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HomeMy WebLinkAbout0050 FARM HILL ROAD - Health 50 Farm Hill Road Centerville A= 247-088 UPC 12534 �a No.2 153LOR I"TLU"1111 No. d I '0 / d Fee Ud THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 2ltlflfation for -Disposal 6pstem Construction Hermit Application for a Permit to Construct( ) Repair(A.Upgrade•()_A�andon( ) ❑Complete System ' Individual Components Location Address or Lot No- y�0 oM %�;I �� Owner's Name,Address,and Tel.No. Ctr✓f-Ct>V t)IC Assessor's Map/Parcel y 9 /VIP i t z X CAS Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �C� 7SIGS f} IJcfC�w� YivC `iC 6071 .v ,-j�eed,Nj vvIC Type of Building: Dwelling No.of Bedrooms Lot Size 76 570 sq.ft. Garbage Grinder( ) Other Type of Building -; , No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '?��,(� gpd Design flow provided �2 N o ,`7 gpd Plan Date 2-;2-t3 j Number of sheets Revision Date Title r i- Size of Septic Tank 1 S00 - 1 c) Type of S.A.S. ')L 1 U ldk qt°�,j Description of Soil Nature of Repairs or Alterations(Answer when applicable) "ew 1 cl a l l o"i � -1 O Swi is Ic:. 1A _ i o c fax' C.-i C) a kA - to 5 Oo G 1!(,-,) c�n c,-�Li � �, i� 1� 'S to.�Y Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date Application Approved by 12 Date f—% Application Disapproved by Date for the following reasons Permit No. 2-0(Q — 0 Date Issued �y I No. ) 0 0 7 d Fee /Od / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: {, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes �4plicatlon for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Vo<Upgra!•(.,..) radon( ), ❑Complete System e'Individual Components Location Address or Lot No,., 10 ��,m J���� ���� Owner's Name,Address,and Tel.No. CW�1k'YU��!C Assessor's Map/Parcel ` Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ' C7J I G S A ',2 S t� (Gw,1 "UivC ,rpe>-L(ep'-7M 1 ay1C_S Type of Building: e Dwelling No.of Bedrooms _ Lot Size 765-0 sq.ft. Garbage Grinder( ) Other Type of Building {jo G,A;. rG No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -Z gpd Design flow provided 'S N F) ,`7 gpd Plan Date 2 lb--1! Number of sheets '1- Revision Date Title Size of Septic Tank 15-00 - 10 Type of S.A.S. G(A1 1 c) s -Description of Soil . Nature of Repairs or Alterations(Answer when applicable) 1 IV S}4\t O -Jew 1 j (�Q Ci(:o l l n') � `l 0 1 r46y) !( +c c 1A - 10 1nn�e �.,►c) a In - t c� 60 c�nLW, ►} �n c� 'S G r i 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of r Compliance has been issued by this Board of Health. ;Signe AA aX l~' .--- - Date �4'� Application Approved by A a /r,..r: Date. -7 - .2/-C F- _Application Disapproved by Date for the following reasons Permit No. Dot - o 7 o Date Issued -- --- -- -- -- -- -- - --- ----------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( (i)�Upgraded( ) Abandoned( )by _L ,��a� r.? Aro�.�..4 n,C at i=c{ran :314 �� �io,� _P1 ra sue} ��%e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. rJh?-070dated 3 i� i Installer`:k�-�A a 5 A rev C Designer j",v)1,4 r Y A-P W&✓fir S #bedrooms '2 2 Approved esignoflow 3)_ gpd The issuance of this.peerrm�it shall not be construed as a guarantee that the system will functionas designed. Date M >/ j 6 Inspector No. _Q2a4-070 Fee /DU� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) \Repair(✓) Upgrade( ) Abandon( ) System located at � - 5-6 o fm VA i�1 1Qr) ���-P/U t�� 'P and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction/must be completed within three years of the date of this permit. Date /� 1 / A rovedb rr ' Town. of Barnstable °4I"E'O'�ti Regulatory Services Richard V..S'cali,lnteriiri Director BARNSTABLE, *. MASS. $ Public Health Division vqj 1639. [ ArED3.te Thomas vlch ean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 .Installer S Designer Certification Form Date: 'Sewage.Permit## 242[ -M0 Assessor's Map\Parcel 2 p Designer GYTi `+rtCe�',nG� Works lric Installer; G n Address: IZ W, Crr,ss -�e l�1 `t J Address: F-0.. —Llox 0.7 3 was issued,a pe1•nit to install.a (date) (installer) septic system at f5r-m J4,0 !ZA C4,A L--R r P11 Le. bases on a design drawn by (address) elated 2I Z-'K� (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 aiid/or septic tank. Strip out.(i;f 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. flan revision or certified as-built by designer to follow,. Strip out (if required) was inspected ���id the soils were found satisfactory. 1. certify that the.system referenced above was constrttcte' nce with the terms of the,RA approval letters(if applicable) KOF PETER,T. WENT"EE CIVIL �nstaller'stwe) ►O.35109 /STEM® Ow*t t (Designer's Signature) (Affih De igner tarnp 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 D.MSION. TI:l,1*VNK YOU. Q:\Septic\Designer C utitication Elorm Rev 3-t4-13.doc Town of Barnstable tan Department of Regulatory Services t r :MAft Public Health Division Date 2-`7 - zo 1,3 r A s63A �� 200 Main Street,Hyannis MA 02601 h•.7 Date Scheduled Time. Fee pd, /coo .Soil Suitability Assessment for Sewage Disposal Performed;gy: 1 Je, Mc r,,4ee SFr- l Scf Z Witnessed By: LOCATION& GENERAL INFORMATION Location Address SU FARM r41 LL-P D Owner's Name LOU'S META X A S CPn++ertrvtll� 27S&Ror-ro AVE,) viv,r is; Pi4uJ rt/cK 1=7"�R t 02$60 Assessor's Map/Parcel: 14 7 [ 0 S,3 Engineers Name e�^y+�.e e r Wa�rks,IH NEW CONSTRUCTION REPAIR i� Telephone# 5_0 8 t(7 7 —.S'3 i 3 Land'Use' Re- �j-#,4'JQ1 j Slopes(%) /' 7, Surface Stones arue Distances from: Open Water Bod —21 y Possible Wet;Area / ft Drinking Water Wel1]lLS 6 ft Drainage Way KV ft Property Line d f ft Other - ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&'perctests,locate wetlands in proximity to holes) z � Parent material(geologic) (1��w`�d Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /"� U"�'/u Weeping from Pit Race liz Estimated.Seasonal.High Groundwater �z 12 DETERMINATION FOR SEASONAL)'NIGH WATER TABLE . Method Used: Depth Observed standing in obs.hole: in, Depth to Soil mottles; - in Depth to weeping from side of obs.hole: in, arouadwa[er AdJustmmnt it. Index Well#. Reading Date: Index'Well level ,,,_„ AdJ,factor_ Adj,.Urootidwater 1 bvel PERCOLAT'JON TEST gate- x'itrtc— Observation ,g Hole# �l �I Time at h" Depth of Pew ?'�!/ , Time at 6" r 1 Start Pre-soak Time Q i ime(9 .6") . End Pre-soak Rate Min;/Inch, F Site Suitability Assessmcnt: Site Passed Site Failed: Additional Testing Needed(Y/It) Original: Public Health Division Observation Bole Data To Be Completed on Back---------- *Okif percolation test is to be conducted within 100' of wetland,you must,first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. QA\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole#_ 1 Depth from Soil Horizon Soil Texture Soil Color` Sod Other Surface(in.) (.USDA) (Munsell) Mottling: `(Structure,Stones,,Boulders. qii. on . ten ravel DEEP OBSERVATION HOLE LOG Hole# Z. Depth from Soil Hod 1zon Soil Texture Soil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,:Boulders. Consistency.% rave o - g A r 0-Ylz -321 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil.Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,,Boulders. Consistency. G DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Teiturc .Soil Color Soil other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i ten ra Flood Insurance.Rate.Man: Above 500 year#lood'boundary No— Yes Within 500:year boundary No Yes Within L00yeacflood.boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally incurring pervious material exist in all areas observed throughout the area proposed for the Soil absorption system? YES If not,what is the depth of naturally occurring pervious maCerial? Certification I certify that on h( h�q� (date)I have passed the soil evaluator examination:approved by the Departinentof Environmental Protection and that the above analysis was performed`by me consistent with the required trai ' ,apAerr ise and experience.described in� . CMR 15.017. f Signature. , Qi\SEPTIC�PRRCFORK DOG _ .........._......................__._. i TOWN OF BARNSTABLE �L CATION 5n 'j c 6101 t �2c SEWAGE# C71S6-0`7 VILLAGECp,*r,t,3- -t ASSESSOR'S MAP&PARCELc 4/ 2 — INSTALLER'S NAME&PHONE NO'7 A \3fcAyrj-5--Ac- SEPTIC TANK CAPACITY O eL D LEACHING FACILITY: (type) ,CX:>o(All C klgn (size) NO. OF BEDROOMS `3 OWNER PERMIT DATE: 22-2-1 - COMPLIANCE DATE: Separation Distance Between the: NQNC' C.`-' ?P(C 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) A Feet FURNISHED BY` t c`1 G S t)r- R y�o •=3g tom. cor OUT-- wf5- i 3o SEWAGE INSPECTIONS I. 71 OCATION 0 F DATE "VI ;LACE Oe c-V ASSESSOR'S MAP & LOT INSPECTOL SEPTIC THINK CAPACITY LEACHING FACILITY: (type) _ (size) NO. OF BEDROOMS BUILDER OR OYfNER 'OWNER MAILING ADDRESS r� i D� r a DATE 3/21 /06 PROPERTY ADDRESS 50 Farmhill Road Centerville5�.� MA 02632 On the above date, the septic system at the address above was Inspected. This system consists of the following: 1. 2-6 X 8 B.Pock ces.a/2oo-ez., Based on inspection, I certify the following conditions: 2.- 7h.iz iz not a . 7.i.tie Five. zept.ic zyzieo.''-':" .is, a sewage hyztem., . 3., Cezzpooiz ate .in paopea wo2k.ing oade2 at� .Ae paezent t-ime.� Both ee,6,61200i,3 we Ze d2y at time o� SIGNATURE Name: Robert A. Paolini = ZZ Company: Joseph P. Macomber & Son Inc.- Address: P. O. Box 66 Centerville. Mass 02632 Phone: 508-775.3338 or 508-775-6412 f 4 CH P. MACOMBER & SON, INC.Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connectionsx 66 Centerville, MA 02632-0066 775.3338 775-6412 • COMMONWEALTH OF MASSACHUSETTS : EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION A TITLE 5 OFFICIAL INSPECTION FORM—.NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PARTA CERTIFICATION Property Address: ..50 Farmhill Road Centaryi 1 1 e MA 02632 Owner's Name: Lee Metaxas Owner's Address: 275 Grotto Ave #1 5 . Pawtucket RT 0260 Date of Inspection: 3/21 /0 6 Name of Inspector: (please print) ` R_obc_rtAP o.l"ini Company Name: 2. l. �l_a c o m eti .S:o.n In c. f, Mailing Address: -� en eay.7 e, 4.6.6. 02632 Telephone Number: 5.0 8-7. 7-5_3 3 3 8 CERTIFICATION STATEMENT I certify that I have personally inspected the.sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in.:the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section.15:340 of Title 5(310 CMR 15:000). The system: XXX Passes Conditionally Passes Deeds Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: - � (U 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- system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that ~. time.This inspection does not address how the system will perform in the future under the same or differe.yt ,a conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION:FORM—:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � PART A CERTIFICATION(continued) Property Address: S n P;xrmh i 1 1 Read _0_entervil1P MA n 6-42 Owner: LPP Mataxac Date of Inspection: -1 f 91 0 6 Inspection Summary: Check A,B,C,D or.lE/ALWAYS,'eompleteall of Section:D. A. System Passes:q FS NO I have not found any information which indicates'that any of the failure criteria described in 3 10 CMR 15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Shytem iz .in paopea woaking oadea at the /2ae,5ent time., B. System Conditionally Passes: NO. One or more system components as described in the"Conditional Tass".s ction need to be.replaced or repaired.The system,upon completion of the.replacement or repair,as ap�rrovetl 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. NO The septic tank is metal and.over 20 years old*,or the septic tank(whether metal ornot)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 Zoard 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: NO 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: NO 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),Jre replaced obstruction is removed ND explain: Z4, 2 Page 3 of I 1 OFFICIAL-INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Farmhill Road Centerville MA 02632 Owner:Lpe M - axa s Date of Inspection:, C. Further Evaluation is Required by.the Board of Health: No 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: No Cesspool or privy is within 50 feet of a surface water Dict 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'Sgppr,if any)determines that the system is functioning in a manner that protects the public health,sa ety4nd environment: No The system has aseptic tank and.soil absorption system(SAS).and the SAS is within 100 feet.ofa surface water supply or tributary to a.surface water supply. N_Q_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. No The system has aseptic tank and.SAS and the SAS is within 50 feet of a private water supply well. N_Q_ The system has a septic tank and SAS and the SAS is less than 106 feet but 50 feet or more frog a private water supply:welI**.Method used to determine distance visual **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 , Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION(continued) Property Address: 50 Farmhi l l Road Centerville MA• 02632 Owner: Lee.;.Metaxas Date of Inspection: 3/21 /0 6 D. System Failure Criteria applicable to all systems:. You.must indicate"yes"or"no"to each of the followingfor all inspections: Yes No _ . X Backup of sewage into facility.or system component duelo.overloaded.or clogged SAS or cesspool X Discharge:or ponding of effluent to the surface,of the.ground or surface:waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2.day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. x Any portion of cesspool or privy is within 100 feet of a surface,wgter supply or tributary to a surface water supply: f. e X Any portion of a cesspool or privy is within a Zone 1.of a:.public well. X 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 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'S ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached.to this form.] No (Yes/No)The system fails.I have determined that:one or mor6of 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 _ x the system is within 400 feet of a surface drinking water supply X the system is.within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen senk'tive 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 CMRf 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 _ OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 Farmhill Road Centerville -MA 02632 Owner: Lee M axas Date of Inspection: 3 L21 1 o F Check if the following have been done.You must indicate`)ies"or"no"as to each.of the following: Yes No X . Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? NIA Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back'1ip` ;rt X Was the site inspected for sip p gns of break out X _ Were all system components,excluding the SAS,located on site? Were the-cuss o � 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information.For example,a plan at the Board of.Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.3020)(b)] y 5 Page 6 of 11 OFFI;CIAL.INSPECTION FORM,—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL,SYSTEM.INSPECTION FORM PART C SYSTEM:INFORMATION Property Address: 50 Farmhill Road Centerville MA 02632 Owner: Lee -Met„axac. Date of Inspection: -1/n1 .1 n ti FLOW CONDTTIONS RESIDENTIAL Number of bedrooms(design):...3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CNIR 15.203 (for example:110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): rt o Is laundry on a separate sewage system(yes or no):n o [if yes separate inspectionxequ. ed] Laundry system inspected(yes or no): n o Seasonal use?(yes or no): tg� 2004-.6, 000 gaeeone qPD=16.� 43 Water meter readings,if available(last 2 years usage(gpd)):2 0 0 5=12. 0 0 0 aa.e i o n s qP D=3 2.18 7 Sump pump(yes or no): n o Last date of occupancy: unknown COMMERCIA4a USTRIAL Type of esta htl ent: NIA Design Howe on 310 CMR 15.203): gpd Basis of degigp;' ow(seats/persons/sgR,etc.): Grease trap present(yes or no):. Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system.(yes or no):_ Water.meter readings,if available: Last date of occupancy/use: . OTHER(describe):. GENERAL INFORMATION Pumping Records Nl R Source of information: Was system pumped as part of the inspection(yes or no): n o If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption.system n 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) —Tight tank _Attach a copy of the DEf approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: unknown . _ fi Were sewage odors detected when arriving at:the site(yes or no):n o 6 Page 7 of 11 _ OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM"INFORMATION(continued) Property Address: 50 Farmhi.11 Road Centerville MA 02632 Owner: Lee Metaxas Date of Inspection: 3/2 110 6 BUILDING SEWER(locate on site plan) Depth below grade: 21 Materials of construction:_cast iron _40 PVC_other(explain): o itna ge&ea g Distance from private water supply well or suction line: 20 t Comments(on condition of joints,venting,evidence of leakage,etc.): Jointz apgeazt tlgh.t No A nA ne Qeakage., vetted th2ough hou.ze vent SEPTIC TANK: NQ(locate on site plan)" Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Complianee(yes,or no):_(attach a copy of certificate) Dimensions: Sludge depth: 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.): ,SeRit iC ank 1A nnf Rlze 6ont GREASE TRAP: NQlocate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet. nd outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,efd.): Gaeal3e t2aI2 i.b not Raezeat 7 Page 8 of 1 I. .OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 ?±armhi l l Road _Ctmnte-vi lle DdA 02632 Owner: Lee Pletaxas Date of Inspection: 3/21 /0 6 TIGHT or HOLDING TANKNO (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: Comments(condition of,alarm and float switches,etc.): Tight oa hoid.ing tanks ate not Raejeat DISTRIBUTION BOXYVO (if present must be opened)(locate on sitd"'P� n) 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.): D-i3 Z-i9l.ti0r1 90X iZ not /21Le,3ent PUMP CHAMBER: NO (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.): l um12 chamgea tb ao.t /24-p—iP_R_.t 8 Page 9 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Farmhill Road Centerville MA 02632 Owner:. Lee Metaxas Date of Inspection: 3/21 /0 6 SOIL ABSORPTION SYSTEM(SAS): -(locate on site plan,excavation not required) IfSA�oca ed explain /2¢ge 10 Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: X overflow cesspool,number: 1 innovative/altemative system Type/name of technology: Comments(note condition.of soil,signs of hydraulic failure,level of pondinng,dnp.soil,condition of vegetation, etc.): Loamy .to medium ./..ine sand., No z.ignh o) ; ": iLaeo So.iez ate_ dares., Vegetation.con ib noama2., CESSPOOLS:ES(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: - —" Depth—top of liquid to inlet invert: 0 Depth of solids layer: Depth of scum layer: 0 Dimensions of cesspool: 6 XR Materials of construction: 2o'ck Indication of groundwater inflow(yes or no): n o Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): So.;.PA f//10 rinUl ,_ rn— -ad-;_ag l-��ge,.4.a-j eio� 4 �A�2�^f 3oth cebb/?oo ez Reae PRIVY: NO (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.): l/ZiVU i,6 not 12^PAen7' � 9 s.. Page 10 of 11 iCIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS I�BSURFACE SEWAGE•DISPOSAL SYSTEM INSPECTION FORM �. PART C SYSTEM INFORMATION(continued) Property Address: 50 Farmhi l l Road Centerville MA 02632 Owner: T.PP Mai-axac Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM -Provide a sketch 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. . I : I i b a I I 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART.0 SYSTEM INFORMATION`.(gontinued) Property Address: 5 0 Farm.hi l l Road Centerville MA 02632 Owner: Lee Metaxas Date of Inspection: 3/21 /0 6 SITE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to groundwater feet Please indicate(check)all methods used to determine the high ground water elevation: �N 0 Obtained from system design plans on record-If checked,date of design plan reviewed: u e z Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board.ofHealth-explain:n.6 na2d no Checked4ith local excavators,installers-(attach documentation) Accessed,USGS database=explain.t�E12 t o wn.,9 a a n s t a�$e, rre•a.:"u e. You must describe how you established the high groundwater elevation: 11.sed Cape Cod Commizion 1date2 7aa2e Coritouas And Pug2.ie ldatea SuI2122y Oeii head paoteetion azeas map., Sept 1995 Ugzte2 aesouzce.s oelice cage cod commi.5.ion., Top of Cround Leaching 5 Pit 'Feet Groundwat3P Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Thekfore,the vertical.separation distance between the bottom of the leaching pit and the adjusted groundwater table is a� f feet. i •rn,nnr�nr►�►'•a,•r'•,,,►�anrennwA'•,,,, 1.tFl►v +wTR►!7lTP.,r••}; TOWN OF BARNST BLFj I30ARD QF 11$A11TH SUBSURFACR SEWA09 DISPOSAL, SYSTSM ItISPFCTION FORM - PART D CERTIFICArio «•aNl'T•:4:1"T TINI•tiSTTVR}IAI'R11�17'1flPM�7/�1n11PR�'�R �► r"�1t ► . -TYPE 01 PRINT CLEARLY- PROPERTY INSPEC=0 . STREET ADDRBS$ 50 Earmhill Road Centerville 02�32 ASSESSORS MAP, DLWK AND 'PARCEL OWNER's NAME Lee Me--T-s_. „_..�,�►.._,_..^_;• ,,,_,,, .__,. PART` D CERTIFICATION NAME 'OF INSPECTOR _ Ro I,iitt Pa.o tin,! COMPANY NAME ;OzaAh .P., Nacomlao t" Son Inc Box 66 •. .C.zn�oay. itz Oabb' 026.32 ' COMPANY AUD.R�SS ' ta$ TOW•or ty. � .Stat LIP COMPANY TELEPHONE ( 508• Y�7.5 ' 3338 FAX 1' 508',1T 90 f 578 . 0 MOW CZRThFI CATION. STATEMENT • ' I. certify that I have personal-l.y .inspeoted <.•the sewage 'dia ' ei`i. system at this address and that .tlid' information reported ,i'a true,. 4.ac0ra•te•, acid omplete as of the time .of• inspection..• The inepe0tivn was performed and any recommendations regard.ing upgrade, .ma•intenance ,' and repair .are• eonoistent with my trainipg and exP,erience in the proper functl-on• and maintenance of on- site sewage disposal. systems. Check one: Systeo PAS91D ; The inspection wh ic.h •I have conducted has .,n•at• found any information . which indicates that the system* ,fails to ' ideq•uately. protect .publi•(; health or the envlropment as defined in- .310 CMR. 16' 30.3•, Any failure criteria riot .evaluated are as stated in the FAILURE• CRITERIA .section of this form. System FAILED* f The inspection which I have aend ted 'has •••faund that •the System fails to protect the public health and the enV4ronmen•t ' in acoerdemce with Title 6 , 310 CMR 15 , 343, and as • speci f icall,y noted -on -Pk.T- C FAILURE CRITERIA of this inspection rm, Inspector SignaturC414�—I'-- Date ' Ycopy of this eertlfi.oat•iar must be rovi•ded 'to : the .QWN9R•, tho. .BUYER re appli•.aa�ble) and thL I3QARD OV HEA Tit. * If the inspection FAILED., thb .ewner'.or"9p06tor •a.heill . up the system, within obe year of the dat-e of the inspection, unless. al;'lowed Qr• req�ki;red nt.hArw{se as Provided in �JO CMR 16 ,3061, a fe. - --EXISTING CONTOUR N LOCUS MADISON AVE x 100.98 EXISTING SPOT GRADE W EXISTING WATER SERVICE f G EXISTING GAS SERVICE °' HILLS RD FARM -6.H. W --OVERHEAD WIRES o lJ UNDERGROUND WIRES N m0 ; v TEST PIT m M FENCE LINE S 62'56'40" E + BENCHMARK $ N F 1o1,6s � LEGEND � _ 75.01' x 101.88 O , TP-2 TP-1 o�° oar `25--{ C� G�� PROPOSED 12�I' � 101.11 SHED \13PROP S.A. SEPTIC TANK i `;� LOCUS MAP 00 1 1,15 j+`::; ..,.� . > EXISTING CESSPOOLS NOT TO SCALE ' TO BE REMOVED 1 00.74 BM 100 s9 (SEE NOTE 11) GENERAL NOTES: ' + 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL cn I 0 0 0 100. 100.39 BENCHMARK BOARD OF HEALTH AND THE DESIGN ENGINEER. O 1 COR./GONG. PAT10 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS Cn \� EL.=103.39 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE PATIO 00.40 100,45 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: w 100. 7 1 0.51 ` Li -310 CMR 15.405(1)(b): 100, 4 1 1) A 5' variance, septic tank to cellar wall, for a 5' setback. EXIST. SEWER 100,4 GO 2) A 5' variance, S.A.S. to cellar wall, for a 15' setback. INV.=99.4t cV r O ^ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR r7 O TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE bo o 1EXIST/NG o aD i DESIGN ENGINEER. N HOUSE(#50) .. N 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING z T.O.F.=101.47f �.. z FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 100. 1'" ENGINEER BEFORE CONSTRUCTION CONTINUES. AMP,... 5. ALL ELEVATIONS BASED ON AN ASSIGNED DATUM. 100.5 \ 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF WAL + THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF \ :;D HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. �' \\ 100,85 m. . 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. / x 100.76 \� x i 1,08 101, 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS p� AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE a� LOT 19-v DIRECTED BY THE APPROVING AUTHORITIES. 7 650 tSF / 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY ' THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 75.00' CONSTRUCTION. 99.96 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS UP S 61'52 30 E 100.65 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 1 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. / ® edge of pavement99 87 99,80 ,� 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND CATCH BASIN NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 99.98 99.74 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC M4ss9��G FARM HILL ROAD SYSTEM COMPONENTS NOT SHOWN ON THE PLAN PETER T. s PROPOSED SEPTIC SYSTEM UPGRADE PLAN McENTEE OWNER OF RECORD CIVIL "' METAXAS, LOUIS G 50 FARM HILL ROAD, CENTERVILLE, MA No. 35109 ; 275 GROTTO AVE.-UNIT 15 PAWTUCKET, RI 02860 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 Engineering by: REGfS(E � SCALE DRAWN JOB. NO. �� I L PLAN REVISION 3/21/18 1"=20' P.T.M. 116-18 1) CORRECTION TO EXISTING BEDROOM COUNT Engineering Woks, Inc. I l�j 2) CORRECTION TOP TO OF CHAMBER ELEVATION 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. PARCEL ID: 247-088 \ (508) 477-5313 2/28/18 P.T.M. 1 Of 2 C I NOTE: TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHAFORLA DISTANCE TO�R56 FROM THE EDGE INSTALL RISERS & COVERS OVER INLET & -- OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISER & COVER PROPOSED S.A.S. SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F=101.47t Y SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT .EXISTING F.G. EL.=100.5t F.G. EL.-100.5t F.G. EL.=101.0f F.G. EL.=101.Ot HOUSE(#50) t MAINTAIN 2% SLOPE. OVER S.A.S. L = 10 3(max.) L = 1 1' ® S=1% (MIN.) ® S=1% (MIN.) 5' % MIN.) ( 4"SCH40 PVC 4"SCH40 PVC2" LAYER OF 1/8" TO 1/2" 4 V ' BO O PVC H TONE _" DOUBLE WASHED S" LE ��"I E74"ESCH BBa�aaa (OR APPROVED FILTER FABRIC) j, 429' 'SrO N 14" o®aaoaa INV.=98.75 48" uaulD ®aaaBa® �-3/4" TO t-t/2" DOUBLE S LEVEL PROPOSE 4' 4.8' 4' WASHED STONE '� Off• Dh cAS�BnFFLE INV.=98.27 _ . 8.10 INV.=98.50 �� EFFECTIVE WIDTH = 12.8 T)3 OUTLETS INV.=98.00 PROPOSED SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS i PROP. S.A.S. SURROUNDED WITH STONE AS SHOWN CONNECT TO EXISTING SUITABLE SEWER H-10 RATED 3" LAYER OF 1/8" TO 1/2" PIPE AT HOUSE, INV.=99.4t verif DOUBLE WASHED STONE I-----25'--I TOP CONC. ELEV.=99.8t (OR APPROVED FILTER FABRIC) BREAKOUT ELEV.=98.50 lanammEmmmmmm NOTES: ®®a® INV. ELEV.=98.00 mmumm 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & 99Ba6B6®®®a SEPTIC LAYOUT INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. a®aBa®aaBea BOTTOM ELEV.=96.00 _T 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' 2 x 8.5' = 17.0' 4' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION ffE3E3 ® ® ®®® 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=91.1 z 3/4" TO 1-1/2" DOUBLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE WASHED STONE H- EO®® ® ®®®® 33" AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. WNZ ®®® ®®®®® SEPTIC SYSTEM PROFILE 102" DESIGN CRITERIA— SOIL LOG 4" KNOCKOUT NUMBER OF BEDROOMS: 2-°B DR MS DATE: FEBRUARY 26, 2017 (REF#15,594) _ „ ��U �J.�Jo SOIL EVALUATOR: PETER McENTEE PE(SE#1542) 20 DIA. COVER SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT DESIGN PERCOLATION RATE: <2 MIN/IN y� /11 ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH 4" KNOCKOUT / 4" KNOCKOUT 58" DAILY FLOW: 330 GPD �� 101.1 A 0„ 101.1 A o" DESIGN FLOW: 330 GPD LOAMY SAND r LOAMY SAND 100.4 10YR 4/2 100.4 10YR 4/2 $„ 4" KNOCKOUT GARBAGE GRINDER: NO-not allowed with design B $' B LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF LOAMY SAND LOAMY SAND .74 GPD/SF 98 6 10YR 5/617- 30" 98.4 10YR 5/6 32' 500 GALLON CAPACITY, H-10 LOADING PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY C PERC CHAMBERS PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED 25"/43" N.T.S. USE 2-500 GALLON LEACHING CHAMBERS IN SERIES M-C SAND M-C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 2.5Y 6/6 2.5Y 6/6 50 FARM HILL ROAD, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 TOTAL AREA:.................................................. .......... 471.2 S.F. 91.1 120" 91 1 120" Engineering by: SCALE DRAWN JOB. NO. Engineering Works, Inc. N.T.S. P.T.M. 116-18 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD PERC RATE <2 MIN/IN. C' HORIZON 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. NO GROUNDWATER ENCOUNTERED (508) 477-5313 2/28/18 P.T.M. 2 Of 2