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Home My WebLink About0054 BAIRD WAY - Health 54�Baird Way Centerville A = 171 277 (part) JaaecrctEo�o � yZ UPC 10259 o- No. H163OR MASTS �, o No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01 pplicatiou if or Yell gtructtou Permit Application is hereby made for a permi to Construct(10 Alter( ), or Repair( ) an individual well at: .a es- /•?/ , �z Location-Address Assessors Map and rcel r biaxi Owner ddr t y� Installer-Di ler Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well t r i n-ct 100 �VL Capacity Purpose of Well 1 fy i c Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Wel Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of C lid' a has been issued by the Board of Health. Signed ✓ / D e Application Approved 5�1 Date Application Disapproved for the following reasons: Date Permit No. '(,I)CPAW ®y 7 Issued G Date ------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Comp " uce THIS IS TO CERTIFY,that the individual well Constructed Altered( ), or Repaired( ) by ALL f A P6 W F I L Installer at `L C✓VI A, has been installed in accordance with the provisions of the Town of arnstab]e Board of Health Private Well Protqction Regulation as described in the application for Well Construction Permit 6 L4 Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector 05-No. 1,,-)a/ Fee BOARD OF HEALTH TOWN OF BARNSTABLE 0[ppYication _for Yelll ngtructiou Permit Application is hereby made for a perm to Construct(`�s), Alter( ), or Repair( ) an individual well at: u f r Location-Address/ ` Assessors Map and Parcel {tl W tYI .St I it 114(� �� -Bli ra lea.(, /ft.7 4-Y,1 ,, Owner j�ddrtess ;Uil_X NoronCikfi 1 ,411 Rn _330"l !? C_ -By"u)"I e✓ 4 1� Installer-Drijler ! ` Address QZ / Type of Building / Dwelling Other-Type of Building No. of Persons j Type of Well Y v, r $mot! Al+� iPV,,-,, Capacity Purpose of Well ti f r I C,, Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed ` "` --_...- Dfe i j Application Approved By-.....� ....- �� Date I ! Application Disapproved for the following reasons: I i Date I� ��rr r ` Permit No. � �� CC)L Issued Date ------------------------------------------------------------------------------------------------------- BOARD OF HEALTH i TOWN OF BARNSTABLE Certificate of C Mp'"auce THIS IS TO CERTIFY,that the individual well Constructed(�, Altered( ), or Repaired( by All- (AP6 lAIf1 tr InstaP,,, J at � �( `tea 1� � -L 1C✓V1 !l-,�_ s has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.y)._'*a q —6( L) Dated 5 �) `�► I THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. I Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Yell Cou5tructiou Permit No. Fee 'i Permission is hereby granted to Installer II to Construct or Repair( an individual well at: No. �� ! Y t� 14 1U G �,64 4 tV 1/I ll�C� Street r as shown on the application for a Well Construction Permit No. OA /,Dated 16 r r Date /l Approved By,., / Zoe 2i. Zoj�c�o G� sa r �G$5 LD / `; j ,Z 51x 2 V I. 1. .o /I J- • \ 16'4 'f ol JL WATER / `mil / `•- /y/�A✓' .) 'nn orry ? \, Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is Centerville MA 02632 March 16, 2013 required for every , , page. Cityrrown 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:Whenfilling out forms A. General Information on the computer, "�U use only the tab 1. Inspector: 20 key to move your cursor-do not Patrick M. O'Connell use the return key. Name of Inspector Septic Inspection Services Co. r� Company Name { 189 Cammett Road Company Address Marstons Mills MA 02648 Cityrrown 7 State Zip Code 508-428-1779 SI 12855 Telephone Number License Number 1 B. Certification 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. Th6 inspection was performed based on my training and experience in the proper function and maintenance of onsite sewage disposal systems. 1 am a DEP approved system inspector pursuant to ection 1"5.340 of Title 5(310 CMR 15.000).The system: +;4 ® Passes ❑ Conditionally Passes ❑ to s ❑ ds Further Ev uatl n by the Local Approving Authority March 16, 2013 Job# 13-17 Inspector's Si nature 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. �I �v t5ins•11110 Title 5 Official InspectVFo : surface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is Centerville MA 02632 March 16 2013 required for every , page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank was not in need of pumping at time of inspection leaching system had no standing water. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 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 wM 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16, 2013 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16 2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•' 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16 2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16 2013 page. City/Town State Zip Code, Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16 2013 page. Cityrrown state Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): N/A Pool and Irrigation system. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2 Months prior to inspection. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) - Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,•�'"c 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is Centerville MA 02632 March 16 2013 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Unknown 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 VA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •54 Biard Way Property Address Dennis Macalese Owner -- Owner's Name information is Centerville MA 02632 March 16 2013 required for every , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Leaching system installed: 2/22/10 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: 2" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments p 9 Y rY 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is Centerville MA 02632 March 16 2013 required for every page. City/Town 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 30" Scum thickness 2" 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 12" How were dimensions determined? 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.): Liquid level was found at bottom of outlet invert, tees were intact. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16, 2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 01. 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.): No solids or high stains present, liquid level was at bottom of outlet pipe 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Three Infiltrators. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching system was video inspected through vent, found no standing water. f Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts 4 - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is required for every Centerville MA 02632 March 16, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately i r i i 54"Z 1-11,11, 1 X'z' " ,'z i "Z ""","Z i i a 29 48 30 I • ,3 77 1 I Vent t I i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 54 Biard Way Property Address Dennis Macalese Owner Owners Name information is required for every Centerville MA 02632 March 16, 2013 page. Cityrrown 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: 20 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: 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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Biard Way Property Address Dennis Macalese Owner Owner's Name information is Centerville MA 02632 March 16 2013 required for every , page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r ' ,f r TOWN OF BARNSTABLE LOCAL ION I SEWAGE# ,26 j(L(4S VILLAGEGf�I,t—�l �Q A SESSOR'S MAP&PARCEL aZ INSTALLERS NAME&PHONE NO. SZ1,�— SdO P &Ieja, SEPTIC TANK CAPACITY I�lJa c� GCdI.. �j Cftf�t LEACHING FACILITY.(type) (size) )�L.;-L d NO.OFBEDROOMS 3 OWNER -beNhi PERMIT DATE: I D COMPLIANCE DATE: a a (} 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 a R A 30 �6 � No. o� ✓ 1 Fee 0 J r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Th5pogal *p5tem Congtructiou Verna Application for a Permit to Construct( ) Repair(4pgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. �� //� �/�i Owner's Name,Address,and Tel.No. Assessor's Map/Parcel C0^�G 17i �77 Installer's Name,Address,and Tel.No. ,J G S•Y6" A, X-V Z- Designer's Name,Address and Tel.No. 2y —e3,6 — s-7 7 ;�,�� s,4,4 Type of Building: Dwelling No.of Bedrooms Lot Size 6./.2 6, sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 -6 gpd Design flow provided i:' 7 d o �f gpd Plan Date . - / o Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) !�j /=/C 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 2 1 Application Approved by Date a J Application Disapproved by: Date for the following reasons tJ � Permit No. d D —O'"I s Date Issued 2 (J No. t It Fee l b J ` I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f a. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for Dioogal *pgtem Conaruction Permit Application for a Permit to Construct( ) Re r(1�Upgrade( ) Abandon( ) ❑Complete System Individual Components t Location Address or Lot No. ��/ 13q"- n Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 171 4277 Instaallller's Name,Address,and Tel.No. fG Sar A . Y-V Zc— Designer's Name,Address and Tel.No. -7 G Type of Building: Dwelling No.of Bedrooms 3 Lot Size .2,,,?6. sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 ,c gpd Design flow provided le 7� gpd Plan Date ,� 5 b o Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. T y Description of Soil St -C L u Nature of Repairs or Alterations(Answer when applicable) nr A j /=/C I 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 Z /I Application Approved by �101AJAP f Date a �d Application Disapproved by: Date for the following reasons Permit No. d 0 'Oct S Date Issued l(d THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by /-Ta swh A rwz at Vy r/Jj W U has been constructed in accordance with the provisions of Title 5 and the for&posal System Construction Permit No. �o 16 G l(� dated r Installer Designer r&IA #bedrooms Approved desi n flow/13Z 7. v gpd The issuance of th' permit shall not be construed as a guarantee that the system will function as designed. Date- Inspector -- ---.—.—.-------_------------------------------ No. .1 cy n tJ t t 1 Fee (` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Digpogal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at (/ , J IAAJ G 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. j i Provided: Construction must be completed within three years of the date of t�tis per t. r Date -1 l, l (0 Approved by ,1�. Town of Barnstable Op tHE tp� ti Regulatory Services o� Thomas F. Geiler, Director * BARNSTABLE, 9 MAC.i639' Public Health Division �� Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: it) Designer: Shay Environmental Services, Inc. Installer: 4:�N Address: P.O. Box 627 Address: R7+ East Falmouth, MA 02536 On o � -I^ was issued a permit to install a (date) (installer) iir,�- septic system at _5� l ff� t2'V P+Y. C� \Y� based on a design drawn by (address) Shay Environmental Services, Inc. dated Z (designer) certify that the septic system referenced above was.installed substantially according to Xthe design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed witfl 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. TN OF Mq x CARMEN (In is Signatu ) E. i> v : S{-il�Y No. 1'181 ., GIs C\2- S Pia Z�grner's Signature (Affix Dest p Here) PLEASE RETURN TO STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form a, TRANS. NO.: 12 8a CITY/TOWN: n �� APPLICANT: �r �-� ADDRESS: ,'_cj A ��-\K7A wo-A DESIGN FLOW: gpd REVIEWED BY: DATE: vp N/A OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for ✓ upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. ✓ [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] �✓ daily flow ✓ septic tank capacity(required and provided) soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on ✓ each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper ✓ elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.2421 Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR ✓ 15.220(4)(n)] Address �K N`\\� Sheet 1 of 7 N/A OK NO Location of every water supply, public and private, [310 CMR ✓ 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case ✓ within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins ✓ located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR ✓ 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[11) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] V Stamp of designer [310 CMR. 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] V Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR ✓ 15.0001 System co m o > 36" deep (unless Local Upgrade / Approval r LUA requested [310 CMR 15.405(1(b)] ✓ Address 6A `��` � �� \� Sheet 2 of 7 N/A OK NO SJEPT4TC TANI � t z 4 a 6 Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR / 15.228(1)] ✓ Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for ✓ upgrades under LUA [310 CMR. 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - / middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, / two for systems >1000 gpd [310 CMR 15.228(2)] ✓ All at-grade covers secured to unauthorized access? [310 CMR / 15.228(2)] V > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] ulhCompartmentdTanks�� ` �M 4 3 Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] j Address Sheet 3 of 7 N/A OK NO z�f.n iYyw= ..o-.ter•, ., - U.,., r.. .. Located at least ten feet from any water line? [310 CMR� 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.21l(1)[1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches ✓ and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller / than 3/8" not larger than 5/8") [310 CMR 15.2151(8) and 310 ✓ CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) DIS�TRIBUTION'BOX ..r_. ; _ . E A4 Stable compacted base [31.0 CMR 15.221(2) and 3 1,0 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 ✓ CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(0] Inside minimum dimension 12 [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd / [310 CMR 15.232(3)(d)] V PUMP CHAIIIBERS x � � . Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] ✓ Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, ✓ disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] Stable Compacted Base [310 CMR 15.221(2)] v Buoyancy calculations needed ? Provided? [310 CMR , 15.221(8)] Address �� \ l_1-J `�v\� Sheet 4 of'7 N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR / 15.240(1)] V Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.2411 Inspection ports specified and within 3"final grade? [310 CMR / 15.240(13)] v Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must / be to grade) [310 CMR 15.253(2)] ✓ Aggregate 1' minimum- 4' maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 1.5.253(6)] TREICHES 310C s .1>5251 '&., 3 � µ , a- ..,,:'�$$�e` T3. 's�"`-�, :xztief.�'� '. .a..,.-9.. ...w .. ,. Width 2' minimum T maximum [310 CMR 15.251(1)(b)] 100 feet - maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] BsEDSAS�(°Maximum size of bred or field 5000 d � minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM RI5.252(2)(d)] i/ Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" ✓ maximum. [310 CMR 15.252(2)(g)] Separation between beds 10' minimum. [310 CMR 15.252(2)(0] V Bottom area used in calculations only [310 CMR 15.252(2)(1)] Address SA �CC� C"'4"'\\'Z_ Sheet 5 of 7 N/A OK NO Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems >2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet / the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by / designer [310 CMR 15.255(2)(b)] v Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] ✓ Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Grav�elless.System j[I/R�flpprovaZletters]3 � � � �� r��°' �z`� � Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Altern atiye::S eticSyste [I/AAPpoval lettes� z .". - ? . � «`,. . . Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance � .�� Are the variances listed on the plan? [310 CMR 15.220 ` (4)(q)] RLS Stamp necessary on plan if a component is within five / feet of property line [310 CMR 15.412(4)] V New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address Sheet 6 of 7 N/A OK NO Natroge�z Se�isataveAreas _ E }� Is the system in a Designated Nitrogen Sensitive Area (Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address S o\ �Q cc� \ i \� Sheet 7 of 7 aF� Town of Barnstable P# ) to Department of Regulatory Services seerer,►BM Public Health Division Date PAA99. t639 ,6�' 200 Main Street,Hyannis MA 02601 Date Scheduled a- a Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: t,v I-:� S . LOCATION & GENERAL INFORMATION Location Address 514 tc�l�C"� W Owner's Name Address Assessor's Map/Parcel: Engineer's Name (fin S NEW CONSTRUCTION REPAIR Telephone# a9 t _-4 j 8 Land Use 1 C� C�`� Slopes(%) Surface Stones �r Distances from: Open Water Body _ft Possible Wet Area ft Drinking Water Well Drainage Way ft Property Line 3b ft Other ! ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) PO/ 0 �J 2 Parent material(geologic) 0�V1..3 0—.5� 0� Q Depth to sedroek. Depth to Groundwater. Standing Water in Hole: -t `Weeping from Pit Face C � Estimated Seasonal High Groundwater (�� (3 5sAXV,4 C DETERMINATION FOR SEASONAL HIGH WATER'TABLE Method Used: Depth Observed standing in obs.hole: — in, Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor— Adj.Groundwater Level PERCOLATION TEST Dale " TIWc t LjQd Observation -ki Hole# Time at 9" Depth of Perc � Time at 6" Start Pre-soak Time @ �+� Time(9"-6") 4( _ End Pre-soak + Rate Min./Inch La M P i Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:4S EPTICIPER CFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1_ Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on i tenc % ravel w h ow DEEP OBSERVATION HOLE LOG Hole# a Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsis en % ravel 0 9Q, 3 N A6 3ati-C s rl1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten ° Flood Insurki&Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes _ t Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious aterial exist in all areas observed throughout the area proposed for the soil absorption system? ---- If not,what is the depth of naturally occurring pervious material? Certification I certify that on ( e) have passed the soil evaluator examination approved by the Department of Enviro tal lion a Tat the above analysis was performed by me consistent with . the required trainin ,expe, se an a enc described in 310 CMR 15.017. Q Date Signature a' Q:\SFPTICIPERCFORM.DOC s Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 54 Baird Way — Property Address Rich &Johanna Maguire — Owner Owner's Name information is Centerville MA 02632 December 11, 2009 — required for State Zip Code Date of Inspection every page. City/Town Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: / VV only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 ienm Cityfrown State Zip Code 508-428-1779 S1 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails eeds Furthe Evaivaiion by the Local Approving Authority t December 11, 2009 1 pector ignature 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. LO IV V of 09-263 Maguire.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Baird Way Property Address Rich &Johanna Maguire Owner Owner's Name information is Centerville MA 02632 December 11, 2009 required for State Zip Code Date of Inspection every page. Cityfrown B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: h static er in the distribution box ❑ Observationbroeor obstructed backup pipe(s) or duet a broken, settled oartunevenl distribution box. System uwill to broke P pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 09-263 Maguire.doc•08/06 J Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Baird Way Property Address Rich &Johanna Maguire Owner Owner's Name 02632 December 11, 2009 information is Centerville MA required for State Zip Code Date of Inspection every page. City/Town B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. Systern•will pass unless.Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. ❑ k and SAS and the SAS is within 50 feet of a private water The system has a septic tan - supply well. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 09-263 Maguire.doc•08/06 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Baird Way Property Address Rich &Johanna Maguire Owner Owner's Name information is Centerville MA 02632 December 11, 2009 — required for State Zip Code Date of Inspection every page. City/Town B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less ❑ ® than_day flow El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 09-263 Maguire.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments wM 54 Baird Way Property Address Rich &Johanna Maguire Owner Owner's Name information is MA 02632 December 11. 2009 required for Centerville State Zip Code Date of Inspection every page. Cityrrown B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section:D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 09-263 Maguire.doc•08/06 I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Baird Way Property Address Rich &Johanna Maguire — Owner Owner's Name information is Centerville MA 02632 December 11, 2009 — required for State Zip Code Date of Inspection every page. Cityrrown 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? ® 0 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)] 09-263 Maguire.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Baird Way - — Property Address Rich &Johanna Maguire — Owner Owner's Name information is Centerville MA 02632 December 11, 2009 — required for State Zip Code Date of Inspection every page. City/Town 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 0 _ Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No N/A Irrigation Water meter readings, if available(last 2 years usage (gpd)): system. _ Sump pump? ❑ Yes ® No two weeks prior Last date of occupancy: to inspection. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 09-263 Maguire.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments H 54 Baird Way Property Address Rich &Johanna Maguire Owner Owner's Name information is required for Centerville MA 02632 December 11, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1999 — Were sewage odors detected when arriving at the site? ❑ Yes ® No 09-263 Maguire.doc-08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 54 Baird Way — Property Address Rich &Johanna Maguire — Owner Owner's Name information is Centerville MA 02632 December 11, 2009 — required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ----------------------------------------------- ------------ -------------------------------------------- 10.5' long x 5.8'wide- 1500 gal_ Dimensions: 4" _ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" 3" — Scum thickness 6„ Distance from top of scum to top of outlet tee or baffle — 10" Distance from bottom of scum to bottom of outlet tee or baffle — Measured — How were dimensions determined? 09-263 Maguire.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 54 Baird Way — Property Address Rich &Johanna Maguire — Owner Owner's Name information is required for Centerville MA 02632 December 11, 2009 — every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert. Observed solids and paper on top of outlet tee. Observed solids on bottom of cover and staining at cover/tank interface. — Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 09-263 Maguire.doc-08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Baird Way Property Address Rich &Johanna Maguire Owner Owner's Name information is required for Centerville MA 02632 December 11, 2009 - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): 11 Depth of liquid level above outlet invert 0 — Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Liquid level was at bottom of outlet pipe at time of inspection, box had solids and staining to top of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-263 Maguire.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Baird Way — Property Address Rich &Johanna Maguire Owner Owner's Name information is Centerville MA 02632 December 11, 2009 required for every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 cultec 330's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS had surcharged into d-box and septic tank system in hydraulic failure. 09-263 Maguire.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Imo— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Baird Way Property Address Rich &Johanna Maguire Owner Owner's Name information is Centerville MA 02632 December 11, 2009 required for State Zip Code Date of Inspection every page. CityrTown D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 13 of 15 09-263 Maguire.doc•08106 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Baird Way ---------------- ---- --- -- Property Address Rich &Johanna Maguire — — — Owner Owner's Name information is Centerville — MA 02632 December 11, 2009 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) 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. Water Service 154, / 1 / r r r r /•r \ \ \ \ \ \ \ \ \ \ \ \ \ \ 26 24 38 28 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Baird Way Property Address Rich &Johanna Maguire Owner Owner's Name information is Centerville MA 02632 December 11, 2009 required for State Zip Code Date of Inspection every page. Citylrown D. System Information.(cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells N/A Estimated depth to ground water: 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: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: 09-263 Maguire.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 i o i / 704te 2G Zojlabo GP � � SG•8 / ZIP �• a�4 �� , IID / l0 2 2G 3 CA TW- IQQI .o I . p v- ' YRa�vss� / m �' • nl �\\ 1614 ST-Py`A� �� 40' �,o Mam S e ' ------ TOWN OF BARNSTABLE ; LOCATION SEWAGE # VILLAGE }a' ASSESSOR'S MAP & LOTS j INSTALLER'S NAME&PHONE NO. 160 o+4 a/O ¢,4 / SEPTIC TANK CAPACITY /,,; LEACHING FACII.TTY: ( ) C u 1 4-a t 3.3 0 (size) NO. OF BEDROOMS ,n BUILDER OR OWNER ' J ilq PERMIT DATE:_a�1 .. �COMPLIANCE DATE: f Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facili ty (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 UP th r ` Tm COW/OMWEALTH OF MASSACHUS.ETfS PUBLIC HEALTH DPOSION-BARNS'TABL.E,MASSACHUSETTS La i Ai"0081 i5wem Cnnotruction 3permit Permission is hereby gamed to Construct(✓)Repair( )Upgrade( )Abandon( ) System located at_1�-'t gflf WAM [' •' y1 t.�•� and as described w the above Applirsti0c for Disposal.System Costmrtraction Permit The applicant recognizes bisther duty rn visions or ial conditions. � �h'with True 5 and the foUowmg local pro spec 00 Provided:Construction n�camp . n three Years of the date of5 � Date: Approved by 00 o x ' u- CD - -'�COMYONYYEALIIi OF IY4ASSACl�IUSETTS� +—_.r—!—�- f- j :D BARNSTABLE, MASSACHUSETT5 00 Certificate of Compliance CD TIAIIS is TO C �thatte Sege D�sp�System Coastr•vycted( ✓Repaired( )UP�od( Ab oned( )by i1S -� oat tdNW has been contacted to accgrdanc � wish the provisions of Title 5 the for Disposal System Construction Permit No. dated O m Installer ca - Mie issuance of this�jt�Bs a guarantee that the Sy ti as Dane Inspector N CL O p 00 0 00 CD N O _ z w LL f 9f h For Parcel` u�` r 171277 a Yftvj 3 Re ' Bustn Zone of Gonfiril� n{YiNy fs f3is�osa!W p9501 99 642 / F�lelPerm��t / .; ssuancesDa#e, w i m 10/01/1999 V " ' ompi Monl atIlk � tec �y e �za of fiAS 4 cul in 12x25x2 LT �.✓sNifn ,../. ///' kc /// _' %O �V/ka 1 y' Ct y` "�,"'�°.• � �' ::: ` h " ' > 54 Baird Way,GP Zone, 1.43 Ac. BAIRD WAY pa WEST PRECINCT REALTY TRUST o loc 52 r� 171277 �; r� p p � u a Met o 4 e Cs;Lxx-le-) ku / 2A TOWN OF BARNSTABLE � LOCATION ��' hJ 64.'r d a1Jo� SEWAGE # M f-4 VILI SAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. G60'0"4o/O -A< ." ccr-?. SEPTIC TANK CAPACITY /,tom a , EACH NG FACIL= (y > C 14- (size) NW..OF BEDROOMS BLTII:DER OR OWNER kWzan MAGUlmr, PERMITDATE: /J�--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.s.ite 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 f=, Furtiistied'by tI t 3c y7, , 3 Cq)7 . No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01pplication for Migoaf *patent COtt$truction permit Application for a Permit to Construct(* Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. �, '�, 'l (s(� Owner's Name,Address and Tel.No. & =2v t i Rico hfLj�) 1 4 i?1t�lE Assessor's Map/Parcel L3 -rjj4 V 9A5-AV6kr). C a4w-V j i�J Installer's Name,Address,and Tel.No. Designer's Name,Addres5 and Tel.No. -7 7 Fit dvtrz t�l I- Z. ►f3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 62,I&S sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ® gallons per day. Calculated daily flow 0 gallons. Plan Date 5 Egr• I fey Number of sheets Revision Date Title C If.p. IN (! )4 V 1 =10 �+G' _�fL eaw Size of Septic Tank i Itpo Type of S.A.S. ijaG Lt- E Description of Soil CO MS E 6JAr-I + ldfAN6L, Nature of Repairs or Alterations(Answer when applicable) Date last inspected`. Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has beenissue�bhis ar of alth. Date Signed Application Approved by c S Date `1— Application Disapproved for the following reasons Permit No. g Y Z Date Issued w Fee/ C/0 No. ►- .�.� ,. ti THE COMMONWEALTH OF MASSACHUSETTS "k: Ente red"in computer: 3 �O PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes 01pprication for XDig;poga[ *p.5tem Construction Permit �Application for a Permit to Construct(✓)Repair( )Upgrade( `)Abandon( ) ❑Complete System ❑Individual Components ocation Address or Lot No. (pr'2, 123 j W,4'y Owner's Name,Address and Tel.No. GE 1 anV I LA.P- IZ4CA W.J� MA 6V1Q& Assessor's Map/Parcel r �' t f '("/�ORLWA V Installer's Name,Address,and Tel.No. 'Designer's Name,Addre and Tel.No. �O t" , i Go7y�` B"Tae- 4— fN E IW-. -77) Fy12 MA IN S7- 4�zb-9131 Type of Building: Dwelling No.of Bedrooms B Lot Size +2,1,&S sq.ft. Garbage Grinder( ) t1 7 f' Other Type of Building No. of Persons Showers( ) Cafeteria( )! Other Fixtures I , Design Flow ?S C:) gallons per day. Calculated daily flow O gallons. Plan Date 5 EP , I6b i 1 G ct q Number of sheets • 2 Revision Date Title C ?,P. I PJ C614 MWILIXeIQ6 COT 14AQ Q it NA/eAT kepq cr - a- (L Size of.Septic Tank I�Y?(7 Type of S.A.S. I- e. Ae l4 ING 6 u i o Description of Soil CO A2S€ 6A Il0, + 1,a A Vd1. Nature of Repairs or Alterations(Answer when applicable) h Date last inspected: Agreement: •� The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oar of Ialth. l�9 /©� Signed Date / Application Approved by � S Ar Date Application Disapproved for the following reasons Permit No. Cl 9-6 Y Z Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTJFY, that Ihe On-site Se age Disposal System Constructed( ✓)Repaired ( )Upgraded � ( ) Abandoned( )by 0 ,l�Jl !!y�`` at LV G ��La.� has been constructed in accordance an with the provisions of Title 5 d the for Disposal System Construction Permit No. 9^6 Z dated—Z0 y Installer ,r / Designer A J �^ The issuance of t �s:permit s all not`lie,cons ued as a guarantee that the sy tem will,7hi cticifi as§'desi ned. Date ! $�G/ Inspector No. / ----------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migaar *pztem Congtruction Permit Permission is hereby granted to Construct( ✓)Repair( )Upgrade( )Abandon( ) System located at� -L RA I QD (AJ , nL I 6,ej V 1 64,&- 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 comp eted w din three years of the date of th's p rmi.. C Date: r' / / ( �" Approved by r ' / / C,1/ � z �3Z -- — 20.9 ---610 - --- 6.10 _ IF Ii II -- -- I� �--- I -12-1 - il 5'6---- 13'1 II M — -- ---18 11 - - —- I I I— ri 14'5 co I,IVrM6 I I _ II m n n I� it S' 8'4 6'8 ... — 6.8 8 4 5: -_ 4L' L!VING AREA 1455 Sq ft 1 13-4--- -4'2--4'4- 5'6 2-11 --4'3 —--5-6 —4'2 9'2—._ ..- ------------------ - 9'4- o cor ul _ �— V L ! NJ v 12'9— ------ v � f— a'1 o-- a'10 - -- 16'9 - fvl A-s rf- Iz- __-- 5 co i3 �,�oo� _. --8-4 - - -- 6'8 —--2.9 --3'11 -:_.. 8'4 5, ---------- 22'9 ---- -- ----- --i,'-3 -- - - _- LIVING AREA 1200 sq ft St vA rA SIU�� F�ttt.`{ RE�RLt�K r�E Pt_A,t�l. oN BAGK- u� 40 Ito SSG &'PVC. PIPE 330c:�A+M> s spalt t>5'e CULTS-- DUST. GPI 1 �•� 5� � � � ?ri' ,(ppLiGAT�ON Al2Zk vriI&W t � PLaN Vtl=1�(/ - Lit-}1t�Y� c1-4AM8Ee5 SltEyIALL AtaE:A' ''� '��x2=i�•S s� PE=O.&Tt tzdTE L S Mi��i /8 /Z STo►+E Zoll. C1�'�j I o i a .CULEG T k 2 d n wws r�P�,�N OF IvlgSs9c � ', • 330 0 ° ' �� n,cF- �T-oNE o` J �G STEPHEN y : I,--- >ilp� I y�C~ N .30916 , co � �p�fj'SEG't'lUN OF CLAM Q fG"I i AL �S 40 tMt i S� t low ,n C oKG ►�. S S:K z LbaGA CNAn4BC S�c. �-� •' 77 SS� GAL = O. VgFk FQ:> WoFtL S4wl to � toy 12.1 Ice DA7G 9, �� y P ctso 1 ws: ��.u�N� 5ktvtiuN PLI�I _ CTtf`f �T 114E Ka RT ci��tR-y5 w rm � st uN� A� j - 'L i`�Lm kr2 vjc OF T1(6 -W x1N OF MAP 01 FIAZCZ�-ZIT IT-41N t' 'iBl►G� 2�pu►26�M6d1T A �t�? 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I 10 a r OLM ET INLET S „ INLET r / . 84D / r 1 .r O THE ACCESS COVERS FOR THE SEPTIC TANK, 92 DISTRIBUTION BOX AND LEACHING COMPONENT • . . __ _ SHALL 8E RAISED TO WITHIN 6 OF ----- � RAVEL ---- �.._,.., •a •• •.: >'< , .>,•. FINISHED GRADE. . zv _ DR IVEWAY V STEEL REINFORCED PRECAST CONCRETE TITE CA S BAFFLES OR EQUALS �iNSTA LTUF 1 ON ALL OUTLET TEE ENDS 3 I Mu \ �a= .er . F. PLAN VIEW La_ _ _ , I 4 REMOVABLE S-2 RE 0 ABLE COVERS F. D 25U E \ { �R �• t.m Gs \ \ \ �3 min. deoronp !' is eur min. 2•min w INLET- T" k to outlet*4* 0 txmFT GENERAL NOTES \ r� .. Lit Tiwl\ J\ ,L G / _ _\ s r ., s r 1. Contractor is responsible for DI safe notificotwn, VERIFlCATION \�.. \ ,. •. and ro ecUon f all nd r r tI � 4-0 min. p t o u e g ound unlit es`and pipes.wone• :, Id •. 1 \ •� aj , Liar+ d.p 2. The septic tank a dtstn utton box shall be set \ level on 6 of 3 4 -1 1 2 stone. !-�\ � • ., 3. Backftll should be clean sond or ravel with no ., r• .. stones over 3 in size. � G K \ s -a i 10-0 4. This system is subject to inspection during installation Y J P 9 - / 1 �9 by-Corms E Shay rv'ISe ices Ina \ 1 Y , ND SECTION 8 R SECTION E , \ 8 i CROSS SECT 0 5. The contractor shall install this system to accordance I ? � i O \ S with Title V of the `Massachusetts state node the approved - Ian to PP P \ / 6 n � � \ A TYPICAL 1500 GALLON SEPTIC . TANK and Local Regulations. 9 i G 6. If, durm installation the contractor encounters an / � � 9 Y \ 3 NOT TO SCALE \ � soil conditions or site conditions that are different , t \ O \ I \ � /I-I 10 LOADING from .those shown on the :soil 10 or m our design \ (• \ o �� ' installation must halt & immediate notification be I \ � made to Carmen E. Shay Environmental Services Inc. \ r ' 7 No vehicle o heavy machinery shall drive over h \ e e o the vY rY - septic system 'unless noted as H 20 septic components._ t PERCOLATION TEST \ _ PP T _ APPROVAL VARIANCE REQUES ED LOCAL UPGRADE - B.-Install 'Tuf-Tits as baffles or equals on all outlet tee`ends. ' \ f� _ 9 4 Date of Percolation Test. DECEMBER 29 2009 me shall 4 i 9 All Distribution L s s a be d ameter Sch. 40 N F_PVC pipes S e \ _ P \ P p, r r N H A Test Performed B . CARMEN E SAY R.S. C.S.E. R APPROVAL O PUT S S \ _.. REQUEST A LOCAL UPGRADE T 1 / Y .. 10, A11 II piping, t fittings shall 4 , sod tees do tt s s a I be diameter - Result Witnessed AVID `STANTON - ARN TABL 0 PP 9 9 N PROVIDED. sB DB S E B H NT PI E HAS BEEN ' -- W GRADE. A VENT P GREATER THAN 3 FEET BELOW G E , \ _ / Schedule 40 NSF-PVC pipes with water tight joints. _ P_ P 9 EXCAVATOR. Shay Env. Svcs. Y _ 2 LOT s-- \ — //j� _ 71' Percolation Rate. <2 MPI ® 32_ 11. MUNICIPAL WATER IS AVAILABLE TO THE SITE and Surroundin g 9 1 4! \ Properties WITHIN 150 FEET.of PROPOSED SAS \ Jig 263 Square Feet t P 9 Test Hole\ e H . :Test Hole \ No. 1 No. 2 \ DEPTH SOILS ELEV. DEPTH I L V. x, DEP SOILS E E t , \ 98.50 98.50 �� } \ O 0 THEPROPERTY IN APPROXIMATE \ nd oam Sand Loom E TY LINES:.;ARE AND So L Y Y MI 1 Q \ �. CO PLED FROM THE PLAN. BY BAXTER do NYE OF BARNSTABLE MA \ ui N MA' ENTITLED CERTFIEO PLOT PLAN OF -LOT 2 AIR 'WAY A \- _B D .CENT. M 2 10 1'R 3 a `C 10YR3 /2 G O DATED 9 16 9 9 _ ,A _ A , 9 'sB.o ss oo s o o s , o N I i 5 \ \ G n AND IS -INTENDED TO BE A SURVEY PLOT:PLAN Loom Sand loam Sand Y Y \ `O Q G� IT SHOULD f o \ S LD BE USED OR :NO PURPOSE OTHER THAN \ ce Bath ,. \ THE SEPTIC SYSTEM.INSTALLATION. _ ,oYRa ,orRas\ r L /a / OFFICE Kitchen - / \ 0 CE \ F _ B » \ - 95.83 95.83 '9 6 32 6 32 _ M Mad-Coarse Mad-Coarse C n Sand� Sad a \ NOTE. ANY STRIP PED ED OUT S01 CONTAINING\ L -LEACHATE 2sY7 4 2aV7 4 FROM H 0 THE EXISTING .LEACH TRENCH-TO B DISPOSED t : c E ED Di ning 9 \ •_ •_ • OF AS PER OAR _ Living Room 3 BOARD OF HEALTH SPECIFICATIONS. LI 32 132 2 132 9 Cf 87.50 87.50 \ \ / N c \ R 0 EXISTING h Trench U E Leach T e h TO BE .PUMP DRY \ N PUMPED D & 0 A\ FILLED IN PLACE \ \ O 1st Floor O EXISTING \ \ / \ 3'BEDROOM , Ca" \ R 7 ASSESSORS MAP 1 1 LOT 277 93 a _ s s\ SE \ HOU E _ _ - NT\ ZONING RESIDENTIAL v s Bath 54 Closet B t Both � 0 r DECK r_ Pe c 1 't .4.. r to 0 _. _ Depth to Pe c. 32 5 ar P _ m MPI Perc Rate <2 Observed ® 132 'NO GroundwaterOb e _ NON ADJUSTMENTE W N ET ND ARE LOCATED WIT E No Observed ESHWT 0 WETLANDS E L C TED WITHIN A 200 RADIUS 0 E � OF THE PROPERTY X o O _E IST. MARK ►. PROJECT-BENCH A o O v 1500 GALLON _5 G LO vFOUNDATION a� O P F m SEPTIC TANK TO 0 - ; to E V._ — 100.00 Assumed LE ALL CUTLET PIPES FROM THE OislRieUTioN X ALL BE p� eo sN 12 COVER SET tEVEI.FOR AT LEAST 2 FT. t'- 2 CRETE - /.V .. LEGEN a•OUTLET2nd FloorKNOCKOUTSVent tNtET.• DENOTES PROPOS D P Eie 8X0 P 6 G • r •. .• •.. r . SPOT GRA , �. DE SHED w N 4 4 CH. 0 Te �. .\.. ti S t.>•s t � DENOTES EXISTING - 3 BR `HOUSE FLOOR SCHEM ATIC X c� 104.46 PLAN SECTION CROSS—SECTION I N S C OSS ECT 0 z o- SPOT GRADE Provided B Owner ) � ` Y )(Description c� . . . .t co cC �t h PL _ PROPERTY IN � 0 H 1 I TRI T E TY LINE t .. 3 HOLE 0 D S Bt1 ION BOX zf, t.. -1 c. .l s i _. �r5, PROPOSED A A TESL HOLE. 1 rr 97 0 OSE CONTOUR SECTION !ry i .- 9 .50 t. ELEV 8 -- -- EXISTING CONTOUR SYSTEM D Bax — _ 98 97 97 PROFILE VIEW OF LEACHING PR _ Desl n Calculations No t to Scale , 9 P DEE TEST HOLE & 8 0 8 f ,>' llaahed Peaetone f 1 / PERCOLATION TEST LOCATION 3 4 t0 f f ,Y Washed Crushed Stone TEST HOLE 2 # Number of Bedrooms: Bedroom EXISTING _ ,5 e 3 ELEV. 98 0 T6.6 Garbage Grinder. No 9 FENCE INSPECTION PORT TO BE E E 4 PVC (CAPPED)' NS r hin i r 0 I. (MIN. V Leaching Capacity Required:ed 33 Ga a PER TITLE Q /D Y l IN STALLED AND TO BE WITHIN 6 OF GRADE 9 P Y ) Septic Tank x 330 Gala Do 660 USE EXIST 1 500 GAL. Septic Tank. 2 E , i Y P _ PRIVATE R ATE DRINKING WATER 'WELL t N TE L ABSORPTION N AREA: In percolation n r _.SOIL BSO 0 E Us e c o ate of <6 min./inch inch _v 9 P / mot' Bottom Area: 0. I ft. s ft. II_ e a s x a ons 3 / Q 9 I 9 . 9 -;. l i ft.Sidewoll Area: 0.: ai. s ft. : x .. ,gallons f s 9 �_ t t� �� , / 9 I '�9 I q _ _ ..� REVI IONS 1 _ Providing: _ gallons S0 S _ 9 9 24 Effective v� ff -- Szdewall �. 98 • - HAVING A EFFECTIVE P _Use. 3 3050 H 20 INFILTRATOR CHAMBERS H NG 2 E FEC VE DEPTH, N DATE: O - 0DEFINITION 4 W x L TO E USED WITH 4 OF .WASHED STONE ON THE SIDES AND _ �3Units @ 7 21 7 e E �. ' F WA NENDS.3 0 SHED STO E ON THE i 1— 5 3,5 3.5 Length Effective 9 8 I SAIL ABSOR PTION SYS TEM , (SAS) AMBER H 20 OREQUIVALENT) U TEG 3050 INFILTRATOR CH C L HT i _24 V HEIGHT S IS3 0 EFFECTI E - NOT E: OVERALL HE IGHT OF INFILTRATOR PR P C 0SED PREPARED FOR : SUBSURFACE SEWAGE DISPOSALSYSTEM l S S EM a 4 inches toll `VENT PIPE O Least 2 e ) i E 40 P.V.C. t OF NOTE. ALL PIPES ARE TO $E 4 SCHEDULE Schedule 4d PVC w Charcoal Odor Filter 10 min. from Existing Foundationto tic tank E �ho.se aeP RI HAR MAGUIRE D BDX caw must b. C DSetank coven must be_ P 54 BAI R D WAY TOP OF FOUNDATION ELEV. 100.00 Assumed within a of GRADE within a in. of finished rads � 9 _ Orede over D-Box- 98.a0 •over SAS- 0a.50 Grade over Septic Tank 96.b0 3 HOLE H-10 DIST. BOX CENTERVILLE MA 54 BAIRD WAY S- 0.02 3' Maximum Cover _ .. EXIST. 5-0.01 or Top OF System- Elev..95.50 O 1S E S Greater 7• -E T RUI MA 0� 632 extsr. pipe o 1,500 GAL. -s- 0. C N E LLE PREPARED BY: IN rn a0 01 Per f f cot _ T• F IIAT ON PTIC TANK a ..FROM EXIST. IX1N I rn SE I > H 10 n it ., a. ,, ., 1 N noN--� ` , . , CONCRETE 2 EFFECTIVE: DEPTH . .4. CA R11.7�'N E. _JSHA Y 01 orIR . v ._ w N i 0 M rr a in.cf 3/4 1 1/2 u; 0 2 0 40 ,,, Y Y 4 4 5o i... �'N IRONME'NTAL SERVICES, `INC. SYSTEM PROFILE- _ composted stone u 4 rn _ c > �J o ';T c it Not to Scale _ > U c v Effective vidtr, 1 1 1 THORNBERRY CIRCLE c — > 0.1 • . 8 in.of 3 4 1 i 2 d , ,. � >w �. � MASHPEE, MA 02649 compacted stone r, o SCALE. 1 —20 � �.� � � ; 0 Z �ti��t TEL FAX 508-539-7966 i w Bottom of Test Hole 2 Elev.- 87.50 NOTE: SEPTIC TANK & D-Box TO BE CONSTRUCTED ON LEVEL COMPACTED BASE • _ SCALE. 1 =20 DRAWN BY: CES DATE: FEB. 9 2010 NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6 BELOW GRADE Groundwater Observed NONE OBSERVED , PROJECT SD-1168 FILENAME: SD1168PP.DWG SHEET 1 OF 1