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Home My WebLink About0124 CAMP OPECHEE ROAD - Health 124 Camp Opeechee Centerville � A.= 210-139..004 l i UPC 12534 ° fLo.2-153L0q�, tlMlM�lr 4. I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 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. A. General Information 1. Inspector. Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Ev uation by the Local Approving Authority 5-11-10 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent.to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Ll 1pt5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Dispoage 1 of 15 6 r Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 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: System is in good working order with no sign of failure. 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 t5insp official document•03/08. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 a. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 page. City/Town 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. t5insp official document•03/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 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 cofiform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/ 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. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes Nor: ell ❑ ® 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. i 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. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts u 11W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: 'Yes No'. ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? .® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. . 0 ❑ 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)] t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 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: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 4-10 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 III Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Not since new in 2001 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 24"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 124 Camp Cipechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 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.): Tank is in good condition with baffles installed and no sign of leakage.' 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): t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 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.): Good condition with water at working level. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 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 Ian excavation P Y (SAS) ( p not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition with no sign of back-up into d-box or surrounding stone t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 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.): t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of.15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�M 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 page. City/Town State Zip Code Date of Inspection 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: S D�auer�sy s• � �3.2 Y , G ' i i t5insp official document•03/08 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Camp Opechee Rd Property Address Michael Curley Owner Owner's Name information is required for every Centerville MA 02632 5-10-10 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 high ground water: 20' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable Regulatory Services BARNSTnBm � Thomas F. Geiler, Director Mnss. 1639. ,e rF�,µya Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 December 14, 2009 RE: 124 Camp Opechee, Map: 210-139-004 On 12/14/09 it came to the attention of the Health Division that the property located at 124 Camp Opechee, Centerville has not been issued a certificate of compliance for the septic system. Prior to a certificate of compliance for the septic system being issued the following needs to be submitted to the Health Division by a licensed Title V system inspector, Town of Barnstable licensed septic installer, or a licensed professional engineer or registered sanitarian: -An asbuilt card -Documentation that risers were installed on the septic tank, d-box and leaching facility -Documentation that a vent is present Furthermore, if the property is to be transferred, a Title V inspection in accordance with 310 CMR 15.000 must be completed. PER ORDER OF TH BOARD OF HEALTH Thomas . Mc ean, R.S.CHO Director of Public Health Town of Barnstable Q:\Order.letters\Sewage.violations\124 camp opeechee.doc No.-Zelv 1—/70 FEE COMMONWEALTH Of MASSACHUSETTS U i Board of Health, /��1� S IR MA. rr APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(W- epairO Upgrade( ) Abandon( Ll�eomplete System ❑Individual Components Location 17,Ll A yvl 6G Owner's Name f j Cum,J<? Map/Parcel# a Q Address T7 fS S` Lot# — Telephone# -- y Installer's Name "� � `� Designer's Name Yq ok ' Address (?, (0 6r 3-2_ Address v ST"R Telephone# L Telephone# S' Type of Building Lot Size d 6J sq.ft. Dwelling-No.of Bedrooms Garbage grinde Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 3 3 gpd Calculated design flow 33® Design flow provided gpd Plan: Date /0— A /` Q 5) Number of sheets Revision Date Title S 1 le- t S-F_w u -14 Description of Soil(s) S,-Ie L Soil Evaluator Form No. .4 g C'MoO Name of Soil EvaluatoJ3 rjoc Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees t1 not to place the system in operation until a Certificate of Cgmpliance has been issued by the Board of Health. Signed Date `0 - ID Vb _ is C� J ZC� No.74-w—t , 0 FEE COMMONWEALTH Of MASSAC14USETTS Board of Health, ',A k P STA b i,5 , MA. CERTWICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) m-egmplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: has been installed in accordance with the r9visio s of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.�7J1—/7® dated /R U® Approved Design Flow (gpd) Installer Designer: VA YU ke'C S V✓Ve V Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. / '/ 70 FEES 4w IL VIf Board of Health, MA. APPLICATION FOP, DISPOSAL. SYSTEM CONSTRUCTION PERMIT Q �Jf t Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) -4ETZ omplete System ❑Individual Components k - Location I 7, Ec.H65 V0 Owner's Name m 1 G cC 2 fi-/'�I a✓ as �UrP. -e Map/Parcel# Address 77 "6,J� Ck-, aVj,� .S Lot# . 13 1- 7 Telephone# 4 Installer's Name a�?tS�'J S)J Z ��(a� Designer's Name rq,vk{e S v✓V E' �U►�J$�<T� r _ Address , (6 6N 3�3 Gam, f - Address y0 X ND u$TR y K U hj> Telephone# L` Telephone# DO S Type of Building 1 LA ' 1`(1 Lot Size t '� sq.ft�.Q Dwelling-No.of Bedrooms '° Garbage grind p Other-Type of Building No.of persons Showers ( ),Cafe teria-(-I)T' Other Fixtures _,#' Design Flow (min.required) 330 gpd Calculated design flow 33 Design flow provided 3 gpd o- 21_7- 0 0 4 a �-- Plan: Date / Number of sheets Revision Date Title S ►'{e + S-e_LV CA k A N Description of Soil(s) Soil Evaluator Form No. -4 I G o Name of Soil Evaluato �t MU/� �jate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to of to place the system in operation until a Certificate of C mpliance has been issued by the Board of Health. -" Signed Date /-0 3 VD 74 f - e No 0 t-t / f FEE 00MMONWEALTH OF MASS CHUSElTTS Board of Health, A R N STA �L 5`"mMA. ✓ t �y 7 CERTIFICATE O ,C®MPL IANCE - 1 Description of Work: ❑Individual Component(s) 6 omplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),.Repaired ( ),Upgraded ( ),Abandoned ( ) at 'CA ,. r has been installed in accordance with the jr � s of 310 CMR 15.00 (Title 5) a the approved design plans/as-built plans relating to application No.��_l Q' dated �. Approved Design Flow V7 (gpd) Insta-ITer` F ,,D'esigner:IW kf� y ✓e Inspector: Date: f \ The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. �` FEE COMMONWEALTH OF MASSAC14USETTS Board of Health, 13 4.✓H Sc.`p ,MA. /t DISPOSAL. SYSTEM CONSTRUCTION PERMIT v- Permission is hereby granted to; Construct(_ Repair( ) Upgrade((�) Abandon( ) an individual sewage disposal system at C A M ? O P E C H EC "kU / as described in the application for Disposal System Construction Permit No.2Z01- D ,dated � O Provided: Construction shall be completed within,three years of the date of is erm 1 cal con >'dons iXust be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Vi "al/ Board of Health i ,� 4 TOWN OORB STABLE .00AIION Cc wi e ee SEWAGE 0 PILLAGE C� e��c11 e ASSESSOR'S 1 LOT NSTALI-ER'S NAME&PHONE NO. I... IEMC TANK-CAPACrrY U ,EACHNG PACIL TY: (type). � rS (size) rs !O.OF BEDROOMS WILDER OR OWNER - 'E IT®ATE: COMPLIANCE DATE, oparation Distance Between tbe, Maximum Adjusted Groundwater Table to the Bottom of Leaching facility eet rivaate Water Supply Well and Leaching Facility (If any weUs exist on site or.within 200 feet of leaching facility) _ -__ Feet 4ge of Wedand and L.eacWng Facility(If an etlands exist within 300 feet ,,caching ha ti 'urnished by��? awe 4yn �� C uewy ��G J A _0 3001 C� 0 0� BENCHMARK- ON TACBOLT OF HYDRANT FLEV= 100' (ASSUMED) o �� GREAT M H ROAD 'Jo O CROCKER 9� / / f 9,0 C ST AS LOT 138 0 0 i o L TE 28 U V VO LOCUS MAP AS MAP- 210/ 139-4 IP ' i \ /' ,gyp TP #' \�� p �\ \ PLAN REF 434/30 \ D,�lv ti 0�' DEED REF 10811178 (fnd) i�h9y ZONING.• "RC" FLOOD ZONE.• „C" �Q r OVERLAY PROTECTION ZONE. "AP" ,a 4.� AS LOT 139-3 `so // I `� PROP. HSE �r2 r� U _ of _ moo. °°° - SITE & SE WA GE PLAN YANKEE SURVEY CONSULTANTS PAULA. " `�l 0 PREPARED FOR P.O. BOX 265 -- ° `�� ' MICHAEL P. & MARTHA UNIT 5, 408 INDUSTRY ROAD �. p@� MARSTONS MILLS, MA. 02648 ✓ / `� sUR`1� (508)428-0055 - FAX(508)420-5553 `�� Q� > CURLEY / LOCATED AT LOT 4 CAMP OPECHEE ROAD ^� GRAPHIC SCALE � , , ti AS LOT 139-4 ti� ti� BARNSTABLE (CENTER VILLE), MA ao o ,s 3o so ,so rt ,�-'? G CEJ, AREA= 43,562E sq/ft 0'ti� 'ell ( � UR7 gY �y OCTOBER 27 2000 ( IN FEET ) 1 inch = 30 ft. / E \�� T JOB# 52528 CB SHEET 1 OF 2 l 113._50_, 719P OF FOUNDATION f 20' MIN. 10' MIN. CONCRETE COVERS �. 4" SCHEDULE 40 P. V.C. MIN. PITCH 1/8 PER FT. 2"'LA YER OF / CONCRETE COVER WASHED S719NE 6" MAX 4" CAST IRON PIPE 6" MINA / 6" MAX � � � (OR EQUAL MINIMUM PITCH 114 PER FT. W CLEAN W SAND 36" MA X 10, FLOW LINE 110.25' INVERT 1 10�� 14" o 0 0 o O cm =I MIN. �z p� 0 00 0 0 0 0 = o 0 0 0 0 0 og0° ° EL.= 111.0__ CAS INVERT 00 0 0 LEVEL ° °° o 0 0 0 0 0 0 0 0 0 0 0 0 INVERT BAFFLE EL = 110.50' INVERT 6 SUM INVERT 0°°° ° o 0 0 0 0 0 0 0 0 0 0 0'�'8 0 ' EL.=110. 75' - 110.25 EL.= 107 75 (TO BE PLACED ON FIRM BASE) DISTRIBUTION (2) 500 GAL LEACH/NC CHAMBERS MECHANICALLY COMPACTED OR 6" OF S70NE BOX EL.=109 2 1500 --GALLONS TO BE WATER TESTED 126' X 25' TRENCH FORMATION ,SEPTIC TANK IF MORE THAN ONE OUTLET PLACE ON 6" STONE SOIL ABSORPTION 3/4" TO 1-1/2" DOUBLE WASHED STONE SYSTEM (SAS PROFILE OF SEWAGE DISPOSAL SYSTEM BOTTOM OF TEST HOLE ELEV. =99.0'_ NOT TO SCALE OBSERVATION HOLE 1 ELEV. PERCOLATION RATE G-2 MIN./ INCH AT _0"-___-___ OBSERVATION HOLE 2 ELEV=112'__ DEPTH HORIZ TEXTURE COLOR M07T. OTHER DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 0-6" A SANDY LOAM IOYR. 4-1 0-6" A SANDY LOAM IOYR. 4-1 �.y 6"-18" B LOAAfY SAND IOYR. 6-6 6"-18" B LOAMY SAND IOYR. 6-6 GENERAL NOTES 18"-8' C1 MED SAND & 18"_8 C1 MED SAND & GRA VEL ; CoBmEs 10 YR 6-4 PERC. GRA VE4• COBBLES 10 YR 6-4 8'-12' Cz MED. SAND 10 YR 6-4 8'-12' C2 MED. SAND IOYR 6-4 1) ALL WORKMANSHIP AND MA TERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF _BARN- LIBLB____ RULES AND NO WATER ENCOUNTERED NO WATER ENCOUNTERED REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO SOIL TEST WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE OF SOIL TEST 6111197 SOIL TEST DONE BY BRUCE MURPHY R.S. 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN WITNESSED BY: JERRY DUNNING 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE DESIGN CALCULA TIONS.' USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. INSTALL- 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL (2) 500 GAL LEACHING CHAMBERS NUMBER OF BEDROOMS . . . . . . . . 3 BE MORTERED IN PLACE. WITH 4' STONE ALL AROUND GARBAGE DISPOSAL . . . . . . . . . NO f5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 12.8' X 25' TOTAL ESTIMATED FL0W DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO ( 110__CAL/BR./DAY x _3___ BR.) 330 GAL/DA Y OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. REQUIRED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR MIN. IN. IS TO CALL "DIG- SAFE" AT 1-800-322-484 4 AT LEAST 72 HOURS pERC# 960 SOIL CLASSIFICATION . 1 DESIGN PERCOLATION RATE I / PRIOR TO COMMENCING WORK ON SITE. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS EFFLUENT LOADING RATE . . . . . . . 74 GAL/DA Y/S.F. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. LEACHING CAPACITY (AREA X RATE) 347 GAL/DA Y 8) PARCEL IS IN FLOOD ZONE___"C" . RESERVE LEACHING CAPACITY . . . 347 GAL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP __210 AS PARCELS 139=4_. (25X12.8X. 74)+(25+25+12.8+12.8)X2X. 74) SHEET 2 OF 2 JOB NUMBER__52528 ______ f .. !L 21'-0" 10'-4 1 2' " .2846 II LINEN I �coNN LA3I HEAL PER iIODULE it I S . , II N ASTER BEDROOM I I L= II II II II II sPt,►xZR /D2 6 D 2/6 I f II - o I ( I RAILING TQJ N eT N TA l D W'I•C' I ON SITE �Y c�•� SITE CO.Nt•I iv I I� I . I I f l � II STATE LABET, D 1/8 r1717C IACCl39 I , IlNE 0r M4 0 n" 90• X YZ' III L _ ._ J o �I UCLD TO 1-1 1 2 X 14 ,yam JUCRO-LAY PER NODULE co rn 4 BEDROOM o o 2846 2846 1'-0 5'-8" , 5'-8• 1'- SCHEDULE INTERIOR FINISH: NOTES: k TYPE MATT SIZE 11 ? f `�� DOOR 0 C S: 1. ALL INTERIOR V I Gt �'J ��x `J (� � ;�. MOULDING: 2. SEE HEADER OPENINGS UP 11y/1 CEILING HEIGHT: SPECIALTIES: ------ GRILLES:-4- EXTERIOR FINISH; , DULE SIDING: TYPE MAT/L SIZE SHUTTERS; ROOF: PITCH: ;� 22'-0 I 0�1t YDoUTop SNP wAJ__ t^b�N D 2 8 �(kIII�Cr 13'-0j' � 15-WALL`•CAB• I W/MICROWAVE- 124JL HDOD COMBO- VENTED , \ N I `D C IV 2 r, i \ Q i 0 _. DN o I O p I � BREAD BOARD N I I 1 I I •- ��.r�lI u� �t �k��K T� . RECESSED IN PORCH — <1 COUNTED 1 i I , - ( � •-xv xTT EN. l y a,C,6e ICI Hibo FEU D 2/6 IA� I � -I d• 00 3 N _ / 17* X 19" SINK W/RICH RISE FAUCET c � \ / �•JJ h ]♦ GEMINI III ♦ % WHIRLPOOL w >l A O � U�� o ` 0 � � (3� I �LXI� LUI. B j� �, \ \ \ IN5TAU,F_D t3Y F.L. IT SPEAKER WIPE GLASS FRONT CAB. • � ca o "� - — ` FOR BAR GLASSESBATB i iVING ROOM WAY vlMt�lEK- 1I7GN l C AS..,`.�I� F FOIDiLJGGGP,'( r 2 l.R / � Do G R, z � T II I AN ucHT I I I I I`�' yr I I I 04 D 2/6 h O F E 111�7c�—, GfiitPl— —(IOI ! I STEREO WIRE p — C�1JtF'-faG10 O N Aa � . � � --�) I11LII�tIb'IwI. �� M ��E ao N # / FDA KI1GF IE11%F�f I E�� f'f�D. Go N j w. .c. yDYERILa 2846 2846 I C4 •2846 2846 MORG D 3/0 �A46� '2846 2846 ..�.�M "T�Ira 4'-7k �hTH- IOUTTOOUT or :1,f WALL t 0 - - -� - ---- - 49'q' t 22'-0" 4 l" 13'-10 our Toou-ror sNv wALL. kb-KEAi516- 6'-0j" 4'-0' 13'-0i'- — PPDF 04�D t�4�1 P.gt,i�1 15'WALL CAa. D 2 8 W/MICROWAVE- HOOD COMBO. VENTED TO EXT. i 24J[ \ N I co DN Ltd O — u AIFANT -- N o a� 3 a BREAD BOARD PORCH RECESSED IN . COUNTER_ I I I t Q 64C6a Kl\X-o TDL AL'E KITCHEN Hl(ov Kli 53 I KIGKSPoLE IIT , /D2 o LAUNDRY � U 0�0 0 _O CV \ ✓ J d 00 Dig \ \ 17' X 1 RI SINK W/HIGH RISE FAUCET I o ( IfL'X 16'LV(, 13�tl A oU�- \ GEMINI III N 2"�c8"GoU.A 0E \ i� WHIRLPOOL O INSTALL�17 t3`f F:L. IT '` \ 0 __ \ GLASS FRONT CAB. - LIVING ROOM FOR BAR GLASSES / _ M " N _3 FCC-DIUG GA'(► I. G1 G,, ,� - H; — BAT 00 H{:� N WAY DlMhltr� ITL : M C"i�4AN UGHT I I I N Vr Q Pl✓�YioN 015 -I Ea �T LI I I-,;, I I I �. I I I I I I I I I I � Dz/s i5E✓ PG4.1 L 6x-t s(rE l3Y =1' F — -I 21 FULI- L-�UGrf+i t'figgoiz 'p - p GCS►�('��G"10 h.CU UI I-.11r �'GG II �ice:l '� 5 3 SD — STEREO WIRE lb''L V 1, t?�M a00 04 o t t cq to I FOP, rO1!; rX)P, coI r - - - = co N r-0 I 3 S ATL t.-A�t 1r5 2846 2846 / FOYER •2846 2846 I N - ' � 21'-2'/Z► MO RG D 3/0 'rG I46 9A46 '2846 8'-0 4'-7g' 13'-0j' z _ i