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HomeMy WebLinkAbout0071 CARRIE LEE'S WAY - Health 71 CARRIE LEFS WAY, CENTERVILLE A = 168 008 UPC 12534 ' No.21�53L�OR 'gr HASTINGS, MN No. l� FeeAYes THE COMMONWEALTH OF MASSACHUSETTS Entered in cPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftprieatiou for Disposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System t4kIndividual Components Location Address or Lot No. fOArr1'e C . Lq Owner's Name,Address,and Tel.No. dq r1 T7-19 ? Assessor's Map/Parcel leekh-le VLA 0 Installer's Name ddress,and T 1.No - � -�$�{ Designer's Name,Address,and Tel.No.jS-3La'' 4/6 v o Type of Building: Dwelling No.of Bedrooms Lot Size 1E, /2 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 4/ gpd Plan Date &JU a-3 Number of sheets t Revision Date Title W&zL Qpe� Size of Septic Tank� 1�f3 /1Q / e6OAzQ,4r- 11- Type of S.A.S. 1 _ 1+10 S00,9!!P Q_6g hS o�2l�a• r Description of Soil p • �.�re.a►� I ��(Cig Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainte the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environment oded- o place the system in operation until a Certificate of Compliance has been issued 6bthis Board of Health.d _ Date (/ Application Approved by Date Application Disapproved by Date for the following reasons Permit No ', ` Date Issued No. Fee 11rl r THE (OMMONWEALTH OF MASSACHUSETTS Entered mcomputer: (� Yes TTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSE � 01ppYication for -Misposal *pstrm Construction Permit Application for a Permit to Construct`( ) Repair( ' Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.f) %`re Le.� Owner's Name,Address,and Tel.No. l36%. 'J 3�.lew? Assessor's Map/Parcel (o� _ 11?� ►/, t {,' r, Installer's Name,Address,and Tel.No.42 Designer's Name,Address,and Tel.No. Soo,3t.�L-c/ V/ rt Ccs�-�vcr 'cnn,inc si� � 3 a(2 n I{ r t n 57- Type of Building: s Dwelling No.of Bedrooms _3 Lot Size /5, /o` F sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _�3 gpd Design flow provided �7 gpd Plan Date 7,d,, s.. q Number/of sheets Revision Date Title P;t C �� t h ! 'E n n n�r (tom— )r'�0-c Size of Septic Tank naui T, � /g.�,A—,�C Type of S.A.S. i+u, <L)�s -aC (`1 s Description of Soil � ,� 4 ` Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement:The undersigned agrees to ensure the construction and maintenance f the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Go e and no place the system in operation until a Certificate of .Compliance has been issued by this Board of Health. i dWAA Date Ifi ,. Application Approved by / / Date Application Disapproved by Date for the following reasons r n r, Permit No.r[ J/ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(N/) Upgraded( ) Abandoned} at ( ;_ ,LL ,' has been constructed' accord. )))))) with the provisions of Title 5 and the fo Disposal System Construction Permit No. ._ kh-Z Ila mot Installer Designer #bedrooms Approved design flow gpd The issuance of this pe it Iall not be construed as a guarantee that the system will un do as designe . Date Inspector ---- ---- -s -� - - - - - - ------------------------------------------�/ f---- No. ' r Fees THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem (Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at y �1 ,4e �oo < r� �or„tea & 'ea 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. d Provided:Construction ust be 6m,leted within three years of the date of this permit. J/ Date Approved by / SEP-14-2019 01:08 From: To:15087906304 Pa9e:1/1 11- Zo7 Town of Barnstable Regulatory Services n l Thomas F. Geiler,Director nAMUMOLS, � Public Health Division �eura�° Thomas McKean,Director ! i 200 Main Street,Hyannis,]VIA 02601 Office: 508-8624644 Fox: 508-790-6304 Installer&Designer Certification Fount► Date: SewagcPermit# 408 Jlo Assessor's Mapu'urcel a Designer: 0 W v\ .Ca.�e �►h¢en� Installer: tll�� � &/�a`I�Y�Ccr� Address: �� � Address: 1 • y01� 7�� )nc On kate)'—&* o` was issued a pernut to install a installer) septic system at e �eg "v based on a design drawn by (address) . I GLn�21 a�Q dated (f igner) - I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved,changes such as lateral relocation of the distribution box and/or septic tank. I certify.that the septic system -referenced above was installed with major changes (i.e. greater than.10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. flan revision or certified as- y designer to follow. OF MMSr, �9= DANIELA, (.Installer's Signature) S CIVIL ,y No.46502 I ` J F.cs►ONA� � (Me's-Igner's Signature (Affix Designer's Stamp Here) ,LEASE RETURN TO '11,4ANSTABLE J!'QDDD:..IC HEALTH DI'VXSXQN. CERTW—Tf,, QF COMPLIANCE WILL NOT BE ISSUED UNTIL )ROTH THIS FORM AND AS-BUILT CARD ARE BBC BY THE BAItNSTAKLE PUBLIC S'TALTkl DIVISION. THANKYOU. ` Q:fiealth/Sepric/Designcr Ccrtiftcsfti Moan 3.26.04.doe '11 Cbw��e. ��w06 M�151�J 0c�� gad^ �jeAaooin L0.0 Wicov, V TOWN OF BARNSTABLE OCATION -7 1 C .4-eim,r- L t,,-t✓'( .UA&�/ SEWAGE# = -Ot 6t-3e!Q JILLAGE 4?L'i L=_UfCLJ X ASSESSOR'S MAP&PARCEL -(,, ,T �►6 INSTALLER'S NAME&PHONE NO. G� .1 . !^OT. 7'Z(- `7311 SEPTIC TANK CAPACITY Ek I LEACHING FACILITY.(type) t) ?� ��¢- (size) c49 K (-A-•�3 Kam.. NO.OF BEDROOMS OWNER �t Cs� PERMIT DATE: 5S- 6- COMPLIANCE DATE: �lb Separation Distance Between the: Maximum 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) eet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY e .Az `4 � t 4 O 1 t� . C- 3 .zf-s' . C -q- ffg � G-.5 �� I �e,r\ COMMONWEALTH OF MASSACHUSETTS EXECUTI VE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary . ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissio 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION f�® Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Name of Owner GERTRUDE WHITE Address of Owner: C/O LAURIE ROBIDEAU BOX 923 FALMOUTH MA.02540 O,e -`9y9 Date of Inspection: 3/16/99 Name of Inspector:tPlease Print)JOHN GRACI N lam a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: John Graci Title V Septic Inspection T' ` Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 Telephone Number: t608)664-6813 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of Inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Furthe Evaluation By the Local Approving Authority performing at the time of the Inspection.My inspection does Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:3/17/99 The System Inspector sh submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspectio .If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.THE LEACH PIT WAS EMPTY AT THE TIME OF THE INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2198 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3116199 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: _ I have not found any Information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: na One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.if"not determined",explain why not. na The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure Is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. na Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced na The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9098 Page 2 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3116199 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nla_(approximation not valid). 3) OTHER Wa revised 9098 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3116199 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nfa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system Is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3116/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (1 5.302(3)(b)) X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3/16/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-4 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):$ Total DESIGN flow: IV Number of current residents:Q Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):JLO Seasonal use(yes or no):DLO Water meter readings,if available(last two year's usage(gpd): IVA Sump Pump(yes or no): MQ Last date of occupancy: 10/1/99 COM M ERCIAIJINDUSTRIAL Type of establishment: n& Design flow: n&gpd(Based on 15.203) Basis of design flow: nLa Grease trap present:(yes or no):�lQ Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):DLO Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) nta Last date of occupancy: nLa GENERAL INFORMATION PUMPING RECORDS and source of information: nLa System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nLa- gallons Reason for pumping: nLa TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: 1985 Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2/98 Page 6 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3/16199 BUILDING SEWER: (Locate on site plan) Depth below grade: IC Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: nta Comments: (condition of joints,venting,evidence of leakage,etc.) n/a SEPTIC TANK: X (locate on site plan) Depth below grade: 4" Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nla If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No n(a Dimensions: L 8'6"H 6'7"W 4'10" Sludge depth: 4_ Distance from top of sludge to bottom of outlet tee or baffle: $Q'_ 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: n(a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) n(a Dimensions: n& Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle:-n& Distance from bottom of scum to bottom of outlet tee or baffle nla Date of last pumping: n& Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) Wa revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3/16199 TIGHT OR HOLDING TANK: NQ (Tank must be pumped prior to,or at time of,Inspection) (locate on site plan) Depth below grade: n& Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) n(a Dimensions: nLa Capacity: n& gallons Design flow: n&. gallons/day Alarm present: NQ Alarm level:j3L& Alarm in working order:Yes_No—: NO Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nLa DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:n& Comments: (note if level and distribution Is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n& revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3/16/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: WA Type: leaching pits,number: 6'M LEACH PIT leaching chambers,number: -n& leaching galleries,number: -DLa leaching trenches,number,length: Wa leaching fields,number,dimensions: Wa overflow cesspool,number: nLA Alternative system: WA Name of Technology: ji/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHTHE PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY PIT WAS EMPTY AT THE TIME OF THE INSPECTION PIT HAS NOT MORE THAN CESSPOOLS: _ (locate on site plan) Number and configuration: n& Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/A Depth of scum layer. n/a Dimensions of cesspool: nLA Materials of construction: m& Indication of groundwater: nLa inflow(cesspool must be pumped as part of inspection)n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: _ (locate on site plan) Materials of construction:o/A Dimensions:Wit Depth of solids: n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) D/A revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3/16/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a OVA Dec � c o C 0 N AR D' (!A � � gay 4�V revised 9/2/98 Page 10 of 11 J • t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 CARRIE LEES'S WAY CENTERVILLE Owner: GERTRUDE WHITE Date of Inspection:3116/99 NRCS Report name: n& Soil Type: n& Typical depth to groundwater: nLa USGS Date website visited: nLa Observation Wells checked: MQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) GROUNDWATER DETERMINED BY USGS MAPS AND CHARTS AT 10+FEET revised 9/2/98 Page 11 of 11 t TOWN OF BARNSTABLE FLOCATION LZ�� SEWAGE # VILLAGE C V\��.. ASS SSOR'S W& LO INSTALLER'S NAME&PHONE NO. ' SEPTIC TANK CAPACITY 6� v f LEACHING FACII.ITY: (type) (size) 1� NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: / 7 Separation Distance Between the: Maximum 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 byQ� Qkc �Cte14 6 v O C O AA 3° Ali ayt AC a'7 6c 3a 3 �t r "a� No.. ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ' ..................OF......... ��.Gt i►!`b�,:"' ....... Appliratinn for Disposal Works Tonstrnrtiun Frrmit Application is hereby made for a Permit to Construct (b,'3 or Repair ( ) an Individual Sewage Disposal System at: p�yp Loc 'on Ad re [ or Lot No. Address Owner i a ..........`� .__....�.�3�1. .. -- ...............................0... .............. Installer Address Q Type of Building Size Lot...../'`2 ......Sq. feet aDwelling—No. of Bedrooms____..__ _.. _ Expansion Attic (NO) Garbage Grinder (00) aOther—Type of Building ctfl._____n �No. of persons.___.Y___________________ Showers (Z) — Cafeteria (00) QOther fixtures --------------------------------------------------------------------------------------------------------------------------•-•------------••••••- W Design Flow.......... per person per day. Total daily flow___.._._.___S vC_._______._.__.._____gallons. WSeptic Tank—Liquid capacityL0 _.gallons Length..../a....... Width....6........ Diameter-__-Vic_........ Depth....t___.... x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area____.7-& .... ft. Seepage Pit No--_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X ) Dosing tan15 ( ) p / / aPercolation Test Results Performed by._. �il�.e�ii _f.._:eA � .__ _ Date........ � S_1-- ;(.__._... .l Test Pit No. ,..____minutes per inch Depth of Test Pit...}___a _______ Deptih to ground water.... 1�t...... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - Description of Soil...... ----- ................. I .... -- �b0j� 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 U 5 of the Sta anitary Code— The undersigned further agrees not to place the system in o era •on until a erti- e of Com ce has bee issued b t e board of health. Signed..... .._ ._ ` ate Application Approved By______ --- :. !.. t ----------•-------- Date Application Disapproved for the following reasons:................................................................................................................ Date No...... •S _--- � �- ) 4- Permit _....Issued_---------•-)•-•------- Date No................_....... Y FEs......' `! THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...._._ _ .................OF......................... .....- -- Appliration for Uiipooa1 Warkii Tontitrnrt"ton rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •-•-----...•............................•---•-•---...---•-•----••----••------• ............................................ -----•------•-•••------------ Location-Address or Lot No. ......................_.......................................................................... ----••--•-----•---•---•-•---••-••-•-••.........----•-----•-...................--•-•---------•-•--- Owner Address w Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building --___•_____________________ No. of persons........................... Showers ( ) — Cafeteria ( ) Otherfixtures ---------------_--•......--•------------------•-•---•---------......-----------------------------------------------•--•-•---•-------••-------•---- w Design Flow............................................gallons per person per day. Total daily flow...................._.......................gallons. WSeptic Tank—Liquid capacity.........._gallons Length---------------- Width---------------- Diameter_------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length..............._.... Total leaching area__.-_--_--____----sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (. ) Dosing tank ( ) Percolation Test Results Performed bY-----------------------------............................................. Date......................................... Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Dept'i-i to ground water_____-__-___-__--_--_--. rz Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 ---•---------•----------------------•---• ........................................................................................._......................... 0 Description of Soil----------------------------------------•---------------------------------•------------------------------------------------------------------------------------------- x U --------------------•-----•--•--- .............................-•-•----•-•----•-•-------•--------- •-----•-••-•-•-••------•-----•--•--•-•------••-................................................... 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 L 5 of the Sta anitary Code— The undersigned further agrees not to place the system in er tion until a ert' to of Co nee has b issue`d�y e board of health. ! A i Slgned................ ----•--------------- .......................... l Date )' Application Approved B ................................. - J' Date Application Disapproved for the following reasons-------------•-•------------------•--------------------------------------------------•-•-•-••---•---------------- --•-•--•---....-•---•--•-------------------------------------------------------------•-------------•--------------------------------------------•-----------------------...------------•--------------- Date PermitNo......................................................... Issued-........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.... .......................................................................... Q-11rrtifiratr of Tomptittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at--------------------------------------•-----------------..............---_---------------------------------•-------•-----------------•------------•------------------------................... has been installed in accordance with the provisions of TIT E r of Tfi State Sanitary Code as .described in the application for Disposal Works Construction Permit �__'�.!.-�Z-_... dated--._...1._y�_1 �/�'�................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. Inspector a .......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTk No... .................... FEE--- ............... Difipm l Vorkg Tonotrttrtion rrmit Permissionis hereby granted--------------------------------------------------------------------------------..•-----•--••-.....-•-•-•-•--•---••-•••...................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.......:..........................••-•---•-•------•-••...-•--•••------•---•••---••-•--•----•-..------•----- ----------•-•---------------- .................................................... Street � // as shown on the application for Disposal Works Construction Permit No 7_�.._.)>�I Z Dated i-�`---):V s'`:(�.............. `DATE--------- ----------- ............................................. Board of Health FORM 1255 A. M. SULKIN, INC.. BOSTON " ♦ 1 y. 1_D T l8 w 9 3 o12 Issr.. r s c'- t ta -27 411 azr K{ L3 LO7�7 leg, •. .� p`� u 2 t ����H aF Mgss� op t A rtSE fir- C3; No.��09 51�O=� z O // a �/ o . 'r-i3 A C.(<S o�FSS/0NA1.���'� ROBER7 LEGEND FdRa19TIN0 SPOT ELEVATION ®$® .' ,, , CERTIFIED PLOT PLAN tE I T'INO CONTOUR --- 0 �--_ L , � � � %` FI I HE® SPOT:. ELEVATION 3 } F N: I�EQ: CONTOUR ® s E , _1) T i7 C.�Rr L�'E .5 U✓ter. f , A�CYI'E ;The location of any existing under round sewexa�;e, walls, or other utilities:shown on tt is, plan is _approx 1N `� M natet'only as determined from x.ecords, an verbal S All ®� ��� �,nbrmatxon., The contractor is responsible for.. the r F�,4.Y, -vea£ cati'on of the existing, locations in the field. SCALE, l � p PATE s /z�0 ,. l�.D'RE1�G IN r3�,y.s �p E ENGINEERING Co. � O P@'T. I CERTIFY THAT THE PROPOSED n ,� Et3I:STERE REGIS4ERED 3. J®® NO. 8 BUILDING SHOWN ON THIS PLAN LAND: .,f CONFORMS TO THE ZONING LAWS E N G FEE R R V ,' ®R,:.N Y+ ..,.,., .�: OF ®A R N S TA H L E , M A S S " .�. >?12 MAIN STREET CH. ®Y ft iYA►iJN I S, MA3S. SHEET..j/.'OF A E REG. LAND SURVEYOR �0 I --,4CN//YG T ?4 /�O7 � 3•/ t/Ef-bYy CAST /,e0,,Y C0J/.FR' Sf/,g1,L f3.t 41S4r-17 /[_. p 0 .10 COYOT5 Mep/. P/YC�I IF/N L>AII VEWA r A . / C377�e• �E CO VF'f�' CL EAN SA/V O �. r.. 6AC.leF/L.L. StAIEDvm4o - - s {J Gi4L.. ® o o f a o4� 6yASHEO ,S7t7NE PeP» 1''7; f SEPTIC, TAN/C Dl ST. ® e e • • e • o ► B m a = . BDX o er � • a seo ► ®°p CI'rVe • ► t o ® D Tits • e e ° c o WAS/! ® S70/15 �' ar t t ® ® tr eme 1 60 a . /(3 K I U m: 1!3 a ao a to m o e aaeo P 0, p j �c�U y.fL-/O A 'CA /ItlYERT AT'ffU/L.D/A/CP �9?. J=I! .J ' FY D/A/✓l. S 6 2 {5EX TA VL -rJOAe). .T.�4A/K F7� F7 VIA DU7"1 .SE 77C TA/iiJ< �6 3' F'-' //VZIFr OISTR/4607`/0M AS .SHC7 /C!N ®.= CaIPOuA/D N }TER TABS E O UTLTDI STROd1T/®/fit 9 5_FT. I)V4.=?' 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PERMIT NO. [gee y _ �t ;PILLAGE co/ 4`" -�oin 616 I INSTA LLER'S NAME A ADDRESS Ce7 Ile, S U I L D E R OR OWNER r DATE PERMIT ISSUED Y / 2 DATE COMPLIANCE ISSUED _ - S>_5 i 13gcK o f hoose b� r r t LOCATION h���� SEWA E. PERMIT NO. of 1 � ,fee` &42 VILLAGE J J pr, collr P,� 6 INSTALLER'S NAME i ADDRESS B U I L D E R OR OWNER / ees DATE PERMIT ISSUED D A T E COMPLIANCE ISSUED _5>5 qGf� Oyr hoU�e -- i SYTE SYSTEM PROFILE MARKEDS WITHCMAGNETICTTAPSHALL E OR BE NOTES n COMPARABLE MEANS FOR FUTURE LOCATION. ° PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS NAVD 88 �3 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS XIS 2" PEASTONE OR GEOTEXTILE EXISTING \ TOP FOUND. EL. 26.5' FILTER FABRIC OVER STONE z 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. � Rd. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 23.9 0 Fuller 4. DESIGN LOADING FOR ALL PROPOSED PRECAST ) NOTE: 2" MIN. WALL BLOCKS OR UNITS TO BE AASHO H-10 PREC:io THICKNESS REQUIRED Route 28 ' RISER PRECAST RISERS a .. 2'� 4"0SCH40 PVC MORTAR ALL:. l Locus H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. s" MIN. SUMP PIPES LEVEL 1ST 2' COMPONENT'S MIN. INT. DIM. �ENDSJ4 (TYP') INV'S EL 20.1 4'SIDES 20.93' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE • �yPO`�O`�O�O�� Oo0o0°O°° WITH 310 CMR 15.000 (TITLE 5.) �a a�. TEE 13 **EXISTING TEE ° ° ° ° �ooa o oaomfF aoa-o �aoo SEPTIC TANK *22.6'f ;°o°o �����0���El� 70 M M�M M M M0� ;00000000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Je Road EXISTING °°°°°°°°°°°° WATERTEST D'BOX °°°°°°°° �aaoaoaaaoo7ao�0000000 > ° ° ° ° f GAS BAFFLE::; ° ° ° ° ° ° FOR LEVELNESS o 0 0 000000000o � oo � 0000000 0 0 0 0 ° ° ° ° ° ° ° ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY c R c >a0000aoo 0000aa�0000aoa0000aoo ,00000000 , 20.37' 20.2' >°o°o°o°o °g°g°g 18.1 OTHER PURPOSE. von Bump h o f8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4° PVC. `-H-10 500 GAL. LEACHING CHAMBER BY .ACME PRECAST OR EQUAL. � 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR ALL AROUND PRECAST STRUCTURES CONCEALED WITHOUT INSPECTION BY BOARD OF *THE INSTALLER SHALL VERIFY THE LOCATIONS cat OF ALL UTILITIES AND ALL BUILDING SEWER 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00, X 12.83' HEALTH AND PERMISSION OBTAINED FROM BOARD OUTLETS AND ELEVATIONS PRIOR TO INSTALLING COMPACTION. (15.221 [21) OF HEALTH. ANY PORTION OF SEPTIC SYSTEM 10. CONTRACTOR SHALL BE RESPONSIBLE FOR "INS1000TALLER GALLONSHALL AND ITS FIRM MINIMUM SUITABILITY FOREPTIC TANRE-USE.KREPLA ESIZE AT VERIFYINGCALLING IGSAFE THE LOCATION OF ALL233) AND UNDERGROUND & LOCUS MAP WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE 13.1' BOTTOM TH-2 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ( 7 % SLOPE) ( 1 % SLOPE) CONDITIONS IF NOT SUITABLE NO GROUNDWATER FOUND WORK. SCALE 1"=2000't FOUNDATION- EXISTING- SEPTIC TANK 32' D' BOX 12' LEACHING 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 168 PARCEL 8-10 FACILITY BE REMOVED BENEATH AND 5' AROUND THE PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS AND REMOVED OR PUMPED AND FILLED WITH CLEAN SHOWN ON COMMUNITY PANEL #25001 CO563J C CCC D SAND. DATED 7/16/2014 99- EXISTING CONTOUR CARRIE X 99.1 EXIST. SPOT ELEV. LEE'S [99] PROPOSED CONTOUR 198•41 PROPOSED SPOT EL WAY / BENCHMARK: CORNER OF TH1 SYSTEM DESIGN: BULKHEAD =25.5' TEST HOLE O■ �O O NAVD88 v 0 GARBAGE DISPOSER IS NOT ALLOWED 2� SLOPE OF GROUND G R �0f NS9• 2� DESIGN FLOW: 3 BEDROOMS © 110 GPD 330 GPD UTILITY POLE - �A6 73 7 USE A 330 GPD DESIGN FLOW FIRE HYDRANT LOT AREA , ._. r NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 15,121 ±S.F. � ,. SEPTIC LANK: -330-GPD (2) -= 660 - 0 **RE-USE EXISTING 1000 GAL. SEPTIC TANK LEACHING: TEST HOLE LOGS PAV ED SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD DRI20'0 BOTTOM 25 x 12.83 (.74) = 237 GPD ENGINEER: DANIEL E. GONSALVES, SE #13587 EXISTING TH2 TOTAL: 472 S.F. 349 GPD WITNESS: DAVE STANTON DWELLING / TH1 O DATE: 7/18/19 TOF = 26.5 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) PERC. RATE _ < 2 MIN/INCH BH WITH 4' STONE ALL AROUND CLASS I SOILS P# PT 19-71 �6 PORCH j ELEV. ELEV. oo . ���`.�� ��"/ MA 0" Q 24 2' 0„ 4 24 1 ' N APPROVED DATE BOARD OF HEALTH FI LL FI LL 25 26" 24" CD A A LS LS TITLE 5 SITE PLAN � N OF 10YR 3/2 10YR 3/2 w 30 21 .7' 32" 21 .4' w B B � #71 CARRIE LEE'S WAY � , LS LS CENTERVILLE, MA i 10YR 4/6 10YR 4/6 46" 20.4' 48" 20.1' o PREPARED FOR w BORTOLOTTI CONSTUCTION, INC. PERC �sCs �p�N OF MAS ,� tH of M DATE: J U LY 23, 2019 M/CS M/CS o` DANIEL DP,NIELA. �s o A. ¢ OJALA off 508-362-4541 �C) OJALA CIVIL fax 508-362-9880 No.40980 No.46502 downcape.com 10YR 6/8 10YR 6/8 'gWFEss 0 ° STEF N//j ��� d� cope en ineeringi /dC. 132" 13.2' 132" 13. y e 8 1 . S�R,E � ss,oNAL civil engineers w � m NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' �1 _`L3_�c� ,� land Surveyors ' 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. �CE � ' �-2�� 0 10 20 30 40 5o FEET YARMOUTHPORT MA 02675 19-207 BORTO-OBRIEN.DWG