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HomeMy WebLinkAbout0692 CRAIGVILLE BEACH ROAD - Health 692 Craigville Beach Road A = 226 - 122 Centerville SMEADO No.2453LOR UPC 12534 smead.com • Made In USA 4Q). O"URCLNG mmumNiF65FRODU " SH OmF ESRPRO GRAAIERTIFIED WWW.SFPROGWL02G ax..,�.,,....., _- l�- �(al lay- No. Fee THE.COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS I- - 21pplitation for Disposal 6pstem ConstrUttion VPrmit Application for a Permit to Construct( ) Repair(Vl -Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. b -- 1`a a nn Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel. o. Designer's Name,Address,and Tel.No. oob� S - S . k �6i 3a Type of Bui ding: Dwelling No.of Bedrooms Lot Size J C)kQ6 sq.ft. Garbage Grindelqq Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3b gpd Design flow provided gpd Plan Date I Number of sheets Revision Date Title Size of Septic Tank Q'%k, Type of S.A.S. Description of Soil ��4_��o S ���'`�v� } d� Q4Q-QAJ Nature of Repairs or Alterations(Answer when applicable) �A. C.Q ( n c4 s,0� ' �T\ g- cry v Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 1 1,p I t,y Application Approved by Date 8-0 Application Disapproved by Date for the following reasons Permit No. (�j - �p ( Date Issued �- - _---_- ------- �_���� �a- - - -- -- - - --- - -- - -- ---- ---- No. 0 6 — J t�J Fee 1 V y• J— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS -- -- R-p ittiOafA iaposal Opstent:'ConBtrurtion permit a :*�� • Application for a Permit to Construct( ) Repair(1Upgrade(_.) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. .2 O -- oZ II Owner's Name,Address,and Tel.No. Assessors Map/Parcel w • Installer's Name,Address,and Tel.No. a J Designer's Name,Address,and Tel.No. %cwkv��V\_ c\3 Oki orb""k ,° S wok 36 x� 3a Type of Bu'ding: Dwelling No.of Bedrooms Lot Size l)k D 0 sq.ft. Garbage Grindetyq Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33b gpd Design flow provided gpd Plan Date C( � ` I`" Number of sheets Revision Date Title Size of Septic Tank Q-K \O6 Type of S.A.S. Soo G-C a C1nGr^b�fS Description of Soil r) ('��_c Lv S �. V Vclnt C f Ovnj Nature of Repairs or Alterations(Answer when applicable) C,Q. '-C Date last inspected: Agreement: .. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date 0 Application Disapproved by Date for the following reasons Permit No. aU (� — �ca ( Date Issued ( o— 14:� ------------------------------------------------------------------------------------------------- ------------------------------------- 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 V(-_ at �,�j a Gf c; G.� �` -eG.e�n a y h s been constructe in aecp��jarce ) / with the provisions of Title 5 and the for Disposal System Construction•,Permit No. C� (7 s dated Sao {� 1 r1 .V_ Designer �� Installer _ g ��`{_ #bedrooms Approved design flow( (./ fl and The issuance o this permit shall not be construed as a guarantee that the system wil functio L designe/d. r Date f �� {� Inspector. /c! 4�,✓ / `�' � ) _ � j Q V --------------------------------------------------------------------------------------------------------------------------------------- No. V Fee (00• THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Nspo$al 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at Cl Q C \V— GC_`,, aJ C..ln 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:Construction must be completed within three years of the date of this permit. Date r 7_ Approved by r r Town of Barnstable Regulatory Services Richard V.Scali,Interim Director MAW Public Health Division .a3 sp Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 10 Sewage Permit# Q. 3(P'JAssessor's Map\Parcel Designer: S�E1Pr Rie m k lk A ks,pc Installer: 5W-T C_ 1 A- 'F—��VL— Address: 7. 0. took Ito Address: 113 0G6. YAJWOV"-1-4 Rb soya I-AX a2-jGo I _ o z&&r-> On V(3 aO l- 5:!e.T- NA � K was issued a permit to install a (date) (installer) septic system at PTr94X12 .Jsefonadessiigndrawwnn by (address) "A&IVIFdated — (designer) 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. Strip out (if required) was inspected and the soils were found satisfactory. 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. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ' l' nce with the terms of the IAA approval letters(if applicable) 0 (Installer's Signature) (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc 4�R TOWN OF BARNSTA-�LE . LOCATION l5J�r� �d Vi MIC ZeQ4,SEWAGE# [ I VILLAGE (".Q��(s'\D4 ��e' ASSESSOR'S MAP&PARCEL © — 1 , INSTALLER'S NAME&PHONE NO. �-� SFn `'1Y 00 T SEPTIC TANK CAPACITY ��C(S I[ Q/� �o LEACHING FACILITY:(type) �a y �'0 �1, (size) 1-2X NO:OF BEDROOMS h e b tri C T{' OWNER 4 1 -P u e. o e S PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Mel s,k Feet Private Water Supply Well and Leaching Facility(if any wells exist on AA � 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) a Feet FURNISHED BY 'Q e kC�!\ '019 PO to � Lf7- Town. of Barnstable P# j 4 Department of Regulatory Services Public Health Division Date se7P 200 Main Street,Hyannis MA 02601 ryu Date Scheduled r Time 0 "I Fee Pd.EZ Sail Suitability Assessment for Sewage zsposal Performed-By:. 5712-9/• e� 4 .Jf,4y4S, nC-�- . Witnessed By: y. LOCATION& G NERAL 7�ORMATION Location Address ` T '. • ��Cn�, �i'v.�,\�, �L���i� �.111 Owner's Name �I Gr'L�VS Address 5'� �1 Assessor's Map/Parcel: - 3-14 1 Engineer's Name NEW CONSTRUCTION REPAIR Telephone af d ' Land Use- Slopes 96 _- p ( ) Surface Stones_ - ti Distances fivm: Open Water Body tt _possible WeLArea ft Drinking Water Well . Dralhago Wey Properly Line fir✓ f— R Other ---- ft SIMTCII:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes) i V) C a Parent material(geologic) Depth to Bedrock Depth to Orcuadwater. Standing Water In Hole: A-10 v_E': Weeping fl'om Pit Pnoe Estimated Seasonal High Oroundwater DE ATION FOR SEASONAL-HIGH WATER TABU Method Used: OT?7 Depth Observed standing in obs.hole: Dollth to Weeping from side of obs.hole: Index Well Ir I°' D°Pdt to soli mottles: In. Oroundwater Adjustment lu. Reading Date: lnd°x Well level •• fit• AU.tkctbr ' Adj,dt�nundwdter "`DERCOI ATI-0114-AIRS ' Aate f-' �1C(tmb, Observation Hole Il / — Time at 9" Depth of Peru y Time at 6" Start Pro-soak Time @ Time .6") End Pre-soak &AD Rate Min./luch Z Site Suitability Assessment: Site Passed Site Palled: • Additional Telling Needed(Y/N) Original: Public H°alth Division Observatlon 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:1S EPTICWERCPORM.DOC C DEEP.OBSERVATION HOLE LOG Role# �_ Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) . (Munsell) Mottling (Structure,Stoneif;Boulders. Cons idtency.96'Qraycll r /32 s -1 3 DEEP OBSERVATION HOLL LOG Hole# Z Depth from Soll Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stonea,Boulders. Conalitchoy.%Gravel) ►r L 5 ��,ti �/� 7/j DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soll Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoncs,Boulders. onslatency.%O DEEP OBSERVATION HOLE LOG Hole# Depth from Solt Horizon Soil Texture Solt Color Boll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,S(opc9;Boulders, Consistency, i Flood Insurance Rate Map: Above 500 year f lood boundary No_/ Yes .z J !T✓!tl!n 5t)tl.ve^t h^_tt ts.�_ . N. Yc� _ Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material oxist in all areas observed thrpughout the area proposed for the soil absorptibn system? VC 5 If not,what is the depth of haturally occurring pervious material's Certification I'certify that on �� ��l (data)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tr cx ertimo and experience described in'10 CMR 15.017. Signature Date QA3 L-PTICIPBRCPORM.DOC Crocker, Sharon From: Crocker, Sharon df Sent: Wednesday, April 13, 2016 3:02 PM Al nll� To: 'veronica_aglegal@verizon.net' l Subject: FW: Full Septic Inspection /Certificate of Compliance c�v� Attachments: 2016_04_13_14_43_55.pdf VelrOKi CA 69 eAMA) Attached is the septic permit for repairs completed on October 27, 2015. ('7, 9 .5— ;Vz� The existing septic tank was not replaced. 7 A new D-Box(Distribution Box) and a new leaching field was installed. Both items were put in with H- 20 grade. (Regular grade is H-10, for heavier traffic areas and concerns with excessive weight on top of system, the H-20 is used.) The certificate of compliance is used in place of a full septic inspection report whenever a new system is installed. The Director suggested the engineer would probably be willing to write a statement that he had examined the septic tank at the time of the work. Hope this answers your questions, Sharon Crocker Administrative Assistant 1 , h 1 No. C�L_ 10 I Fee C'. r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplitation for Disposal �&pstem Conetrurtion permit Application for a Permit to Construct( ) Repair(V�..Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. .2 a(. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel t t�y1Q Installer's Name,Address,and Tel. o. J Designer's Name,Address,and Tel.No. � 3,� a ' 066 Type of BA ding: Dwelling No.of Bedrooms Lot Size (17R0 6 sq.ft. Garbage Grindetjq Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 b gpd Design flow provided gpd Plan Date �( � 1 Number of sheets Revision Date Title Size of Septic Tank Q.'X i!:A k 06p rsG` Type of S.A.S. S700 G 6:` \-Na b Description of Soil N 126_('r,�EsC S t, J Nature of Repairs or Alterations(Answer when applicable) 'C�. U2. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. - Signed Date \ 6 ` 1 1,* 1(,Y Application Approved by Date 81-0 Application Disapproved by Date for the following reasons Permit No. -Zo (7 ��p ( Date Issued t Q-LO l� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V Upgraded( ) Abandoned( )by ,q n c � at (s�'1 a C f c..r_ c t`f- U-L G.L.\n a h teeonstructe in accpf apce S 1 with the provisions of _(Title 5 and the for Disposal System Construction•Permit No. C� (�� ated 1 d, t� Installer S CO �1 �i `(�L Designer `l- c_\J—f_, #bedrooms Approved design floW,1 2 gpd The issuance o this p rmit shall not be construed as a guarantee that the system will functi h1as designe Date ~ ( Inspector c. / v No. Fee (00, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBal 6pstrm Construction permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at cl G-.c c,v L� GC,�. a J C.)"N 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:Construction must be completed within three years of the date of this permit. r C Date �. Approved by �{� / YOU WISH TO OPEN A► BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which - t give you permission too operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 you must do by M.G.L. it does no gi y p p ) Main Street, Hyannis, MA 02601 [Town Hall) DATE: / Fill in please: I�Se§iC•��IN.fIG:ii`i�ti:!':t`I• :L4 Fa vrl i.. '{ ' APPLICANT'S YOUR NAME/S: �° %�1,'�'1 Hh�Nf rva�,!�15)i;li '�tli. I sL,irK�r_eia'iF BU NESSj YOUR HOME ADDRESS: _ Y' VO 7/' VO F!r,�F l�l 11 e ( � Z TELEPHONE # Home Telephone Number � f- -2 yq NAME OF CORPORATION: NAME OF NEW BUSINESS - TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO � _ 7 `�` ADDRESS OF BUSINESS iu a'il' � �h MAP/PARCEL NUMBER V V (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: s 2. BOARD OF HEALTH This individual has bee for 'ed of the permit requirements that pertain to this type of business. MUST COMPLY WITH ALL HAZARDOUS MATERIALS REGULATIONS Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature*.* COMMENTS. DATE:5/24/02 PROPERTY ADDRESS: 692 Craigville Beach Road ----------------------- /_lA Centerville , Mass . ------------------------ 02632 ------------------------ On the above date, I Inspected the septic system at the abovea ressIVE® This system consists of the following: 1 . 1-1500 gallon septic tank . JUN U 4 2002 2- 1-1000 gallon precast leaching pit . ( 61X10 ' ) F BARNSTABLE 3 , 1-Distribution box . T�WHEALTH DEPT. Based on my inspection, I certify the following conditions: c54 1' 49 4 . This is a title five septic system. ( 78 Code ) 5 . The septic system is in proper working order at the present time . MAP - `Z2 6 . Pumped the septic tank at time of inspection . Heavy scuARCQ & solids layers were present , t' LOT SIGNATURE:-,- Name:_J _�.__Macomber �Jr.______ Company ; Joseph_P_ Macomber-& Son , Inc , Address ; Box 66 _-Centerville , Ma ,-02632-0066 Phone: 508_775-3338 --- -------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH MP MACOMBER & SON, INC. Tanks-Cesspools-Lea hfleld5 anks•Ce:spools Leachflelds Pumped & Installed Town Sewer Connectlons P,O. Box 66 Centerville, MA 02632 0066 775.3338 775.6412 y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 692 Craigville Beach Road entervi e ,Mass . Owner's NameMarie Walsh Owner's Address: Same Date of Inspection: 5/2 4/n 2 Name of Inspector: (please print) Joseph P.Macomber Jr . Company Name: J. P.Macomber & Son Inc . Mailing Address: Box 66 Centerville ,Mass _ 02632 Telephone Number: 5 n R—]J a-3 13 R 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP l approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes _ Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails. `1 Inspector's Signature- Date: The system inspector shal ubmit 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 ****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 1 Page 2 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:692 Craigville Beach Road en ervi e , . Owner: Marie Waish Date of Inspection: Inspection Summary: Cbeck A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: AlJ�a have not found any information hich indicates that any of the failure criteria described in 310 CMR 15. 003 or to 4 exis . ny failure criteria not evaluated are indicated below, Comments: The septic system is in proper working order at the present time . Waste water is14" below--the invert pipe of leaching pit . 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. X)ID 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: Va 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 — distribution box is leveled or replaced ND explain: /)0 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: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:692 Craigville Beach Road Centerville ,Mass . Owner: Marie Walsh Date of Inspection: 5/2 4/0 2 C. Further Evaluation is Required by the Board of Health: AID 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(l)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: �d 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. ,40 The Svstem has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than l�0 feet but,�0 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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. 3. Other: I I � 3 • Page 4 of 1 1 A OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:692 Craigville Beach Road entervi e , ass . OwoerMarie Walsh Date of inspection: 5/24/02 D. System Failure Criteria applicable to all systems: You must indicate "yes" or"no" to each of the following for all inspections: Yes No/ �/ ffl ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge or ponding of effluent to'the surface of the ground or surface waters due to an overloaded or /clogged SAS or cesspool 1/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool • l.l,/1..iQov VKIb' ZLiquid depth in eoaipvol is less than 6"below invert or available volume is less than ''A day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number /bf times pumped �. y 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. _ �y portion of a cesspool or privy is within a Zone I of a public well, y portion of a cesspool or privy is within 50 feet of a private water supply well. J 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 qualiry analysis. (ibis 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.) t)d_ (YesTO)The system fails. I have determined that one or more of the above failure criteria exist as described in 3 10 CMR 15 303. therefore the system fails. The system owner should contact the Board e, 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• 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) des �no I/ 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 li 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 ..\es" in Section D above the large system has failed. The owner or operator of any large system considered a s:entficant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR S 304. The system owner should contact the appropriate regional office of the Department. 4 page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:692 Craigville Beach Road Centerville ,Mass . Owner: Marie Walsh Date of Inspection: 5/2 4/0 2 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes Ypurnpu-ig information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks ? Z_ 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: 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)] 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 692 Craigville Beach Road entervi e , ass . Owner: Marie Wa 7h Date of Inspection: 5 2 4 0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): -1 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms). Number of current residents: A Does residence have a garbage grinder(yes or no):*12 Is laundry on a separate sewage system es or no):.P-b [if yes separate inspection required) Laundry system inspected(yes or no): `t Seasonal use: (yes or no): VP Water meter readings, if available (last 2 years usage(gpd)):2 00 0-6 3 , 0 0 0 gallons=172 . 61 GP Sump pump(yes or no): gallons=19 7 . 2 6 G P D Last date of occupancy: COMM ERCIAUMUSTRIAL Type of establishment: 40 Design flow(based on 310 CMR 15.203): 10 gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):.,7 Industrial waste holding tank present(yes or no):,�)4 Non-sanitary waste discharged to the Title 5 system (yes or no):,f, Water meter readings, if available: to Last date of occupancy/use: 16 OTHER(describe): 1W GENERAL INFORMATION Pumping Records / C Source of information: 16� Was system pumped as part of the inspection (yes or no): If yes, volume pumped:-1'03d gallons-- How was quantity pumped determined? Reason for pumping: Pumped septic tank . Heavy scum & solids layers were present . OF SYSTEM TY Septic tank,distribution box, soil absorption system 4!t Single cesspool '40Overflow cesspool 4 Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) VA Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank tip!¢ Attach a copy of the DEP approval /vv Other(describe): ,/� 9.pproximate age of all com on nts,dat installed (if known),;nAwurce of information: Were sewage odors detected when arriving at the site(yes or no): 40 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 692 Craigville Beach Road Centerville ,Mass. Owner: Marie Walsh Date of Inspection:S/2 4/0 2 BUILDING SEWER(locate on site plan) Depth below grade: �v / Materials of construction: v cast iron 40 PVCA4 other(explain): .trip Distance from private water supply well or suction Iine:d'/- Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight . No evidence of 1 a agP T�yystem is vented through the house vents . SEPTIC TANK: Zlocate on site plan) /15M,44X A1-C Depth below grade: i, Material of construction: concrete A3C metal,�cl fiberglass polyethylene NDother(explain) djl� If tank is metal list age: tLP is age confirmed by a Certificate of Compliance (yes or no): (attach a copy of certificate) �� F Dimensions: �%6 'ou Sludge depth: (� Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: ell> Distance from top of scum to top of outlet tee or baffle: O Distance from bottom of scum to boUrn of outl t to or baffle: How were dimensions determined �,r"L/ -.e-7 � Comments (on pumping recommendations, inlet arfd outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Pump the septic tank ever 2-3 years . Inlet & outlet tees are in piace .The tank is structurally sound and shows no evidence of leakage . GREASE TRAArke— locate on site plan) Depth below grade:�//� Material of construct ion:AlA concreteA)4 metal,44 fiberglass t/'Apolyethylene�Of other (explain): Dimensions: q)A Scum thickness: 1U/9 Distance from top of scum to top of outlet tee or baffle: /VX Distance from bottom of scum to bottom of outlet tee or baffle:_ J� Date of last pumping: *1l 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 trap is not present . 7 Page 8 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:692 Craigville Beach Road en ervi e , ass . Owner: Marie Walsh Date of Inspection: 5 2 4 0 2 TIGHT or HOLDING TANK/ -(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: IV4 Material of construction:�iAconcrete.,W metal A110 fiberglassd//f polyethylene VY other(explain): All Dimensions: _ 6 Capacity: Im gallons Design Flow: 14).4 gallons/day Alarm present(yes or no): Alf Alarm level: 64 Alarm in working order(yes or no): Date of last pumping: _-/4 Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present . DISTRIBUTION BOX: Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 40 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.): Di .t-ribntinn hnx has one lateral . No evidence of solids carry over . No evidence of leakage into or out of the box PUMP CHAMBER4,AVe,(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):�i� Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Pump chamber is not present . 8 Paae 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 692 Craigville Beach Road Cente.rville ,Mass . Owner:Marie Walsh Date of Inspection: S 24 02 SOIL ABSORPTION SYSTEM (SAS): Zlocate on site plan,excavation not required) 1-1000 gallon precast leaching pit . 6 'X10 ' If SAS not located explain why: Located ; See page 10 Type � leaching pits, number: V00 leaching chambers, number: C ,UJ leaching galleries, number: —Q- kV leaching trenches, number, length: Cp 47.1) leaching fields, number, dimensions: 0 �' overflow cesspool, number -4w innovative/alternative system Type/name of technology: ZY 41v e ) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition o vegetation, etc.): Loamy sand to medium fine sand No signs of hydraulic failure or ponding . Vegetation is normal Waste water is 14" below the invert pipe . CESSPOOLSR. P- (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: r� Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cesspools are not present . PRIVY4AjL(-(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.): Privy is not present . I 9 Pagc 10 0(11 OFFICIAL TNSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSA-L SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properry Address:692 Craigville Beach Road entervi e , ass . Owocr.Marie Walsh Dw of Inspcctioo: 5/24/02 SKETCH OF SEWACE DISPOSAL SYSTEM PrOridc + skctch 0(thc scw+t;c dispos+l systcm including tics to o<nchrnuks Loc+tc +II wells with It Icast two perm d encnt refcrenee Innmarks or . in 100 (cm Loc+tc whcrc public water supply enters the building. e V CDp \ N THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF 9EALTH TOWN OF BARNSTABLE FEE..... his n tt� nrk (gnnarnawn fermi# Permission is hereby granted..J P. Macomb_er...Jr.......................................................................................... .... . ...:.. t to Construct ( ) or Repair �X? an Individual Sewage Disposal System rno rr?i a-ri lle Beach....Rgad....We.st...HY.an.n. .sp :o t................................................................. � N Q5 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ✓ 9 TOWN OF BARNSTABLE FEE......T.....3-0---00 No..........7........ 11w1 n ial Workii (gnnn�tutinn >ermtf Permission is hereby granted.. ... .... J . .Mac omb-e r.... r... ......................................:..'..................................................... P to Construct ( ) or Repair �X} an Individual Sewage Disposal System at No..... .9.2... x. �°�1�.�..�. ...Bach...Road...We s t...HJ'a st e spor .. .......ted... .�' ... :...��.... .. as shown on the application for Disposal Works Construction Permit No- W.... . ... ... . --- . .i.................. Board o Health DATE........... .... .. FORM 36308 HOBBS&WARREN,INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ger#tf rate of Complianre TL�I S TO CE TIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX ) �1 � Macom�er fir. by ....................' ..........................................,...............................................................................,...................................................:........................................... Ins�alirr at ..........92....Cram:'' .11.e....B.eac.n....Road....we.r.t.....Hy.annizp.sot.t..................................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ............... ,,... ........ ......... dated ..., �'...... r_ .' 2 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BVCONSTRUEAS A GUARANTEE THAT SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................ ...................... Inspector ...............4711.� )..................................I..................... Page 1 I of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 692 Craigvillebeach Road Centerville ,Mass . Owner: Marie Walsh Date of Inspection: 5/2 4/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells i Estimated depth to ground water V feet Please indicate (check) all methods used to determine the high ground water elevation: ine om system design plans on record - if checked,date of design plan reviewed: �j'7 ,�&�ibserved si�(attng prope / bservation hole within 150 feet of SAS) hecked wi oar o ealth-explain: 14 hecked with local excavators, installers ( n docum Cation) �j r Y Accessed USGS database explain: Glll� yOl642. /�1�����/��fE�.�J/ You must describe how you established the high ground water elevation: Used ; Gahrety & Miller Model . 12/16/94 Water levels above 'sea level . Used ; Observation well data . June 1992 Used ; USGS ; Technical bulletin 92-000-1 January 1992 . Annual ranges of ground water elevations . r un Leaching � J! Pit �'� ;eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the boti m� % Of the leaching pit and the adjusted groundwater table is feet. f 11 �.r r+nrr.•-rt:�—.-rr-.rrr.-irr.rm ns-•per.reTrrr.:•.�+••r-tan:+�nns-ats*�ar.rir.rs•crt TOWN OF Barnstable BOARD OF HEALTH 0 -•••T '-- •_SUIISURFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION r7 = wnrtn n•t*err�r.*v�rrrrrrrr.•.—rrr•r-•�. •-..� -TYPE OR PRINT CLEARLY- PROPERTY INSPEC7'ED STREET ADDREW92 Craigvillebeach Road Centerville ,Mass . ' ASSESSORS MAP, BLOCK AND PARCEL # /milli OWNER' s NAMEMarie Walsh* PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P .Macomber Jr . COMPANY NAME J. P.Macomber & Son Ina-f * COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 790 -1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true , accurate , and omplete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one : Y�System: PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con ticted has found that the system fails to Protect the j)ublic health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this .inspection orm . Inspector Signatur Dal dam`to :Xne copy of thi rt,ification must be provided to the OWNER, the BUYER here applicable ) and the BOARD OF HEAL7'11. * If the inspection FAILED , the owner or operatorshall upgrade ' the eyatem Within one ,year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 , partd .doc TOWN OF BARNSTABLE LOCATION7. 1 ��Q l�rl�� D�I� SEWAGE # 30 VILLAGE' ASSESSOR'S MAP LOT _ INSTALLER'S NAME PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEASHING FACILITY:(type),y /"1 ffX a. 7 BIZ (size). 30 X 2 NO:`:OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ' BUILDER OR OWNER VuLD 12 2EL-11,44 DATB'PERb(IT ISSUED: DATE.; COMPLIANCE ISSUED ri' - la Ilk ed VARIANCE GRANTED: Yes No i f 00 k4l No..1.............. F�s...3"J 00.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Diopooa1 Works Tonotrur W c Application is hereby made for a Permit to Construct ( ) or RepairNXX) an Individual Sewage Disposal System at: 692 Craigville Beach Road We,6�t Hyannisport ,Mass -. _ •__-..-._ Location-Address or Lot No- Walsh ...............................•----...---••••---•••----......---••-------•-•--...............--•- rra J.P.Macomber Jr. owner Address Installer Address Type of Building Size Lot...:........................Sq. feet V DwellingXXNo. of Bedrooms...............3..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures ------------------------- ----------------------------•---•----------••--•--------•--•----•----•---------------------•--.....--------•--••-•--....... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of.Test Pit---................ Depth to ground water........................ a ------------------------------•-•--•--•-••••--••••---------•---•--------..........-------•---•............................................................... 0 Description of Soil............................................................................... -------------------------------------------.....------------------------..........------ c4 ...............Sand...&...Gra ve-1•------------------------------------------------------ W V Nature of Repairs or Alterations—Answer when applicable................ ............................................................................ 1--15Q0--.gallon• tank 1-1��0_�J__ a_llon leach p_it one distribution box. -------------------•---------------------------------...._......---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersi ned further agrees not to place the system in operation until a Certificate of Compli nce ha be iss ed by t and of health. � 12/18/92 - - Dace Application Approved By --------- ------------ - ----------------------------- ....-..../`----- ------/ 7`- Dace Application Disapproved for the following reasons: ...... . -------------------------------------------------------------------- -------- -------------------------------- ---- ------------------------ ------------ - -------------------- -- - --- ------------------- ------------------------------ -- -- ------------------------------------ - ------ ---------- -------------- -- --- Dare I,z Permit No. .....--- --�-� ------ -- ---- -------------- Issued -----------`-----------�.�— .� Dare AR 2; No. /FEB_29Lt_Q0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF' HEALTH TOWN OF BARNSTABLE Appliratilan for Disposal Narks Tonstrnr#iun f aria Application is hereby made fora Permit to Construct ( ) or Repairx(XX) an Individual Sewage Disposal System at: 692 Craigville Beach Road West Hyannisport ,Mass •----- ----- ---- ----------------------....._._..... ___________-------_._._ Location-Address or Lot No. Walsh - -__......... - ... W J.P.Ma e o mb e r Jr. Owner Address ,. ......... ................... - -- --------- Installer Address d Type of Building Size Lot....-----------------------Sq. feet aDwellingXXNo. of Bedrooms----------------- --------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.-.______-__-_____-__-_--__- Showers ( ) — Cafeteria ( ) Other fixtures - ---------------------------------------------------------------------------- - .. W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length---_----------- Width................ Diameter---------------- Depth--------------_ x Disposal Trench—No..................... Width.................... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet-------------------- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `4 Percolation Test Results Performed by.......................................................................... Date---------------------------------------- 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water....................... Gi, Test Pit No. 2----------------minutes per inch Depth of Test Pit--------------------- Depth to ground water------------------------ 04 •----------------------------------------------------------•-----------------------------•------------------------------------------------------------------- 0 Description of Soil----------------------------- --------------------------------------------------------------------------------------------------------------------------•------------- xSand--�--Grave 1----------------------------------------------------------------------------------------------------------------------------------- W � ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations-Answer when applicable-----------------------------------------------------•___...................................... 1_-15U0__w_allon tank 1-1'-'0Q__.__allon leach pit one distribution box. ------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli nce ha bee iss ed by the board of health. igned e 12/1B/92 --- ----- -------------------------- ---------------------------------------- Date Application Approved By ......... Application Disapproved for the following reasons- -------------------------------------------------------------/------------------------------------..._------------------------------ ------ ---------------------- --------------------------------------------------------- ----------------------------------------------- ---------------------------------------- 5 Dare i, Permit No. ------.. ----------------------------Issued -----------j/e--7 "--- -------------------------....... I5are 1..../ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (gontyliance THIS IS TO C l,b TIDY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX ) j .P.Macunl e Jr. by Installer at 92 Craigville -Beach Road Weft Hvanni-stomtt------------------------------------------------------------------------------------ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........ .IF. ...... dated .../,/ -----7�".. . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUED AS A GUARANTEE THAT-THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------------------------------------I -- v7 y` ....> Inspector �- -------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �C �, TOWN OF BARNSTABLE $ 30.00 No......... L� FEE.....••---------------- Disposal ]Burks Ton#ructian famd J P Macomber Jr. Permission is hereby granted -----------•---- ----- .-__ to Construct ( ) or Repair X)X an Individual Sewage Disposal System at No.....F92...Craigville__---each__Road__West_-_Hyannisport---------------------------------------•_ __ - -___ _ Street / as shown on the application for Disposal Works Construction Permit No��%_-.:P Dated... ---------------------- W----- ------------------ j DATE............ -=�----��------ 57.................. Board of Health FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS TOWN OF BARNSTABLE LOCATION Crn'�e- ,Gee,c A 17d SEWAGE # r $ VILLAGE . ;,',IIe 5L ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. l� dYlaco ��� r.S'a,� 14c. SEPTIC TANK CAPACITY cc,/ LEACHING FACILITY:(type) �. T. (size) bz 4 NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER W DATE PERMIT ISSUED: ' ?� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 /J �\ 1 � �, ��� �� _ ��. / � � J'�� ' � � }���. r"' - - - - p ,� k ACCESS COVERS MUST 8E WITHIN 3" MINIMUM. INVERT ELEVATIONS -DES l GN CR I TER/ A .- GENERAL NO TES : 6" OF FINISH GRADE 3' MAXIMUM COVER MIN 2" OF -PEASTONE OR FILTER FABRIC INVERT OUT SEPTIC TANK: 98. 1 FIRST 2' TO DESIGN FLOW: CHARCOAL L / INVERT IN DI5T. BOX: 96.77 3 BEDROOMS AT I lO G.P.D. PER I. THIS PLAN IS FOR THE DESI GN AND CONSTRUCTION BE LEVEL CHARCOAL FILTER '✓ IB• MIN INVERT OUT DIST. BOX: 96.6 BEDROOM EQUALS 330 G.P.D. . OF THE SEWAGE DISPOSAL SYSTEM ONLY, 4' DIAM PIE +INVERT IN LEACH CHAMBER: 96•S 3/4` - I I/2" D l A. NO GARBAGE GRINDER ✓ 2. VER T I CAL DATUM IS ASSUMED. FOR BENCH MARKS BOTTOM OF LEACH CHAMBER: 94.5 98. 1 96.6 2 ' DOUBLE WASHED STONE SET. SEE SI TE PLAN. GAS 96.77 v 96.5 $ 94.5 ADJUSTED GROUND WATER: N/A BAFFLED SEPT I C TANK REQUIRED: 3 OUTLET 2-500 GAL LEACHING CHAMBERS OBSERVED GROUND WATER: N/A �� � --�--- 330 G.P.D. X 2b0� � 660 GAL, J. ALL CONSTRUCTION METHODS AND MATERIALS AND EXISTING D-BOX �l/4' STONE AROUND, 12.8'w x 25'1 x 2'd BOTTOM OF TEST HOLE f: 88.9 SEPTIC TANK PROVIDED: 1000 GAL, EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1000 GAL H-20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6" CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DESIGN PERC RATE ( 5 MIN/INCH SOIL TEXTURAL CLASS - I 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER PROFILE : NOT TO SCALE EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED TAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. PROVIDED: 2-500 GAL LEACHING CHAMBERS W/4' STONE AROUND. A-471 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 471 S.F. x 0.74 - 348 G.P.D. APPROVED EQUAL. - 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED SOIL TEST PI T DA TA & PRECAST CONCRETE OR APPROVED POLYETHYLENE. INDICATES �_ INDICATES BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER cBiDH FND 8O.00 PERCOLATION OBSERVED TESTED FOR LEVEL WHEN THERE IS MORE THAN'ONE CB/DH FND T srocKAaE FFENCE�" � TEST - GROUNDWATER OUTLET. --`_ (_ r j°o- ` TP #1 P#14745 TP #2 AREA EA 7. BEFORE CONSTRUCTION CALL "DIG-SAFE". ( ( r ( 1 I HORIZON TEXTURE COLOR HOR l ZON TEXTURE COLOR 1-888-DIG-SAFE AND THE LOCAL WA TER DEPT. b" 99.9 0" 99.9 FOR LOCATION OF UNDERGROUND UT I L I T I ES. 1O. OOt S.F. � ' I ll A LOAMY IOYR A LOAMY IOYR I / I SAND 3/2 SAND 3/2 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE ( 1 � i/ DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION p LOAMY IOYR LOAMY IOYR I I © SAND 5/6 B SAND 5/6 OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE OfC 26- - - - - - - - - - - - - - - - - - - - - 97.7 24" - - - - - - - - - - - - - - - - - - - 97.9 CONSTRUCTION INSPECTIONS. MED-COARSE 2.5Y C/ MED-COARSE 2.5Y SAND 7/3 SAND 7/3 EXISTING LEACH PIT TO BE PUMPED DRY AND I BM. CORNER STEP , I i I BACKFILLED. . i ExI sTIN i /0. WHERE THE SEWER LINE CROSSES THE WATER L I NE, SEPTIC ANK I I I 44_ SLEEVE THE SEWER LINE WITH A LARGER DIAMETER 4 9B.2 EX/Sr/NG O�ECC/NG I i PIPE FOR l0' EITHER SIDE. Ill.6 - ��i NO WA TER NO WA TER I II 132" 88.9 I20" 89.9 SEE NOTE 10. f f DATE: JULY 9, 2015 LEACH �( (( 1 TEST BY: STEPHEN HAAS PIT 97.8 WITNESSED BY: DAVID STANTON PERC RATE: < 2 MIN/INCH w � N o \�-STONE DR I VEWAY �� ( II Ml � t a s ', a,, TPxI p ^ly 2-500 GAL ---- , D-BOX LEACHING CHAMBERS 1 t W14 STONE AROUND / Z�?f 10 99,5r ....... I I FLAGPOLE 99.2 VENT J ! 97.J 97,6 7_` I SIDEWALK+ S E P T ! C S Y S T i.�. ! V/ C) L7 Sl O / Y 97.7 - 97.S 97. ! ! I 692 CRA I GV 1 L L E BEACH ROAD . MAP 226 , PCL 122 BARNST*4BLE . MA . t CENTER V 1 L �,.. E ) CRA I GV I LLB' BEACH ROAD PREPAREC� FOR LEGEND z M l CHEL E AL VES � ■ CB CONCRETE BOUND FR o -W WATER L I NE L OC /CCF c J GVILLE BEACH ROAD CO HYDRANT S C,4 L E : I -- 2 O S E P T E•M B ER 3 2015 1 G GAS LINE OHW---- OVER HEAD WIRES S T E P H E N A . H A A S C IGHT POST E NC-.G f N E E R i N G INC -f--- UNDERGROUND ELECTRIC LINE -T- UNDERGROUND TELEPHONE L l NE /� o P . O . B o x 16 -CTV- UNDERGROUND CABL EV I S I ON LINE / /j,~ i�`• 1 �1\�� s o u t h D e n n i s MA 0 2 6 6 0 .508 ' 362-8 1 32 +40.4 SPOT ELEVATION CENTERVILLE HARBOR i _­."'40 EXISTING CONTOUR ' 0 /O 20 40 PROPOSED CONTOUR 1 LOCUS MAP JOB NO: 15-039 i j 'i 'i