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HomeMy WebLinkAbout0274 BAY LANE - Health 27I BAY LANE, CENTERVILLE h 1 1 UPC'l2534 • No.2 i LOR HASTINGS,i1N s r May 17 2018 00:16 HP Fax page 4 /cq -oo1_3 Commonwealth of Massachusetts 191 Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 274 Bay Lane �`J • Property Address The Trust of Virginal Carothers Owner Owner's Name / Information is required for every Centerville 1/ MA 02632 5-15-18 page. City/Town Stale Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important When filling oul forms A. General Information / ,+uuuuirr on the computer, `��+��jN OF kJqSS use only the tab 1. Inspector: Ins Pe ti y key to move =�°:` JAMES cursor-do not James D.Sears use key.the return Name of Inspector * ;C., Capewide Enterprises ; A-,-. ° o, Company Name ,, lF�.. T�C,v 0, VQ ;153 Commercial Street �,SPor+++��� Company Address Mashpee MA 02649 City/Town 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 16.000).The system. ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-15-18 ,ffigpector'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 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.doo•rev.6116 Title 5 OfNdal Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 r May 17 2018 00:16 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 274 Bay Lane Property Address The Trust of Virgina Carothers Owner Owner's Name required for every formation is Centerville MA 02632 5-15-18 re 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist, Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and two Trenches. Note: Outlet tee has a zable filter. 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): l5ins.doc•rev 6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 f May 17 2018 00:16 HP Fax page 6 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 274 Bay Lane v Property Address The Trust of Virgine Carothers Owner Owner's Name information Is required for every Centerville MA 02632 5-15-18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt.): ❑ 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 tSns.dcc•rev.6116 We 5 Official Inspe7ion Forth:Subsurface Sewage Disposal System-Page 3 of 17 May 17 2018 00:16 HP Fax page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 274 Bay Lane Property Address The Trust of ViMina Carothers Owner Owners Name information is required for every Centerville MA 02632 5-15-18 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 mj 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 pond ing 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 is less than 6" below invert or available volume is less than %da flow .4&4c 1jv& ISine.doc•ray.6lt6 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 4 of 17 May 17 2018 00;16 HP Fax page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 274 Bay Lane L Property Address The Trust of Virgina Carothers owner Owners Name information is squired for every Centerville MA 02632 5-15-18 page. Cilyrrown 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 jgk. I have determined that one or more of the above failure criteria exist as described in 310 CM 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.doc•rev ems Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 May 17 2018 00:17 HP Fax page 9 commonwealth of Massachusetts 0 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 274 Bay Lane Property Address The Trust of Virgina Carothers owner Owners Name information is required for every Centerville MA 02632 5-15-18 page. City/Town Slate 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 How based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): 330 t5ins.doc•rev.6/16 Title 6 Official Inspecton Form:Subsurface Sewage Disposal System-Page 6 of 17 May 17 2018 00:17 HP Fax page 10 Commonwealth of Massachusetts Title 5 official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 274 Bay Lane Property Address The Trust of Virgina Carothers owner Owner's Name information is required for every Centerville MA 02632 5-15-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 Gal. Tank D Box andtwo trench's. Number of current residents: NA Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® ,No Water meter readings, if available last 2 ears usage 2016-97,OOOG2Is g ( y g (gPd))' 2017-144,O000al's 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: 15ina.doc•rev.5116 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 May 17 2018 00:18 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 u 274 Bay Lane Property Address The Trust of Virgins Carothers Owner Owner's Name information is Centerville MA 02632 5-15-18 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: 2011 /2012/2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box; soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 50ficial lnspeclion Form:Subsurface Sewage Disposal System Page 8 of 17 May 17 2018 00:18 HP Fax page 12 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 274 Bay Lane Property Address The Trust of Virgina Carothers Owner Owners Name information is required for for every Centerville MA 02632 5-15-18 page. Cfty/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2008 Permit # 2008 -467. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26"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: 16"feat 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 H-10 Sludge depth: 2" tbinsAoc-rev.SA6 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 May 17 2018 00:18 HP Fax page 13 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ��• 274 Bay Lane Property Address The Trust of Vi[gina Carothers Owner Owner's Name information is required for every Centerville MA 02632 5-15-18 page. Cltyrrown State zip Code Date of Inspection D. System Information (cons.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness ill Distance from top of scum to tap of outlet tee or baffle $ 11 Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Plan-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 at working level.Tank at 16" below grade w/both cover's at 6". In and outlet tee's. No sign of leakage or over loading. Note: Outlet tee has a zable filter. 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.doc-rev.6116 Tills 5 OfTidel inspection Form:Subsurface sewage Disposal System•Pape 10 of 17 May 17 2018 00:19 HP Fax page 14 Commonwealth of Massachusetts lip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'' 274 Bay Lane Property Address The Trust of Virgina Carothers Owner Owners Name information is required for every Centerville MA 02632 5-15-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlef 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 t5ns.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Swage Disposal System-Page 11 of 17 May 17 2018 00:19 HP Fax page 15 Commonwealth of Massachusetts IIp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 274 Bay Lane Property Address The Trust of Virglna Carothers Owner Owner's Name rquiredifore ry Centerville equiredforeve MA 02632 5-15-18 page. Citylrown State Zip Code Date of Inspection D. System Information (coat.) 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 16x16"x16" below grade w/two line's out. Box is clean and solid wlno sign of over loading or solid carry over. Note: Inlet line has a PVC TEE. 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.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•ev.8/16 Title 5 official Ins"otion Form:Subwrfew Sewage Disposal System-Page 12 of 17 May 17 2018 00:19 HP Fax page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 274 Bay Lane Property Address The Trust of Vir ina Carothers owner Owner's Name information is required for every Centerville MA 02632 5-15-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number. ® leaching trenches number, length: 2 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativetalternative 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 two trenches of six biodiffusers per trench-total 12 chambers-stone less. Camera out and prob. No sign of over loading or holding water. Chamber's are clean 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 151m.doc-rev,&16 This 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 13 of 17 May 17 2018 00:19 HP Fax page 17 Commonwealth of Massachusetts 9 Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 274 Bay Lane Property Address The Trust of VirRina Carothers owner Owner's Name information e every Centerville required MA 02632 5-15-18 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.): 1541s.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Oiaposal System-Page 14 of 17 May 17 2018 0020 HP Fax page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °( 274 Bay Lane Property Address The Trust of Virgina Carothers Owner Owners Name information Is required for every Centerville MA 02632 5-15-18 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 � r y 1 r CK rl �J. 3 ' t5hs.doc-rev.W16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 0117 May 17 2018 0020 HP Fax page 19 Commonwealth of Massachusetts Ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 274 Say Lane Property Address The Trust of Virgina Carothers Owner Owners Name information fired is every Centerville re ulred for eve MA 02632 5-15-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells o N Estimated depth to high ground water: 10 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 10-27-08 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Heafth -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 10-27-08 10' no G.W.. Bottom of chambers at around 4'below grade. Bottom of chambers at 6' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. I5ins.doc•rev.6116 Title 5 Official Inspecrion Form:Subsurface sewage Disposal System•Page IS or 17 May 17 2018 00:20 HP Fax page 20 Commonwealth of Massachusetts Title 5 official Inspection Form ,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 274 Bay Lane J� Properly Address The Trust of Virginia Carothers Owner Owners Name Information is Centerville required for every MA 02632 5-15-18 page- CltylTown 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 t5 m.doc•rev.6H6 Title 5 Official Inspeclion Form'.Subsurface Sewage Disposal System•Page 17 of 17 /a TOWN OF BARNSTABLE ,.00ATION c1�' j SEWAGE# 2 VILLAGEA ASSESSOR'S MAP&PARCELrr� INSTALLER'S NAME&PHONE NO. _�f41g.� �,f nri S-e S,Z-�- S U z SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 12_ 11^C &o (size) NO. OF BEDROOMS �{ �— OWNER !:�;rci✓1 c �3r0 S PERMIT DATE: i �/a�{_lO�i COMPLIANCE DATE: ►i q lzcoc Separation Distance..Between:the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility a / feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within,200 feet of leaching facility) feel Edge of Wetland and Iaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHEDBY �aQew �?� �t�nfj L-L` Ar F7-- c i3 1 31 G 1 367 Z 3 � �J y3.v C 3 t{ 1.0 13`( sO 2 I _ i TOWN OF BARNSTABLE LOCATION . �,�P Lf �� _. SEWAGE# "2c cZ, - `11y i VILLAGE ASSESSOR':S MAP&PARCEL Ano INSTALLER'S NAME&PHONE NO. f,,/e)�61 kf Qrl 5X 4�� BYO 2,R SEPTIC TANK CAPACITY SHOO �� /D Ya. LEACHING FACILITY:(type) /2. WC_ .(e �,.o ►�FG (size) (�) 3 `30 NO.OF BEDROOMS a OWNER Virojn ,yv PERMIT•DATE: 1 f e'f° 0 8 COMPLIANCE DATE: 11! i q/21D®S Separation Distance;.Bgtween,the: -Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility u feet Private Water Supply Well and Leaching Facility(if any wells exist on site or withhQ00 feet of leaching facility) feet Edge of Wetland and l!"achingi acility(if any wetlands exist within 300 feet of leaching facility). I feet FURNISHEDBY LA&,;,V; A C�v 30 131 3+ C I 367.2 3 3� V� C L 3i o y3.� Cq C s r R KY. • (�1 t�No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes fttlfltation for BispoSal *pstrm Cons"ttion permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 'Z 7 y 13,q (-Av%.Q Owner's Name,Address,and Tel.No. (J; j2 .,4 L44i1eerf Assessor's Map/Parcel (a mr-btL,".( Installer's Name,Address and Tel.No. ", pea,g 6kjAge,-> Designer's Name,Address,and Tel.No. T.L t l 1i0 O K� P u�o�c-2 C�3 285•{ 6-,A ►6 /7 1A-% �Y c 7 Ce-hre =(l-. i�4 E r wA��c f�.�.� Z7 3�— 3 7? Type of Building: Dwelling No.of Bedrooms Lot Size ?11,100 J, sq.ft. Garbage Grinder( ) Other Type of Building S i %n.. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) o gpd Design flow provided 3 y Lo-3 gpd Plan Date 1() ZS Number of sheets ( Revision Date Title 2'7 q 1�. Size of Septic Tank t 50z, Type of S.A.S. Z S T ),Z145S - -/`�rh Description of Soil D WA-? e— 0 2,8 Nature of Repairs or Alterations(Answer when applicable) 1566 ►4-( ht '[Q -T*t> 7—(3a,' 7 0 fU ��• s�'r 1 Yps�t cl•�� Date last inspected: 7A?& 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 Healt Ai ed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued 410, 3 No. Fee_0 `- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: " PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppYitation for disposal\*pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components E Location Address or Lot No. �2 7 q 6q j l.r4vLQ Owner's Name,Address,and Tel.No. t f;r ,2 1'.4 4C'-1tCr". � 27,,�34 Assessor's Map/Parcel / g f /Z �� 7 p'� Installer's Name,Address,and Tel.No. Gp Designer's Name,Address,and Tel.No. � GG p-o. 3�vc'7G�3 285Y Crartl�.✓/7 /J1w y LFS qo ZG rzhrektJef . P?qs r- WA✓e 1414#+ 7- 13 3-7 7 Type,of Building: J, Dwelling No.of Bedrooms Lot Size Z9,cley - sq.ft. Garbage Grinder( ) Other Type of Building Ej 14, No.of Persons -L Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 O gpd Design flow provided 3 y L�•3 gpd Plan Date I Q 2�7 Number of sheets I Revision Date Title a4. A Size of Septic Tank (50z ,t Type of S.A.S. e.�S T✓-<iv��, -e} Description of Soil 44, �` $ Nature of Repairs or Alterations(Answer when applicable) l SW � ( 'f 1�+ `�—�'��� 7 c� 7- rO'`) 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 Healt . i ned J) Date Application Approved by Date - Application Disapproved by Date for the following reasons Permit No. Date Issued - - 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 ��,Q�,,�.t�9. C�}'L ��l> rs ( L*— at 7--7 '( 34)1 has been constructed in rc1d e with the provisions of Title 5 and the for Disposal System Construction Permit No _ Installert�J2.t� Lff J 15(f.S (4- DesignerzQn #bedrooms 3 Approved design flow ( gpd The issuance of this�p�Ti shall ll o be construed as a guarantee that the system will n do a igned. Date I Inspector 7 — - -- --- ----- --- N -- ------ =.. ---------------------------------------•---------------------------=-•---Fee�---- 09— ---- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 33isposaf 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair fi,) Up rade( ) Abandon( ) System located at oC (L 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:Constructio m s be co pleted within three years of the date of this permit. Date Approved by / i �r owe, 01 D'arnstame I i Regulator y Servicc's CIAN �L .Thomps F. Geifer, WriettorilA B.. Public Healih �3ivisiob , ; ; Tjllomas 1VYclderin, Direa'tar_' ! I 200 Main Street,lliya nnis,MA 02601 . { !i Of ice; 501- W-4644 Fax, 508-]90,.630Ait I. Installer & De i ner „ erti cats I�'or i ,. f4 ,m i , Mite: r It ib -a8 l)c:si .tter. r�te'e.t�' Installer: Ga Address: i `a y �:ccanber l !a�:^ Address; ,. �, _; �_� warelr��rr,� �(�__0 2�3�y 3 i � � � �a�..t`u I( ✓wa- a :' 01, -_.. was issued ai pr�rmit to install a _.�.d ctc• ,. i� ( ! (zn taller) based'` n�a deli a drawn by fi I (address) i l i • ; i £(designer) � .: I S/ 1 :E rti.f`y that thF� septic systerti referenced above{was installed'sub stantially according to the design; which tray includpe rninoq approved changes such as lateral relocation of the i i di sl ributxoh box and/or septic iaTik. ;! I ! stify that',the septic system•► referenced above was installed with; major changes ( t ' c e.. 8q e ctex than 1'0 lateral relocation of. the SAS or any vertical relocation of any cocnpr�neiit oi'f hie'septic system) but ih aGcardance with State &;X�cteal Regulatiorts. Plan revision car cc r,ified as-built by'designer tb follow, ! I k iit . jF _ f a .111Gr's Signs Tc) `IV (Des) r's!SI e)�,...w. s' —np Here)T` E t ! I i, _KETU O E IC T � VI N. Rr CA'I,r«; 0 CO d PL L NOT 1� T C I AL SI AN. i � ! Q Health/S!p is/)esi er Certification F07' � 1 1 DN I 833N I DN30t wa 99: e T 8e@,Z—V L e% N TOWN OF BARNSTABLE j LOCATION . 7`( ? ;, �� SEWAGE# .2 c +-11e7 l ; VILLAGE L-9f--, ASSESSOR'-S MAP&PARCEL_ r 3 INSTALLERS NAME&PHONE NO. _ arty ll�r��Jrl SEPTIC TANK CAPACITY r /b LEACHING FACILITY: (type) /_Z (size) 3 +� 3Q NO. OF BEDROOMS �- OWNER PERMIT DATE: it�a �p g COMPLIANCE DATE: it r-�/zoos Separation Distance:.Between:the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility u feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within,200 feet of.leaching facility) feet I Edge of Wetland and 1 ..aching:Facility(if any wetlands exist I within 300 feet of leaching facility). feet FURNISHED BY PF 30 t3 I 3 y C.I 3672 3� C z 13 6-0.2- Cf 3�.J i I oF� Town of Barnstable P# Department of Regulatory Services • auwar�arr. Public Health Division Date � 16J9. �� 200 Main Street,Hyannis MA 02601 QK) Date Scheduled - Time ! Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: M CAA - T Kp3re-, L.t.T. G S.G-• Witnessed BYT- 0AJAJA � LOCATION& GENERAL INFORMATION Location Address 2--7 L{ r3 L4,-Q, Owner's Name U,r�.�yt,,a C Address 3 LvjJ e Assessor's Map/Parcel: j ,Co! 0 3 Engineer's Name ev '` t / 5.L,. NEW CONSTRUCTION REPAIR Telephone# Land Use "'4510LO IAA— Slopes(%) 16 Z.o Surface Stones ` C j 2 1 b0 ir, NJ�1 Distances from: Open Water Body 7/0 _ft Possible Wet Area� _ s ft Drinking Water Well • ft Drainage Way it) ft Property Line 'I� ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) NT04% Depth to Bedrock 'T Depth to Groundwater. Standing Water in Hole: y t t�~ Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Zlgfm OLSE&h4(1Q1f Depth Observed standing in obs.hole: Y20" in. Depth to soil mottles: IZo in. Depth to weeping from side of obs.hole: 1U In, Groundwater Adjustment NIA-- ft. Index Well# - Reading Date: Index Well level Adj.factor. Adj.Groundwater Level PERCOLATION TEST bete i :l of T n e L6 5 Anl Observation Hole# Time at h" Depth of Perc Vk-y` �. Time at 6" Start Pre-soak Time @ J0.*6 AM 'rime(9"-6") End Pre-soak M.'ty Ath Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) 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:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# t Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel 9-y" Lirr p-$' /'� to ova -zs" 13 wAmy 5allo IoYQ.'5I(9 2$-tto" M�EO.-CoARSE54ta0 2S'f 501"t og e . •Cot.a� DEEP OBSERVATION HOLE LOG Hole# •- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% ravel y:'b A w my 5wo to 3 t $y 8 LOAMYpp5A►XP 10 Yf �j IZo' C MEO.-IAARsE SAnp 2. h°�(a 10OX ` Sd Coto 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 to Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes __ Within 500 year boundary No= Yes Within 100 year flood boundary No r! Yes ` Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material 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 ie27-9 9 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was.performed by me consistent with . the required training,expertise nd experience described in 310 CMR 15.017. Signature —a � Da te 10-36-08 Q:\S.EPTl0PERCFORM.DOC AsBuilt Page 1 of 1 fTOWN OF BARNSTABLE N LOCATION 1-9, ea SEWAGE k aQA VILLAGE-_-�arKd? ASSESSOR'S_MAP&LOT. c� INSTALLER'S NAME&PHONE N0, Man&,&( SEPTIC TANK CAPACITY 0 0c LEACHING FACILrt'Y: (type) P (size) j8 �r a,SJ NO.OF.BEDROOMS BUILDER OR OWNER Q t a a r(c prr!*) PE.RMITDATP,: 11 'O 15' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ..,I, Feet Private Water Supply Welland 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 ,Q within 300 feet of leach'leachin2 faci' �ectt Furnished by �� 66 . y ty)) � I - gq ® 6 rank 47 X- 5� —r s �1 � 77 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=186082&seq=1 1/28/2019 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel / O Permit# je It Date Issued Health Divisionl" a� Conservation Division f>d ' Fee C. Tax Collector s J �/ ,ell a SEPTIC SYSTEirO Treasurer �v„t �1 r s INSTALLED IN C01APLq; WITH TITLE 5 pate-D d-by-P-lannfng-Beard ENVIRONMENTAL COD i':,.. TOWN REOULAT ICN3 +firtsxi9KH., Preaelty +s-- Project Street Address Village . ' U - era Owner Qw Address Telephone 7i Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation2� Zoning District Flood Plain `1Db Groundwater Overlay Construction Type Lot Size —Grandfatfiered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Age of Existing Structure %4,�o L Historic House: ❑Yes On Old King's Highway: ❑Yes o Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) — Basement Unfinished Are (sq.ft) Z Number of Baths: Full: existing• Z, —new Half: existing new�— Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas N(Oil ❑Electric ❑Other Central Air: ❑Yes alo; Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0410 Detached garage:❑existing ❑new size pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Uexisting ❑new size� i Shed:Cl existing ❑new size Other: 7nin 4np?d of Appeals ?.ation- 01 Arpeal_# Recorded C] - - - - -. Commercial ❑Yes ❑ No If yes, site plan review# Current Use L<S1' ,0h � Proposed Use ;f - 1 REVIBIDMs by •� \�. [slurf eRPAK OAMIL •oo ocT.El 'e0 HV • � \. __ R4.wk eooF 4q ocT• o .lu I - - II - II � ELEVA'T !i. LF:V-1 ;I. AC411'ON •. �APdf11iRS I I .._. I _ AJ/ � � Cli j Z- v "'1 '. LEGEND \ �,iIISTIrt6 exfeting wall• to romain �r� Exietinq wells to he removad Uvl r+6 - li 14SS&-0s INio 041-rb _ _New cell• �aul+OM lore IL9" R o orq ' FoF tw+,o•onP SS42-w ?4 OUz 2 -' /•y�a,�p, wee a..A,y wf GhslpENT• `•. r ax151 f•�'L' d.�L��'��'If� 1 — — —� L— 1'2)UIn 9og2�{} 2— 3Pi47t w?; I Ar ti of RDoM Hit FK4�IRSSKCNT � I i j � �•— /'1i y -- 3 GR.ewt_ SPA�F c (�( m .FLAT f�. i _0 d v L13F-A ICY �[IUN6 I �! � .in 11 6 MIL v.B a.elL I e EIEVI�IID i r 1{ Poe.euv 0A56 oN - - _o o MIRRdt 11 1 0l 1lWi?p OASC vDN1 It 11 DB :. 40 4t Dr1�. n WALK Iw•wK Sc�EfNEO 441,G RE.o'� •11 DI �I III Iq D11 'I OY ells-- tP-' Z9. 71 EDDLTl oA1 24�of p0Dl't'l01•l - . JOe I91 G•00 _ C- LOCATI N SEWAGE PERMIT NO. _ 4 �.jqn VILLAG Ono4ecu l -- INSTA LLER'S NAME i ADDRESS C�6"woc i �<ecu ieg, BUILDER OR NER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 4 \\ \ ��© Q. Qj � �j� �� � � `� �'S C � � 2 � � °� ., .a .�, �,� - ��} ���� -. ..........L5.,A_ THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH ........Tasn..............OF.................Barnstable._...... Appliration for Disposal Works Tonstrur#inn 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ?7L.... ....Q2632............ .................................................................................................. Location.Address or Lot No. Malelxtp—.E.017.ax11............... ................................. 27 .. Y... enterville..-MA----026. 2....----- Owner Address W A & B Cesspool Service 128..Bishops Terrace, Hyannis= MA 02601 ---....•..---- ................. Installer Address Type of Building Size Lot.... ......... ._..Sq. feet aDwelling—No. of Bedrooms..............)........................... Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -----•------•-•--•--•---•----•-- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No--_----------------- Diameter.._................. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -•••--••-•••----------------------•-•-•------------------•--•---...------•----------•----•-----••--•......................................................... 0 Description of Soil........................................................................................................................................................................ W U ...-------•................•-----------•-•-••----............---•--...----•-........------•--•-------•-••----------------•------...--•-----------•-------•------------................--•----•-----•----. W ---------------------------------------------------------------------------------------•-------------------------------------------------------•-----------------------------------------.....---------- U Nature of Repairs or Alterations—Answer when applicable_.instal.].ati-on---of__a..I,0110.•gal l-on,..•pre.-cast, stone..packed..learh..pit_..(-ayerfl.ow)._---------------------------------------------------------------------------------------------------------------•-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the��oard of health 9/14/-81............ Date Application Approved By.......___. :.. -------. /_��1 9/ ------------------- ----------. 1 Date Date Application Disapproved for the following reasons--------------------------------------------------------------•-------------------•---•------••-••---•-........_ ----------------------------------------------------------------------•--------------------.---------•-------------------------------------------------------------------------------------------------- Date Permit No$_!..................................................- Issued_......9114AI................................ Date No.....81 FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•----. --.....T a^t.n..............O F..................Barnsta.ble------..................................... for Disposal Works Tonfitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 274 -----926.3Z........... .............•--------------------------•---------•--•-.....-----...........-......_............ ------------- Location-Address or Lot o. riadelirle.iIold---•--------------------------------------------------------- 27 Bay Dane, Centerville, PEA 02632 a A & B Cesspool Service ner._._......_ 128 Bishops Terrace;d yannis, VIA 02601 Installer Address UType of Building Size Lot............................Sq. feet a Dwelling—No. of Bedrooms.................3 ........................... A2ttic ( ) Garbage Grinder ( ) a, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) G4 Other fixtures --------•----------=-------------------------- W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box' ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_--__-------_-_--.._---. rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x --•--------•---------------------------------------------••-••-•---------------••-•••--------------......----------•------•----•-.....-•-----•-•-------•----- 0 Description of Soil................................................................................................... U --------------------•-----.------------------------- •------------------------------------------------------- •------ -------------------------------------- •------ •----- ------------------------------------------------------------------------------------------------------------------------W U Nature of Repairs or Alterations—Answer when applicable.-.inst"tign;--of--a-•1,000-_gallon,._-pre-cast, stoic__pa�ke _. ech__pit..(oye of)!---------------•------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health: Signed -C 'idf-�•6tll/lt,�/,tt�-- 9114�81.... _ / --- Application Approved BY ._._....✓/e � � -----------..1 D Applicationte Disapproved for the following reasons__________________ ............................................•------•--------------------------------.........------........ --------------•--- Date Permit No81-...............................................- Issued•...9/14/81-----------•-------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................T own...........OF..................Barnstable............-----------.........----.... C9rdifirtt#r of TonalifiFanrr THIS IS TO CERTIFY, Thate Individual Sewage Disposal System constructed ( _) o paired by A & B Cesspool Service, IA Bishops........•• ------------- -- -------------- ----- ... Terrace, Hymnis, MA 02601 - 775-�2� -• ---- •.--------•-•-•. ----•........... ---------- 274 Bay Lane, -Centerville, NA 0263 ns=atlRolland at........•------ ------- -------- - ------•-------------•--- ----- -------- _;,--------••-•------------------------- has been installed in accordance with the provisions of TIT JER 5 of The State Sanitary Code a �1e�sc�r�lied in the application for Disposal Works Construction Permit No----------__..1_<I!............... dated-...-._-._----_y-_/__1_---------__-------_--_.-•-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A.GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............9/14/81.................................................. Inspector------------. ............................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable 81- 536 ...........................................OF $ 5.00 No......................... FEE........................ Ropootaf Workv %Toni#r ion amit A & B Cesspool Service Permission is hereby granted...................................................................................................... ................................. to Construct � I°�arne, en`te*v llne ivj�, -ve Disposal Si o�Tand atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No..81 ............ Dated.._......9. 14 81 -------------- �:.Z -�r--_'_.--------------------------------------.........-----...---- ' 9/14/81 Board of Health f DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOP OF FOUNDATION = 28.8' ± ' 4"SCHEDULE 40 PVC MIN. SLOPE 1 % ' �+ INISH GRADE OVER D-BOX= 23.0 ±' FINISHED GRADE OVER INFILTRATION= 22.8 - 23.0 (T1) GENERAL NOTES PROVIDE CONC. RISER WITH SLOPE @ 2% MIN. COVER OVER INLET&OUTLET FINISH GRADE OVER TANK EL.= REMOVABLE COVER OVER RISER TO INSPECTION PORT WITH 21 .5' - 22.0' (T2) FINISHED GRADE TO WITHIN 6"OF F.G. WITHIN 6"OF FINISHED GRADE ACCESS BOX TO WITHIN 6" I 24.0 - 26.0 OF F.G. (ONE PER TRENCH) 1 UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION @ FOUNDATION = VARIES 5" DIA. OUTLET(S) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE 2C MIN.ACCESS ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. COVER(3 TYP.) 9"MIN. 36"MAX. r ' 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD EXIST. SEWER PIP 9"" MIN. 9" MIN. 20.03 T1 PROP. SCH.40 36 MAX. 36" MAX. TOP OF SAS/B.O. = 19.03' T2 OF HEALTH AND THE DESIGN ENGINEER. PVC PIPE 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL MIN.SLOPE @1% 6" 3" 2" DROP MIN. 3„ g„ BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 3"DROP MAX. PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN MIN.SLOPE JOINTS (TYP.) PROP. SCH.40 10" T4" PVC IN FROM 1.33' ELEVATION =20.03' (FOR TRENCH 1)AND 19.03' (FOR TRENCH 2)FOR A DISTANCE OF 15' PVC PIPE 14" 21 .75� EPTIC TANK 4" PVC OUT TO (I Yp ) 16"TYP AROUND THE PERIMETER OF THE SAS. UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACED O LEACHING FACILITY 0.90' fio.75"TYP 12"STEP AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF THE LINER IS NOT LESS THAN THE 424.0'4- 22.001v 1 + BREAKOUT ELEVATION. 12" ' --I---- 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 48" OUTLET TEE 19.87 MIN. 19.7Q' 19.60'(T1) 1$,7Q' T1 17.70' T22.875'(34.5") 5.75' 18.60'(T2) 5 0' (TYP.) � 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 4"TEE 6" CRUSHED STONE (�,p ) 22"ZABEL FILTER MODEL#A1801-4x22 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO 20.5'TO FND (GAS BAFFLE ON BOTTOM) OVER MECHANICALLY 5'MIN. COMPACTED BASE 11.50' BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR 5 30.0'(TYP FOR BOTH TRENCHES) INSPECTION. SYSTEM IS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING 6" CRUSHED STONE OUTLET DISTRIBUTION BOX APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER. TO BE INSTALLED ON A LEVEL STABLE , 8. ELEVATIONS BASED ON ASSUMED DATUM OF 20.24' ESTABLISHED OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 11 .00 COMPACTED BASE Q "T1" =TRENCH 1 "STEPPED" ON A NAIL IN PAVEMENT AS SHOWN ON PLAN. PROPOSED 1 ,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 72" =TRENCH 2 BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION LENGTH 10' 6' WIDTH 5' 8" DEPTH 6 8" (Dimensions per Wiggin CROSS SECTION VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE Precast Corp., Pocasset MA) AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY , CONTRACTOR TO VERIFY ELEVATION SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 12 ARC 36HC (#3616BD) BIODIFFUSERS DISCREPANCIES TO THE DESIGN ENGINEER. NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE NOT TO SCALE STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR / a �" • T TEST PIT DATA ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH � • * PERC#: 12397 DETERMINATION FROM APPROPRIATE AUTHORITY. NOTE: .r '� , ' INSPECTOR: Donna Z. Miorandi, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS � 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP . 0 LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE EDGE OF EACH SEPTIC SYSTEM COMPONENT. , / o ,� ,* u • EVALUATOR: Michael Pimentel, E.I.T. THEY SHALL WITHSTAND H-20 LOADING. 2. THIS PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHED. �e / ^'� APPROX. WATERLINE LOCATION; �. • ' , + �� DATE: October 27, 2008 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND � • • CONTRACTOR TO VERIFY "; ! • TEST PIT#: 1 FINES. 00 N N , ELEV TOP= 22.00' 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND Q LOCUS 0 ELEV WATER= < 12.00' UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF O� 4° MAP 186 LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN Off' a' L! 0 PERC RATE _ <2 Min./In. COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN LOT 20 �' ACCORDANCE WITH 310 CMR 15.255(3). �k/ J�1 / / m I �- DEPTH OF PERC = 28"-46" 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN v� �O / / • • TEXTURAL CLASS: 1 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. EXISTING 40 v4- 16. PROPOSED PROJECT IS LOCATED WITHIN: BIT. DRIVE + i ._, 0" 22.00' ASSESSORS MAP 186 PARCEL 23 W Litter 4" 21.67 OWNER OF RECORD: VIRGINIA RICE CAROTHERS B Loamy Sand ADDRESS: 274 BAY LANE cl ` ^M 10YR 3/1 • {� •• t/ -- 8" 21.33 CENTERVILLE, MA 02632 • • 1 B Loamy Sand FEMA FLOOD ZONE C UP 227/1 , " 10YR 5/6 28 19.67 AS SHOWN ON COMMUNITY PANEL# 250001 0016 D MAP 186 ' i '`* / Perc r 17. PLAN REFERENCE: LOT 23� � MAP 186 • ' +� � � � 1. BOOK 73, PAGE 5• + • 18. DEED REFERENCE: 29,900 S.F.± ,(\ J LOT 21 ♦ , C Medium-Coarse Sand 1. BOOK 7730, PAGE 69 o #274 j � � • + + - 2.5Y 6/1 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. / ) ' (Loose; EXISTING Some Variegated 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY � 3-BEDRROM • . . . ,r' Colors) FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY / - / . . . \� • •�' - FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. \ / DWELLING 26 O 0 TOF = 28.8'± _ - -- ?6 -_ EXISTING CESSPOOL TO BE / ' / �� �oF _ LOCUS PLAN PUMPED AND FILLED WITH C FSF _ 120" 12.00 CLEAN COARSE SAND&ABANDONED-- 24- _ T _ SCALE: 1"= 1000' No Mottling,Weeping or O\ \ DECK / Standing Encountered PROP. CLEAN-OUT TO\ � ti� w PROP. TOTAL 12 ARC 36HC BIODIFFUSERS --- - - / .0 \ GRADE & LONG 990- \ N o (6 BIODIFFUSERS PER TRENCH) TEST PIT DATA cP \ iWEE)?ING BEND bi o DESIGN DATA - \� / \ PROPOSED INSPECTION PORT WITH PERC#: 12397 LEGEND \ \26, �� ACCESS BOX TO GRADE (TYP OF 2) NUMBER OF BEDROOMS (DESIGN) 3 INSPECTOR: Donna Z. Miorandi, R.S.- 00 2 DESIGN FLOW 110 GAUDAYlBEDROOM EVALUATOR: Michael Pimentel, E.I.T. .� -.� 100 EXISTING CONTOURS PROPOSED 1500 \ -TRENCH 1 0 1V TOTAL DESIGN FLOW 330 GAUDAY DATE: October 27, 2008 UP 227/17 GALLON SEPTIC TANK 22� _ TP 1 DESIGN FLOW X 200 % = 660 GAUDAY TEST PIT#: 1 J 102 PROPOSED CONTOURS TRENL112� 22- / \ �20 0 s _ USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV TOP= 21.00' 102 PROPOSED SPOT GRADE \ \ PROPOSED � I \ \ DISTRIBUTION BOX \ 20x5 3off TP 2 , �� ELEV WATER= 11.00, p/H/W - EXISTING OVERHEAD UTILITIES \ \ PERC RATE N88°18'06"E _ -\_ \ 78 1� '� 21. 0' Benchmark 4.32 /� \- '� \ \ 19x1 ` Nail in Pavement - --W W-- EXISTING WATERLINE o \ \ \�g ?0\ Elev. -20.24' INSTALL 12 - ARC 36HC (#3616BD) BIODIFFUSERS DEPTH OF PERC = IN 4°54'00"E I Assumed TEXTURAL CLASS: 1 n M \ \ ' � SYSTEM CAPACITY � TEST PIT LOCATION S8 J \ \ \ \ \ \ 0` MAP 186 0" 21.00' O O PROPOSED 1500 GALLON SEPTIC TANK EXISTING DRIVE\ \ \ LOT 22 ) )(TOTAL L.F. OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD Litter PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE (60.0')(7.8 SF/LF (0.74 GAUSQ.FT. = 346.3 GAL. LEACHING/DAY 4" 20.67' WRA 36 \ \ \ \ B Loamy Sand ❑ PROPOSED DISTRIBUTION BOX WE9A \ \ LIGHT \ 10YR 3/1 \ � 10YR 5/6 POST I 1 TOTALS: 8„ Loam Sand RA 35 \ 30.34' ` \ \ \ B y PROPOSED ARC 36HC(#3616BD)BIODIFFUSER \ \ W 34 \ \ I TOTAL NUMBER OF BIODIFFUSERS: 12 28" 18.67' ` \ \ N__1 \ , TOTAL NUMBER OF COUPLINGS: 0 IL \ / TOTAL LEACHING AREA: 468.0 SQ.FT. \ J TOTAL LEACHING CAPACITY: 346.3 GAL./DAY REV. DATE BY APP'D. DESCRIPTION / � Medium-Coarse and�&\V. \I ,33 2.5Y6/1 PROPOSED SEPTIC SYSTEM UPGRADE I �= \ \ oo (Loose; I ` �o NOTE: Some Variegated PREPARED FOR: 1 W A 32 M EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE Colors) �N DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER LOT 2 CAPEWIDE ENTERPRISES I MAP 4 ` \ \ \ "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO I � AL A L � ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST LOCATED AT N/F TOWN OF BARNSTABLE \ \ MODIFIED JULY 23, 2008). TRANSMITTAL NUMBER=I W000052. ,� 274 BAY LANE CONSERVATION COMMISION ".� 31 `� , 120" 11.00'No Mottling, Weeping or CENTERVILLE, MA 02632 JIL _ Standing Encountered , RESERVED FOR BOARD OF HEALTH USE SCALE: 1 INCH = 20 FT. DATE: OCTOBER 29, 2008 I I F W h 1___' RA 30 4 0 10 20 40 80 FEET N nr \ qj�/ - PREPARED BY: o C'r, RCHILL JR JC ENGINEERING, INC. 8�4°F AILN c IIN7 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 SITE PLAN _ 508.273.0377 SCALE: 1"=20' Drawn By: BSM Designed By:MCP Checked By:JLC JOB No.1508