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0016 HILL CREEK ROAD - Health
16 Hill Creek Road Centerville A = 187 024 aftn&fiemr y a H 1521/3 ORA 100/6 P2 t i 1 �� � �:� � �q 1 i Do•_= 1 Y 174 s 22a 09-26-2011 1 :2L l BARNSTABLE LAND COURT REGISTRY. DEED RESTRICTION WHEREAS, L VC.2 V_0,,4 or* Mom-/ G. L,JC2K-,M� of (ownees name) W o VMAI C'iIZozeK MA (address) is the owner of llv ftI u CTzAII- c READ located (address) at � MA (hereinafter referred to as Lam' a t.re-jD c*jF-17 Qt�D�r-� o?'lool _A and being shown on a plan entitled "Subdivision of Land in MA, Property of et at, duly recorded in Barnstable County Registry of Deeds in Plan Book Page Or on Land Court Plan Number WHEREAS, Dec- ISL WVC-Z .C,4 ; as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number.of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15..000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Bamstable Board of Health, as a pre-condition-to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Tale V, Minimum .Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a•single family home on this. property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, dccdr DAj I ,.��z,�,, ; ,�o.R.yC.. NOW, THEREFORE, does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his aglePfJlefl with the_.TQwa.of Bar n�ta fa Rnar�Nealt-h-, whf£4?-r'-e�v s-h� run with the land and be binding upon all.successors in title: I U µ'tL-L. Ctzowtc A�,n , G J1t.uf may have constructed (address) upon the lot a house containing no more than FFiZ' (5j bedrooms. & y -VC-L . agrees that this shall be-permanent deed (owner's name) restriction affecting Pt=r tfsslocated on Lo i o?a- MA, and . being shown on the plan recorded in Plan Book , Paged Or on Land Court Plan 2?$01 -A (5'N'e-95i- 1) For title of see the following deed: Book , Page Or Land Court Certificate of Title Number 1115118 ' Executed as a sealed instrument Oa day of n—g;:gpj�ao i 1 Owner's signature Owner's si at e Owners signature COMMONWEALTH OF MASSACHUSETTS , ss , 20I ( Then ersonally appeared the above-named i GzlCato known to me to be the person who execute the foregoing instrument and acknowledged the same to be free act and deed, before me, Notary Public My commis ion expires: CAITLIN B. SULLIVAN C t 1 3 NOTARY PUBLIC (date) Commonwealth of Massachusetts My Commission Expires deedr February 1, 2013 r TOWN OF BARNSTABLE LOCATION °Cl _ SEWAGE# $'— q41 VILLAG e4/--e Vj l SESSOR'S MAP&PARCEL 4` INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size)� r x '`/ NO.OF BEDROOMS _ OWNER�Vl`� PERMIT ERM T DATE: o� COMPLIANCE DATE: Separation Distance.Between the: r 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 L-aching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY y 6: F \ ' F ' bq 4 No. v r - Fee /0 o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Bisposar bpsteta Construction 3permit Application for a Permit to Construct RepairXUpfrade Abandon S stem ❑ Individual Location Address or Lot No. C�� Owner's Namedddress, d Tel.No. III ktv � ��> v�,/E q C,iet RIP Assessor's Map/Parcel '7_ (�� ��Qdv� C? Insta er's Name,Address,and Tel.No. RAn9-1t6-!° ?ZOO` Designer's Name,Address,and Tel.No. 6 9!r— Type of Building: Dwelling No.of Bedrooms Lot Size / ./k f Garbage Grinder( ) Other Type of Building No.of Persons Showers( .) Cafeteria( ) Other Fixtures Design Flow(min.required) j C(3 gpd Design flow provided !%Z gpd Plan Date_/fjvu.. �—Z J f Number of sheets Revision Date Title Size of Septic Tank / Type of S.A. - Description of Soil Nature of Repairs or Alterations(Answer when applicable)-�/1f�i.in t� /fbOU �;o/. %���/t �•- 13fii�( 41113 S/ 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 E ironmental C and not to place the system in operation until a Certificate of Compliance has been issued by this Board He th. Date 10/2 "/n S% Application Approved by ` Date Application Disapproved by Date for the following reasons -' Permit No. vZtl a Date Issued tro 4 L-------------------Y •+Y�v,. •w•{+ f^'"M'^'i"MSr•r,r. ,4 ....- ..ti . ""'h> .1z. a.. .` ..'Vr"�w. mow...-w . .,pr, K -..i.yyy�., r- ,,.'1. .., a. 0 ... �, 1 rX i� W Fee /d a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Vopo$al 6pstem Construction 3permit Application for a Permit to Construct( ) Repair KUpfrade( ) Abandon( ) ,Complete System ❑Individual Components Location Address or Lot No. ' (� �. Owner's Name, ddress, d Tel.No. Assessor's Map/Parcel '7- C72 L-/ B',L�Q�I J/e AWA) 694/ �J� Z// Cter. Q� Insta er's Name,Address,and Tel.No. R��.a f� Rn P Designer's Name,Address,and Tel.No. J�b71 Sv /a 95 Type of Building:Dwelling No.of Bedrooms Lot Size ( A l �C�P/s�rtt�Gazbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S V gpd Design flow provided gpd ��77-'•• I Plan Date:.1U� 72 —Number of sheets f Revision Date % Title Size of Septic Tank 9 Type of S.A.S___7,,�.�r Description.of Soil 1 Nature of Repairs or Alterations(Answer when applicable) Woqoq;eic 4 J�aoo Okl. %.t.,*- Date last inspected: �Agreemeit: 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 E ironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by th s Board He th. Date /D/__uU y Application Approved byy v -J r Vk Date �o.ba, r o It Application Disapproved by Date / for the following reasons Permit No. )-UD - n i Date Issued 0 ��IA,,F -- ----- -------- -------_------_------ -- -------- - - - _------------------ ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (certificate of Contpiiante THIS IS TO CERTIFY hat the On-site Sewage Disposal system Constructed( ) Repaired) Upgraded( ) Abandoned( )by ���lL (�UvtiOl (J at 4J/ (gyp k has been constructed in accordance with the provisions of�Title 5 and the for DD*ssp�o'ssal/System Construction Permit No.0 00, -y� d-ateed �/0 Installer ;�~��J?L ! ;1/I�k.C�lam" Designer A�i�/r^�/V #bedrooms Approved design flow C'"'' 0 / r? gpd The issuance of this peimit shal/not.befconstrued as a guarantee that the system will function as desiyg/nedq.� Date t _ 1 Inspector �f(,/Y r� i f ./... � - ----- - - _ - - - - -- ----- ------ --.----- ------------------- '------ -- - -----------�- __\ . . No. 2a a Fee CI THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 3Disposal *potent Construction permit Permission is hereby granted to Construct( ) epair ) Upgrade( ) Abandon( ) ' System located at �� C y p �[ /( / cp e&.,J� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permif` j P� Date 0( 2 r'1 1 d Approved byy I v r Town of Barnstable Regulatory Services Thomas F. Geiler, Director BARNMBLE. MAS& Public Health Division � 1639. ♦0 oT� R° Thomas McKean, Director - 200 Main Street,Hyannis,MA 02601 Office: 503-362-4644 Fax: 503-790-6304 Installer & DesiQner Certification Form u / Date: a4 0� Sewage Permit# c�` Assessor's Nlap\Parcel AVV Designer:J(AX'(ff installer: Sc,01-1 Address: �0 Address: 32-. R4066 127-C to- On Z':; DC� &_6 IT C d3�LL was issued a permit to install a (date) (installer) septic system at (o H I't �, ►1 �U based on a design drawn by (address) k 'i ©� dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation or tale distribution box andlor septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or anv vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or cert'fied as-built by designer to follow. OF Mgs�9c DA N y� Installer's ,,nature) t No. 1140 f I / RfG/STENO I/V SANITWi� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTAB PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUE UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNST.ABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-04:1doc r. , A DATE: 3/31 /98 PROPERTY ADDRESS: 16 Hill Creek Road _ - _--- (x' r� v -_-Centerville, Mass ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. 3 . 2-1000 gallon precast leaching pits . Based on my inspection, I certify the following conditions: 4 . This is a title five septic system. ( 78 Code ) 5 . The septic system is in proper working order at the present time. SIGNATUR Name:- J. P. Macomber Jr. --------------------- Company:Joseph PM�com�er & Son, Inc. Lt� � Address: Bo _-____-____.�.,-r1a-_Q�632-0066 �ZPhone:__508-775=3338 ______ �- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 r PI) COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS z DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617-292->500 WILLIAN1 F.WELD T.RL D1 CO Govcmor SGCrfL ARGEO PAUL CELLUCCI DAV!D 3 STRU Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissio PART A CERTIFICATION Property Address: 16 Hill Creek Road Centervi11eAddress of Owner: Date of Inspection-3/31 /98 (If different) Name of Inspector: ,TnGp?h P_Ma comber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc. Mailing Address: BOX 66 Centerville,Mac;s _ 02 32 Telephone Number: 5QR_77c,_3_j-jR CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reponed below is true accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper iunctoon and maintenance of on-site sewage disposal systems. The system: _L Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 sF.all submit the repon to the appropriate regional office of the Department of Environmental Protection. The original should be sent to tf* sys:em owns and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 Crt.2 1 5.303 Any failure criteria not evaluated are indicated below. COMMENTS: B) SYSTEM CONDITIONALLY PASSES: _Jl) One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The sy>tem, up( completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain vvhy not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Cenricate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the lnsD'cIion, the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exHira:mr, or tan failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming scat c tank as approved by the Board of Health. (rovisod 04/25/97) Fag• 1 of 10 DEP on the World Wide Web: hnp:/nvww.mapnet state.ma usMep Printed on Recyoed Paper ' J ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ry CERTIFICATION (continued) Property Address: 16 Hill Creek Road Centerville,Mass . Owner: Lisa Pajolek Date of Inspection: 3/3 1 /98 BJ SYSTEM CONDITIONALLY PASSES (continued) 4A9 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or pipets) or due to a broken, sealed or uneven distribution box. The system will pass inspection if (with apprcvai re Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipes; The system w:l! G3's inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 iaihn€ :o Prc.(rcl the public health, safety and the environment. t) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING ill A ntA�NER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: �J Cesspool or Pi y is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. y 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DE-TE �,ES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface �er s cc , or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a publhc water pot; .rl g,o The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private Nater s.;DDI, —, ,d,o The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more irc- a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounes one tales that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nrtroger s ec�ai to or less than 5 ppm. Method used to determine distance '4J4 (approximation not valid). 3) OTHER (r.vs..a 04/25/97)) p6ge 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORtiA PART A t I CERTIFICATION (continued) Property Address: 16 Hill Creek Road Centerville,Mass . Owner: Lisa Pajolek Date of Inspection: 3/31 /98 D) SYSTEM FAILS: You must indicate ew er "Yes" or "No" as to each of the following: /t/O_ I have determined that the system violates one or more of the following failure criteria as defined in 310 C.,,IR 15.30 r e oas,s for this determination is identified below. The Board of Health should be contacted to determine wha: will be necesidr, corre�. the failure Yes ^o� Backup of sewage into faciliry or system component due to an 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 c!oggz. ;-\S or cesspool. Static liquid level in the dis rib lion box above outlet invent due to an overloaded or cloggec SAS or cess:oc Liquid depth in cawpo6l is less than 6" below invent or available volume is less than 1/2 day flow. 4/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped 0— Any ponion of the Soil Absorption System, cesspool or privy is below the high groundwater eie at,on Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary .o a surface �z:er s.:o Any portion of a cesspool or privy is within a Zone I 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 pnnale wafer suoo.� ell •.::r nc 42 acceptable water quality analysis. If the well has been analyzed to be acceptable, artach copy of -ell wa;e ifa .s:s :or col!form bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) URGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: A/D The system serves a faciliry with a design flow of 10,000 gpd or greater (Large System) and the system is a signif,cJn, :n->.,; to public health and wfery and the environment because one or more of the following conditions exist Yes No the system is within 400 feet of a surface drinking water supply i /L/4 the system is within 200 feet of a tributary to a surface drinking water supply .{>/9 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area •.IWPA) or a mappe-c Zone a public water supply well) The owner or operator of any such system shall bring the system and faciliry into full compliance with the groundwater trea:T.e-: :.c2r<� requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for funher information tr.vl..d P49. 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16 Hill Creek Road Centerville,Mass . Owner: Lisa Pajolek Date of Inspection:3/31 /9 8 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by th owne , occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recentiy or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,4cluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condrt,on of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. — The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if cUfferent from owner) were provided with information on the proper mam(enance of Sub-Surface Disposal System. ZExisting information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) )15.302(3)(b)) (revised 04/25/97) P&q• 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 16 Hill Creek Road Centerville,Mass . Owner: Lisa Pajolek Date of Inspection: 3/31 /9 8 FLOW CONDITIONS RESIDENTIAL: Design flow:o5VO P.d././bedroom for S.A.S. Number of bedrooms: Number of current residents Garbage grinder (yes or no): Laundry connected to system (yes or no):� Seasonal use (yes or no):,C/C) Water meter readings, if available (last two (2) year usage (gpd): 9 I�7 9. Sump Pump (yes or no):.,VQ ? &3 a a- ,s;,��,a%e,� Sys �r�s�r Last date of occupancy: �1- �— COMMERCIAUINDUSTRIAL: Type of establishment: A�44 Design flow: A) gallons day Grease trap present: (yes or no)AIj, Industrial Waste Holding Tank present: (yes or no).,IQfJ- Non-sanitary waste discharged to the Title S system: (yes or no), Water meter readings, if available. A,W 14,14, Last date of occupancy:A_ OTHER: (Describe) i(W Last date of occupancy:�iJ GENERAL INFORMATION PUMPING RECORDS and so of information: System pumped as part of inspection: (yes or no) S If yes, volume pumped:�/G7� allons Reason for pumping: h V it i TYPE Septic tank/distribution box/soil absorption system _/t/11 Single cesspool Nl�_ 0verflow cesspool AW_ Privy Shared system (yes or no) (if yes, anach previous inspection records, if any) Nij VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of infor ation: D �ll/���/ JCS v i!�i�11.-� Sewage odors detected when arriving at the site: (yes or no)—� (r.vissd 04/25/97) P&y• 5 of 10 SUBSURFACE SOVAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION (continued) Property Address: 16 Hill Creek Road Centerville,Mass . Owner: Lisa Paj olek Date of Inspection:3/31 /98 BUILDING SEWER: (Locate on site plan) Depth below grade. 9� Material of construction: _ cast iron 00 PVC _ other (explain) Distance from Private water supply well or suction Jine 0— D ameter Corr�nents: (condition of joints, venting, evidence of leakage, etc. _ ll SEPTIC TANK: lZZO Qr ' (locate on site plan) Depth below grade: /f Material of construction: _L/concrete _metal _Fiberglass _Polyethylene —other(explain)if lank is metal, list age t Is age confirmed by Cenificate of Compliance2/fib (YeVNo) Dimensions: Sludge depth: Distance from top of sludge to bosom of outlet tee or baffler Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ Distance from bonom of scum to bonom of outlet tee or baffle: How dimensions were determined: TdJ�t/& �'CT%ljD Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inert, suuc.�rai isle nry, evidence of leakage, etc.) f i � = J Z4 :S' GREASE TRAP: (locate on site plan) Depth below grade:�`� Material of construction:4/Aconcrete. frsetal4)�4Fiberglass (_aPolyethylenerif�other(explain) Dimensions: 414 Scum thickness: 44 Distance from top of scum to top of outlet tee or baffle: - ,1-7 Distance from bottom of scum to bosom of outlet fee or baffle: V4 Date of last pumping: .n_� Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invern, integrity, evidence of leakage, etc.) IS' �T -3 yC, lr.v18.d P.9. 6 of 10 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR" PART C _ SYSTEM INFORNIATION (continued) t Property Address: 16 Hill Creek Road Centerville,Mass . o"ner Lisa Paj olek Date oI Inspection: 3/31 /98 TICHT OR HOLDING TANK:,6j��(Tank must be pumped pr,c)f to, or at time, of inspeNon) (loca:e on s,le plan) Depth oeiow grade A)h rnalenai of consuucllon:wo4concreteti_4metal,VAFiberglassiv olyethyleneAfother(expla n) Dimensions A)h Capacjr/ VA gallons Design i:o., a2q gallonVday Alarm ie,el _ ) _ Alarm in working o(de(A)fi)'esyl/a Nu Dale 01 Dtev,ows pumping. A,, COmmentf tcond,t,on of ,nlet tee, condition of alarm and float switches, etc ) a G r or z� ,a1i3 DISTRIBUTION BOX:z tloca,e on s,te plan) Dep:r i -c-d level above outlet -nven Co--e-:s tnote f ie,el and distribution IS a ual, evidence of solids carryover, evidence of leakage into or out of box, etc i / 7 % ' ae, T y PU•'AP CHA.%ABER: /. /c (locxe On site plan) Pumps -r working order: (Yes or No) Alarms -n Dorking order (Yes Or NO)ldiid Cornmen:s (note core,t,on of pump chamber, condition of pumps and appunenances, etc.) ur12✓✓ )n � !C AldT 01-e5e2- - lr•�>,..c .�/75/97) ➢.g. 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:16 Hiil Creek Road Centerville,Mass . Owner: Lisa Paj olek Date of Inspection: 3/31 /9 8 ' SOIL ABSORPTION SYSTEM (SAS):�yr�d tj,4 'U (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number. leaching chambers, number: leaching galleries, number: leaching trenches, number,length: 0 leaching fields, number, dimensions: C/ overflow cesspool, number: Alternative system: l� Name of Technology: / Comments: (note conditi n of soiilsigns of hydraulic failure, level of ponding, condition of vegetation,,etc.) _ 7? i s r CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid,to inlet invert: yy Depth of solids layer: 4W Depth of scum layer: Ally Dimensions of cesspool. Materials of construction: Indication of groundwater: lt% inflow (cesspool must be pumped as pan of inspection) ,d 4,V T Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) S S a no S i4re -W T XW�G'.ur;_ PRIVY: lhtive (locate on site plan) Materials of construction: /Jj/� Dimensions: Depth of solids:_419� Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) A; VdT ArrSN.c� (revised 04/25/97) Pegs 8 of 10 �1 SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPE.'TION FOR-M PART C SYSTEM INFORMATION (continued) Property Address: 16 Hill Creek Road Centerville,Mass . Owner: Lisa Pajolek Date of Inspection: 3/31 /98 SKETCH OF SEWAGE DISPOSAL SYSTEM: ^:lode ties to at least rwo permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) ; I � P,f i (r•v1.•C C�/35/97) ➢ag. 9 of 10 SUBSURFACE SEWAGE DISP SYSTEM INSPECTION FORM SYSTEM INFOI: :iO.N (continued) yProperly Address: 16 Hiil Creek Road Centerville,Mass . Owner: Lisa Pajolek Date of inspection:3/31 /98 I'.r Depth to Groundwater A Feet Please indicate all the methods used to determine High Groundwa!W FIV.a.ion: Ootained from Design Plans on record Obse vailon of Site (Abuning property, bservation hole, baserr,-&camp etc] Determine it from local conditions Cneck with local Board of health Cneck FEMA reaps Cneck pumping records _ZCneck local excavators. installers Use USGS Data Describe n• your own words how you established the High Grounci�w,rcr i levat,on. Must be comple(edi Used Water Contours Map Gahrety & Miller Model 12/16/94 lr•�1••C 0�/7 s/97) P•S• ���t 10 ..n r+ nrr--rr '•m.—m.•nrrrrrnr..rerr.rr..r:-.�.-r-rv.r:�nr-ernm mnvt�:rv..rs+ a zr-s �m-a r eca i a�T_�,_ I TOWN OF Barnstah] e BOARD OF HEALTH SUBSURFACE SF•WA(;E i)ISPOSAL SYSTF,M IN311F.CTION FORM - PART D •- CERTIFICATION � A•••�....T.•••.♦-�.tlT.-.�T.T'�T'.t.'tTiTT.T.T111TT.T'.�-•1+-1RT'n1 tRfTnT•'TnTnC.14T RiSTn'i'iTTCT1 Is.n ltTRii�+TTiV�TTrr�r.:�.r-.-.r � .�. -TYPE OR PRINT C(.EARLY- PROPERTY INSPECTED STREET ADDRESSI.6 Hill Creek Road Centervi�ljle.Mass . ASSESSORS MAP , BLOCK AND PARCEL l OWNER' s NAME Lisa PaJol-ek PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber .& S06Tnc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or Clty Stat- tip COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 ) 790 - 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : __ZSystem PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have con iicted has found that the system fails to Protect the 'public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . � , Inspector Signature 14d A4r1x1xy Date 3/31 %98 One copy of this certification must be provided to the OWNER, the BUYER ( Where applicable ) and the BOARD OF 11BAL7'll. * If the inspection FAILED, the owner or `oparator shall upgrade ' the aystem within one year of the date of the inspection , unless allowed or' required otherwise as provided in 3.10 CHR 16 . 305 . partd . doc 7 f�� r 1 THE COMMONWEALTH OF MASSACHUSETTS 4 DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title d CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A of the P P General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Aging Director of then of Water Pollution Control �L/,����TOWN OF BARNSTABLE C.e►��evp /L SEWAGE # ` '0�4S5& ASSESSOR'S MAP & LOT INSTALLER'S NAME&.PHONE N0. —J���i � 1a�"f�D't� SEPTIC TANK CAPACITY _ LEACHING FACILITY: (type) -,�i�0 1�.�' (size) NO.OF BEDROOMS S BUILDER OR OWNER k PERMITDATE: COMPLIANCE DATE: .Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility ( any wetlands exist within 300 feet of eaching c' `� Feet Furnished by - 4;�t i o zq, No.... 1'- FIus....$ ..3.0.00. APPROVED THE COMMONWEALTH OF MASSACHUSETTS Barnstable Conservation DepaRment BOARD OF HEALTH l Y-gS-TOWN OF BARNSTABLE g' Date Ap.phratiun for Divi-puuttl Work.5 Tunutrnrtiun rrrM' d Application is hereby made for a Permit to Construct ( ) or Repair XXN an Individual Sewage Disposal System at: 16 Hillcreek Road Centerville -----•---•-•-•--------•--------------------••-----------•--•---------------------•-•.._..-••--•-•- ................................................................................................. Pa j olek Location-Address or Lot No. ......................-.......................................................................... •-•-•••------------•-•••--•-•----------....•----••••------...•---•---------------...-----.......-- Owner Address W J.P.Macomber Jr . Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms......... ---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building ____________________________ No. of persons----_---_--_.-___--_--.---- Showers ( ) — Cafeteria fixtures .. W Design Flow .............................gallons per person per day. Total daily flow--------------------------------------------gallons. W Septic Tank—Liquid capacity............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..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............................................. Date....................................... Test Pit No. I----------------minutes per inch Depth of Test Pit---_----___-__-_-__- Depth to ground water_............__..._..... (s. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...-___----_-______-_--- c�,' ....••-----------------------•--•-•-•-•••--•...--•--•••----•---•-•--•---•••---•-•--•---------•---•--......................................................... 0 Description of Soil........................................................................................................................................................................ v ......................................................Sand-'---------------------------••-----------------------------------------------------------------------------...._•-----••----•=-•----•---. W UNature of Repairs or Alterations—Answer when applicable.....Mov i n-ccr ex i_s t-i nq. __7 0 0 g a 11 o n s t i e tanlr. ---------------------------------------------------------------------------------•-----__--•- 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 has bef n, ' sue by the oa,,d of health. 1-4-94 Signe ------_: ........ . - ��7a_ .._.- --- '--�--------_...........----... ...............'Dace --------'--- Application Approved By ............. .. . -------------- ............. ..--- ---- Date Application Disapproved for the following rearons- ---------------------------------------------------------------------------------------------------------------------------------- ........................................... ._............................,.............._. ._................................ -----------------------------------...- p Dace PermitNo. -----,[...�......../........................................ Issued ............... . . . Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /-/- ��/TOWN OF BARNSTABLE,. A lirttti>�n �nr i n ttl 3 nrlt Cnomitrnr#tun �r hermit Application is hereby made for a Permit to Construct ( ) or Repair �TX)g an Individual Sewage Disposal System at: 16 Hillcreek Road Centerville ----•-----------------•------•----....-----•------------•--••-------••••--••••-••--••---•---...... ................................................................................................. Pajolek Location•Address or Lot No. ' ......................_.......................................................................... •---•------•-----•-•••------•---•••-•-----••-••••---••---•-•-••-••---•------•---••-------------••- l wncr Address W J.P.Macomber Jr . X Installer Address vType of'Buildin Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms...................................._..._-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons-----.---------------.--.-.- Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width---------------. Diameter---------------- Depth................ x Disposal Trench— No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------_---------- Diameter.----_-----------. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.......__.........__ Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 04 •--•----••------------------••-•--••••-•---••-••-•-----•-•••••--...••----......••--••......--•-•••-•................................... 0 Description of Soil.................................................................................................................................................. V ....•------•-•-•-•--•--••••-•--•••......--•••--•--Sand--------------------------••--------------------....--------------------------------------•-----•----------------•-••-•-••••......•--•-••• W UNature of Repairs or Alterations—Answer when applicable.....-MOv i nq ex i sting 1500 gall on septic tank. ••------------ ------------•-------------------------------------------••••••----....._-•••-•.... 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 has b ien�issued by the oa d of health. Signe ---- -- ------ 1-4-94 --- �............................... Dare •--.�„� Application Approved By ............. ................. ......_ ..�-w - Application Disapproved for the following reasons: ..... ................................ ..... .. . ...... . ........ . . ............... ----------------------- ..---------- ........--- ------------ .------- --- ------------------ Date PermitNo. ! .......y---------------------------------------- r Issued ................... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE THIS IS TO CERTIFY That the Individual Sewage Disposal System co.nstructed ( ) or Repaired (XXX) J.P.Macomber Jr. by -... .... . ........_ ...._...... ""'I" 16 Hill Creek Road Centerville - ..... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described it -- the application for Disposal Works Construction Permit No. _.` .. --------------------- dated ..._................................. _.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �(', ��-},� DATE ---------�� .- - Inspector .- .................. "-- ...... ........ ---------------•--------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4 TOWN OF BARNSTABLE 30 00 No........�.'�..f�_ FEE---�--•----•-•---...... Dtovv�.st. vo kii Tomitrudion "rani Permissionis hereby granted--------------------------------------------------------------------------------------------------------------------------------------------- to ConsstrucBt i(11) �r airVX)Rbada�eritervl.Sewage w ge Disposal System It) le atNo.--•--•-••••--•••••--••••••----••-•••••-•-•••-----_----_-------- -----------•--------------------------------------.....-------------------------...------------------------------•------- Street q as shown on the application for Disposal Works Construction Permit No.l.-�_'. -_-_ Dated...1.�.�.-�.Y................. --------------- Board of Health DATE................. ------------------------------------- FORM 3650a 3880E HOBBS&WARREN.INC..PUBLISHERS -`' TOWN OF BARNSTABLE 'LOCATION_ /4_ Z L G 4-feA . /?� SEWAGE # 'VILLAGE C efl rel, I/ ASSESSOR'S MAP 6& LOT 7 INSTALLER'S NAME & PHONE NO. ,J-, / M 460/vt SEPTIC TANK CAPACITY / OOO LEACHING FACILITY:(type) A �/T (size) /-®Dp/ d NO. OF BEDROOMS ✓� PRIVATE WELL OR PUBLIC WATER B E-R-OR OWNER °Pd DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED VARIANCE GRANTED: Yes No 1 1 oe. t or\ ��O THE COMMONWEALTH OF MASSACHUSETTS �-� BOARD OF HEALTH Q TOWN OF BARNSTABLE AppUratinn for Diupnuttl Warks Tanutrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair F) an Individual Sewage Disposal System at: 16 Hill Creek Road Centerville ...•--• -__-.__._...............................•------------••-------•-•-•-••--•-_.... .....•------------•----••-----------------------------.....---.._..------•--------------......---- Michael Pa j o t ekcation-Address or Lot No. ------••---------------- -• - ---••-------------------------------------------- --------- ..................................................................................... W J.P.Macomber Jr. Owner Address -- --------- -------- ------- .. Installer Address Type of Buildir Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ........_................... No. of persons............................ Showers ( ) Cafeteria ( ) d Other fixtures _..-•--••-•--•---•-----------------------------------•• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons . Length................ Width______________- Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------------------------------------------------------------------------•----------------•---------------------------------- -........ ----------_----- 0 Description of Soil.................................................•--------------------•---••--•----------------------•------------___---------------------------------------•-•-••----- Sand & Gravel V -•-------------------------------------------------------------•-----•------•----------••-...---------...•--------------•-----....--•------...-••-•-----•----.....-------...-•-----•-------•..._._...--- W U Nature of Repairs or Alterations—Answ w pli _ — g1c�ri ...pits ...............................•........................................................................................................................................................................ 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 Complian has bee iss ed he.board of alth. Signed --... :_ d9'f��G�� 9/6/90 -- ---------------------- -------------------------------------- Date Application Approved BY ..---- - ---------------- ----- == .�e .................... .„---..-----. ..-------. .. / Date Application Disapproved for the following reasons- ---------- --- -------------------------------------------------------------------............................................... ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ----------- -------------------------- Date Permit No. f' ' ;----------------- .:Issued .......... "':�'r - - Date l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE I� Appliratton for Disposal Works Tontrurtion rrrmit Application is hereb mad for XX��e o a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: k 16 Hill Creek Road Centerville --........• __... .............................. .... --•--------.....------------------------------ ot .- ......................................... olLation-Address orNoMichael. eX ............................................... --•--------••--•••---• --- ------------------------------......----------- Owner •• , Address w .P.Macomber Jr.. ........................... Installer Address Sq. feet U Type of Buildin� � Size Lot............................ t, Dwelling—No. of 4 Dwelling Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( ) Other fixtures ...................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No__________________ ... Total Length________._____..____ 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........................................ Test Pit No. I................minutes per inch Depth of Test Pit____________________ Depths to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------•--------------------------------------------------------•----..._..------•••--------••-•••••.......................................................... 0 Description of Soil---------------------------------------------•---•--•---------.._...-----------=........................................................................................ x Sand•_& Gravel W ------------------------------------------------.........................................................=............................................................................................ V Nature of Repairs or Alterations—Answe whe a plicab�1e_______________________________________________________________________________________________ lon ----------------••--•---------...•--------------------..._•-----•--....-------_..__....--•--.._.._•-•-----••••-•---_------ 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 Complian has Zee *s;,Vs �d'by-)he..board of alth. Signed �� . ���11� �0"1V... _.------------------- 9/6/90 Dare Application Approved By --------------- .------------------------ ....-- ---------------- ------ .. .. �..�c� Dale Application Disapproved for the following reasons- -------...........................----------------------------------------------------------------------- ----..---------------- --------------------- ------------------------------------------------ -------------------------------------------------------------= --- ----- .---------------- ------------- ----------- � Permit No. ......fog . -------- Issued �".............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C er#tfir Hof (Eomplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired X=X) by J.P.Macomber Jr. -------................................-------------------------------- ------ ---------------------------------------------------------------------------------------------------------------------- --------- ------------- 16 Hill Creek Road Centerville l"s'[]" at ---------------------------------------------- -------------------------- -----------------------------------------\------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of he State Environmental Code as d,scribed in the application for Disposal Works Construction Permit No. ... _^.. ._ .. dated ......�_..- .��:.�,�.,,�....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bi CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----- .................... ' ... Inspectof- ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE _"........... - � � FEE....f�. Disposal Works Conotrudion thrutit - Permission l hereby granted.... J.P.Macomber Jr.---- -•---•--___._----------•-•----•----r, to Construct (( or Repair 4X*an Individual Sewage Disposal System at No....16-_H.. 1. Creek Road Centervil e••-•----•----...----•-..._..--•..........................••-•-------••---...---------•...---•-_-••••- ........---• ----------- ------•- Street as shown on the application for Disposal Works Construction Per : o'A%. XDated_-___.• ..� ..�'.�".. _,d_.. `�l ........ Board of Health FORM 36508 HOBBS&WARREN,INC..PUBLISHERS 10-10-199? 6y-2t7HM CENT DST FIREDEPT ` SOOr,90�3f�5' P.02 1� MaKe appucauon io iocai rare uepanzmenL Fire Department retains original application and issues duplicate as Permit 'APPLICATION and PERMIT Fee:____1_0 00 for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: r Tank Owner Name(please print) -2°Ielk 241-20 /C X agnscure(Firlilyingtorperm4l Address Hill Creek Road, Centerville, MA street pry snre Z]p • • • • ' Company Name Enviro-Safe Corp- Co.orindividual Enviro-Safe Corp. pm Print Address P.O. Box 304, Sagamore Beach, MA Address PAN Pnnr Signature lying fo =e ) Signature(if applying for permit) X_IFCI Certified Other C IFCI Certified = LSP Other L IT M. Tank Location 15 Hill Creek Road, Centerville, MA 02632 Steal Address C-* Tank Capacity(gallons) l :000 Substance Last Stored #2 FuelFOil Tank Dimensions(diameter x length) Remarks: Firm transporting waste Fnviro-Safe Corp. State Lic. # MA-329 Hazardous waste manifes E.P.A. # Approved tank disposal yard Turner Salvage Tank yard# 002 Type of inert gas Tank yard address Lynn, MA City or Town Centerville FDID# 01920 Permit# Date of issue October 15, 1997 D to of expiration October 29, 1997 Dig safe approval number. 973708060 [Dig ale Toll ree Tel. r-600-322-4844 mb Ifill, /1 Signature/Title of Officer Granting permit —44- -- yl I - - I After removai(s)send Form -70-29OR signed by Local Fire Dept.to UST Regulatory Compliance Unit,One Ashburton Place, Room 1310, Boston, MA 02108- 618. SDI j� �f ? r' -�f��✓� r2�t'I aV(�� TOTAL P.02 TOWN OF BARNSTABLE LOCATION (� �i i� �E'(' C�( `.IZ� SEWAGE # (, VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME.& PHONE NO.�_J ►c rrim J,e r XScys. ,-Lo C, SEPTIC TANK CAPACITY (. LEACHING FACILITY:(type) �,'fi (size) UG NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER wStjbOOR OR OWNER 1,6 1,� DATE PERMIT ISSUED: �� -7 DATE COMPLIANCE ISSUED: ?—/ice.^ � VARIANCE GRANTED: Yes No �� . - _ . I - �. >i ��.�_ �/ � � �_ /'W � / � f� ��� v � , )c4 �\\ l; No. 3._/3 Fz;s ...... .. ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /b ` ...........................................OF.......................................------------------------------..._................. ApPration for UWposal Works Tonstrnrtinn Vamit �l Application is hereby made for a Permit to Construct (rj or R, it Individual Sewage Disposal System at:,��� f .....:.......... .... ......................... ---••••---.............-------•----------------..............------ Lo lion-Address r Lot No. .... - . " ... .................................... 'f�... ,.. ........................ Owne Address W --- :�. . .. .... ......--•••----•--.......--•----•--- ......--- � a� - :..... � ------------------------------------•-•---- Installer r Address UType of Building Size Lot.Se.Q--.� ------Sq. feet �-, Dwelling—No. of Bedrooms--_-.,,...................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ................................. . wDesign Flow........ ....................gallons per person-per day. Total daily flow------- 30................_...........gallons. WSeptic Tank v�Liquid capacity N ..gallons Length................ Width................ Diameter---------------- Depth.............. Disposal Trench—No. .................. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit N(CO_.r_0?o__----- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.........._.......... __- PL4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -----------------------------------------------------------------------------------------------•••--............................................. ....--.----- ODescription of Soil................................................................................................................................... ................................ x c, w UNature 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 TITL1Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance Ws bee 'ssued by the board of health. >gn '3!Date gg ... .. s1......Application Approved By---- ------ . -•------------------------•-----...---•--.......................------ ------ Application Disapproved or a following reasons----------------------------------------------------------------------------------------------------------------- -•-------------------------------------------•-•••••--•-------_...._..-•-••----------•---•...•-•---......-------------•---•--•-----•-•-•-•---•--•-----•-----••--•----•--•-----•••-•---•-------•-•------- Date PermitNo......................................................... Issued....................................................... Date v, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � ................. .......................OF........................................ ��� �� ��ppliratmwv* ��� �+ospasol Works Tv4vuurtKon ������ t � Application is hereby made for u Permit to Construct ( �� or Repair ( ) an Individual Sewage Disposal System at: __---- . cation Address or Lot No. - - ~ YA ' Aaaress Type of Building Size 8n feet Dwelling—No. of Bedrooms_-�3---------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other--Type of Building -......................... No. of persons............................ Sbm,rro ( ) -- Cafeteria ( ) ~� Other fixtures --_--- '-_-.---.'-- Dro�� / / per person per duv Iotu �u�v 330 Septic Tank-�Liquid Diameter-.----- Depth.............._ Disposal ��6 I�u �u�b Total �� _�. � ~� l�.(0 [u��'----- Width Total �-----'--'- ~~ ~~`~~o -----' � Seepage P� ".----^.--.. Diameter.................... Depth hclmv inlet.................... Totalure�-.---.--' ' �� Other D�t�bu600box ( \ Dosing tank � ) ~~ Percolation Test Results Performed 6y---.--.- ..................................................... Datc-----.-----.-.-...... Test Pit No. l................minutcoyccinc6 Depth of Test pit.................... Depth to 07000d water'_'--_-_.- Tea Pit No. 3................minutes per inch Depth of Test Pit.................... Depth toground water--_--_-_.- o4 --_------._'--.--''-.__'___--___'____________________________'____...___ 0 Description o of Soil\ ------'-'--'-.---------------'------------------_-----------.--.-----_---_--'-----. � U _----_----'-_.---__-__'_-.-'-_--_''--------'_-_---'-__--_----__-------_'_-----_._�_'-- -__----.--------_----_.--.--_-'---__--.-_'--_---.----_-'-.'--------..'--_'-___-- U Nature of Repairs or _-Answer when applicable...........................................................`................................... ................................................................................................................................................................ ..................................... � AXcerozout: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the o of�Z�IE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ~- operation until a Certificate of Compliance hwbeen issued by the board of health. ---------- /_3 Ao��u600 B11thollowing '' '' ' ..... .............. . -' -- ���''''----- ��py/u�tivo uivalg�rvvouxuxomx:------------------------._-----------------------'--- _-_-__.__--_-__-'---' _____--__---__-_-_—'---'_-'^........................ .............................. Date Permit | THE oOmMowvvsALrH or mxSsAc*usErrs � | ' BOARD OF HEALTH ..........................................OF..........---____'____________.__.__ � TyW � «�o����o�� �~°f Toutpliatta TH 0 CERTIFY, That the Individual Sewage Disposal S_stem constructed ( )ot'FIR-epaired �H 0 isp/osa1S- * .............�-�� ~ has bee instal ed in accordance with the provisions of TITLE 5 of The State Sanitary C Ve .'� in the application for Disposal Works Construction Permit THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONSATISFACTORY.DATE.---------------------------------------' Inspector.................................................................................... THE COMMONWEALTH ormAssAo*ussrrs | BOAR / ( �"� _ - -----�X�F-' --------- w' - � '". �- ��w r w~ t Li z3 qs s • • Z9 , 5 01� 88�a ei cl 0 CIO R!•b � povHL7. �4 l g411 � �30, q3, o t�.0ox ,3 81 L too \ Esc P -73 .6 J1 10-4 ,,.�_ G " � b . '18�G •V i �`A ,v PLPtN i S CANLE : I t ty. = O TV T, S11JG1.L- FAMILY - BEORUOM I . ►JO ,GARBAGE (�szII�D[�2 j pAILY F1_ow - Ito x 3 = 33o&pD• SEPTIG TA►JK = 330x150% ' ,4956YO %OOO GAL. o15Po5A1- PIT u5E 1000 51 DwJAIL Av-SX 150 5.F X a•5 t 5 EE HEE STL- BOTTOM AcLEAj �o �F• Po-- �=0� Pl_�t� 5 A c 5.t? x 1• o .�• 'TOTA 1- p ESIGN * .�-2�j G.P D. - c,TA.%- DA I1_Y F%-ow s 330 G•Po" j PE2GoLATIDu RATE] 1''IN 2MIN oft-E�55 � � , .6OF Mgss' aSN OF _ `T WIWAM J.+;. oa ALANC. c,G\ fV Y E `' o W' �► `$ ,p mo. 19334 O + N 2510Q y Cq�,U suR�E` f � J 90 TOP FNo-g1 0 HOLfs e IWV. a 1,o�aM >! loco INq. D15T. INS. GA1.. 8®,O SU6 SOIL BoyC p7.7 Scv Q'1. D (000 IIJ� -rA►AK �.6AGL1 INV. INV. ME'D1UM PiT ��� . • W17IA 87.3 SI��i.D 1��3/4•I%s. .� • I 1 WAWS0 6•ry►d 6 I i 81 • 0 . ,� ., .. �1 � � �I•� GESZTIPIC-s!� PI-oT PI..At�1 I.oCA-ticN Cr►J�''EQ.� 1 l..lo.�E No SCALE SCALE AS No-m1h.- No whT>=2. pL.AN REFra GE• z/ 3 /e3 csmr%FY -r p"r TNE�'RoP•Yjou�U , 5Noµ1N ►,Ar,.RG01,A COMPLY:S WITN-r HF- Auo sE1rt5AGK R.6Qvt12�MEN't� of Zµtr '(vWN OF'81�RNSTRBLFANv 1Li tAOT• �•...G• Z.`1 0 0 t 1.OGP.TE WIT 1*1 T F�.O0D PL IN D/.T E'� BAXTEIZ a W. C- INC.- R.EGiS�EQ6V LAN�Su "T1dl�j PI-D.I�1 Ili Nam- 4A�i�p AN OSTic2.VIl.LFs � �A'Ss• (. j1J5•T-R•uMEN'1' SVQVG-`( �r�'TNE OFK'SE"r5 6uQU!+� APP.LI�AP..IT No-t DG--. v,r �,-rcr pc'.Tc:.c -MI►�C I_�`� 11.tcr , �, -- , .:_r.; l�0 H rJ E.L`- P�Cc U A T J `. LOCATION SEWAGE PERMIT NO. y --VILLAGE .. U th INSTALLER'S NAME & ADDRESS t UILOE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 3o . t Pv ', Hi 11 cpee K !I O TOP OF FOUNDATION EL 41.0 Raise covers to within 6" of finish grade install risers as needed Raise covers to within 6" of STANDARD NOTES finish grade install risers as needed Raise one cover to within 6" of 31.0 finish grade install risers as needed 1) THIS PLAN IS FOR THE INSTALLATION / REPAIR OF A SEPTIC SYSTEM. tsROL14'7� SURFACE EL 25-t 2) ALL INSTALLATION PROCEDURES AND MATERIALS SHALL CONFORM TO 310 CMR 15.000, THE STATE ENVIRONMENTAL CODE, �- --------- TITLE 5, AND THE TOWN OF ----Barnstable---- SUBSURFACE DISPOSAL REGULATIONS. Proposed 3) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE OF A VAILABLE PROPERTY INFORMATION WITH RECORDED DEEDS D - BOX { MIN 2' LAYER DOUBLE WASHED 29 2'MIN--3'MAX Install MIN 2' LAYER DOUBLE WASHED ; 1/8'- 1/2' STONE Qg MIN 2' LAYER DOUBLE WASHED OR ZONING REGULATIONS. 2'MIN-3"MAX 1/8'- 1/2' STONE 1/S'- 1/2' STONE 4) THIS PROPERTY IS SERVICED BY TOWN WATER INVERT EL 10 28.Ei `_ Tee - -- _- - TOP EL 22 0 15' Min J '� 14" V EL �- -� "� Slope Breakout I 5) THERE ARE NO KNOWN WELLS WITHIN 150' OF THE PROPOSED SOIL ABSORPTION SYSTEM 29.05 / IN 1 p 14„ /� 28.35 - --- - El 21.0 " 28.8 Proposed _ _ -- _ _ _ _ 24- IN 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TO WITHIN 6 OF FINISHED GRADE VERT EL INSSTALL INV EL _ -_ _ _ EFFEi'T1 T �� 7 ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY Existing INV EL � R INSTALL Proposed s1DEWALL ) BAFFLE Existing GAS BAFFLE 21.55 r snMNE BASE UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, WHICH WOULD INTERFERE WITH THE PERFORMANCE, ACCESS, INSPECTION 6"STONE BASE 01.38 21.0 •b b PUMPING OR REPAIR. INV EL L3/.4' 1/2 DOUBLE s" STONE BASE INV EL INV EL --- -- 500 Gal Conc H-10 ti "� ED STONE 6 NO DRIVEWAY, PARKING OR TURNING AREA, OR OTHER IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION Chambers with -4- stone all around S ) Existing (H-10) 3/4'- 1 1/2" DOUBLE 0. SYSTEM, EXCEPT WHEN VENTING HAS BEEN PROVIDED. 1,000 Gal Septic Tank Proposed H-10 WASHED STONE i500 Gal Chambers ) , p ( ) „ , o �I BOTTOM EL 9 SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE 12 To Remain 4 1,000 Gal Septic Tank 32; (4'-.10" x 8'-6 x 3-D ) h( ti TO ENSURE STABILITY AND PREVENT SETTLING. S = 0.06 S = 0.05 -� I 14' 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENGTH. 42' x 12'-10" SAS 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' EL 7 2 Bo Test OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE USED. 42.0' Pit # --- 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC. 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESS VENTING HAS BEEN PROVIDED. 14) IN THE AREAS OF EXCAVATION, EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS: 15) IF SOILS ARE ENCOUNTERED DURING THE EXCAVATION OF THE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM THE DEEP OBSERVATIOM HOLE LOG, CONTACT A & M LAND SERVICES AND TOWN BOH BEFORE PROCEEDING. 16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES: PRIOR TO CONSTRUCTION 17) CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION TO A & M LAND SERVICES AND TOWN BOH FOR REVIEW AND APPROVAL 18) CONTRACTOR SHALL NOTIFY TOWN AND DESIGN ENGINEER AT LEAST 24 - 48 HOURS PRIOR TO INSPECTION(S). Map 187 Parcel 4 DEEP OBSERVATION DEEP OBSERVATION 6601200, HOLE LOG HOLE LOG N 19 Test Hole #1 Perc# Test Hole #2 Perc# (EL = 18.2 t) 12255 (EL = 26.2 f) 12255 D lev Soil Soil Soil p h ev Soil Soil Soil � 1 ft) Horizon Texture Color fat} �ft) Horizon Tezture Color (USDA) (Munsell) (USDA) (Mansell) 0 - 8" 17.5 AOE LOAMY SAND 10YR5/1 o - 1z' 25.2 AOE LOAMY SAND 10YR5/1 cSl 8" - 2x' 16.4 B LOAMY SAND 7.5YR5/6 1x' - z8" 23.9 B LOAMY SAND / 7.SYR5 6 \ �S 22" - 132" 72 C COARSE SAND 2.5Y716 28" - 122" 16.0 C COARSE SAND 2.5Y716 w/blotches w/blotches Map 188 Parcel 122 Deep Ohs Hole Date: 5130108 Deep Ohs Hole Date: 5/30/08 \ 1 Soil Evaluator. ED STONE Soil Evaluator. ED STONE Witnessed By.. Don Des pmrds Witnessed By: Don Desmarts Pere Rate: <2 A/in/In ® 48" Pere Rate: <2 JGa/!a R = 150 \ \\• Soil Survey Description: CARVER Soil Survey Description: CARVER J _ Geologic Material: GLACIAL OUWAsa MOARAINE Geologic Material• GLACIAL ourrasH yaexALNE Depth to Water. NA Depth to Standing Water. NA I L - 48.83 D/yy r 1 - - _f� Depth to Weeping g Water. NA Depth to Weeping Water. NA Depth to Mottling(Color): NA Depth to Mottling(Color): NA Est Seasonal High GW: NA Est Seasonal High GWs NA, USGS Observation Well: NA USGS Observation Well: NA Date of last Measurement: Date of Last Measurement: I > - _ Comments: - Comments: Lot a �, \ t a A cres p - DESIGN DATA Number of ]Bedrooms: 5 \ St \ Garbage Grinder: NO X3� Design Flow: (110 Gal/BR/Day 1,000 Gal � g x Number of BR) 550 \ pQ 0 / / Septic Tank:; (To Remain) .111000 tiJ-/Tank r I ,} `� (Minimum Design Flour x 2009) Gal. /, / Pool / / 4jnn, Septic Tank: Proposed 1,000 ,00� �V (Minimum Design Flow z 200R) Gal �0' Leaching Area: o . Proposed G / � g a,R / �j�, Map 188 Sidewall: / 1, 000 Gal / Parcel 77 (2 SidewaDs x 4z_Ft x 2' Ft) + Deed Reference S- Tank / � 1z B�-r x 2-_Ft) Cer t 152036 / I / (2 Endwalls x ^- 219 Sq. Ft. 0 / '�C / Bottom: 538 Sq. Ft. / /\ 42_Ft x _1ze3Ft) 757 sq. Ft Plan Reference \ / L. C. Plan 27801A Long Term Acceptance Rate (LTAR): x 0.74 �Tub Leaching Area Design Capacity 560 GPD / Pero (Sidewall Area + Bottom Area) x LTAR p � O / \ De9k , b, A / F / 18'/' r w 24 ' \ � ASSESSORS MAP � � Holeyl- 30 Proposed 560 GPD Provided - 550 GPD Required _ _10_ Reserve / D-Box ......._. ,5� / ! - ....:... .� Septic t upgrade Repair -Plan i..... / / Remove existing leach pits / 4o't Prepared For. -.- ' ..•••• ���-/ Pump, crush and sand.fill as required per Title v Appleant/Owner • � Kevin Gral ton Proposed , - " �,t�OF RA& �- 16 Hill Creek Road ' Floor Plans - - / �`4S e/ ' , i ,--,, aR � cyG�� Centerville, MA 026�32 1 V. 1 . M�YER No. 1140 Bed �F �o PREPARED BY. s a A & M Land Services �+NITAR\P 618 Main Street / Obs '/ Parcel .�. West Yarmouth, MA 02675 /$Hole ' , � / 45 Bath Family Room (508) 771-5263 Cell 508 737-1777 ti Locus Map 0�` (lath N.T.S. �r " $e Bed Kier �ygr�of h2� SCALE. 1" = 20' , DATE.• June 4, 2008 A� A. Bed gain s /eke' II'1"v' R1 �'G��` Q+ I Kit Bath REV. 10128108 R = 100' / Foyer Bath STC31G �v '.,.� - No,26 L = 75.0 - / / �Q ,L Bed / Holly Hill �oT � - DiYl 4F,F1 .! 7 c Bed LOCUS 1 DWG. NO. 5025 SHEET 1 OF 1 Living GRAPHIC SCALE v Scudder Bay 20 0 10 20 40 80 in Second Floor R = 18.0 L = 28.27' First Floor' ( IN FEET ) i 1 inch = 20 ft.