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0005 HAYES ROAD - Health
HAYES ROAD A. 210 - 091. I A/ SMEAD No.2-153LOR UPC 12LU smaad.com a Mad*to USA ms-,007) 01s�aueoNnawooucrua A a��vaoc www aAMM I I. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS RpPfication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(�i) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No..>i"H4yes Owner's Name,Address,and Tel.No. rel 74;g'8sr' eeu�'���/1r�i Assessor's Nlap/Parcel Ins ller's Name,Address,and Tel.No.5�� ?ts=�8z Designer's Name,Address,and Tel.No.3-e4-0- O P, G ouo ems' >�>« S�>asr �-„��:�vrrr�� 4.6-f-5 ®—,ZP 4gsz Type of Building: Dwelling No.of Bedrooms 3 �" Lot Size / y� 8.5 J�q.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Id Number Number of sheets '3 Revision Date Title Size of Septic Tank Type of S.A.S. j Description of Soil a tsQ c GL >x°/� "` ,�i�©•�r/�� Or �� d ��� %iris-e_ /�' �X 3T > 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 Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date .-4 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ] ( Date Issued TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL z/v INSTALLER'S NAME&PHONE NO. IE.. SEPTIC TANK CAPACITY -roo�g� LEACHING FACILITY:(type) (size) Air it 37- NO.OF BEDROOMS OWNER PERMIT DATE: COMPL/,aching C DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Facility 1J;__ 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 facif'ty) 1J/ Feet FURNISHED BY Za � Ong �QQ.f Qy a� r �h I Q V Fee /CJ THE"COMMONWEALTH OF MASSACHUSETTS Entered in computer: L./ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLatlon for Misposal 6pstetu Construction Permit Application for a Permit to'Construct( ) Repair Upgrade( ) ,Abandon Complete System ❑Individual Components Location Address or Lot No. #— Owner's Name,Address,and Tel.No.morel- cew Assessor's Map/Parcel v _ o v 'Installer's Name,Address,and Tel.No.s cay.9- 7r S= Designer's Name,Address,and Tel.No. s cl 7, Sic ��l :��ir�/.tr c Gs^iG C ar,� .S'c vr�'r S►e��rri'v Lc-,r9,.iev err'/Lr/p'' Type of Building: Dwelling No.of Bedrooms j Lot Size / y> sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) d gpd Design flow provided 4 gpd Plan Date i„ ��L� Number of sheets Revision Date Title Size of Septic Tank / S�/ Type of S.A.S. r=•• Description of Soil ,�E, // ,f�, �✓ l'c,,a,� .T.,,,,, i5/ ,y ��.,� �'e Nature of Repairs or Alterations(Answer when applicable)��i ,.., Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5=of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date I Application Approved by Date Application Disapproved by. Date for the following reasons Permit No., ) Date Issued �. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(yi)� Upgraded( ) Abandoned( )byd at_ f' f£� ,,,0�/�_ �t f�i/,. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nq,.W1 dated Installer �,�! �'�` Designer #bedrooms '7 Approved design flow gpd The issuance of this pe it shall not be construed as a guarantee that the systewill functio k designed. � tt / Q Date J `4 f i Inspec2o_r _ - ----.----.--.---------.---.'-.---_-------_----- --------.---.---------- --. .- - - - . _ .- - - -. -_ - - -- - -- •------ .. No. � 65 'R Fee THE COMMONWEALTH OF MASSACHUSETTS �— PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposar bpstem Construction Permit Permission is hereby granted to Construct( ) Repair(v1� 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. Provided:Construction 9must be completed within three years of the date of this pe it. Date / �,•/-��{�//j� Approved b� 1 Q i �I'mn Barnstable wa Regulatory Services, Riehal*d V. Scali, Inteai,m IJirecifcit . riARNSTABLE, - _ Public Health Divisfo�il Ar�D rrtA�� "rhoma,&&IcK.ean,Director 20.0 Main'St:reet Iiv:annis;MA 132't?1 o€fice: 508-862-464 t 508-790-6-1,04 Installer &Designer Certification I{oren Date Sewaue,Penu t# i�0l8_ 3FFAssessar's,KaP\Paf ce! P� r 1'mot C G' +'P�: va.r Installer: (_cLe-- (Ack,, Sa{7 :C r.�t rZlicA.S, Address: j Z W. Cr,,j5.cIcl 12 1 Address: o• 5 #- (,r.?-,Ye�. t�t �lq i was issued a permit to:instal! �t Oil z (date) j nstaller) septic system at r "1Cn based on a design drat�n b} (address) _ a Crt� r��erir'1 1 . { c+✓LCs f dated (designer) — f I certify that the septic system referenced above Was installed:substarttiall y according to i the design, which may iMILI'de minor approved changes such as lateral:.relocation of the distribution box and/or septic tank. Ship out (if re9 fired) eras inspected and the sQi,ts were found satisfactory. 8 t i I certify that the septic system referenced above was installed with major changes (i.e. .tenter. than 1.0 lateral relocation of the SAS or any vertical relocation of any conlPoz'en,t x of the septic system) but in accordance wit11 Stat a ie & Local R.e ulati ons. Plan revision'or certified as built by designer to follow. Sti-ip otit.(it required)was inspected artd tlle.soil,s .. were found satisfactory. - i l certify that the system referenced above was eciistructEd in_c with the tcrnis of tine VA approval letters jif applicable) a (Installer,��igna�ture) cNiL typ.35108 o �9y„'Qf 015T��� (Designer's S �nantre) (,4f#ix Desi�ne ``��``EE'' - er ) - PLEASE RETURN TO BARNS?ABLE PUBLIC HEALTH DIVISION, CERTIMATE OF COMPLIANCE NVILL NOT BE `ISSUED UNTIL BOTH THIS FORM- AND AS- BUILT CARD ARE RECE IVED BY THE; B,AI2NSTABLE PUBLIC HEALTH DIVISION. x THANK YOU Q',SepticDesigner Certification Funai Rev 8-14-11doc Engineers note:This certification is limited to.an.as"built inspection of system components,as installed prior to backfill.The, engineer did not supervise construction of the system.The ins;agar'assumes.responsibility for all materials,workmanship,backfilling to specified grades with proper compaction and etti ng risers-'covers as shown on tare design plan.. fi fi v, AsBuilt Page 1 of 1 TOWN OYBARNSTABLE: LOCATION S f Q yes . . � SEWAGE ?eV ASSESSOR'S MAP&PARCEL.:z/o INSTALLER S,NAME.&PHONE NO SEPTICTANK CAPACITY LEACHING FACILITY.(type) (size) ;NO.OF BEDROOMS QWNER,..zyea' io_. l . � f PERMITDATE: ?�z�ie. _ . COMPLIANCE DATE ��9. Separation Distance Between.the: Maximum Adjdsted`Groundwater Table the to. Bottom of Leaching Facility .. .. Feet Private Water Supply Well and Leaching Facil►ty any wells ex*st on s sitebr:withm 200 feet ofI eachmg facility Feet. Edge of Wetland aiid Leaching Facility Of any wetlands eaust within, 300:feet of leaching facil' :) Feet: FURMSBED BY,- •'. Stu �/ calf/!/ _ 3J a. y $1 3r, v e �¢ 3 VIO r ;- �, Q5 a. http://issgl2/intranet/propdata/prebuilt.aspx?mappar=210091&seq=3 8/6/2019 Town of Barnstable r# t 4544-5 . , oFTMe rorr� - Departimeat of Regulatory Services MASS. > t>~ Public Health Division Date Z; ` 17 �, . A s63g `d 200;Main Street;Hyannis MA 02601 Date Scleduled Time ,JCf Fee Pd. 1 0`d _ Soil Sui -ability for Sewage Disposal .. Performed By: �•?4'l-✓- 1MC 51*ek S Fi—1,Sy�2j . Witnessed By: LOCATION&.GENERAL INFORMATION. l oeation Address f Owner's Name . C�t� .---._ A:ditress �� r"'1.4�L✓U(—,{vu l�S;l�i.',•.�:p Assessor's Map/Parcel: Engineers Name t • ��5 t n,et..►-d�� t�t1�b fry NEW CONS E RUC770N REPAIR Telephone tt Land Use StoPeS(`�) Z— Surface Stones Distances from: 'O a Water Pe Bod' y c5p ft Possible Wet Area N.�- ft Drinking Water Well i U f Drainage Way f` ft Property Irne 6� .20 ft Other ft ►SKETCH:(Street name;dimensions of lots exact locations.of test'holes&.perc,tests,locate wetlands to proximityto holes) 01 '4� Parent material(geologic) W Q h Depth to Bedrock 6 �4 Depth to Groundwater. Standing Water in Hole: Weeping t'rboi pit Face rr Estimated Seasonal High Groundwater DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: — -_ to; Depth to soil Mottlgs: in. Depth to weeping from side of.obs.hole: : In Groundwater A4juatrnentv ft. Index Well ti Reading Dater Index Well level Adj.flCctor Adf.C7toutltlwtiter IxVpl,,® PERCOLATION TEST mite.- Thme Observation Hole# 1 r t Time at h" Time at 6 Depth of Pere �j Z ajc�� Start Pre-soak Time @ __ L M^- 'lime(911.6") . . End Pre-soak ie RateMin./Inch. SiteSuitabilityAssessment Site-Passed� Site Failed Additional Testing Needed(Y/N) - Original: Public Health Division Observation Hole Data To Be Completed on Back------- ***If percolation test is to be conducted Within 100' of wetland,you.must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:%SEPTiC%FERCFORM.DOC DEEP-OBSERVATION HOLE LOG Dole# f Depth from Soil Horizon Soil Texture Soil Color- Soil Other Surface(in.) (USDA): (Mansell): Mottling '(Structure,Stonea;'Bootders: 's t en ravel —.2 DEEP'OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil; other Sur ac.(ie.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% ravel - -z-7 Z�ugw. >uY/� �l6 BEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (Munsctl) Mottling (Structure,Stones,Boulders.. Cnire %G vel -DEEP OBSERVATION HOLE LOG Bole# Depth from Soil Horizon Soil Texture SoiI Color Soil Other Surface'(n.} (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Cansi enc Flood.Insurance Rate Mae:- Above 500 year flood boundary No Yes ..- Witttin 500:ycar boundary No J& Ycs Within t00.year flood boundary NO Z Yes Depth of Naturally Occurring Pervious Material Does..at least.four feet of naturally occurring pervious tilaterial exist in All areas observed tltr+?ughaut the area proposed.for the soil.absorption.system? If not,what is the depth of-naturally occurring pervious material? Certification I certify that on �'q (date)I have••passed the soil evaluator examination approved by the Department.of EnvironmentalProtectionand that the.above analysis was performed by me consistent with the required ` ing expertise and experience described in 3 10 CMR 15.031. Signature Date �. I''' Q:\SEj-nC\PERCFORM.DOC !t C)WV111 � _C\, Commonwealth of Massachusetts 10— Q� Title 5 Official Inspec ion Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �x ,M 5 Hayes Road 9 Property Address y Jean M Wilcox Owner Owner's Name ' information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown State Zip Code Date of Inspection 0 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: `lam key to move your �- 1 cursor-do not David B. Mason use the return Name of Inspector key. David B. Mason x:e ICI Company Name 4 Glacier Path Company Address East Sandwich MA 02537 Cityrrown State Zip Code 508-367-1617 S 1287 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 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Eva ation by the Local Approving Authority nspector's Signature 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•3113 Title 5 Official Inspecuon Form:Subsurface Sewage Disposal�IYP.ge 1 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown 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 observations noted in this report represent the condition of the system only on this date of inspection and the information contained herein does not guarantee the continued operation of the system. 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): The existing concrete septic tank appears to be adequate. There is no distribution box and the pipe entering the leaching chamber is not secured into the chamber and is resting in the stone outside the chamber. Recommend installing a distribution box and replacing the line to the leaching chamber. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 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 (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): ❑ 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. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown 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 0 ® 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 Y day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityfrown 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- 10,000gpd. ❑ ® 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 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. t5ins•3/13 Title 5 Official Inspection Form: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 M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown 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? El ® 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-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 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? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gp ))� Detail: 2014;47,000 gallons and 2013; 42,000 gallons . Sump pump? ❑ Yes ® No Last date of occupancy: UnknownDate 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•3/13 Title 5 Official 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 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown 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: Board of Health 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): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1992 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 10+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2feet 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 Typical Sludge depth: 2" t5ins•3113 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 M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown 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 47" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. PVC tees in place at time of inspection. 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•3/13 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 �M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown 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 t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 o Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is Centerville MA 02632 October 6, 2015 required for every page. City/Town 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 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.): No distribution box as part of the system. Recommend installing an H2O distribution box 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: Leaching field without inspection port. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: Unknown ❑ 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.): 3 infiltrators with approx 4' stone. No standing effluent noted during probing. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown 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.): Privylocate on site plan): ( P ) Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts 4 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2015 page. Cityrrown 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 t5ins•3/13 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 wM 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is Centerville MA 02632 October 6, 2015 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated high depth to round water: 18 p g g 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: Groundwater Contour Map ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater Contour Map Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 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 5 Hayes Road Property Address Jean M Wilcox Owner Owner's Name information is Centerville MA 02632 October 6 2015 required for every , 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 I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARN STABLE ,�'-OCATION SEWAGE VILLAGE ,L,.. rci.',�rkSSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ff Cc. . cc S�ca (size) NO.OF BEDROOMS N I (t 1 Q w 0 OWNER Or eAptl I". `LC a r- PERMIT DATE: O C 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 BY Os- Hi O` f� �yj f No. v_ `J Fee_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(ppYicatiou for Misposal *psteut Construction Vermit Application for a Permit to Construct( ) Repair(Agrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot Nor ry/ s'�Q �O Owner's Name Address,and Tel.No. Asr �arJ el 'U � LCO Ins er's Na e,Address,and Tel.No. ��7sS�� Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /to('� Q Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) -D5V52L L W GCe) .0 J5�VR,44? Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and no ace the system in operation until a Certificate of Compliance has been issued b;* e'd, B�of . Date % '�— Application Approved by Date j Application Disapproved by Date for the following reasons Permit No. &I 3�`� Date Issued(Z) /y�ay t, No. `} �' 1 a F Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitatlon for Disposal *pstem Constructioni3ermlt Application for a Permit to Construct( ) i Repair(Agrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No �ys' p 09 Owner's Name Address,and Tel.No. �f !/JGL w a ,x� f U FW}OA/ 2 4 JWl-1 Assessor�/Parcel Ins er's Name,Address,and Tel.No. 902-7%�SOa Designer's Name,Address,and Tel.No. i Type of Building: 3 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title 'Size of Septic Tank '1 Q o Q Type of S.A.S. j//) /L� �j Description of Soil Nature of Repairs or Alterations(Answer when applicable) ,US Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and no ace the system in operation until a Certificate of Compliance has been issue:S* y this Board of r ed Date Application Approved by Date Application Disapproved b 1 Date for the following reasons i - Permit No. &(� .' 3 Date Issued ------------ ---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS # BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(bj,�,Upgraded( ) Abandoned( )by at ' ��5 26 C-,F (Xg7AZ4/GL F has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No A)5 -394 dated 11Pw4 If- Installer Designer #bedrooms 7* Approved design flow /i gpd The issuance of this permit/shall not/be/construed as a guarantee that the system will futnction as des\igned: Date /fir' f �t' / Inspector -------------------------------------------- ---------------------------------------------- _ No. JI Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal .pst�emm Construction i9Prmlt Permission is hereby granted to Construct( ) Repair(Y) Upgrade( ) Abandon( ) System located at i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi n must be completed within three years of the date of this permit. Date / Approved by % f' AsBuilt Page 1 of 1 TOWN OF'BARNSTABLE 1,0CATION` p:) /Z cam( SEWAGE# ��rASSESSOR'S MAP&PARCEL - - INSTALLER'S NAME&:PHONE'NO at-r SEPTIC:TANK:CAPACITY LEACHING FACILITY:>(type) NO OF.BEDROOM$ rU . OWNER tr'e4df/` PERM IT DATE; d COMPLIANCE,DATEs a Separation Distance Bettveen the: Maximum Adjusted Groundwater Table;to the'Bottorn of Leaching Facuity Ee Pnvate`Water Supply Well and Leacfiitig Facility`(lf any wells exist on site or withn200 feet:of leaching.facility) Fe Edge•o.f Wetland and Leachin 77 g taciliry(jf.any wetlands exist within A feet of leaching facility): Fe FURNISHED ay .. _.... s T� i� C. J x http://issgl2/intranet/propdata/prebuilt.aspx?mappar=210091&seq=2 8/6/2019 TOWN OF BARNSTABLE LOCATION S 4 SEWAGE # lC� VILLAGE ASSESSOR'S MAP & LOTe-4,6 —d9l INSTALLER'S NAME & PHONE NO. &I2:-ML&V y �o SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /,�ViYC.Tf.,frAU (size) 7ytcP'y75" NO. OF BEDROOMS PRIVATE WELL OR <9EE WATER BUILDER OR WNE ! Ui DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I AZ, >r ASSESSORS MAP NO: k a= PARCEL NO: 09/ No-15ai W THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH A� TOWN OF BARNSTABLE Applira#ion for Disposal Works Toes Application is hereby made for a Permit to Construct ( ) or Repair CK) an Individual Sewage Disp•sal System at -----_�—��"1 ----- ------------------------ .............0................. �_ Loca'tilork-Address ...................... ..�---•--. IN/L CQ .. -._.. .... %� .... Lot j-= -•............... Owner -•-•- ,A,Address ,,,��e Installer Address d Type of Building Size Lot......AV_ .Sq. feet Dwelling—No. of Bedrooms......................!3-------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------•-•---------------------•----------- WDesign Flow...................a ..............gallons per person per day. Total daily flow_............1-Y ...............gallons. WSeptic Tank—Liquid capacity«!-.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. ........./....... Width......77------- Total Length_c_. f.?�F Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fTq Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water............---.....-... Ri .....................................................................................-....................................................................... 0 Description of Soil.............................................................................. -----------------•----------...-----....----------------....---------.....-----.----- V .......................................-...................................................................-................................................................................. ------ W x .--• -----•-------------------------------------------------------•-----•---•-------------------------------------•--------------------•------------•-•-- .........................---................ U Nature of Repairs or Alterations—Answer when} applicable../ -----/ -•T✓ /ZIr___�,�:...idQ-Ac ....4�F-------------------------------•-••-------•-------------------...............------•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance b /isseMe board of health. Signed .......... ............ ...Application Approved By -..... � ----------------------------------------------------- ----- Date Application Disapproved for the following reasons: .. .......... .......................... ..------.--........--- -------------- --........... ....------ ------ ........................................................... ----------------------------- -- --------------..................... ---------------------------------------------------------- -- .................................... t Date PermitNo. .............. .-`.. ...... -----------.............. Issued ...................................................... Date /s. Q+ ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirtation for Diopunaal Work C�uaa r -r i s-_ _ Application is hereby made for a Permit to Construct ( ) or Repair. (� an Individual Sewage Disposal System at: x .-----................ ... .J� LocatAddress : ............o r Lot - ................ i4 L --------...:�..---� FPS /��Q--••-•--C •�J Owner Ad ress a � GGG�'�.------•�'u �-- fin'-.._.� ' ........................,/1'�•._ � �-s.. � .. Installer Address Type of Building Size Lot..._...��. _Sq, feet Dwelling—No. of Bedrooms.....................-`-7....................Expansion Attic ( ) Garbage Grinder ( ) P`4 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P-1 Other fixtures w Design Flow..................S ..............gallons per person per day. Total daily flow............. .................gallons. WSeptic Tank—Liquid capacity 4Z,6_gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.........../_...... Width........ ...... Total Lengths---"-.X2SnTotal leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.............._..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 --••---•-••-------------••••-•--•----•----------•••--------•-•...-----•-•-------....•--...---...........--•----•--•------••....._.._------•...._...._••...... 0 Description of Soil......................... x U ............................................................................•--••----•-•--------•-------------••-------------------------•-•-•-------•--•--------------••---------•...•-----..._...... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable_1_ j- f ______���� ' __7- i1�r_.. �.__��1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h ` be iss ed y� e board of health. Signed ----------•' ... ....................... '-�0 - Application Approved By ..................... I�. -----------------------------------------------------------_---------- .....;1�.-.�.e- cJ� Application Disapproved for the fol�owi�ngreasons: .............................................................................. .. ---- ------------ --------------- . ............................--------- ---------- ------..................... Permit No. .... Issued Dace Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE kCrrtiftrate of Torayliance THIS IS TO CERTIFY, That the I dividual Sewage Disposal System constructed ( ) or Repaired (�) by ---------------------------- �`' 1 / -.......... ^l Installer has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .........O .p..m-aj;:a--6.------ dated .....................................---------_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY'. DATE............... G " L................................... Inspector ................. S�).--------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No, �' TOWN OF BARNSTABLE ` =� I'EE...`................. Disposal Vorkg 01. unntr tion rantit Permission is hereby granted............................... .........�-�✓ ...... 5 - ...................................... to Construct ( ) or Repair (X) an Individual S .vcrag Disposal System ------------------�------------ ---------- at No.. -- Street as shown on the application for Disposal Works Construction Permit No. _:_ ,� .. Dated.......................................... •............................. _ Board of Health DATE...........�?-_--'--)_7.P:•...•-----------•------••--••--•--.. V FORM 36506 HOBBS&WARREN,INC..PUBLISHERS AsBuilt Page 1 of 1 { TOWN OF BARNSTABLE r I LOCATION y€s SEWAGE # !'� VILLAGE e-&JI "ILO— ASSESSOR'S MAP & LOTc:;?-d 691 INSTALLER'S-NAME & PHONE NO.*� SEPTIC TANK CAPACITY /400 p. LEACHING FACILITY:(type) 3 1AhqCrXpfrAe9 (size) 734cWl, S i NO. OF BEDROOMS PRIVATE WELL OR BLIC WATE _ BUILDER OR WN LUNG COJC DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: "42 VARIANCE GRANTED: Yes No i / 1 http://issgl2/intranet/propdata/prebuilt.aspx?mappar--210091&seq=1 8/6/2019 r - 40:p- ,({lo,T-ON r _ 3 Ne d - - - � '1'' sij�jam. / \ \•� I NY T LP 1 -0 r I { — a W+24wle - ff v , 1 1 i N =_ 2E,sacs. i (JEW? x IO.:DtCK I —-- _ =L�i� 9A1... — L at t PvLp CZ�G� � I ifz s 6cu :cc tee-va T DN UP . _ F125T-._�-L601�. PL�(.N. CIA_ WAT F_=�._-t 'FU�hE..R.LMOVIn_-_.__- �_ 11�J�v 1 IsooµR•E' I 6 cc' - .. .. ..... � ou v - POOr Ja _ - w F 5.x_CLPJ- 3 =:�-v�Rcxut .�.1:. O •.I k[Tca+aM—..:-C�IF.I[N � C� ry �� ' -' '�Exwnu:. 2 L'r 1 FwRt�-^ACC . QCo sri 5 2„q scvrr - z n.w 26 P z- a r kA ut o --- _ i Pa'EYJROo - y Li a • � s?vcsLt-��ti7-_t��tcs�i'T--<'T Bruce Devlin Desi gno 774.33"773 j LEGEND N EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE Wequaquet 40 PROPOSED CONTOUR I i Lake 41.0 PROPOSED SPOT GRADE H,{q�— OVERHEAD WIRES LOCUS % ^,I G EXISTING GAS SERVICE W EXISTING WATER SERVICE TEST PIT Q°�`�D °�P Dr BENCHMARK Great Marsh Rd V��g ff n\ `ccsiy Roate 28 i Ro t 28 Qr west tiloi c� St ^ LOCUS MAP 2°Nj�C pis NOT TO SCALE �IC R� EXISTING S.A.S. 41.57\Q X 43.12 TO BE ABANDONED X 0 •S' EXISTING SEPTIC TANK TP-1 2�. ^� \67•� TO BE PUMPED, RUPTURED /� 7 9S STRIPOUT BOUNDARY TP- FILLED WITH SAND & ABANDONED �0 2 P GARAGED \ 73. 60.0'�F (TO "C" HORIZON) T.O.F.=43.2 PROPOSED SEPTIC TANK & 8 .O.S.=42.2 a .; A� 43.61 PUMP CHAMBER COMBINATION 3. . (1500/500 GALLON H-20) \ � .:,;::: 3�• DRYWELL RECOMMENDED TO 38.8 ,. :;'3' 4 INTERCEPT SURFACE RUNOFF X 44,43 Is• 0 3 ' .: � I 40, BN ...' , 2 DRI AY .. /I DO Ory X ��W ^ 39.16 Q 39:4 7 9.8 DECK 43.30 44,94 X BM O O 44,-,& Obi O 40,69 R � 38,74 EXISTING 41.72 X HOUSE#5� � �9P��-� T.O.F.=43.9f(REAR) W W,, 45,24 \ 41,68 � �' �'" � FF=45.6f �, i 40,30 44.48 • 5,55 z 40,58 45.24 a� Q 44 41 .44.46 -- X 44.20 o, z Y EXISTING.:'::: 44,42 LOT 3 ss 1 Q 45,50 'X 44.60 14,857±SF 45.4 F 45,69 45,12:.. 45.41 �� ea9P of L=7�"� rE NCHMARK 2X43 PRET. WALL/CORNER 45.81: =44.54 45.47 45, OF MgSS�O 45.39 o �GARY S.LABRIE OWNER OF RECORD U NO.40039 FITZGERALD, MARIA SULFIDE o & SILVA GIST 33 HARBOR HILLS ROAD Si0gg1 �H OF Mgss9�y PARCEL ID: 21 0-091 CENTERVILLE, MA 02632 PETER T. o� PROPOSED SEPTIC SYSTEM UPGRADE PLAN FLOOD PLAIN DESIGNATION � M CIVILEE N 5 HAYES ROAD, CENTERVILLE, MA 02632 NON HAZARD-ZONE X No. 3511009 Prepared for: Maria Fitzgerald, 33 Harbor Hills Rd, Centerville, ,MA 02632 ZONING CLASSIFICATION: ZONE RC I$TE Engineers: Survey review by: SCALE DRAWN JOB. NO. SETBACKS: FRONT YARD=20' S Engineering Works,Inc. Warwick&Assoc.,Inc. 1"=20' P.T.M. 294-17 SIDE/REAR YARD=10' 12 West Crosssfield Road Box 801-63 County Road MAXIMUM BUILDING HEIGHT = 30' ('Z,. ��. Forestdale, MA 02644 North Falmouth, MA 02556 DATE CHECKED SHEET NO. WIND EXPOSURE CATEGORY: Exposure B 1 (508) 477-5313 (508) 563-7777 10/2/18 P.T.M. 1 of 3 w• NOTE: TO PREVENT BREAKOUT, THE PROPOSED PROPOSED SEPTIC TANK f PUMP CHAMBER PROPOSED D-BOX FINISH GRADE SHALL NOT BE < EL:41.1 PROVIDE RISERS WITH APPROVED FRAMES & COVERS FOR A DISTANCE OF 15' AROUND THE OVER EACH ACCESS MANHOLE AND SET TO FINISH INSTALL A WATERTIGHT PROPOSED S.A.S. PERIMETER OF THE S.A.S. GRADE. MANHOLES BROUGHT TO GRADE SHALL BE FRAME & COVER SET FINNISHISH GRADE. INSTALL INSPECTION PORT (MIN.) SECURED TO PREVENT UNAUTHORIZED ACCESS. F.G. EL.=41.3t F.G. EL.=41.3 to 43.5t MAINTAIN 2% GRADE (MIN.) OVER S.A.S. An T.O.F.=43.9t 4 DIAM. INSPECTION PORT, L = g'(M/D(,) 16' x 37' LEACHING FIELD W/3-4" PERFORATED IN S.A.S., SOLID F.G. EL. PROVIDE ENOUGH WIRE p S=1% (MIN. ABOVE S.A.S., WITH SCREW CAP EXISTING F.G. EL.=41.OtSLACK TO REMOVE PUMP 4"SCH40 PVC) SET TO WITHIN 3' 0 GRADE. eT __ CAPPED ENDS ® S 1%1 MIN.) TOP EL.=37.17 H 40 PAC I SLOPE OF PERF. PIPE = 6.5% INV. EL.=40.50(END) 4' MMM SCH40 PVC „ SC CKS a�O 5 r 37' EFFECTIVE LENGTH io 14 o TAR p`� BEND PROPOSED INV.=40.75 kINV.=36.0± NVERT S AREU BPVC / D-BOX SOIL ABSORPTION SYSTEM (PROFILE) 35.75 J INV.=40.83 INV.=40.68 IzneEi oOur� MAX. G.W. EL. 34.7(redox) STANDING G.W. EL. 31.4 BOTT. EL=31.00 INV.=38.5t 2" OF 3/8" NATIVE CRUSHED STONE ONNECT TO EXISTING INV.=34.50 (MULCH OR VEGETATIVE COVER OUTSIDE DRIVEWAY) SEWER OUTLETS EFFLUENT FILTER SHALL BE INSTALLED ON OUTLET 12"(MIN.) OF COMPACTED BANK RUN GRAVEL TEE AS MANUFACTURED BY ZABEL OR EQUAL. FILTER (VERIFY) SHALL BE INSPECTED AND CLEANED ANNUALLY. FINISH GRADE (See Pump Detail, Sheet 3 of 3) EL.=41.3 to 43.5t 15 0/500 GALLON SEPTIC TANK/PUMP CHAMBER BREAKOUT ELEV.=41.03 H-20 TANK EL.=40.85(END) NOTES: ELI 1) SEPTIC TANK/PUMP CHAMBER & D-BOX SHALL BE SET BOTTOM ELEV.=40.00 WASHED 1STONEU LEVEY & TRUE TO GRADE ON A MECHANICALLY COMPACTED 5' MIN. SEPARATION TO G.W. 3' 5 5' 3' 6" CRUSHED STONE BASE, PER 310 CMR 15.221(2). AND 4' OF NATURALLY 16' EFFECTIVE WIDTH 2) INSTALL INLET & OUTLET TEES AS REQUIRED. OCCURRING PERVIOUS SOILS SOIL ABSORPTION SYSTEM (SECTION) 3) MAX. COVER OVER TANK, D-BOX & S.A.S. SHALL BE 36". EST. HIGH G.W. EL: 34.7 4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS (REDOX FEATURES) PRIOR TO CONSTRUCTION. INSTALL STABILIZATION FABRIC WITH A GRAB TENSILE STRENGTH OF 315 LBS PER ASTM D 4632 LAY ACROSS BED & EXTEND 2' BEYOND S.A.S. FOOTPRINT SEPTIC SYSTEM PROFILE USE ADS GEOSYNTHETICS 315W WOVEN GEOTEXTILE, OR EQUAL GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL O BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ,0 LOCAL RULES AND REGULATIONS. except as requested below: ADO -310 CMR 15.405(1)(b): CONTENTS OF LOCAL UPGRADE APPROVAL kP 1) A variance to the maximum cover requirement of 3' over the septic tank of 3', for at maximum cover of up to 6'. Septic tank shall be rated H-20. Bh 50. ' 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE rN DESIGN ENGINEER. _ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING c h FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN y ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. �Fc 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. F St39F�SJ 5 7. WATER SUPPLY PROVIDED BY TOWN WATER SUPPLY. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED SEPTIC SYSTEM. S6� E9�QJ 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE SEPTIC LAYOUT DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING SOIL LOG CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND DATE: DECEMBER 19, 2017 (REF. P#15543) REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). SOIL EVALUATOR: PETER McENTEE SE#1542 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE WITNESS: DONALD DESMARAIS RS HEALTH AGENT INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 13. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED EXISTING ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. 40.2 0" 39.8 0" 14. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND A SANDY LOAM A SANDY LOAM IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 10YR 4/2 10YR 4/2 39.7 6" 39.3 6„ B SANDY LOAM B SANDY LOAM 10YR 5/6 10YR 5/6 _ DESIGN CRITERIA 37, C 28" 37.6 26" PERC C NUMBER OF BEDROOMS: 3 MED. SAND 24"/42" MED. SAND SOIL TEXTURAL CLASS: CLASS I 2.5Y 6/4 2.5Y 6/4 20% GRAVEL/ 20% GRAVEL/ DESIGN ,PERCOLATION RATE: <2 MIN/IN COBBLES COBBLES DAILY FLOW: 330 GPD 34.7 HIGH G.W. _ 66" 34.7 HIGH G.W. _ 61" DESIGN FLOW: 330 GPD (REDOX) (REDOX) GARBAGE GRINDER: NO 31.4 STDG. G.W. 1 06" 31.4 STDG. G.W. = 101" LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 30.2 120' 30.8 108" PERC RATE: <2 MIN./IN. .74 GPD/SF STANDING GROUNDWATER, EL.=33.4 PROPOSED SEPTIC TANK/PUMP CHAMBER: 1500/500 GAL., H-20 CURRENT LAKE WATER SURFACE, EL.=34.1 MAXIMUM WATER SURFACE, 34.8 PROPOSED D-BOX: 1 INLET, 3 OUTLET (MIN.), H-20 PROPOSED SEPTIC SYSTEM UPGRADE PLAN INSTALL A 16' x 37' LEACH FIELD 5 HAYES ROAD, CENTERVILLE, MA 02632 SIDEWALL AREA: NOT APPLICABLE Prepared for: Maria Fitzgerald, 33 Harbor Hills Rd, Centerville, MA 02632 BOTTOM AREA: 16' x 37' = 592 S.F. Engineers: Survey review by: SCALE DRAWN JOB. No. TOTAL AREA:....................................592 S.F. Engineering Works,Inc. Warwick&Assoc.,Inc. N.T.S. P.T.M. 294-17 12 West Crossfield Road Box 801-63 County Road DATE CHECKED SHEET NO. LEACHING CAPACITY = 0.74 GPD/SF x 592 SF = 438 GPD Forestdole, MA 02644 North Falmouth, MA 02556 (508) 477-5313 (508) 563-7777 10/2/18 P.T.M. 2 Of 3 1 NEMA 4 JUNCTION BOX CORROSION RESISTANT & LIQUID—TIGHT CABLE CONNECTORS SUPPORTED PROVIDE WATERTIGHT CONCRETE RISER WITH BY 1-1/4" PVC CONDUIT. JOINTS TO BE MADE SECURED FRAME & COVER TO GRADE WATERTIGHT. USE SJE RHOMBUS—JB PLUGGER OR EQUAL. PROVIDE ENOUGH WIRE 2" BALL VALVE (FIELD ADJUST FOR 20 GPM RATE) SLACK TO REMOVE PUMP (INSTALL QUICK DISCONNECT FOR EASY REMOVAL) INSTALL 1' PVC CONDUIT TO HOUSE FOR WIRING HOISTING CABLE 7x19 STAINLESS STEEL WITH WATERTIGHT JOINTS. WIRE HIGH WATER ALARM 1/8" DIAMETER. / 1,760 LB. STRENGTH FLOAT TO SJE RHOMBUS TANK ALERT XT ALARM PANEL PROVIDE ENOUGH WIRE ON CIRCUIT SEPARATE FROM CIRCUIT TO THE PUMP. SLACK TO REMOVE PUMP INV.(IN)=35.50 2"SCH. 40 DISCHARGE (THROUGH RISER—SEE PROFILE) 1/4" WEEP HOLE ALARM ON EL: 33.0 PUMP ON EL: 32.84 2" 90' ELBOW ADDITIONAL 3/16" VENT HOLE BOTTOM OF PUMP OFF EL: 32.17 1811 116" 2" SWING CHECK VALVE 8„ �. PUMP CHAMBER 2" SCH. 40 PVC DISCHARGE PIPE ELEV.= 31.00 PROVIDE 2- WIDE ANGLE FLOATS: �6" FLOAT` NOA: PUMP ON/OFF-SJ RHOMBUS (PROVIDED WITH PUMP) LIBERTY LE40 SERIES PUMP .4 H.P. 115 V FLOAT-NO.2: ALARM ACTIVATION FLOAT-PROVIDED WITH ALARM PANEL WITH 2" DISCHARGE, OR EQUAL (ON SEPARATE CIRCUIT FROM PUMP SPECIFIED) PUMP AND ACCESSORIES AVAILABLE AT: CAPE COD WINWATER WORKS CO., HYANNIS, MA. (508) 862-0166 NOTE: APPROVED ALTERNATE MAY BE SUBSTITUTED. PUMP DETAIL N.T.S. 20" DIA. COVERS (TYP.) 1-4" POLYSEAL INLET 3-4" POLYSEAL ('� I I I OU TLETS 22 Ef rD N+ i LL - ' 4„ CROSS PRECAST 14 SECTION PLAN MEW 4" KNOCKOUTS PLAN VIEW (TYP.) H-20 LOADING 4"(8" H-20) 20" DIA. COVERS (TYP.) DISTRIBUTION BOX 4" INLET KNOCKOUTS 5'-8" 4" OUTLET 3" (6—'2" H-20) 4„ KNOCKOUTS 4'7" SUPPORT (SEE NOTE 3)� 4'9" H-20) 4'-3" /� BEAMS LIQUID (4'-5" H-20) COMPARTMENT (TYP) LEVEL ALL AVAILABLE.* BUOYANCY CALCULATIONS 5„ 4"(6" H-20) H-20 SEPTIC TANK/PUMP CHAMBER CROSS SECTION A-A BOTTOM OF UNIT EL.= 31.0 AT of H-10: 18,852 LBS. HIGH GROUNDWATER EL.=34.7 WT of H-20 24,721 LBS. (USE FOR THIS JOB) BUOYANCY FORCE PER FOOT OF DEPTH: 12.2' x 6.7' x 1' x 62.4 Ibs./cu.ft. = 5100.6 Ibs. SPECIFICATIONS MAX. DISPLACEMENT = 34.7' - 31.0' = 3.7' 1) CONCRETE 4,000 PSI AFTER 28 DAYS. MAX. UPLIFT PRESSURE = 3.7' x 5100.6 Ibs/ft = 18,872 Ibs. 2) CONSTRUCTION CONFORMS TO DEP TITLE V REGS. WEIGHT OF UNIT EMPTY = 24,721 Ibs. 310 CMR SECTION 15.226. 3) TONGUE & GROOVE JOINT SEALED W/ BUTYL RESIN 24,721 Ibs > 18,852 LBS. Ibs O.K. 4) REINFORCEMENT PER ASTM C1227-93. 5) PROVIDE POLYMER WATERPROOF COATING H-20 SEPTIC TANK/PUMP CHAMBER 1500/500 DOSING & STORAGE REQUIREMENTS WIGGIN PRECAST CORP., BOURNE MA. (800) 564-6774 DESIGN FLOW: 330 GPD DOSING REQUIRED: 4 CYCLES/DAY (SAND) PROPOSED SEPTIC SYSTEM UPGRADE PLAN 330 - 4 = 82.5 GALLONS/CYCLE DISTANCE REQUIRED BETWEEN PUMP 5 HAYES ROAD, CENTERVILLE, MA 02632 ON AND PUMP OFF FLOATS: 82.5 GAL/CYCLE --a- 125 GAL/FT = 0.66 FT/CYCLE (USE 8") Prepared for: Maria Fitzgerald, 33 Harbor Hills Rd, Centerville, MA 02632 STORAGE REQUIRED ABOVE WORKING LEVEL: 330 GALLONS Engineers: Survey review by: SCALE DRAWN JOB. NO. STORAGE PROVIDED: Engineering Works,Inc. Warwick&Assoc.,Inc. N.T.S. P.T.M. 294-17 12 West Crossfield Road Box 801-63 County Road DATE CHECKED SHEET N0. INV.(IN) EL: 35.50 — PUMP ON EL: 32.84 = 2.66' Forestdale, MA 02644 North Falmouth, MA 02556 STORAGE PROVIDED = 2.66' x 125 GAL/FT = 332.5 GALLONS (508) 477-5313 (508) 563-7777 10/2/18 P.T.M. 3 Of 3 ob LOT 7.4 lrF hw,,+ a., IP FOUND 8.2 ZONING DISTRICT RD-1 S61'19'50'E ZONING DISTRICT RC 100.0 C 96.7 a +96.1 H O EXISTING LOT 1S � a GARAGE M,8S9f S.JR. (o 100.4 96.3 3 e 94.8 �0 ABNIL J Go CF my -o N EL 10 5.1 LOT 14 PO �p�d� gas' a 4 C�R�fdc'I�IA Z 5 s.2 25.1' 27, � s �, 36.43' T O W +99.1 G 95.8 .� OG • 0� 96.5 100.8 ui ►) +100.0 9� Vy��ti90 ' N66'00'20'W - .36 f 100.9 GE OF PAVEMENT 100.6 GREAT (PUBLIC VARIABLE WIDTH) MARSH CB/DISC FOUND DRAW Br: LA& R.J lK DA?E 03118/Y6 20 0 10 20 Cy1 atw BY.' siffT 1 art SCALE 1 /NCH = 20 FEET %(and Prolctv 2004 jsst60WjAp %"6oI -9*-dwg 40'-0" - A A3 o EXIST. KITCHEN FSKYLIG-II-IT ABOVE I- EXIST. BEDROOM EY O EXIST. DE DINING DE .i 4 DN. 4 CLOS, EXIST. EXIST. EXIST. BEDROOM LIVING DN W.I.C. CLOS. 40'-0" 10'-6" 5'-4" 3'-7" lo BULK�H1EA I (� A3 �I MULLED AWNING DH WINDOW - - - - - - - - - - EXITING POSTS&FOOTING REMOVED&NEW FOUNDATION I 1 WALL/FOOTINGS INSTALLED W/ WOOD FRAMED WALLS ON TOP T NEW NEW NEW GAMEROOM STUDY STORAGE (4"CONC.SLAB) B ------- -------------------- 4TION WALL i CMU SHELF O N bAlH O �IL y 8'-6" 11— " CMU WALL INFILLED I BETWEEN EXIST. 12"DIA. 1 I I CONCRETE SONOTUBES ON 24"DIA. BIGFOOT EXIST. I I I FOOTINGS BASEMENT I f UP - - - - - - - - - I J =XIST. 3EDROOM FDECK OUTLINE ( I