HomeMy WebLinkAbout0153 HARBOR HILLS ROAD - Health 153 Harbor Hills Road
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Centerville
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c Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart& Fay Boyer
Owner Owner's Name
information is required for every Centerville ✓ MA 02632 3-19-18
page, City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
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Capewide Enterprises o
� Company Name
153 Commercial Street ''''��''�SRINt•SP`rG��c
Company Address
Mashpee MA 02649
City/Town State Zip Code
508-477-8877 S1623
Telephone Number Ucense 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of
Title S(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
3-20-18
,ifispeclor'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 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.doc-rev.6fIS Tide 5 official Inspection form Subsurface Sewage Disposal System-Pape 1 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
'UP:�
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart& Fay Boyer
Owner Owner's Name
information Is required for every Centerville MA 02632 3-19-18
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The system is a 1000 Gal. Tank D Box and two chambers.
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.doc•rev.6116 Tills 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
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Commonwealth of Massachusetts
Title 5 official Inspection Form
i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart& Fay Boyer
Owner Owner's Name
information is required for every Centerville MA 02632 3-19-18
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cunt.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass Inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
I. 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
t5m.doc•rev.6116 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 3 of 17
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c Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart& Fay Boyer
Owner Owner's Name
infuriation is required for every Centerville MA 02632 3-19-18
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cunt.)
2. System will fall 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 9MOM is less than 6" below invert or available volume is less
than '/day flow 4 Eq eylly
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Lam` 153 Harbor Hills Road
Property Address
Stuart& Fay Boyer
Owner Owner's Name
required for
Is Centerville MA 02632 3-19-18
required for every
page. Cityrrown 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 collform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other fallure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000g pd.
® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or'no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15,304. The system owner should contact the appropriate
regional office of the Department.
I5ins.doc-rev.6/16 Tills 5 Official Inspection Form:Subsurface Se,vage Disposal System•Page S 0117
l,l• a5ed xeJ dH 6t,:ZZ 860Z OZ JeW
Commonwealth of Massachusetts
Title 5 Official Inspection Form
' Subsurface Sewage Disposal System Form . Not for Voluntary Assessments
u
153 Harbor Hills Road
Property Address
Stuart&Fay Boyer
Owner Owner's Name
information is required for every Centerville MA 02632 3-19-18
page. Citylr'own 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 Ian 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
i5insAce-rev.6/16 Thle 5 Or9cio Inspection Form:Subsurface
ace Sew Di sal System�page 89B � Y6 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
153 Harbor Hills Road 1UP
Property Address
Stuart& Fay Boyer
Owner Owners Name
information is required for every Centerville MA 02632 3-19-18
page. Cityfrown State Zip Code Date of Inspection
D. System Information
Description:
1000 Gal. Tank D Box and two chamber's.
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage (gpd)): 2016-112,000Gal
Detail: 2017-51,000 Gal's
Sump pump? ❑ Yes ® No
Last date of occupancy: Present
Date
CommerclaVindustrial 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:
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
c
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart&Fay Boyer
Owner Owner's Name
information is
required for every Centerville MA 02632 3-19-18
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: NA
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):
t5nls.doc rev.6116 Title 5 Official Inspection Form:Subsurface SewaSe disposal System•Page a of 17
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Commonwealth of Massachusetts
U
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
153 Harbor Hills Road
ss Property Addre
Stuart&Fay Boyer
Owner Owner's Name
information is required far every Centerville MA 02632 3-19-18
page. CityJTown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
2013 Permit#2013-308.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 22"feet
Material of construction:
❑cast iron ®40 PVC ❑ other(explain).-
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Pipeing is 4"PVC SCH -40.
Septic Tank(locate on site plan):
Depth below grade: 1
feet
Material of construction:
®concrete ❑ metal [I 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. Precast H-10
Sludge depth:
1"
t&ns.doc-rev.&t6 Title 5 Official Inspection Form:Subsuface Sewage Disposal System-Page 9 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart& Fay Boyer _
Owner Owner's Name
information is required for every Centerville MA 02632 3-19-18
page. city/town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(coot.)
Distance from top of sludge to bottom of outlet tee or baffle
29"
Scum thickness
8
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
18"
How were dimensions determined? Asbuilt- Plan -Tape
Sludge Judge
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 at working level. Tank and cover's at 1' below grade. Inlet old type wall baffle, outlet tee. No sign
of leakage or over loading.
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
15ine.doc-rev.8116 Title 5 Official Inspection Fortn Subsurface Sewage Disposal System-Page 10 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
E�
153 Harbor Hills Road
Property Address
Stuart& Fay Boyer
Owner Owner's Name
information is required for every Centerville MA 02632 3-19-1 B
pie City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage,etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present; ❑ Yes ❑ No
Alarm level: Alarm in working order. ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
•Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
l5kis.doc-rev.&16 Title 5 official Inspection Form:Subswfeca Sewage Disposal System•Page 11 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
t 9�,—Vf
153 Harbor Hills Road
Property Address
Stuart&Fay Boyer
Owner Owners Name
information is required for every Centerville MA 02632 3-19-18
per. cityfrown State Zip Code Date of Inspection
D. System Information (cont,)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
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 is 16"x16"-33"below grade wlcover at 8". Box is clean and solid wttwo line's out. No sign of
over loading or solid carry over. -- —
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No`
Alarms in working order: ❑ Yes ❑ No'
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc,):
If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
l5ins.doc-rev.6/16 Title 5 Ofriael Inspection Form:Subsurface Sewage nieposal System-Page 12 of 17
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Commonwealth of Massachusetts
o Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart& Fay Boyer
Owner Owner's Name
informations required for every Centerville MA 02632 3-19-18
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont,)
Type:
❑ leaching pits number:
® leaching chambers number: 2
❑ 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,):
Leaching is two 500 Gal. dry well chamber's w/stone. Chamber's at 43" below grade w/cover at 8".
2"water in chamber's w/clean like new walls.
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
15ins.doc-rev.6116 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
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Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart&Fay Boyer
Owner Owner's Name
information Is required for every Centerville MA 02632 3 19-18
page. Cky/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.doc-rev.6116 Title 5 omciai Inspection Form:Subsurface Sfn-age Disposal System•Page 14 of 17
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Commonwealth of Massachusetts
TV
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart& Fay Boyer
Owner Owner's Name
information is required for every Centerville MA 02632 3-19-18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cons.)
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
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t5ir)s dx-rev.6116 Title b Olfidel Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
153 Harbor Hills Road
Property Address
Stuart&Fay Boyer
Owner Owner's Name
information is required for every Centerville MA 02632 3-19-18
page_ City/Town State Zip Code Date of Inspedion
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
N�
Estimated depth to high ground water: 10
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: 7-22-13
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:
T.H. n Design I -o Des g pan 7-22 13 10 no G,W.. Bottom of chambers at 6 below grade. Bottom of
chamber's at 4'above T.H. Depth.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
L51ns.doc•rev.6016 Title 5 Official Inspecdon Form:Subsurface Sewage Disposal Syslem-Page 16 of 17
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Commonwealth of Massachusetts
ugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
, 153 Harbor Hills Road
l
Property Address
Stuart& Fay Boyer
Owner Owner's Name
information is
required for every Centerville MA 02632 3-19-18
page. Cityrrown 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
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` iI TOWN OF BARNSTABLE
LOCATION i b-1-AtZMg tZ[:tU_ N SEWAGE# J,O Or e.17'
VILLAGE ,, ILL.r` ASSESSOR'S MAP.&PARCEL --
INSTALLER'S NAME&PHONE NO—LI" a�6t-rn r l b,?/"l Q-(3r
SEPTIC TANK CAPACITY L7Kf i o "-6 1G�5.6 h!0 �,
LEACHING FACILITY:(type ,iZ�'1-tG(�► (size),30 x-9
NO.OF BEDROOMS 70 At-
OWNER
�l,Z
PERMIT DATE: Z'• 14- Q 1 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility $- -IN Feet
Private Water Supply Well and Leaching Facility(If any wells exist ori` R
' site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility.(If any wetlands exist within
300 feet of leaching facility) A'. Feet
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No& rJ Fee v�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpYitation for ]Disposal 6pstrin Construction 3permit
Application for a Permit to Construct( ) Repair()( Upgrade( ) Abandon( ) ❑Complete System PtIndividual Components
Location Address or Lot No.1,j"3 f-ja4 jof-.14,7 15 Owner's Nam Address,and Tel.No. <3'e�$� +" Q0 ?/O/
o2a`7�6_�. °(..�'t14ez'vo'bl� `Stcxt►--{- {c
Assessor's Map/ParcelM AA O
talle 's e, s , d Tel•No.(jpl�-- qo'S• Desi er's Nam Address and Tel.No. 6-bT
Ns�v o'o» d � Cn rnI'�'o' j���hc
,# .
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size jO sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ,3 30 gpd Design flow provided 33 C gpd
Plan Date w Number of sheets ! Revision Date
Title e Q
Size of Septic Tank i5 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) °
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental der of to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health
gned Date ��. / 3
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. -�O Date Issued — —
,.-,ems..-..,_r+-• �..-�,r.iw`4-r�.r,:�-,r. .. �.1.�./..., .,.��.a -,..+a�y-{*�?:"gat�.a•. ....swa'n,aewr-..F..:_-.....,.-.:.....�.w.-., ..�.._... .m....,x,,..,a,.. v/._�.,..- - `.-.....-ti'�
y No. lO V cJ 4` - y Fee 1v�
" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION..,TJ_ WN OF BARNSTABLE, MASSACHUSETTS Yes
application fOr Nsposal Opstetn Construction Vermlt
Application for a Permit to Construct( ) Repair(,W, Upgrade( ) Abandon( ) ❑Complete System ®"Individual Components
Location Address or Lot No. /J'.3 t-61 Loy-/• ,'(t S R, Owner's Name Address,and Tel.No. J U q�iu-}/al
C.er�Ierv�ale srk�.e.,L �g Curry �cwnb Gr
t Assessor's Map/Parcel
,n
�t ,rnZ ""0 k4.,7A
J,ytalleris N e,gas , d Tel.No �t�� ��� r�ja( /Designer's Name,Address�aridTel.No. SAS v ivor) 'IS 1nc�trf/�/y ./Ck�v/� r G! ;t)ee t'�- 735 1�141,0 5,�.
Type of Building: / I
Dwelling No.of Bedrooms Lot Size , t a.3 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 30 gpd Design flow provided 3 6w gpa
Plan Date JoIQ ::)q Number of sheets y ) Revision Date
Title /,.41, .-S,4 10/0,41 � �� ga 4a!r" �,��� �c�/1 l�io17 k_,2-a 42
Size of Septic Tank �_ 1 c n Type of S.A.S. ,f,f-C.�,� cd . - ( A 10� Sr,n_o V 0/fYTn�
Description of Soil �.ps, 2
Nature of Repairrs__orAlterations(Answer when applicable)`a �.Je )�,b ., kAX a _ / c10 t `
1 aA!Oa►'—, R. 7 bl - 3 W X/ 'D .54e nloJ a
Date last inspected: r ----
Agreement: r
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental-Code an¬ to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health Signed '' -..�. ". .. w ._ Date Vl3/f�.-3
Application Approved by \ Date
Application Disapproved by Date
for the following reasons
Permit No. �,� 3 G Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CCERTIFY,that the/Ong-site Sewage Disposal system Constructed( ) Repaired(�)� Upgraded( )
Abandoned( )by V r a�r, 1 ' c �ar n -_T—ri c-
at IS
_3 14 1,4^ r 14,11-, R ,. 0,o (�,���;/�� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No-,_-�/3—304ated 1
Installer ( � �/11�, ��:,�� ae� ism �i►C Designer 1��A^�•� �,�,p �1,,� i met r��`
#bedrooms 'a,V t Approved design-flow gpd
_ W
The issuance of this permit-shall Xot be construed as a guarantee that the system will function asas/desiigned. r-
Date / Inspector
r , � -
No. (���. � G .. . � ,� ._ - __ �____...___--_-- -•---_____- Fee / QC�----..�.�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
NSPOSal Opeitem Construction permit
Permission is hereby granted to Construct( ) Repair(, ), Upgrade( ) Abandon( )
System located at
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.
r
Provided:Construction must be completed/wf'thin three years of the date of this permit.
Date /� I ! ) Approved by___-_.__�_ -ice
RUG-26-2013 12:02 From:BORTOLOTTI CONST 5084289399 To:15087906304 P.1/1
Regulatory Services
Tbo mas IF. Geiler,Dh-eeto-r
& P ublue Health Dnvusiola
1699-
Arto 5 Thomas IY1 cKelsnA,DiTector
iao l oju Weet,ny000is,MA 02601
Office: 509-862-4644 Fax. .508-790-6304
Losulller&Desaglmer Certn>ficatio><n_Foirlmn
Datte: ? Sewage lPen mit# AoI A�ses>ie 's 1V>EMys1]Pa>reeil 2 Z �°2�
Z?
Addtress:
OL't 1~l' L3 �.1 wn 1s5' ed a perzlt to install a.
- -(6ate) t'Lr t l,er)
septic Vstem at ( 1 G-� - based ou a desip drawn.by
(address
desi�er.) �
I rexi2fy tiler rho se'pti.c systt-,m-referenced above was -iwtalled adbstantially according to
the design, �vhichmay iuolude minor approved changes such as Iatezal relccnlidn of t?xe
distribution.box an.cUor segtir,tok.
I. cerffy that the septic sy�tNru refere-aced above was m5talled with �nff1Jor ab.axtges (i.v.
greater thoxi 10' lateral relow6on of the SAS ox arty vertical,relocation of atay cozuponent
of the septic. systa at in accordance,with State� Loca.l RPg'Ld8110:0,% Plan revision or
ce er.'e as- ' ,b eslgner to follow,
�HbFM,gS,v
`y DAN15L,A
OJALA
(lnst:i]Jer's Silpature) CIVIL �^
No 46602 a
1 gftZI13 s' ONAL
(Designer's rIgIM'NA Affix Desif�er''s Stamp Here)
apMlt RETT. ' _TO TiARIYS'r_1BLF j&1C BEAL"1'H DIVISION. I CE.RTT��CA. E Qll�
CQy1YL1&Nq&..WILD, VOT BE !-L8 TRD 13MID., ROTS MIS FORM, AND AS-13U LX CARD.ARE
l[tFr
,grnD BX TIM F.A .TA.BT,F,EtlBLIC IM,ALTF.f,P.MION. TI1f�A U
Q;Healt7lSeptiuDesiguer C'er9cat ou Form 3-26-04_dee
TOWN OF BARNSTABLE
LOCATION i 1z,,\ SEWAGE
VILLAGE CL-", r V—V1LL1L-7 ASSESSOR'S MAP.&PARCEL )=32-7-4 —
INSTALLER'S NAME&PHONE NO ��6Ztr7 i a _
SEPTIC TANK CAPACITY L,X I
LEACHING FACILITY: (size)
NO.OF BEDROOMS `Z, Se
OWNER Z—0
PERMIT DATE: 14,11 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility $- Feet
Private Water Supply Well and Leaching Facility(If any wells exist on:
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BYi.�
<® ❑ ❑
29'
O
Certified mail: 7012 1010 0000 2850 9866
"THE 1 �, Town of Barnstable
Regulatory Services
' BARhT$fALE.B �
�tM g Thomas F. Geiler, Director
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
June 20, 2013
Mr. Stuart Boyer
48 Currycomb Circle
West Barnstable, MA 02668
NOTICE OF VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE
TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF
SANITARY SEWAGE AND TOWN OF BARNSTABLE CODE & 353-9-DISCHARGE ONTO r
GROUND PROHIBITED.
On May 8, 2013 and June 14, 2013, Health Inspector Donna Z. Miorandi, R.S. investigated a
complaint regarding effluent being discharged onto ground at the property owned by you located at
153 Harbor Hills Road, Centerville. The following violations of 310 CMR 15.00, the State
Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage
and the Town of Barnstable Codes were observed:
Town of Barnstable Code 4 353-9: Discharge of effluent onto the ground.
(1) You are directed to keep the on-site disposal system pumped as many times as necessary to
keep it from overflowing onto the ground. Every day if necessary.
You are order to comply with the above orders within fourteen (14) days of receipt of this
notice.
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 the issuance of a non-criminal ticket citation of $100. Each day's
failure to comply with an order shall constitute a separate violation.
QAOrder letters\Septic\l53 Harbor Hill Road,Centerville.doc
�r
i
i.
PER ORDER OF THE ARD OF HEALTH
TChomZascKean, CHO, RS
Director of Public Health
Q:\Order letters\Septic\153 Harbor Hill Road,Centerville.doc
i
3
l r .
. oar
Town of Barnstable P# (/
' Departitnent of Regulatory Services
rtttaT„ar� i Public Health Division Date
ia39 200 Main Street,Hyannis MA 02601
Date Scheduled �j Time
]Fee 1'd. V i)J• �U
►o ' ►dui ability ,A.ssesment for ter e ,his l �'
Performed By:
Witnessed By: �f
LOCATION&GENERAL INFORMATION
Location Address `�3 Owner's Name
/ � �
Assessor's Map/Parcel: a of (�C� Engineer's Name U
NEW CONSTRUCTION `` {
REPAIR Telephone# CJ 3i J U[ —
Land Use: L G�� Slopes(%) a- �7- Surface Stones //M ti
Distances from: Open Water Body G R Possible Wet Area 7�a�
ft Drinking Water Well >�ad ft
Drainage Way > ft Property Line 2C ft Other ft
SIM'TCH:(Street name,dimensions of lot,exact locations of test holes&pore tests,locate wetlands•In proximity to holes)
Sy, (IS
car
• - of \
11 TA
N •
36
Parent material(geologic) o 1 t 4-�vak v
Depth to BedrQck___••_' / ^-
Depth to Groundwater. Standing Water in Hole:
�l IT Weeping from Ph Fnae
Estimated Seasonal High Groundwater
DFiERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: IA-
Depth
Observed standing in obs.hole: In, Depth to soli mottles: (tt,
Dcpth to weeping from side of obs,hole: In, Groundwater AdJustment f.
Index Well# Reading Date: Index Well level-- ___ Adj.factor Adj.ClraufldwateY Level ,
I Observation PERCOLATION TEST bate ?/�Z Than laroO
Hale# Time at 9"
Depth of Perc Time Lit G"
Start Pre-soak Time @ Time(9"-6")
End Presoak �Q Ub
Rate Min./Inch C�t-,,;1)I1,,,
Site Suitability Assessment: Site Passed Site Failed: Additional Tasting Needcd(YIN) /t/
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(I) week prior to beghluing.
Q:\S EPTIC\PERCPORM.D OC
t
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders.
• o i tc �V.`%'Gravel)
lveS loyR �l�
DEI+JP OBSE . A -10iv HOLE LOG Hole# Z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
- !; (Structure,Stones,Boulders. -
Qopsistgncy.%Crave
s 0���i�
>- S 10yA s
yA��,�
]DEEP OBSERVATION HOLE LOG hole#.
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Collgigtoncy,%G e
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horzon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Co si ten
y
Flood Insurance Rate Map: r
Above 500 year flood boundary No— Yes
Within 500 year boundary No `!+ Yes '
Within 100 year flood boundary No. �% Yes
Depth_ of NaturaUy Occurring Pervious Material
Does at least four feet of naturally occurring pervious piterial exist in all areas observed throughout the
area proposed for the soil absorption system? `/ �'
If not, what is the depth of naturally occurring pervious matarial?
Certification
1 certify that on / 3 (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the requited training,expertise and experience described in 110 CMR 15.017.
Signature /—L - f Datb //-
Q:\S•EPTIC\PERCPORM.DOC
k _
TOLD! OTRIN,
(5 ) 428.89 6 DATE OF ORDER
CUSTOMER'S ORDER NO. PHONE MECHANIC HELPER STARTI G DATE
-1101 S/ %ate
BILL TO ORDER TAKEN BY
ADDRESS
❑ DAY WORK
CITY /� �. � � ❑ CONTRACT
/\1"// G/ ❑ EXTRA
JOB NAME AND LOCATION ` t p
�t cv t-C ��1 i-��
I JOB PHONE
DESCRIPTION OF WORK
CA 1 or,.-)
TOTAL MATERIALS
TOTALLABOR U
TAX
DATE COMPLETED WORK ORDERED BY
TOTAL AMOUNT $
❑ No one home otal amount due ❑ Total billing to
Signature &Albt V. r above work:or be mailed after
completion
I hereby acknowledge the satisfactory completion of work
of the above described work.
BO RTOLOTT I CO N STRU CT I( If in agreement with this Proposal
Sign both copies,keep one for your
records,send one back to us.Thanks
DRAINAGE LAND DEVELOPMENT BORTO CONSTRUCTION
June 12,20E
Stuart Boyer
48 Curry Comb Circle
West Barnstable,MA 02668
Telephone: 508-420-9101 914-522-4177/C ell
RE: 153 (aka 59)Harbor Hills Road— a ,MA
Bortolotti Construction,Inc. proposes the following Title V Septic System Repair as per The Town
of Barnstable Board of Health requirements for a three bedroom application(Preliminary Plan
Review):
Furnish and install anew (11-10) distribution box,2—(H-10) 500 gallon leach chambers with
stone surrounding in a 107W x 30'L x 21D leaching area, connect to existing septic tank
in rear of dwelling(existing tank assumed suitable—if a new tank is required,it would be
an extra cost).
INC: Engineered plan,permit fee,pumping at time of repair and filling of existing leach pit,
all materials and labor,backfill and grade, removal of excess fill,re-loam and seed
disturbed grass area..
NOTES: Soil conditions assumed suitable. If encountered, removal of unsuitable soil and
replacement sand would be an extra cost. We are not responsible for repairs to driveway
due to heavy truck traffic,irrigation repairs to lawn sprinkler systems or any other
underground devices. Shrubs to be saved must be removed by others prior to
construction. Topsoil and seed will be applied once; however,guarantee of growth and
maintenance is owners responsibility.
CLAUSES: Dig Safe only marks out main roadways—if private mark out is required, due to
underground utilities,it will be billed at an additional charge.. A finance charge of 1.5%
per month will be charged to any invoice that is not paid in full upon receipt. If any phase
of work is delayed,due to circumstances beyond our control,a payment for work
completed will be required. Acceptance must be received within 60 days roposalte O
or prices may be subject to change due to economic circumstances. We r e the Wlit
to modify our proposal and explain changes,if any,once engineering is c� lete. O
N —ra
The total price for the above stated-work will be, approximately, $6,790.00 with pa` ent tei:&s as-120
follows: $1,500.00 Deposit Due,Upon Acceptance,Balance Determined Upon.Fina Plan Apffova) g
4-7
Thank you for the opportunity afforded us in offering this proposal. caa
ACCEPTANCE: SincerAlAXI, V 13,du, -�
' C
DATE: ;Robert J.Bortolottt P ent
Stuart Boyer Bortolotti Construction,Inc.
P.O. BOX 704 • MARSTONS MILLS, MASSACHUSETTS 02648 • (508) 771-9399 • FAX(508)428-9399
bortolotticonstruction@verizon.net
JOB PHONE'
i
DESCRIPTION OF WORK
Prope -- �rn� PnC���
UNIT#
Assesso ` . e(1"X� C�G
Total Nu.
Owner's
Date of 1.
Telepho , S—
(Home F
Owner's
Mailing TOTAL MATERIALS a t aj
TOTALLABOR
Owner's
Address:
TelephoA TAX
DATE COMPLETED WORK ORDERED BY
TOTAL AMOUNT
OCCllpan
f ❑ No one home otal amount due ❑ Total billing to
Daytime r above work:or be mailed after
Signature completion -
I hereby acknowledge the satisfactory completion of work
Number I. of the above described work. dv
an apartn
Do You Have Zoning/Building Division Approval for an accessory apartment?
Will there be any.children under the age of six who will be occupying the rental unit?
(circle one) Yes
Was the dwelling constructed prior to 1979? Yes o
I certify that the information provided above is true:
Appli is i ature
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 151 FL, 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: 33 a 1 /a Fill in please: �U
APPLICANT'S YOUR NAME/S: ' D�
BUSINESS YOUR HOME ADDRESS: ,5t,Y dY �l
A783 v l I e oa a o�(,3 a
t tr � P • Jai[ iv'a�ui
TELEPHONE # Home Telephone Number `7-1 L -f3 3(0- a-7 A SO - 3 - S 3 -7 5
NAME OF CORPORATION.
NAME OF NEW BUSINESS S r e Y TYPE OF BUSINESS
IS THIS A HOME OCCUPATION?_ _YES NO
ADDRESS`OF BUSINESS- t^ ► 0� MAP/PARCEL NUMBER (Assessing) ;.
'Oa, (-3 _�7 0C, 1-k
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.'- (corner of Yarmouth
Rd. & Main Street] to matte sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISS ONER'S OFF1 E MUST COMPLY WITH HOME OCCUPATION
This individJal has b.tl infor e6 f fDnX pe mit requirements that pertain to this type of business. ;RULES AND REGULATIONS. FAILURE TO
�i ����- - C ONIP►_Y MAY RESULT IN FINES.
Aut orized i n, tur
COMMENT �� ! / /U0 C
2. BOARD OF HEALTH
This individual ha inforM50 of the pe mit re irements that pertain to this type of business.
77-
Authorized Si ature**
COMMENTS: MI IST nMPLY WITH ALL
4-A.ZARDILS MATFRIAI S RF ,l 14 ATTW-,
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Citizen Web Request Pagel of 3
wed"q,
fi y.09-
EZRNST
\�
t9��
Logged In
iora Citizen Request Management Friday,June142013
TOON\OWN\miorandd
to U e/s Search Requests Create Requests
Request Information
Request ID: 45395 Created: 5/6/2013 12:42:28 PM
Status: Assigned To Staff Assigned To: Miorandi, Donna
Health Office
Anonymous: Yes Request Category: Title 5 : Section 353-7 Sewage edit
Routine work: No Estimate: No edit
Date scheduled: edit
Estimated 6/6/2013 Change Estimated May June 2013 Jul
Completion Completion Date:
Date: Sun Mon Tue Wed Thu Fri Sat
26 27 28 29 30 31 1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 128 29
30 1 2 1516
Created By: Wadlington, Ellen Priority: Medium edit
Health Office
Citation Numbers: edit
Requestor Information
Requestor Request
DETAILS: LOCATION: 153 HARBOR HILLS ROAD
Hyannis, Ma 02601
Request Parcel Number
Septic system spewing into yard. Map: 000 i Block: 000 ,Lot: 000
Spoke with tenant who said he has
contacted the owner several times Parcel Lookup
and heard nothing.
Email:
Edit Reauestor Information
10
http://issgl2/lnternalWRS/WRequest.aspx?ID=45395 6/14/2013
Citizen Web Request Page 2 of 3
Track Request Progress
Request Work History: Internal Note History:
Entered on 5/21/2013 8:27:03 AM System entry on 5/6/2013 12:42:28 PM:
by Miorandi, Donna
Assigned to Miorandi, Donna
DZM has had NO time to send a letter but has
talked to the property owner and told her to register System entry on 5/24/2013 9:22:00 AM:
her rental, change the number on her house and get
the septic system pumped and repaired. Estimated completion changed from
update delete 5/20/2013 to 6/6/2013
Enter work progress: Enter internal note:
(Viewed by everybody) (Viewed internally only)
,
tt'e;
A,� bi'rx
NAA
Spell Check Spell Check,,
Add document or image link:
Browse:.:
*You can also type in a folder name to see everything in the folder
Current Links:
Time worked on request: 2a70. Response time: 8..I
*Time entries are in hours. Examples of time entries: 1.25, 0.5, 0,75, 1, 3.5, 0.25, 0.10
* Response time: Measured from the creation date to your first actions on the request.
* Do not include nights,weekends, and holidays in response time for most departments:
(F%Save changes r Check to notify town employee below
to review this request. i
0Save changes and notify Health Office �
citizen* . . . .__
k Crocer, Sharon 1=
r.Close request - -- -_. ___.._._._._.__ ._
Brief message to reviewer:
c; Close request and notify citizen*
*notify works if email address was given
Update _.._ ..._.
j�_" pelll heck',
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Vppp—
No.---------`--r--—------ Fimu..1;2..'....... ..........
LTH
THEBOARD aOF FHEALTH4
TS
P Appliration for ]Rapp al orko Tomitrnrtilan inmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: `
Loca n-Address -, or Lot No.
- ----------- --------
..._... ---- - L.... - - ----- -------
Owner Address
W ..... --------- -------------------------------------
Installer Address
Type of Building Size Lot__ . ....... feet
Dwelling—No. of Bedrooms........... ............................Expansion Attic ( ) Garbage Grinder ( )
pa-, Other—Type of Building No. of persons----------4-------------- Showers ( ) — Cafeteria ( )
Q' Other fixpe�s -- -
W Design Flow....................C)..................gallons per person per day. Total daily flow...........3 __________.________gallons.
WSeptic Tank—Liquid capacity]VQ.gallons Length................ Width................ Diameter................ Depth-_._--_.-___-.-.
x Disposal Trench—No... . ___.•.•_..._ Width.................... Total Length------- Total leaching area--------_-----------sq. ft.
Seepage Pit No._. Diameter____________________ Depth below inlet--______ _•_ Total leaching areaF� ._.__sq. ft.
lA ----
Z Other Distribution bbx ( Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
,_4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(3� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
N ............. ------------------- -------------------------------------------------------------------------------------------------------------------
ODescription of Soil....................... -• •----•---•---•----------------------------------------------
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 provisions of Article XI of the State Sanitary Co e— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee sued by the board ozfl
()
Sig - Le�l1 - -Date
=:_7
Date
Application Approved B �_._ __ _ 2
PP PP y---_•-- ---- •••... -- . -- -------- ---- . -- 7
ate
Application Disapproved for the following reasons---------------_--------- -------------------------------------------------------•---
----------•-------••-•---••-•------•--••------••••---•---••----•-•-••---•-----•------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..� st. .............OF a �° ., d: r,
No......7 ....... }� FEE
Permission is hereby granted--------=-----------•------------------- ------------------------------•------••---•-•-----------.----------••----..--..
to Construct r Repair ( ) an I dividual Sewage Dispo a System
�7
at No.. = f
as shown on the application for Disposal Works Construction Permit No ( Dated:.t Afr �p ............
------------------------------
��
DATE-------'-`--------------------------------------------------------••-••••-......
FORM 1255 HOBBS'& WARREN. INC.. PUBLISHERS
No..---=� '------ FEEL. ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............._.........................OF....................................-..._...
Appliratinn for 13itipntia1 Worko Tantitrurtiun rantit
Application is hereby made for a Permit to Construct (. ) or Repair ( ) an Individual Sewage Disposal
System at
�-= � ..............................
Location:Address or Lot l�o
i..y ..^ -
W 12d, `✓ Owner /�. l T' Address
........................... " .-•s' Ate---- ......
•-`-----r i-ts'--•-••-•------—a*---� .,r
----------- -- ----- ---------
�� 13 "� Iaaller n�'r t' Address
Q Type of Building ,� Size Lot..*_ _ .;r__ __--____Sq. feet
U Dwelling—No. of Bedrooms_____________"-----------------------------Expansion Attic ( ) Garbage Grinder ( )
a Other—Type e Building �' .._.� yp of B g _;,�_„_,::e u�t,f..._. No. of persons---------- .............. Showers ( } — Cafeteria
OtherG res . ------ - --------------------------- ------------------------------ -----------------------------•••--
. --
W
Design Flow................ '1... .... gallons per person per day. Total daily flow__._... ��,�.r �{� •--•--....-•---•--gallons.
WSeptic Tank—Liquid capacity.!_ft gallons Length................ Width---------------- Diameter---------------- Depth__-_____--_-.--.
x Disposal Trench—No. ................... Width Total Length______.-_----,__._._ Total leaching area....................sq. ft.
Seepage Pit No... �_.__ Diameter____________________ Depth below inlet.__.._,__._.___ Total leaching area a _ _____-sq. ft. .
z Other Distribution box O. Dosing tank ( )
1 W Percolation Test Results Performed by.-........................................................................ Date----------------------------------------
1-4 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
1%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------.............
P4 -----------------=------------------
ODescription of Soil-------•-----------_�' � ------------------•-•------•----•--------•---------------•---•-------•-----------------•----------•-------------------
U .---------•-----•---------•---------------------------•-----•......••----------------------------------------------------------------------------------------------------------------------------
VNature 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been,"-
issued by the board of health.
Signed _ -prat._. .,,r °r, _ _ ,_.
. 3. ---{ f� �'�"''^r` r--. 6.-r +�y..,„, �' Date
Application Approved By_.,`� z� --------- -- ?
��'ate. h
Application Disapproved for the following reasons----------------------------- Ir
------•---•-.......----••---•---------------•--------....-----•-----------------•....--------------------•-•-•--••---------•----•--•---•-------------------------_...-•---•------.....-----------•-----
Date
PermitNo.......................................................... Issued--------------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...'
OF.... .......................
P' C�rrtif tr�� ;rr� �nt��tFin�P
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by--.--
---- ----
Installer �;
at----
incV ------------------------------------
has Ue�l rialled� iccor�refic� i£}i f) e�poriof�Att`cfe Xfo��e J�tate�Sa"n f� Code as described in the
application for Disposal Works Construction Permit No...................... .. dated �'
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A G6&i�►R 6VT�E -61AT THE
SYSTEM WILL F, NCTZ ON�,SlATISFACTORY. �DATE Inspector ------. . ---
----------
°`?"Er°�♦ TOWN OF BARNSTABLE
BAWSTABLE, i
M 9
0 M BUILDING INSPECTOR
nY a•
APPLICATION FOR PERMIT TO .. . ,
TYPE OF CONSTRUCTION ................Z�LZ ..•,•••.••.•••..••.••.•
�....... . / ...........................................
.�5 ........................19. L�
TO THE INSPECTOR OF BUILDINGS:
The undersigne hereby applies for a permit according, to the following information:
,++ J
Location .... 1).....��.......1.�/��!:�......
Proposed Use ...,�•..�:(,�.;(?�C:Cr.!�.•
Zoning District .. ...........................
Fire District
Name of Owner ..v% 1��.............. . i'1�2,....Address �J................................. ./..................
Name of Builder ... . . .. lt-G�_/C-4V��- ,4AcldressGt.....r. . .G..�e--: ............................................
Name of Architect ......... ............................Address
Number of Rooms ....Foundation
.. . .. .......................... ... ...............
Exterior a,�!< . -
�J ...........
�.L.Z ..... ..W...JCL% . ........!Z ... ..Roofing :. . Z Gfr ,./.........
' U1i` L ..........
%X .: ��
Floors `✓
......................'..-............
�i .Interior ..
Heating ;,,,.. � C�J G �................
/ Qom...........
u Plumbing ,
..... ............... ........ ........... ... -.. .......
..............
Fireplace ...... Approximate Cost 0
...........................................................
Definitive Plan Approved by Planning Board ---_----- .�l------19
Diagram of Lot and Building with Dimensions � ----
SUBJECT TO APPROVAL OF BOARD OF HEALTH
23
1�{_4
/41 I
' h
--
• �� � �v l � `JJ��JJ//'ff���
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
A
f
Name
r
ALL
TE
LL
SYSTEM PROFILE MARK DS WITHC MAGNETIC TTAPEAOR BE
PROVIDE MIN. 20" DIAM. WATERTIGHTEW (NOT TO SCALE)
COMPARABLE MEANS FOR FUTURE LOCATION. NOTES roc
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" APPROX. NGVD
PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS
\ TOP FOUND. EL. 35.7' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING
�ti I MINIMUM .75' OF COVER OVER PRECAST 2% SLOP'_ REQUIRED OVER SYSTEM 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
PRECAST H-10 BLOCKS OR Locus �� c s
RISERS (TYP.) PRECAST RISERS 4. DESIGN LOADING FOR ALL PROPOSED PRECAST
+. ' 2'0 33.2' 4"4SCH40 PVC MORTAR ALL UNITS TO BE AASHO H-10 orseshoe Ln
PIPES LEVEL 1ST 2' �ENDS
4� COMPONENTS H-10(NP') 5. PIPE JOINTS TO BE MADE WATERTIGHT.
SIDES
10. EXISTING 14" 31 .9 Craig
Beach Rd.
°°°°°° °°°° °°°°°°°° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE
TEE ���� 0 aO Q�C?� o°o°o�0 00�0-0 -�0�� 'o°o°o°o° ,l
TEE SEPTIC TANK** *� ° ° ° ° ° ° ° ° ° °
o000000000c� °° ° ° 0000 � 0000 � o o ° o o WITH 310 CMR 15.000 TITLE 5. 7
° o .00
I�I�aa MMF-I 1E oo°o o mmmmmm=1 �� ( )
o°o°o°o°o°o° o°o°� O O O O O 0 0 C] oo°o°o O O O O O O O O '0000000o N ;'
GAS BAFFLE::` 4 ° ° ° ° ° ° ° 0���1]D����C� 7, THIS PLAN IS FOR PROPOSED WORK ONLY ANDct
o�o�o„o„o_ nj 00000000 000000 o°o C
°p°°°° aoal�01�I�01�a1� -°o°o°o°o ,
o ° ° ° ° ° 290
31 .3' 31 .13' o00 0 ° o000
°°°o°°°o °°°°°° °°o°o°o° NOT TO BE USED FOR LOT LINE STAKING OR ANY ?
" 6" MIN. SUMPL OTHER PURPOSE.
12" MIN. INT. DIM. H-10 500 CAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8, PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Nantucket
3/4"-1-1/2" DOUBLE WASHED STONE (2) UNITS REQUIRED Sound
6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF-STONE: 30' X 9.F3' 9. COMPONENTS NOT TO BE BACKFILLED OR
COMPACTION. (15.221 [2]) b -H CONCEALED WITHOUT INSPECTION BY BOARD OF
HEALTH AND PERMISSION OBTAINED FROM BOARD
( 1 % SLOPE) ( 1 % SLOPE) OF HEALTH.
FOUNDATION- EXIST. SEPTIC TANK 50' D' BOX 15' LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP
FACILITY 25.0' BOTTOM TH-2 CALLING DIGSAFE (1-888-344-7233) AND -
NO GROUNDWATER FOUND VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE
*THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE WORK. ASSESSORS MAP 227 PARCEL 62
PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE GROUNDWATER EXPECTED AT
CONDITIONS IF NOT SUITABLE ELEV. 10 PER MAPS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED
SHALL BE REMOVED 5' BENEATH AND AROUND THE
PROPOSED LEACHING FACILITY.
12. EXISTING LEACHING FACILITY SHALL BE PUMPED
AND REMOVED OR PUMPED AND FILLED WITH CLEAN
SAND.
2X5� -
TEST HOLE LOGS /!% ?8 0�\ 57�, 84•65, SYSTEM DESIGN:
��� / ' p R I V D �
1-31.62 X 30.72
ENGINEER: DANIEL GONSALVES, SE O 83 8� ✓\\ E d 32 7�3 . 8
GARBAGE DISPOSER IS NOT ALLOWED
DONNA MIORANDI RS O �� /
WITNESS: 22 13 ' �- �' �4Q163 \/ 52.5 DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD
DATE. / /
< 2 MIN INCHz.33 5\ �"� X 33.86 USE A 330 GPD DESIGN FLOW
PERC. RATE _ 32.84
�// �,•/ 2. 34.69 SEPTIC TANK: 330 GPD (2) =- 660
CLASS I SOILS p# 14074 / _ DECK
3.13 EXISTING X 4 9/ �/ **RE-USE EXISTING SEPTIC TANK
2 J
�0 // DWELLING / 36.40
ELEV.. EL. F 35.7' SHw 33.E 33.5/ �` LEACHING:
0 35.5 0 `V 35.0' o Q / EXIST ST** SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD
33.8,E 33.14 34.
A A
�//31.23 C 2.43 rr __ _ 6 36.90 BOTTOM 30 x 9.83 (.74) = 218 GPD
LS LS E�Ec
3.6 X , r TOTAL: 454 S.F. 336 GPD
- - G 3.59METER 35.07� X � 3 �
10YR 4/2 10YR 4/2 //
619
799 G' 35 i " b
04308 4 - USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
B B 73 WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5'
LS LS 2.6; w �3.7a X 33.91 �Q X 3 i c loll moo/ BETWEEN UNITS
10YR 5/4 33.6' 10YR 5/4 32.8' \_ 2
��5 ry 4� � 5.8 37.81
23 26 ROCKLINED X - >.06
GARDEN i TH1
XS5 BENCHMARK
O 14" COR BULKHEAD
EL. = 35.1'
CHERRY
C C LOT 59 j �36.17
PERC 10,523 SF o X 35 36 a• MA
M/CS M/CS
X 37.46 X 37.74 APPROVED DATE BOARD OF HEALTH
10YR 6 6 10YR 6/6 98 36, TITLE 5 SITE PLAN
/ OF
153 HARBOR HILLS ROAD
120" 25.5' 120" 25.0'
CENTERVILLE
NO GROUNDWATER ENCOUNTERED PREPARED FOR
BORTOLOTTI CONSTRUCTION/BOYER
JULY 23, 2013
` VM� s�' �W CO)rra�S � off 508-362-4541
fax 508-362-9880
DANIELA ti�� ,' DANIEL `c p
downcope.com
o OJALA A.
cl`y`'L . 400;?0°JOJALAdown cape eaginee�ingf %nC< No.46502 �! No z
° •�aF civil engineers
/SV � la s c'
Scale: 1"= 20' "> sS"oNA
land surveyors
/�3/13 ' 939 Main Street ( R t o 6A)
3- > 38 0 10 20 3 0 40 50 FEET DATE DANIEL A. OJALA, P.E., P-.L.S. YARMOUTHPORT MA 02675