HomeMy WebLinkAbout1258 CRAIGVILLE BEACH ROAD - Health (2) 1258 Craigville Beach Road
Centerville P
A = 206 081001
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No. 4210 1/3 O RA
Pendaflexe
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No. l Fee �oV
- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: "
,Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpphration for Mtgaal bpgtem Conttrurtion Permit
Application for a Permit to Construct( , )Repair( )Upgrade( . Ab on( ) O Complete System ❑Individual Components
Location Address or Lot No. s dress an 6 No.
C��vfi%ti B
Assessor's Map/Parcel
Ins er's�gtpe,Ad s,and Tgj•Np.�P / Designer's Name,Address and Tel.No.
p� rvCrioSJ -�- NL
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank C?r Type of S.A.S.
Description of Soil
Nature epairs or Alterations(Answer when applicable) �d t.J f 5�� � 4VIA k
:94
Date last inspected:
Agreement:
The undersigned agrees to the construction and mainte ce of the afore described on-site sewage disposal system
in accordance with the isions of Title 5 o onmerta ode and not to place the system in operationTo
l a ertifi-
Cate of Compliance h b issued o e R
Sig Date
Application Approved by : Date 116b&
Application Disapproved fo a following reasons
Permit No. z 00 Date Issued 4 0 ,,
f -
` No. 0v 1`t's 1 y 4ry "; =�^' —t lea 4 Fee r `
THE C M ONWE TH r0�'MA�SS�4 HUSETT Entered in computer.: t�
= " t Yes
PUBLIC HEAL�TH DIVISION -TdOWN OF BARNSTABLE., MASSACHUSETTS
'f '� prtrati `for fg 65al Stem Conttrurttot� Permit
p Sao 4 .
Application fora Permit to Construct( )Repair( )Upgrade( elan on( 1) l Comple� rle�System` El Individual Components
' Location Address or Lot No. ��, �j 's arse, dress an l.No.
t�
Q A S fi•
Assessor's Map/Parcel / C oM
�P t
e
Inds�1�eINae,ASs,and Tg�ls No. Designer's Name,Add d Tel.No.
Oa laJtrroU 4- AjC
Type of Building: 4�
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Pers ns Showers( ) Cafeteria( ) s
Other Fixtures _
Design Flow gallonsper dalculated daily flow gallons.
Plan,,Date Number of she t Revision Date
Title
Size of Septic Tank f C��. Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 0 t�J e
�!' �1jO—A 5 l S/
�)J n., �k.f non u we
Date last inspected:
Agreement:
The undersigned agrees to ensur a the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the r• v�ns of Title 5 o f, ronmenta" s ode and not to place the system in operation until a Certifi-
cate of Compliance ha§be is,ued�by this oat e
Signed, 1 Date
Applicatio,~',-Approved by- � Mtn 1 � Date - /i://,>/`, 2
Application Disapproved for the following reasons' f
Permit No. 2 Oo? ,�/ Date Issued 1� /�
I THE COMMONWEALTH OF MASSACHUSETTS
kf !o r'� je'A'- , ,7/
BARNSTABLE, MASSACHUSETTS
Certtftrate of Compliance
THIS IS TO CER ,t at the On- ite Sewa a Disposal System Constructed( )Repaired( )Upgraded(x )
Abandoned( )by �f r0S rr v[ t e,/ 'Tip: C.
at 2 fb' v • , �� has been constructed in accordance
with the provisions o Title 5 and the for Disposal System Construction Permit No. W -91 dated� %,/u l o u
Installer Designer ' • �,
The issuance oft0i
pe t shall not be construed as a guarantee that the syste wP•l n tion as esigned.
Date lJ� Inspector -` P
No. U U — .-5 ! Fee Od
a THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Miopoar *pgtem Cottgtrurtiou Permit
Permission is hereby granted to Construct( )Repair( )Upgrade(�4,)Abandon( )
System located at 2S r
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes,his/her duty to
comply with Title 5 and the following local provisions or special conditions. '
Provided:Construction must be completed within three years of the date df this p—�it�
Date: /0 l 0— 0 3 Approved by __l G�J
� zel
h
`I
-� COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE 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
Govemor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION /
P
Property Address: 1268 CRAIGVILLE BEACH RD. CENTERVILLE o� u� Q1�0 L`
Name of Owner JOAN BRUNNICK �}
Address of Owner: SAME
Date of Inspection: 5/5199 �
Name of Inspector:(Please Print)JOHN GRACI Q Q
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: n/a �`Z9 i ems'
Mailing Address: n/a
Telephone Number: n/a Z A
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 Further Ev ion 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:5/6/99
The System Inspector shal submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL
LIFE.
revised 9/2/98 Page 1 of 11
1,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1258 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:5/5/99
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:
nla 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.
nLa 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.
n/a Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health).
_ broken pipe(s)are replaced
_ obstruction is removed
distribution box is levelled or replaced
nLa The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
_ obstruction is removed
revised 9/2198 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1268 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:5/5/99
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 9/2/98 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1268 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:5/5199
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 n1a.
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 9/2/98 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1258 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:515199
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.
xAs 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: 1258 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:5/5/99
FLOW CONDITIONS
RESIDENTIAL:
Design flow:A4.Q g.p.d./bedroom
Number of bedrooms(design): 4 Number of bedrooms(actual):4
Total DESIGN flow: RU
Number of current residents:)
Garbage grinder(yes or no):YES
Laundry(separate system)(yes or no): NQ If yes,separate inspection required
Laundry system inspected(yes or no):JLQ
Seasonal use(yes or no):_NQ
Water meter readings,if available(last two year's usage(gpd): n/a
Sump Pump(yes or no): NQ
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow: n/a gpd(Based on 15.203)
Basis of design flow: n/a
Grease trap present:(yes or no):.NLQ
Industrial Waste Holding Tank present:(yes or no): NQ
Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ
Water meter readings.if available:n/a
Last date of occupancy: n/a
OTHER: (Describe)
n/a
Last date of occupancy: n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n/A
System pumped as part of inspection:(yes or no):NQ
If yes,volume pumped n/a. gallons
Reason for pumping: Wa
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes.attach previous inspection records,if any)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other: n/a
APPROXIMATE AGE of all components,date installed(if known)and source of information:
NEW SYSTEM WAS INSTALLED 3 5 YEARS AGO BY BORTOLOTTI
Sewage odors detected when arriving at the site:(yes or no) NQ
revised 9/2/98 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1268 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:6/6199
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 2.6..
Material of construction:_ cast iron X 40 PVC _ other(explain)
Distance from private water supply well or suction line: TOWN
Diameter: nLa
Comments: (condition of joints,venting,evidence of leakage,etc.)
D&
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 2'
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
DLa
Dimensions: L 10'6"H 5'7"W 6'8"
Sludge depth: Z!
Distance from top of sludge to bottom of outlet tee or baffle: 2
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: HE
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 PLUMPING SYSTEM EVERY TWO YEARS
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain)
nLa
Dimensions: n&
Scum thickness: n&
Distance from top of scum to top of outlet tee or baffle:jiLa
Distance from bottom of scum to bottom of outlet tee or baffle Wa
Date of last pumping: nta
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.)
nta
revised 9/2198 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1268 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:6/6/99
TIGHT OR HOLDING TANK: NQ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: n1A
Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain)
D&
Dimensions: n&
Capacity: n& gallons
Design flow: n& gallons/day
Alarm present: NQ
Alarm level:jila- Alarm in working order:Yes_No_ NQ
Date of previous pumping: n1a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n&
DISTRIBUTION BOX: X
(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.)
THERE IS A CLEAN-OUT IN A CONCRETE BASIN, LIQUID WAS FLOWING PROPERLY
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/A
revised 9/2/98 Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1268 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:5/5/99
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:
n(a
Type:
leaching pits,number: Wa
leaching chambers,number: 6-500 GALLON DRY WELL CHAMBERS
leaching galleries,number: 1]/H
leaching trenches,number,length: Wa
leaching fields,number,dimensions: Wa
overflow cesspool,number: Wa
Alternative system: n(a
Name of Technology: ji&
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE DRYWELL CHAMERS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY SYSTEM SHOWS NO SIGNS OF FAUILURE
CESSPOOLS: _
(locate on site plan)
Number and configuration: n&
Depth-top of liquid to inlet invert: n(a
Depth of solids layer: n&
Depth of scum layer. Wa
Dimensions of cesspool: n&
Materials of construction: Wa
Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)n&
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
Wa
PRIVY: _
(locate on site plan)
Materials of construction:n& Dimensions:n&
Depth of solids: n&
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n&
revised 9/2/98 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1268 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:5/5/99
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
Gg QvfC�
ft �
GA (�
J ,J
I
O eck. g A AA 14
a AB
M Iq
I3h I
revised 9/2/98 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1268 CRAIGVILLE BEACH RD.CENTERVILLE
Owner: JOAN BRUNNICK
Date of Inspection:515199
NRCSReportname: Wa
Soil Type: nLa
Typical depth to groundwater: nLa
USGS Date website visited: n&
Observation Wells checked: NO
Groundwater depth:Shallow _ Moderate _ Deep _
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
_ Shallow wells
Estimated Depth to Groundwater 12 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
_ Obtained from Design Plans on record
X 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)
USGS MAPS AND CHARTS AND VISUAL
revised 9/2/98 Page 11 of 11
No..e. k; Fim.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
I.0.C)4).--..........OF........
Appliration for Dispaiial Works Tonotrurtion rnmit
Application is hereby made for a Permit to Construct or Repair (A-)-an Individual Sewage Disposal
System at:
...&AP
................ .... ..............................................
Location-Address or 1, No
.......... ..... ... .
C
_4............................... r ._. _jV
J"rdd
e!!7g,5 TZ,
.................................. K�
..................................... .....
_r.................... ...........................
Installer Address
Type of Building Size Lot----4-1---S....5......1_5_......Sq. feet
U
14 Dwelling—No. of Bedrooms..........Ce..............................Expansion Attic Garbage Grinder
a
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Other fixtures
Design Flow.............J-1-6..._...._._.._._____gallons per person per day. Total d4ly flow__.____..___...
..................gallons.
1:4 S tic Tank—Liquid capaciV.160d allons Length Width-5.-9;� Diameter---------------- Depthe'-Vf
W q. ft.
Z No. ......../P...... Width..11,17....... Total Length.....6.7!!jO.. Total leaching area.-10-9-!�.4s-------
Seepage Pit No_____________________ Diameter..__.___._......_ Depth below inlet.._............._... Total leaching area..................sq. ft.
Z Other Distribution box A,�r Dosi ank
Percolation Test Results Performed by._ 0 -----------------------
Test Pit No. I......2-------minutesperinch Depth of Test Pit___1,0.......... Depth to ground water.TIk]49Z.......
rX4 Test Pit No. 2......e.......minutes per inch Depth of Test Pit...1-4:n... Depth to ground water_r70)_?_Q--------
1P ,. 00
....C..
T-P*I.... ....... r
0 Description of Soil-------------. --------......
U ---------------------------------------------44
...........
----------------------------------------------------------------------------------------------------WL.............................................................
------------------------------------0950!_�425_*.....
Xt-T
.............................
U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
......................................................................................................................................................... ..............................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewa��Disposal System in accordance with
_i _
the provisions of TITLE 5 of the State Environmental Co, he andsigned-le further agrees not place the
system in operation until a Certificate of Com n b e s e board of 4ie
Signe .....- .... .... ....... ...... ---- ------------- ..../-------16--------- ------- ..........
Dar
ApplicationApproved By . ..... .... ..... ----------- .. .. ... ... ...... ------------- ---------------------------------------
Date
Application Disapproved for the following ream s. .......................................................................... ------------------------------------------------------------
-------------------------------------------
....... -- --- .... .................................
---- ---- -------------------------------------------------------------------------------------- Date
Permit No. ..... Issued ...
---- -- --- --
D t,,
No................_....... Fx$..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
- r
f—
r� . ..
ApplirFation for Disposal Works Tnnstrnrtinn rumit
Application is hereby made for a Permit to Construct ( ) or Repair (4a. an Individual Sewage Disposal
System at:
Location-AAdress or Lot No. r
dC:f:*.-----".......................... I_?: (f_!/3 4 = -�4-•'- 1(.. � yJ:� fc_ve C
_.:�_ _ "=. ..._
Owner Address 0 G I
W
Installer Address
Type of Building Size ?.. �.....Sq. feet
Dwelling—No. of Bedrooms........ ..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q'I Other fixtures ................................ .
Design Flow.............1•10....................gal lons per person per day. Total daily flow.._..........._.�.f4...- ::..................gallons.
M Se tic Tank,—Liquid capacity__�.� /gallons Length_ ;?_:. �_._ Width_�"','t.:_ �..._ Diameter-_.--___--_-_- Depth.z'. ---_-
W D4_ "` 'rerek�-No.................... Width-_U..i.7....... Total Length""-- ZO.. Total leaching area.�!::�_r2.:.=-.sq. ft.
x
Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( +y'j DosiVank
aPercolation Test Results, Performed by-----.-IZ CJ .......................... Date.. .4-.L_:"..E_ -�_.►_.1.._E.,)
14 Test Pit No. I..... ........minutes per inch Depth of Test Pit....C............ Depth to ground water_s' -.Q....,...
44 Test Pit No. 2.....Z........minutes per, inch Depth of Test Pit---)._Ca......_... Depth to ground water.; %t-�_e--------
* t# I f
O x � iF tcs Soil � _ '
1 � tZr 5
f' _ - , �
"--""""-""------------------------"...-"""""""---""--"""------------"--"-"""--""---"--...-------•"---""•-----""----------•--------""----------•-"""""......"-----""--""------------•---....-•------•-•-
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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed ---------------- ---- --- ----------------------------------- --- - ----------------------- -----------------------------.........
ApplicationApproved By ------------------------- ------ --- ------- --------------------------I-------------------------------------------------------------------- --- ---------------------------------
Dare
Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------------------------------------------
................................................................................................................................................................................................................ ... ..............................
Date
PermitNo- -- ------ ------- ------ ----------- ----------------- Issued --------------------................-- ----- --.....--....--....
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF.HEALTH
OF . ; t!: 1 .j. � '� --- . - C'lertifir tt of (foutylianre
T.
Tgr}C` ` �FY, T at the Individual Sewage Disposal System constructed ( ) or Repaired
by s ------------�--� - '----------- ------------- -- ............._.................----- ------- --------......................
- Installe .. . .......... . ....................................
at �'`b - - --------------------- ------------ ._ .. ` -
has been installed in ��'C-Cordanctglwlth the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ................................................ dated .................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WIL��FU11N SA;TIS TORY. � le
�•j
DATE.... ............................................................. .. . ...........................---......-------------------------------- Inspector ._..........------- ------- `.... ......._.-...
THE COMMONWEALTH OF MASSACHUSETTS
y BOARI?,j OF HEALTH
-
�.: !�
No......................... OF.... FEE........................
Disposal Works Tonstrnrtion frrmit
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..................... Dated..........................................
•---"•--•"•"•--•-"......""-"""..............."-----........."""""----...•.......__..._..............._._
Board of Health
DATE_"---""""---""-"""""""-"-"-•---"""""""-•---"-•.................................
FORM 1255 A.M.SULKIN CO.
i
4 f
Town of Barnstable
R
? ABM Department of Health, Safety, and Environmental Services
MA98.
�""'� S: Public Health Division
t63¢ ♦�
61 367 Main Street, Hyannis MA 02601
Office: 509-790-6265 'Thomas A McKean
FAX: 508-775-3344 Director of Public Heafth
9/27/95
Joan Brunnick
1258 Craigville Beach Road
Centerville,MA 02632
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5.
The septic system owned by you located at 1258 Craigville Beach Road, Centerville was
inspected on June 12, 1995 by Hilliard Hiller a Massachusetts licensed septic inspector.
The inspection of your septic system showed that your system has failed under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Static liquid level "into the bottom riser"
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen
days of receipt of this notice. You are also directed to bring the septic system into
compliance within thirty (30) days of receipt of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
[Installer letter] Sl
TO: '�92'&A✓>e 1 ' (Date)
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5. ,«�i 'Z z '
The septic system owned by you located at
inspected on 95"by /-4 tAfioe! a Mass chusetts licensed septic
inspector.
The inspection of your septic system showed that your system has failed under the
guidelines of 1995 TITLE 5 (310 CM 15.00) due to the following:
R
A6L,d 17-4c �Z; c �,9 i Z-('22 0 2V4
You are directed•to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of
receipt of this notice.
You are also directed to bring the septic system into compliance within thirty (30) days of
receipt of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
Town of Barnstable
PA F--. Reall Estate Syst.Ea,rn C,3ener-al F:T,operty InquiAr-y He 1 p
t No, Par-enti
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T,,il::<' T i t I e" A c t:C)i..,t n t 'F...-ni e n c Press X11"IT for-, mtoie data
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ASSESSORS MAP NU; '
PARCEL Na
CERTIFIED SEPTIC SYSTEM REPORT
LOCATION
1258 CRAIGVILLE BEACH RD .
CENTERVILLE, MA 02632
MAP 206 PARCEL 081001 LOT 1
PREPARED FOR
SELLER
MS. JOAN BRUNNICK
1258 CRAIGVILLE BEACH RD.
CENTERVILLE, MA 02632
BUYER
NONE AT THIS TIME 10" �� A
Cj _
1� Fe f �
PREPARED BY
HILLIARD HILLER, JR. S
P .G. BOX 250
CENTERVILLE, MA 02632
508-778-1472
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Address of property /aS-3 111?10 /y/I/IV tfa_Ze
owner's name Al--fS.
Date of Inspection ,��30� G!� $ G/i1 Jqg''
PART A
CHECKLIST
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of
Health.
&--f None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during that
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection.
✓ As built plans have been obtained and examined. Note if they are not
available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
i/ The site was inspected for signs of breakout.
✓ All system components, excluding the SAS, have been located on the
site.
The septic tank manholes were uncovered, .opened, and the interior of
the septic tank was inspected for condition of baffles or tees,
material of construction, dimensions, depth of liquid, depth of
sludge, depth of scum.
r// The size and location of the SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Address of property /05-8 G/1#Xl IcG,E
Owner' s name 1-74S, J.
Date of Inspection 6-1,2,-21
PART A
CHECKLIST
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of
Health.
!/ None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during that
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection.
V/11 As built plans have been obtained and examined. Note if they are not
available with N/A.
The facility or dwelling was inspected for signs of sewage back--up.
y The site was inspected for signs of breakout.
(/ All system components, �cluding the SAS, have been located on the
site.
The septic tank manholes were uncovered, opened, and the interior of
the septic tank was inspected for condition of baffles or tees,
material of construction, dimensions, depth of liquid, depth of
sludge, depth of scum.
The size and location of the SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
r/ The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
tom=
8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
NJi9/�!l �}ovS F_
FLOW CONDITIONS
If residential
L/ number of bedrooms
number of current residents
garbage grinder, yes or no
Vfe laundry connected to system, yes or no
-_ILla seasonal use, yes or no
If nonresidential, calculated flow:
Water meter readings, if available: /91y
(/SA�,E /,flG L vD,� Gv7TfJ�sE Gil /,��G�' /�/93 85/av0 GfI L
S194174f Last date of occupancy
GENERAL INFORMATION
Pumping records and source of information:
System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
'type of system
_Z,,," 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)
Other. (explain)
Approximate age of all components. Date installed, if known. Source of
information:
Sewage odors detected when arriving at the site, yes or no
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK: Y,6S
(locate on site plan)
depth below grade: ZV f n/ od1G v io4
material of construction: &,,e concrete metal FRP other(explain)
dimensions:
/O sludge depth
-R3„ distance from top of sludge to bottom of outlet tee or baffle
/3" scum thickness
3 '' distance from top of scum to top of outlet tee or baffle
distance from bottom of scum to bottom of outlet tee or baffle
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, recommendations for repairs, etc. )
NO 51641. of 444-, 'AGE L lcr/�4Sc G Cp Gc�C�
DISTRIBUTION BOX:_
(locate on .site plan)
depth of liquid level above outlet invert
Comments:
(note if level and distribution is equal, evidence of solids carryover,
evidence of leakage into or out of box, recommendation for repairs, etc. )
iVaif/� �,E/1 /,ySTT1GLG(S .D//1G./lgi�i
PUMP CHAMBER:
(locate on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs, etc. )
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) : YfzS
(locate on site plan, if possible; excavation. not required, but may be .
approximated by non-intrusive methods)
If not determined to. be present, explain.:
6 gg2. GaZlAel =/7 ' q/SAS "' ;Z I-D
Type
leaching pits and number
leaching chambers and number
leaching galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool, number
Comments:
(note condition of soil , signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
CESSPOOLS (locate on site plan) :
number and configuration
depth-top of liquid to inlet invert
depth of solids layer
depth of scum layer
dimensions of cesspool
materials of construction
indication of groundwater
inflow (cesspool must be pumped as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
PRIVY:
(locate on site plan)
materials of construction
dimensions
depth of solids
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc, )
- 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM: /a5 F G�i�lGv/LlE C�Ef/Gfl �QD h�'�
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100 '
/ G
F v,uT
DEP'1H TO GROUNDWATER
depth to groundwater
method of determination or approximation:
61�i?�I.STAigL 2 G/S 1,�'T 7''11 X
OAT`/ f0 TN�E 7-11 5.-V )5 G" %&,C 6-6G5 /s a? 7'
ggo- JcVS- - 9,7_ G,8"
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined" , explain why not)
/N Backup of sewage into facility?
- Al Discharge or ponding of effluent to the surface of the ground or
surface waters?
Static liqquid level in the distribution box above outlet invert?
A114 Liquid depth in cesspool <6" below invert or available volume< 1/2 day
flow?
P Required pumping 4 times or more in the last year?
number of times pumped
IV Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent?
Is any portion of the SAS, cesspool or privy:
LJ below the high groundwater elevation?
within 50 feet of a surface water?
_I within. 100 feet of a surface water supply or tributary to a surface
water supply?
within a Zone I of a public well?
within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the, SAS) ?
_ within 50 feet of a private water supply well?
A/ 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 analysi
for coliform bacteria, volatile organic compounds,' ammonia nitrogen
and nitrate nitrogen.
r
TOWN OF BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM- PART D - CERTIFICATION
-TYPE OR PRINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS IaSB
ASSESSORS MAP, BLOCK AND PARCEL # a�f�8i�� L�r /
OWNER' s NAME /'15. voIfV /2. /IL-IA1-i "t
PART D - CERTIFICATION
NAME OF INSPECTOR f1/G1_111X-D 111Z-Z 11 J/1-
COMPANY NAME
COMPANY ADDRESS _ �G? &,:fix o?SD
Street Town or City State ZIP.
COMPANY TELEPHONE (,SOS ) 77� - /y FAX
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate , and
complete 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 :
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.
C- t
=_S-y-s-te.m FAILED
The inspection which I have conducted has found that the system fails to
protect the public health and the cnvironment in accordance with Title
5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form.
Inspector Signature Date 7 S 915�
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF HEALTH.
* If the inspection FAILED, the owner or operator shall upgrade the system
within one year of the date of the inspection, unless allowed or required
otherwise as provided in 310 CMR 15 . 305 .
partd.doc
,
KEY NUMBER <742 >
NAME <BRUNNICK, JOAN > B-C 1 B-C 2
B-C 3 B-C 4
STREET 1258 CRAIGVILLE BEACH ROAD
CITY CENTERVILLE ST MA ZIP 02632-3506 REF 1 REF 2
PHONE ( ) - REF 3 REF 4
METER NO. < 1576> DATE READING CONS
STREET <CRAIGVILLE BEACH RD NO. 1258> 12/31/94 215 25 y�
CITY CEN P ST LOC 06/30/94 190 16
PHONE (508 ) 790-3124 12/31/93 174 248s
06/30/93 150 61
ROUTE NUMBER 24 12/31/92 89 35
SERVICE DATE 03/27/54 06/30/92 54 35 7-19
METER DATE 08/12/91 12/31/91 19 29 y8
CAPACITY 7 06/30/91 0 19
STYLE T10
SIZE 2 RATE SCHEDULE
KEY PIT PLASTIC
NOTE RR LEFT SIDE ADDITIONAL CONS 0
ALTERNATE MIN 0
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.....!.. U)n.........,OF..... .. r SSl..fi(..F.1L ....................................
Appliration for Disposal Works Tonstrnrtion 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System-at
p
. .. . ..__ - ------------------------------------------------------------------------------
Location-Address /� - or Lot No.
--------------------------•--------- L c.11". .1'IdJ.�.ej�............--............................................
Owner Address
a �.T,�°_L))?? bey-... . �` ........... r..t�,�11. .......................................................
Installer Address
PQ
Type of Building Size Lot.............................Sq. feet
U Dwelling—No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' 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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x
s--- p
O Description of Soil-----.....- .. C1L----------------•-•--------------------------------•--------............_....-•---------------•
x
t., -•----------------•-----------------------. -- ......---------------------------------------------------------------___-------------------------------______---------------------------------------
x --••-••-•-••-------------------------------••--••••-•--•--•---•-•---•••-•-•--•---••••-•-•--•._.•-•••-. ..•••-••••••-------------------
U Nature of Repairs or Alterations—Answer when applicable.......... Q.J .- JW7...................................................
Agreement: �-
The undersigned agrees to install the aforedescribed Individual`Sewage Disposal System in accordance with
the provisions of iiTH.;,,. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en issued by the board of health. 1
ell Date
Application Approved By.. - ---'--G � L ..
Date
Application Disapproved for the following reasons:-------•--------------------------------------------------------------------•---------------------._.....•-----
------•-----------------------------------------------••-••-•---•-•---•-------••---------••-••--•--...---------•----•---•-----•-----•-• •-•-••••••---••-•-•-----••--•-••---•--------
Date
PermitNo......................................................... :Issued ......................
Date
No8Q.-s��'___`__2 Fxs..........._.......
�._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f..-""--".....OF.. .:.....:......................' ......../
.............................................
Appliration for Disposal Works Tonstrnrtion rrutit
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at• .
................_.:......... ...................................................... -----....._..-•----•--••----•------••-------......---•------------...-----------..................
Location-Address r or Lot No.
' t
.... _.....................: .:.................................•-------...-- •-•--.....----...._....c...-•---•=--•-•----....__.....---••-----•-----............._.......-......
Owner Address
W ,
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a'4 Other—T e of Building No. of persons............................ Showers
YP g ---------------------------- P ( )--- Cafeteria ( )
dOther 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........................
fL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
............................------•-•------------------.......------......._----••---•------__-•--••.........................................................
Description of Soil = .:..:_..,.
x --------------------•--...------------------•------------.....-----•--.....---.....-•----------......_---------••---
W
Z.
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 AITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
ned -- --•-........ ---•------••---•--------------
Date
Application Approved BY. , �---
................... ..... ... .
Date ._..
Application Disapproved for the following reasons:__...-----•••••-----------•---------------------•-•---•••---•-•-----•---•-••------•......_..--•---......_------
••...............•-•---------•-------......---------•--•••-------•---•----...-•------••---...-----....----••-•---.........-•--------•---•----------•----••-------------•••--•-•--••-••--------...-•-•---
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
:...'....:.................OF.....
Tutifirtt#r of Toutpliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by '...........- -••'•--1.....-----•-- r --_r---'--•-••------------------------------•----•--••------•-•---•---------•----............._-----
Installer
has been installed in accordance with the provisions of TITT� 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.- oit.. ............. dated-...............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.... •--•• `_.. ! :.................•--....-----••••• Inspector......_.. .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No 4/ C..................... FEE._.......__.............
Dismal Works Tontrnrtion frqtit
Permission is hereby granted..._f...t:f._..1d !f/_c'__/ J !- -1 :. /i.......r-_
•-------------•----........................_..
to Construct ( ) ,or.. Repair an Individual Sewage Disposal System --—
at No... ._ .........t I�/�rJ �!-!c= ='- ......................r r� �S'j ! t- --:/ //•--, l "l---_--•--
f
-•- y ••--••.... --------•----------- ------------•----
,,,--Street
as shown on the application for Disposal Works Construction--P�er No..................... Dated..........j...............................
f -------------------
................................. Board of Health
DATE.......... --�-���-,--�----��'�--�`1
FORM 1288.,HOBBS & WARREN, INC., PUBLISHERS ��
LEGEND ABBREVIATIONS
4
n . l
• •"' ♦: •"
BRB SEAL
'°` = UTILITY POLE
: FND/SEAL
• '` -
x. - - - YARD LIGHT
' o BOUND
n
>
o STAKE & TACK SET
MAG NAIL SET
FWM1 WATER METER
GM = GAS METER
EM
ELECTRIC METER
«w--Oft«�- = OVERHEAD WIRES
u{ 160 = TREE LINE
00 = TREES & SHRUBS
as
\ - - ,00--- = CONTOURS
. es 7,6 W/F B 1
too.o =
� x SPOT GRADES
1 1
f�
. , :, . � :b,>- .< k ;,r.,: S ,,•< . `..fir I 16.0 \
tS.L ui+s,1, y;.f r^ •=.r' '.:A• .sr.' a'm. ,..>' �, ,wr .'���, V � ..� �M:""r, ,:n. ,>,{d. ,Ae :',': Q � , EL
ELEVATION
,,.. UTILITY
_ s U L POLE
.... .,.,..5
♦.�:.,. k^s;.+µ 1 r a� .,...as �� z i v r .::.. . M.t �... .I!.�' d <+r.r.ti#.:'� ^'�".. 'I \ \
'.y:...,1. . ..fir ..r,r„- ...y_ ...: ,,.. -,,.+_,d f ,.. '• t .. r'.'..t. SG+ Y', . - . _
, t,W,i.. x r y!yK 71 + at!,.f :,•, -t:, t.. .,,i, ,. . - .X4 ,Ya'+'ti, S.. , I \ - - - ----
;�. \ � N - s LAND
14,9 o CB CONCRETE BOUND
DH
/. , 1 Z o� = DRILL HOLE
■ c , I �, 162. W
LOCUS MAP SCALE. 1 2000' ^ 13.4 02 F H o / BRB = BARNSTABLE ROAD BOUND
11.5 �_ �.`- 1 B-2,` N a EOP EDGE OF PAVEMENT
oA_
Fto00 1 4 ti �p1p� o BCC = BOTTOM OF CAPE COD BERM
16,4 1;15,7EOP � _ ZONE A W/F
3 O
O 16,8 , 10 m _
I 15.9 \ �� �Ei• 11.0 W/F e- 40000
WF - WELAND FLAG
I 13.9 ,�a(J° �� �ftW/FB-5 LSA = LANDSCAPED AREA
16.4 \ 11ORSESH FND FOUND
' UP 1 27 4 / 17,0 \ /i � \12,4 ..............................
�•�, 4U A 0 L W/F B-6�Cy �y �,� 13,E p�UC � =
I _ , rr `� � a � � ti. �,\ �\ _ _ _ ' g 11. Aqy � 18 A1 Y•,E l.0 10,3 PROJECT BENCHMARK: DATUM NGVD _
i V `'- _ _` _`12.2 �'S3 26" E 58 LAYC / TBM = MAG NAIL SET IN PAVED DRIVE ® ELEV.= 21.08
� * LAWN .. 15, -,.. i11'
BRB/SEA. ZONING DISTRICT: RD-1 (W) & RC (E)
-
/ -- F�
14
O r - -_ - ND
/ �_.'LRFIDSCAPE17 __ __ __ ---- ___'--_ - - E1
O 15,8' '9 i 18.8 'AREAS -21:8 �2.9 - ----------- --=�.:_=___--- - ,���- !� 1�� MINIMUM FRONTAGE. 20
16,5 'f� - _ _ 2� �-- __ ��- - _ __--� 13 '� R+� MINIMUM WIDTH: 125 _ _
-_ -
_
G -
-. 3
S
' '� - - _ "•80. s. FRONT YARD - 30' SIDE YARD - 10' REAR YARD - 10'
'- 3 E
2 4 R LOGq ' -- ` W/F B-
21.6 i $f 1E 22,7 x ----' x'2q`$� • � s: +� 8.8 RC
l9,5 41 ��Is P71C C \ \ 15.�i O
ON 21,9 , S MINIMUM FRONTAGE: 20'
,� s q� 9.7
o r% Aq 0. 17.2 �' i LAWN r CR�E P + O• '
L ZA¢ 22.9 22.6 ��`2 `, �? p MINIMUM WIDTH: 100
POOL 22,2 1 `� STAKE s FRONT YARD = 20 SIDE YARD = 10 REAR YARD = 10
J / 22 /
r `J � I
' b 7' �` i z2s WOOD 2.s 22.9 HOUSE �, 22. I I 1>� so. OVERLAY DISTRICT AP (AQUIFER PROTECTION)
o c
• 22 I
-
r .t. �Y
I rr ,v X
l
°': s "£ SRI(`K 7 , OVERLAY DISTRICT RPOD (RESOURCE PROTECTION OVERLAY DISTRICT)
' 20 9 1.3• ,a L$A DEC Pq�10 22.3 LAWN - ` 9 • ` i'
J 22.4 -' K 22,9 SIiAH 23.4,� I I i cp O
o a 22A 21.8 1„�x 1 LOCUS PROPERTY IS SHOWN AS:
V
ASSESSOR'S MAP 206 - PARCEL 81-1
r I _
\ �.,FDw5E8 W .o l f LOCUS DEED.
18 e2
LAhDS
22,3 AREA ED i '� DEED BOOK 14408 PAGE 99
1
' \22.4 PORC 241 1 I PLAN REFERENCES:.
7,4 PLAN BOOK 337 PAGE 59
I 28. 16f Sly. FT. MAG LET . 2 '
4 u .. eel �i ./ 2i 12f,,3 / 52 36 PLASTIC PIPE, PLAN BOOK 147 PAGE 11
.. 0. t ACRES r . 22 22.6 t�i .3 INVERT EL 0.24
16.5 1 .9 2 i l ; 22 5i4, O 1 x 21.7 / C o/ i ,3 2
x 20.9 22, �/ /c �1100, a COMMUNITY PAREL NUMBER 250001 0008 D
UP# 106--BM IO 16.7 I \ x 22.1 a 22 3 e. / i i" ?y \_ 22.3 21.7 � OF BQ THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONE C.
LAWN - 2,0 22,0 / , � N/F KAIN A ,
_ I N� ON , �� EQ _ a `__�S4_ 22 ,___ x 21.s / ^ / � .'`��, AN AREA OF MINIMAL FLOODING.
W/F A 6 5p� I ADD . 22.3 0�
8.0 I 17.2' ON 1 ' N _ 1.8
21,7 i ry h �, y �c o,� 15, q ��S 7.0 ` WETLA14D DELINEATION CONDUCTED BY SAMUEL HAINES AND NAOM! DeLOACH
• I 16,8 o �, 21,7 .' � �tiF o� sB• ,7 OF ENSR ON 11%3
m I� 1 1�.2 i x18,7 ��� 21 21 6 ��____ , B
i i r
o i \ ` 17� Ar
1 .s �� °y HE Es y` 20.5 \�� /� 20,7 15 7 � m�8 � �� ` � LOCATION! OF UNDERGROUND UTILITIES ARE APPROXIMATE AND
• - D� / ' FOp / SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE
9,6 A-5 -� tp 1, t17.4 18 20. �a PAVED DRIVE / / / / o O
LA_Iq , 17. 1 18.4 18.7 19.7 ok{{� , 20.6 , / \ MAG/SET 61 UTILITY COMPANY PRIOR TO ANY CONSTRUCTION.
\ i N \ MAG SET 20.8 20.1O�
O
o \, a 17,8c' 18,1 tD �' 21,4,o B8X 20 j `0 36" PLASTIC PIPE 1,8 SEPTIC SYSTEM LOCATION IS APPROXIMATE.
O SET 20 9 , r INVERT EL -0.04' '
W 7.5 7, 8,9x E ES � 20.5 -- 21.4 HiNG c / PER INSTALLERS CARD PERMIT # 95-1818
I
I IF FN .07 �� 20,7 y --- _ MBE x 19.5 i ; r
_. 20,
LINE BEARING DISTANCE 1.8
15,6 D E
• N 84'12'5�'`Y1r- 1�.20_ L - - Pit 1o6A 19,s - 0 /� % / g1' / L1 S 30'56'31 W 22.83 1.8 2 0 THIS PLAN IS BASED ON AVAILABLE RECORD INFORMATION,
' ` --____ ____ -12 E L2 S 35'35 06 w 1 t.84 PLANS AND AN ON THE GROUND FIELD SURVEY BY THIS FIRM
I ` ----------- -- •
1--- ______- �1�3� ^ ` % 11,0�•01 L3 S 62'2334 E 34.55 ON 3121103.
---------- 1.9 1.9
-
15,s �6.b` � 1,s 1.8 PROPERTY OWNERS:
W/F A-4 _a--- ------ 17 --:9 `�, �. 1 3 x18,8
/:- - 7,0 1 x 18.3 �� 1,8 PATRICK MARGUERITE & TR.
7,2 / M - v:2 8 3�3.12 la6 B/DH o 4 EDGE HILL ROAD
N 88'21'01' W FND WELLESLEY, MA 02481
. 2 a pV 1.8
1258 Craigeville Beach Road
N/F THOMAS ; SQ L
24.00.
W/F A-31- 7412.52, >,�o, �, Centerville, Massachusetts
$• �0 PREPARED FOR
`�S
I N/F COPPERRIDER 0,72
F A-2
ry N/F DOIRON 1.9 x
Richard Thomas
W/ 0 •
• 6,s - 100•
/ ME
1.8
1,9
2
W/F A-1
Wetlands Permit Plan
6,6 3 1,6
•
6g•00' N
N '
BAXTER, NYE & HOLMGREN, INC.
� r�2 Sy• W -- � 1�
iH of Mq s Registered Professional
o� TEP N °yam Engineers and Land Surveyors
N
30218 o.
812 Main Street, Osterville, Massachusetts 02655
/ N
�e Phone - (508)428-9131 Fax - (508) 428-3750
6/STEP I
�SS/0NA1 Ems/
20 0 20 40
b
SCALE IN FEET
CONSTRUCTION NOTES: SCALE:1"=20' DATE: 05/12/03
35.24� 1 ) The existing septic tank is to be relocated as shown. REV. DATE: REMARKS
N 8'5754• W -1- 6 04 03 Relocate Septic Tank
2 All work is to conform to all applicable plumbing & building codes. e
) P P P 9 9 -2- 10 1 03 Relocate Septic Tank
DRAWING NUMBER
0: 02 02- 119 surve worksht 02- 119Pro ldw
2002- 119
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FVVs
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f a it P° ''i° ! h`��S•', +m r '!`' f�M '"t�.. F,.y�.:
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5gy
F
TEST PIT #1 TEST PIT #2 1 ---�lo,_b.• - GENERAL NOTES
p `LF', = I4x46 EL - 13x66
I LOAM , I - _ _ ' ®��� O � �� N, 1. AL(_ F!._EV.ATIONS SHOWN ARE BASED UPON AN
SANDY '-�
IOYR3/a SANDY 1 -
_ _ _ r� N ®F1�E4M nI� Mom' ASSUMED DATUM,
14" IOYR3/4 LOAM I - -
cFILu o o �2®m I INES A MINIMUM OF "/8" /FT. UNLESS
_ _ ?_. PITCH ALL flu D=EM Elw="mom
LOAMY ,30" I OTHERWISE SPECIFIED.
7YR5/8 I in - i i•!� �
SAND (FILL) 1 _
—
(BURIED LOAMY N 8' - 6" 3. ALL PIPES TO AND IN THE SYSTEM SHALL BE CAST
(,� �, I IRON OR SCHEDULE 40 PVC.
44" SEASHELLS)
7YR5/e SAND '-- - -- -- -- --- - _ -- - - ____ � � - - Y
',BURIED
60•. ROOTS) `�� ,_ f -��—�- � — � �-�>-.' • ' .- _• � �-��' �_ . •: - . �•-. ,. 4. ALL SEPTIC TANKS, DISTRIBUTION BOXES, AND
-- �� ♦ a"KNOCKOUT LEACHING PITS SHALL BE DESIGNED FOR H-20 WHEEL
5YR5/6 ? SILTY \ C, 20" DIAMETER COVER cn LOADINGS WHEN UNDER PAVING.
I SILTY
, f ! ' 5. REMOVE ALL UNSUI ,ABLE MATERIAL BENEATH THE
SAND 5YR5/6 10
z 14"
4' KNOCKOUT +"KiVOCKouT �, INVERT ELEVATIONS OF THE FLOW DIFFUSOR FOR
SAND
4,_�,, �, TYPICAL DISTRIBUTION BOX `= A DISTANCE OF 5 FT AND BACKFiLL WITH (,LAY -
FREE SAND 8 GRAVEL HAVING A PERCOLATION BATE
I `''r"i D E
NOT TO SCALE 4"KNOCKOUT = OF 2 MINUTES PER INCH OR LESS.
120" _ NOTE DISTRIBUTION BOX AND 1 6. THE TOWN OF BARNSTABLEBOARD OF HEALTH MUST
NO WATER-ENCOUNTEREo GAL REINFORCED SEPTIC TANK BY BE NOTIFIED WHEN THE SYSTEM IS NEAR COMPLETION
OBSERVATION PIT TYPICAL 1500 GAL. SEPTIC TANK ACME PRECAST OR EQUAL TYPICAL DIFFUSOR UNIT AND PRIOR TO BACKFILLING.
7 UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS
NOTE:DIFFUSORS BY WIGGINS PRECAST SHALL BE INSTALLED IN ACCORDANCE WITH TITLE TT
PERCOLATION RATE= < Zn�nt(nch NO,r TO SCALE CORPORATION OR EQUAL. OF THE STATE SANITARY CODE AND _A�Y-t-OCAL r
OBSERVATIONS By: GERALD DUNNING NOTE TANKS REINFORCED THROUGHOUT WITH 1 RULES WHICH MAY APPLY.
TOWN OF BARNSTABLE BOARD OF HEALTH ELECTRIC WELDED WIRE WITH 24-1'/2"
ENGINEER ARO ENGINEERING INC. EMBEDDED STEEL RODS IN TOP aBOT- 8. CONTRACTOR IS TO NOTIFY ENGINEER, PRIOR TO THE
DATE OCTOBER 12,1995 TOM. CONCRETE IS 4,000 PSI TEST. INSTALLATION OF SEPTIC SYSTEM., OF ANY DiSCREP-
ANCIES BETWEEN TEST PIT RESULTS AND FIELD
CONDITIONS.
9. ACCESS MANHOLES TO SEPTIC TANKS AND LEACHING
..-- PITS TO BE BUILT UP TO 12 INCHES BELOW FINISH
0 GRADE.
v-
�' � � !0. NORTH ARROW NOT TO BE USED FOR SOLAR PURPOSES.
0 / Io2''
�1
N 15rt76
TS �
J S 17'29'33" W 16T5 FOUND.' ON
151.08 2,R19 6 m r i v +40 _FINISH GRADE SMH FINISH GRADE OVER LEACHING
/ o F INi;H GRr,i �, i�Vf_k TANk ELEV. = 14+8
5xo6 w m �, f l FV I9+5 riser Ef_E.`J. 19+5 RIM- 20+9
o EXIST. GROUND
R r REgER`� FINISH GRADE
_ __ _
r n got % `_ _ -- {� D ` T 5 .65 F-77777T' ! INS - l8+ -- �-- ------,�_ -� _. \ OVER ,.p„ BOX \ Il
�'• - _
sMti ELEV. - 15+0 ry
i 11
L j�RSE ��0 iNV.= i7+5® I; .,- ,
O Inv Mi-6r70 \g �6 R6 -{, - - ' IrJ00 I7t j ��« s " "
a,V out 62 Q �� 6 REINFORCED N
TOI*S 20+'�"` _ gF v9� cv CONC;RETE v -- i SHIED STONE
V , O
NOTE: ����� ������
EXISTING CESSPOOLS AIrO 1 c, N c+a rsti a O❑❑O d
v EACH PIT TO 8E PUNPEU- P N, cp SEF'T1( T�,NK 1 V.-14+00 • •, �� - ---3/4">J I/2'
rn �1�� �� I 5� \pI iNV_.=jA+_ 7� ���• j QpIIOC1IDClo]0111=1 Qa i WASHED STONE
OUT AND FILLED IN \�� ��� I s\Vky `'� _ - � co ( 1` BE I_E..'1F l STABLE. ) �1 - — _ INV.=� ,.
"� I ,�� s z -1.3+47 t NV =13*l
INV
0 =z�� -, SNG'18 TYPICAL SEWAGE SYSTEM PROF
I LE
t ' I CessPPOOLj �) 1 \15 LDI G -7 A 17'45'50" W
_ ). \\ TO ggga���B RA�E.D 38.96 NOT TO SCALE NOTE ELEMENTS OF SYSTEM TO BE
LEVEL AND STABLE.
01
-41
�•�
o
PROPOSED -�- -- LEGEND
A i500 GAL 10.51• -
SEPTIC TANK2 ttI258 F y I7 F \ - -' MAF' SECTION PARCEL �.O? ADPRF>`,
EXISTING SEPTIC I I EXISTING 2 \ EXIST CUN TOU R 8 8 206 81-1 #I 258
r I DWELLING c '
TANK TO BE �- � PROPOSED CONTOUR
D PUMPED-OUT FI. EI.-21.40
AND REMOVED^�" ' EXIST SPOT ELEVATION 8 X 0
z T/EXIST. / ; PG ' o PROPOSED SPOT ELEVATION 8 t-0
m LEACH PIT E� ZONING OISTRICY FL000 HAD BONE
1 PERCOLATION TEST aJ A2ARDFJA
oo
2 8 515 ± s f E 6 16156 \ OBSERVATION PIT H RC _
PARCEL 81 1
civic
DESIGN CRITERIA REMEDIAL CONSTRUCTION
56 / s PROPOSED SEWERAGE UP-GRADE
/ NUMBER OF BEDROI)M_, -_
F'EkSON PER BEDROOM — 2 P RCEL 81-1(#1258) CRAIGVILLE BEACH D.
N f 45',6" E
_ GALLONS PFR PERSON I:EH [SAY _5 C f�1TERVILLE (BARNSTABLE) MA
C `p LEACHING REQt11RED 89L9sf ow I /
RAIGVILLE BEACH ROAD LEACHING PROVIDED 909.4$f ` =
NO
D1;POSAi_
- ,-- AF�FLICANT : _ER
JOAN M. BRUNNICK ARO ENGINEERING INC.
SEWER DESIGN
' _____._ 1258CRAIGVILLE BEACH ROA 39 STRIPER LANE
M1111111 __ ___-__ ________.___ E. FALMOUTH, MA. 02536
3 v CENTERVILLE,MA. 02166
- SiDEWALL - ( 57+57+11.17+11.17) (2)= 272.7 sf
SCALE IN FEET BOTTOM: ( 57•x 11.17 ) = 636.7 sf DATF SHEET
909.4 sf AS SHOWN NOVEMBER 8,1995 1 ,)F_ L
6 . [:1RA`,tVN BY CHF(,K.EL) ICY Appb 3Y F'I_.AN �+IC)
APPLICArQN RATE; 6 x 110 + 0.74 s 890 8f _-.._.-_ SJR 'HP RER