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HomeMy WebLinkAbout0021 HYDE PARK ROAD - Health (2) 21 k-I_yde Park sCpm-�cI A 1?3=0 1'6-010 SMEAD No. H163OR UPC 10259 smead.com • Made in USA �crot� I 3 v 14 Us it ���r �+oJ�4� ' bv���' :A l 4 f� tFr� o r p 209 21 Hyde Park Road,Centerville (�%fvd w•r � 'Sit-i,�t c' �, � � 7"front steps Frist Floor K 4� LP F i Living Room r Study i 1 pr.try Rr S One car Garage 24' EC 0 Kitchen Dinning Room Full ba 11 throom reo m with vas her drierEI Deck 14' 16' 2nd floor ' 14' I 14' c Vaulted Ceiling Closet Closet t e t r Cat tall Bedroom 1 Bedroom 3 M Bedroom 2 C c Bath 0 room e t 20' 0 P.AAlN WATER 13' SHUTOFF :SEATI N'G WATER HEATER GAS 1018.. ROOM y HEATTMEG GAs io°2" s� sH F ' UNFINISHEC 35 i concrete STORAGE _�� _ _ iX�_ �~_~ 0 1 inchTongue and 5 = Groove Foam insul. 5' a internal wall not insu[ L L ,v 5D 'Q stud wall insulated To Bulkhead Door Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Hyde Park Rd. CQ Property Address Dorothea F. Hanabury 1-73 _01b _CIO Owner Owner's Name information is required for Centerville, Ma. 02632 7/9/2008 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Importslin When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your- Raymond F. Dumas, Jr. cursor-do not use the return Name of Inspector key. Dumas Landscape Const. Inc. Company Name VQ 564 Old Stage Rd. Company Address Centerville, Ma. 02632 City/Town State Zip Code 508-778-0249 S1437 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 1,5,340 of Title 5 (310 CMR 15.000). The system: , ® Passes ❑ Conditionally Passes ❑ Fails_ G ❑ Needs Further Evaluation by the Local Approving Authority C� co w 7/9/2008 �- c is Si nature Date f�1 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. Title Five Inspection Forms 08.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville Ma. 02632 7/9/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR.15.304 exist. Any failure criteria not evaluated are . indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville, Ma. 02632 7/9/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 El obstruction is removed ND Explain: 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 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. Title Five Inspection Forms 08.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 11 Commonwealth of.Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments „ 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville, Ma. 02632 7/9/2008 every page. City/Town State Zip Code Date of Inspection. B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) 'System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or, clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® 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. Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville, Ma. 02632 7/9/2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes .No ❑ ® 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. Title Five Inspection Forms 08.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville, Ma. 02632 7/9/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in h previous ® ❑ y the p e ous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance.is unacceptable) [310 CMR 15.302(5)] Title Five Inspection Forms 08.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts ECENRUM W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville Ma 02632 7/9/2008 every page. Cityrrown State Zip Code Date of Inspection 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 d x#of bedrooms): 9P )( P 330 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 3000 gal 2008/ 30000 gal 2007 Sump pump? ❑ Yes ® No 7/9/2008 Last date of occupancy: Date 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: Last date of occupancy/use: Date Other(describe): Title Five Inspection Forms 08,doc-03108 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Hyde Park Rd. Property.Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville, Ma. 02632 7/9/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Home owner 6/26108 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 El Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 12/5/85 Were sewage odors detected when arriving at the site? ❑ Yes ® No Title Five Inspection Forms 08.doc-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville Ma. 02632 7/9/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 23"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Good Septic Tank (locate on site plan): Depth below grade: 4"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: approx 6'x8' Sludge depth: none Distance from top of sludge to bottom of outlet tee or baffle n/a Scum thickness none Distance from top of scum to top of outlet tee or baffle n/a Distance from bottom of scum to bottom of outlet tee or baffle all water How were dimensions determined? Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts w . Title 5 Official Inspection . Form a a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville, Ma. 02632 7/9/2008 every 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.): Good condition 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 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): Title Five Inspection Fortes 08.doc-03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville Ma. 02632 7/9/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at level 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 carryover PumpChamber locate on site plan): ( p ) Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 5. 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville, Ma. 02632 7/9/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of.technology: flow diffusers 28' long 8'wide 1' deep Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): All good Title Five Inspection Forms 08.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville Ma. 02632 7/9/2008 . every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration no cesspools 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title Five Inspection Forms 08.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title- 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM y 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name information is required for Centerville, Ma. 02632 7/9/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. J-- r y 23 I i i m VA-ir k L;iqG i Title Five Inspection Forms 08.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 Hyde Park Rd. Property Address Dorothea F. Hanabury Owner Owner's Name informatifor on is required Centerville, Ma. 02632 7/9/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells 12 ft. Estimated depth to high ground water: 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: 11/20/85Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Info from board of health records ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plans on record Title Five Inspection Forms 08.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 SECTION - SEWAGE -SEPTIC TANK- �.. _;.D..BOX- TOP F FON "2"OF 118TO Ih" (MSW i! WASHED STONE ' l 6g•� / �c.o tN- OUT IN• � � �DOOG -�N•- _ OUT- 66,2, TANK SEPTIC ELEV. ELEV. ELEV. f 1 ELEV. �I — 1 _.._...... �\I n �J JJ I_��, ••'' /� j -WASHED STONE J!1 I - �.o�u s�Ir� wo.T� • TEST HOLE LOG u_Wa:I- �g.S TEST BYIE� I�P-�K -� •��Ol�LC�1�,� WITNESS TEST DATE /,a /6 cQ �} BEDROOM HOUSE g D€V�G+7 T.N. T T.H. 2 -LC ELEV.&6, I ELEV. NO PERC RATE MIWIN. DISPOSER DISPOSER G` tJ FLOW RATE 33ckGAL./DAY) 3� - SEPTIC TANK a50 4r) y Go„ S� in REQ'D,SEPTICTANKSIZE l ooc� LAN `FACFLI Z s SIDE WALL. 72 =. S c/D. T TOUL_nF 53. USE: WATER ENCOUNTERED --� I11OTE5 (UNLESS OTHERWISE NOTED) L DATUM IMSL);TAKEN FROM �'� 1 QUADRANGLEMAP 2.:MUNI CI PAL WATER AVAILABLE 3.PIPE PITCH:%-PER FOOT �/ 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO-• Tf /O -44 ��t� OF 5-MIN-GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. 6:PIPE JOINTS SHALL BE MADE WATERTIGHT ARNE 7:CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. STATE ENVIRONMENTAL CODE TITLES QJALA, 8. Tt-a+s 'at�J.a_J FoL 7'��'7t7.�c� I.JorG)C p•.J�Y a:.�� 'S+-ic��`� % c� ;CIVIL:�- w I--to-t� V.LE U�� r'a� .�Lo7c..L�`� t-.vC= '��-a.C.++._tG� j•j, � �,• ti0_-307$2� LOLL t4v46UITAP,-Lr MATE►Zl4\L TO f5G- =- REG. INEE 9F_:r,AGED t3E-jWer_-j-1 ELEV. C ,4 /��IL For, 10' /-J kOL( I`l0 BOARD OF HEALTH CONTOURS IPRo OSED)-0-0 0-0- APPROVED - DATE � i•. ".i l;: ��q �• � - ...Syr i i .. LoT 1(12 �W/ 17,`1231 -� / r (C�' nl, . x 2' nor H� 1•, — t joT = L R p,/:) J5 i I\.l j ICATE G8 ECr�CU� �= t�t�JtJOF� GE�Ti�� rD I+ 1�T c� �TtS. -Tlo�f-t. SITE PLAN o"' LOCUS: L07- E I�r r'` of - /� REF: dm ►n cape en�i���rin� ' ; yes -- � s���� eo��T► cc���i�� H. ^' PREPARED.FOR: CIVIL ENGINEERS -Ot-Vr.177- )G Y �II-7/8 �iV.�l�fbli3 LAND SURVEYORS D SUg� /STEM SCALE ,,�4 DATE ' F1HE Town of Barnstable O Tp� Regulatory Services BARNSTABLE, Thomas F. Geiler,Director MASS. E1639. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC Disclaimer Private Septic Inspections.DOC' WF Fa No erg: .` 1. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �C�L�.� ........O F..............P ,!..A 5.T .4.... .... Appliration for Disposal Works Tonstrudiott rtrMit Applicatio is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal system at: Ruh ti-a t .... 7 ... " .-. f..�.. ' r z ,. a :..................•- ....... Location Ad ress •/. ............ .... ...................Lot N»................................»....... (e.�ner Address .............s:.' .c-->. �...`� �f.. ................... ......•-------.........---•-•--- ...• •----•-••---.............---................... Installer Address Type of Building Size Lot../2i•2.?—.?_-_;t..Sq. feet a Dwelling—No. of Bedrooms...............�3......__......__....._.._...Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .........:.................. No.. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures .........--•.............. ...................................................................................-•----..............-----•.........---- W Design Flow.............IQ......................gallons per person per day. Total daily flow......... .�. ...1.. ............gallons. WSeptic Tank—Liquid capacity/.QdQgallons Length.�...�Q?'f Width: ".. Dia'meter=7 Depth�:...... x Disposal Trench—No..................... Width..................... Total Length-------------------- Total leaching area....................sq. ft. 3 Seepage Pit No.._ _ '�_.. Diameter......1 P....... Depth below inlet.......1......... Total leaching area.Z24:.d.sq. ft. Z Other Distribution box k�Q) Dosing tank ( ) Percolation Test Results Performed by.....: ......... I........T ..:.:.,._..15. ;� .d. ............... Date..... 0 /...../..:.... 14 Test Pit No. 1.G.Z...minutes per inch Depth of Test Pit...!a.E)—s Depth to ground water..... T.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ........--•••--•••---•..... ............... •.................................. ............................................................. O Description of Soil......, .. dF----.L ......47.._. ff ... W •-••--........�J!Qc%L_e......... -•--.�i'!t' :.. !4T C .. i ....... ... T... .. C� VNature of Repairs or Alterations—Answer when applicable............................................................................................... ........... . . .................. .............. Agreement: The undersigned agrees to install described Individual Sewage Disposal System in accordance with the provisions of:IM S of the Sta i ry Code—The undersigned further agrees not to place the system in o n until e i to of Comp a as bee issued by xhe bo d of health. _ f,Ej',,.1� .Signed j�... ��yy ... !/J ........--•--------------••-• .......................... ©.... �i�i �c; rs� ' ............._ .....A 'cation A roved B ! Date Application Disapproved for the f of 'ng reasons:.................•---...................------•--•--•-••--....------•--••---.................................... ..........................................................•-•-----........---................---.............:----•---•--..........................-•---............--••-•----•-......................... Date PermitNo......................................................... Issued................ ................................ Date 1 �' ' ��'"7HE COMMONWEALTH OF MASSACHUSETTS 1-73 Yap BOARD OF HEALTH ..-`-tax v l ...........OF.............�-..A.�.�.�r��C............. Appliration for Disposal Works Tonotrwion rrrmit Application is hereby made for a Permit to Construct (A-for Repair ( ) an Individual Sewage Disposal System at: �...1. u<_f, +4 0 1 ....�?. . .... Address .7 fij �cl T� Tit ?'Ylas�:.................... Location- or Lot No. .............. ............. ......--•---..................«......_..... e _ _a Address `d ?. r ............................ ............. ..... ... ..... fit--................... ..-••--..............."-•--..........................--•--••---................................... Installer Address Type of Building Size Lot._1.,.2z. ..Sq. feet .. Dwelling—No. of Bedrooms...............��......._......_._...........Expansion Attic ( ) Garbage Grinder',( ) aOther —Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria (1 ) QOther fixtures ................ -... ...........•-•---•----....--••--•--.....•--...---.......... W ' Design Flow............&�......................gallons per person per day. Total'daily flow.......:. ?'?................gallons. W Septic Tank—Liquid capacity j gallons Length.2'.��. " Width:`F.����. Diameter:.-"."""'.'-. Depth.��:' x Disposal Trench—No..................... Width.................... Total Length............-------- Total leaching area....................sq. ft. 3' Seepage Pit No...�la.o_... Diameter.......1.p........ Depth below inlet....ti......... Total leaching area-: �.d.sq. ft. Z Other Distribution box( ) Dosing tank ( ) r 1"4 Percolation Test Results Performed by......Z'--..+..�A/�-" -� AJ Date.... e �d—Ag�..... ....•.•--•-...... Test Pit No. i.G"4-...minutes per inch Depth of Test Pit... ._Er)Depth to ground water.....?.F7".. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil..... .. ........®�...._.�? -:�.... ....SL{ �:©�G._. ...3 r-7 , -C% .c-c. ,c1,,.. .. /ti! '`�,o.wtl + -7 F?", �F GL�,�r-4- c c? , V ...... ------------ .---- --------•••-------... . ..............." W `'�L�ti�t� �, c v a r _ ,S/l�ca 1.t e r✓` .'j-7- [2 rr, I•---•----------••-•--------•.............•. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ......................................................................................................................................................................................................... Agreement: The undersigned agrees to install described Individual Sewage Disposal System in accordance with the provisions of TI"' - 5 of the , a i y Code—The undersigned further agrees not to place the system in o n..until e i to of Comp as bee issued by e b d of health. Signed .. .... ... .....................•--••-.. ................................ Da acation A proved By.................... Date .... Application Disapproved for the f of ing reasons:.............. ............................................................................ :.................... .......................................•-•-•--.......•--•--................................... ..._....•--••-......-•••-•-•--•-•••••••--•-•-•-.........--•--......-----•.............--•-.-•--•- Date 1 Permit No..................................................... Issued....................................................... Date ,�ab'MpF#Fa•�.•mrr'�5a��aa op-�wc..sa.aa,.,.�xrsasw�iit FfF 4.'A`«a S44'ri•i8�s E-fl�•g-rtie^fSP6�n.aphis}r+...assgs}�3,:f!�.��i+rF b;i:�5«4!F?Ofa•c. s{w�p i.wg THE COMMONWEALTH OF MASSACHUSETTS ----�'" BOARD OF-,HEALTH ..........................................OF................ .Nam....!`......Z `................. Cnrrtifiratr of Tomphattrie THIS IS TO CERTIFY, That the I.ndividual Sewage Disposal System constructed ( ) or Repaired ( ) by....................` 7 S f 1 r c :� -. ..................---•--....--•---------....................---.............................._ Ins ? -f-i+ Q, --q-r �C'�tatter �/ .,V at............... - . •---....,....................;...-•--... ................................................C`................................................................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in 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. to DATE...... �l_. .. ........................................ Inspector...... `...................--•----•---••-- ....---........................ ...........«......... ............... .....-..................wr.....„w e.,w..�..e»e•e...u.�se..,ra..a•o.a.as...r..... .........-- TH'E COMMONWEALTH OF MASSACHUSETTS V ' BOARD OF HEALTH 5 L, CO/ p NO `fryer ..,.:._; Q6- 1 6 �? !..........oF....��`..� 't........... ... ....:.....5•+!:( No......................... F ........ lRispos' al Works Unshvdigla f amif _. Permission is hereby granted.......... :...... . ........... .. ... to Construct ( ) `or Repair ( ) an Individual Sewage Disposal--System r f' at No.............. ....�.s-?i..-41.�........... H,m(0 1/)A i': �I ..... ._.._ i?.,v`; }l f3�. ....... !.. ..... .... ..... ..... ..... � •� Street • as shown on the application for Disposal Works Construction Permit No.._.��?'a�-� � ted..._.... � PP P r 1 r,, /�-, oard of Ifealth DATE..._.... ... / =� I...-----•-........ ` z 4 '� t r 362.4541 926 main street yarmouth mass. 02675 do wo Cape en��nee�,�n� civil engineers& land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys site planning August 5, 1986 sewage system designs Barnstable Town Hall inspections Board Of Health .South Street Hyannis, MA 02601. permits Gentlemen: Please be advised that on June 17, 1986 Down Cape Engin eering inspected the septic system installation located at Lot #9 on Hyde Park Road, Centerville. We hereby certify that the installation complies with Massachusetts Environmental Code Title V, Town of Barnstable Health Regulations, and our approved site plan # 84-198-9 revised March 10, 1986. Sincerely, Arne H. Ojala, P.E., R.t.S. AHO/amp Inspected by Timothy Covell r l �J I, R.2p0 PAR 1� 00 A.2p 03 � M n b n 10 = x� U- l�Y �o �U i o o �T' b�S C'Or Or Pl j +� I�Lor,1-0 (.!JP 0r F!� \ EL. .. / 44 1 �� 0 I i1 r r�P✓ r C j%t'jK' l"TOJ JOB # 84-198 CERTIFIED PLOT PLAN PREPARED FOP.- LOCATION: LOT-9 HYDE PARK BARN SCALE: 1=40 DATE. 04/14/86 REFERENCE: PB383 PG39 BAYSIDE CONSTRUCTION I HEREBY CERTIFY THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON H OF ,, AR down cape engineering CIVIL ENGINEERS Ao #26 48 0 LAND SURVEYORS ��ss '�Ec�ST ROUTE 6A YARMOUTH MA DATE RE Sak4�'� J VEYOR � 362.4541 926 mein street yarmouth mass. 02676 down cape engineering civil engineers&land surveyors structural design Ame H.OJala P.E.,R.LS. !and court Richard R.Falrbank P.E. surveys site planning June 18, 1986 sewage system iesigns Barnstable Town Hall nspections Board of Health South Street Hyannis, MA 02601 )ermits Gentlemen: On June 17,;1986 Down Cape Engineering inspected the Installation of the sewage system on Lot 9, Hyde Park Road and find that it meets the intent of our design #84-198-9 revised March 10, 1986. Very truly yours, Arne H. Ojala, P.E., R.L.S. Inspected by: Timothy Covell AHO/amp - - -- ,-. �y R.20p.00 PAR1� Ar2p 03 M tv go L oT 10 = All. 6 b yy•o� o. 14 o Xi-rp4oD-BOX OF Pi PE - #F00 TOP PI P5� �6 ►y0'pp OUTL r 44�UPArl0►.1(TbP OF PI P�� Il1LE(" TO �PfC'1'A�li�C'rOP OF PI P�> EL.._ &7.20' OUTi r FROM .PfiC -VANK(10P of PI P�) _ JOB # 84 . 198 CERTIFIED PLOT PLAN 'A6-6J1U-rl � 'G � G `31 PREPARED FOR: LOCATION: LOT-9 HYDE PARK BARN SCALE: 1=40 DATE: 04/14/86 REFERENCE: PB383 RG39 BAYSIDE CONSTRUCTION I HEREBY CERTIFY THAT THE BUILDING SHOWN ON THIS PLAN .IS LOCATED ON THE GROUND AS SHOWN HEREON Z11 OF - AR down cape engineering CIVIL ENGINEERS �' x26 o- LAND SURVEYORS `�•Is �f'IST POLITE 6A YAPMOUTH MA DATE I W-�EYOR TOWN OF BARNSTABLE LOCATION - SEWAGE# '/// `VILLAGE ASSESSOR'S MAP&PARCEL /73 /oi O INSTALLERS NAME&PHONE NO. T 3� � SEPTIC TANK CAPACITY l 000 LEACHING FACILITY: e Q,,� (typ ) 3 2 (size) V1 NO.OF BEDROOMS OWNER PERMIT DATE: /2— S- S�� COMPLIANCE DATE: (P /2- 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 vat' � , �! �G �� i 3 �� ��� f V PARCEL ASSESSOR'S MAP NO l 1 LOC T�104 SEWAGE PERMIT NO. 'VILLAGE Ce�.�-ecv��� INSTA LLER'S � NAME i ADDRESS �08UILDER OR OWNER alck DATE PERMiIT ISSUED 0� DATE COMPLIANCE ISSUED -L.��� 1j V3- -cattt $2 A� w�m1 1 Jt" ^wA C SECTION — SEWAGE SEPTIC TANK- _,.D..BOX - 41 TOP F FON 1 ( \ (J/� —"2"OF VaTO 4t" !=IL(MSI)s WASHEO STONE - ZD IjN, OUT• } IN• OUT• IN• 7� ,• � SEPTIC TANKs.4 `f�f,e ELEV. ELEV. ELEV. l �^ I ELEV. �I —i f. ��G JI/�Li_✓ 1"_I-V�-1 .1 _:_ ELEV. ELEV. !. hT- Icy mW/ 1 ., I. 1 ' WASHED STONE OFW"-1Vt TEST HOLE LOG / 1 TEST BY - ATE WITNESS �} BEDROOM HOUSE TEST D DESIGN r t \ I \ T.H.- T T.H. 2 \ \ - -_.L[ ELEV.C�. I ELEV. NO • n r.:.a \ I \;( �1 \ �I L S P C? M N IN. DISPOSER DISPOSER _ - 24 �� Y+y 61 ERC RATE I / FLAW RATE 33�IccAL/4Av) - a% v c(ti A �. N 1.. — t�o-( v � . ll� SEPTIC TANK_ a . (/S= ►� `' tih REQDSEPT-IC TANK SIZE IOC�c� � '_ 9 %i`' ` ' a �� . I - .. GL -,�.I.t 58 S•� LEACH 'FACILI T SIDE WALL I (��) G/D. d 1 ---BOTTOM C� ..� } < ,3 :. G./D. }DI TOTAL 17,7 3�� � ( � L0I� ;2 0 USE: �+-iR, P�L_j_1 � 10 J1s / 'S WATERENCOUNTERED ^ yy-� /�/� (� NOTES': (UNLESS OTHERWISE NOTED) �i��C;-t-�or�1 <�• ��.i�.1oF� 1 I -r-r G DATUM(MSU TAKEN FROM ' ` QUADRANGLE.MAP � v� �� ��±�`` G�F- T. 2.PMU CIPALPITCH:WATER FOOT ^AVAILABLE3. ,(� I -} GCiI--- 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- / ' -/ -44 `t11 Qf I , i I ����Tr`��T 1��' 5.MIN.-GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. 6.PIPE JOINTS SHALL BE MADE WATERTIGHT ARNE H. 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. F STATE ENVIRONMENTAL CODE TITLE 5 Q ' o IAL�► O SITE PLAN : •�� _ 8. �-1-,,,g mac.-�.� Foc ����.�a �,c't�C ou`-c <..::►v ��s�.'� _ i �.r ,•CIVIL : LOCUS• Np_-307$f✓ - 1-10T @sE USED �a�- .�ZO r`Z=L�`� l_��..LG— �Tla,��+.sC+ �7, .. . 9 AI-L L(�1sui a6Lt M/JTEIZIAL To t�ovc-17_ fl �;. pf _ )`r_-rLAGEV r6E[WE�-1 ELEV, �4� /Wvc, A<o F-O REG. INEERI /��t/OF � �' .. REF: l o' �.RoLt�lO Ii�AGi�lt-lC��,►�E.4. _ I _ ,% � o� . ARk�; yo i` ii� ��jf!•�C �IL�JTt2C�C�'t?J��� WOW Ctlpe @O���Ij��PIB�� ;'� ;`q � H. �^ PREPARED FOR: CIVIL ENGINEERS TOURS IzZQjG� Y 1/1-7 �>��o � BOARD OF HEALTH ' ��.��'�; LAND$URVEYORS — '�G sTt SCALE - ON d- T (EXISTING)------- 'l� C (PROPOSED)- -*-O-O- APPROVED DATE ����J y !Y'` MA 'S/ 4l 111�/ DATE v "