Total leaching area._.I�O.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
`-' Percolation Test Results Performed by----- `+� .. C < fC Date... 0 ... `��/
y------------------
Test Pit No. 1--- __-_minutes per inch Depth of Test Pit.................... Depth to ground water-----------------------
GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...............
•........::........•---•.........
0
xDescription of Soil..... ....... �f S° -1--�•--•--•-'--••-•-•------•---•------•-------------
W •••--•------------------•-----------------------•-•-------•-----------------------•'----------•---------------•----------------------•-•---------------------------•--------•-------•------•-----•------
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
-------•-----------------------------------------•--------------------------------................-----......---------------------•----------------------------------------------------------......•--.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT 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.
tned----•-•........ .._.�.«. -- == ---------•--•-•-------•----••----•--
Application Approved BY =. -• .................................................................................. att�-/-------
Date
APPlication Disapproved for h following reasons- --------------------------••--•----------------------------------------------------------------•-----•---.._...
-•-------•-----------•-----------------------------------------------•-----------------------------••-••------•----------------------•-------•-------•--•---------------•---------------'--•---•--------
Date
PermitNo......................................................... Issued.......................................................
Date
s
Nf ...
-' THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. . ........OF......
�.j.9i2/�1. G��..........................
Appliration for Disposal Workii Tonitrnrtion Vanfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
--?.. ......................................................i3 ...•. Go 7"__._ ----......-----..............--
---------------------- ------- --........
Location-Address or Lpt N,oq
WG-2L CQiI/S_'M .._�, wAZ/�dGE�
-----•...............• ..._....---------•••--------------••/--•-•••-ires ..........................................
Owner Address
a ----•-------••••---•-------•----••-••••••-•••--••-----•........................................... •.....•-•-•...------.........••------•-----.........•••---•-----••...............................
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms....:....... ............................Expansion Attic ( ) Garbage Grinder ( )
PLI Other—Type of Building .........................•.. No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures
W Design Flow............... ........................gallons per personper�day. Total daily flow--- -330..._. gallons.
WSeptic Tank—Liquid capacit/ .._gallons Length. G....... Width`� --_ Diameter---------------- Depths '
x Disposal Trench—No..................... Width.................... Total Length.................... Total.leaching area....................sq. ft.
Seepage Pit No-------/........... Diameter.._14........ Depth below inlet 3fs........_. Total leaching area.3 7 9...sq. ft.
Z Other Distribution box ( ) Dosing tank (
'-' Percolation Test Results Performed by....l-Gb✓__._ ....................................................W Date..P ....5 4�;8
G3 �-------------------
Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----- ------------•---•---------
x Description of Soil... � 'r Sc�. Sri -----
_
------------••------•--------•-------------------------------------------•----
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
------------------------------------------•----------------•-------•-----------------....------.....----------•---------------------------------------------...------...--------------...---......•---..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI M' 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.
igned.............. �_._.
r"- D r`
Application Approved By........ ._
Date
Application Disapproved f o t following reasons-----------------------------•---....----------------•----------------------•--------•-----------••----.....-•-•-
---------------------•--••••••-•-•••......--•---....------•-•--------•-•--------------...._..---•-•-------------•-...-------------•-•-------------•------------•••-------•-------•-------------...__..._
Date
PermitNo.......................................................- Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............o.'.^��+ ..........OF............ ..........................................................
wrtif irFate of Tomplinnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ((/f or Repaired ( )
by . ...................
-- Installer - ---------- - -----------------------------
at. la .......... -`^ f d= - ......................-------------------------------------------------------
y S been,i stalled in accordance w' i the provisions of T of �T State Sanitary C,rade s bed in the
ptn for Disposal Works Construction Permit No.. �_' ............... dated--- _ ---- ----- ..........................
THE IS8 ANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM L F CTION SATISFACTORY.
DATE....... �•-�1-------•-•-----------------------•------•------------- Inspector.....11-----• -----.-----------•----------..•----------------•.-----.--•-•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No -.... � FEE........................
Disposal Works Tonntrurtion eranit
Permissionis hereby ranted-•---------------------•-•----------------•-.-----------•-------•-------•-....-------•----------•-•-------....---•••---......-•----••.
(t,./j to Construct it ) an Ind' ' 1 S rag isposal System
- ✓ b
at No............... ---------• ,
Street
as shown on the appl' tion f isposal Works Construction Perml ................... Dated.............9'._. .___.-.
------------- ---- --------------------------••-----------•--------•----•-------••-......•...._.._
�� �/ Board of Health
DATE....... ........... ...
1255 A. M. SULKIN, INC., BOSTON
T.O.F. EL.= 84.8'f FINISH GRADE OVER D-BOX = 81 .0't FINISH GRADE OVER CHAMBERS= 80.6' - 81 .1' GENERAL N GTE S
PROVIDE H.D.P.E. RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED
w/COVER TO WITHIN 6" REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISH GRADE OF F.G. (TYP OF 2) RISER TO WITHIN 6" OF FINISHED GRADE 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS
@ FND. EL.= 84.0'f F.G. OVER TANK EL. - 5" DIA. OUTLET(S) MIN SLOPE 1% 2"OF 1/8"TO 1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
- 83.5 t BOX TO F.G. (SEE NOTE 19} STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES.
-�-20"MIN.ACCESS f ---- ---- .-- ---- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
COVER(TYP.OF 3) 9"MIN. TOP OF SAS=78.08' PLACE RISERS ON ALL
PROPOSED 4" 36"MAX. 9 MIN. CHAMBERS WITH 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
EXISTING 4" PVC SEWER PIPE � „
SEWER PIPE 77.25 36 MAX. BREAKOUT EL= 77.75' INLET PIPES TO 6" OF SYSTEM UNLESS OTHERWISE NOTED.
FINISHED GRADE
I611 3" 3" DROP MAX 3„ g„ L = 441± 4. TO PREVENT BREAKOUT THE PROPOSED FINIS
HED GRADE SHALL NOT BE LESS THAN
2 DR MIN MIN.SLOPES 1"/, PROVIDE WATERTIGHT ELEVATION = 77.75' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
4" PVC IN FROM JOINTS TYP. 40 MIL GEOMEMBRANE LINER IS PLACE LACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF
14" \ *79 6'± SEPTIC TANK • 4" PVC OUT TO O O o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
' LEACHING FACILITY o °o �
12 6 p 0 0 0 00 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
CONTRACTOR CONTRACTOR SHALL OUTLET TEE 78.00' MIN. 77.83' 2� oo °° 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL,
SHALL VERIFY SIZE 48 VERIFY CONDITION OF 00 p o0
AND CONDITION OF EXISTING TEES •, 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
�--GAS BAFFLE 6 CRUSHED STONE o Q o00 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o � 0 0 0
TANK NECESSARY COMPACTED BASE NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
5 4.0' 8 5' (TYP) 4 0' AND DESIGN ENGINEER.
OUTLET DISTRIBUTION BOX 4.0` 4 83' 4 0 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 80.00'
TO BE INSTALLED ON A LEVEL STABLE
BASE. FIRST TWO FEET OF OUTLET 33.5 < 60.00+ (TYP.) ESTABLISHED ON A FIRE HYDRANT BONNET, AS SHOWN ON PLAN.
EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 75.25' GROUND WATER ELEV.= 12.83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
_ CROSS SECTION VIEW 3-500 GALLON CHAMBERS 5' MIN. CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
pn�/ TYPICAL CHAMBER PROFILE 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
"CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE: DISTRIBUTION' BOX DETAIL TO THE DESIGN ENGINEER.
TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE
CHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
NOT TO SCALE
�T E S T PIT DATA TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
` C lr r � o � �• - REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
11° �
O/y^,O 0 5 ' - PERC NO. 15102 APPROPRIATE AUTHORITY.
'vI 4 PERC N0. 15102
SWING-TIES SCALE = 1"=20' �.'� vV� 4 G 'j/ ° . w, INSPECTOR: David W. Stanton, RS INSPECTOR: David W. Stanton, RS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
M'°gNy Ty r' ( �1 • W. EVALUATOR: Michael Pimentel, EIT, CSE EVALUATOR: Michael Pimentel EIT CSE LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
DESCRIPTION HC-1 HC-2 L THEY SHALL WITHSTAND H-20 LOADING.
�ASFM FcTl4ic -----` [ C.S.E. APPROVAL DATE: Oct. 1999 C.S.E. APPROVAL DATE: Oct. 1999
CORNER OF STONE (1) 33.3' 53.0' \ �NT " DATE:__ July 12, 2016 DATE: August 4, 2016 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
CORNER OF STONE(2) 33.3' 75.4' �` . �+ X, r TEST PIT#: 1 TEST PIT#: 3 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
CORNER OF STONE (3) 44.9' 83.9' _ ° I,. E;; „ f° ELEV TOP= 81.00, ELEV TOP = 80.50' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
.- t n
;' ' . ,, / 1/a � ELEV WATER= <69.00' ELEV WATER= <68.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
CORNER OF STONE(4) 44.8' 64.5' wt... , n J l "
15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
PERC RATE _ <2 min./inch PERC RATE _ <2 min./inch
} LOCUS SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
MAP 349 DEPTH OF PERC = 40"-58" DEPTH OF PERC= 40"-58"
rn LOT 30 o Q, ��fr`;' • 3` % ` - 16, PROPOSED PROJECT IS LOCATED WITHIN:
; . r - TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 ASSESSOR'S MAP 349 LOT 30
62,413 S.F.± �gtit -
a NI ` `� i // -' • '"` - ----- OWNER OF RECORD: EUGENE P. & LILLIAN E. ZUBRINSKI
N rK f - _K ZONE 2
�, �s - „ 0„
M 4 ?, �A y: 0 81.00' 80.50'
- ""'"'�! _ �' - � �'� - . �.... �'��, <- - j Fill Fill ADDRESS: PO BOX 331
„ CUMMAQUID, MA 02637
80.17
FEMA FLOOD ZONE X
_, ER PROTECTION W / 4Jr-` � Loamy Sand Loam Sand COMMUNITY PANEL# 25001 CO559J
GROUNDW A Y pls�RICT _ ., 10Yr 5/6 10Yr 5/6
r� OVERLA > '` L; 17. DEED REFERENCE: BOOK 11607, PAGE 140
r`" '�-` ��
a, 18. PLANREFERENCE: PAN
40" 77.67' 40" 77.17' 362, PA L BOOK GE 69
Perc Perc 19. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A
kA°0 M ! �.: ° _ J� f _..' ' 76.17' DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A
,• Y•�(,, _' .�a i 55" 75.67 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
_. Loamy Sand Loamy Sand 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
I k_r C 2.5Y 6/4 2.5Y 6/4 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
C FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
(Trace of Silt) (Trace of Silt
„/ � � � ~ / °''• •"•. .�r,.. ` Ili;* �f i �'.,;• � � )
21. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL
REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT.
LOCUS PLAN
SCALE: 1" = 1000'
�'' DECK #379 EXISTING 1,000 GALLON SEPTIC TANK 144° 69.00' 144" 6$5p� LEGEND
EXISTING -TO BE UTILIZED IN THIS DESIGN
4-BEDROOM w No Mottling, Standing or Weeping Observed i No Mottling, Standing or Weeping Observed EXISTING SPOT GRADE
_.._ --
DWELLING �41 �, DESIGN DATA TEST PIT DATA TEST PIT DATA EXISTING CONTOUR
APPROX. LOCATION OF EXISTING TOF= 84.8±
UNDERGROUND UTILITIES ",,, gyp, , qs
PERC NO. 15102 PERC NO. 15102 50 PROPOSED SPOT GRADE
i �ry o EXISTING LEACHING PIT TO BE INSPECTOR: David W. Stanton, RS
PUMPED& FILLED WITH CLEAN, , INSPECTOR: David W. Stanton, RS
r� PROPOSED CONTOUR
COARSE SAND AND ABANDONED EVALUATOR: Michael Pimentel, EIT, CSE EVALUATOR: Michael Pimentel, EIT, CSE
�.� STOOP NUMBER OF BEDROOMS (DESIGN) 4
r ,� l C.S.E. APPROVAL DATE: Oct. 1999 C.S.E. APPROVAL DATE: Oct. 1999 �% - EXISTING UNDERGROUND UTILITIES
LP �` DESIGN FLOW 110 GAL/DAY/BEDROOM DATE:_ 2016 DATE: August 4, 2016
July 12,
TOTAL DESIGN FLOW 440 GAUDAY EXISTING GAS LINE
�'•`� HC-2 � � � TEST PIT#: 2 TEST PIT#: 4
\ o-CN
o Q DESIGN FLOW x 200 % - 880 GAUDAY ELEV TOP= 81.00' ELEV TOP= 81.00' W W- EXISTING WATER LINE
\ 12" 2„ / M �OJ USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER= <69.00' ELEV WATER= <69.00'
MAP 349 16" ko TEST PIT LOCATION
LOT 94 ~ / / S PERC RATE = PERC RATE _
Z 4U
\ HC-1J - 10 1 12 / / Q DEPTH OF PERC= DEPTH OF PERC = O O O EXISTING 1,000 GALLON SEPTIC TANK
d Qo
INSTALL 3 - 500 GALLON CHAMBERS w/ STONE
3 ?r' \ 12" 18" �4 TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
s„ a 82 - ��, / SIDEWALL CAPACITY
10" (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY 0 PROPOSED DISTRIBUTION BOX
/ 1 \ 10" (1) 12" 2)ER 2) / (33.5'+ 12.83') (2 ) (2' ) ( 0.74 GPD/S.F.) = 137.1 GAUDAY p„
\ PROP. DISTRIBUTION BOX 81.00' 0" 81.00'
d TP-1 10„ --
I f �> PROPOSED 500 GALLON LEACHING CHAMBER
N�2o J I 00 10 m' 12 ? BOTTOM CAPACITY Fill Fill
4 80.67 4 80.67
f239'4gpw , .-,Jx °,: �a 0 TP 3 / (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY
J18 ° 8•O�xS d' /12° RESERVE AREA (33.5'x 12.83') (0.74 GPD/S.F.) = 318.1 GAUDAY B Loamy Sand Loamy Sand
7�--.
(4) 81 x 33.5' \\ ^� 10Yr 5/6 B 10Yr 5/6
PROPOSED 3-500 GALLON 1b`-.15"- 1 8-4-16 MCP JLC Added TPs 3&4 and reserve area
LEACHING CHAMBERS
' � "` TOTALS:
WITH AGGREGATE a 12 0 , 40" 77.6T 40" 77.6T REV. DATE BY APP'D. DESCRIPTION
\ / 22" 2('„ TOTAL NUMBER OF CHAMBERS 3
yigM a u Q� 6 TOTAL LEACHING AREA 615.1 SQ.FT.
PROPOSED SEPTIC SYSTEM UPGRADE
(40-W gD ,,: a' Fz�36o�o f PROPOSED INSPECTION PORT WITH TOTAL LEACHING CAPACITY 455.2 GAL./DAY PREPARED FOR:
W/o 1'-- - N68, 02 27 W �78 \ �, Loamy Sand Loamy Sand
�Y01J7 �- 1010' � 1s„-18' � ACCESS BOX TO GRADE (TYP OF 2) C 2.5Y 6/4 C 2.5Y 6/4 CAPEWIDE ENTERPRISES
(Trace of Silt) (Trace of Silt)
LOCATED AT
Benchmark 379 MIDPINE ROAD
Hydrant Bonnet ARNSTA LE, MA
Elev. =80.00'
Approx. M.S.L. SCALE: 1 INCH = 20 FT. DATE: JULY 29, 2016
f 144 69.00' 144" 69.00' ►►e4t4 0 10 20 ao so FEET
j NOTES: 11� l
No Mottling, Standing or Weeping Observed No Mottling, Standing or Weeping Observedr
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH RESERVED FOR BOARD OF HEALTH USE , Jor L. �,
PREPARED BY:
CyvE� JC ENGINEERING, INC.
SEPTIC SYSTEM COMPONENT. CHuRcr+iLL JR. �.
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE ;,` Nt�.'4�807 2854 CRANBERRY HIGHWAY
PROPOSED LEACHING SYSTEM TO ENSURE CONSISTENCY WITH TEST PIT DATA �� ; ?' ^T EAST WAREHAM, MA 02538
SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SITE PLAN � -'• _ 508.273.0377
SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. SCALE: 1"=20' � ,.� DnMm By: SA - Designed By:MCP f Checked By: JLC JOB No. 3543