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HomeMy WebLinkAbout0040 ANGUS WAY - Health 40 Angus Way Centerville A = 251 053 y 4' UPC 12543 No, 53LOR HASTINGS, h7N G> V� e P k a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RCEL �10 PdAR. 0 .3 2005 TITLES ?.� TPBLE OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 40 Angus Way Centerville Owner's Name: James Goode Owner's Address: Date of Inspection: O j Name of Inspector:(please print) W i 1 1 i am E_ .Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P 0 Box 1089 Centerville. MA Telephone Number:—(5oB 1 775-8776 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.lam a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: —/ses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: lc2 ,,`� ���`'"�. y Date: --o 1 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 approxing authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 40 Angus Way Centerville Owner: James Goode Date of inspections Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syst 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: B. Sy. tem Conditionally Passes: ne or more system components as described in the"Conditional Pass"section need to be replaced or repaired. he system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer ye ,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The eptic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,a ibits 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 s ptic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating at the tank is less than 20 years old is available. ND expla bservation of sewage backup or break out or high static water level in the distribution box due to-broken or _ obstru• ed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): / broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND exp in: e system required pumping more than 4 tones a year due to broken or obstnxted pipe(s).The system will pass insp ction if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is r w vcd ND explain: Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: _40 Angus Way Centerville Owner: James. Goode Date of Inspection: C. urther 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 failin to protect public health,safety or the environment. 1. S stem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1) b that the sy tem is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated.wetland or a salt marsh 2. S tem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syste 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 urface 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 frorrl 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and - the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other allure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: i 3 s Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 40 Angus Way Centerville Owner: James Goode Dale of Inspection: D. System Failure Criteria applicable to all systems: You mus indicate'.jes"or"no"to each of the following for all inspections: Yes No ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or logged SAS or cesspool tatic liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or 4esspool squid depth in cesspool is less than 6"below invert or available volume is less than day flow equtred pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number cf times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within I00.feet of a surface water supply or tributary to a surface •ater supply. y portion of a cesspool or privy is within a Zone 1 of a.public well. y portion of a cesspool or privy is within 50 feet of a private water supply well. y portion of a cesspool or privy is less than 100 feet but greater than 50 f^_ct from a private uatrr supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory.,for coliform bacteria and volatile organic compounds indicates that(lie well is free.from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) Yes[No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems:To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gp Yo must indicate either"yes"or"no"to each of the following: (Th following criteria apply to large systems in addition to the criteria above) 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 We Protection Area—1WPA)or a mapped Zone 11 of a public water supply well If ou have answered"yes"to any question in Section E the system is crosidered a significant threat,or answered "y s"in Section D above the large system has failed.The o-Arner or operator of arty large system considered a si nificant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 1 .304.The system owner should contact the appropriate regional office of the Department. 4 r Page 5 of i 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 40 Angus Way Centerville Owner: James Goode Date of Inspectional -p 1 Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes N 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 7 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?. V/ 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 7 Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS,located on site? JL _ 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: Yes .no - !/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(3)(b)) 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 40 Anctus Way Centerville Owner: James Goode Date of Inspection: T— FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms(actual): _ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x.4 of bedrooms): G Number of current residents: 3 Does residence have a garbage grinder(yes or no): d 1s laundry on a separate sewage system(yes or no): 4.,o [if yes separate inspection required) Laundry system inspected(yes or no): n Seasonal use:(yes or no):/I/d Water meter readings,if available(last 2 years usage(gpd)): 2004 — 63, 0 0 0 Sump pump(yes or no): 2003 — -67, 000 . Last date of occupancy: /Z—Z" COMMERC IANDUSTRIAL Type of estab ishment: Design flow based on 310 CMR 15.203): gpd Basis of de¢ilgn flow(seats/persons/sgft,etc.): Grease tr4 present(yes or no):_ lndustriaywaste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water eter readings,if available: Last d to of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPF�GF 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components date'installed(if known).and source of information: Were sewage odors detected when arriving at the site(yes or no):,�,d 6 )'age 7 of I 1 OFFICIAL INSPECTION FORA7—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Properly Address: 40 Angus Way Centerville Owner: James Goode Dale of Inspection: 2-—� d 3 v BUILUINn SEWER(locate on site plan) Dcpdt be ow grade: Material of construction:_cast iron _40 PVC_other(explain): Distant front private water supply well or suction line: Comm ms(on condition of juutts,venting,evidence of leakage,etc.): SEPTIC TANK: t/(locatc on site plan) Depth below grade: Material of construction. cullcrele metal fiberglass�Polyethylene _oUtcr(explain) — — If tank is metal list age:— Is age confinned•by a Certificate of Compliance(yes or no):certificate) t —(attach a copy of Dimensions: �, ae G 41,0 i,L Sludge depth: Distance Gom top of sludge lu bottom of outlet Ice or baffle: Scum thickness: Q Distance from top of sewn to top of owlet Ice or baffle: t Distance from bottom of scum to bottom o owlet tee or baffle: G I low were dimensions determined: Q e-^— 66 V 1'a S Comments(on pumping recommendations, inlet and ou(lct tee or baffle condition,structwal integrity,liquid levels as related to outlet rove ,evidence of leakage,etc.): , r GREASE TRAP:_(locate/01'1"csr ite plan) - Depth below grade:_ Material of construction:� ete metal fiberglass__Itolyetlq Iene__other (explain):_ — — _ Dimensions: Scurn Ihickncss: Distance from lop of Sc�nt to top of outict Ice or baffle: Distance Gom bottom IF scum to bottom of outlet Ice or baffle: Dale of last pumpin . Conunents(on roping tecontrnendatiuns, utlet and outlet Ice or baffle conditio:,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc): 7 Page 8 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0101 PART C SYSTEM INFORII'IATION(continued) Property Address: 40 Angus Way en ervi e Dwncr: James Goode Dote or lospcctloo: � ITr"O TIGHT or IIOLDIN TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of eonstty lion:_concrete_metal_fiberglass_polyethylene othcr(explaut): Dimensions: f Capacity: / gallons Design Flow.j gallons/day Alann present &es or no): Alarm level: I Alann in working order(yes or no):— Date of last pumping: Comments(condition of alarm and float switchcs,ctc.): DISTRIBUTION BOX: (if present must be opened)(locate-on site plan) ) Depth of liquid level above outlet invert: Cornrnents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of - leakage into or out of box,ctc.): t7 PUMP CHAMBER: (locate on site plan) Pumps in working o der(yes or no):— Alarms in workin order(yes or no):— Conuncnts not col '( tdlUon of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION_FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Angus Way Centerville Owner: James Goode Date of Inspection: -�L /7-6 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,ezcavation*not required) If SAS not located explain why: Type y caching pits,number:_ :7 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): 6 CESSPOOLS: esspool must be pumped as part of inspection)(locate on site plan) Number and cone ation: _ Depth—top of li id to inlet invert: Depth of solids ayer. Depth of scu layer: Dimensions f cesspool: Materials o construction: lndicatio of groundwater inflow(yes or no): Comme s(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials f construction: Dimens' ns: Depth f solids: Co ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Angus Way Centerville Owner: James Goode Date of Inspection:.f_ 6 . SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. t G J 1] 10 I Page 91 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Angus Way Centerville Owner. James Goode Date.of Inspection: Jam-a SITE EXAM Slope Surface water Check cellar Shallow wells x Estimated depth to ground water 2. 6 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: ticked with local excavators,installers-(attach documentation) II Accessed USGS database-explain: You must describe how you established the high ground water elevation: y /�a 13- 1 U f I1 /) TOWN OF BARNSTABLE •140CATION LC� Nrl- y tis G.cAi ,) SEWAGE # VILLAGE " ` ' ASSESSOR'S MAP & LOT-ZS O S a INSTALLER'S NAME&PHONE NO. `Z, 6,4 SEPTIC TANK CAPACITY i LEACHING FACILITY: (type) -" (size) NO.OF BEDROOMS -3 BUILDER OR OWNER Go -0 �V PERMITDATE: .e-s A COMPLIANCE DATE: Separation Distance Betwee the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i �� . � � z � _.�r � ------ �.- ��� -� ,� '� r ,j, �� ��.� ,�/' GI �: ..�� �/ TOWN OF BAMSTABLE - LOCATION �d 147Z9f5 Gt/ SEWAGE # VILLAGE Ca14-e--V1`/� ASSESSOR'S MAP & LOT oZ /-DS3 I' INSTALLER'S NAME&PHONE NO. � imzn 7-7S- a•7-76 SEPTIC TANK CAPACITY LEACHING.FACILITY: (type) (size) I Z .xzSX NO. OF BEDROOMS 3 BUILDER OR OWNER OnnJ9— PERMITDATE: -7-aS-Dq- COMPLIANCE DATE: -ZS-� j Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ` 1r �co,1 T6W�N1OF BARNSTABLE LOCATION '/ W SEWAGE # -VU.LAGE �� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and.Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by R^ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address.- Cooly fie/}f• • kr 6 Oo 6:�;2 Owner: "' "^° Daie'of'Inspection: 7—/0 9 -- y 7. SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references landmarks or, benchmarks 4 locate all wells within 100' : 1:1. Cf is n G US W A`/ Cen� • Pt Id t3fl 26% Y'r 0T.N 00� ,, 1 sP pooh Vl A (ox$Block, pool t¢ N a Nn 1 t Sysfcrn �s bu i A J, 0 Od LU 01Z k; )5 CoAd"41on, ovta-F1o,0 p oo i`s !I•kc New cone'+i o n S••FArn Itne Show) never r,RS been AA6A.G. 4hAn DEPTH TO.GROUNDWATER Lott, Depth to groundwater: /14 feet / method of determination or approximation: t�ir��] (revised 9/Is/951 .9 No.,— Fee Fee$5 0 -0 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for Miopoga[ *pgtem Cow5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( xkAbandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 40 Angus Way Owner's Name,Address and Tel.No. Centerville, MA Jim Goode Assessor's Map/Parcel a S l -05-3 02632 Same Installer's e,A ss d Tel.No. Designer's Name,Address and Tel.No. m. `; 1�"obinson Sr. Septic Sv Daniel Johnson P.O. Box 1089 804 Main St. suite B Centerville MA 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Residential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 331 .5 gallons. Plan Date 7/1 8/0 2 Number of sheets 1 Revision Date Title Subsurface Sewage Disposal System Size of Septic Tank 1 S 0 0 as 1 _ _Type of S.A.S._ ry-we l 1 2 Description of Soils Gravely course sand- c> urSP -.and Nature of Re airs or Alterations(Answer when applicable) We will replace cesspools with 15 gal. tank and 2 drywells @ 25' L x 12'W x 2'11 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 Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by this d o ealth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. 2� — 142 any e Issued U' No. d29 7 .Fee $5 0.0 0 THE COMMONWEALTH OFMASSACHUSETTS Entered in computer: ✓ ✓ Yes , PUBLIC HEALTH-DIVISION -TOWN OMB°ARNSTABLE, MASSACHUSETTS_ J Application for pigpogaY *potem Contruction Permit Application for a Permit to Construct( )Repair( )Upgrade( XkAbandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 40 Angus Way Owner's Name,Address and Tel.No. Centerville, MA Jim Goode Assessor's Map/Parcel ').5 _ 0.5 02632 Same Installer's re Adcjress,�anobIn°son S�. p Designer's Name,Address and Tel.No. m. r,. Septic av Daniel Johnson P.O. Box 1089 804 Main St. suite B Centerville MA 02632 o Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Residential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 331 .5 gallons. Plan Date 7/1 8/0 2 Number of sheets 1 Revision Date Title Subsurface Sewage Dio4noaal Syst em' Size of Septic Tank 1 500 Gal. Type of S.A.S. my-wet 1s Description of Soil Gravely course sand- course sand Nature of Repairs or Alterations(Answer when applicable) We will replace cesspools with 1600 gal. tank and 2 drywells @ 25 L x 12'W x 2'11 Date last inspected: 1 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 Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by this d o ealth. e� Signed Date 0` Application Approved by Date Application Disapproved fonthe following reasons Permit No. . 9 ��- U�y' /���• ate Issued ?f v Go THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS --- ; Certificate of Compriance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired( )Upgraded*xx) Abandoned( )by Wm. E. Roh)bnson Sr. Septic Service at 40 Amgu s WAy,, Centerville, MA 02632 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. . - -2g7 dated Installer William E. Robinson Sr, Designer Daniel Jo, n.®,-on The issuance f this_p4rmit shall not be construed as a guarantee that the syst ill f<u tion as d ed. Date U I Inspector ► a �/`� . No. �o 0 "a FeeFee$50.00 Goode THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migooal *p5tem Contruction=hermit Permission is hereb rant to Construct( { )Repair( )Upgrade(Xx)Abandon( ) System located at 48 A gus Way,•, Centerville, MA 02632 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of • ermit. Date: 2 0 Approved by •Eti✓`- TOWN OF BARNSTABLE LOCATION. �!'1 5 SEWAGE # .2002 L,297 VILLAGE ASSESSOR'S MAP & LOT ZI-05-3 INSTALLER'S NAME&PHONE NO. 1L?C�//�� 7--Y5 SEPTIC TANK CAPACITY �iS�CID l� LEACHING FACILITY: (type) (size) �,� X"Z5—X2 NO.OF BEDROOMS �3/� II BUILDER OR OWNER Gnc�d2, PERMITDATE: -7'c)S-D9_COMPLI4NCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by v , N • SRS/O1 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM J hereby certify that the engineered plan-sig,ned by me dated _ '211 N/ concerning the property located at .,4 6 Js t LA-1.74 L Fq rCIL 111 LL meets all of the following,criteria: —_ • This failed system is connected to a residential dwelling,only. There are no commercial or business uses associated with the dwelling.. • The soil is classified as.CLASS I and the percolation raie is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or chang,e in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching,facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable]' Please complete the following: A) Top of Ground Surface Elevation (using GIS information) B) G.W. Elevation 31. +adjustment for high G.W. DIFFERENCE BETWEEN-A and B 31 � 7-rJ7 P4r.LPfi--C9 SIGNED : ',� DATE: ( Q NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder.percezmp L e 1500 GALLON SEPTIC TANK. C. H1v of >CPTlL Sl �j�"r�l TEST PIT DATA MODEL TK-15001SHEA CONCRETE LOP, EI;I_i'JALENT`. kALE l _ A + Performed By: Daniel B. Johnson - I - 1 FINISHED GRADE I 24"DIA. 44"Di.4 L9"(MIPII 24"D14 Date: July 5, 2002 = 3" �� H 10 eK TP-1 (EL. = 98 . 3) 4' SCH 40 0" - 6" P_/o, 10YR4/3 Loam sand FLOW LINE �( 4"SCH 40 10 i 1a" 1 ZABEL FILTER ,A- 100 6" - 4 2" 3w, l 0YR5/8 Loamy very fine sand 2 . SY7/2 4'SCH 40 TEE SEPTIC TANK TO AaEE1 00 4'UQUID LEVEL REQUIREMENTS OF 42" -108.1 Cl, 5R5/8 Gravely coarse sand 1 GASBAFFLE 310 CMR 15 226 FOR 108"-132" C2, 2 . 5Y8/2 Coarse sand 4"SCH40 `,HATER TIGHTNES No Observed ESHWT TEE ETC. 9�rz No Observed Groundwater ALL WALL SLEEVES/GASKETS ME C.HANICALL) SHALL BE CAST IN PACE OR r-' b" (MIN) <= O PERCOLATION TEST DATA INSERTED AT FACTORY �° O' O COMPACTED y CRU/4"DCASTQtJE r2E�/S�,e�BJ`^' ,2 nK STABLE LEVEL BASE Date: (July 5, 2002 SEPTIC TANK DIMENSIONS. IV 6% X T 8"W X 5V*H Soil Class : Class I (0. 74 G/SF) Perc Rate: < 2 MPI (TP-1 ) DISTRIBUTION BOX Ev+;tirvb H - 10 [fts rOoE.s I I Depth of Perc Test : 42" - 60" , REMOVABLE COVER / / 4"SCH 40 OUTLET LATERALS DISTRIBUTION BOX TO MEET ---- SHALL BE SET LEVEL FOR A SCHEDULE OF ELEVATIONS R5 Q32(WATERTIGHTNES.MR / FEET AND CONNECTED TO MINIMUM OF THE FIRST TWO �ESSPoo� T� I (A/vpK CONSTRUCTION,ETC► I s.L EACH DISTRIBUTION LINE +5 fv,� Inv. Out Foundation (existing) 98 . 5 TH5DLIDSCH4t3f�trPIPF Inv. In Septic Tank 97 . 00 No OFpUTLETS . 4"5cH4o �" WI Inv. Out Septic Tank 96. 75 - o o ----- SMECHANICALLYCRUSHED A a• o,< ' /Soo �ALLo^r Inv. In Distribution Box 95. 25 °0 0 6'(MIN) a , "gcN4o rAnIK o Inv. Out Distribution Box 95. 08 SEP�ICSTABLE LEVEL BASE q _ �4 DIA) �"'} 99 a Inv. Begin Dry Wells 95 . 00 ° 3 Bottom of Dry Wells 93 . 00 q''uNao Bottom (TP-1 ) q No Obs .GW/ESHWT 87 . 3 tcN4� � 9pf° �" �"`�•R 91><4 �� LEACHING DRY WELLS 500 GALLONS � i "END"CROSS SECTION 4 9 Existing Contour - - - 98 - - - MODEL. SHOREY PRECAST CONCRETE � I fGEt�-l03,9_ FIFO=/ov °O BFE = 95,9'- � I FINAL. GRADE TO BE STABILI�D � FINISHED GRADE(SI.OP'F • 021 �E/vGNMRELIC l (s�a� � Proposed Contour 98 �. SJr"F ,gs EC 100,00 � � Test Pit � 12"tMINI Tbt OF t 0/1 aLe7E __ __._. _.__w__.___.___� ..�-- H •10 3 Fff 0. LEACHING DRY WELLS '2 Finished Floor Elevation FFE 0 9 � Q !4" 1/?'DOUBLE S� I I<6"LX4"IWWX2'1"H WASH PEA SIONE. CD Basement Floor Elevation BFE ° c r r c. 4' :S'LXIZWX7H Ewa � 2'1` �� c:4..y UVE L HIND ARFA .��. ""WASHED 3/4"•t 1I2"OOUBLE Water Line --- W WASHEDSTQNE LEACHING DRY WELLS TO COMPLY WITH THE REQUIREMENTS OF 310CMR 15.252 WAY . b .�.-;ter'. "� • .. ,,KCV AV a A- JJE o 1 Ho:,✓ V E 1 r t � of NOTES All construction methods shall conform to the Title V ( 310 CMR• 15) and the Barnstable Board of Health Regulations. er * f wPJrC ° r 2 . There are no known private or public wells within 3 FFEU'1°3`9' r°�tr + `� ? feet/400 feet, respectively, from the proposed leaching Ioq CENTE RV IILE ,?a i r�.S `-�40 � area. 41' . -� :owG � I cirrcc . - o F�• � " *' 3 . Existing cesspools to be pumped and removed prior to vo Nr Poimr FG a`'U installing the new septic tank. (oX �vENT PO'Nr ( " b CHR7J/:N S 4 . No changes are to be made in the field without the approval of the Board of Health and the design engineer. q PA / o t a ?i ,el v ou,ss(T KV ,,, 5 . Proposed leaching area is not designed for use with I P garbage disposal. .,eOPo>Eil GeA�E ,E pa �� O t .2 .r iTER ,CA1jT/E1((t &ILAbE jm=oNEs S t RD r 9t�{ W " Ora a *rRRp6N-s� 6. Contractor to notify Dig Safe 72 hours prior to flf� tf "0� 4 `tCAPE AIDFgRMS construction . (800) 344-7233 . � � o 28 7 . Property line information taken from Subdision Plan, dated J� �o -�� - ? F�> � ^1 4/10/57 . Septic Plan not to be used as a property line 9� y� -� survey. f CALCULATIONS s 6FE' 9S,9: � ��'�•' `�--°�> '',••�- � --.- zs ____----_ -� 3 Bedrooms (Existing) ?10 GPD/Bedroom X 3 Bedrooms = 330 GPD 9S -_use - Percolation Rate - < 2 MPI (TP-1) b,� ( Soil Class: Class 1 (0 .74 G/SF) O l� W f ' f t PROPOSED LEACHING AREA: oo 99 Dry Wel l:� : at 2511, X 12'W X 2' H 1 Side Area : 148 SF X C.74 G/SF -= 109. 5 GPD I%� y Bottom Area: 300 SF X 0. ?4 G/SF tSno &.44.c0�/ % � � Total Leaching Capacity: 331 . 5 GPD SC�Pf%C TANK T'r0N z-nfly wEc� 9 I f i ( s 51) z 90 IX i a 1 Q I I z { N A 2 W W cc Z 4 a go i r-0 7P' 1 C�1..'i �.�� SUBSURFACE SEWAGE DISPOSAL SYSTEM ,vo 5�S• try ' - � 40 Angus Way, Centerville SCALE: _ As Sho;n APPROVED BY DRAWN BY _ s t4o a�s, ES 0 {m DATE: 8/02 Daniel B Jornson D.B. Johnson 6 ---- ----- f - _.._ T �___ _..- _ -T _ ._ --)--_-___. _ r ... J Pr ar ed r -r, t-_-._ r_-____._____ T' N0.1f377 ep Tim Goode (508) 539 - 31:0 a W 0+00 o+to p�jo vt34 ©too ptSfl 0+•bo p+lo ar�� U+�° ItaQ t�`Or fq�v,la _ / For 40 ling°s Way, C®ntezv;lle,MA Ar L/o/t l"%IO' A y► �)rJ� repare .y._ Z9P C DESIGN, INC. (508) 42c-15c4 M� ` JtA t �� DRAWING NUMBER .4 la,.; Street, sl.�te B, Csterv__le. MA 0_F°5 -'';4