HomeMy WebLinkAbout0030 ELLIOTT ROAD - Health 30 Elliott Road
Centerville P
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
0
M ,•''r 30 Elliott Road
Property Address
00
Alan Reed
Owner Owner's Name
information is a
required for every Centerville Ma 02632 10/12/2016
page. City/Town State Zip Code Date of Inspection eS►
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Sean M. Jones
use the return Name of Inspector
key.
S.M.Jones Title V Septic Inspection
Company Name
74 Beldan Ln.
few Centerville Ma 02632
City/Town State Zip Code
774-248-4850 smjonestitle5@gmail.com S14522
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
10/12/2016
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The dwelling located at 30 Elliott Road Centerville is served by a Title V septic system consisting of a
1000 gallon septic tank, distribution box and a 1000 gallon precast leaching pit. The system was
found to be in proper working condition at the time of inspection.
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.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cont.):
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
I
❑ 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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M '( 30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.)
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
1 0,000g pd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
G M , 30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
2014=41,000 total = 112 gpd 2015= 67,000 total = 184 gpd
Sump pump? ❑ Yes ® No
Last date of occupancy:
current
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M , 30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
�
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Original system installed 1996 per town records
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2.5
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joint were ok, no leaks, vented through the roof
Septic Tank(locate on site plan):
Depth below grade: 2
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallons
Sludge depth:
6"
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M , 30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
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
6" �
Distance from bottom of scum to bottom of outlet tee or baffle
10"
How were dimensions determined? opened covers, took
measurements
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank was structurally sound, water level even with outlet invert. Tank should be cleaned soon and a
gain every 2 years for proper maintenance.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Distribution box was video inspected and found to be in good condition, no rot, water level was even
with outlet invert.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
*If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M a 30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach pit was video inspected and found to have 1.5'of standing water with a stain line only slightly
higher. Tree is under a large tree.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Lt5,,ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions .
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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A ► Zti
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t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12'+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
30 Elliott Road
Property Address
Alan Reed
Owner Owner's Name
information is required for every Centerville Ma 02632 10/12/2016
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
t DATE :10/28/02
PROPERTY ADDRESS: 30 Elliot Road _
Centerville,Mass.____^-_
02632
------------------------
On the above date, I inspected the septic system at the above addrRECEIVED
This system consists of the following:
1 . 1 -1 000 gallon septic tank. NOV 1 2 2002
2 . 1 -Distribution box.
3. 1 -1 000 gallon H1 0 precast leaching pit. ( 6 'X1 0 ' ) TOWN OF BARNSTABLE
HEALTH DEPT.
Based on my inspection, I certify the following conditions:
4 . This is a title five septic system. (78 Code)
5. The septic system is in proper working order at the sil
present time. �O
6. Pumped septic tank at time of inspection.
7 . Waste water is not present in the leaching pit. (dry)
SIGNATUR /
Name :_ J ._ P . _Macomber .Jr .
Corripany :,7gaaph p _ Macomber & Son , Inc .
Addr'ess :__BQx
U�_Ma'-22632-0066
Phone :__508- 775_ 3338
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tan ks•Cesspools•Leachflelds
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632.0066
775-3338 775.6412
COMIvfONWEALTH OF N- A,SSACHUSETTS
EXECUTI-V-E 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: 30 F.1 1 i ni- Rpgrj
ce tert -Maass.
Owner'sName;Jennifer Fallon
Owner's Address: 20 C71 es nrcb.a.r_d
Duxbury,Mass. 02332
Date of Inspection:1o/28/02
Name of Inspector: (please print) Joseph P. Macomber Jr.
Company Name: J.P. Macomber & Sons Inc
Flailing Address: Box 66
Cc-nt-Prvi 1 1 P Ma 02632
Telephone Number: 508-775-3338
CERTIFICATION STATEMENT
I cemh that ! have personally inspected the sewage disposal system at this address and that the information reposed
below is rrue. accurate and complete 3s of the time of the inspection. The inspection was performed based on my
minute and experience in the proper tuncton and maintenance of on site sewage disposal systems. 1 am a DEP
appr'oved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
1//Passes
Conditionally Passes
.Needs Funher Evaluation by the Local Approving Authoriry
_ Faiis
g
Inspector's Signature: Date:
•
P
The system inspector sh 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 now 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
authorir).
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.
r`
Title 5 Inspection Form 6/15/2000 page I
I
Page 2 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 30 Elliot Road
Centerville,Mass.
Owner: Jennifer Fallon
Date of Inspection: 1 0/28/0 2
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A System Passes:
Cave not found any informations hich indicates that any of the failure criteria described in 310 CMR
15.303 or in CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments: _
The septic system is in proper working order at the
' present time
B. System Conditionally Passes:
L)D 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.
4-�2_The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 1 I
it
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 30 Elliot Road
Centervi e,Mass.
Owner: Jennifer Fallon
Date of lospectioo: 1 0/28/02
C. Further Evaluation is Required by the Board of Health:
t/6 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.
I. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner wbich will protect public health,safety and the environment:
i110 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:
a The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or rtibutary to a surface water supply.
,1,!y The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple.
n The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
&L6 The system has a septic tars; and SAS and the SAS is less than 100 feet but feet or more from a
private water supple 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 rtiggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 30 Elliot Road
Centerville,Mass.
Owner: Jennifer Fallon
Date of Inspection: 1 0/2 8/0 2
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No/
_ �r/Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
Slogged SAS or cesspool
tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
/ cesspool //,,P_,ed-o
squid depth in sesspeel is less than 6"below invert or available volume is less than h day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped L.
Any portion of the SAS, cesspool or privy is below high ground water elevation.
ZAny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
/water supply.
_ t/ Any portion of a cesspool or privy is within a Zone I of a public well.
/Any portion of a cesspool or privy is within 50 feet of a private water supply well.
i/ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
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)
yes no
_ he system is within 400 feet of a surface drinking water supply
— J/ the system is within 200 feet of a tributary to a surface drinking water supply
— the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of ;
OFFICIAL INSPECTION
SEWAGE O E DISPOSAL SYSTEM INSPECTION TA_RY ASSESSMENTS
S CTION FORM
PART B
CHECKLIST
Property Address: 3O E 1 i nt Rnar7�_
Q-nt-arvi 1 1 e *���—
Owner: J p n n i-fiar—Z-a-14 On
Date of lospectioo:
Check if the following have been done. You must indicate -yes" or"no" as to each of the following:
Yes III0
Pumping information was provided by the owner, occupant, or Board of Health
�u'ere and• of the system components pumped out in the previous two weeks
Has the system received normal (lows in the previous two week period ?
_ /Have large volumes of water been introduced to the system recently or as pan of this inspection
2 _ were as built plans of the system obtained and examined? (If they were not available note as N/A)
4ZI— Was the facility or dwelling inspected for signs of sewage back up
was the site inspected for signs of break out
4.7
\ycre all system componcnts,`+*cluding the SAS, located on site
Km/eTafnes
were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition
or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum
2_ Was the faciliry 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
�Ycs no
_ Existing information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of dis:=n:c
,s unacceptable) 1310 CMR 1 5.302(3)(b))
5
i
Page 6 of 1 I
' r
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 30 Elliot Road
Centerville,Mass.
Owner:Jennifer Fallon
Date of Inspection: 1 0/2 8/0 2
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):—�— Number of bedrooms(actual): .
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # oFb-edrooms):.g V le
Number of current residents:
Does residence have a garbage grinder(yes or no): Va
Is laundry on a separate sewage system (yes or no):;�& (if yes separate inspection required)
Laundry system inspected s or no):yC.s
Seasonal use: (yes or no): 's
Water meter readings, if available(last 2 years usage(gpd)): 2 0 0 0—2 9, 000 gallons=79. 46 GPD
Sump pump(yes or no):4,'0 2001 — 54, 000 gallons=1 47. 95 GPD
Last date of occupancy: ��
COMMERCIAL/INDUSTRIAL
Type of establishment.
Design flow(based on 3'10 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):. X1,4—
Grease trap present(yes or no): dl
Industrial waste holding tank present (yes or no):.LL4
Non-sanitary waste discharged to the Title 5 system(yes or no):40
Water meter readings, if available:
Last date of occupancy/use: A—
OTHER(describe): 4Jx
GENERAL INFORMATION
Pumping Records ,
Source of information: ��je /Jlftl.�r4 1'�
Was system pumped as pan of the inspection(yes or no):
If yes, volume pumped:IWM gallons -- How was quantity pumped determined?
Reason for pumping:mint- Heavy scum & soilds layers were present
TYY,E OF SYSTEM
%/Septic tank, distribution box, soil absorption system
Single cesspool
Overflow cesspool
�l Privy
Shared system(yes or no)(if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank eb Attach a copy of the DEP approval
/th Other(describe):
Approxima a age of all o ponents, date installed (if known)and source of information:
7 =IN
Were sewage odors detected when arriving at the site(yes or no):x4-4
6
Page 7 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 30 Elliot Road
rRntarui l l P _Mas
owner: .7?IInfer Fa11,=
Date of inspection: 1 0128 102
BUILDING SEWER(locate on site plan)
Depth below grade: z
Materials of construction:.0 cast iron /40 PVC 4 other(explain):
Distance from private water supply well or suction line: /D`I'
Comments(on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight_ No eyiden _ _ of l akage_The system is
vented through the house vents.
SEPTIC TANK: Zlocate on site plan) /d�n�yl�lbfJS
,J
Depth below grade:
Material of construction: concrete,4b metal,�fiberglass LpolyeLhylene
iJ�other(explain)
If tank is metal list age: d is age confirmed by a Certificate of Compliance (yes or no)., (attach a copy of
certificate) /
Dimensions: ��,/t�KCi �J/Ll✓i ��/�jy�l
Sludge depth:
Distance from top of sludge to bosom of outlet tee or baffle: __
Scum thickness: _e� 1
Distance from top of scum to top of outlet tee or baffle: Ci
Distance from bosom of scum to bottom of outlet tee or baffle: 6
How;were dimensions determined: Pumped at time of inspection_
m Coments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Pump the septic tank every 2-3 years_ Inlet & outlet tees are
in place.The tank is structurally sound and shows no evidence
of leakage.
GREASE TRA%k(locate on site plan)
Depth-below grade:20
Material of construction:41A concrete/jQmeta(dfiberglass j?XpolyethyleneA/Mother
(explain):
Dimensions: 410
Scum thickness: _ 41,14 _
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bosom of outlet tee or baffle: dhJ
Date of last pumping: A);+
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 1 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 30 Elliot Road
Centerville,Mass.
Owner: Jennifer Fallon
Date of Inspection: 1 0/2 8/0 2
TIGHT or HOLDING TANK4&(tank must be pumped at time of inspect ion)(locate on site plan)
Depth below grade: A0
Material of construction: concrete metalfiberglass 0 polyethylene/,,,y other(explain):
Dimensions: A14
Capacity: V,4 gallons
Design Flow: IVA gallons/day
Alarm present(yes or no):
Alarm level: AM Alarm in working order(yes or no):
Date of last pumping: 40
Comments(condition of alarm and float switches, etc.):
Tight or holding tanks are not present.
DISTRIBUTION BOX: r (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
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.):
Distribution box has one lateral.No evidence of solids carry
over-No evidence of leakage into or out of the box.
PUMP CHAMBER/ e-(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.):
Pump chamber is not present.
8
I
Page 9 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 30 Elliot Road
Centervil e,Mass.
Owner:Jennifer Fallon
Date of Inspection: 2$ 02
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required)
1 -H101000 gallon precast leaching pit. 6 'X10 '
If SAS not located explain why:
Located; See page 10
Type
leaching pits, number: 1-ZVX)0"
AJ1I leaching chambers, number: Z)
leaching galleries,number:
LI? leaching trenches,number, length: d
4)d leaching fields, number,dimensions: (7
,f)&l overflow cesspool, number: Q
4)1) innovative/alternative system Type/name of technology: /�7j/� �� 1¢Alb
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
Loamy sand to boney fine sand.No signs of hydraulic failure or
ponding- Soils are dry Vegetation is norma
CESSPOOLS(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum laver:
Dimensions of cesspool: T
Materials of construction:
Indication of groundwater inflow(yes or no): /L
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
CPt4tRnr)n1 s a not present
PRIVY�A�(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.):
Pri vS7 i -, nr)t- nrt—, nt
9
P+dr IO o/ l l
OFFICLA� INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SU8SV7U^CE SEWACE DISPO$Ad SYSTEM INSPECTION FOR"
PART C
SYSTEM INFORM�,TION (con,Invco)
arov rr) A („ 30 Elliot Road
Cent e ass.
0-or/ Jennifer rallvrr ----
01ir of IniP,c, oo: 1 0 2 /02
S"'-tTCH Of SEWACC DISPOSAL SYSTCM
IlcicA ol,A( ,c..,(c o;IPo„1 Iyl,cm incIvo(n; Ilcl l0 11 It{71 fW
LQcm wAcrc PvOlic wl,rr I Pply�cAnrtrnllhtclOviloln1lNCmcrc,
I
v
18
o
Io
Page I I of I I
• OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 30 Elliot Road
Centerville,Mass.
Owner: Jennifer Fallon
Date of Inspection: 10/28202
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Y
Estimated depth to ground water 70 feet
Please indicate(check)all methods used to determine the high ground water elevation:
YES Obtained from system design plans on record - if checked, date of design plan reviewed:
YES Observed site a utttng roe observation hole within 150 feet of SAS)
Iq_0 hecked with local Board of Health-explain: AJA
)LES Checked with local excavators, installers- (attach documentation)
yZ&Accessed USGS database-explain: http; //town, barnstable,ma.us.
You must describe how you established the high ground water elevation:
Used: Gahtrety & Miller Model. 12/16/94 Ground water elevations above sea level
Used: USGS, Observation well data. June 1992
Used: USGS; Technical B111 1 Pt-i n 9 -000-1 Plate #2 Annual ranges o groun
wa ter P1 Pyati Ons
i op or�� �no
Leaching / y
Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft J per Fnmptcr Method
Therefore, the vertical separation distance between the bottom
Of the leaching pit and the adjusted groundwater table is
feet.
11
f
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FUWN OF Barnstable BOARD OF HEALTH
SONSUNFACF SFWAGF DISPOSAL SYSTEM INS['RCTION FURM PART D CEK'ffF1CATlON
•.•—••••T•••.. —+. -.^--r.+•.-m•n:T.v rZ n'.rrr rT.r•r•.�—•.'1--lrr+irs lRnar—'r**!T`[t1s sTiT7 mn r+'mrre.r.rT Pr-r.Trrn-.::r•r,—.r._,. �. A
-T1'PE OR PRINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS 30 Elliot Road Centerville,Mass.ASSESSORS MAP , BLOCK AND PARCEL # ��'1,20
OWNER' S NAME Jennifer Fallon
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P. Macomber Jr
COMPANY NAME Joseph P. Macomber V-ton Inc
COMPANY ADDRESS Box 66 Centerville Mass 02632
Streat Town or City Stat• ZIP
COMPANY TELEPHONE ( 508 ) 775-33-38 FAX ( 508 ) 790-1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system nt
this address and that t)re information reported is true , accurate , and
omplete as of the time of . inspection , Tile 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 oil-
site sewage disposal systems ,
Check one :
_/t_//Systeui PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
h0alLh. or• Lhe environment as defined in 310 CMR 16 - 303 , Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection which I have cony cted has found that the system fails to
Protect the i)ublic health and the environment in accordance with Title
5 , 3t0 CMR 15 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature v �� Date
e copy ofthis ert.ification must be provided to the OWNER, the BUYER
On
where applicable ) and the DOARD OF HErAL'1'll ,
If the inspection FAILED , the owner or"`operator ehall upgrade the system
wii.hin one ,ear of the date of the inspection , unless allowed or required
otherwise as provided in 310 CPIR 16 , 305 ,
partd . doc
ur SEWAGE INSPECTIONS
LOCATION30 Elliot Road DATE 10/28/02
rVTLLAGE Centerville,Mass. ASSESSOR'S MAP & LOTA (10
-INS £CTOR Joseph P.Macomber Jr.
...
SEPTIC TANK CAPAC=1 000 gallons + D-Box
:LEACHING FACILITY: (rypcy -LP-1000 6/X10 ' (sizc) 1500 gallons
NO. OF BEDROOMS 2
--,BUILDER OR OWNER Jennifer Fallon
OWNER MAILING ADDRESS
20 Coles Orchard
Duxbury,Mass. 02332
li 781 -585-1753 ,
�J I
�- . , . ,
.,\\.,�
,�,
��, - � ��.
�� � �� � �
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�( —_ � a ,
jIIII�e�./� � V O� '�3 �� \
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\ \
Q \
- - EAGLE SURVEYING &
ENGINEERING, INC.
J
923 Route 6A
Yarmouthport, MA 02675
Telephone (508) 362-8132 / (508) 432-5333
Frank Whiting, P.L.S.
Stephen A. Haas, P.E.
November 8, 1996
Mr. Edward Barry, Health Inspector
Town of Barnstable
367 Main Street
Hyannis, MA 02601
Re: Septic System Inspection
30 Elliot Road, Centerville
Dear Ed:
This is to certify that I have inspected the completed septic system at
the above location. I found it to be installed substantially per the
design plan prepared by Levy, Eldredge & Wagner Assoc . , Inc . Job No.
1292, dated July 2, 1987 .
It was found during construction that the soil conditions in the area of
the leach pit were different from the soil test . The leach pit was set
in the medium-coarse sand layer at the proposed elevations . Therefore,
the 10 foot soil removal was not required as shown on the design plan.
Please call should you have any questions .
Very truly yours,
EAGLE SURVEYING & ENGINEERING, INC.
Stephen A. Haas, P.E .
V4
r �' / �
q�o
�Y��� /,� �+ .. _.Fee_.
No. iJ�l
/J THE COMMONWEALT OF MAS ACHUSE
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pprfcation for Miopaar *pgtem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
eui aff9001 K7� fiff/o
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
DESIGNINo cl�GINEER MUST SUPER ISE
INSTALLATION Na
Type of Building: �(�� THE SYSTEM WAS INSTALLED IM WMCT
ACCORDANCE TO PLAN.
Dwelling No. of Bedrooms 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
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 Enviro mental Code and n t to place the system in operation until a Certifi-
cate of Compliance has been issue Ooffis
Signed 7 oA Date
Application Approved by
Application Disapproved for the following reaso
Permit No. Date Issued 00
V4
THE COMMONWEALT OF MAS AC SE
6 f
PUBLIC HEALTH DIVISION -gTOWN OF BARNSTABLE., MASSACHUSETTS 1
01pp,rtcation for Migpo5a1*pgtem' Congtructton Permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lo o. - Owner's Name,Address and Tel.No.0 e
w.
Installer's Name,Address,and Tel.No. , Designer's Name,Address and Tel.No.
(3ev;1G
Type of Building: �J
Dwelling No.of Bedrooms 1 Garbage Grinder
Other Type of Building. No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow i gallons per day. Calculated daily flow gallons.
Plan Date dumber of sheets Revision Date
Title _
-Description of Soil
Nature of Repairs or Alterations-(Answer when applicable)
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 theEnviro ental Coden t to place the system in operation until a Certifi-
cate of Compliance has been issue is
-----
Signed • , Date
Application Approved by
Application Disapproved for the following reaso __`
Permit No. ...► Date Issued 42
_—---lam_---- ----.—------ -- —,.-->_.—�--��,��
C671
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS.TO CE TIEY.that the On-site Sewage Disposal System installed( )or repaired/replaced( )on
by for
as has been constru ted in orda e
with the provisions of Title 5 and the for Disposal System Construction Permit N �` dated
Use Use of this system is conditioned on compliance with the provisions set forth below:
No. VAI ' V a; Gm��C.l--� Feb
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
` Mtg ogal p stem Congtructton Permit _.
Permission i h�eby granted to Il J. 1J 4 C (
to construct(ll )repair(( )an On-site Sewage System located at �I`ic
7 `
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.
All construction must be completed within two years of the date below. ~ -
Date: A� Approved b
TOWN OF BARNSTABLE
LOCATION v� �I i of oa-d SEWAGE # q�' I Lal
VILLAGE LVA-ev V i I I- ASSESSOR'S MAP & LOT `7®
6-0a�
INSTALLER'S NAME&PHONE NO. R,s' BeV'r n c!Q l
SEPTIC TANK CAPACITY I040® QQ [!C-Vl
t �i
"LEACHING FACILITY: (type) (size) 1�'famLtAt,(-
f iNO.OF BEDROOMS
* BUILDER OR OWNER a Q r(�)o 1r QLrL(
PERMTTDATE: IO-AR 16 COMPLIANCE DATE: /ram K
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by t y Z,4 4 ZLjEef
L o-E I E l l; oi- -Ra., ce-%AtrvAle.
t y 3'. ►
1
i
i
No................-....... Fax..........................._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... ..............0F......... ...............................................
Appliratintt for Uiiipaaal lVnrlw Towitrurtintt Vantit
Application is hereby made for a Permit to Construct (?Q or Repair ( ) an Individual Sewage Disposal
System at:
I
..Lux.. .._t_ 1:).)_c3.1:_!ZC;.K?!;K............................................... ...a46.}} i_��!:�:�.�_..l252..........---
Location-Address or Lot Qo.
............................................................... s?.C1�1�fA...Q1.'_IULSI-'CtlilltlCX. �C.i.. i,��rZ. =J�►:f�('
W Owner Address l J
Installer Address
Type of Building Size Lot....��,,. "�'.......Sq. feet
U
.� Dwelling—No. of Bedrooms...........71 �c� .....................Expansion Attic (/V,) Garbage Grinder V11)
04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
F4 Other fixtures ...... •..............................•..-..
Design Flow...................................
,rs..gallons per person per day. Total daily flow..............................3,.35r....gallons.
W
WSeptic Tank—Liquid capacity/at .gallons Length..e...`..._ Diameter.....----...... Depth.,:5._.!k''
x Disposal Trench—No. .................... Width....-............... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No......u�w........ Diameter......1Z -...... Depth below inlet.....`��......... Total leaching area.a �....._.sq. ft.
Z Other Distribution box (A) Dosing tank ( )
'�' Percolation Test Results Performed by..<,4v. ..._F�d' 5.4.'.. �5_xKC........•........ Date......i�.'%` �._...........
14
Test Pit No. L._3un?....minutes per inch epth.of Test Pit........14.`f.-.. Depth to ground water.._....---....•.......
f=, Test Pit No. 2................minutes per inch Depth of Test Pit................•... Depth to ground wa
tY, ------
•--------------- ....•.........................••••..........................
O Description of Soil...._C�...lcJtl a.�.!]Cnecl tin._rtt!xrc�.--1� - .._ :u-bsoi--_________••--___-_-•.................. ....•...-_•.... _
V .................................(�V-•---..y4a._r.ltszt ��---/21 STEPNEfV
��////
n a o
................................`1(a_��—.1��}�t 1"UML&..1fC
n1�Yt'An... efr!{!'k --`>i«a.(!................................ ALIYN
U Nature of Repairs or Alterations—Answer when applicable...................................................... . .... . .NQ.i .
•..............................•----...........---...........-------•-------............._._......_-•••_.... •-•----•••---•-- ....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste' i ith.9/fig/f
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agr es not'to place the
system in operation until a Certificate of Compliance has,bben issuedbb the board of health.
Signed .. �'f ,. 4t................ ........................................ s
Dve
ApplicationApproved By ......................................................................................... .......................................................... ........................................
thfe
Application Disapproved for the following redsonr: ........................................................................................................................................
................................................................................................................................................................................................................ ........................................
the
PermitNo. .................................................................... Issued .........--.........................................................
Mee
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
!�
-........ OF ..................................................................................................
Clertifirate of Compliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ........................................................................................................................Ak.......................................................................................... .................................
at .................... ...................................................................................... ................ ................................................................
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 ............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE._........... .......... ....._......................_-..... . ....................-._.... Inspector ...... --....- --
I
20 /T. MIN. y SOIL TEST
0 2
DATE OF SOIL TEST
TOP � F8UNO. -9-/YF Fi
EL.• 10 FT MIN' WITNESSED BY ToM Mc.fG•✓7
CONCRETE 4" SCH. 40 PYC PIPE CLEAN SAND PERCOLATION RATE L_M
iN
COVERS MIN. PITCH 1/8 PER FT. OBSERVATION HOLE 1 OBSERVATION HOLE 2
CONCRETE 2" LAYER OF ELEV• 5al ELEV.-
12 COVERS 1/8"-V2"WASHED ntm41 M.+f,;
4"CAST IRQN PrE
(OR FAUATJ MN. STONE _fpfL tub �°i✓
PITCH 1/4 PER FT
� � 24 LY7t '7AMJ l�R►VEL
FLOW LINE lei
10
EL• '10"5 MN. a Fy 4'1 90 ZO C4o2'� 0 -.
EL EL)-• 4g•I 41• 0 LEVEL
EL- 9'1' D h(7
DIST. EL•-A� B °• WATER AT /4 a ELB 3B 7 WATER AT EL'
BOX 3/4"-11/z` ,; , • • DESIGN CALCULATIONS
000 GALLON WASHED STONE
1.I o EL.- 42-1
NUMBER of BEDROOMS 3
SEPTIC TANK
PRECAST LEACHING 4 GARBAGE DISPOSAL UNIT' "''u
BASIN OR EGUIV.
No 3 6'DUM 3 TOTAL ESTIMATED FLOW
( +=�: GAL./BR./DAY s 3 BR.I 3T:0 GAL. DAY
SEWAGE DISPOSAL SYSTEM PROFILE 1 ' REOUIRED SEPTIC TANK CAPACITY _4,j GAL
ACTUAL SIZE OF SEPTIC TANK po0 GAL
NOT TD SCALE __
LEACHING AREA REQUIREMENTS
BOTTOM Of TEST HOLE OR USGS PROBABLE WATER TABLE EL'_ -L SIDEWALI AREA 2 t GAL/AF.
OBSERVED WATER TABLE( / / EL' BOTTOM AREA �,- GAL/SE
LEACHING CAPACITY(BOTTOM•SIDEWALL) GAL.
1 �Tx Y-14 4.2 41*C9µ>b�Ce�10 i
I r v LEGEND; RESERVE LEACHING CAPACITY A'j 0 GAL
EXISTING SPOT ELEVATION OCIP
/ EXISTING CONTOUR=---Do-
FINAL SPOT ELEVATION NOTES;
FINAL CONTOUR I. ALL WORKMANSHIP AND MIRERIALS SHALL CONFORM TO OE.O.E.
I �-� �:"-�-- Lef l i9 IN G 1r..+� c� oufL13Ld•lo..l SOL TEST LOCATION TITLE S AND THE TOWN OF AjgR:! tOPYL� RULES AND
•/ UTILITY POLE REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
-0- 1
�• l I �l _� .-.cx ' 2.ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
TOWN WATER �W CATCH BASIN \®,
�� 1 �`�_ I Gp% / f/iT_ r'/�• life�7 O` WITHIN 12"OF FINISHED GRADE.
10 I fI.Z ��� //1w sa fT /c/=�'N cam' l•r� 3.EXISTING AND FINAL GRADES SMALL REMAIN ESSENTLAUY THE SAME.
a G 99co �_ I ,�/o�c.� �f 49 7 �e t Y1Jay:
J 4.ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE
V .fZ�� rjl'A G 3 liiec:400rl P.1 sf OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR
O I � /• Tc „"L¢Evt[, �w�..1 T3`r 24�1'"1- WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING
-' z -IPVy P mac" MIN.FRONT SETBACK Zo SHALL BE USED UNDER OR WITHIN 10 FT.OF DRIVES OR PARKING.
9.ANY MASONARY UNITS USED TO BRING COVERS TO GRADE
Mgt REAR SETBACK
Mµ SI6E SETBACK /� SHALL BE uORTAREo IN PLACE.
no"�o •-1 [pr�• //•'//�6.NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
,� ' "'"O T..¢ '•' W `> / ,,.rECLy -,' + DEEDED OR ZONING REGULATIONS.OWNER/APPLICANT IS TO
` I O O 4r OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
O ti•..._� - �•° ° :`w aAPPROVED; BOARD OF HEALTH
l
q�_ `x
DATE .AGENT
IMIOJER 1CCJTIOw
��.2,,,•
uraT
M4''v
SI-
H � Y1
I�; �,\ `1 •••_ '�•` _
CAE LEVY, EGDREDGE,B WAG/VEW ASSOC /A/G
p ,,�2'`` /7 ENGINEERS-LAN0.5GAPE ARCHITECTS
!cF o 1 Tol or CpTLH eLs,-1 �/0T 3^ ,� PLAPINERS-LAND SURVEYORS
t\,,' �� �zrr� '?: <cc.��.•--,.J - �_�� EA,s y�`L�y�s� B89 WEST MAIN STREET
,50•00 �J64S 4.11Li-) l V 1 CENTERVILLE.MA 02632
. / V '� 5ca�e• I"•zo' trwH,al{tb�l i•z•e7
G - I
SHEET I OF
LOCATION MAP '0�M0 129Z I
` C:A`I-1UN l 11 ri
LLAGE DATE J
PLICANT I�� : . 1 FEE
DRESS j'/ - ' t,r ' TELEPHONE NO.�^�j�*-(Non-refunds
l_CS C- TE E HONE NO
TE SCHEDULED
plicant s signs ure)
SSESSUII'S�AlAP�4 LOT NO,..................". ...........
•........................
7,.> SOIL LOG
B=DIVISION NAME DATE `I a_' TIME 9. /'5
2ANSIOII A7;,RIIVATE
: YES NO C� /.�v4jf_5 ENGINEER h
�N WATER WELL _Zn2r::� ,L/C,r16:e jo BOARD OF IIEAL'1'I1
EXCAVATOR
'TCII: (Street name,etc. ,dimensions of lot, exact location of test holes and
• percolation tests, locate wetlands in proximity -to test holes)
NOTES:
d' 4k,.
COLATION RATE: G Z M ��j A
T HOLE NO: ELEVATION: TEST HOLE No. ELEVATIONI:
1 1
2 +- K Z c� 72�p 2
3 . 3
4 '<�tr't' �iT7 C. 4
5
6 �i C tz�.�7c� f-r A . 6
g c;fLrtyE C B
9 �' 9
10 _ 10
3
• 11 �i�.}�� 11
12 12
13 A z.) 13
14 14
15 15
16 16
TABLE FOR SUB-SURFACE SEWAGE: . LEACHING FIELD_✓LEACHING PITS
LEACHING TREN.CHES�_
;UITABLE FOR SUB-SURFACE SEWAGE. REASONS:
C: ENGI14EE�RING PLANS MUST SHOW NUMBER ASSIGNED .ON PERC TEST APPLICATION
GItIAL: CONPLRTED IN ENTIRETY BY P. E. AND RETrJRNED TO BOARD O1 II(ALIII
"�: 11E'I'AI21CD BY APPLICANT
tj 01
S
ter, -
9�a ! , A.NI. e✓
c.s. 1 9e•�
/-fi
E e 1
P
., 0Al f P a a
ti
o. co e
o ,
00
y
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y .
•� C`v • .J io :JEC6E27_/He C...s/
�Z
ALL4JCJ•JSE G✓T2 k//GCEQ ,
- FPi•lo,.e.oC ,u Of .P�Q u�LEO [..,v0lL
T.✓E' J..-0 ✓/SOON CNT�OC LiPW.
To.rfjo.y To.s..usr y
..re.re et-: •.J� �.ivir•N ifs n `n /J
M•RP
-��.CNS���GE •,'�VL!/Fr Go—aJS4c:.Yy� /NL �"�� •
LOB ,+lq N J:-FEET
't 77
cif _ i �(a v� oo ;•
1?rat-rS c134. .17' S'-
oFTHE ro TOWN OF BARNSTABLE
OFFICE OF
s BAMSTMM r BOARD OF HEALTH
y N"&
°,ems 039. A 367 MAIN STREET
CEO MAY�\
HYANNIS, MASS.02601
April 24, 1995
Edith Romano
78-6 South Quinsigamond Avenue
Shrewsbury, MA 01545
RE: Assessor's Map 248, Parcel 170
Elliott Road, Centerville
DWCP Application Filed March 24, 1995
Dear Ms. Romano:
You are granted a variance from the Board of Health Regulation which limits sewage
flows to 330 gallons per acre per day within certain zones of contribution to public water
supply wells. The variance will allow you to install an onsite sewage disposal system at
Lot 1 Elliott Road, Centerville with the following conditions:
(1) The applicant shall remit one hundred dollars ($100) prior to obtaining
approval of a disposal works construction permit at the Health Division
Office.
(2) The septic system shall be installed in strict accordance with the submitted
plans dated July 2, 1987.
(3) No more than two (2)bedrooms are authorized. Sewing rooms, study
rooms, finished attics, sleeping lofts, and similar type rooms are considered
as bedrooms according to DER
(3) The dwelling shall be connected to Town water.
romano2
s+ a
The variance is granted because the area surrounding this property contains homes of
similar or larger size. It is the opinion of the Board of Health that the construction of one
additional septic system in conformance with Title 5 and all other Health Regulations will
not alter the quality of the groundwater in the area.
Sincerely yours,
C
J seph C. Snow, M.D.
cting Chairman
Board of Health
Town of Barnstable
I
JCS/bcs
romano2
I TOWN OF BARNSTABLE
�FTHETn
OFFICE OF
Z BAHdMBL i BOARD OF HEALTH
%639. `� 367 MAIN STREET
MAY k HYANNIS, MASS.02601
April 24, 1995
Edith Romano
78-6 South Quinsigamond Avenue
Shrewsbury, MA 01545
RE: Assessor's Map 248,Parcel 170
Elliott Road, Centerville
DWCP Application Filed March 24, 1995
Dear Ms. Romano:
You are granted a variance from the Board of Health Regulation which limits sewage
flows to 330 gallons per acre per day within certain zones of contribution to public water
supply wells. The variance will allow you to install an onsite sewage disposal system at
Lot 1 Elliott Road, Centerville with the following conditions:
t
1 The applicant shall remit one hundred dollars($100)prior to obtaining'
( ) approval of a disposal works construction permit at the Health Division
Office.
(2) The septic system shall be installed in strict accordance with the submitted
plans dated July 2, 1987.
(3) No more than two (2)bedrooms are authorized. Sewing rooms, study
rooms, finished attics, sleeping lofts, and similar type rooms are considered
as bedrooms according to DEP.
(3) The dwelling shall be connected to Town water.
romano2
The variance is granted because the area surrounding this property contains homes of
similar or larger size. It is the opinion of the Board of Health that the construction of one
additional septic system in conformance with Title 5 and all other Health Regulations will
not alter the quality of the groundwater in the area.
Sincerely yours,
J seph C. Snow, M.D.
cting Chairman
Board of Health
Town of Barnstable
JCS/bcs
rom=2
f!
x 3 the Harwich
"e 141 4!1_
r ;/ .•
7
............
r
—
Yfi y
—. _
Elevation 2
1224 sq. ft. of living area. Overall size 24' x 34'.
.� 34'-O'� 34'-�•
I
i
{ o l 1-BATH,
� STORAGE
J JJJ KITCHEN•E
. $ -DINING-
O ALL o HAL
BEDROOA\•
I� BEDROOM- ° -LIVING• ROO&
� 15.3:, x I I�6� Kcaa wccass
•STORAGE• STORAGE
a _
0
Plan 2
-Iles
TECHBUILTMANUFACTURERS OF HOMES AND BUILDINGS
585 State Road • P.O. Box 128 • North Dartmouth, MA 9 02747 1-617-993-9944
✓; He NO.
LLAGE DATE )
I PLICAUT � Gl./
t FEE �
DRESS !, i j/ - ' �r TELEPHONE NO.,92 Non-refundable)
INEER n f}as SSGLees G TE E HONE NO
TE SCHEDULED
plicant s signat ure)
SSESSUII'S�AIAPSe LOT NOc..................... ....................................
SOIL LOG
B=-DIVISION NAME DATE TIME 9.
ANSION ARE : YES NO �7 i�/�fy /-A,4 -fS ENGINEER ?
�IQ WATER / PRIVATE WELL BOARD OF 11EA L 11
A�✓y/`� �7Z�T EXCAVATOR
'TC11: (Street name,etc. ,dimensi.ons of lot, exact location of test hole' s and
percolation tests, locate wetlands in proximity -to test holes)
NOTES:
E L L 1 C57- lz-U 7
nD
N.
d� Al
COLATION RATE:
T HOLE 110: ELEVATION: TEST HOLE NO: ELEVATION:
. l 1
2 K/�(6<� 72-p 2
3 . 3
4 'r7v z3`�tr7 4
5
5
6 — -... 6 —
7 ,G�tQ5 y,9 rv%�
8
10 f! - 10
,
• 11 �r�x�� 11
12 _ 12
13 13 ,
14 14
15 15
16 16
TABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD ✓LEACHING PITS
LEACHING TREN.CHESk-;
UITABLL•' FOR SUB-SURFACE SEWAGE. REASONS:
'E: ENGINEeRING PLANS MUST SHOW NUMBER ASSIGNED .ON PERC TEST APPLICATION
GIilAL: CONPLETED IN ENTIRETY rw a_ F AND RI"PURNED TO BOARD OF 11fALI11
Y: 1ZCIAINED BY APPLICANT
1
r 29
04 1 t o TOWN OF BARNSTABLE DATE ,
#' OFFICE of FEE
11A•I'7'n BOARD OF HEALTH RECEIVED BY _
MAY��fi 367 MAIN STREET
IIYANNIS,MASS.02601
VARIANCE REQUEST FORH
ALL VARIANCES MUST BE SUBMITTED FIFTEEN 15 DAYS PRIOR TO
TILE SCHEDULED BOARD OF HEALTH MEETING.
NAME OF APPLICANT Edith Romano
TEL. N0.
ADDRESS OF APPLICANT 78-6 South Quinsigamond Ave. , Shrewsbury, MA 01545
'`ditil Romano
NAME OF OWNER OF PROPERTY
SUBDIVISION NAME DATE APPROVED
ASSESSORS MAP AND PARCEL NUMBER Map 248 Parcel 170
LOCATION OF REQUEST Elliott Road, Centerville, MA
SIZE OF LOT 11,200 SQ.FT WETLANDS WITHIN 200 FT.YES
VARIANCE FROM REGULATION(List Regulation) NO X
"Interim Regulation for the Protection of the Groundwater Quality within
Zones of Contribution to Public Supply Wells"
REASON FOR VARIANCE(May attach if more space is needed)
Hardship on land and property owner; prior permit to build issued
in 1970 and 1980`s; increased tax base and is reasonable and
necessary to prevent a manifest injustice'.:to .taxpayer.
PLAN - FOUR COPIES OF PLAN MUST BE SUBM C 1QLE
OUTLINING VARIANCE REQUEST.
Q�
,Q 4) '
VARIANCE APPROVED Mq /�/�+�NOT APPROVED
REASON FOR DISAPPROVAL
BRIAN R. GRADY, � C IRMAN "...�
SUSAN G. RASK, R.S.
JOSEPH C. SNOW, M.D.
BOARD OF HEALTH
TOWN OF BARNSTABLE
�� � S 3 y P k l� f,•. � fi
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fit
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7' - 14' 7' - -
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fig.
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X Concrete Floor o-'
s
Cl) Cl)
3-Ox6-8
UP
PAD to 2x6 Thickness
Storage 5/8"Sheetrock on South Side
2x8 Sleeper Floor
2-6x6-8 Workroom
2x8 Sleeper Floor O=,Q
0
ao 0o ao
co co cn
x x x
N N 19
N Garage
- �; � 1
EXISTING UNCHANGED 4x6 Post to RidgeM Al2
Mud
Storage
Room 2x8 Sleeper Floor
2x8 Sleeper Floor o
H
�i
3 1/2" C? Cl)
N
Concrete Floor ——— r
Ramp up to 2x8 Sleeper Floor System
3-Ox6-8 2-Ox3-6 2-Ox3-6 Align Sheetrock
I
9-4x8-2 9-4x8-2
=LL1
n
c"Q r>Q �Q WEST �a
0
A2
m
3' WHITCOMB REMODELING, Inc.
z FIRST FLOOR A
P.O. Box 501 , West Hyannisport, MA 02672
8
GARAGE ADDITION for Alan Reed
SCALE:1/4 = 1'-0�' 774 487-4714 - whitcombremodeling@gmail.com
30 Elliott Road, Centerville, MA 02632 � ) 9@9
'c
�.t.
4
1]
Y
.O
N
,
FT. , x MIN,�
TOP 4F FUND.
SOIL ES
EL. 0 FT. MIN. ;
„
DATE OF SOIL :TEST "� I
CONCRETE �1 , " W TNESSED 8Y �
CLEAN
SCH.
P C PIPE
L E N ��
C fYA COVERS PERCOLATION ...RATE � '
1
+� MIN. INCH _
MIN. PITCH !8
G PER. FT. s;
OBSERVATION
RATION HOLE ` i : OBSERVATION
CONCRETE
_ ERV TION HOLE ,2 `
1�
ON ETA
2 EL
CAST 1R N PIPE
L YER O ELEV.
A t3 —
FOR U MIN. !! 1/2 EQ Q WASHED �,�.�'� a ,t
t,l H Ma � '
PITCH, I!a PER FT.
d
'sTcalvt _ � �c•
z ,
FLOW trltJE 42 �►��P � �I.
IO
,� ..
EL S 3
EL.-- ids
----� a
41
EL 48 LEVEL
;. rt R p
EL
Li
EL.
DIST. EL. .
WATER AT l4 .= 38' 1
- BOX
�`'y(�/'�) � .. '� E L WATER AT� E L
4 I1
3/ " I !2 -
opo GALLON WASHED STONE U. 0 c •
00 DESIGN CALCULATIONS
=. 2
SEPTIC TANK d EL .� .,..-1
PRECAST LEACHING NUMBER OF BEDROOMS ,
BASIN OR E U GARBAGE DISPOSAL UNIT p
- V Q I 6 DIAM. 3
TOTAL ESTIMATED FLOW
t r GAL./BR./DAY x, 3 BR.} A ! A
.. SEWAGE DISPOSAL SYSTEM PROFILE � '�. � G L. DAY
REQUIRED SEPTIC TANK CAPACITY{+ � 5' GAL.
NOT TO SCALE ._..
ACTUAL ^&
CTU L 512E OF SEPTIC TANK 1000 GAL.
c, = LEACHING AREA REQUIREMENTS"' ;
BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL. 8 "1
OBSERVED WATER TABLE ! l EL.= SIDEWALL AREA � bAL./S.t
� } 2,
BOTTOM AREA L, GALJS.E
LEACHING CAPACITY l BOTTOM+ SIDEWALL} A _
G 1.
x IA + I+¢ a4 4>�co
LEGEND:
x �• L-� RESERVE LEACHING CAPACITY . GA ;
EXISTING SPOT ELEVATION
---
EXISTING . CONTOUR O O
--------------
FINAL SPOT ELEVATION
FINAL CONTOUR
NOTES
M ,. _ ,r L00 -
I , r�a � c� ftL.�t i. ALL .WORKMANSHIP AND MATERIALS SHALL CONFORM TO D:E.4.E.
o �'� UTILITY POLE TITLE 5 AND THE TOWN OF `RULES AND
�� yy REGULATIONS FOR THE SUBSURFACE DISPOSAL 'OF SEWAGE.
�,
TOWN WATER W---__= _ _
r' . '. f - 2. AL
� j I ,��...� � .�� '.�'r-7 L COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
( CATCH BASIN
c.�� �� WITHIN 12 OF FI I
t..i N SHED GRADE. :, <• ;
EXISTING AND`FINAL GRADES SHALL REMAIN ESSENTIALLY THE £.
.. ,q .._. SAME.
,
4.
i r< ALL COMPONENTS OF THE SANITARY SYSTEM HA BE 'CAPABLE
/ ,.�.� t I���,. SHALL L
rM � t � OF`WITHSTANDING .. ,
� N H !0 LOADING UNLESS THEY ARE UNDER OR :.
--- WITHIN IQ FT: OF
DRIVES 0R PARKIN AEA 20LOADING
U ..� �a G AREAS. H
I
_ �,{ c
1 MI : A ,✓' SHALL BE USED UNDER R F >
N. FRONT SETBACK 0 WITHIN 10 t OF DRIVES OR PARKING.
�. A A A' MiN. REAR .SETBACK i ANY M SON RY WHITS USED TO BRING COVER T RAD
C� S 0 G E
4
I A
MIN. SIDE SETBACK SHALL BE MORTARED IN ,PLACE. ._
y
6.
NO DETERMINATION HAS BEEN MADE AS-T0 COMPLIANCE WITH ,_
0 0
DEEDED OR ZONING REGULATI
ONS. OWNER/APPLICANT IS TO
,.
�r ., - ,. - , 0 N SUCH DETERMiNA'tION FROM APPROPRIATE AUTHORITY. ... . .. <
x
4 g
/
s
_ E ,, r � APPROVED BOARD OF ...HEALTH..
a
{ .
r °1
DATE -AGENT :
....•
PROJECT 1 t
...-- � OJ C7 'LOCAT dN i
t
67/
�. --.-�. w �: _a!ice" a
! a� APPLICANT
> n s
! _
-�
,
, c ,
LEVY ELDRE w.
1
DBE � l�li,4�lVER,AS
,
c
.
ENGINEERS LANDSCAPE ARCHITECTSr LANN RS - LAN SURVEYORS
7o ,.
_
88 '
9 WEST MAIN STREET
Q CENTER VILL,E MA 02632
r
,
,..
4
, 4 08 Nd, r
LOC
ATION MAP CON :�..u. - F
[SHEET"_ C? _
,
n
„
,
r