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0086 BRALEY JENKINS ROAD - Health
86 Braley Jenkins Road Centerville P 01 A = 171 182 w e { 1521/3 ORA 100/6 P2 i No. �6 �`�� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z(ppfiration for Misposai ,pstrm Construrtion 'permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Loo ttiionnddr# s or Lot No. g/p 1 CQ ey C A f n cG' Owner's Name,Address,and Tel.No. AJsdSs r6 s Ma11p/Parcel Uf ,�G (-1 1 -G ace( Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Bt8 GXCccgat1o(1 SD9 ~ t-In L �ir"onrne tG: I Dq�93,3 ,Zll Type of Building: Dwelling No.of Bedrooms ,3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S`i Cl No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 313 0 gpd Design flow provided gpd Plan Date � ) ,I I u Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) (2) IS Q cAaA(P a r,ha rn s Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar H It ed Sign Date 5-5 - i L Application Approved by A Date Application Disapproved by Date for the following reasons Permit No. Date Issued ..� 'No. C✓ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes r flplication for Disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Wfipgrade( ),Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. $to (q e e n I n S Owner's Name,Address,and Tel.No. ��,fr,j1� ,,��AA 1 �I�Iissgbklmon 5Gz - & Iq - 6r� W� Assemr's Map/Parcel ,/v` L I-f 1 `PGi(cc( I Q 2 Installer's Name,Address,and Tel.No. r` Designer's Name,Address,and Tel.No. 13+3 03 C. ylc'onrne tcz( 509,933 - Z»7 s Type of Building: J . Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 51 d L.e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3J gpd Design flow provided gpd Plan Date S 1�. Number of sheets Revision Date " Title Size of Septic Tank Type of S.A.S. Description of Soil (f s Nature of Repairs or Alterations(Answer when applicable) RIO d t� 7 l2 S Q QrAA(p ( S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board- H It Signed l9" Date 5 - Application Approved by A 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( 1� Upgraded( ) Abandoned( )by :B-'r(-� n V of(6)n at {o ((� 1 I{> Q n 1 n ('CL s been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated �- Installer h{'�T (� Designer B n U ► (l��1�Y1 P n r l #bedrooms - Approved design flgCy gpd The issuance o this p it shall not be construed as a guarantee that the system w' 1 h n as desi d. fn Date 7 3b Inspector -------------- / - - ------------------------------------------- ----------------------- ------- --------- No. �� 6 — q� A Fee 160 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal :�Ppstrm Construction permit Permission is hereby granted to Construct( ) Re air( ) Upgrade( ) Abandon( ) System located at Ca L I Ce e. 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:Cons ction�Qust be completed within three years of the date of this permit. Date -- lam(') Approved by �a �41 �SfU1� e3_�I, •L-'C¶�eri� T�'��LW T, e:W u! 0 f 1B a Y n 9 1 ta,b T e, Reg .1 r s+-17SJ5`��ELE: r u abdic 1Uh Dky,1sion 46�g= ... Thomas MvIK-eqin,Director �0,O Ojn Sin e�t�� y*�� 9 t/1T ®96�D71 Ora c6: 508-962-4644 rax_ 509-790-6304 gmsrta�llllPu Des r nerr CeTtuft9-tnon r+1nreel �S Date- V °� �ewaae Lies'MiM- ABS 1Map\C1'ar �esn�iexa W OaJ r� Q Ti"sta er: Adidin ess: cf't Ad d ess. U On -was issued a permit to i7sta11 a (date) (installer) septic system.at kJ� v �'-+'� K4 cased on a design drawn by r (a- ess) a, l �1 �` Ovia, dated (aesigner I certify�jatihe septic system-referenced above eras installed substautially according to the design, which may include minor approved changes such as lateral relocation of ffiie distribution box and/or septic tank. I certifrr 'that the septic systern Ieferenced above was installed with major changes greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance,Nith. State &Local Regl.�lations. plan revisiau aT certified as-limit by designer to folio W. ��A8FMgss�c DANIELA. yGs� XXX/// /!✓ o OJALA AnstallP ' �S3gI]�t uTe)uTe) CIVIL A No.46502 PpX, �G 1 S T V- It O SS/ONAL EN (�FS1gneI'S SlgnaIe) (� 1�E5IgIIeT'S Stang Ilk 1e) I LrLJ�+l la�+�lT l� TO BkUTuUOLT FtlJ�5JLA0 171FEA]L`1H kMVISM4. CE TLMCA1—h OF C�ni .a,T dC1l f L NOT Flu ! � a���'b' €. 'r 9 FOPM -A-ND AS-BUILT CAS AMA i YOU. n-;xP.PIA NP.ntir.Mps7GDEi CertiucaSoaFc,�n 3-26-04.r'oc t-- TOWN OF BARNSTABLE OCATION $(,Brolcu -3cr.K,n5 RJ- SEWAGE# 7-011. - 1413 VILLAGE ASSESSOR'S MAP&PARCEL 1`] - IBZ INSTALLER'S NAME&PHONE NO. O- SEPTIC TANK CAPACITY 1000 LEACHING FACILITY.(type) 5004o,1 LAC- Z (size) 13)tZ.Sx Z- NO.OF BEDROOMS OWNER 1\ mo. PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Minimum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al AZ"3s1y" I sZ-2,6 U P-sZ' O f33" y9'10•• M-S�• B A i3y "S9, REAR k Olk v Town of Barnstable P# (6 0 Department of Regulatory Services L BAB„BrABLE : Public Health Division Date ZZ 200 Main Street,Hyannis MA 02601 It Date Scheduled Tune Fee Pd. l/VP'd M. Soil Suitability Assessme,it for Sew Disposal a, Performed By: 1 �^� Witnessed By: ,Q1/ LOCATION&GENERAL INFORMATION Location Address Owner's Name/�(''[_A VC/ �Y� Address l"(i7�"t't(r Assessor's Map/ParceL �"� 1� �� - ,Q/��yp'� Engineer's Name U.1 CONSTRUCTION N W REPAIR V Telephone# - /j yy E Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) r% t, Parent material(geologic) Depth to Bedrock Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation Hole# �f \ Time at 9" Depth of Perc t I J` Time at 6" Start Pre-soak Time n � � C.� Time(9"-6") End Pre-soak � / Rate MinJlnch C _xv r Site Suitability Assessment: Site Passed" Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC 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 L,5 bJQ f � 0, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sod 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. Consistency.%Gravel) Flood Insurance Rate Mau: Above 500 year flood boundary No /yes Within 500 year boundary - No Y//yes Within 100 year flood boundary No 1/ Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring per,i ma rial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of na lly occurring p rvious material? Certification I certify that on d (date)I have passed the soil evaluator examination approved by the Department of Enviro en 1 Protection and that the above analysis was performe by me consistent with the requ a lg,expertis ex nce de 'bed' 310 CMR 15.017. (, Signa Date Zorr� Q:)SEPTIC)PERCFORM.DOC hk Illo 5 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION V i 0 Qn Q �< TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY AS SSMENTS> SUBSURFACE SEWAGE DISPOSAL SYSTEM F� PART A no CERTIFICATION rn Property Address: Owner's Name: 1� Owner's Address: 1 1>0 Date of Inspection: • `""-� ' Name of Inspector:(please printl3ouglaS A.Brown Company Name: 1)01 Anlas A Rrnyyn Septic Inspections Mailing Address: RO Box 145 Telephone Number: enterville, A 02632 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspdction.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�S,ecn 15.340 of Title 5(310 CMR 15.000). The system: Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 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. Notes and Comments 1 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I �� «� �YQ A13112itv Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: C Owner's Name: Owner's Address% QAt--v Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sysstt Passes: I have not found any inform aho n which indicates that any of the failure criteria described to 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: R � ,V . f M Wot inl ,li� t ..Cp B. Sy m Conditionally Passes: one or re system components as described in the"Conditional Pass"section need to be laced or repaired.The sys ,upon completion of the replacement or repair,as approved by the Bo Health,will pass. Answer yes,no or not det ed(Y,N,ND)in the following statements.If"not ed"please explain. The septic tank is metal an r 20 years old*or the septic tank( er metal or not)is structurally unsound,exhibits substantial infiltra or exfiltration or tank failure i ent. System will pass inspection if the existing tank is replaced with a complyin ep.c tank as approved a Board of Health. *A metal septic tank will pass inspection if i ' structurally soun not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old r ailable. ND explain: Observation of sewage backup or break o or high stati ,ater level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled o even distribution . System will pass inspection if(with approval of Board of Health): bro pipe(s)are replaced o ction is removed distribution box is leveled or replaced The system req ' d pumping more than 4 times a year due to broken or obstructed pipe(s). a system will pass inspection if approval of the Board of Health): broken pipe(s)are replaced obstruction is removed i Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR_M PART A CERTIFICATION(continued) Property Address: F ('cw 43 -(y MO AACC Owner's Name: Owner's Address:_. t C ate of inspection: C. rther Evaluation is Required by the Board of Health: Con " "ons exist which require further evaluation by th d of Health in order to determine if the system is failing to prote ublic health,safety or the enviro 1. System will pass u ss Board ealth determines in accordance with 310 CMR 15.303(1)(b)that the system is not function a manner which will protect public health,safety and the environment: Ces r privy is within t of a surface water spool or privy is within 50 fee a bordering vegetated wetland or a salt marsh 2. Sy ill fail unless the Board of Health(and Public Water Supplier,if any)determine at the system is func g in a manner that protects the public health,safety and environmen - _ the system has a c tank and soil absorption system(SAS)and the SAS ' thin 100 feet of a surface water supply or tri to a surface water supply. — The system has a septic tank AS and the SAS is within a ne 1 of a public water supply. _ The system has a septic tank and SAS an a SAS is 50 feet of a private water supply well. The system has a septic tank and SAS and A " less than 100 feet but 50 feet or more from a private water supply well**.Method used to ermine di **This system passes if the well wat sis,performed at a DEP ed laboratory,for coliform bacteria and volatile organic co ands indicates that the well is free from ution from that facility and the presence of ammonia ni en and nitrate nitrogen is equal to or less than 5 pp provided that no other failure criteria are trigge .A copy of the analysis must be attached to this form. 3. Othe A OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: & 31 (r,\ Owner's Name:--rhome'-C)o Owner's Address: - t!Hn;-�e t,; 'o c• Date of Inspection:_if,- -d D. System Failure Criteria applicable to all systems: You must indicate"yes"or"nd'to each of the following for AL 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 _ t/Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool . _✓Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow t/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. _LL" Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ley 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CUR 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 b onsidered a large system the system must serve a facility with a de ' flow of 10,000 gpd to 15,000 Epd. You must in ' ate either"yes"or"no"to each of the following: (The following c ' 'a apply to large systems in addition to the eria above) yes no _ the system is wi ' 400 feet of a surfa g water supply the system is within 200 t tributary to a surface drinking water supply the system is locate a nitroge sitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a pu water supply we If you have answ "yes"to any question in Section the system is considered a significant threat,or answered "yes"in Se D above the large system has failed.The caner or operator of any large system considered a signifi at under Section E or failed under Section D upgrade the system in accordance with 310 CMR I Page 5 of 11 OFFICIAL INSPECTION-FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: cp k ' 1 �, S Owner: � } , Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes Now _ Y 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 -jsV 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 ? t:CAkk�tj f. Were all system components,� e 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? —1�<as the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no Existing information-For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] F - - 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: -- Owner's Name: Owner's Address: Date a e of Inspection: RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):3_Number of current residents: 2_ Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage system(yes or no):AV)[if yes separate inspection required) Laundry system inspected(yes or no):ALOS Seasonal use: (yes or no):ALO Water meter readings,if available(last 2 years usage(gpd)): 23r G Pa 04 Sump pump(yes or no):AU 8 ? GPI b S Last date of occupancy:CLXL&4 -. CO RCIALANDUSTRIAL: Type o lishment: Design flow sed on 310 CMR 15.203): Basis of design (seats/persons/sgft,etc.): Grease trap present or.no): Industrial waste holding pre es or no): Non-sanitary waste disc har the Title 5 system(yes or no): Water meter readings, ' ailabl . Last date of occu /use: OTHER(des ): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):—� If yes,volume pumped:_____gallons—How was quantity pumped determined? Reason for pumping: TYPE,IF SYSTEM eptic tank,distribution box, soil absorption system _Single cesspool Overflow cesspool `—Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) T_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: Were sewage odors detected when arriving at the site(ves no): Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address% Owner's Name: can Owner's Address: K Date of Inspection: - l -d� B ING SEWER(locate on site plan) >Depthbelow e:n n: cast iron 40 PVC—other(explain): private wa supply well or suction line: condition of jo venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade:jE / Material of construction:_cv oncrete_metal fiberglass—polyethylene other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: f f&C Distance from top of scum to top of outlet tee or baffle: a Distance from bottom of scum to bottom of outlet tee or bale: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE (locate on site plan) Depth below grade:— Material of construction: oncrete metal— fiberglass_polye —other (explain): — Dimensions: Scum thickness: _ Distance from top of scum to top of ou r baffle: Distance from bottom of scum t om of ou ee or baffle: Date of last pumping: . Comments(on pum ' recommendations,irdet and ou. tee or baffle condition,structural integrity,liquid levels as related to invert,evidence of leakage,etc.): Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C o�_ SYSTEM INFORMATION(continued) Property Address: 1�3f � . Owner's Name: Owner's Address: f Date of Inspection: TI or HOLDING TANK: (tank must be pumped at time of inspectio ate a on site plan) Depth below Material of construch concrete metal ass_polyethylene other(explain): Dimensions: Capacity: Design Flow: allons Alarm present(yes or Alarm level: Alarm in working order(yes o o): Date of 1 camping: Co nts(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:�Je 1. 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.): PILW oc CHAMBER: (locate on site plan) Pumps in order(yes or no): Alarms in working er(yes or no): Comments(note conditi camber,condition of pumps and appurtenances,etc.): i Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION(continued) Property Address:J,;�C U � C�-�7Ff�:�►\ `P Owner's Name: Owner's Address: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_(locate on site plan,excavation not required) If SAS not located explain why: Typed ` ; teaching pits,number: 100C—) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configura io . Depth—top of liquid to inlet rt: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of cons . n: Indication oundwater inflow(yes or no): Co s(note condition of soil,signs of hydraulic fail level of ponding,condition of vegetation,etc.): PRIVY: to on site plan) Materials of construction: Dimensions: Depth of solids: Comments a condition of soil,signs of hydr failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: t93 ' Owner's Name:_i V,0 c-n Owner's,Address: Date of Inspection: 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. � 3 � 1 `-) LA i " 2 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYST +m INFORMATION(continued) Property Address: Owner's Name: Owner's Addr � Date of Inspection: SITE EXAM Slope:. Surface water% Check cellar: Shallow wells Estimated depth to ground water IS—feet Please indicate(check)all methods used to determine the high ground water elevation: _ Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: A bat1+ cj tnq���Pc� �C)►v ���p�; � C�cu��� G�>�1�u�0 Certified Mail#7006 2150 0002 1041 8801 t r � Town of Barnstable Regulatory Services MRN �6M .. Cap% M&RA g Thomas F. Geiler, Director O 1619. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 1, 2008 Cesar Pena 17618 Coke Avenue Bellflower, CA 90706 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION, THE STATE ENVIRONMENTAL CODE, AND THE TOWN OF BARNS_TABLE CODE CHAPTER 170. The property owned by you located at 86 Brady Jenkins Road, Centerville, MA was inspected on March 27, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint /he following violations of the State Sanitary Code were observed: 1,05 CMR 410.450: Means of Egress: Observed two rooms being used as bedrooms within basement without adequate emergency egress (second means of egress). Furthermore, you do not have the septic capacity to be using these rooms as bedrooms. Your septic system (permit # 86-459) is engineered for three (3) bedrooms which were observed on first floor. OS CMR 410.503(A): Protective Railings and Walls: Observed stairway leading into basement without handrail. The following violations) of the Town of Barnstable Code were observed: L,,§170-10—Maintenance of Smoke Detectors and Carbon Monoxide Alarms µ—No CO detectors observed within home. 1§ 70-4—Certificate of Registration. Home not registered with Town of Barnstable Health Division QAOrder letters\Housing violations\Rental ordinance\86 braleyjenkins L You are directed to correct the violations listed below within twenty four(24) hours of your receipt of this notice by installing CO detectors on main floor and basement area in accordance with local fire regulations. You are ordered to remove the beds from the two rooms in the basement and ceasing the use of said rooms as bedrooms. You also must install hand rail leading into basement. You also must register home with Town of Barnstable Health Division. Note: COMM Fire Department has been notified of violation on CO detectors. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the.date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OFT BOARD OF HEALTH omas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\86 braley jenkins `' , a ��� � O J �q�r� P , +� Citizen Web Request Pagel of 3 r 3 ro �,� ` €+ -°'"sue' •,.,..'°*,'`f ^h i a $`'�-'' t��°` ✓ k a �. kk�:,. •_ ./f' � ,a. ,�'� s" as i t� e f €Ct7,^.,c?{ C:annv l Citizens u 'men [1 €"usiti. *"c3,° =C:'i, .�, .,1ac'_. ,._ ..i<L; ...,`.S C..F'i a.., f�Q::.....S 4/V.�. cJ Request Information Request ID: 21709 Created: 3/24/2008 2:12:25 PM Status: Assigned To Staff Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: Chapter 170 : Housing Overcrowding - Night Only edit _.___.__ .._..............__.............__...............__.._.._____......._..._.___.__.._...__.................... � Estimated 3/26/2008 Change Estimated Feb March 2008 Wrr ( Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 24 25 26 27 28 29 1 2 3 4 5 6 7 8 i - - 9 10 11 12 13 114, 15 16 17 18 19 20 21 22 23 24 25 27 28 29 30 31 1 2 3 4 5 _ _ - - _ - . ................._...._....._..._..........._.........._.............--...................-......_ ......_......_.... ..._._._......._...._.....------- Created By: Wadlington, Ellen Priority: Medium edit Health Office I Citation Numbers: � edit 27 Request®r JLnoda�ti® �...�, � _..._._.._._..�......_,._........_..__..�.. .._......�.m.. .______�......__....._...... ' Requestor Frank McDonald Request DETAILS: 55 BRALEY JENKINS LOCATION: 86 BRALEY JENKINS ROAD ROAD Centerville, Ma 02632 Centerville Ma 02632 `j -.-__._.._....__............____..........._50..... 3018 .__.. Request Parcel Number _ I I At night there are approximately 8 Map: 171 Block: 182 Lot: ,000 cars parked in yard with 2 vans. This I is mostly at night. Possible Parcel Looms overcrowding. f 5o 3r7 �46 http://issgl2/intemalwrs/VvRequest.aspx?ID=21709 3/2 /2008 Citizen Web Request Page 2 of 3 Email: Edit Requestor Information. Track Request Progress Request Work History: -Internal Note History: System entry on 3/24/2008 2:12:25 PM: Assigned to O'Connell,Timothy Enter work progress: Enter internal note: (Viewed by everybody) (dewed internally only) nR g Spe1l�Gheck SpeII Check i - j -Add document or image link: Browse You can also type in a folder name to see evetytlhing in the: folder Current Links: i....._._......._.........._.........___..............._...............-..............................._..................... _--___. __........._........._........ ...._..................._....... Time worked on request 10 . Response time: 10 'K Time entries are in hours, Exaniples of time entries,. J.4 1, 0,5, 0,75 l, 3.5, 025, QA Response time: Mecasurea from the creation date to your first� tion5 nr tide r�?t1a,1e t, K holidays l C3 not inrii,€ nights, t.t" l rCat and in r :3p C?sJr' o o Cpa tt-nei'afS. Save changes , Check to notify town employee below to review this request. i Savelchanges and notify Health office citizen* Barrett, Caitlin . .. _ ' Close request * Brief message to reviewer: 0Close request and notify citizen http://issg12/intemalwrs/WRequest.aspx?ID=21709 3/24/2008 r .,� Citizen Web Request Page 3 of 3 �Aotify arks if email address vvas given Update ' '"� SpelhCheck ••k ..rwn«ww. Public Use: Printer Friend) ry Version I..M.ernal-Use:._Printer._Friendly_.Version. http://issql2/intemalwrs/WRequest.aspx?ID=21709 3/24/2008 Town of Barnstable dgtME T(� y�a �a Regulatory Services nAxtarA Thomas F. Geiler, Director F1AS5 S* °o 1639 , Public Health Division ArEa Mai a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 31, 2008 Attn: COMM Fire Health Inspector Timothy B. O'Connell conducted a rental inspection in accordance with Chapter 170 of the Town of Barnstable Code. In accordance with the State Sanitary Code, 105 CMR 410.482, the Health Department is required to notify the Fire Department if there is a smoke detector violation, or possible smoke detector violation. The following property had possible smoke detector(and\or CO detector) violation(s): 86 Braley Jenkins Road Centerville,Assessors Map-Parcel: (171-182): -No CO's within home. ramr ^ Timoth} B. O'Connell-Health Inspector Q:\Order letters\Housing viol ations\Rental ordinance\\Fire Violations\FIRE TEMPLATE.doc Parcel Detail Page 1 of 3 M'r :6 �� £� 9R'i��PmL,swi�st� _ ,...w•—w�yam�, .. rh35: e f ��§ - ��F Logged In is: VV ed i i sji'y, A Parcel Detail Parcellnfo DeveloperLOT 149 .. Parcel ID 171-182 Lot Location"86 BRALEY JENKINS ROAD Pri Frontage Sec Road Sect Frontage _..._._ ._.... ....__. ... _ .... ... . ......... __.. ._.__.. _.__., .._.__. _. village'CENTERVILLE Fire DistrictC-O-MM _.........._..... __.m_.______._,_._. — .._.._. . ..___.__..-. Sewer Acct Road Index i0165 Interactive Map Nam' Ly_ .._ n Ower Info ........__. _ ... _ . Owner,PENA CESAR Co-owner. Streetl j 17618 COKE AVE Street2 _. City;BELLFLOWER State CA zip 90706 Country US Land Info _. _ . Acres,0.35 use;Single Fam MDL 01 zoning RC Nghbd 0105 Topography Level Li Road Paved Utilities I Public Water,Gas,Septic � ~ . ..,.._�.�. Location Construction Info Building I of I Year Roof ,. .. Ext .......... . ... ,1987 Gable/Hip Wood Shingle Built Struct Wall Effect Roof AC Area 2026 Cover Asph!F GIs/Cm Type None _ . Style Cape Cod wall Drywall Bed t3 Bedrooms ww w,w Rooms' Model Residential Int Hardwood Batty 2 Full Floor Rooms . Heat�.".,, _ Total Grade?Average Type'Hot Air Rooms 6 Rooms http://issql/Intranet/propdata/ParcelDetail.aspx?ID=11657 4/2/2008 i Parcel Detail Page 2 of 3 ix i2 a fk � 95 .... _ .._ ._.._. . _. Heat .,_._._ _ Found- INc� 3 'teaq _ stones;1 1/2 Stories Fuel Gas anon Poured Conc W t � Permit History_.. ._...._._ _. ....... _. _. Issue Date Purpose Permit# Amount Insp Date Comrr 6/25/2001 Swimming Pool 54180 $12,000 1/1/2002 12:00:00 AM 4/13/1998 New Addition 30125 $10,000 6/9/1999 12:00:00 AM 8/1/1987 B31082 $60,000 1/15/1988 12:00:00 AM CE 11) - Visit History___..._ ..__...__..._ . ..... ......._ __.___...._.... .. .. ...__ .. Date Who Purpose 3/4/2002 12:00:00 AM Martin Flynn Outbuilding Insp Only 2/3/2000 12:00:00 AM Paul Talbot Meas/Listed 9/15/1992 12:00:00 AM ML Sales History_._._._. ..._ _... Line Sale Date Owner Book/Page Sale P 1 3/18/2005 PENA, CESAR 19631/118 2 12/24/2002 THOMSON, RICHARD J 16142/067 3 1/29/2001 THOMSON, RICHARD J TR 1 351 7/1 52 4 10/17/2000 THOMSON, RICHARD 13302/241 5 7/15/1996 BYRD, ORUS W& EVELYN M TR 10307/199 6 6/15/1993 BYRD, ORUS W& EVELYN M 8605/165 7 3/15/1992 BRALEY, JAMES E 7901/335 8 11/15/1987 BRALEY, JAMES E & 6025/009 9 11/15/1987 SOLLOWS, JEFFREY A TRS & 6025/007 10 7/15/1986 SOLLOWS, JEFFREY A TRS 5133/065 Assessment History . Save# Year Building Value GAF Value OC Value Land Value Total Parc( 1 2008 $185,600 $2,700 $18,500 $148,100 3 2007 $219,500 $2,700 $18,500 $148,100 4 2006 $191,810 $2,700 $18,900 $149,800 5 2005 $176,500 $2,700 $19,400 $135,700 http://issgl/lntranet/propdata/ParcelDetail.aspx?ID=l 1657 4/2/2008 Parcel Detail Page 3 of 3 6 2004 $140,600 $2,700 $19,600 $135,700 7 2003 $124,200 $2,700 $19,800 $44,900 8 2002 $124,200 $2,700 $600 $44,900 9 2001 $124,200 $2,900 $600 $44,900 10 2000 $97,700 $2,900 $300 $30,600 11 1999 $94,000 $2,900 $0 $30,600 12 1998 $94,000 $2,900 $0 $30,600 13 1997 $99,200 $0 $0 $27,200 14 1996 $99,200 $0 $0 $27,200 15 1995 $99,200 $0 $0 $27,200 16 1994 $96,500 $0 $0 $30,600 17 1993 $98,500 $0 $0 $30,600 18 1992 $112,200 $0 $0 $34,000 19 1991 $107,100 $0 $0 $54,300 20 1990 $107,100 $0 $0 $54,300 21 1989 $107,100 $0 $0 $54,300 22 1988 $0 $0 $0 $16,300 Photos http://issgl/lntranet/propdata/ParcelDetail.aspx?ID=l 1657 4/2/2008 FORM30 C&W HOBBSS WARREN TM THE COMMONWEALTH,OF MASSACHUSETTS SOARP �FETT CITY T WN W t DEPARTMENT ADDRESS SV.. ONE Address — Occupant_ Floor Apartment N No.of Occupants No.of Habitable Rooms_._No.Sleeping Rooms_ No. dwelling or rooming units No.Stories Name and address of own r + Remarks Reg. Vio. YARD Out BI s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls.- Foundation: Chimney: BASEMENT Gen.Sanitation: D ness '— ^� tairs: L' STRUCTURE INT. Hall,Stairw, Obst'n.: Hall, Floor,Wall, ilin : Hall Lighting: Hall Windows: HEATING Chimneys: 3�'4 Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 b� Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. -Vent.,Plumb.,Sanit'n.: Wash Basin, Shower or Tub: J Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: .e ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPO IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJU ' INSPECTOR c TITLE ll" 4Ak DATE. e2-i � — TIME— -6A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not inci'ud'ed-in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant-in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit,.passageway or common area caused by any object, h including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling,unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders.either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. Ili S 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION RECEIVE 86 Braley Jenkins Property Address:Centerville,Ma AUG 1 ..7 2000 Address of Owner: (if different) TOWN OF BARNSTABLE Date of Inspection: 06/12/2000 HEALTH DEPT. Inspected by: James Holler I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Holler& Son Construction LLC Mailing Address: P.O. Box 702,Marston Mills,Ma 02648 Telephone: (508)420-0280 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: ®Passes ❑Conditionally Passes ❑Needs Further Evaluation by the Local Approving Authority ❑Fails Inspectors Signature Date: The system inspector shall subr it copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: ®I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below: Comments: B) SYSTEM CONDITIONALLY PASSES: ❑One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of detennination in all instances. If"not determined", explain why not. ❑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 conforming septic tank as approved by the Board of Health. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (Continued) Property Address:86 Braley Jenkins,Centerville,Ma Owner:Wesley Byrd Date of Inspection:06/12/2000 B) SYSTEM CONDITIONALLY PASSES (continued) ❑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). Describe observations: ❑ broken pipe(s)are replaced ❑ obstruction is removed ❑distribution box is leveled or replaced ❑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 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 THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. El 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 APPROPRIATE)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 to 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 1 of a public water supply well. ❑The system has a septic tank and soil absorption system and the SAS is with 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 (approximation not valid). 3) OTHER I r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:86 Braley Jenkins,Centerville,Ma Owner:Wesley Byrd Date of Inspection:06/12/2000 D) SYSTEM FAILS You must indicate either"Yes"or"No"as to each of the following: ❑I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to 15.304.determine what will be necessary to correct the failure. 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'h 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. ❑ ❑ Any portion of a cesspool or privy is with 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 with 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. 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" as 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 ❑ ❑ 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 R of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:86 Braley Jenkins,Centerville,Ma Owner:Wesley Byrd Date of Inspection:06/12/2000 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. ® ❑ As built plans have been obtained and examined. Note if they are not available with N/A. ® ❑ The facility or dwelling was inspected for signs of sewage back-up. ® ❑ The system does not receive non-sanitary or industrial waste flow. IZ ❑ The site was inspected for signs of breakout. ® ❑ All system components,excluding the Soil Absorption System,have been located on the site. ® ❑ 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 or the Soil Absorption System on the site has been determined based on: Z ❑ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. ® ❑ Existing information,Ex.Plan at BOH. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)] t I� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property address:86 Braley Jenkins,Centerville,Ma Owner:Wesley Byrd Date of Inspection:06/12/2000 FLOW CONDITIONS RESIDENTIAL Design flow: 110 gpd/bedroom for SAS Number of bedrooms 3 Number of current residents:2 Garbage Grinder:No' Laundry connected to system:Yes Seasonal use:No Water meter readings,if available (last 2 years usage in gpd):Not Available Sump pump:No Last date of occupancy:Current COMMERCIAL /INDUSTRIAL Type of establishment Design flow: gpd Grease trap present: Industrial Waste holding tank present: Non-sanitary waste discharged to the Title 5 system Water meter readings,if available Last date of occupancy OTHER:(describe) GENERAL INFORMATION PUMPING RECORDS and source Homeowner System pumped as part of inspection No Volume pumped:N/A Reason for pumping:N/A TYPE OF SYSTEM ®Septic tank/distribution box/soil absorption system ❑Single cesspool ❑Overflow cesspool ❑Privy ❑Shared system(y/n)(if yes,attach previous inspection records,if any) ❑I/A Technology etc.Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information: 13 years,BOH plans Sewer odors detected when arriving at the site:No � l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:86 Braley Jenkins,Centerville,Ma Owner:Wesley Byrd Date of inspection:06/12/2000 BUILDING SEWER (Locate on site plan) Depth below grade 18 inches Material of construction❑Cast Iron®40 PVC❑other Distance from private water supply well or suction lineNone Diameter 4 inch Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK (locate on site plan) Depth below grade 16 inches Material of construction®concrete❑metal❑Fiberglass❑Polyethylene❑other If metal list age is age confirmed by certificate of compliance Dimensions: 1500 Gal Sludge depth:3 inches Distance from top of sludge to bottom of tee or baffle 37 inches Scum thickness 3 inches Distance from top of scum to top of outlet tee or baffle 1 inch Comments: GREASE TRAP (locate on site plan) Depth below grade Material of construction❑concrete❑metal❑Fiberglass❑Polyethylene❑other Dimensions Scum thickness Distance from top of scum to top of outlet tee or baffle Date of last pumping 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 leak,etc.) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:86 Braley Jenkins,Centerville,Ma Owner:Wesley Byrd Date of Inspection:06/12/2000 TIGHT OR HOLDING TANK:❑(Tank must be pumped prior to,or 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: GPD Alarm level: Alarm working?❑yes❑no Date of previous pumping Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:level Comments(note if level,and distribution is equal,evidence of leaks or solids carryover,etc.) No solids carryover PUMP CfiA4fiER:❑ (locate on site plan) Pumps in working order: (yes or no) Alarms in working order:(yes or no) Comments:(note condition of pump chamber,pumps,and appurtenances,etc.) I _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:86 Braley Jenkins,Centerville,Ma Owner:Wesley Byrd Date of Inspection:06/12/2000 SOIL ABSORPTION SYSTEM:(SAS) (locate on site plan,if possible,excavation not required,but may be approximated by non-intrusive methods) if not determined to be present,explain: Type; leaching pits,number one, 1000 gal leaching chambers,number leaching galleries,number leaching trenches,number&length leaching fields,number&dimensions overflow cesspool,number: Alternative system: Name of technology Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation,etc.) CESSPOOLS:❑ (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 Material of construction Indication of ground water inflow(must be pumped as part of inspection) Comments:(note condition of soil,signs of hydraulic failure,ponding,and vegetation,etc.) PRIVY❑ (locate on site plan) Materials of construction: Dimensions Depth of solids Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:86 Braley Jenkins,Centerville,Ma Owner:Wesley Byrd Date of Inspection:06/12/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM Include ties to at least two permanent references r benchmarks,locate wells within 100'and where public water supply enters house. ' i 2 2 301 - L 3 '� sit -o 3r -o y4-o `f ql-o r � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:86 Braley Jenkins,Centerville,Ma Owner:Wesley Byrd Date of Inspection:06/12/2000 Depth to Groundwater<15 feet Please indicate all the methods used to determine High Groundwater Elevation: ❑ observed from design plans on record ❑ observation of site(abutting property,observation hole,basement sump) ❑ determine it from local conditions ® check with local Board of Health ® check FEMA maps ❑ check pumping records ❑ check local excavators,installers ® use USGS data Describe in your own works how you established the High Groundwater Elevation. (Must be completed) PT No.. -- E?-.` � j Fps .. ..a.s.�...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH P ...Icc clA J------- ------OF........... a `T ............................ Appliration for Disposal Works Tonstrnrtiun thrmit Application is hereby made for a Permit to Construct (✓�or Repair ( ) an Individual Sewage Disposal System at: fi-j _�f , qg .. ..• ---•-- ........ L..- ................... Loration•Add Q�9't �4e. , or Lo.3 �cc a...... ._ ................... . ..... ..... -• ...-/t................ 2 --•--- resne � •---•• -•---014.*4 ...Grc� ....f D...................y!9..k ..21.�..-.5......-- pq Installer Address U Type of Building 00JJ -�Q© Size Lot--------1_................. Sq. feet �., Dwelling—No. of Bedrooms............................................Expansion Attic fy Garbage Grinder Other—Type of Building .... — Cafeteria yp g `s.!1� No. of persons....____..�.............. Showers,(�' (�- a' Other fixtures ... w Design Flow....................................... gallons per person per day. Total daily flow..............--3130 ... WSeptic Tank—Liquid capacity_ 0017gallons LengthAY. .G_ Width__,..�a..�Diameter................ Depth.-g.�.Q.�� x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No-----------I........ Diameter.....L2.!..... Depth below inlet.... Total leaching area...2_4�sq. ft. Z Other Distribution box (✓f Dosing tank_(-� aPercolation Test Results Performed by... �� 2 ... j�✓�.Y .......... Date...G /2 ... a Test Pit No. !................minutes per inch Depth of Test Pit. . Depth to ground water..... _..".... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' --------------•-----------•------•-•--------------------•...........-----•--•---•71.......................................................................... O Description of Soil..........ln_ 1 _`� N'`� W L l- Cs�-.�f ��'z Vim'le___ x ........•-.....--•--- w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----••-••-------------------------••--..........--••----...---.....----------------•--•--..........•---...-•-----------•-------------------•-------------------•--------------._.-----•------......-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL- 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. SignedG • --- -------- ------ ---- Tb. A lication A roved B � .. jcD`� PPPP y-•-••----••••••-•---••-----•---•.................•----------....---- _--- ----. . ---••-••-•.--••- IIate Application Disapproved for the following reasons:................ ----------------••-------- ----------------------•--------------- -••••-••-••--•------------------------••-•---------•-----._...-----------•••-••---------•--•-•••--------.-•-•••--....._....•----••---------•------••--••••-•------------••-----•---------------...•----- Date PermitNo......................................................... Issued-....................................................... Date No........ �S� FEs.......�.�........... THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALTH P I- E3 7 4 ------..... ............oF.......544( T - -ems ApphrFa#ion for DispnsFal Works Tnnstrur#ion Famit Application is hereby made for a Permit to Construct ( V-J"or Repair ( ) an Individual Sewage Disposal System at: �?.� S€ �6 .....��Y........�ICN�cr�....9 ...... -���e!.c��............................................ - Location• -Add r r Lot No. ner QV7/t h A44Wss j D a .. ..........- `fir G-"I'� Yj ...�..0.............. Installer Address Type of Building Size Lot_..���.d......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic �� Garbage Grinder � aa Other—T e of Building ' ... No. of persons ............. Showers YP g ------•---------------- p (�--- Cafeteria (� dOther fixtures ..-�---••--•••-••-----•-----•--•---••-••......-----•••-••••----------- -----•----••......•-••••--••-----•••. . V . W Design Flow.....................E-1z;............gallons per person per day. Total daily flow____-•_-.--•----..._..._........._..........gallons. W Septic Tank—Liquid ca.pacity.!�r?gallons Length...&....�._ Width.. _._!.`'. Diameter________________ Depth_.-5...... '. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.................. ft. Seepage Pit No............ ....... Diameter.......?.Z__..... Depth below inlet.....-��.: ._.. Total leaching area.....G'.`h?sq. ft. Z Other Distribution box ( k-r Dosing tank.(-^")— _ '-' Percolation Test Results Performed by.....`....r_�.._-'_.�=!Z...G. � '�...._.._. Date.... ......�........ Test Pit No. 1..`l_.Z.....minutes per inch Depth of Test Pit......LK!_... Depth to ground water...... fr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-••-----•-•-----•--•--••--...-•..............•------------•-••...--••••--••--. r.....-_-....._ ._......._... O Description of Soil............ ; x-a � ✓ _ y'............................................... f'? ✓� W UNature of Repairs or Alterations—Answer when applicable- ......................................................-................................................................................................................................................. 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 oar of health. 4j- rig Signed....... -- ---------------------•-•-•-------....-------------•--- Application Approved BY ........ ••. ..... =' to Application Disapproved for the following reasons:................. ...................................................................................... .......•---------••••-•••----------------••-----•--••----•----••-•••••----•-•-••••-••-----•---•••-••••••-•••••••-•-••-•---------..............................................-........................ Date PermitNo......................................................... Issued------ ................................................ Date 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :.........................oF....Egg.... .....................C...........---.................. Trrfif iratr of TuntpliFanrr THIS IS TO CERTIFY, hat the Individual 5ewage.Disposal System constructed (-V<Or Repaired ( ) by - L -C -X�A.......... `c`�u------------------•--------•---------..-..-.------•-- Installer at......—�.. 1_�J' ( C '`�°..._ E1J1Li � '�'�D-------------- -- / � = has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated--------------------------_........_............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... ........................................................ Inspector.................................................................................... i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ..........sl..coca./!t�.............OF.......�.�..! �.5...�1 ..�'..u-~..............._.......... No... " : � Oc FEE.... .. ............ �is�rgs�al arks ��ans�rnr�iarn rrnt�# .. Permission is ereby granted...• - --•-� 11�_-------k.C=k to Const uct ( ✓),r Repai ) an Indiviyal Sewage Dispo4 System at No... t � '�J`I ------`�EItJ1j0U .-------l�D �� t Street as shown on the application for Disposal Works Construction Permit No.._�.�_6`VF?_ Dated........... 46.1�............ G 6 rd ealth -----------------•-•----••-----------•-- DATE.......�Q. .-�-�..-.Q�------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS C-- TOWN OF BARNSTABLE LOCATION rA SEWAGE # VILLAGE C Q\-��e.c ASSESSOR'S MAP & LOT- IN)() INSTALLER'S NAME PHONE NO. �%CA ' C SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) cpj NO. OF BEDROOMS_PRIVATE WELL OR PUBLIC WATE BUILDER OR OWNER (_� h �,� SQ�� U S DATE PERMIT ISSUED: j DATE +COMPLIANCE ISSUED: I�n VARIANCE GRANTED: Yes No ?C �GKLA LA i :ATION �..a�- 1y� V1''GL:�2- � � 1 ( NO. �4 SLAG E r i DATE % fill g5 ?LICAN �.• FEE*, )RESS f ELEPHONE NO. (Non-refundable ;INEER t nl - ': e kgELEPHONE NO. - CE SCHEDULED I 10- 10- 95 (Applicants signature SOIL -LOG .. , M�� de Y .l '6 G61Y�"DATE /D -/D fj'S TIME/O,Ol-1 3-DIVISION NAME / , ?ANSION AREA: YES l/I70 �it►%h7 E/�/yG�/-�•SUc..c./r low ENGINEER :�' M WATER (yPRIVATE WELL �1 Al BOARD OF HEALTF • �olfj-; 4lJ� EXCAVATOR ;TCH: ,(Street name, etc. ,dimensions of lot, exact location of test holes and .'percolation tests, locate wetlands in proximity to test holes) NOTES : RCOLATION .RATE ST HOLE N0: ELEVATION: TEST HOLE NO: ELEVATION: 1 Lv.4i411,SvB:501e • 1 2 Z , 2 5 L irr6,QQi/��._._ 5 , 6 6 7 GL • i(.J�� 7 8 9 9 10 10 11 11 . 12 12 13 13 14 14 15 15 16 16 ITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD L LEACHING PITS 1 LEACHING TRENCHES 'SUITABLE FOR SUB--SURFACE SEWAGE. REASONS:- )TE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION :IGINAL: COMPLETED IN ENTIRE` y By P . F , AND RETURNED TO BOARD OF HEALTH )PY: RETAINED* BY APPLICANT 7 J-1 ...... 7 -:�T_77- �7-77 7; w L �G 5 .,D A T -2 p WITNES'SE-D 8 Y: ... ... 77., Aon jo ZFD I VM v 7 o- 7 7— 1-48 M A N H 0 L E S A N D -COVEF 9V I L T w I r H I N E L E V.,T 0 P or- Of ' F I N I SM E 6, 'G R A'D FOUNDATION u I W. SLOPE K 6�RA DE. INISHED v 4:'C AST,I Ro C 1q.4 0 1 S Pvc,, ,s ZIP i�41FT. I N., Z L AY E R`� OR p VC_SC H c H �,l 1;. '40 LEV" 0 P t 17 C H IT TONE oo E A S t/4�%F T. GALLON .- :�INVE R T N'rp RT 3/4 1 TONE -:WA S H E D ,5 ;:IN 47. 4 112 D I A . tE PTIC.TAN K VE RT _kR 0 U�N I N E-R T w ',A L L so T INVE-R '�O E L'E V.-,S OT T-_O M --GAReAG R I N*D E R or, 7 p f" -0 D I Am�43' 0 , KA I N. 77. -164 -E v iROU D �O F N WATE R T A 9 436 PA F I L E ' -0 Z 154 0 v%/- , 0 'E AN ITA, R P OSA L, � S Y ST TA L E, D ES, '-D A OT To�S�CA B D'R 'O 0 U S Atj AY 's CONSTR U CTI'O N OF A TAR Y: �F I DE540 W C-'H _CONFO T 0 M AS S S:H A L R ,M, S YS TE L H '��R LE-A C' E M I N./I AT 1 E'N V I'R 0 N M'E'N T A L CIO D E. T,1 E V,IS E D' 7 H 'CA P A'C I T Y i -N PROPOSE E 0 F AIN D ,T H I-: ,, T'O,W H G U,LAT I ON S. E ALTH R E D (S T Rf 8�UT,lb N BOX AND LEACHING E PT I C TANK - PITTO �SE OF 'REINFORCED 'CONCRErE: . , 443 GAL, A:, MI N; C ON C,R ETE S TH �30 00 �P�s I T�R E'N G m I N. STE E L ,' ST'R'E N G rH . 2 OOP'S I' H 10 D E S I G:N , LOADING _OV E R' SYSTE M DR B E� L 6,c -Ar E D ' IVEWAYS 'N OTT 0 , N G_ITl D UNLESS H 0:,DE S I G N ��L'O A D'I S :�VSE O ( PESIAN FITTINGSTO BE- wATERTIGHT AND �e - ALL . D '. C 0 F ST I RO N 0 R S� H E D 4 0 -P.;V C. T 0 ' S H. I -OF , LSHS. - S I-T-' Ez - ' .P L '/A'�N ,S:H..OWING ' -,P, R-OPO' S �:D.T'-- C�O'N 'STRUCTION 'L.0 C A T lb N: L EGEN D A P F O'R : P R' O t: H E-A �LTH , OT : D' :T S ckt E:" DW' E 6 J6 S rl N G,, C-0 N TO U R U 6 E Ft R Tq C� E BUILDING SETBACK REGULATIONS P E R E X I N P EC T,O�R 0 R U'l Lb VN G A L 'I N G ' ( _O NTO U Re , ATE� :� AGENT ' 16 -0 N �R BUl D P P O'S E b C C 0 KAM 1 S Sl : ' EX I S TI NG -S POT E L E V AT( 0 N' 17, 6 �T SETBACK , I'N.' F R ON RAI HO SEI BA K E D , W AT E R ,��,S E,R V C E ,!': RAI RO,fOS Ml N D,E ' rtsr �HOLE L-OC T ( 'A N fVIL' C2YIL' NO. 7483 I N.�: R E�A R �5 ETS AC K : T A ND,-:SURVE OR S ' PROF SSI N k y E N G M E�E S E '(R ST E AS N" REE N,rN,I'S MA At I :S ' ,'0 T E.-6 A ,�2 6,,4 --- -��� Cre:' ASSESSORS MAP : 1 -- --- ----- - ------_ ___ TEST O E T HOLE LOGS c�1� PARCEL. : - 18Z- _ 1) The installation shall colnp with Title V ai;J Town of�dWIft Board of . Oil�i FLOOD ZONE: G� �y,��JG � SOIL EVALUA OR: 1 V lb I lealth Regulations. WITNESS : � REFERENCE: �� /���� IC WV 2) "flee installer shall verily the location of utilities, sewer inverts and septic f ._ _II DATE: 2 components prior to installation and setting base elevations. � �-�� f^2'�� ' �J, 12C� PERCOLATION RATE: G 2 I , 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first '��' / �� V� two feet out of the d-box to the ieaching shall be level. - ---- 7, V/ TH- I TH-2 4) This plan is not to be utilized for property line determination nor any other - n ,, _ purpose other than the proposed system installation. `�✓ i L�'� 5) All septic components must meet Title V specifications. �'0 1� 6) Parking shall not be constructed over II 10 septic components. LwW -� � 7) The property is bounded by property corners and property lines. 10 L7 8 The property owner shall review design considerations to approve o p p y g pp f total LOCATION MAP ° design flow and number of bedrooms to be considered for design. Receipt / of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. v 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per 1 aJ Title V specs. p Np wwR� `\� 10)System components to be 10 feet from water line. Sewer !fines crossing the 1 1 water line shall be sleeved with 4 inch SCI 140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place. S E P r I C SYSTEM DESIGN 11 g g) If a garbage grinder exists it is to be removed and is the responsibility t of the g P Y owner to ensure such. FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line it such lD ��� i exists. r � BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY 13)Tae installer shall verify the location, quantity and elevation of the sewer lines exiting the dwelling"rior to the installation. o SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting t\ mil, Title V requirements. I1<� / to aqGAL/DAY x 2 DAYS - GAL � R USE I GALLON SEPTIC TANKtU�J(1I, i M NO SOIL ABSORPT I O1J SYSTEM h, SIDE AREA: Z 7i�J -}- I2� o UAVID g. c -- ---��-----# _ -�� - — �--- �- 1 BOTTOM AREA: No.1064j! 6 � T SEP IC SYSTEM SECTION i ►�_ __ All h b �,l -7 r D—Bc� 1000 GAL 0 o SEPTIC TANK d5 X1Z � � Now 6,5 SITE AND SEWAGE PLAN 0 L 0 C A T 10N KI �f> P PREPARED FOR : Z k6,1Y4 7 O. M O+ SCALE DAV I D B . MASON DATE: �' J DBC ENVIRONMEN�'AL DESIGNS W EAST SANDWICH . MA z DATE HEALTH AGENT 508 ) 833— 2177