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Home My WebLink About0049 GUILDFORD ROAD - Health 49 Guildford Road , _ - 3 Cemerville P A 172 081 3 I i I atYaFc� llll ® y� NoP2 OR ' � HASTINGS. MN ,� S .j -� { �� vr V M ,� ,�,,. 7 7 `� No. V .� �V Fee < 0 v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Mispo8AY 6pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No.Lk� 651�� bye�2�i \N i Owner's Name,Address,and Tel.No. �are .�, 'y;/g�►� ,� C_e r%cv�rvt V.C- �� lA°��Ya r�• � l'—�►v`�' �'�•1 Assessor'sMap/Parcel let < ✓ 3Zo`L Installer's Name,Address,and Tel.No. Designer's Name Address,and Tel.No. "SL yu- � �-, gyp. "�L �rar2...,� �. mg Type of Building: Dwelling No.of Bedrooms Lot Size ,Lf y) sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided - gpd Plan Date 1 WMIZ Number of sheets 21 Revision Date Title Size of Septic Tank tx,I �, Ar, Type of S.A.S.( � �'� Description of Soil See. Nature of Repairs or Alterations(Answer when applicable) A e_f?\a,e_ 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 Enviro tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o e th. ` igned Date l�J cy Application Approved by Date Application Disapproved by Date for the following reasons Permit No. = 9- 3 156 Date Issued / C) No.£�''��,� � Fee a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pphration for Misposal *pstrm Construrtion 3dErmit 'Application for a Permit to Construct( ) Repair( ) Upgrade(_ ) Ab�a� on( ) ®'Comple to System ❑Individual Components Location AddfErress or Lot No.4°j 6 t �i+r N, Owner's Name,Address,and Tel.No.-f i too t�y t f,t►�q� r Assessor's Map/Parcel tZo 3 Installer's Name,Address,and Tel.No.*� �i i r..r, Designer's Name,Address,and Tel.No. f� o �3A� -1 A•.ryro� S��v :b A/c (L T - tl�7 0.na.��.y. h*t- (1`®Y -.J/ Type of Building: ii Dwelling No.of Bedrooms Lot SizeUi 4 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(mint.required) 330 gpd Design flow provided �* gpd Plan Date 11\13\\x Number of sheets Revision Date Title _ Size of Septic Tank r_'xrsc,e►K , ®ts Type of S.A.S. : �!, •"Z o ar, ��,, �, G�a�,�j� Description of Soil . Nature of Repairs or Alterations(Answer when applicable) A Q.p\A`C_ i CCttti,,-10 �M G�� ,Date last inspected: s Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system;irr•?{ accordance with the provisions of Title 5 of the Enviro en al Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. ,?r igned Date A., � � /4 _ Application Approved by �^----'" "� Date / It b !/�8— Application Disapproved by Date for the following reasons Permit No. �� .� Date Issued ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Ctrtifirate of Compliance THIS IS TO LLCERTIFY,that the On-site SewageDisposal system Constructed( Repaired( ) Upgraded( ) Abandoned( )by� T� ' t.�G•f r w i a�n�¢ c— at. & %\am. r ,.�,,t•` (r► ha s been constructed in accordance / t. with the prouision�'r of Title 5 and the for Disposal System Construction Permit No!)N&__355 dated he Installer d v Designer S.,r- AQ� TAIK_ #bedrooms App oxed�desigfi The issuance of this permit Mall not be �onst ed as a guarantee that the ystem wi fimct':o �des geed. Date I � Inspector --- -- --------------- - ------ -------------------- -------- ----------------------- No. cW/ 3 5'-5 Fee A:' 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstem ConstrUrtion 3pPrmit Permission is hereby granted to Construct( ) /Repair ! ) Up de( ) Abandon( ) System located at co, I 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 perm" it. Date Approved by �� r Town of Barnstable Regulatory Services Richard V. Scali,Director NAM Public Health Division " Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Date: Sewage Permit# ��"aS3� Assessor's Map/Pareel 2 of �sj 1WI414 Installer& Designer Certification Form Designer: Installer: CGS 7Qi( Address: D � Z� Address: ?/T" 6V On was issued a permit to install a (date) q (installer) septic system at -J 6UI;6gPfl RbG�IW based on a design drawn by (address) ��11,2)0 F75POT/ dated G V (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor a�ppproved changes such as lateral relocation of the distribution box and/or septic tank. VStripout (if required) was inspected and the soils were found satisfactory.v/ /2 6 I certiA, that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. I certify that th iced above was construct `- = liance with the terms of he proval letters (if applicable). DA1/dD D. FLAHERTY,jR, iA (I aller's Signature) No. 1211 9� T T � X esigner' Sig tore (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc 'I TOWN OF BARNSTABLE' N LOCATIO :;, ,e � G v i �L✓ �r.J ~" SEWAGE# VILLAGE C ASSESSOR'S MAP&PARCELZ?Jy INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /.0 b LEACHING FACILITY:(type)µ? _ 5�°� 4' (size) //�X;Z-- } NO.OY BEDROOMS OWNER 1n, L� �.'"✓ PERMIT DATE: ��=/'�.."�`r COMPLIANCE DATE: _c -►� 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 NO feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within .ra 300 feet of leaching facility) R Feet �? FURNISHED BY 1 2/, A. ..,. d! ,� �� gam,�, Town of Barnstable P# Departiment of Regulatory Services .,► u l Public Health Division Date r i679• 200 ain Street,Hyannis MA 02601 �' 12,q 1 e ED MIK � �f S GO Date Scheduled Time Fee Pd. Soil Suitability Assessment fog- Se a Dis osal P �S Performed By: C t V?,j is Witnessed By: LOCATION& GENERAL INFORMAMON f ✓ Location Address Owner's Na s'/� t/t e 11 97 S b c-c �L9 n l� I �l o t n Assessor's Map/Parcel: 1 G 9,f eo gineer's Na ��j�No i✓/ c' • ' NEW CONSTRUCT Q � 4 6 CI ION PAIR Telephone# ��— 2 — Land Use (�l-P+I��W "rV /S elm o E Slopes(%) Surface Stones Distances from: O en Water Bod ---1� `� ft Possible Wet Area P Y — ft Drinking Water Well c.SZ V ft / �y,�, e Drainage Way__._ Property Line _} Other_C!�t S6 1z, ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands In proximity to holes) It Z 'AA 9 • I P� Parent material(geologic4& LAG& 4 / Gn" "v� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: . I Z_ Weeping from Pit Face Estimated Seasonal High Groundwater f 2 DETERMINATION FOR SEASONAL HIGH WATER TABLE " ' Method Used: Depth Observed standing in obs.hole: AJ in, Depth to soil mottles:_,, Dcpth to weeping from side of obs.hole:�1� _in, Groundwater Adjustment �✓ fL- i Index Well#_�Reading Date:,� l Index Well level Adj.&ctor,. -,o----Adj.Groundwater Level-,y2/ PERCOLATION TEST bate Time �/A Observation Hole# / Time at 9" Depth of Pere --` �- / Time at 6" rl Sz Start Pre-soak Time @ r Time(9"-6") ��Pr 4, 11 End Pre-soak /l r 3 7 � fy1 Dt Rate Min./Inch tijP/ I Site Suitability Assessment: Site Passed v Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If 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. Q:\SP-PTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# X GB z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,'Boulders. i ten cv.%Gravell `- (21v ° y� DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Grave y s� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.Yg G DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency, a a Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No_ Yes Depth of Naturally Occurrint=.Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring Wrvious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of E vironmental Protection and that the above analysis was performed by me consistent with . the required trainin a 'sea ex ie d a described in 110 CMR 15.017. Signature Date ,?,13 Q:\S.EPTIC\PERCFORM.DOC w 10i2'.;'2riiS .;19 Fm FF.OM: 50E-420-395. Cet;e ury _T" DOE-:71-2652 FPGiR. 0 2 JF PiJ_ I enl ^oi,c 7•ra "W r;' )' � Tr (,v. __ (7.7(r ) i zocr.'Pit o / "'14) / Proposed of 14'x20'Addition t Lot 90 1 E,d ': F Q' i 40 -Ya I r AAA N l I PLOY PLAID! Showing r roposK;Addiwo irI ,P% A ABLE (CENTERVILLE) j NOTES. tl A R, VA 7 F. 27/0 C!.`Cf8 SCA L C- 1"=40' 1..i I'h ,;fiU::.i''t?j S? Yvgi •gvt'e i--cotes on 'iit8 `. ";.,Ur 0 20 36 4L; 8iI t F_. P,' :c i)y cc' ve"lti-rd DUI-Vey M'n'-hods ,n ;>_ /0`.._ j c- I;rope,-h, line m lc,"r ;jti_n sh..-.-*,r:n iicre .' w is Timothy � t. t:r ncthy W. Me>rx,,i�r i cor:piled run ovaiicble record irrcrrro. on. a9 Guildford Road Centerville MA X 6312 d c i.,. 'C I:P used `tY deed ,��SCri�f Glly '>LI'_ Sec. �R--PAKEU`L'i: Cl P� Sure i J FIELD B". K!?i_: i.,!L_ RECEIVED ECOJECH T292002 Environmental OC WWW.eco-tech.us TOWN OF BARNSTABLE HEALTH DEPT. THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 49 Guildford Road Centerville Owner's Name: Scott&Sharon Breen Owner's Address: 10 Dearborn Road Somerville,MA02144 Date of Inspection: October 27, 2002 Name of Inspector:(Please Print) David D. Coughanowr,R.S. Company Name: Eco-Tech Environmental MAP Mailing Address: 43 Triangle Circle O� PARCEL Sandwich,MA 02563 Telephone Number: (508)364-0894 LOT 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: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature -,t Z, (.�_ 4 Date• Oc-+ The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority NOTES AND COMMENTS Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ****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. Title 5 Inspection Form 6/15/2000 page 1 ' j 1 ECOJECH 'I OCT 2 9 2002 Environmental , www.eco-tech.us r ni-''J1L1�1J 1 THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 49 Guildford Road Centerville ll Owner's Name: Scott&Sharon Breen V Owner's Address: 10 Dearborn Road Somerville,MA02144 Date of Inspection: October 27,2002 Name of Inspector:(Please Print) David D. Coughanowr,R.S. Company Name: Eco-Tech Environmental MAP Mailing Address: 43 Triangle Circle O PARCEL Sandwich,MA 02563 - -- Telephone Number: (508)364-0894 LOT 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 CNM 15.000).The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature �� } Cam-- �S Date: of 2'9" ZOO The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority NOTES AND COMMENTS Inspector's Note=> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ""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. 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: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A) System Passes: X J have not found any information which indicates that any of the failure criteria described in 310 CMR 5.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no,or not determined(Y,N,or ND). in the_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. ND explain: Observation of sewage backup or breakout or high static water level in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced. ND explain The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain 2 Page 3 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety and environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless the Board of Health(and public water supplier,if any)determines that the system is functioning in a manner that protects the public health,safety,and environment The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. -- `- -The system has aseptic 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 by 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 t t Page 4 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 D) System Failure Criteria applicable to all systems: You must indicate either"yes" or"no" to each of the following for all inspections: I have determined that one or more of the following failure conditions exist as described in 310 CNIR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. yes no X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS, cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed by 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) No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore,the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E)Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes" or"no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no 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 H 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 CUR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 Check if the following have been done:You must indicate either"Yes" or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant or Board of Health. X Were any of the system components pumped out in the last two weeks? X _ Has the system received normal flows in the previous two week person? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available as N/A) X _ Was the facility or dwelling inspected for signs of sewage back-up? X _ Was the site inspected for signs of breakout? including X _ Were all system components,exelia the SAS. located on site? X Were the septic tank manholes uncovered,opened,and the interior of the septic 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 disposal systems? For information on the proper maintenance of subsurface disposal systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: X _ Existing information.For example,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 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):n/a Number of bedrooms(actual): 3 DESIGN flow based on 310 CUR 15.203 (for example: 110 gpd x#o belrooms): n/a—no plan on file Number of current residents 3 H� �Pa v.� .; Qa S Does the residence have a garbage grinder(yes or no)"` yes w�c Is laundry on a separate sewage system(yes or no):no° :(If yes separate inspection required) Laundry system inspected (yes or-no): n/a Seasonal use(yes or no):yes Water meter readings,if available(last two year's usage(gpd): 497 gpd Sump Pump(yes or no): no Last date of occupancy: current COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203):: gpd Basis of design flow(seats/persons/sqf/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 source of information: System pumped approximately one year ago(Owner) Was system pumped as part of the inspection: (yes or no) No If yes,volume pumped: gallons--How was quantity pumped determined? — - Reason for pumping: TYPE OF SYSTEM: X Septic tank,distibttex, soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternate technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe) APPROXIMATE AGE of all components,date installed(if known)and source of information: Age: Approximately 29 years—home built in 1973.No plan or permit on file at Board of Health Were sewage odors detected when arriving at the site: (yes or no) no 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: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 BUILDING SEWER_(Locate on site plan) Depth below grade: 2 ft Material of construction:_cast iron X 40 PVC_other(explain) Distance front private water supply well or suction line 20+ Comments: (on condition of joints,venting, evidence of leakage, etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of certificate) Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 6 in Distance from top of sludge to bottom of outlet tee or baffle: 28 in Scum thickness: 8 in Distance from top of scum to top of outlet tee or baffle: 5 in Distance from bottom of scum to bottom of outlet tee or baffle: 11 in How dimensions were determined: Probe to top of tank Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): Pumping recommended at this time,and maintenance pumping is recommended every 2 years.-Liquid level at outlet invert.Tank and tees appear structurally sound and functioning as intended.No evidence of leakage in or out. GREASE TRAP: none (locate 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 and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 TIGHT OR HOLDING TANK: none (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 inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.) PUMP CHAMBER: none (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.): 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: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan;excavation not required) If SAS not located, explain why: Type: X leaching pits,number 1 _leaching chambers,number _leaching galleries,number _leaching trenches,number,length _leaching fields,number,dimensions _overflow cesspool,number —innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) Soils above leach pit appeared unsaturated.No evidence of surface ponding,breakout,lush vegetation, or other evidence of hydraulic failure was observed.Leach was dry CESSPOOLS: none (cesspool must be pumped at time 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 or no): Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY:none (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 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'(Locate where public water supply enters the building) LOCATIONS A B C 1 19 ft 6 ft LEACH 2 21.5 f t 8.5 f t S PIT 2 3 30.5 f t 6.5 f t °a SEPTIC c g o TANK A 3 BEDROOM DWELLING # 49 W Z J U W H Q 3 GUILDFORD ROAD NOT TO SCALE 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Guildford Road Centerville Owner: Scott&Sharon Breen Date of Inspection: October 27,2002 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to ground water: 30+ - feet Please indicate(check)all methods used to determine high ground water elevation: Obtained from system design plans on record-If checked. date of design plan reviewed Observed Site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of health-explain: _ Checked local excavators,installers-attach documentation) X Accessed USGS database You must describe how you established the high ground water elevation. Town of Barnstable GIS Department records indicate that the groundwater table lies over 30 feet below the surface of the lot. 11 TOWN OF BARNSTABLE LOCATION 40 Guildford. Road SEWAGE NSA - VILLAGE Center ille ,Mass ASSESSOR'S MAP & LOT Ins ectors NAME A-PHONE NO. J.P.Macorriber & Son Inc. SEPTIC TANK CAPACITY 1-1000 LEACHING FACILITY'Atype) 1-leac`;inL pit. (Sim) 1000 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER P;.W• 'BUILDER OR OWNER Mitchell Of Inspection : DATE 3/27/93 T I Report DATE SSUED: 3/30/93 _ VARIANCE GRANTED: Yes No xxxxxxxxxxxxx i CENTERVILLE RACE LAND 0� 67 --" LOCUS o �oJCZ' srgc�� N/F OFP�OpO o�� 90 TOWN -OF BARNSTABLEt - - -- �O PARCEL ID: rL� TBM: INSIDE N/F �O 172/154 �1 CELLAR ENTRY MICHAEL NADILE EL=69.64 Zs LOT 91 j EXIST. PARCEL ID: Y 1000G ` 0 172/082 p o TANK�;1 \66 0, � O \ CO , _ _ - �� .0. INV.=66.7_ LOCUS MAP 49 20. j LOCUS INFORMATION IQ PLAN REF: 247/84 3-BEDROOM =_= G TITLE REF: 70 9/79 DWELLING - _ (J PARCEL ID: MAP 172 PAR. 81 ZONED: "RC"-"GP" (o IN STATE ZONE II O N/F 'j� O + GF' C.O. TCF=70.70_ = S FLOOD ZONE: X" STANLEY & DELORES s ••;:::��j = INV.=67.7 - G COMMUNITY PANEL: 250001-0015-C DATED:08/19/85 KNOLL PARCEL ID: •;;;. , ti -_ TELE SEPTIC SYSTEM 172/153 s- .:::.. :: . . _ - _ ► REPAIR PLAN O O r`G'P > � PP�OF < O 7 / /// LOCATED AT: `' v5 QOJ�P�-P \ �, W 49 GUILDFORD ROAD s �. \ // CENTERVILLE, MA. PREPARED FOR \ VENT \ oy \W goo /�� TIMOTHY W. MEAGHER y/ \ \ // NOVEMBER 13, 2018 68 \ / 57.2' \\ ��N OF MASS P�`N OF MASS EDWARD LOT 90 \`\ / \ \ //! \ P q"y s A yG. \ � o s PARCEL ID: \ GRAVEL _' A. a 172 081 \ PARKING / U ti s / \ / STON FL E JR AREA=16,427f S.F. \ // O PO P 0. 8 N 1 S o c/STERN UPOLE '0 ANC S SANI TAR�pN w N/F TIMOTHY W. MEAGHER LOT 89 PARCEL ID: � �� E . A. S. 172/oso G 66.9 GRAPHIC SCALE SURVEY, INC. 20 0 10 20 40 80 P.O. BOX 1729 SANDWICH, MA. 02563 ( IN FEET ). BUS:(508)888-3619 CELL:(508)527-3600 1 inch = 20 ft. SHEET 1 OF 2 J#1388 T.O.F. 4" SCHEDULE 40 P.V.C. {{ „ II EL=70.701- (10' MIN.) EXISTING MIN. PITCH 1/8 PER FOOT + 2" LAYER OF CLEANOUT W/SCREWCAP 1/8" - 1/2" TO GRADE �, DOUBLE WASHED STONE OR FILTER FABRIC CLEAN SAND FILL PER 310 CMR 15.255 VEL=68.0 EL= 68.0 68.OFG 68.OFG 68.0 FG. . . .... ,..,.,. .....9 fti.RISER RISER a�-N) COVER - RISER F=D RISER A NEEDE A W EDE o o a RISER49 a�w 65.0 EL= 66.76 w 87 1. LEVEL rn 72' S= 0.015 FOR 2' 14' 0 S=.015 ® ® ® 0 FLOW LINE 0 11 O" s" SUMP ° ° INVERT ® ® ® ED ® ® ® EN ® ® ® ® ® ® o o°EL=65.66 MIN. 14EL= 65.46 64.38 6 BASE OF 64.21 640 0 0 ® ® ® ® ® ® ® 4' ® ® ® ® ® ® ® °N) ADD MECHANICALLY 1 0 000 OEM oft 0 0 (TO REMAIN) 4 GAS (TO REMAIN) COMPACTED SAND I 4 ° 4' 62.0 BAFFLE PROP. (H-20)DB3 3/4" TO 1&1/2" DISTRIBUTION DOUBLE WASHED STONE BOX 29' 2(H-20) 500 GAL. CHAMBERS EXISTING PROFILE OF THE PROPOSED (5'w x 8'-6"L x 3'-o"H) a. SOIL ABSORBTION (TRENCH FORMATION) v 00 1 ,000 GALLON TANK SEWAGE DISPOSAL SYSTEM AT: SYSTEM (S.A.S.) 11' x 29' ui (TO REMAIN) 49 GUILDFORD ROAD, CENTERVILLE BOTTOM OF TEST HOLE #1 ELEV.= 56.2 NO GROUNDWATER I CERTIFY THAT AMOF GENERAL NOTES ENVIRONMENTAL IPROTEC IONNTLY PUR PURSUANT TOD 310 CMR BY THED15.017T^TONCONDUCT DESIGN DATA SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED NUMBER OF BEDROOMS......... 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE GARBAGE DISPOSAL.................- NO TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS DESCRIBED IN 310 CMR 15.017. 1 FURTHER CERTIFY THAT THE RESULTS OF MY - NO FOR SUBSURFACE DISPOSAL OF SEWERAGE. TOTAL ESTIMATED FLOW 2. ALL ACCESS PORTS OVER TANK TEES SHALL BE SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, (110 GAL./BR./DAY X 3 BR.) _ 330 ARE ACCURATE I A ANCE WITH 310 CMR 15.100 THROUGH 15.107. ------ ACCESSIBLE WITHIN 6" OF FINISH GRADE. 330GPD X Z00% = 660 GAL 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE USE EXIST. 1000 GAL. TANK CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY EDW A. S ONE, CERTIFIED S L EVALUATOR INSTALL: 2(H-20) 500GAL CHAMBERS (W/4' CRUSHED STONE ON THE MUST WITHSTAND H-20 LOADING. 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION ENDS AND INBETWEEN AND 3' ON THE SIDES). BACKFILL OF ALL UTILITIES PRIOR TO ANY EXCAVATION. TEST PIT RESULTS: P 13490 WITH CLEAN SAND FILL PER 310 CMR 15.255 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. SOIL TEST DATE: 12 13 11 SOIL CLASSIFICATION................-- 1 6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE DESIGN PERCOLATION RATE..... <2 MIN. IN. OVER THE S.A.S. AND DISTRIBUTION BOX. B.O.H. AGENT: DON DESMARAIS 7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF EFFLUENT LOADING RATE.........__74___ SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE SOIL EVALUATOR: EDWARD A. STONE REQUIRED LEACHING CAPACITY.....330 GAfDAY THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. BACKHOE: RODNEY FISHER 5_4 LEACHING CAPACITY PROVIDED.....3 GAL DAY 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN SIDEWALL: (11' + 29')X2X(2 SIDES)(.74)= 118 GAL/DAY 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. TH#1 EL.=68.2 PERC RATE<4MIN./IN. @62"BOT. BOTTOM: (11' x 29')(.74)= 236 GAL/DAY 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES. 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER TOTAL= 354 GAL/DAY BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. 67.5 0-$" FILL 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND 354 GPD PROVIDED - 330 GPD REQUIRED = 24 GPD RESERVE FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL 67.2 8"-12" A LOAMY SAND 10YR4/3 BE LEVEL. 66.0 12"-26" B LOAMY SAND 1OYR5 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION /6 TO EAS SURVEY, INC. FOR B.O.H. AND DESIGN 56.2 26"-144" C MEDIUM SAND 2.5Y7/4 10� GRAV. ENGINEERS REVIEW AND APPROVAL. PFRC NO GROUNDWATER/NO MOTTLES , E ��P�tN O F ,�gssgcy CONSTRUCTION NOTES: TH#2 EL.=68.4 E. A. S. SURVEY, INC. ELEV. DEPTH IN. HORIZON TEXTURE COLOR MOTTLING OTHER � P.O. BOX 1729 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND � H ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 67.6 0-10 FILL FL JR N 2 SANDWICH, MA. 02563 WORK ON THE SITE. 56.2 10"-14" A LOAMY SAND 10YR4/3 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 66.1 14"„28" B LOAMY SAND 1OYR5/6 A/STAE IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 56.4 28 -144 C MEDIUM SAND 2.5Y7/4 10% GRAV. BUS:(508)888-3619 CELL:(508)527-3600 3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING �� TAPE OR A COMPARABLE MEANS. NO GROUNDWATER/NO MOTTLES ` SHEET 2 OF 2 J#1388A -'«�-t-m. t-�rra ,'s»�«,,,�"'• � s�: .�--. .. �;ci.-. ..w- ,. .•Fkzaa.0 -r:.:s "'� ,,,-,,;a .�.,-..w:...-- .:.._..t a v77 7 7M _ r JP - , �r a Z �I (I nkA J C"iF a _ 4,Q cs. ri it s o ; I TJ fj III _f... r� I 13} I { 1 -�� i �j•: __ r— '-�= a ��. f� Jam_ _ - 1 I �- a H 1 _. yp C � � I y V 4 LA. oP \ 1 � I - cit o is lLk i .. � {' I �� Via•. L i 7 I � � � - "1 �-� � I � � .. 1 1 I i <A ; C-Q� ' r i IS � s -oi Oe . oc� r • 1". 1 �o�.e Qck ek,,A,,& ¢5 II 1 " � .. . _ -4-o be; no Moen . 5)g xio f� 1,".. 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