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Home My WebLink About0140 BAY LANE - Health 140 BAY LANE Centerville A = 186 - 029 - 001 ---------- -- -- -- SMEAU No.2-153L.OR UPC 12M .er.dcom • Ysft 1w U" wwurowwwoaau� IOF I OFU MMOwaww�s 140 Bay Lane - Smoke detectors and existing �G house layout FEP Bedroom 4 O Os Basement Proposed bottom of Bedroom Bedroom Bedroom Stairs AR- O Basement; 2nd unit existing LO ATION SEWAGE PERMIT NO. / — VILLA GIE E re c) (c, Aq5�-F- 51�0- 09 m4p 4 I N S T A LLER'S NA E & ADDRESS 2ct-0C ( C r �.L u ., B U1'LDE R OR OW E - r Al2Q, H t c U -TL DATE PERMIT ISSUED S DATE COMPLIANCE ISSUED ��+ i � � �. =� � i� 1 �f� ,y �� , �y� �`� � � -, �� 1 .� .� :� .a � �_. �� v�� ► THE Town of Barnstable Barnstable pF Tp� 1� ty Regulatory Services Department AD-America �"a� 1.�'� ARNSCABLEr public Health Division�tb 200 Main Street, Hyannis MA 02601 2007 Office: 508-80-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 6857 October 15, 2012 Margaret Beech Beech Tree Trust Centerville, MA 02632 The septic system located 140 Bay Lane, Centerville, MA was last inspected on 9/27/2012 by James D. Sears, a certified septic inspector for the State of Massachusetts. The Health Division has determined that the system "Conditionally Passed". • Distribution-box needs to be replaced You are ordered to repair or replace the septic system within Two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH omas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\140 Bay Ln.,Cent..doc I Commonwealth of Massachusetts Title 5-Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 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:When A. General Information ,,++++lllllff►►►,,, filling out forms �jN OF MgSp��O on the computer, use only the tab 1. Inspector: ` O�y��.R' 9�yG key to move your =JAMES u' cursor-do not James D Sears = use the return SEAR c - Name of Inspector = — :�n key. Capewide Enterprises LLC, Company Name ��' I'�5 I N Sa AN p� ��`` 153 Commercial St ''�►n►nnunu+++````�� Company Address Mashpee Ma 02649 Citylrown State Zip Code 508-477-8877 S1623 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" ❑ Needs Further Evaluation by the Local Approving Authority C -f 9-28-12 pector's Signature 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. t5ins•1 U10 Title 5 Official Form:Subsurface Sewage Disposal System•Page 1 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Flame information is required for every Centerville Ma 02632 9-27-12 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: 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•11110 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 y 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page. Cityrrown 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): need to replace d box ❑ 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-11l1 Q Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Se wage a e Disposal System Form Not for Voluntary Assessments 9 p Y rY 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 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 El ® Liquid depth in is less than 6" below invert or available volume is less than %day flow L E1 111W G 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 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page. City/Town . 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 N 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 El ET Area—IWPA)or a mapped Zone 11 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owners Name information is Centerville Ma 02632 9-27-12 required for every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design) na Number of bedrooms(actual): 2, DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 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 y 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page, City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1500 gal precast tank d box and four flows Number of current residents: 1 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d na 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: present Date CommerciaUlndustrial 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: t5ins-11/10 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 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 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: 7-5-11 .1 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/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Forth: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 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1992 permit #92-44 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 23" 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.): pipeing is 4" pvc sch 40 Septic Tank(locate on site plan): " Depth below grade: 15 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: 1500 gal precast tank it,Sludge depth: l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 • Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 811 Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? asbuilt-tape-sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): tank and covers at 15",tank at working level w/in and outlet tees.no sign of leakage or overloading Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): ry 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•11r10 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page. City/Town 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 W - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owners Name information is required for every Centerville Ma 02632 9-27-12 page. Cityfrown 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 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.): D box is 16"x16"-2' below grade, walls are gone need to replace box.need to install H2O box, box in stone drive 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-11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 17 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bay Ln l — Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page, Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ® leaching chambers number: 4 ❑ 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 is four flows ,16'x36',flows are 34"below grade w/cover at 8", camera and probe, no sign of over loading or solid carry over Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and con-figuration 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-11110 Title 5 Official Inspection For n:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bay Ln ,p — Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 Forth: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 UV 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page. Cityrrown state Zip Code Date of Inspection D. System Information (cunt.) 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 z i - i i / , r 1 / / %Of t /. W • j t5im-11mo 'age 15 or 17 t ..� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 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 101+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 bservation 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: hand augr 10'-10"no G.W. auger hole 6'-6"below bottom of leaching 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 r 140 Bay Ln Property Address Margaret Beech Beech Tree Trust Owner Owner's Name information is required for every Centerville Ma 02632 9-27-12 page, City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. 00Q- J 12, Fe� � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLation for Misposai *pstrm (Construction Vermlt Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System M/Individual Components Location Address or Lot No. I (jGL�I � Owner's NiajCe,Address and T 1.No. 668-77 S 7U(o r�c �reo.' v�s Assessor'sMap/PazcelILIO t3� Installer's Name,Ajess,and Tel.No.r of 77 F.$$`lr) Designer's Name,Address,and Tel.No. MA Type of Building: �) (�j Dwelling No.of Bedrooms /" Lot Size -b k sq.ft. Garbage Grinder( ) Other Type of Building \b11 A✓ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) AM gpd Design flow provided A'/1- gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 0t Type of S.A.S. N Description of Soil 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 Certificate of Compliance has been issued by this Board of He th. Signed Date Application Approved by Date to/S 2-mt"2.._ Application Disapproved Date for the following reasons Permit No. Date Issued �� rZ No. ZOIZ '3 12 Fe� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for jBispoBal 6pstem Construction Verm* it Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. !.\ 0 e�nsc, Owner's Na e,Address,and T 1.No. 8�77 s-7U(o (j y ��.c.��_ ga r e4 SG Assessor's Map/Parcel g(g OvZ°r L r � I..,,k ce.-o V3kp Installer's Name,Address,and Tel.No.. 0Q"t/77++7F 9 j Designer's Name,Address,and Tel.No. ses NNAO MA Type of Building: I �)y� Dwelling No.of Bedrooms /�rT Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _ WA: gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title I 4 Size of Septic Tank 1AA I Type of S.A.S. /Ill ' Description of Soil Nature of Repairs or Alterations(Answer when applicable),, C kd✓ Q-- s 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 f7 "� e� t �•.. Application Approved by Date /D( 5 2•v i L, Application Disapproved Date for the following reasons Permit No. 7012. 31Z Date Issued /a hoiz. r` - - . -. .:------------------------------------- -------- ----------------- ----------------------------------------------- --------------------•----- THE COMMONWEALTH OF MASSACHUSETTS\ ✓" BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS CERTIFY,CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(a Upgraded( ) Abandoned( )by `- ,P Q --J, ' at aY R 0"%WLQ e,_- � Ly has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7oi z-317 dated / S Z o IZ Installer CAe:y ,w�14- �� EIIv Y-�w Designer #bedrooms mod. Approved design flow AJif- gpd The issuance of this permit sh Il not b construed as a guarantee that the system ill Date / � func- as e -gn 5 � p� Inspector ------------------ - ------------------------------------------- No. 20 1 Z ) 2 Fee0/000v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(1 Upgrade( ) Abandon( ) System located at y sty �O V.Q- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit / Date /[� 5 Z Approved by /- r Fss.(........................... THE COMMONWEALTH �� FI-IEALT ETTS BOARD ................. ..............OF..........�G i S ..................... ApplirFatiuu for Bispooal Workii Tonutrnrtion 1hrutit 00, Application is hereby made for a Permit to Construct (1111or Repair ( ) an Individual Sewage Disposal S stem at: T— - h. �/�-__- ._...-------••••.--.•---------------------- .---..............._........__---------.- Loc -Addre or Lo No. ._ . r - ---------------• - ....1_.. .... - ............... Owner Addr s ------... �_.. � -------------------------------------- . ....... . �. ........... Installer Address d Type of Building Size Lot......... `�__�__-_-_Sq. feet V Dwelling—No. of Bedrooms...............-__•--__..__••___•__-Expansion Attic ( ) Garbage Grinder (�' '4 Other—Type T e of Building ............... No. of ersons..............._........_.__ Showers — Cafeteria a YP g ------------- P ( ) ( ) Q' Other fixtures --------------- ---•-•-•-•-•... - W Design Flow ........................gallons per person per day. Total daily flow................ ...........gallons. 1:4 Septic Tank—Liquid capacity.1.5;Atallons Length................ Width.................Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- • meter.............------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-._-_._______-_-•--.._-. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... R', .............. .........................I............... O Description of Soil------------- = ------ ..... ----------- ESIGNING U ............................................................. . enem2lTAlA.A!-` I IN5TAUATIOTT�A�•C�tR i Irr—.i--It4--i W ---•-•-•------------------ - .......... x iRE SYS I L U Nature of Repairs or Alterations—Answer when applicable-_____-_:JUz;CRUANCE_T0-PLA%_____________________________•---_-----__. --------•---------------------------------------------------------------------------•--.............•----••...-----•------------•••-••----------••------•--------••••--••----•-------•-•------••-•-----. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTT : p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certincate of Compliance has been issued by bo f t Signed..._ Application Approved By-•-•--•---•-•--•- 7 --`-------- -------- ............. -----� �`�f /----•--•--- Date Application Disapproved for the following reasons:............................................................... ................................................ ....•.................................•--......------••----•-•--.............-•----------•---•••....-•-••-••-•-•-------------•-------•-••-••----••---......---------------••----•-.._...--•------------- .i. Date PermitNo.......... ' - _._ _-- - --•----•------------ Issued-----=------ ......................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OR.................. (� ...............................•... VTOrrtifiratr of TI-ImplitUtrr THIS IS TO CFRTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.......... LQ,: ...............•---•--••--...........---•••••----------•----------••-•-------......--•-----._...-•-•-•-------•-------------..........••....----......•----- Installer has been installed_in ccordance with the provisions of Ti IE j of The State Sanitary Cod as d -cr ibed in the application for Disposal Works Construction Permit No. ............................ dated_.: f _ ................. THE ISSUANCE OF THIS CERTIFICATE SHALL POT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. �� DATE................................. ............ .................................... "'Inspector.................................................................................... f 0ESIGNING ENGINEER MUST SUPERVISE Ges� r10� THE COMMONWEALTH OF MASSACH°emu kW.A ION AND CERTIFY R� WRITING ' v `HE SYSTEM WAS INSTALLED IN STRICT e,:f BOARD OF HEALTH^CORDANCE TO PLAN. .............Gi!nI-.................. ...--••••.................._.. NO .oF..... FEE...........�.�.`.. 2�• Rupoual orku (1111nu#rurjtion amit Permission is hereby granted------..... ��-----------•----------------------- ........................................................ to 1Construct ( ) or Repair ( ) an Indivi al Sewage`Bisip_osal System atNo......... �.__...� ..... &)....._.._...�_V_1L-__-----------------•--_-•-----_--_-_•----•-•-•--_ Street as shown on the application for Disposal Works Construction Permit No Dated........t __� ............ G Board of Health DATE................................................................................ ��,��^^^^ FARM 1255 HOBBS & WARREN, INC.. PUBLISHERS % y► _ � 4 x iD. N ._.. FE:B(.......:.'.. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD Off` HEALTH OF......... ....15 .......... .... ......................... , ppliratiou for DW-Vaiial Worko Tons rurtiun Prrmit Application is hereby made for a Permit to Construct (4 or Repair ( ) an Individual Sewage Disposal System at: .. - ------------- ............................................................. .....- Lo�n-Addr s or Lot No. /............... ................................ / OwnerAddress y Installer Address Q Type of Building Size Lot...h':_-!% -------Sq. feet Dwelling—No. of Bedrooms...............:............................Expansion Attic ( ) Garbage Grinder (---) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' _Other fixtures ............................... . . Design..FlovK.':�_.'� .._._..gallons per person per day. Total daily flow............. .�t_h__r,1......._...._gallons. W g �------------------ g P P P Y• Y --w-- ,.- 9 Septic Tank—Liquid capacitvl..---64gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No. ................ Width_:.................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- ameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) PercolationTest Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------_--- 44 Test Pit No. 2................minutes per.inch Depth of Test Pit.................... Depth to ground water........................ O �- .== ..Description of Soil------------•--._.._. Z►.��___...-•`�=�-�d---._�.�.-----•-----------------------------------•----------------------------------.._...._.. W -----------------------------------------•-----•-••-----------------•-••--••-------•-------•---•------......--------------------------------------------------------•••-.......--•--•-••-•-•---------•- UNature of Repairs.or Alterations—Answer when,applicable................................................................................................ ----------------------------•--••------•-------------------•------------------------................---------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with k - the-provisions of T11"ILE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t e boa, i lth,. Signed...................................... / �G ............. .-•...� ...................................• Cf� ...-.... Application Approved BY------------- .......... Date Application Disapproved for the following reasons-------------------------------•---------------------•----------------•-•-•---•---------•--------•--••-••-••-- ..............•------•------------------•-•-•---•--•-------...---.............-------------•---------••----------....-----------------------•---...•--------------•-----•------•------------------------ • Date PermitNo........................................................... Issued----..:-.........--------•----------•---••---------••- Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................. ( ..................................... (In ifiratr of Tnutpfiaurr THIS IS TO That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by �- --------------------------------------------------------------------------------------------------------------------........................................................... Installer at.--- -------- 1 ........ --•------•-----------------•------------------------....----•----...----•----------------------------------- has been installed in accordance with t e provisions of iTm�r. 5 of The State Sanitary Coe as escribed in the application for Disposal Works Construction Permit No.�__.. . ._ ..a--�__________________ dated_..�_ ._` ��" __......_.._____.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. .. Inspector - DATE A + ....... P t------------------------------------------------------------- M _ THE COMMONWEALTH OF MASSACHUSETTS P " / BOARD OF HEALTH No j . ✓vl�L........... OF......... ................................. FEE . ' .... .... .........•••-- �i��a�n ��k� ��an��rtinn anti# . d � Permission is hereby granted--------------.......-....................................................................................................................... = to Construct ) or Rerpair ( ) an Individual Sewage.Disposal System Street .. __�t.�..............as shown on the application for Disposal Works Construction Permit No_ .�.__ Dated___._ `-_. �.� ....................•---------------------- ----- ----------------- Board of Health .DATE-----------------------------------•---......---•----------..........._...•-•-•• FORM 1255 HOBBS & WARREN, INC., PUBLISHERS SAXTER & NYE, INC. Professional Land Surveyors and Civil Engineers 812 Main Street .Osterville, Massachusetts 02655 Tel. (508) 428-9131 FAX (508) 428-3750 WILLIAM C. NYE, P.L.S. -President PETER SULLIVAN, P.E.-Vice President-Engineering RICHARD A. BAXTER, P.L.S.-Vice President August 20 , 1992 Town of Barnstable Board of Health P. O . Box 534 Hyannis , Ma 02601 Re: Permit 92--44 140 Bay Lane Centerville Dear Board : In accordance with the terms of your -Disposal Works Construction Permit .we have provided construction supervision for the installation of the septic system for 140 Bay Lane . The system . has been installed in strict accordance to the plan of record . a I trust that this meets your present needs . Very truly yours , Baxter & Nye, Inc . P ter Sullivan ,4PE c .c . William .Archibald OF ,1 PM s �uv�n PS: slg � P9o. 29733 �h 6 MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS . a LO ,AT ION SEWAGEPERMIT NO. a VILLA GfE EE N T rE6?0 t S SSG I N S T A LLER'S NAME & ADDRESS t 6 U I l D E R OR OWNER DA T E P ERMIT ISSU E D DAT E COMPLIANCE ISSUED Gam. 65 1 i --- y '�t-�` � I\I 'Y �1 —�,— d' I�� *i �-� -�__._.�� ;'i L •-c� t�C ? { ,1 � Silo' I i .� "--_—•—_ . ,I to FINAL COP-' S�N1'�}� �EkS�14 t�ti�ry �� Ir b} vk}� r111 syaa Permit Number: Date: Comp 1 eted by � ` 1 HIGH GROUND-WATER LEVEL COMPUTATION Site Location: --G,[�`( L�+u C�n1TE1✓�(��.�-�=. Lot No. Owner: Address: Contractor: Address: Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /Z date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: A) - Appropriate index well B) Water-level ran.ge zone . . , , , a46 usa t3 C.0�.15ecR.�4Ql V�. STEP 3 Using monthly report"Current Water Resources Condit.ions" determine current depth to 120� water level for index well . . . . ..11 mo yr STEP 4 Using Table of Water-level Adjustments for index well STEP 2A ., current d&pth to water level for index_well (STEP 3) , and water-level :zone (STEP 2B) 'determine water-level adjustment . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . STEP 5 Estimate depth to high water by .subtracting .the water- ; level adjustment (STEP 4) from measured depth to water . • . . level at site (STEP 1) . . . . 60 8Z- 7 ' l N®TES, U EXIST. EXIST, 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS & DIMENSIONS IN THE FIELD W HALL KITCHEN 2.) CONTRACTOR TO VERIFY ALL INTERIOR & EXTERIOR MATERIALS, EXIST. DETAILS, & FINISHES IN THE FIELD WITH OWNER 0 a 1 BATH ExisT. 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT x FIRST FLOOR TO BE 6'-8"ABOVE SUBFLOOR w � mm 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS � W N2 STATE BUILDING CODE, 8TH EDITION AMENDEMENT & IRC2009 � W-00 ON. � w �ou °D ExisT. 5.) VERIFY ALL PLUMBING & ELECTRICAL DETAILS W/OWNERS ON THE SITE �, EXIST. } DURING FRAMING CONSTRUCTION —_-- 6.) FOLLOW ALL REQUIREMENTS OF THE IECC2012 RESIDENTIAL ENERGY bo EFFICIENCY REQUIREMENTS & VERIFY ALL DETAILS WITH THE INSULATION zo INSTALLER/CONTRACTOR FOR THE STRETCH ENERGY CODE zo IECC2012 RESIDENTIAL ENERGY EFFICIENCY DETAILS CLIMATE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION / TABLE 402.1.1(MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) FENESTRAT40N S:{YLIGHT CEiU1'O \YOOD FRA�!EO YfALL FLOOR BASEMELJT IVALL BASEMENTSLAB CRAIYLSPACr:VML U-FACTOR U-FACTOR R-VALUE R•VALUE R•VALUE 15119 10(2IR FT. TE R-VALVE ANDERSEN 0.32 0.60 49 so 30 +sne 10(2FT.DEEP) +a+3 TW2446-2 NOTES: NEW 2 X 6 WALLS 1.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS. 2.15/19 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR d OF THE HOME OR R=15 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL 3.REFER TO IECC 2012 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS NEW T BEDROOM O , 12 Aif A Al A X EXIST. 1 -- EXIST. NEW BATT INSULATION(R49) }� RELOCAT D GARAGE W W DOOR EXIST.2 x 8 s@ 16 o c TOP OF PLATE �I ® W I � r I 112"GYP.BOARD Q W ao ON 1 x 3 STRAPPING 518"FIRECODE GYP.BD. 10'-4" 13'-2" @ 16"o.c. TYPE X OR C .--NEW SPRAY FOAM INSULATION(R20) NEW EXIST. P., � BEDROOM GARAGE W 0 C) 314"T&G PLYWOOD NEW 2 x 6 WALL W/ 30 H SUBFLOOR-GLUED&NAILED GATT INSULATION 5C0 ; 24,4' tE .T.2 x 12's @ 16'o.c. TOP OF FOUND I/41,p I'-O" 4-P.T.2 x 12 BEAM PA9 ; LEGEND: 9/23/2016 EW RIGID INSULATION(R30) CJ EXISTING WALLS EAL ALL JOINTS @ GARAGE A CONSTRUCTION TO BE REMOVE® EC°TI®N. NEW CONSTRUCTIONl Illot,No—,www-a"n-w Ang M My ��too qzmwwp�lO "Nos M. Inot ............0, A iTZAA Q ,;.son M- ion-via Mv InStoll 11C) Cy j_--)< V\ l<19,10 10 A Oki Ogg 14-171 Mon 1 !Rill wall 14 V,0.le-lei i �Vv L M FBI --.(P— 1,41 FPO,A(e, ty oft. EII Ila 10,Mg, Nit" 13 yg A �Z_"oo,19 -7—I':3.0 on, Sam Rio.M nwe 11k IM Aglaia:1, I L;6--up'. b7 IV Who JD.-7 Von � n -I5\44 -53 ell Q PO4 C>VJ C ok-j e>kO Tr_ I.1 1 too to"!j "TWAy TGtr M4 nun iff j KIV.8 A my,I K(t<IPE TER log:SU it off AWN LUVAN SAXTE Iwj::,No. 23 402 F:woo ONAL ELSS (_0 Z7 5 no-r W I 'C L Ub(="M oil 511 K ........... ----------- "k ;!I, lA!!;. /Y1 I.I............ oe, erz- 07 I3 10 10, 0 10 PC -,7 z �Ae 4 14117 `I� A, 4, AILL ..........I. V 01 —7 7 4-�5-0 2::> ta :5, Lo GQ 77' 4\ 0 :59 %J O(r 01 00, Z, OKI 77Z:> 19 12 C.C-Tm 1 ---T (LOT ..........................7 7, W 44 -4 4 �,Z.G KI V. OF Kh< PETER 4CHAR SULLIVAN SAXI -R No. 2q73 -7,0 .0 ST'; SO#ONA L WokTIS L 6., -44 1� LO-r s z T'L 'Mo C--xv-ou wATEe- r-