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0056 GOFF TERRACE - Health
56 GOFF TERRACE, CENTERVILLE A=170-088 LOT 18-18A f 1 �v'��to UPC 12543 "° No. 53LOR 9�`� '� HASTINGS. MN No. 0 I I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphration for Nspo8al 6pstem Conefturtion permit Application for a Permit to Construct( ) Repair(V6 Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. , �1 Owner's Name,Address,and Tel.No.91? Hd Assessor's Map/Parcel 0 1 GCIZr�ss exw S line Ca CL ®�1�1�1�h Installer's Name,Address,and Tel.No. 5;@8•179/— 3? Designer's Name,Address,and Tel.No.,-,% r�la��'®n&�tiZ�s�t'CJ�n '�•c•C, tiA��rGas �� ��C.�v �r+c �3�/fin V\lk 0_a4 41 Type of Building: Dwelling No.of Bedrooms 3 Lot Size /�o /�O(o sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures (' Design Flow(min.required) _550 gpd Design flow provided 399, gpd Plan Date J4 t 01� Number of sheets I Revision Date Title "—' ff � , nn Size of Septic Tank��(IIS r t i p0A o_rtX. Type of S.A.S. 1pl•t3 CCU Description of Soil 65M Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ,v. , The undersigned agrees to ensure the construction and maintenance of thib afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental a and to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by �Z Date Application Disapproved by Date for the following reasons Permit No. g d a Date Issued - - ------------------------ --------------- No. d r i Fee THE COMMONWEALLTH-0 MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippYicatiou for -Misposal �pstrtwCoristructiou Vermit Application for a Permit to Construct( ) Repair(,,4 Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. (' 6& Q, � Owner's Name,Address,and Tel.No.�/js/_a3�5J;89 Assessor's Ma /Parcel/70 ' "►"�l � ! ►gin e r�� d SiCx���n P . , t0 Installer's Name,Address,and Tel.No. rJg•�j/j/-9 g Designer's Name,Address,and Tel.No.,,,g-3t,a —y,5-r// At \ h Type of Building: r - Dwelling No.of Bedrooms e Lot Size f 6 7 c 66 � sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _�55 b gpd Design flow provided 9 gpd Plan Date ,f„ Tao 1r'1 Number of sheets t Revision Date a Title —, .,LG, Size of Septic Tank k,I S�t a„c ► Q Type of S.A.S. /AA3 r y s e �e�E►%�,11 �t - I�1 U�S _ 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 deseribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and eo place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ► Signed _ Date /. Application Approved by ' Date Application Disapproved by Date / for the following reasons Permit No. (j Date Issued 2 --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,,� Upgraded( ) Abandoned( )by,(nrkk 0,nS&,,L 1.,G at S 6r4 L o g i2,1,6R;11 M4 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�7 of r1' 2 7 0 dated Installer !o �cA41-6� �,r �,,� ) Designer #bedrooms 3 Approved desi r wkw A ?(I gpd The issuance of this pen it shall not be construedAas a guarantee that the system will functio I designed. Date Inspector n ` ---------------------------------------------------------------------------------------------------------------------------------------- No. OI 1 a� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair(4 Upgrade( ) Abandon( ) System located at 57 o 6?1 , / „4, 4 4 A_. ( �.s�i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to,,omply 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 ''� p� ( Approved by r AUG-06-2019 21:29 From: To:15087906304 Paae:1-11 Town ®f B stable "s Regulatory Services Thomas F.Geiler,Director NABA Public l8[ealth Division °te a Thomas McKean,Director 200 Maus Street,Hyawufis,MA 02601 Office: 08-862,4644 fax: 508-790-6304 I[nsjL er&Mesigaer Certification Form. Date: Y�1�1 I� sewage JPerm&#a70 ��'a7C� Assessor's MaplParcelj 0 6 Designer: PDWN (APE ag[KIMU M6_ Instmiler: AML-0 ' , C'A W CI R Ad&rP99: q3q M�s8�cE��c1k�O� Address: µel 11��U R� On 71a5 i9 �oP�zs�a'{ '(c 7)�" s issued apt to install a •(date) (installer) `— septic system at 5re CROW TEWC'C C',m=I LL& based on a design drawn by d(a ess) • i MIR-A. LIJALA 6 M dated (desigmeoo - i I cm1ify that the septic system referenced above was installed substantially according to the design,which may include minor approved changes such ea lateral relocation of the distribution box and/or septic tank. 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 s )bat in accordance with State&Local Regulations. Plan revision or cerCifi y dwig=to follow. �110F Am - � DANIELA. , OJALA �. (Installer's fgnature) CIVIL .q No.46502 C 1 P°F9�G)S TC��O.��'� �--� L C �,IS/Jl1 SS�ONAI E�6 (Desxg er's Signature) esigaeea Stamp Here) ME"]& RETURN TO BARNSTARIS XIJMC HEALTH DIMION CERTIFICATE OF CQMPI.TANCE wILL N®T SE XSB[JEID UNI'1)L BQWH— TMS FORM AM AS BUILT CARD AIM ]ItECETVED B`!CZIIEBARNSTABBLAKUL1CMALM TAI810N. TM4NXY0U Q:Health/Septie/Dedgaer CedEcebonPo=9-26-04.doc i TOWN OF BARNSTABLE LOCATION 6` i taZZc "- SEWAGE# _3-01esI VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. .�. SEPTIC TANK CAPACITY LEACHING FACILITY. (type) 14 (size) _'�!5,C LA•%'3 K-10.� NO.OF BEDROOMS OWNER PERMIT DATE: 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) e- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �+ Feet FURNISHED BY 1 04/V G �r �i�pyy���ivzt ear - 39% 31� Town of Barnstable Barnstable Inspectional Services j tiIa ftI BARNf3TABLE, "'A Public Health Division pr�0j"p�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean;CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7770 May 14, 2019 CAREY, JO-ANNE 50 SLOUGH ROAD BREWSTER, MA 02631 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 56 Goff Terrace, Centerville, MA was inspected on 04/30/2019 by Shawn McElroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thom c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\56 Goff Terrace Centerville.doc Town of Barnstable r • BAL . Inspectional Services Department tfD MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 C AX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS O 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: 0:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts � t Title 5 Official Inspection Form : Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Goff Terri Property Address ` Jo-Anne Carey Colson Owner Owner's Name information is '. required for every Centerville MA 02632 4-30-19 page. Cityrrown State Zip Code Date of Inspection r- 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. A. Inspector Information 57 113(ao[e Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 4-30-19 spectors 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 1 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form i I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 p Y ry 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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 ON ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i;i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :. > 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 - page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will.pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 El ❑ 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 ON ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form ,� wa Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form r�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - T, > 56 Goff Terr =_. Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ 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 '/2 day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ® ❑ 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. 5) 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 CA. 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 t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '(r 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is Centerville MA 02632 4-30-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system'considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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? ® ❑ Wasthe 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form ral Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a ,' 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El 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: Sump pump? ❑ Yes ® No Last date of occupancy: r 4-30-19 Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts la� Title 5 Official Inspection Form `., it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner---pumped 4-2018 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 ram" Commonwealth of Massachusetts r� Title 5 Official Inspection Form rl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ``4Y1 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: Tank and pit 1979 with new field installed in 1990's Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 24" Depth below grade: 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.): Good condition. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 L _ Commonwealth of Massachusetts A Title 5 Official Inspection Form 'A i'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is Centerville MA 02632 4-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 16"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 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" 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 15'" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `OI 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of i nspecti on)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ; �- Title 5 Official Inspection Form Iw�' ,.i-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a ,M 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA. 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 1" 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-box had signs of back-up with water level at 1" above outlet invert. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form F�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-1000 gal ® leaching chambers number: 5-Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form 1.1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °1 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Infiltrator leach field was filled beyond capacity and backing into d-box at inspection. Leach pit was empty at inspection with evidence of past failure. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp,doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts ;w Title 5 Official Inspection Form C�t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts ' ,. Title 5 Official Inspection Form �-i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lr 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 fad I gg may. ' . 01 31.46� 36, ? y� r f 7 S 9 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 t Commonwealth of Massachusetts 4. Title 5 Official Inspection Form ! i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments } a I a 56 Goff Terr Property Address Jo-Anne Carey Colson Owner Owner's Name information is required for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 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: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins .doc-rev.7126=18 p Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts 3 .. . Title 5 Official a Inspection Form wa rl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Goff Terr 1. Property Address Jo-Anne Carey Colson Owner Owner's Name information is required'for every Centerville MA 02632 4-30-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 18 of 18 TOWN oF BARNsTrABLE LOCAMON. .SEWAGE V LA�I "SESSOWS MAP&L(3x..� 1146TAJ,LER'.S NAME*PROM No. a� TAN ell LSACIMGj.1PACB l'I- No .C) �h3l3Dk�Ot7NLS L e�4 oP-4—' /- cR}-p9 �}'ERNdtT1�A'�'E� t"p1►/drit..�F,I�1f.�E 1�� p►uatcon� �irine Between vhor aMaximum�u!}usttJ:Cn'autAdwptec Tableto tUc Bc�ttarnafLeahing Facility. P��tv qs;1 'aitwr Supply Vlu�1'iiyd LeaaltrnS t?act easy sells exist ' aa�eltcs oc tvi: ii.,2QQ foot of le00E ing fhowty) Few e cif' /etland:ttad X.e iPic�tey.tL my.wetlan AcbinaOexist FurWiopd'bi _4 :aO u+ltlali►3Ua feet of iedc��ic��`ualliny : r ice y Oak- I o ► JJ- ) 7' 3 - 31 ' TOWN OF BARNSTABLE ...:LOCATION, SEWAGE # 3- V LLAG):��N�QAL6 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY de <`I E.ACHING FACII.ITY: (type) �3�� (size f ►bt- UL NO:OF BEDROOMS HUII DER OR OWNER .PERMITDATE: �(3 I�� COMPLIANCE DATE: Separation Distance Between the: :Maxu"num Adjusted Groundwater Table and Bottotit of Leaching Facility: Feet :;Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) f"— irv� _ Feet Ed$e of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)' Feet Furnished by j ,oA 1 ' oo ��_. o88 D No. •_ . 1-11 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mopogal *_ ppaem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 5j \i Owner's Name, an 1�0�N � Assessor's Map/Parcel O —L Install 's Name,Address and Tel No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations PP (Answer when a 1'cable) D toll _ 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 Certifi- cate of Compliance has been issued'A AB%r�d of Hea . Signed Date Application Approved by ® 71WJ Date Application Disapproved for the following reasons Permit No. Date Issued - 088 � � Nd. . •, +"- Fee t� ✓✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprica�tion for Miopoml *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade O Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Ow er's Name,Address and 1.No. IM Assessor's Map/Parcel tG t 4 J + ISfy",.. Instal '�N e,QTe�I.Igo.� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.©.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septi. ;Tan Type of S.A.S. Description of Sq> t Nature of Repairs or alterations(Answer when app l cable) . TVkL (A 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 Certifi- cate of Compliance has been iss ed qyth s d of Heal. Signed 1 :`Date Application Approved by ` ® : Date Application Disapproved for the following reasons r" Permit No. Date Issued ————————— —————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS P (Certificate of (Compliance THIS IS TO CE FY„that tt On-site Sewage Disp.sal System Constructed( )Repaired( )Upgraded(V ) Abandoned )by at has been constructed in accordance with the prov"' s of Titlq,�the for Disposal System Construction Permit No.q --S-' _dated Installer ` ., Designer The issuance of this i shall not construed as a guarantee that the system wil unction as designed. Date `/��_ Inspector No. ----------------------------fr- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS MfSpo5ar *pgtem (Construction Pl•ermit Permission is hereby granted t onstr cct�( )Repair( )Upgrade(Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The,"applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc on in be pleted within three years of the date of tlpe Date: � � % Approved by � !� 0� v 1019/97 1-7 N®TICE: This Form Is To Be Used For.the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION ORA DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) works L , hereby certify that the application for d> posal construction permit signed by me dated ,concernt,',' property located at meets all of the 7__� following criteria: i • There are no wetlands located within 100 feet o the proposed leaching facility • There are no private wells within 150 feet of the roposed septic system • There is no increase in flow and/or change in us proposed • There are no var'a ces�gaes jeeded. • If the pro eachwlg fac' it wile located ithin 250 feet of any wetlands,the bottnm:;of the i sed leaching facility ill bOocated less than fourteen(14)feet above the maximum adjusted oundwater table elevat' n. OPI e complete the f lowin i A)Top of ound Elev itiotvaccording t the Engineering Division G.I.S.map). 3a I ° l B)Obse ed Groundwa er 7Sple Elevati n(according to Health Division well rna { W � y i D: DATE: 1 LW TIC SYS�I t E TOWN OF BARNSTABLE NUMBER j [Attach a sketc p an o I a proposed system..,-Also If th licensed Installer posesses a cart Ifled;plot plan, this plan should be submitted). q:health folder:cert ` i .. t a i - i 3a f i O • i r 4 ' TOWN OF BARNSTABLE LOCATION ���� SEWAGE # VILLAG � Wer ASSESSOR'S MAP & LOT LT d a ?f r INSTALLER'S NAME&PHONE ff NO. _ SEPTIC TANK CAPACITY L O SCE + LEACHING FACILITY: (type)�`� l®lv 5 (six tit UL N0.OF BEDROOMS . BUILDER OR OWNER' S PERMITDATE: —COMPLIANCE DATE: "labs R. 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 � l r-314 30 No..................... Fizim.............................. THE COMMONWEALTH OF MASSACHUSETTS BOA RLD OF HEALTH 0 F 13 - .. j..t' ......... ........................ Appliration for UWVviial Works Tiamiuurtion rantit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at., ..... Co. .........*'. - cc-A]..T!wAr. .. ....................... ... ... ............................................ L lion-Address _b. JC .................................... .......Sd... . km �Owner A dress ................................................. ......; ....LLMT.....O..U.). Installer Address )....... Type of Building Size Lot.. .......Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (A, Other—Type-of Building ............................ No. of persons_........................... Showers Cafeteria Other fixtures ................................. ----- -----------------------------------------------------------------------------------------------------Design Flow.../1.10...............................gallons peb� peg day. Total daily flow.......3-:3--o......................gallons. C4 Septic Tank—Liquid capacity............gallons Length________________ Width._............._ Diameter._...._..._..... Depth................ Disposal Trench—No. .................... Width..........._..._.... Total Length.....___._........_. Total leaching area....................sq. f t. Seepage Pit No_____________________ Diametpr... - ------ --- Depth below inI t Total leaching area..................sq. ft. Other Distribution box Do sin tank r C 44�/`Mate_._.� A� Percolation Test Results Perf-er� .......... ..?�. f. Test Pit No. I................minutes per inch Depth of Test Pit_________-____-.____ Depth to ground water------------------------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___................._... 4-------------------------------------------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil........S.........40 Q.b. 0.6-o'.3........................................................................I.............................................. ........................................................................................................................ ------------------------- ................................ ................................................................................................ U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'L I'= 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issffuey the boar� health. Signed . ........A---- ------- ................. --- Application Approved By------ ------------_-------_-- ------_----------Da-t-e-------------- Application Disapproved for the following reasons:................................................... .......................................................... ..................................................................................................................................................... ...... ............ .............................. Date PermitNo......................................................... Issued....-7 --------------------------- ate, r �5S [70 - LO C A T a2fs r ION SEWAGE W AG E PERMIT NO. y VILLAGE INSTA LLER'S NAME i ADDRESS "fa-(f, .13- aye Via• i ti 0 U I L D E R OR OWNER L DATE P EWMIT ISSUED DATE COMPLIANCE ISSUED_ 72! 17 a 11 = 3 No.._._.......3_g.L FIMs................`...........f THE COMMONWEALTH OF MASSACHUSETTS ' f -BOARa OF HEALTH x a .. ..A .... ........OF.. ,. ... .. - .l ..........................• Appliratiun for Dispaii al Works Tome rurtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System t 47 iw L n n-Addr-ess .� Owner Installer Address U Type of Building Size Lotlt.�ft[[ ...4-------Sq. feet Dwelling—No. of Bedrooms........ ............. ................Expansion Attic ( ) Garbage Grinder (10 Other—Type of Building No. of persons............................ Showers — Cafeteria p•l O er_.fixtures ------------------------•----------!---- ------------ W Design Flow... . . ...............................gallons per p> per day. Total daily flow___-___ _ ._ _-__.___._._..._._.___gallons. WSeptic Tank—Liquid*capacity......_.....gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diamet r.................... Depth below inl5 ..F Total leaching area..................sq. ft. Z Other Distribution box ( ) ' P , Dosing tank ) T F Percolation Test Results Perfvrravd aTest Pit No. I................minute's per inch Depth of Test Pit.................... Depth to ground water___-_________-_.__.----- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ - �' -----------------------�--- = x Description of Soil..: QQ h-- -------------------------------------------•--------.................................... V .................................... ---- i_.. ., W ................................. :. j ' = ./lei_I'!. t.0.......... �.....------------....------------------------------------•------------•----------------------. UNature of Repairs or Alterations Answer when applicable.............-------------...................................................................... ............................................................------------......------......------------------------------------------------------------------------------------- ....................... v� Agreement The undersigned agrees .to install the aforedesc ibed Individual Sewage Disposal System in accordance with the provisions of TITLE p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue the board Aheathlth . ' Si W14 ...../...................... .------------------------.--- --------------- ----- DD ate . APPlication Approved By--•••-• J ate Application Disapproved for the following reasons--------------------------------------------------------------------------------------------------------------•- _ ..•---------------------------------------------------------------•------------------------------..........------------...------------------------------------------------------------......-----........ Date PermitNo............................................ ........... Issued-....................................-.................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FQ! ..t ..........o F..�.14 D..�,. . �:.�. ............................ ' :.,4_ CIrr# firatr of (�Vmjllialtrr T, IS IS TO IF That the Individual SeK ag > posal System constructed ( ) or Repaired ( ) by.. _:b .a,. ------,.-JJ. .... ----- .- - vyd_.► �P»- -- ------------------------------- >. [/ ./�s �r +/. Installer .. �e�*� K ... H:_� has been insta ed in accordance with the';provisions of T f_�`'T�Jle State Sanitary Coc�e as 1-� .cr 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............." wwviM i ,asn+6r�r0�arEy 1 5y�C ` � 'Y m • THE COMMONWEALTH OF'MASSACHUSETTS .. a �r -BOARD OF HEALTH ...........1. .. ..........OF.... .. .t .0 46. .. No. FEE......................... "` i btu 1 ur (gott rnrtwn antic Perm> s<on_is hereby granted......•--! . _41. - _:.._. .�. m- Sri n "� to Construct ( o Repir an Ivi u 1 Sewa e Dispo al Sy at No.-- SJt: -- : 54.E. / �.----.-----���w-..--�tits ♦ � Street �+ as shown on the application for Disposal Works Construction Pe t No __________ _ Dated___._.. ...................�......_. ie- i Board of Health•• f� �► DATE------- -----------•----•---��__...-------.._.........-•.............. . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS . F. �� F,,,, o FF TElz2A E E�E ti' . 3 /00.00 I I � a. I � I 449 DWI a E�45 6 ( � I Fl•a� 43 t . eZ'FV 7-op of ExisTini6- vJo � i ' /covNOAToN. 47,/3 Lo 7- '"/e ,2S't Fj. v � �l.Egc H oe'xr • �b3 P�O�SEsD FuTuRE �4 � NoTE- ELEYi4T o.�/S BASED oN �c• �`' CERTIFIED PLOT PLAN LOCATION CEn/TERv!CCE, r/gss. . . . . . . .. . . . . SCALE . /,. 30`. . . . . DATE /979 . PLAN REFERENCE BE!.vG„C "`i8. ,qs Sf/o w�/ aN A PLAN of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4A 0 .ZCC0lZDfD. . .^/ . . . . . . . . . . . . . . / PL. 4x1. 4 74'. Pc�< SS. . . . . . . . . . LoT ' /g I CERTIFY THAT THE Ex/STN�s. ,Fv�vpATQn/.. SHOWN ON THIS PLAN IS LOCATED ON THE GROUND Gp JcjC ,eA�� AS SHOWN HEREON AND THAT IT CONFORMS TO THE S TRACK REQUIREMENTS OF THE TOWN OF L7CJlZK� A/0/IES . !?2!vST.Ao4$ . . . . . . . . . WHEN CONSTRUCTED. 77,/o,¢wToN D2/vtz-7' DATE . . . . . . . . . . . .. . PETITIONER: 1-11,9AIA /S/ �IAS.ra- REGISTERED LAND SURVEYOR 1 TOP OF FOUNDATION 6„ CONCRETE COVER CONCRETE COVERS 47-7-27 e 4"CAST IRON 12"MAX. 12"MAX �!T � .EQUIV PIPE (OR 4"ORANGEBURG(OR EQUIV.) )— MIN. PIPE- MIN. LEACH PITCH I/4"PER., . PITCH 1/4�'PER.FT PIT ono PRECAST ,'• INYV o Q LEACHING e EL... ¢� INVERT INVERT o . c `e' PIT OR o'. SEPTIC TANK DIST. e W ' ' EQUIV. INVERT EL... 3`74 BOX EL0. ,4 >__ .•: �caa GAL. INVERT p O' � o' EL.'¢+3'�� INVERT V va 0: ::� 3/4"TO II/2 ELIM41 w o O EL43,00 ; u- WASHED w STONE �1 C /7 �• •.% '.• 13'-- -WDIA. Alo • ., �'---lb D IA.----.-� PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE TIME. j. BOARD OF HEALTH TEST HOLE I TEST HOLE 2 Tj�t,+ R� . Ga .��E I�E.. ENGINEER ELEV. .1f47`,3. . ELEV. .. .. . . . . . ,,, w�4P DESIGN DATA : a ' NUMBER OF BEDROOMS . . . .`.3 30.E TOTAL ESTIMATED FLOW . .3'�� . GALLONS/DAY BOTTOM LEACHING AREA 7B' c7>. . . SO.FT. /PIT �'IGrDiu� SIDE LEACHING AREA . .�BB`rn SQ.FT./ PIT S/r�•D GARBAGE DISPOSAL (50% AREA INCREASE) TOTAL LEACHING AREA . Z`7�oo . SQ.FT is PERCOLATION RATE .4. . . . .. . . .. . . MIN/INCH 'LEACHING AREA PER PERCOLATION RATE . . . SQ.FT. Nv.WATER ENCOUNTERED 1 p�WiTi�,/ Tt✓c NUMBER OF LEACHING PITS . . . . . . . . . . APPROVED . . . . . . . . . . . BOARD OF HEALTHTa,� p3TZ�Nb; G/✓ ALL S/TaE' /.5'4 7aN5f DATE. . . . . . . THOMAS E.KELLEY CO. AGENT OR INSPECTOR ENGINEERS—SURVEYORS 346 LONG POND DRIVE __ r.,-`-`SOUTH YARMOUTH,MASSZN OFiy WT � &� / 02664 // THO AS 24269 is PETITIONER i SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR co F7COMPARABLE MEANS FOR:FUTURE LOCATION. o (NOT TO SCALE) 1. DATUM IS NAVD 88 ash/ ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE e 2" PEASTONE OR GEOTEXTILE a TOP FOUND. EL. 53.6 FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING \ 2X SLOPE REQUIRED OVER sYSTEM 51.3' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o+ S c o MINIMUM .75 OF COVER OVER PRECAST PRECAST H-10 WATERTEST„D'BOX FOR LEVELNESS PRECASTKS ORISERs 4. DESIGN LOADING FOR ALL PROPOSED PRECAST :t MIN. 2 WALL THICKNESS RISERS ('TYP.) UNITS TO BE AASHO H-LQ ' 4"0SCH40 PVC MORTAR ALL r o 49.6 INVERT IN 47.53 G E PIPES LEVEL 1ST 2 �ENDS COMPONENTS 4 (TYP•) ;, 4' � 5. PIPE JOINTS TO BE MADE WATERTIGHT." " > SIDES 48.36 �. 10 EXISTING 14 .. .° _ 00000000 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE TEE SEPTIC TANK** TEE �482 '* o'o 0 0-0 6" MIN. SUMP o°g°g°g° °°g°g°go WITH 310 CMR 15.000 (TITLE 5.) too �o° Da s o�a�o�o�o�o� ' °°°°°° °°°°°o°° e ,,0000,o,c,g 12 MIN. INT. DIM. °°°°°°° 0 ° c e t °°°°°°°° °°°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND i o� GAS BAFFLE :: °g°o°o° 46.53' Q t 47.80 47.63 ° ° ° ° ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY r�. „ `H-10 500 GAL. LEACHING CHAMBERS OTHER PURPOSE. Z �r .:.i �, .. ;. .,.t• a: ERS BY ACME PRECAST OR EQUAL. •� 5e 3/4"-1-1/2" DOUBLE WASHED STONE 4 MIN. „ (2) UNITS REQUIRED $. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. 6" CRUSHED STONE OR MECHANICAL l��6 n ALL AROUND PRECAST STRUCTURES OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' CL COMPACTION. (15.221 [21) 9. COMPONENTS NOT TO BE BACKFILLED OR ^ o CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD ( 2 X SLOPE) ( 1 R SLOPE) OF HEALTH. LEACHING , FOUNDATION EXIST. SEPTIC TANK 20' D' BOX 12' FACILITY 10. CONTRACTOR SHALL BE RESPONSIBLE FOR pp CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP 40.5' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & 40 GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF **INSTALLER SHALL CONFIRM MINIMUM WORK. SCALE 1 =2000 f *THE INSTALLER SHALL VERIFY THE SEPTIC TANK SIZE AT 1000 GALLONS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 170 PARCEL 88 LOCATIONS OF ALL UTILITIES AND ALL AND ITS SUITABILITY FOR RE-USE. BUILDING SEWER OUTLETS AND BE REMOVED BENEATH AND b' AROUND THE REPLACE WITH 1500 GALLON SEPTIC PROPOSED LEACHING FACILITY. ELEVATIONS PRIOR TO INSTALLING ANY TANK APPROPRIATE TO SITE SITE IS LOCATED WITHIN A ZONE II PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. LEGEND. 99 EXISTING CONTOUR , "Y) SYSTEM DESIGN: X 99.1 EXIST. SPOT ELEV. -[991 PROPOSED CONTOUR YY i GARBAGE DISPOSER IS .NOT ALLOWED 198.41 PROPOSED SPOT EL. EXISTING 3 BEDROOM. DWELLING TH1 50 sQ DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD 0 TEST HOLE \ �, USE A 330 GPD DESIGN FLOW 2 SLOPE OF GROUND \\\ C-0.) UTILITY POLE SEPTIC TANK: 330 GPD (2) = 660 FIRE HYDRANT o **RE-USE EXISTING 1000` GAL. SEPTIC TANK - �, \ �\ i NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING �► - \ LEACHING: SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD O \ �p0' \\��N BOTTOM 25 x 12.83 (.74) _ 237 GPD TEST HOLE LOGS �F \ TOTAL: 472 S.F. 349 GPD . DANIEL E. GONSALVES SE 13587 \ F ENGINEER. ' # \ \\ \\ USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) DAVID STANTON, RS \ \ WITH 4 STONE ALL AROUND WITNESS: LOT AREA s2 \ \ DATE: 7/1/19 16,966t <y \ PERC. RATE _ < 2 MIN/INCH METERS \\ CLASS I SOILS P# 19-57 \ \ /> BENCHMARK:TOP \ / OF BOTTOM STEP MA ELEV. n ELEV. 'Oo =53.2' NAVD88 APPROVED DATE - BOARD OF HEALTH n p» 51.5' 0,, w 51.9' DWELLEXISTING NG Doti q q FFLR=54.6 LS LS TOF=53.6�// `�\ �� 10YR 5/2 10YR 5/2 BH �\� �`� a 4» 5» B B s N , % �� TITLE 5 SITE PLAN LS LS sHR 3`3✓ s� .3] v�Q`� OF » 10YR 5/6 ' 10YR 5/6 49.6' s�6�3 26 49.3 28» � BECK /`'�o• o�, , �s DECK H �P�? #56 GOFF TERRACE 9 �C' CENTERVILLE, MA C C PREPARED FOR PERC `_�� (b<v M/cS M cs fs,.s� O°`, � BORTOLOTTI CONSTUCTION � �p DATE: JULY 15, 2019 AAA 2.5Y 6/4 2.5Y 6/4 of ;�� 9Qti tH qss off 508-362-4541 SHED G S� C o DANIEL s . �a tiG , fox 508-362-9880 A gag DANIELA. sm I OIAIA OJALXI downcape.com No.409$0� CIVIL No.6502 OWN Cope engineering, Ive. 132" 40.5' 132" 40.9' �. �qNF s S �� o��FO,S T E �Q� C%vil eng%neerS rr e SURD r S ONAL .NG `Scale: - 20 -� _�S_�� -. .: � - land surveyors NO GROUNDWATER ENCOUNTERED - � - y � 939 Main Street ( R to 6A) LICE # 19- 195 o �0 20 30 40 5o FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 19-195 BORTO-CAREY.DWG i r