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HomeMy WebLinkAbout0012 SPYGLASS HILL ROAD - Health 12 Spyglass Hill Road Barnstable A= 355-002-002 I� i I �I a a l TOWN OF BARNSTABLE gAT SEWAGE# L MGE ASSESSOR'S MAP&PARCEL 35Y-1- 02-07— INSTALLER'S NAME&PHONE NO. gj, Oe,.(L "5D8� 88-77 SEPTIC TANK CAPACITY I SM LEACHING FACILITY:(type) �(_(k�yy�;Z (size) M 03 }C ZS NO.OF BEDROOMS 3 OWNER of P4 0 -4 Ge­ P PERMIT DATE: !i W`n COMPLIANCE DATE: 1 2 Separation Distance Between the: "-TT�� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility NO t't7 H•5 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 ou-e. CO. _ A i �2 ,� z. �� ►s 53o.a �� o . s a No. ✓ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �- Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9pplito.tion for Mr0i iW 6pstem Construction Permit `r� Application for a Permit to Construct( ) Repair ":Abandon( ) ❑Complete System ❑Individual Components h. Location Address or Lot No. f 5��� /�,gQ(Z) Owner's Name,4ddress,and Tel.No. C"M vl j RoLAA b Fx4�5 FprR/ice Assessor's Map/Parcel t� Installer's Name,Address,and Tel.No. 3jQ9--4"7 7 $ff 7 7 Designer's Name,Address,and Tel.No. 568-a73-Q-37 % i t a RCV !�!9 &UH 4F� Type of Building: $ Dwelling No.of Bedrooms 3 Lot Size v27 0 O 1 — sq.ft. Garbage Grinder( ) Other Type of Building R6R; D&W'rl A-(_. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided ��5 gpd Plan Date 3 )1- vZ®1 i Number of sheets f Revision Date Title e 2- SP YCVA_5S 14!LL AMD C'_U nil C c)t jb Size of Septic Tank i �,�, ('(rp Type of S.A.S.6A) 'z� g.A.C, a&wsasz Description of Soil Z 0&1r y 5 I-t> (X� d e / 6C'5 i)zyk) Nature of Repairs or Alterations(Answer when applicable)- Us.= �rl�`t«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,--. Si Date Application Approved by Date (� Application Disapproved by Date for the following reasons Permit No. ' Date Issued ''•F,..y,.;.q.♦cur,«...:u'W+�...-.wa„i" "'"`-` t.. -. '-:.#-,-� • _:�yr".sa*4.e �, .+:-�w pA.,--..,. v `. ��n. drs.;.,v� ;NVFW.+ ^^.`2: 1.�. '�`6.e, ,,,...� _ ,.k.,,, . �„ -4 ''i..:s.V 1 �•� �...-•-•..-"�. s F ;. �'.1rr��s�"-•x Min .''.,'�''� �'u ?6� .. M w. . VA _ " No. , A Fee Entered in computer: ' THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE,,MASSACHUSETTS. . ,ice 2pplicatto for.II�tl08 r ip8tem onstrUtt101i hermit , plication foPerm . o Complete System ❑Individual l Componentsra it to Construct Rep it _Ap t Location Address or Lot No. Owner's Name,Address and Tel.No. ; C rl >��D FtvL AM�> d 4"45 FC)t1al��,:.,,�� Assessor's Map/Parcel 35 /oz-6a $P�fG�FSS ,�lG� R Installer's Name,Address,and Tel.No. SOS:-4'77'-$$7`T Designer's Name,Address,and Tel.No. SbSs� 173-0377 O�Q2T b 40k Co Type of Building: Dwelling No.of Bedrooms a 3 'Lot Size 017,01� "`' sq.ft. Garbage Grinder Other Type of Building Rm1 I A! No.of Persons Showers( Cafeteria( )' 1 � Other Fixtures Design Flow(min.required) v � gpd Design flow provided�� gpd u Plan Date _3 3 I- 0 01.1 Number of sheets Revision Date . ' Title 1� 52)LGrW� 14 L.C. AQAZ) 4, Size of Septic'Tank !_� G-�{ )�S Type of S.A.S. { 5' " Description of Soil L.U� a� ,(� �� �rj¢'' illy F T � � �•.tl� tits", �� `Nature of Repairs orAlterallons(Answer when applicable)��_SfG :�. `�� /( 500 GAL Q A) 6 C�rL�;, �x : ��-�� ���,r����7('�1 �� �,,�.cL�.l Ltar�R.�r ��r4�e •. Eti�sA;. f r; 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 theEnvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt E Signed + Date -'• °rj--sC3.f Application,Approved by bate �j�/ (pA� Application Disapproved by Date for the following reasons IPI Permit No. q ' Date Issued to r --------------- ---- - - - - - -- - --------- -- -- - - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-stte Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by� 7 is OaL �tk. a, at I'l S A YG—[�S� 14ILL. An. Cc3RW�4C�t)has been constructed in accordance with the provisions of Title 5 and the for+Disposal System Construction Permit N . V' dated I d- Installer R Ud� A 6(j� � Designer ZG CWGj aU e4exi X IS Xu� #bedrooms Approved design flow ,� d gpd The issuance of this permits all not,be construed as a guarantee that the syste w 1 furl on as deNgned. ' Date �j// Inspector ey ' i 1.: :qy,; -..�{ "j£ -^'-.b.�'. 1. .14.: 4 1L ✓Y�"N' *ter, _-__ �(/+���¢c.Jc.�:-1-� _�--n .•. .No. ____. w ...-. .. x., r Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH'DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction Permit Permission is hereby granted to Construct( e.) Repair( Upgrade( ) Abandon( ) System located at 1 S��G—LT> f((„(_ fK(� GU1c�Ikl �U 1 and as described in the above Application for'Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed/with/in three years of the date of this permi. ""'""""°�. Date / LU� ( Approved by i r . Town of Barnstable- Regulatory Services ' Richard V. Scali,Interim Director &MMS'AB E 9 MAMM Public Health Division . 16s9. Thomas McKean,Director ' 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 ". Fax:f Y508-790-6304 Installer& Designer Certification Form M ' Date: 5-17-21' Sewage Per mit# ZQZ,I " Ilko Assessor's Map\Parcel 355/02-02 . Designer: SC ,.E0i J(n eer0 ":r V1 Installer: Robert.B. Our Co., Inc. (RBO) Address: 2 8 5`1 Cron�oe.rry �l i�1n w n y_ Address: 363 Whites Path r ns 4 uuarzJ+�a�n N 0 z 53 ,. South Yarmouth,MA On RBO ..was issued a ermit to install a (date) (installer) p septic system at 12 Spyglass Hill Road based on-adesign drawn by ¢ + (address) r _ datedy 3-31-21 .T (designer) t X I certify that the septic system referenced above was installed substantially according' to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was in, 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 iance-with the terms of the I\A approval letters(if applicable) '�wy�PLSn GF 14gSs9c6 JOHN L °� # CHURCHILL,11t CA s a ler's nat e) CML 41 (D 'ne"r's.Signature r (Affix:De p Here) PL SE RETURN TO ARNSTABLE PUBLIC HEALTH D SION.r CERTIFICATE OF COMPLIANCE_WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS ' BUILT CARDARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. ' :THANK YOU. f: Q:\Septic\Designer'Certificatiorr Form Rev 8-14-13.doc t , . , f 'F Commonwealth of Massachusetts- r { p Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 12 Spyglass Hill Road Cummaquid M -355 P-002 Property Address . Alvan Fuller _ Owner Owner's Name information is PO 408 Cummauid MA 02637 April 2 2015 . . Box , q required for every State Zip Code Date of Inspection page. city/Town D. System Information (cont.) 4 Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: IG ® hand-sketch in the area below ❑ drawing attached separately ' 2 11 71 3S 16, (1 1 t5ins•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts y �. p . Title 5 Official-Anspection F rm,. W Subsurface Sewage Disposal System form-Not for Voluntary Assessments y 12 Spyglass Hill Road, Cummaquid ° '` " M -4355 `P 002 M Property Address1 .. a ,. 1. ... .. Alvan Fuller Owner Owner's Name information is QT1 required for every P.O. Box 408, Cummaquid MA . 02637 April 2, 2015 . page. City/Town State _Zip Code' Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end.of the form.' Important:When filling out forms A. General Information ' on the computer, 4 " use only the tab 1. Inspector: .y> key to move your �• cursor-do not Troy Williams use the return key. Name of Inspector 7 - Troy Williams Septic'inspections " �y Company Name _ 19 Hummel Drive `" r Company Address F South Dennis `MA 02660 4 CitylTown ,. , •. State . 'Zip Code , . (508)385- 1300 S1682 r Telephone Number License Number'"' e B. Certification ° I certify that I have personally inspected the sewage.disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience iri the`proper function'and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of, ' Title 5(310 CMR 15.000).The system: y ,., ® Passes ❑ Conditionally Passes ❑4 Fails ❑ Needs Further Evaluation by the Local Approving`Authority ' t April 2, 2015 Inspector's Signature' r r Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow.of 10,000 gpd or greater, the inspector and the system owner shall submit the .report to the appropriate regional office of the DEP. The original should be sent to the system owner ` and.copies sent to the buyer, if applicable, and the approving authority. • ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. •L t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 4, _i r `. Commonwealth of Massachusetts w Title 5 Official Inspection Form s Subsurface Sewage Disposal System form-Not for Voluntary Assessments 12 Spyglass Hill Road, Cummaquid M-355 P-002 Property Address Alvan Fuller Owner Owner's Name information is p O B8 required for every P.O. 408 , Cummaquid MA 02637 April 2, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: .. ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. B) System Conditionally Passes: y ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"'please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts = Title 5 Official- Inspection Form Subsurface Sewage Disposal System"Form -.Not for Voluntary Assessments 12 Spyglass Hill Road Cummaquid -'M -355 P-002 Property Address Alvan Fuller Owner Owner's Name , .F information is P.O. Box 408, Cummaquid' „ MA ; 02637 April 2, 2015 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) y t , ❑ Pump Chamber.pumps/alarms not operational.,System will pass with Board of Health approval if pumps/alarms are repaired.. -- ; : r . •: : ., , B) System Conditionally Passes (cont.) ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken;_settled,or'uneV6n distribution box.System will pass inspection,if(with approval of Board of Health): ;: ❑ broken,pipe(s)are replaced �,, ❑ Y ❑, N s Q ND(Explain below): ❑ obstruction is removed .w `t . , - ❑ Y aEl N f,❑_ND (Explain below): ❑ distribution box'is leveled or'replaced ❑ Y ❑ N •❑ ND (Explain below): AL ❑ The system required pumping morethan 4 times a yeardue to broken orbbstructed pipe(s). The system will pass,inspection,if.(with approval of the'Board of Health): ❑ 'broken pipe(s)-are replaced ❑ Y ^❑ N ❑ ND (Explain below): ❑ obstruction is removed ' ❑ Y : ❑ N ❑ ND(Explain below):, A. C);, Further Evaluation is Required by the Board of Health: ❑ Conditions exist which `require further evaluation by the`Board of Health in order to determine if the system is failing-to protect public health, safety or the environment. A. System will,pass'unless Board of Health determines in,accordance-with,310 CMR V - 15.303(1)(b)that the system is not functioning,in,a manner which-will,protect public'health, safety and the environment: . .., a ❑ Cesspool or privy is within 50 feet of a surface water LL ❑, Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.,, t l5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of V Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �., 12 Spyglass Hill Road, Cummaquid M -355 P -002 Property Address Alvan Fuller Owner Owner's Name information is P.O. Box 408 Cummaquid MA 02637 Aril 2, 2015 required for every _ � p page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: .You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or 4 clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts r Title 5 official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Spyglass Hill Road, Cummaquid M 355 P„-002 Property Address 7 = Alvan Fuller Owner Owner's Name information is p O. Box 408 Cummaquid 'MA.. 02637 Aril 2, 2015 a required for every _ - � ' `' - P page. City/Town State Zip Code Date of Inspection B. Certification.(cont.)' j. Yes No Required pumping more than 4 times in the last year NOT due to clogged or E] .® obstructed pipe(s). Number of times pumped: [I ® An portion of y the SAS,,cesspool or privy is below high ground water elevation. 0 ® Any portion of cesspool or'privy is within"100 feet of a surface water supply or. tributary to a surface•water supply. - L Any portion of.a cesspool or privy;is within a Zone 1 ofTa public Well. . ❑,11 ® • 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 r100,feet but greater:than 50 feet from a private water supply well with no acceptable water-quality analysis. [This n, system'passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, -provided that no other failure criteria are triggered:A copy,of the analysis_ and chain of custody must be attached to this form.] The system is a cesspool serving a,facility with a design flow of.2000gpda ❑. 10,000gpd. t The system-fails. I'have:determined that one or more.of the above failure ❑_" ® criteria exist as described in 310 CMR,1&303, therefore the system fails.-The system owner should contact the Board of Health to determine what will be necessary to correct the failure" gip„ J E) Large Systems: To be considered alarge system the system must serve a-facility with.a design flow of 10,000 gpd to 15,000 gpd. For.large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. <, Yes No El ttie system is within 400 feet of a.surface drinking water supply' N, ❑ ❑ jhe,system is within 200 feet of.a tributary to a�surface drinking water supply= El Area system is located-in a nitrogen sensitive area (Inter6 Wellhead Protection - Area-IWPA)or.a mapped Zone,ll`of a-public-water,supply well y If you haveanswered'yes"to any,question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3l13 -� • Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page,5 of 17 Commonwealth of Massachusetts Title 5 Official I Inspection l�s action F®r s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Spyglass Hill Road, Cummaquid M -355 P-002 Property Address Alvan Fuller Owner Owner's Name information is required for every P.O. Box 408 Cummaquid MA 02637 April 2, 2015 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as.N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑. Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection Ford- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments h 12 Spyglass Hill Road, Cummaguid M -355 P-002 Property Address Alvan Fuller Owner Owner's Name information is p O. Box 408, Cummaguid MA 02637 April 2, 2015 required for every .- page. Cltyrrown State, Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ® Yes ❑ 'No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes No Laundry system inspected? :x:k ® Yes ❑ No b, Seasonal use? r ❑- Yes ® No 14=48000 gals. Water meter readings, if available(last 2 years'usage(gpd)): t. 13=45,000 gals. Detail: t t„ Sump pump? a, t ❑ "Yes ® No occupied Last date of occupancy. Date Commercial/Industrial Flow Conditions t R Type of Establishment: Design flow(based,on,310;,CMR_15.203):, „�, N/A -Gallons perday(gpd), Basis of,design flow(seats/persons/sq.ft., etc:): N/A Grease trap presents „ `.. „ . ; t ❑ 'Yes ❑ No Industrial waste holding tank present? r ❑ Yes "❑ No� Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No x Water meter readings, if available: N/A t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 r Commonwealth of Massachusetts -- W Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments a �.H 12 S _Spyglass Hill Road, Cummaquid M 355 P-002 Property Address Alvan Fuller Owner Owner's Name information is p O. Box 408 required for every , Cummaquid MA 02637 April 2, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): N/A General Information Pumping Records: Source of information: Owner having tanked pumped after inspection. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts : Title 5 Official lhs- pection# dorm Subsurface Sewage Disposal System Form,Not for Voluntary-Assessments 12 Spyglass Hill Road Cummaquid M-355 P-002 • - Property Address Alvan Fuller Owner Owner's Name information is P p Box 408 Cummaquid MA-- 02637 April 2, 2015 ' required for every State . ' Zip Codes *Date of Inspection page City/Town D. System Information (cont,) . c i n:to ~ nd source of informa _ f known a A proximate age of all components; date-,installedY (i ) Tank, d_box and leaching were ins talled d on 3/15/90 per com ance. _ iry • Were sewage odors detected,when arriving at the sites -, ❑ Yes ® No } Building Sewer(locate,on site plan). t t • r ,.. r 18"+ _ Depth below grade: feet 4 Material of construction: _ ca st iron 40 C' _ , . othe r(e X plain):in . , Distance from private water supply well or suction Ine: „ 'feet Comments(on rcondition of joints,venting;evidence of leakage, etc) Flushed lines and found clear at the time of inspection. Septic Tank(locate on site plan): 2'with riser to 1' Depth below grade: ;,. °feet' Material of construction: ' ®concrete ❑ metal+ a ❑fiberglass ❑ polyethylene t El other(explain) • 'If tank is'metal, list age: years ,, Is age confirmed by a Certificate.of Compliance? (attach a copy of certificate) ❑ Yes '❑ No` 1500 gallon ^ Dimensions: Sludge depth", t5ins•3/13 T Y ,, ~. y a r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 12 Spyglass Hill Road, Cummaquid M 355 P 002 Property Address Alvan Fuller Owner Owner's Name information is required for every P.O. Box 408, Cummaquid MA 02637 page. City/Town April 2, 2015 State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 21811 Scum thickness Distance from top of scum to top of outlet tee or baffle 6„ Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? probe/measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pvc inlet and concrete outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank being pumped after inspection. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness) N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins"3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System"Page 10 of 17 i Commonwealth of Massachusetts w Title 5 Official Inspection Forrtn .. . F Subsurface Sewage Disposal System,Form -Not for'Voluntary Assessments 12 Spyglass Hill Road, Cumma uid M 355 P-002 , . Property Address . Alvan Fuller Owner Owner's Name information is p O. Box 408;Cummaquid MA -02637 ' 'April 2 2015 =. 2 required for every Ci r Bo F. State, 'Zip Code 'Date of Inspection page. own D. System Information(cost.) Y Comments(on pumping recommendations, inlet and outlet tee or,baffle condition, structural integrity, liquid levels as related to"outlet inGert, evidence of leakage, etc.)- Tight or Holding Tank`(tank must be pumped at time`of inspection) (locate on,,site plan)` _ - N/A Depth below grade:... Material of construction: ❑ concrete El metal, k ❑,fiberglass• ❑ polyethylene -E other(explain): x Y N/A Dimensions: , - N/A Capacity: . gallons N/A Design Flow: 4k, gallons per day `< Alarm present: 4 f El Yes ; ❑ No larm in working order. Yes. ❑ No, N/A A Alarm level: � g N/A Date of last pumping: Date Comments(condition of'alarm and float switches, etc:): y Attach copy.of current pumping contract(required). Is copy attached? ❑ Yes ❑ No " 15ins•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal system-Page 11 of 17 L Commonwealth of Massachusetts -- Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M ,•°'• 12 Spyglass Hill Road, Cummaquid M 355 P 002 Property Address Alvan Fuller _ Owner Owner's Name information is P.O. BOX 408 required for every , Cummaquid MA 02637 April 2, 2015 page. Cityrrown - State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 ! t Commonwealth of Massachusetts F ` Title 5 Official inspection Formt. s Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments',, F. s M -355„ R_002 12 Spyglass Hill Road, Cumma uid Property Address Alvan Fuller Owner M r :. Owner's Name information is p O. Box 408, Cummaquid' '' MA' 02637 s' ',April Z 2015 required for every i State Zip Code', Date of Inspection page City/Town D. System Information'(cont.) Type: .- 1•-6 X6 pit with ® leaching pits _ number ` . 2'of stone ❑' leaching chambers f= number: ❑ leaching galleries! number. 4 ❑ leaching trenches r number, length: ❑ leaching fields number, dimensions. . ❑ overflow cesspool F u number: _ ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil;signs'of hydraulic failure, level of*ponding,�damp soil, condition of vegetation, etc.): y s s r M Leach pit was found with water'level'approx 2' ve below'inlet in rt with walls found clean above water level No evidence of hydraulic failure or problems in the past were found at the time of inspection. , Cesspools (cesspool must be pumped as part of inspection) (locate.on site plan): _N/A �. Number and configuration " N/A- ' Depth-top of liquid to inlet Invert w N/AY *r Depth of solids Mayer, N/A Depth of scum layer _ Dimensions.of cesspool N/A Materials of construction Indication of groundwater,infl_ow ❑ Yes ❑ No •3/13, Title 5 Official Inspection Form:Subsurface Sewage Disposal System Tins 13 of 17 J r Commonwealth of Massachusetts " Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 12 Spyglass Hill Road, Cummaquid M -355 P-002 Property Address Alvan Fuller Owner Owner's Name information is required for every P.O. Box 408, Cummaquid MA 02637 April 2, 2015 page. CItyrrown State Zip Code Date of Inspection D. System Information'(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure,-level of ponding, condition of vegetation, etc.): N/A t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ., : gyp. Commonwealth of Massachusetts Title 5 official Ins ection Forma n Subsurface Sewage Disposal'System.Form .;Not forVoluntary Assessments 12 Spyglass Hill Road, Cumma uid M: 355 P-002 t Property Address Alvan Fuller Owner Owner's Name information is P.O. Box 408, MA : 02637 April'2, 2015 required for eve Cummaquid._ 4 4 every � State`, • � Zip Code Date of Inspection page Citylrown s D. System Information•(cont.)` i Sketch Of Sewage Disposal System: Provide a view of the'sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells withinr100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below' . 5' ❑ drawing attached separately . ... w. . � .:Air.. r . • ... +' i . a • 1y , Y - l I r t S Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r t5ins•3/13 Commonwealth of Massachusetts . Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Spyglass Hill Road, Cummaquid M -355 P-002 Property Address Alvan Fuller Owner Owner's Name information is required for every P.O. Box 408, Cummaquid MA 02637 page. City/Town April 2, 2015 State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 13.0'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 10/2/89 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: AIW 247 Zone C 24.1' 4.5'adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 15.0'. Test hole 5.9' below bottom of leaching showed no water found at a depth of 15.0'. Groundwater adjustment at the time of inspection was 4.5'. Bottom of leaching at 9.1'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Ihspecti®n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 12 Spyglass Hill Road,Cummaquid r M.-355 a P-002 R Property Address { Alvan Fuller Owner Owner's Name information is required for every P.O. Box 408 Cummaquidc" MA 02637° April 2, 2015 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A; B, C, D, or E checked~ ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed +. ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page,15 or attached in separate file, 5 • 4 r x. t5ins•3113 : Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 17 of 17 �oT oL g o . to L0CATI .N:, SEWAGE PERMIT NO. 4 i u VILLAGE - INSTA LLER'S NAIVE & ADDRESS B UI'LDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE' ISSUED I u 3� R . 1; s .Sty Q0P7` r - I.P. TION �` SEWAGE PERMIT a0. ` VILLAGE UU✓LW� IHSTALLER'S. NAME b : ADDRESS rz i- -d v't b� BUILDER OR OWflEQ 94�.V !r✓ FU Z,&,itz-- f DATE PERMIT ISSUED DATE COMPLIAWCE ISSUED 3/go e-, - 36 "wN 03p- No.. .... .. Fss ✓.�...�:�� THE COMMONWEALTH OF MASSACHUSETTS , 5 'bOL�DO� BOARD OF HEALTH Appliration for Dhipoii ai IV nrk n itrUrtion rrmit r Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: - / �� s LocatiQyiAdr�ss or Lot No. caner Address ....-----•-•---•-••-----•----- :. .. .............. ---•--•••--•--------•--•--•---------------•--......-•------•----........••••--•_____.....---...... Installer Address Type of Building Size Lot....Z7 aL4e....Sq. feet U U Dwelling—No. of Bedrooms...- ..................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building .................:.......... No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures .------•----------------------•-----•----------------------------- WDesign Flow............... .....................gallons per person per day. Total daily flow.-----------•--3� ............... 0i Septic Tank—Liquid*capacity.lQeP...gallons Length.g_ _--... Width...C.?. .. Diameter................ Depth... W Disposal Trench—No. .................... Width..._................ Total Length.... Total leaching area....................sq. ft. x o Seepage Pit No._._....I........... Diameter........1_c?.._.._ Depth below inlet.....(z._...._... Total leaching Z Other Distribution box (A) Dosing tank ( r Y � �t�>- ?Vie Percolation Test Results Performed b .... .........................:....� LhCt.__.___«_____.__._........ Date... ... ------ ,aj Test Pit No. L_.G 7..._minutes per inch Depth of Test Pit.....1 _ ___... Depth to ground water.... _Q.�_.__.. LL, Test Pit No. 2... .•..minutes per inch Depth of Test Pit..... s _��___ Depth to ground water.__._._�ou... t .......... ................................................. ...... -----•--•------•------------------••---------•-•---•------------------.......--- U _--------- ---------•......1 . O Description of Soil......................5.Le....... ....................................................•--------------•-•••-•-•...._._............---....-••-••--••----------------------.....---•.........----------•-------•-.....-------------•------- W •-----------. ------------------•----- ....... ._._...---------------•-•---------•--._.-------- •.............. .-.-.--------- .-........ -------._---------•--------•--•-----•-••-•• UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•-------------------------------------------------- •---------------.._....----........._---._------......------------•--------•----•--.......-----••----•------•••-----------•-----•-•---••--_..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with theprovisions of I-ITi." g p y 5 of the State Sa ode—The unde signed further agrees not to lace the system in operation until a Certificate of Complianc hth. 1,4A� ./ $lgn ------- `=•--= --•---•--•--.......... _....--ate .. ��. A roved BXA-7plication PP Y----- Dare.. Application Disapproved for the following reasons------------------------------- •--•--------•••--------------......-••-----......•-------...-------•-••----•-- ....•..--••----------------------------------•----=-------------.......--••-----------=----•-•----------------•----••------------------------•----•-•--•------------•••----. ......---•---------.••-•-- Date --- Issued__... ... 1� d Permit No.-•-•--•............................................. �~ --------� -----•--•------•-•-. Date No.. ........ » THE COMMONWEALTH OF MASSACHUSETTS ARD OF HEALTH .....................................OF........ ApV iration for Uhipoottl Works notrnrtion Permit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal system at: C_ LocatiQy�d�r�s�� or Lot No. . caner Address a ......................................Installer......... ._................------••-- --.....---................ •-..........»Address ....: - •-�•-••••-•-•••••--....... Type of Building Size Lot....Z2 aL ....Sq. feet 2 ., Dwelling—No. of Bedrooms...,?.................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building .......... No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures Design Flow.............. ..........:..........gallons per person per day. Total daily flow.............. 31a................ . r Septic Tank—Liquid capacity_�49 P...gallons Length..!�..ei?...... Width..: .. ..;.. Diameter................"Depth..4.0.... WDisposal Trench—No..................... Width........:...........Total Length....:.............. Total leaching area...................sq. ft. 3 Seepage Pit No......... ........... Diameter........I.C2....... Depth below inlet.....(a.......... Total leaching area.........:_. . Z Other Distribution box (71,) Dosing tank ( ) r '-' Percolation Test Results Performed by...L4� '�r �hC. ......�i.:................ Date..I�-2'��...._.....I�.=-77��' A Test Pit No. 1... '....minutes per inch Depth of Test Pit...._15.G?...... Depth to ground 44 Test Pit Nro. 2..!�i t...minutes per inch Depth of Test Pit..... Depth to ground.water.......00 L...... Ix .........................• .................._................................................................................................... ODescription of Soil_.... ---•---•---57----e?........f.!M...............................................•-.................................------.......----•-............ U ...................................... ...................--- •....-•-•-•---------.................•-•-.... ----...... ------........ W ••-•.........--••..........................•--•........................•--•----.._................--•-•-...._..••--•.......•---•-•-•---...•-•-••••----••..........-•-.....-••-•--•..............•--_.... UNature of Repairs or Alterations—Answer when applicable......................................................•.......-:................_.............. ..•....................................................f --••--•-••-•----•-----............... ................--•-••---............-----..........•......---.........•••......--•••-•-•---••---• Agreement: ' The undersigned agrees to install th escribed ndi i al Sewage Disposal System in accordance with ^ITi.i: the provisions of . 5 of the State a e -tlier agrees not to place the system in operajaon g a ertific�e,of-Cr> lianc 1th.. / v c�2 ✓ ate Application Approved By..... . •- r ! a Application Disapproved for the following reasons:............................... .........................................................................»»» ................................................... .....-----•---................:..».............»......•----.........------...................................................._•• -- Date �Z Permit No. »%-,�f.... .................... Issued.-...l..`.'�� .�Q._..»..._....» Datc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C ................OF...5?XV '.AA SW(f C..................... Trrtif iratr of Tompliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.........................................•-.........................._..........................:..........--••-•---............--•----...........•••--......................................_._... • Insta � at..........X.......... ..... .... ._�fl t'� i.�l F .c 10'Amex-(....................................---...- . ...... ..... ...F ..... ... has been installed in accordance with the provisions of TITjy j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No Ili.............. dated.... °'Z .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL 94INCTIJO SATISFACTORY. I' ,` � .......DA ......... Insn ^ r � •• ----•-•. . i - • sr, inn izIA r / 441 ' I (cbK4 � (o�,c8 ��L71�'`'" •'�'���31��'� G5 x5 q � Z r t i► i. J1 J ,._. T _ FINISH GRADE OVER D-BOX= 63.0kt T.O.F. EL.= 64.5�t FINISH GRADE OVER CHAMBERS= 62.5' - 63.5' 3/4 TO 1-1/2DOUBLE WASHED � GENERAL NOTES SLOPE @ 2% MIN. OVER SYSTEM PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET 8 RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL OUTLET TO WITHIN 6"OF F.G. 0 2"OF 1/8"TO 1/2"DOUBLE WASHED FINISH GRADE ' 5" DIA. OUTLET(S) MIN SLOPE 1 /o BOX TO F.G. (SEE NOTE 21) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 63.6 t F.G. OVER TANK EL. =63,5 t - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE „ } DESIGN ENGINEER. TOP OF SAS= 60.53' PLACE RISERS ON ALL f PROPOSED 4" 9„MIN. 9"MIN- CHAMBERS w/PIPED I 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL -EXISTING Q" SEWER PIPE SCH. 40 PVC 36 MAX. ! 59.70 36"MAX. BREAKOUT EL= 60.20' INLETS TO WITHIN 6' SYSTEM UNLESS OTHERWISE NOTED. i f' I _ SEWER PIPE OF FINISHED GRADE 6�3'• 3" DROP MAX Lg�t 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - 2" DROP MIN 3 9rF MIN.SLOPE 0 1% PROVIDE WATERTIGHT ELEVATION=60.20 FOR A DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. UNLESS A 13" 4" PVC IN FROM JOINTS (TYP.) �� 0 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 1k60.rj'f SEPTIC TANK 4 PVC OUT TO 0 O o o o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE --- -- LEACHING FACILITY o0 00 0 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. SPECIFIED DROP BETWEEN 2„ " { o� oo 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. INLET AND OUTLET CONTRACTOR CONTRACTOR SHOUTLET TEE 60.00� MIN. 59,83� 2' 0 o 0 0 ��SHALL VERIFY SIZE 48 VERIFY CONDITIO 00 0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE 00 Q� 0 CDR FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY 8 NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE AND DESIGN ENGINEER. 5 4 0' 8 5' (TYP) -I 4'0' 4.0' 4 83' 4.0' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 65.00' OUTLET DISTRIBUTION BOX TO BE INSTALLED ON A LEVEL STABLE 25.0' (TYP.) ESTABLISHED ON TOP OF HYDRANT BONNET BOLT AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 39.00' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. Zr,7.70 12.83' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1,500 GALLON CONCRETE SEPTIC TANK 4' MIN- CHAMBEr rLi,4iJ VIEW __CROSSSE_CTION VIEW 2 - 500 GALLON CHAMBERS 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES c _ TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. 'CONTRACTOR TO VERIFY EXISTING SEPTIC TANK P RO r I L ' �^�i� � �I I IbiJA �'��� �,r I��i i V I R D E ! A I l S 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. i ELEVATION PRIOR TO ANY WORK & '.�..J 1 NOT TO SCALE I NOTIFY ENGINEER IF DIFFERENT, 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 -• ; ��► { _:_. _ �; • • " ,` > ,, TEST PIT DATA ' . ' APPROPRIATE AUTHORITY. SWING-TIES - , ! __ . PERC NO. 21-71 rc - ' / S ? {!� ' ° • '' ~ UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR q INSPECTOR: David W. Stanton(BOH) 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED DESCRIPTION HC-1 HC-2 �°✓� / - s0o� �/ '� ' EVALUATOR: Michael Pimentel, EIT, CSE TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. r MAP 355 t • f C_S.E. APPROVAL DATE: ! CORNER OF STONE(1) 38.4' 33.3' Q S 08' LOT 02-08 [ n 3 '` Oct. 27, 1999 1 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. Q / �} DATE: March 22, 2021 CORNER OF STONE(2) 46.4' 45.5' 04 cqs - ttr � ca �;�� • i , • ' TEST PIT#: 1 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) 33.6' 57.6' 4 / c�5 --. _ `> " f Q - ' i t ELEV TOP= 62.30' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, \ ! -'F FINES OR OT CORNER OF STONE (4) 21.4 48.5 v _ / , cis t �i ELEV WATER= < 50.80' HER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). W W , w • 25 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN W_ �qs��- __ �� p` LOCUS PERC RATE= 3 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. / W'�,_W/ GAS � �" �`' s DEPTH OF PERC= 24"-42" 16• PROPOSED PROJECT IS LOCATED WITHIN: `` W` +� F ^� TEXTURAL CLASS: 1 _ ASSESSORS MAP 355 LOT 02-02 I i OWNER OF RECORD: ROLAND POIRER JR. & FRANCES POIRIER O� / w H'-� !! � �- Ott ADDRESS: 12 SPYGLASS HILL ROAD � J =� Fill CUMMAQUID, MA 02630 ZONE 11 24„ 60.30 // , C> �'erc FEMA FLOOD ZONE _X [ti COMMUNITY PANEL# 25001CO559J t � Q N `� / � ; � 42" 5880, , Q" ? / /. ° ,� so- Loamy Sand ` , �. � 17. DEED REFERENCE: L.C.C. #206121 a / MAP 355 c. �- B 10Yr 5/6 LOT 02-02 P 118. PLAN REFERENCE: L.C. PLAN#41246-B � III 27,016t S.F. `�-TOF=64.5'± - 60" 57.30' 19 ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 09 N // J ° �'` C-1 Loamy Sand 5Y 6/6 20�� ,�" 2. FOR SEPTIC LSYS EM UPGRADE. JIE INFORMATION IS OG ENGINEERINNLY IG 1MLL NOT ASSUME ANY MATE. THIS PLAN IS TO B L Ar,'L TY g _ - / �~ �. 55.30' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. U / #12 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A EXISTING - C-2 m Sand DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3 OF FINISH GRADE. A Mediu \ 3-BEDROOM diu 6/2 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. \ srf DWELLING 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL \ LOCUS PLAN REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. / ED D _PA V " / SCALE: 1"= 1000' , 138 50.80' No Mottling, Standing or Weeping Observed w !DESIGN DATA 1 . DA 1 LEGEND :,,ARAGE PERC NO. 21-71 INSPECTOR: David W. Stanton(BOH) 504' EXISTING SPOT GRADE \ Q NUMBER OF BEDROOMS 3 \ �z U EVALUATOR: Michael Pimentel, EIT, CSE - - - 50 - - - EXISTING CONTOUR \ ©� ;j DESIGN FLOW 110 GAUDAYBEDROOM \ v 0- C.S.E. APPROVAL DATE: Oct. 27, 1999 ` --L50 PROPOSED CONTOUR TOTAL DESIGN FLOW 330 GAUDAY 6'sr\ HC-1-/ DATE: March 22,2021 DESIGN FLOW x 200 % = 660 GAUDAY 50 PROPOSED SPOT GRADE TEST PIT#: 2 EXISTING 1,500 GALLON �. \ 10" SEPTIC TANK TO BE USE EXISTING 1,500 GALLON SEPTIC TANK ELEV TOP= 62.30' ' --- - �N EXISTING GAS LINE \ PROPOSED �\ _ HC-2 j USED IN THIS DESIGN ELEV WATER = < 50.80'Benchmark �/�i.. DISTRIBUTION E/r/i EXISTING UNDERGROUND UTILITIES \ f `� \ ,:���-� Hydrant B.B., _ �..�� ' -- _, BOX ��C, �� E � INSTALL 2 - 500 GAL. CHAMBERS W/ STONE PERC RATE_ Elev. =65.00 � r'` � � W V�` EXISTING WATER LINE Approx. MSL �� PpE. �-y--Y `� ._; �' i,! x DEPTH OF PERC= �P,NOSG (4 k SIDEWALL CAPACITY TEST PIT LOCATION % TEXTURAL CLASS: 1 6�i �aC,E OF - ` k {LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY EXISTING 1,500 GALLON SEPTIC TANK " r (25.0'+ 12.83')(2 ) (7 ) ( 0.74 GPD/S.F.) =112.0 GAUDAY O O T 2 P 1 \ A 0" 62.W PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE -�-~-� BOTTOM CAPACITY \ 2x , S 1 / Fill \ f \ BUSH (TYP) 62x3 62x3' 3x3 (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY Q PROPOSED DISTRIBUTION BOX (25.0'x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY 24" 60.30' + ' O PROPOSED 500 GALLON LEACHING CHAMBER \ \ 16 _ 63_ -X TOTALS: B Loamy 10Yr 5/6 Sand V _ - \ t _ `64 12" i ,N ,63x6' 63x7' TOTAL NUMBER OF CHAMBERS 2 REV. DATE BY APP'D. DESCRIPTION \ - 2 .0, LP TOTAL LEACHING AREA 472.2 SQ.FT. 60" 57.30' 63x3' 24" TOTAL LEACHING CAPACITY 349.4 GAL-/DAY Loamy Sand PROPOSED SEPTIC SYSTEM UPGRADE MAP 355 2) �` C-1 2.5Y 6/6 PREPARED FOR: LOT 02-03 o' '\ �" 55'3°' ROBERT B. OUR CO., INC. ` - � � EXISTING LEACHING PIT TO BE PUMPED, NOTES: � C_2 Medium Sand LOCATED AT ti FILLED w! CLEAN _ PROPOSED 2.5Y 6/2 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF INSPECTION PORT SAND &ABANDONED I 12 SPYGLASS HILL ROAD EACH SEPTIC SYSTEM COMPONENT. CUMMAQUID, MA 02630 , i 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED TWO (2) SCALE: 1 INCH = 10 FT. DATE: MARCH 31, 2021 PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT 500-GALLON LEACHING SgB, 138" 50.80' i 0 5 10 20 40 FEET DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF #26 PREPARED BY: CHAMBERS 2500•F No Mottling, Standing or Weeping Observed " s,E HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. I EXISTING -- JOHN L• w� '� 3.) PROPERTY IS LOCATED WITHIN A MASS DEP ZONE 11, GROUNDWATER DWELLING RESERVED FOR BOARD OF HEALTH USE CHUB VIL JR. ti JC ENGINEERING, INC. PROTECTION OVERLAY DISTRICT AND THE ESTUARINE WATERSHEDS. • 41807 2854 CRANBERRY HIGHWAY 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY = EAST WAREHAM, MA 02538 FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS S T508.273.0377 IN THE FIELD PRIOR TO INSTALLING THE SYSTEM. CONTRACTOR SHALL I 1 E P LA N Drawn By: MC- P -r_Designed By:MCP Checked By:JLC JOB No.5643 NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. SCALE: 1"= 10' �----- --- 1 . I i 59.-75 Aim - 59.00 53. o0 I i - r, ill O T& EXTE,VZ) ALL t9PPLICF? 8LE V E /2 . SCFLE O MAN1fOLE CO /EP-S TO WITH/AI�Oi2/Z. SCAL _ Proposed around=.Pl"of'//P_ ! /2 OF- .F/til/SHED ` G.2,9DE R !n. %4"f5a 1/ layer of SHHED ¢o RV O. 0,2 CrMn/mum Ya" Per f'OOf') 3�8-•pea5-to ne EQU19L To 5EPTic -- P/PE To BE TANK , i LEVEC- F02 2' /4- >°pa GrgU/D D9 � � � �•e LEVEL D/STT BOX j - ump washed s fon GAG . 5EPT1G 7-iQ1Vk LEtgCH P/T Sg- T� S -T" -/ � ' 'L zp G AJ _ /L'7 f�OUF_- !D Z-r` Y' j♦ ", %' z_ y { ill raY.__ �� _ -- WITNESS: - �. _ FLOW i2ATE- Sao G/9LS.`DAY <04 d S E PT/c 7-i9 Nk 3 3— x /.5= 495 I usE: nW GAL. TANK � £• 3-z Co° LEf�CH/NG H2Ef� 3z S/D8Wt9LI: Oa,3 x Z,5 • 471 ,3 G.P.D. a0 TO 8 D. THL U6 E 1-c 6q PI'f 1417-' ,it C Y T T E B U/L D1"4s / E2T/F HA TH ND W �-o►-� �D P�20F>OSE D OK/ THE (-,k2oUND AS ri csxs SHOWN ON THIS PLAAJ DOES co/vFO,eM TO THE BU/LDIA JG SE7= — s l T-E - S E l�.l� G PL A l�l `� _ ---------=— BACK /2EG?U1A2E1'-7EAJT6 OF THE TOLA)AJ OF STo,�� FOQ : L..oT Z s�(G1�ss 1�11.1_ ��. �JMMis,c�il1D, SS , dr ni baD OF 6o i r �I � EVER, H. f' .0 r T U. P2EPARED F02 AL-Ix) I'"l 1� �. I a HINCKLEY �' i EVER"T I ' W 13230 �� "k' ;1 II BIt�,,,IEY lo CIVIL 176 0 SCALE: AS A/OTED DATE: SAKI. F,, V) q rn vvv /P L Iq XJ (S C A L E: /" -� � V I E W ! i o �o �. r/1 M�Q(„� ►� � �-TS r I O• Co e x i s f-/ my e/e va-f'i o n B L D G. S E T B AC K. T o.00 = Proposed /� vatiorl /2EQU/.QEMENT6 3PPROVEZD -Pr-o/-7 �`- - �'S T'f-. - --- - - - - exist- /nc� corrfovrs ; BoAreD OF HEALTH S/ de _ 7,5 "; MASS• 7/4 MA/N 57 -T P P 7,S j Ytgr2MOUTH POr27, MASS rear I - - � PRoFE55<oNAL ENG/NEERS fr LAND SUQVEYo,25 # _ I�