HomeMy WebLinkAbout0009 HALYARD WAY - Health 9 Halyard Way
Centerville F/R - -
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OPendaffor
1521/3 ORA 100/O P2
Commonwealth of Massachusetts 7r)a L--�
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
6' Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
A. General Information
1. Inspector: e
H:.wY# taw
Shawn Mcelroy :1
Name of Inspector , 4
Upper Cape Septic Services ' ; 'J t�
Company Name °
29 Atwater Dr
Company Address ; —a
E. Falmouth MA 4 02536.
City/Town State Zip Code"
1-508-495-0905 S13971
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of
Title 5 (310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
8-24-12
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future.under
the same or different conditions of use.
t5ins-11/10 Title Vlnecti.n m:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form +
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.) .
Inspection Summary: Check A,B,C,D or E/ahvays complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
System is in good working order with no sign of failure.
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
' Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
El broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ 'Y ❑ N ❑ ND (Explain below):
+ T a
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-.11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M, 9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates"absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
,
You must indicate "Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2 day flow
t5ins•1 U10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
f Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is Centerville MA 02632 8-24-12
required for every -
page. City/Town State Zip Code Date of,Inspection
B. Certification (cont.)
Yes No .'
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
•"I0,000gpd. `
❑ , ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area IWPA) or a mapped Zone'll of a public water supply well
If you have answered "yes"'to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 5 of,17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�. 9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid,depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D: System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form -
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
Property Address
Bank Owned (Contact David:Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville .' MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
' D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected?. ❑ Yes ® No
Seasonal use? - ❑ Yes ® No
I Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 6-2012Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ -No
Water meter readings, if available:
t5ins-11/10 Title'5YOfficial Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
f Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville- MA 02632 8-24-12
page. Cityrrown : State Zip Code Date of Inspection
D. System Information (cont.)
s
Approximate age of all components, date installed (if known) and source of information:
2005
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan): R
Depth below grade: 28"feet
Material of construction: 1
❑ 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.
Septic Tank(locate on site plan):
Depth below grade: 20"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
12°
Sludge depth;.
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y 9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
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
16"
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.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
•
page. CityTrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2-500's
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology-
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach chambers in good condition and empty at inspection with stain line at 8" below inlet invert.
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
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way '
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
o
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fit= c � fi�2
73
•
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form=Not for Voluntary Assessments
M 9 Halyard Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health - explain:
® Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Original design plans show no groundwater at 12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Halyard Way
Property Address
Bank Owned(Contact David Holt @ Today Real Estate 1-800-966-2448)
{ Owner Owner's Name
information is required for every Centerville MA 02632 8-24-12
page. City/Town State Zip Code Date of Inspection
E. Report Completeness. Checklist
® Inspection Summary:A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
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Certified Mail#7006 0810 0000 3525 0663
s KE Y, Town of Barnstable
Regulatory Services
> IARNS'I'ABLE,.
MASS. Thomas F. Geiler, Director
i674• ��
Arf°""AYA Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
October 2, 2007
Albertson Ferreira
26 Compass Circle
Hyannis, MA 02601
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 9 Halyard Way Centerville, was inspected
on October 2, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable.
This inspection was conducted on the basis of the rental registration in accordance with
Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.300 &310.15—Title V. Observed four(4)bedrooms when septic
capacity (permit#2005-024) is only for three (3) bedrooms; garbage grinder observed.
The following violations of the Town of Barnstable Code were observed:
1� 70-10—Smoke Detectors and Carbon Monoxide Alarms. No CO alarm provided in
basement.
You are directed to correct the violations listed above within twenty-four(24) hours
of your receipt of this notice by installing CO alarm in basement.
QAOrder letters\Housing violations\Rental ordinance\9 Halyard Way.doc
You are directed-to correct the violations listed above within thirty (30) days of your
receipt of this notice by either removing one bedroom by removing bed and
widening room entrance to 5' wide and by removing garbage grinder, or by
upgrading system to satisfy the requirements of 5 bedrooms and a garbage grinder.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten(10) days after the date the order is served.
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER ORDER OF T BOARD OF HEALTH
homas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Meredith Morgan, Health Inspector
QAOrder letters\Housing violations\Rental ordinance\9 Halyard Way.doc
I
FORM30 C&W HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BORDZ MLTH
rC�TY TQ
W V
a D PARTMENT D
c e AD RES
4,'M SveyW
'TELEPHONE
11.
JAddress — Occupant . �
Floor--A rtment No. No. of Occu2j7 nts
No.of Habitable Rooms__-1 Rooms
No.dwelling or rooming units No.Stories &gV
Name and address of owner 49 0 �� INU)
Remarks 1o. M��
YARD Out Bld s.: Fences: I06701
Garbage and Rubbish tC�
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls: —
Foundation: p V�
Chimney:
BASEMENT Gen.Sanitation: aTI I
Dampness:
Stairs:
Lighting: j
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box.-
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom(1),
Bedroom 2
Bedroom 3 �7
Bedroom 4 oL� `
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTIO EPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTI OF R '
INSPECTOR TITLE
DATE TIME / '^� •M-
A
THE NEXT SCHEDULED REINSPECTION P.M.
i
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter ll, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is'not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the,order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B) and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
D Failure to provide the electrical facilities re uired b 105 CMR 410.250 B 410.251 A 410.253 and the lighting in com-
mon q Y ( ), O, 9 9
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water. ,
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(I) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
r_ .
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B). + .
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not-enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
Parcel Detail Page 1 of 3
Logged In As: Parcel Detail Tuesday, Octo
Parcel Lookup
Parcellnfo
Parcel ID -194-081 Developer:—LOT 45
- - Lot
-
Location 9 HALYARD WAY - -!I Pri Frontage '
Sec Road I Sec
Frontage
Village CENTERVILLE l Fire District,C O-MM
Sewer Acct 1 Road Index 2004
7 -
t,
Interactive
MapbedkW76
l ;
Owner Info
_
Owner FERREIRA, ALBERTSON Co-Owner
Streets 26 COMPASS CIR l Street2
City HYANNIS State MA zip :02601 Country
Land Info
Acres 0.46 Use Single Fam MDL 01 zoning - -- J Nghbd 0106
Topography Level _ -II Road ,Paved
Utilities Public Water,Gas,Septic ~ _ Location Marginal View
Construction Info
Building 1 of 1 n
Year 1985 I Roof Gable/Hip I Ext Wood Shingle
Built I Struct�- --- - -- - Wall -- -. -------
Effect. - Roof AC
1747 J As h/F GIs/Cmp Type None
Area Cover _--p- -- --� ----------
Int style'.Cape Cod WallRooms'Drywall3 Bedrooms
Bed
- ---I - --- ---
Int, - -_ - "- ' Bath "-- - - -
Model ,Residential I 2 Full
Floor' Rooms
Grade Type=Average I Heat Hot Air^ Total- Rooms'6 Rooms -_ - --- -- - -- _ -- -
http://issql/intranet/propdata/ParcelDetail.aspx?ID=14120 10/2/2007
Parcel Detail Page 2 of 3
211.
;� 1fDIC y�
is. 3
Heat _ - Found- -
stories 1 1/2 Stories Fuel Gas I ation Poured Conc__l
-- -- -- -- — FH5
s B§T ;GA_F
2 '�
36r
Permit History
Issue Date Purpose Permit# Amount Insp Date Comrr
3/2/1985 B27580 $55,000 1/15/1986 12:00:00 AM CE 1.E
3/1/1985 B27580A $55,000 CE 1.E
- Visit History
Date Who Purpose
1/6/2006 12:00:00 AM Paul Talbot Meas/Est
1/7/2000 12:00:00 AM Paul Talbot Meas/Listed
12/16/1999 12:00:00 AM Paul Talbot 2nd Visit-1st Notice Left
12/8/1999 12:00:00 AM Paul Talbot Meas/Est
8/15/1986 12:00:00 AM HM
- Sales History
Line Sale Date Owner Book/Page Sale P
1 4/6/2005 FERREIRA, ALBERTSON 19695/126
2 9/15/1993 CHENEY, LYNN D 8770/019
3 4/15/1985 GAVENAS, ALGIS R 4471/297
4 4/15/1985 SMITH, JAMES K TRS 4471/293
5 SMITH, JAMES K TRS 4351/263
- Assessment History
Save# Year Building Value XF Value OB Value Land Value Total Parc(
1 2007 $191,100 $2,700 $0 $154,700 ;
2 2006 $166,600 $2,700 $0 $141,500
3 2005 $154,800 $2,700 $0 $109,300
4 2004 $123,500 $2,700 $0 $77,100
5 2003 $109,900 $2,700 $0 $47,000
6 2002 $109,900 $2,700 $0 $47,000
7 2001 $109,900 $2,900 $0 $47,000
8 2000 $85,700 $2,800 $0 $32,700
http://issql/intranet/propdata/ParcelDetail.aspx?ID=14120 10/2/2007
Parcel Detail Page 3 of 3
9 1999 $85,700 $2,800 $0 $32,700
10 1998 $83,200 $2,800 $0 $32,700
11 1997 $91,400 $0 $0 $21,600
12 1996 $91,400 $0 $0 $21,600
13 1995 $91,400 $0 $0 $21,600
14 1994 $92,400 $0 $0 $32,400
15 1993 $92,400 $0 $0 $32,400
16 1992 $105,100 $0 $0 $36,000
17 1991 $100,400 $0 $0 $57,600
18 1990 $100,400 $0 $0 $57,600
19 1989 $100,400 $0 $0 $57,600
20 1988 $79,100 $0 $0 $18,600
21 1987 $79,100 $0 $0 $18,600
22 1986 $0 $0 $0 $18,600
Photos
http://issql/intranet/propdata/ParcelDetail.aspx?ID=14120 10/2/2007
No. ; Fee
c THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASA^HUSETTS
Zipplitation for Miopozal 6p!Aem Con!Arurtion Permit
Application for a Permit to Construct( . )Repair(><Upgrade( )Abandon( ) El Complete system,A:andividual Components
Location Address or Lot No. "V&-ypQ 0 WPfY Owner's Name,Address and Tel.No.
Assessor's Map/Parcel t 1 A f 1_ wIN C_N€N*
I 4 �8r �AM�
Installer's Name,Address,and Tel.No. _ Designer's Name,Address and Tel.No.
,Ge SrtR� �rvv��ncr� �� SvCS, mac.
(off- S ?>N D ls3g- +9 taco
Type of Building:
Dwelling No.of Bedrooms Lot Size 19 3-'4?>q.ft. Garbage Grinder
Other Type of Building 1\)or& No. of Persons 4 Showers( v3 Cafeteria
Other Fixtures LA-j ATc i2Y K rrn+—a uwgbey
Design Flow 'J 30 gallons per day. C Iculated daily flow gallons.
Plan Date \ ii_ 05 Number of sheets Revision Date
Title AL
Size of Septic Tank x IS- ma Ckn\ A-C, k Type of S.A.S.
Description of Soil.
S-�z3tVz
Nature of Repairs or Alterations(Answer when applicable) psk rN
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 provisio s of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been iss d by is Board of
Signe G Date 1— 3 6
Application Approved by Date
Application Disapproved or the following reaso s -
Permit No. Date Issued
r
No. CDs*. Fee
LX
> - - - , ;THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTWDIVISION -TOWN OF BARNSTABLE, MASSSACHUSETTS
01ppYfcatfon for ;0f!6'Po2;a1 bpztem Con6tructfon 3permit
Applicition for a Permit to Construct( . )Repair(Q Upgrade( )Abandon( ) ❑Complete System.,>gIndividual Components
Location Address or Lot No. -�}'"t `�`YAQ� (JJ�Y Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
t\Ne I Mpp R (L- Nw owk)V
I OU�
Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No.
'_Rb\CQ C �tCQ `jt�Al� �NVtcUf�M�fiG� SvCS. sac.
-� (DLA8- s
Type of Building:
DwellingNo.of Bedrooms _ Lot Size s .ft. Garbage Grinder
-19 q g
Other Type of Building No. of Persons 4 Showers( y� Cafeteria( ✓ '
Other Fixtures LA.,A- no y K,Te* EA `'ujk. LAyW. �>,Y
�b gallons per day. Calculated daily flow c bl•S gallons.
u... ". Design.Flow � g p Y• Y
Plan Date \ \ 1 I n s Number of sheets t Revision Date
Title Sorn-l-ir �t�C-IRM l�ta �Cc �ra
Size of Septic Tank I'( ,�-t- , Ior,r, Gci\ -kra � Typ of S.A.S. v-� ,cbc"G ` Gk�t.har5
��� Stu
Description of Soil '' kr .L kr^,,.
Nature of Repairs or Alterations(Answer when applicable) `�V Ql r -�n CACt",
Date last inspected:
i' 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 by this Board of Realth.
Signe w IWLIT A G Date 1--I J_6
v/
.Application Approved by v r r � � Date
Application Disapproved or the following reaso s
J
Permit No. Date Issued
—— ' —— r————— —
THE COMMONWEALTH OF MASSACHUSETTS
D�-00 5 '0 BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CER Y, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded(,V)
Abandoned( )by
at r joh d A has been constructed in accordance
with the provisions f Title 5 and the or Disposal Syste Construction Permit N,. �"' dated
Installer /X/ 0i Designer S v
The issuance of this pegnit shall not be construed as a guarantee that t cs—ystern il: f unction as designed.
Date / 0 5 Inspector---A
. f
-- -- —^-- ———————————————————
No. / �J Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
30f5poof *pgtem Construction Verinft
Permission is hereby granted to/Construct/( )Repair( )Upgrade(\/)/`�bandon
System located at T,/!o(�'`/�! �x 01 i !
U
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: Constru tion must be completed within three years of the date of thi e
n
Date: �� !// Approved by i
L_711
Town of Barnstable
°�T"E rOw Regulatory Services
Thomas F. Geiler, Director
BARNSTABLE,
;b Public Health Division
p'ED 39. 1. Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date:
Designer: f�)�DWY &U, SVCS. Installer:
Address: "- (421 Address:
[_, (`n�1n , (fit-f� A
On I i D,S � i�-iG�VC_ was issued a permit to install a
date) (installe )
septic system at 9 4,C)Lyarw') L"r- , i I based on a design drawn by
c (address)
qA c� C dated O
(designer)
VV
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
Z k.OF ikgS
nst er s a n tore- o� r
�f SHAY N .
No. 1181
(Desig 's Signature (Affix De e�, ere)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIS N. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
TOWN OF BARNSTABLE
LOCATION lial-44rV SEWAGE # ®d-
VILLAGE c ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO." Z&7
SEPTIC TANK CAPACITY Ste"
LEACHING FACILITY: (type) (size) �o zG 4 aV— Y,,
NO.OF BEDROOMS `
BUILDER OR OWNER N;E
PERMTTDATE: OMPLIANCE DATE:
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
1
1t °
' F4t ® �`�°
ct
;5
A
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTIO
i � t
`
� QED INSPECTION
,
' � DEC 1 5 2004
6V! � � f
TITLE 5 --
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A 19 g"
CERTIFICATION .
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632 l,l
Owner's Name: MR.CHENEY
Owner's Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Date of Inspection: 11/22/04
Name of Inspector: (please print) JOHN GRACI,INC.
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
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:
_ Passes
_ Conditionally P s!es
_ Needs Furtlje; valuation by the Local Approving Authority
X Fails
Inspector's Signature: Date: 11/22/04
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
SYSTEMFAILED TITLE V INSPECTION.LEACH PIT WAS FULL AT TIME OF INSPECTION AND STAIN LINES
INDICATE THE PIT HAS BEEN FULL OVER INLET-PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING.
****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 lnenartinn Fnrm 6/15/ Ono 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
SYSTEMFAILED TITLE V INSPECTION.LEACH PIT WAS FULL AT TIME OF INSPECTION AND STAIN
LINES INDICATE THE PIT HAS BEEN FULL OVER INLET-PIT IS PAST THE EFFECTIVE DEPTH OF
LEACHING.
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,ND)in the for the followingstatements. If"not determined" leas
please explain.
n/a 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: n/a
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of
Health):
_ broken pipe(s)are replaced
_ obstruction is removed
_ distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
_broken pipe(s)are replaced
obstruction is removed
ND explain: n/a
Page 3 of 11
Ct
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
C. Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect public health,safety or the environment.
Y 8
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 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 n/a
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and
volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy
of the analysis must be attached to this form.
3. .Other:
n/a
I
z
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
D. System Failure Criteria applicable to all s
y PP stems:Y
You must indicate"yes"or"no"to each of the following for alLinspections:
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 %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 SYSTEM WAS PUMPED IN APRIi 2000 PER OWNER.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface 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 at a DEP
certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.]
YES (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
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
_ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have.answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat
under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
a
• Page 5 of 11
E
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
Check if the following have been done.You must indicate"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 previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out
X _ Were all system components,excluding the SAS,located on site?
X _ 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 ?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X _ Existing information.For example,a plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable) [310 CMR 15.302(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: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 425
Number of current residents: 2
Does residence have a garbage grinder(yes or no):NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)): Rhr ilz �_ 39 000
Sump pump(yes or no):NO
Last date of occupancy: n/a �'j, - )ZI NO
COMMERCIALANDUSTRIAL O y I31000
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no):NO
Non-sanitary waste discharged to the Title 5 system(yes or no):NO
Water meter readings,if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: SYSTEM WAS PUMPED IN APRIL 2000 PER OWNER
Was system pumped as part of the inspection(yes or no):NO
If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X 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)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
Approximate age of all components,date installed(if known)and source of information:
18 YEARS PER OWNER
Were sewage odors detected when arriving at the site(yes or no):NO
• Page 7 of 11
i
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
BUILDING SEWER(locate on site plan)
Depth below grade:30"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 24"
Material of construction:Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: L 8' 6" H 5' 7"W 4' 1011"
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle:33"
Scum thickness: 0"
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: 18"
How were dimensions determined: MEASURED
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.
RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP:_(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
n/a
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level:N/A Alarm in working order(yes or no):NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: n/a.
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 WAS VIDEO INSPECTED,LIQUID LEVEL IS HALF WAY UP PIPE.
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no):NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
R
Page 9 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GALLON 6'X6' LEACH PIT leaching pits, number:
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):.
LEACH PIT WAS FULL AT TIME OF INSPECTION AND STAIN LINES INDICATE THE PIT HAS BEEN FULL
OVER PIPE-PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING- BOTTOM IS AT 9 FT.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no):NO
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
4
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet.Locate where public water supply enters the building.
V�1
A
o
o
0
A152-7 �
p At 3-5 t
3
��13 31
to
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 HALYARD WAY CENTERVILLE,MA 02632
Owner: MR.CHENEY
Date of Inspection: 11/22/04
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 12+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS),
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
HAND AUGER- 12+FT.
tt
TOWN OF BARNSTABL.E
LOCATION 11? `I_a`y a re W cl y/ SEWAGE
VII I AGE hq iel U J�I 2 ASSESSOR'S MA.P& L
1 INSTALIXR'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LACH3vG FAcI.gTyr: ( ) (size)
1�
NO,OF UDROOMS.,._.3 _ ....
bUILDER OR OWNER.
l PIER IT®ATE:,.,—...—__.,,. CO1b P DICE DATE:
' Separation Distance Between the:
Maximum Adjusted Groundwater Fable to the Bottom of Leaching Facility Feei
Private Water Supply'Well acid Leaching Facility (If any wells exist
on site or wld& n 200 fett of leaching facility) Egg
Edge of Wetland and Leaching Facility(if any wetlands exist
vvit.hin 300 feet of leaching.facility) r ec � Fee
Furnished by u r C�
GAG.
D
CoUe�
D o
l ,�
TOWN OF BA.RNSTABLE
LOCllvareOSEWAGE # J —e;L
VILLAGE `` ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
y,LEACHING FACILITY: (type) (size)
NO,OF BEDROOMS ✓ �/ , t
BUILDER OR OWNER "1 N N C ik N,F_
PERMITDATE: � COMPLIANCE DATE:
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
.�
INV
Ae)376
- r
33
a� -7o
lS
Board of Health A
Town of Barnstable ' -
_� P.O. Box 534 VC)
No... .............� Fmm.......J�. �`"�
Hyannis, M`assachusetts 02601
THE COMMON`EALTH OF MASSACHUSETTS
BOARD E HEA:.LTH
.........OF...... .............. .. . .... ...... .....................
ApplirFation for Disposal Workii Tontrurtion ramit
Application is hereby made for a Permit to Construct ( 4T'-or Repair ( ) an Individual Sewage Disposal
System a
....� ....... .... ... .• . ........... -•-- . .. .-•---. . ..................................................
ati ddrees No.
•... . . .. ......................... ........................................
w dr as
a ...._.....�.......................... ........ --' --•-•--•---------.-.•--.----.---
Installer Address �
Type of Building Size Lot__J_�[j___I3 1_ __Sq. feet
Dwelling—No. of Bedrooms____________________________________________Expansion Attic (�� Garbage Grinder go
Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Othe fixtures --------------- -------------
W Design Flow.........../.0.........................gallons per person per day. Total daily flow_______ . ...............gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter.............. Depth____-__---_--__.
xDisposal Trench—No:.................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-------------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing too ( ) 99
~' Percolation Test Results Performed by.
9L Date_ o�__"__ .'•... _..._.
S�
Test Pit No. 1................minutes per inch Dept i of Test Pit_............_.__.. Depth to ground water_.___._______.___.._.__.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -------- ---------------------------------
•------------------------
O Description of Soil.......
xr ..
..........................................................
wl
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 TITT= 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operati ti1 Irttkatigtof Compliance has been issued by the board o iealth.
Signed LAP ..................... �!'_ e 5,
Date
plca ion Approved By--------- ------ ---- -----• ..... .-- ...................................... ..---_.�- 57.......
Date
Application Disapproved for the following reasons:.............................-----•----•-------•--•----••------....-•-•-•------•..............•-------- ...._
..................•.•----------------.._...•-•--•----•-------•-•_......----••-••------........------......---•-----------•-••--•--•---...------------.•---•----•------------------.--Date----------•---
tz
Permit No....... "'5........�,..�. ... Issued._.. -------•--•-
Date
l_ ___ — _-- -----------
.-------
r '
' r s\► N,
i
No..--•----------_�.._.. Fes$.. .P.?a-:----�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD9F HEALTH
__.:....... ......--OF....._....... //till,? .-L- ... ..............
Apptiration for Disposal Vorkg Tonstrurti.un 1hrmit
Application is hereby made for a Permit to Construct (L-1-or Repair ( ) an Individual Sewage Disposal
System t: ,
' �. ,� r '
.... ...!.J r'. - - ! �/✓ ' ---------------------------------------------
bcati Address r I,9f No.
- .
Ow e? �� Add ess
IW,1 ---.... 1� .,�s�././.7C_ y� iit�'"`✓ ---•---'e✓''k� r..."f '
Installer Address Gj ��,, rr��
Type of Building 3 Size Lot/ ,---�___f__�....Sq. feet
U Dwelling—No. of Bedrooms._.._._._•..................................Expansion Attic (V Garbage Grinder kO)
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
POther fixtures -------•----•-----------------------•--.........----...-----------------------------.......--------•---.
W Design Flow........ ....•.........................gallons per person per day. Total daily flow-__--�?--_.__-Q__.........._...__......gallons.
WSeptic Tank—Liquid'capacity........_...gallons Length................ Width................ Diameter................ Depth................
x
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing�ik
Percolation Test Results Performed by.../„... � - c .........
Date-/)........3......f!/
Test Pit No. 1................minutes per inch Depth of Test Pit.......... ..... Depth to ground water........................
f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 .................................................... ------- __.._.._.__.__ ...
O Description of Soil......�>------`)..... ; /� =''� �.....r !•�. ! -,_ ...------ ------ ---- --------- ---- ------------ -----------•-----•1
V ......................................` - j t:(-?�_ _ 1cr,� �` , / -z-------------------------------------------•---•-----------•----
W
VNature of Repairs or Alterations—Answer when applicable...............................................................................................
------------------------------------------••-----------------•-••---•-•--•-•--•--•-•....•----•-••------•--•....---•----•----•-------•-------•--------•...----------------------•._...-••---•--•.........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the prov•sions of T�Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
oper 'o Iunt' e of Compliance has been issued by the board af'health.
Signed..' -'-115_ %1 ,_+- ' �` ,... •�^`" .............
_. ,.� s
�� / - Date
Application Approved BY ' .. -��' .�!! �?�.� .�+_ :"�.................................. .."'
.�
ate
Application Disapproved for t e following reasons--------------------------------------------------------------•------------------...-•--•---------•---.........._
.....-•...............••--......----••--_....._.....--------.........-•----. --------'Issued_ -------•----•--
Date
THE COMMONWEALTH OF MASSACHUSETTS
yBOARD OF HEALTH
-J....O F. ...................
Tn#ifiratr Of Toutphatta
T�I,76 IS 0 (7ERTIFY jhat the Individual Sewage Disposal System constructed (---for Repaired ( )
by----- �..................:............•-----•-------------.----------...--------------...---------•---•----•--•---------------...-•------•--•------------
_,rf r ins t`allat er
has been in�alled��accordan e.� tl�t. provisions,`ef TITLE moo.��!/-� .-� ._ .________________________________________
5 The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..... _'-_ ►_F_#--____--__-_ dated------ �`w -----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUED AS A GUARANTEEHAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.....3..._�..... --•--•------------------ Inspector ---..._.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD .OF HEALTH
7E��-2_ Iq ... 0 F A/Ie�__ � .......................
No......................... FEE........................
Disposal Workii Tunutr uan rrutit
Permissioni hereby granted...............................................................................................................................................
to Construct or e�air//� ) an Individual Sewage Disposal Sys ern
V r Street
as shown on'the application for D' osal Works Construction Permit Dated_ .-6-7.$ ..............
Board of Health
DATE. Z ......................................................
�` FORM 1255 A. M. SULKIN, INC., BOSTON
_ICES/G/V 0,4 7`.4
3,4
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USE
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No. 297?3 v; aka BAXTER
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LOCATION SEWAGE PER IT N0.
V I L L A C E
`INSTA LLER'S NAME i ADDRESS
BUILDER OR OWNER
s �T/
VrI DATE PERMIT ISSUED
p DATE COMPLIANCE ISSUED
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V I L L A G
-
INSTA LLER'S NAME I ADDRESS
1";q A& 5
a u 1 0 E R ®R OWN iw
D
� 0ATE PERV. IT ISSUED
DAf w v0MPLIANCE ISSUED
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10' min. from- 'NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. -D-Box cover must be SECTION A- -A1rauM�wla
ALL OUTLET PIPES FROM THE
within 6 in. of finished grade - - - _ - DISTRIBUTION BOX SHALL BE
Existing Foundation House to septic tank PROFILE VIEW OF LEACHING SYSTEM ,2• -- o
SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER
TOP OF FOUNDATION = ELEV. 100.00 (Assumed) Septic tank covers must be
within 6 in. of finished grade -i-. .. r- __l �. l
Grade over Septic sunk - 94.00 to 92.00 -erode over D-Box - 92.00 ode o'w SAS -- F1EV=- 92.00 to 90.00 `\- I 3 - 5•OUTLET y-'. 2 O.. �.
-- .f/�•ter r/t Id7W G►�rAN 8.wr� of I/w'- f/t• w-*.d P-.4.- KNOCKOUTS
/ I' -_.- ------ INSPECTION cover must15.5' OUTIFT `-,, 1 -- 12• NLEf yCa
within 6 in. of finished grade
S - 0.02 _- --- 3 HOLE H-10
Dist. eox �� u��.;�.,,,�,� c:�,.P� / Top of SAS-Elev.=90.50 I � 6-
K� 16' EXIST. S=O.Ot or Greater 5- 0.010- PM /cx,l . / 1 2' �,I NMyftra my
EXIST. PIPE o 1,000 GAL. _
fRpt E%IST. FWNDATIOi a�i u) SEPTIC TANK N 10 -- - -y- -- O O OO O O O 4" - SCH. 40 T >7S•
( °° 20' o E"ecw. o.oth o ^ o PLAN SECTION CROSS-SECTION ll - KT u-, Kn -
CONCRETf F XI FOt1NDA > II H-10 0 0 I 2 Units Q 8.5' = 1T
a� u m ° ,n 4' 1� - 19'� 4,
u 1l 3.Sy 5' +3.5' n
6 n.af 3/, , z- j " •-' 3 HOLE H-10 DISTRIBUTION BOX
SYSTEM PROFILE cornpoctad stone 12' °I° z5'
Not to Scale c c' °' m u Effective Length NOT TO SCALE �159r
Effective Width j
) IN,'^,E4 Ply\eK•Kyi
c c m SOIL ABSORPTION SYSTEM (SAS) ------- ----- -- -------- p
6 in.of 3/4--1 1/2' 0 500 - C H-10 LEACHING UNITS / WIGGINS PRECAST GENERAL. NOTES
compacted atone a)
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE Bottom of Test Hole 1 Elev_= 78_00 Not to Scale 1. Contractor is responsible for Digsafe notification
Obs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED and protection of all underground utilities and pipes.
2. The septic tank and distribution box shall be set
level on 6" of 3/4"-1 1/2" stone.
Backfill should be clean sand or gravel with no
r --- - -- -- - - ----- --- -- -. -_ - - ---- --- stones over 3' in size.
PERCOLATION TEST __ LOT #4A L0T #3A % 4. This system is subject- Environmental
inspection during installation
b Carmen E. Shay Environmental Services, Inc.
- ------- The contractor shall install this system in accordance
Date of Percolation Test: JANUARY 14, 1985 with Title V of the Massachusetts state code, the approved plan
Test Performed By. BAXTER & NYE. ---- - Pi and Local Regulations.
Results Witnessed By. BARNSTABLE B.O.H. 93.36 _ - _ 6. If, during installation the contractor encounters any
Percolation Rate: Less Than 2 MPI ® 24" --- soil conditions or site conditions that are different
from those shown on the soil log or in our design
- installation must halt & immediate notification be
Test Hole LOT #45 - made to Carmen E. Shay - Environmental Services, Inc.
No. 1 7. No vehicle or heavy machinery shall drive over the
DEPTH SOILS ELEV.
19,973 Squctre Feet +/- septic system unless noted as H-20 septic components.
-0 ----- 92.00 ,-' 8. Install Tuf-Tite gas baffles or equals on oil outlet tee ends.
Sandy - - 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
Loom 10. All solid piping, tees & fittings shall be 4" diameter
I
0"-t2" A 91.00 Schedule 40 NSF PVC pipes with water tight joints.
g 11. Municipal Water is Connected to The Residence and Abutting
Sandy
Loom g Properties Within 150 Feet.
,' i' ro P
12'- 2a" Be 90.0o LOT #44 THE PROPERTY LINES ARE APPROXIMATE AND
COMPILED FROM THE SURVEY PLAN GENERATED BY
Fine BAXTER & NYE OF OSTERVILLE, MA, ENTITLED
Sond "CERTIFIED PLOT PLAN OF LOT 45 HALYARD WAY, CENTERVILLE, MA"
24"-168" C, 90.00 DATED FEBRUARY 14, 1985
& THE DEED DESCRIPTION ( BOOK 8770 PAGE 019)
' - ------ IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
r90 ' THE SEPTIC SYSTEM INSTALLATION.
_
/ LOT #46 EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE OR
REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION
61& /� 861 to NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
FROM THE EXISTING LEACH PIT TO BE DISPOSED
OF AS PER BOARD OF HEALTH SPECIFICATIONS.
Perc y1 PROJECT BENCH MARK
�- - - ,.'� NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY
Depth at Perc: 42" to 60" TOP OF FOUNDATION
Perc Ratee Less Than 2 MPI ELEV. = 100.00 (Assumed) �'' ASSESSORS MAP 194, PARCEL 081
Groundwater Not Observed _
No Observed ESHWKT _ _- - Failed LEGEND
ADJUSTED H2O Elev. = None _ Leach Pit
--- --- ------- 18�I -25' 15'
2-18' CAM. ACCESS MANHOLES ��_- ,�' "` _a .-:- :'' -. _ - DENOTES PROPOSED
e
F ;-EACH ING: ' 1�, --- 104X1 SPOT GRADE
AREA
198 ' 1 - - ' DENOTES EXISTING
r` ----- - _ �_�_ �s-�� ?� 104.46 SPOT GRADE
TEST-HQL #1
�'EX)5T. 1000 gpL-Q ELEV.= 92.0!D- 191- PL PROPERTY LINE
:-- 0UT.EI ' Sgptic Toak
------ Or 23.5'
` --_ - -- - 96P PROPOSED CONTOUR
h- THE ACCESS COVERS FOR THE SEPTIC TANK, ' ' 1 1 ----
DISTRIBUTION BOX AND LEACHING COMPONENT �� i' _. ._- -.-- --._- ry
SET DEEPER THAN 6 INCHES BELOW FINISHED , DECK. \ --- - --9 f EXISTING CONTOUR
~ - GRADE SHALL BE RAISED TO WITHIN 6' OF /
STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE.
PLAN VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS ���\ DEEP TEST HOLE &
3-24• REMOVABLE COVERS-� 96_, `-_ - EXISTING PERCOLATION TEST LOCATION
{ 3 BEDRARAGE
6 FOOT STOCKADE FENCE
.
__3 min. aemance I �` IY INLET' f • HOUS \
INLET 8• Ti.T- 2" min inlet to outlet - '
--------1---- e-a,w,. --
r-' Liquid lewd I OUTLET I #y I 1
. P5 -T ;. - n t- r 5 -T• - tl 0 T P LA N
ss g8\
E e 4'-0' mm. I J I
---
..? O V Or YNr �• Liquid depth - -
OF PROPOSED SEPTIC SYSTEM UPGRADE
' 4' -io - � I J I PREPARED FOR
e-� , I I 1
CROSS SECTION END-SECTION l MS . LYN N C H E N EY'
4 I I 1 I
ASPHALT ; ; AT
TYPICAL 1000 GALLON SEPTIC TANK DRIVEWAY: #9 HALYARD WAY
NOT TO SCALE ,' 1 1
' I C E NTE RVI LLE, MA
Design Calculations F
h' ¢ ---- -- --- - - -
Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) (b I___ fit,_ % ���$�j A q�y P EPARED BY:
Garbage Grinder: No 5 °I I I �/ o R N G CARNEY E. ,��'HA Y
Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) I I �J
Septic Tank : - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. I",/' ��`-- U I ENVIRONMENTAL SERVICES, INC.
1 �
SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch -------- ------- No 1181
Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. = 222.00 gallons 0 20 40 JU Rya P.O. BOX 627
Sidewall Area: 0.74 gal./sq. ft. x 14-8 sq. ft. = 109.50 gallons _fJ1 �J Y R� WA �' r~- s G/STE r\ EAST FALMOUTH MA 02536
r�ti AhITARIi
Providing: = 331.50 gallons
Use: (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, (40 FOOT RIGHT OF WAY) ---
TEL/FAX 508-539-7966
TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND SCALE: 1 "=20' SCALE: 1 "=20' DRAWN BY: CES DATE: JANUARY 1 1, 2005
4' OF WASHED STONE ON THE ENDS. PROJECT#SD677 FILENAME: SD677PP.DWG SHEET 1 OF 1