HomeMy WebLinkAbout0028 FARM HILL ROAD - Health 28 Farm Hill Road
Centerville
A= 247-081
SMEAR
No.2-133LOR
UPC 12M
snrnd.awn - us&In UY
IMIW NM WI�W
e
OIN
TOWN OF BARNSTABLE
LOCATION -Z!a rro.r0-% kA,1 I RJ, SEWAGE# 'ZO18 -093
VILLAGE CcnJrr V;11 G ASSESSOR'S MAP&PARCEL Z4-1 -%1
INSTALLER'S NAME&PHONE NO. EXeaxlo.A;on 4'1'l- 0&53
SEPTIC TANK CAPACITY 1S00 go-1
LEACHING FACILITY: (type) SOO 9a.1 LIC 0 (size) 13 X ZS X 7-
NO.OF BEDROOMS 3
OWNER a, a
PERMIT DATE: y-L- ig COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
A►- zz
AZ' Zg'
a2 17 W !AR
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Rppl Cation for -MispoSal *pstem Construction Permit
Application for a Permit to Construct( ) Repair(v<Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 2$ Fe.r&% }I 1 RJL Owner's Name,Address,and Tel.No.R,yynond 040-81 C-
Assessor's Map/Parcel 2.41 1 8I 6�A ZS F xr-N W I 1 { JL
Installer's Name,Address,and Tel.No.Q E;ko&V*,Ai0 0'% Designer's Name,Address,and Tel.No._Dy, fla�,mrAL
H 'Tk.00-crr-c.l La
Type of Building:
Dwelling No.of Bedrooms Lot Size $000 sq.ft. Garbage Grinder( )
Other Type of Building RtS icA�r_^j ics,.l No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 O gpd Design flow provided 3 y$ gpd
Plan Date Ll-S' 18 Number of sheets 2 Revision Date
Title Size of Septic Tank 1500 Type of S.A.S. SOD cjcLl C"&%I z r 5 &2:\)
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) -TAOV,- tJ Sax- Lc M c�%i^!i
Date last inspected:
Agreement:
r The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Si d Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued p
co
No. ( Q 3 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rpplication for Disposal *pstrm Construction Vermit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
jLocation Address or Lot No. 28 77, 14;11 Rom. Owner's Name,Address,and Tel.No. (ZaHrnond (3cat4;e--
Assessor's Map/Parcel 2 4-7 g] Z S
I
Installer's Name,Address,and Tel.No. $ E XCa Vo.,1 o Designer's Name,Address,and Tel.No..() v_
ly T�a�cC'c-�.` l-►J sandw, �1-.. Q•O• .�ax �� `�a�rroJih Ppc-•�
Type of Building:
Dwelling No.of Bedrooms 3 I Lot Size $O UO sq.ft. Garbage Grinder( )
Other Type of Building R r-5,,A Z cj t 0. 1 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 lJ gpd Design flow provided .3 yg gpd
Plan Date y-S- 18 Number of sheets Z Revision Date
Title \
Size of Septic Tank 1500 Type of S.A.S. .SOO S z 1' 5
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) TAtJPl - o BO x c Wt 4%1
Date last inspected:
E
Agreement:
t
r.
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
w - .
Sign d Date
Application Approved by Date �p p
Application Disapproved by Date r
for the following reasons
Permit No. �isL 3 Date Issued
-----------'-----------------------------------------------------------'----------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certifirate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ✓f Upgraded( )
Abandoned( )by (3 E X C-a ua.A;d f\
at ?_$ f a r+r\ iA; 1 1 R 4 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit NoG�t�� .3 dated q)(?
Installer 1 13 EXc-u.-A 1 o/\ Designer 1),x u c. F'I a h t r-A L
#bedrooms 13 Approved design flow 3 8 and
The issuance of this permi shall not be construed as a guarantee that the system will functio psi 7 e,
Date q7�a�l 8- Inspector
---- -----------%�-J ---------------,---:---------------------------.----------------------------------------------------j -------
9�
THE COMMONWEALTH OF MASSACHUSETTS Fee
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction 'Permit
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( )
System located at 7_ 8 F•� r� 1�;1\ (�
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must b'corrtlpleted within three years of the date of this permit.
1
Date /
!�� A pproved b,1
yY�1
Town of Barnstable
Regulatory Services
Richard V. Scali,Interim Director
• BARNSfABLE,
M' Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: y-13 18 Sewage Permit# 2 0113- 0 93 Assessor's Map\Parcel Z.4'1 S 1
Designer: FLa.hcrlu C1ju,r'O!')=t)Jcx-' Installer: �-R CxcouoAip,-\
Address: 9 O. Box S 1 Address: ILA Tco�c rc-K z�
�c3rr-�ov$ Qor f6rc.5.1Jc-I
On y- - g Z #e B Ex ea,)a,a i o^, was issued a permit to install a
(date) (installer)
septic system at Z Z A, 11 Rol.. based on a design drawn by
(address)
. .�c F10,h dated
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed ' c to.fiance with the terms
of the IAA approval letters(if applicable) � �N of*ssga
DAVID yGs
D.
L FLAHERTY;JR. N
(I taper's Signatur No. 1211
zi �FGISTS
sAN1TARIPN
(Design is i ature) (Affix Designer''s Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 8-14-13.doc
" j ti
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M y 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms 31�
on the computer, V1,5b`
use only the tab 1. Inspector:
key to move your
cursor-do not Ricky L. Wright
use the return
key.
B & B Excavation,lnc.
r� Company Name
14 Teaberry Lane
Company Address
Forestdale MA 02644
City/Town State Zip Code
508-477-0653 S 14595
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
4/6/12
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.
L,& /
q q--�I ?)'zb/ 't"a
t5ins•11/10 Title 5 Official Inspection Form:S T
Sewage Disposal System•Page`1 of 17
d
IL --
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. Citylrown 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:
® I 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:
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•I V10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
4
t
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. City(rown State Zip Code Date of Inspection
B. Certification (cont.)
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:
❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
i�
c
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. Citylrown 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. Citylrown 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-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
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•11/10 Title 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
28 Farm Hill Road
M
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. Cityfrown 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): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 Farm Hill Road
Property Address
Estate of Joseph McDonough
9
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ® Yes ❑ No
Water meter readings, if available last 2 ears usage d n/a
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ❑ No
Last date of occupancy: 2006
Date
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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
°M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
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:
30 + years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 3
feet
Material of construction:
® cast iron ❑40 PVC cast/clay
® other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
At time of inspection, building sewer appeared to be in good working order no sign of leakage or
blockage.
Septic Tank (locate on site plan):
Depth below grade: 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:
Sludge depth:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. CityTTown 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
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
How were dimensions determined?
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 (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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box if resent must be opened) locate on site plan):
( P P ) ( P )
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.):
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11/10 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
28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
® overflow cesspool number: 2 in series
❑ 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.):
At time of inspection cesspool#2 appeared to be in working order,no sign of back-up ,cesspool was
dry.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration 2 in series
Depth—top of liquid to inlet invert dry
Depth of solids layer dry
Depth of scum layer dry
Dimensions of cesspool 6x6
Materials of construction block
Indication of groundwater inflow ❑ Yes ® No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
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.):
At time of inspection cesspools appeared to be in working order, no sign of deteration,or back-up.
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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface-Sewage Disposal System Form Not for Voluntary Assessments
°M 28-Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. Cityrrown 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
I�► - Z7
o
t5ins•11/10
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: >10feet
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:
Hand augered threw dry cesspool.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•1 V10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
j Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 28 Farm Hill Road
Property Address
Estate of Joseph McDonough
Owner Owner's Name
information is required for every Centerville MA 02632 4/6/12
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
E Inspection Summary: A, B, C, D, or E checked
E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
E System Information—Estimated depth to high groundwater
E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-1 Ill Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILETOP OF FOUNDATION BROUGHT TO WITHIN 6"OF FINAL GRADE Flaherty Environmental Services
EL. 60.0' EL. 58.0' (not to scale) INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. Box 8'
2" of 8" to " DOUBLE WASHED EL. 58.0' Yarmouth Port, MA 02675
4" CAST IRON or EQUIVALENT PEASTONCOR GEOTEXTILE
MIN. PITCH 1/4" PER FOOT FILTER FABRIC 774.994. 166
a"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE
VENT IF REQUIRED
FLOW LINE (fiiat2'to be level) :.
_! 0' 1.5%
.5
�'. ��'• i 4 ',•.I .r
:.'•: L.57.0' 14" �� . . O O .. 0°0°o0o0c
!" ELL..55.75' EL.55.5' —� _ 0°0°0°0°0°0 0 0 0 .' K5 � °0°0°0°oc
o 0 0 0 0 0 0 0 0 o e
' EL.55.03' °o° ° o 0°0°0°0° gig ®� o°o°o°o°c
' EL.55.2' ° o°o°o°o°o°o° o°o°o°o°c 2.0'
' o GAS BAFFLE (H-20D-BOX EL.55.0' o°0°0°0°0°0°0°0° E ®� [� ®• o°o°o°o°e—
.�._10'MIN. (2.5/oL—� 0000000000 000000 a .' . :0000o000c
•.a. o 0 0 0 0 0 0 •• a • °0°0°0°oc EL.53.0'
NsrALL INLET TEE SOIL ABSORPTION SYSTEM
' �' 'i •• 6"CRUSHED STONE OR i"ABOVE OUTLET INVERT
•1'' �' •°' MECHANICALLY COMPACTED 1 (2) 500 GALLON H-10 CHAMBERS
• WITH 4'STONE AROUND IN A 5.5'
(DATUM: ASSUMED) ~� 3" to 1�" DOUBLE WASHED STONE
1500 GALLON SEPTIC TANK _ 12.83'X 25'X 2' CONFIGURATION
(PROPOSED) BOTTOM OF TEST HOLE EL. 47.5' EL. 47.5'
USGS ADJUSTMENT: N/A LOCAT/ONMAP
GROUNDWATER ELEV: N/A
N TH
Farm
o .
S8 LOC JS
LOT 25 10000,
8,000 SFt 58
MAP 247 LOT 81
a `
/y® EXISTING
3 BR NTS
CP
DWELLING ��ZN OF M4s.
DADV G�` •
0
PORCH CP o " F HER ,
{ 21
0 0. 11
DRIVEWAY �+
\ TH_1
\ Y 0 ?f
10, / 10, DATE.'41512018 REVISED.
SITE AND SEWAGE PLAN FOR
B & B EXCAVATION, INC./
RAYMOND BEATTIE
28 FARM HILL ROAD
BARNSTABLE(CENTERVtLLE),
SCALE : 1" = 30' MA
REF.'PB 118 PG 133 PAGE 1 OF2
t
:............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
...................................................................................................................................................................
GENERAL NOTES DESIGN CALCULATIONS SYSTEM DETAIL Flaherty Environmental Services
P. 0. Box 81
1. ALL PRECAST COMPONENTS TO BE H-10 + Yarmouth Port, MA 02675
RATED UNLESS OTHERWISE SPECIFIED.
DISTRIBUTION BOX(ES)AND ANY NUMBER OFACTUAL BEDROOMS 3 774.994. 1166
COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO
VEHICULAR TRAFFIC TO BE H-20 RATED.
2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW
ALLOW FOR THE USE OF A GARBAGE (110 GAL/BR/DAYX 3 BR) 330 GALAVAY
GRINDER. REQUIRED SEPTIC TANK CAPACITY 660 GAL.
3. MUNICIPAL WATER IS AVAILABLE.
4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1500 GAL. (PROPOSED)
310 CMR 15,000 AND ALL OTHER _
APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION _1
CODES AND REGULATIONS,
5. INSTALLERICONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MIMANCH
VERIFY ALL ELEVATIONS AND DETAILS 12,8 3'
EFFLUENT LOADING RATE 0.74 GAL./DAY/FT
AND REPORT ANY DISCREPANCIES TO2 ,. s'•''•
DESIGNER PRIOR TO CONSTRUCTION OR
ASSUME ALL RESPONSIBILITY. LEACHING AREA
y:
6. INSTALLER/CONTRACTOR IS (2)x(25.0'+ 12.83)(2) =151 SF
25.0'x 12.83' =320 SF 2 5,
RESPONSIBLE FOR MAINTAINING SAFE 471 SF 0.74 =348 GPD
WORK AREA, VERIFYING ALL UTILITIES
AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-10 CHAMBERS WITH 4'STONE
(1-888-344-7233) 72 HOURS PRIOR TO /N A 12.83'X 25'CONFIGURATION AS DIAGRAMMED
CONSTRUCTION,
7. ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY N/A ;
THIS PLAN MUST BE APPROVED IN —
WRITING BY FLAHERTY ENVIRONMENTAL
SERVICES AND LOCAL BOARD OF
HEALTH,
8. FINISH COVER OVER COMPONENTS IS
NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS)
UNLESS SHOWN PER PLAN,
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION
FILLED WITH CLEAN SAND OR REMOVED N OF Mys
TEST HOLE#1 P#15632 TEST HOLE#2 P#15632 S'
AND REPLACED WITH CLEAN SAND. Evaluator.• David D.Flaherty Jr.,RS,REHS Evaluator. David D.Flaherty Jr.,RS,REHS �0�� DA 9O
WALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755
WITH WATERTIGHT ACCESS PORTS BOH Witness: Don Desmarais,RS BOH Witness: Don Desmarais,RS
WITHIN 6"OF FINISH GRADE. Date: April4,20f8 Date: April4,2018 FLA R.
11.ALL SEPTIC TANKS, DISTRIBUTION TH-1 ELEV.58.0' TH-2ELEV 58.0' c 1
BOXES AND PIPING TO BE INSTALLED / TERM
WATERTIGHT. o"-9" A LS 10YR 312 0"-9" A LS 10YR 3/2"
S4AII R1
12.NO KNOWN WETLANDS OR WELLS
WITHIN 100 FEET OF PROPOSED 9"-30" B LS 10YR 5/5 9"-30" 8 LS 10YR 5/5
LEACHING.
13.THIS IS NOT A CERTIFIED PLOT PLAN
AND UNDER NO CIRCUMSTANCES IS THIS Pero l certify that on November 12,2002,1 have passed SITE AND SEWAGE PLAN
PLAN TO BE USED FOR ZONING OR the exam/nation approved by the Department of FOR
BUILDING PURPOSES, Environmental Protection and that the above analysis
14.LOT IS SHOWN AS ASSESSOR'S MAP 247 has been performed by me consistent with the B & B EXCAVATION, INC./
LOT 81. required training,expertise,and experience described
30%126" C2 MCS 2.5Y6/4 31"-120" C2 MS 2.5Y6/4 In 310 CMR 15.018(2)." RAYMOND BEATTIE
15.LOCUS PROPERTY IS NOT LOCATED 28 FARM HILL ROAD
ENTIRELY WITHIN AN AQUIFER BARNSTABLE
PROTECTION DISTRICT(ZONE II). G.W.ELEV.N/A G.W.ELEV.N/A ,CENTERVILLE)BOTTOM TH-1 ELEV. 47.5' BOTTOM TH-2 ELEV. 48.0' MA
PAGE 2 OF2
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