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HomeMy WebLinkAbout0051 BLANTYRE AVENUE - Health 51 BLANTYRE AVENUE, CENTERVILLE A=229-114 i No. 42101/3 ORA r. ESSELTE 10% O 0 0 0 Commonwealth of Massachusetts j - Title 5 Official Inspection Form C4 6�- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rt 51 BLANTYRE AVE v Property Address COLUMBO e� "//q Owner Owner's Name information is required for CENTERVILLE MA 02632 4/22/08 every page. City/Town state Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. 'p°'l"t When filling out A. General Information W forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A. BROWN INC Company Name r� P.O. BOX 145 Company Address CENTERVILLE MA t632 rvCity/Town state ode ES rD 508-420-4534 S14297 Telephone Number License Number N r�: v > B. Certification Cn n I certify that I have personally inspected the sewage disposal system at this addre and thfab the' information reported below is true, accurate and complete as of the time of the ins ction. e inspection was performed based on my training and experience in the proper function and ma ntenance 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: o _ ® Passes ❑ Conditionally Passes ❑ Fails _ - ❑ Needs Further Evaluation by the Local Approving Authority i � 4/22/08 Inspecto gnature 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. Title V Inspection Forrn.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 1 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 51 BLANTYRE AVE Property Address COLUMBO Owner owner's Name information is required for CENTERVILLE MA 02632 4/22/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: NO OBSERVATION ON THE S.A.S, COULD NOT TELL LEVEL OF PONDING B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined(Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ 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 ❑ obstruction is removed Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is required for CENTERVILLE MA 02632 '4/22/08 every page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. 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 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. Title V Inspection.Fonn.doc•0=6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I 1 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is required for CENTERVILLE MA 02632 4/22/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "* This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than'/z day flow ❑ ® 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. Title V Inspection Form.doc•08106 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '( 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is required for CENTERVILLE MA 02632 4/22/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title V Inspection Form.doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is CENTERVILLE required for MA 02632 4/22/08 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)] Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is CENTERVILLE required for MA 02632 4/22/08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal uses El Yes M N Water meter readings, if available (last 2 years usage (gpd)): 06-153/07-282 Sump pump? ❑ Yes ❑ No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title V Inspection Form.doc•08f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is required re wired for MA 02632 4/22/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 5-15-1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Form.doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is required for CENTERVILLE MA 02632 4/22/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 6"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 Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? PUMPED AT TIME OF INSP Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is required for CENTERVILLE MA 02632 4/22/08 every 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.): PUMPED AT TIME OF INSPECTION Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Title V Inspection Forrn.doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal tj,,,� Pe g System•Page 10 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is CENTERVILLE required for MA 02632 4/22/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): 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.): BOX LEVEL NO LEAKAGE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is CENTERVILLE re uired for MA 02632 4J22/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO OBSERVATION PORT Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 11 X41 X2.3 ❑ 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.): NO SIGNS OF HYDRAULIC FAILURE, COULD NOT TELL LEVEL OF PONDING Title V Inspection Form,doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is required for CENTERVILLE MA 02632 4/22/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title V Inspection Form.doc•0&06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 BLANTYRE AVE Property Address COLUMBO Owner Owner's Name information is required for CENTERVILLE MA 02632 4/22/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 7.1 FT FROM BOTTOM OF S.A.S 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: 4/22/08 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: 1 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Tide V Inspection Form.doc-08W Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 15 of 15 P— Commonwealth of Massachusetts Title 5 Official InsPection Form Subsurface Sewage Disposal System Fonn-Not for Voluntary Assessments 51 BLANTYRE AVE Properly Address------- Owner COLUMBO information is Owner's Name q&6d-for CE --ILLE--:--- -,- _ -.r-,--T�,�-,.--,�. _MA every page. own 632"' 22)08 -6t—ate— -ilp—Code Date of—Inspection MOM.. D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A I 2-161 3-15- 13 1 9-2 Title V Inspection Form.doc,08/06 Title 5 Offlcial Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 s 2000 AL�DTPS?kE COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS ~ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Address of Owner: BOX 82 E.SANDWICH MA.02637 Date of Inspection: 2/9/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Secdon 15.340 of Tale 5(310 CMR 15.000) Company Name: JOHN GRACI SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 Telephone Number: 608-664.6813 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes Conditionally Passes _ Needs Further Evalua'on y the Local Approving Authority Falls Inspector's Signature: /� Date:2/10/00 The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM NOW AND MAINTAINING EVERY TWO YEARS. revised 9/2198 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Date of Inspection: 2/9100 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. n& The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. n1a Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced nLa The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Date of Inspection: 2/9100 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n&(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Date of Inspection: 219/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Il. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner: WILLIAM HOLT Date of Inspection: 2/9/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health. _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Date of Inspection: 219/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual): Total DESIGN flow: 440 gpd Number of current residents:0 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system Inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: 1110/00 COM M ERCIALnNDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1997 PERMIT 96-123 Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Date of Inspection: 2/9/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 14" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 8" Material of construction: _concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: L 10'6"H 6'7"W 6'8"" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 12" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 4" How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW AND EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Date of Inspection: 2/9100 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallonstday Alarm present: NO Alarm level:n/a Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 +y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION'(continued) Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Date of Inspection: 219100 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(n/a)n/a leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)I V X 41'X 2Z FIELD overflow cesspool,number: (n/a)n/a Aftemative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE FIELD APPEARS TO BE FUNCTIONING PROPERLY.THE SOIL PROBED DRY IN LEACH FIELD. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: nla Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Date of Inspection: 219100 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 6 0 I �a rS6 CA Ih�g revised 9/2198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 BLANTYRE AV. CENTERVILLE, MA MAP 229 PAR 114 02632 Name of Owner WILLIAM HOLT Date of Inspection: 219/00 NRCS Report name: nla Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: nla Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surfacewater _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet Please Indicate all the methods used to determine High Groundwater Elevation: NQ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) NQ Determined from local conditions NQ Checked with local Board of health NQ Checked FEMA Maps NQ Checked pumping records NQ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET revised 9/2/98 Page 11 of 11. TOWN OF BARNSTABLE LOCATION 41?& SEWAGE# ii T VILLAGE�1ffgj,J) ASSESSOR'S MAP&PARCEL ; INSTALLERS NAME&PHONE NO. a�ec �DCQ(,% A &MA)Q ki SEPTIC TANK CAPACITY �. LEACHING FACILITY.(type) tidd 11X9JJX11, (size) NO.OF BEDROOMS OWNER Cpt O NlV O PERMIT DATE: N I` dcy 1ti2S `C?A) COMPLIANCE DATE: P Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f o Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY P JW 1 00 RereXD(n& 2� iG' 1 1'fo-fj ' 4- 3 -2 5'`8." Town of Barnstable Department of Health, Safety, and Environmental Services MASIL Public Health Division & P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health February 23, 1998 Mr. John Aalto Ground Surgeon 150 Walnut Street Marston Mills,MA 02648 ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE,TITLE 5. The septic system installed by you located at 51 Blantyre Avenue,Centerville was inspected on February 20, 1998 by Jeremy Dunning because of a complaint. The inspection of your septic system showed that the septic tank does not meet following criteria contained in Title V: 310 CMR 15.28 Only 5.5. inches of cover material(soils)over the septic tank Septic tanks all have a minimum cover of nine inches. You are directed to place an additional 3.5 inches cover material(soils)over the top of the septic tank at 51 Blantyre Avenue, Centerville within sixty(60)days or receipt of this order letter. Failure to comply with an order will result in further action. A violation of the State Environmental Code may be punishable by a fine per M.G.L. 21A Section 13. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE B ARD OF HEALTH Thomas A.McKean,R.S., C.H.O. Agent of the Board of Health cc: Anne Holt John Iafrates McKean Thomas From: McKean Thomas To: Geiler Tom Cc: Gatewood Rob; Crossen Ralph; Gillis Jack Subject: RE: Holt Property 51 Blantyre Rd Centerville Date: Tuesday, November 25, 1997 3:36PM REPLY TO YOUR E-MAIL Yes- There is a plan on file at the Public Health Division. It is dated March 20, 1996, and is signed and stamped by Peter Sullivan, P.E., and John R. Ellis, PLS. It does show a 12" conc. pipe which is connected to a catch basin ending approximately five feet south of the Holt's property line. [Your Question - does this plan constitute a false document?] This plan is not an as-built plan. Peter Sullivan stated to me today that "it is a site plan of the conditions which existed as of March 20, 1996." Has a land surveyor verified that a pipe actually goes onto the Holt's property? The grade is pitched in such a way that surface water would run onto and along the Holt's property at that pipe discharge location shown on the plan. From: Geiler Tom To: Crossen Ralph; Gatewood Rob; McKean Thomas Subject: Holt Property 51 Blantyre Rd Centerville Date: Friday, November 21, 1997 4:03PM Builder; J lafrate - I believe you are all familiar with the Holt's and there complaints about the construction of this home and there concerns with there contractor. Much of there concerns center around potential civil action. However ; I want to be sure that this project is not in violation of any state or local law or regulation before we close the books on this one. O f particular interest is the Holts position that the contractor or the contractors surveyor filed a false application or document in that the as built plans show a catch basin with a pipe leading from the basin, on land to the south of the Holt property. The Holts indicate that the pipe actually continues on to there property. They also contend that this constitutes a false document. My question to all of you is ; does this document exist in any of our files? If yes; does it indicate the pipe stopping south of the Holt property? If yes; does this constitute a false document? If yes; is this a crime or violation? If yes; of what law , rule or regulation? Please check your files and get back to me. I would like to close the books on this one . Thanks S Page 1 i �TME Town of Barnstable Department of Health, Safety, and Environmental Services IMRNSTAB A93. public Health Division ` � M �rEop 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health September 12, 1997 Mr. and Mrs. William Holt 51 Blantyre Road Centerville, MA 02632 Dear Mr. and Mrs. Holt: On September 11, 1997, I investigated your complaint regarding the subsurface drain pipe which originates from 41 Blantyre Road and is located approximately twenty (20) feet away from your soil absorption system. Although, the subsurface drain is connected to a catch basin which is located on your neighbor's property, no violations were observed concerning the septic system or the drain pipe. The State Environmental Code, Title 5, (Section 15.211) requires only a ten (10) feet separation distance between a soil absorption system and an open surface or subsurface drain. According to the as-built records at the Public Health Division Office, your soil absorption system is located greater than ten (10) feet away from the subsurface drain. Therefore, no violations were observed and no violation notice will be sent to your neighbors in this regard. Sincerely yours, Thomas A. McKean Director of Public Health cc: Thomas Geiler cc: Robert Gatewood ,. �� f�ny � V� I f�' � t .3 � � � � Q y zg, 2B. �., �o o . e sr�.� f- F_- 3 AQESSO�MAp No. PARC9.N / Fee 1CO THE COMMONWEALTH OF MAbb a PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rp plication for Migozal *pgtem Cougtruction Permit Application is hereby made for a Permit to Construct or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. MsEsso a-5 M i vj PI-L 1 14- Owner's Name,Address and Tel.No. -T-7 5- -7 4�B 7 L}51 NI-AWT'1QE Aves",-J �AtivlEw ccp-Pa2A�o�►i Ce3—17e-a2 4ILLi= MA-,� O�l.lo32 P.o, f�oX 'Lo48 Installer's Name,Address,and Tel.No. 4'z a- q sal`s Designer's Name,Address and Tel.No. O 1-t ti+ A Ak LLTO f3 A X"T-C-L 4 N--f m 11-iG� 1150 W A L_"u T S12aE T 91 2 AA A-t�_r S T'2-¢:'S_r AAA-LSTct_4'% AAsL.LS, MA.,02(048 Osi�l2.yi�L.1r� MA.,01"T'S Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(wo) Other Type of Building r-,a-a No.of Persons ti to Showers(N/a) Cafeteria(4/A,) Other Fixtures �-+6+-+c Design Flow I t 0 gallons per day. Calculated daily flow 33o gallons. Plan Date AA e-a c.1+ 'Le I a`+cp Number of sheets ors E- Revision Date nor-+c3 Title Description of Soil T�-4# 1 o - I (A) 'T-oP5= L. : 1 - 2.5, (a) s u e3 so I 12's - t o' (C) 5 r3 - �f 2AT�M GL�A9J Mao SA-WO W/G',Q-ANgeL. - h+a NJ,4r . r^- lo' Ta-1 A 2 : O - CA-) TAP- �lL_ I S' (�) 5,jN 5-n2A--'rLtin : cl.O&�-« AAC--o so'r.+D - ti,a wT2 C. I'1✓ Nature of Repairs or Alterations(Answer when applicable) I-r oT A-P P L1 C^-rSL_E- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. _ Signed Date -S Application Approved by Application Disapproved for the following reasons Permit No. , '� Date Issued'"--��-� 41`4- No. +^" ` \� - Fee 100 THE COMMONWEALT96-OF MASSACHUSETTS a PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 1 Application for Migpool *pgtem Construction Vermuit ' Application is hereby made for a Permit to.Construct( ✓)or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. ASStSSU Q. M -vi of 4 Owner's Name,Address and Tel.No 1"7 5— 3 7 0-5 ANf l�E Ar aav �?7A�l.tf ccaC-PcaG2 1':iar a, Ct= IL..L.E ArtA., 0-t631 P ox 104-13' AAA. , <,�''}-(.3'L Installer's Name,Address,and Tel.No. 4 Z.�s r cl S "f S Designer's Name,Address and Tel.No. 2 F, 3 p/ )OH N A A t 1 C1 r°./1C k-f •mil k-a`I a g 1 '5 0 W A L_"o T S"M r�E T 1 _ / AnrA, C3'tr7PiS pAiLfr�,,MA. 02L4-a Sx } Q AAA. :)/14oi`S t/ E Type of Building: Dwelling No.of Bedrooms � E' Garbage Grinder(kvo) Other Type of Building i���� No. of Persons f n Showers(­1A) Cafeteria(LtA) Other Fixtures ' I—k k Design Flow I I C) gallons per day. Calculated daily flow 33e> gallons. Plan Date M# 2c F-k ,L o, f q q 'o '�Number of sheets 1= Revision Date f-4 v� Title Description of Soil 44' 1 : 0 - I ' {A 71<_1P-,cn+ L ; 1 - '2.�` (f3) � r�so k g Z,� - i c�' �c ) � r� �i"teF'1vM CLCAt-.k AAC0 -x,A�,f0 vV C;_ 10' T>1 0 2 AIL- 1'- 3 t3 l �. (f-.SC9f L 3 - I r'f-' (G.� a✓Is'STOIl Z+M G).C`7`f n--1 M r:0 S✓�'!+i L1 fN G_1 �l�r'1"k'. C:. k'l.r Nature of Repairs or Alterations(Answer when applicable) f-+ca r fi P P L f c e- Date last inspected: `, Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of.Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. �r Signed (/i Date S r Application Approved by Application Disapproved for the following reasons Permit No. � /� Date Issued THE COMMONWEAL �54AS ACHI ETTS /V, PUBLIC HEALTH DIVISION -+BARNSTABLEMASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed(�°)or repaired/replaced( on_� by for °! as has been constructed in accordance'''! with the provisions of Title 5 and the for Disposal System Construction Permit No. " dated "��, "'40 " Use of this system is conditioned on compliance with the provisions set forth below: No. �"'/ i.:/ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE.,.MASSACHUSETTS Mtgpont *p5tem Construction 3permit Permission is hereby granted tom to construct(✓)repair( )an On-site Sewage System located at It 51 P�,LA f-4 1 f a.b A,,iCn-4,,,,ia: cc k - and as described in the above Application for Disposal System-Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: 7 �ppfoved by c f U { 0 i 3 k E 1 TOWN OF BAMSTABLE OP �1171q LOCATION S� aN '' �� SEWAGE # 96 3 VILLAGE C�h/Q��i ��rc ASSESSOR'S MAP & LOT 1 INSTALLER'S NAME&PHONE NO. 10" � SEPTIC TANK CAPACITY f 5'0U LEACHING FACILITY: (type) ti4a4+%-ji (size) NO.OF BEDROOMS 5 BUILDER OR OWNER PERMITDATE: S'/y'L5� 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of.leaching facility) Feet Furnished by y �, t• afar � i a - l 3 � � � � � � 6 � ! � _�- - -- - - --- t 86" r 9` �=` t" `-T � �6� � 2�. ag, .�,, �o o _ � .�rc.� R TOWN OF BARNSTABLE LOCATION s� �"~ �r �v Q. SEWAGE # YII.I;AdE C�a/�/''�� e ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. JU�''' �'' y2�•g SgS' SEPTIC TANK CAPACITY �VU LEACHING FACILITY: (type) 4,'r�6- �F�* (size) NO.OF BEDROOMS 3 BUILDER OR OWNER. PERMITDATE: Sl7 COMPLIANCE DATE: .. Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet ' within 300 feet of leaching facility) Furnished by log ✓/� _ , 0dd V i •c>. . •rso • .. _ ,_ _ _: ENGINEER. BAXTER- ac_NYE, INC. BOARD OF HEALTH: £DWARD F. ,3ARRY r( •" BACKHOE:- JONN AALTO •f c C • USE 11' x 41' LEACHING BED/FIELD. .. LOGS S HOLES - •: ; ' 'r p . :;• (2) 4 DIAMETER DISTRIBUTION LINES L OF TEST LES P 8570 • u5 REMOVE UNSUITABLE MATERIAL FROM BENEATH SYSTEM IF ENCOUNTERED 9/19/95 'OVERDIG 1 INTO MEDIUM SAND.• . . / LAYER PERC RATE. < 2 MIN PER INC,-1 ` BACKFILL WITH CLEAN MEDIUM SAND PER 310 CMR 15.002 ti •5•• ;�: o I TOP FOUNDATION EL 40.5' r. � TH 1 TH 2 v EL 39.5 DEPTH ELEVATION DEPTH ELEVATION 0' 37.5' 0' 37.9' AO TOPSOIL A TOPSOIL 1 36.5 1' 36.9' BSMT FLR EL 33 6.5 3 � - INVERT ,_ 8 SUBSOIL ' 36.0 1500 GAL EL 35.0 CB� SUBSOIL SEPTIC TANK - _ , LOCATION 35.5 = 2.5 35.0 � �� 35.0 END PIPE EL 34.8 35. 5 7 , H 0 .• _ r 2 .. P 3' BOTTOM`HYANNIS QUADRANGLE , Q AN LE 35.3.. 3 34.5 .3 34.9 ,. .1. SCALE 1•25,000 -- . . • •....a••S•tom. BEDDING AS P • C SUBSTRATUM ASSESSORS ER TITLE 5 11 , MAP 229 PARCEL 114 CLEAN MEDIUM SAND WITH GRAVEL C SUBSTRATUM 10 10.5 91 2.5 O M y 10' 27.5' NO WATER ZONES: CLEAN MEDIUM SAND AQUIFER PROTECTION Q R T£CTION..OVERLAY DISTRICT ZONING - DISTRICT. RD 1 MINIMUMS 12' 25.9 NO WATER AREA = 43,560 S. F. FRONTAGE0' 2 WIDTH 125' FRONT SETBACK TBA K 30 OE1► QPEC� P � OF PROPOS SEP31O SIDE SETBACK _� 15 � . REAR SET BACK 15 BUILDING ' HEIGHT 30 NOT TO SCALE (O R 2.5 STORIES IF LESS cx L u5 Wjl-44t1_4 FLm0 1 w=6jF G L.�• Fi2M CaMMJ�-a1 R- D ..�-EL , N 2Sooc> t 00o S ' ADD 1 8 1 S ,x / /2 To,JE AS REQUIRED a MAY BE REPLACED WITH :2 TO MEET 3-FOOT r MAXIMUM ! INSiTU MATERIAL 4 PERF SCHED 40 PVC IF ENCOUNTERED REMOVE - UNSUITABLE MATERIAL To INSURE THE 2' OF 3/ ' - 1 1/2- REMOVE UNSUITABLE MATERIAL 4 i 51D£WALL AREA OF SYSTEM IS IN ' - CLEAN MEDIUM SAND OR FILL PER 7 STONE FOR 5-FEET (SEE NOTES), , _ 310 CM R 15.201 15.293 LINES TO ; 4 3 4 DISTRIBUTION box 5, 11 5 ' 1 2 DETAIL � DESIGN DATA. CH FACILITY ; END SECT10 PROPOSED 3-BEDROOM SIN N �SINGLE FAMILY DWELLING NO'GARBAGE GRINDER N.' T. S. DEVIL LEACH FA CILITY DESIGN W: ' E GN FLOW: 3 x 110 GPD = 330 GPD PLAN VIEW S _ 1=PTlC TANK. 330 GAD x 150% - 495 GPD N. T. S. USE 1500-GALLON SEPTIC TANK PER TIT LE 5 330 GPD 0.74/ / G/SF/D 446 SF EFFLUENT LOADING RATE 4 3 4 USE 11 x 41 FIELD/BED WITH '(2) 4 DISTRIBUTION LINES 4 SCHED 40 PERFORATED PVC PIPE TYPICAL ALL PIPE TO AC - PLACE CAPS AT ENDS LEACH FIELD TO BE SCHEDULE 40 PVC SOiLD ' ALL PIPE IN LEACH FIELD TO BE SCHEDULE 40 PVC PERFORATED • ENDS TO BE CAPPED NO ALLOWANCE FOR SIDEWALL°AREA i TOT DESIG N-GN: 45I SF REQUIRED: -44.6 SF PERCOLATION RATE LESS THAN 2 MINUTES PER INCH (ASSUMED) cp N TEST HOLE BY J. ELLIS, LICENSED SOIL EVALUATOR N BAXTER & NYE. INC. 812 MAIN STREET OSTERVILL.E MA., 02656 2 5S r Q j 1 E L D Z 2 Z N s7 C_ 0 HO WA�� E 29.8 L 1� 32 30 ; J r 34 N Z �1"22'30 E �6 � 8 L 0 T 2E A , L c� � 0T T L 0 3 .m D o►yty 38 , !N 00 , 28 A 0 154• 20,850 'S_ F. t" n x6.3 COMPUTATION'\,.� 33,2 '� (TO C©M.. J.ATION LINE) 50' cIIi 6 4 ROJ TOP OF BANK 1 0 173 2 1 � GARAGEt N/1 a D AY -vo, n0 E r mr > ; m x I 1 r,� v o ✓� .: z � �� J 1 p"J "( 1 6,2 _f Wq -v o z> x 34.7 I n_n- ' > i w/.o . t a v x 29.7 ' r+x r'# v i a of m 9 r P -� o ,9 r z 1 o , c,+ 1 C , 3L$ CA z.ca u z aicomeam z x q pOGO p l <C! to 26. ` Qp�1� # ZOP Oo 3Q13 m g,$ 0 TOP 37.5 7 j . t 4 Z ' ;x 5 3a.7 3 WA 2 S f �. 23 34 � 1 C 8 X 1 8 148.00• q �*t 3S .,fir w �'+ _ S s3'O2 L C;1 I 12 CONC PIPE �3m a cs H _ 7 r, L INV EL - 37.6 o EL 39.7 �- N q NGVD m V _ F N CAT -+ o CH BASIN p _ t m v > K E Y .. :o D N r- Z O N • O ' CB H FOUND o' n I /D N CD PROPOSED COi4t UR N ' - D(ISTING CONTOUR 48 8 °' N i r� 1 . , �,WN soiL TEST �o1- V >v m TER , 0 SITE PLAN 40.00 w AT 1" BL.ANTYRE AVENUE CENTERVILL.E MASS. FOR BAYVIEW CORPORATION OR RATI0N NOTES: - WATER SUPPLY FOR THIS LOT IS MUNICIPAL N AL WATER SCALE: 1 a 30 MARCH ZOf 1996 LOCATION OF UTILITIES NOT ,N SHOWN ON THIS PLAN. AT , LEAST 72 HOURS PRIOR TO ANY EXCAVATION FOR THS PROJECT THE CONTRACTOR SHALL MAKE THE REQUIRED BAXTER & NYE, INC. NOTIFICATION TO DIG SAFE (1-800-322-4844) AND 812 MAIN STREET APPROPRIATE WATER DISTRICT FOR LOCATION DATA. OSTERVILLE, MASS. 02655 _ R IS REQUIRED TO SECURE APPROPRIATE (508)-428-9131 THE CONTRACTOR 7E PERMITS FROM -• TOWN AGENCIES FOR CONSTRUCTION` DEFINED , Y I 8 THIS PLAN. INSTALL RISERS AS REQUIRED TO WITHIN 12 OF FINISH GRADE. GRAPHIC SCALE - ALL STRUCTURES BURIED FOUR FEET OR MORE OR SUBJECT 30 0 13 30 60 120 TO VEHICULAR TRAFFIC TO BE,H-20 LOADING I ELEVATION DATUM TAKEN FROM TOWN G. I. S. SHEET #229 ELEVATION LONG POND SHOWN AS 26.12 IN FEET ' 1 _1 inch 3 0 14 OF OF 58LUVAN NO.23733 H OWL74 •.a 95163 PPP02.DW , >w ,