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HomeMy WebLinkAbout0030 JUNIPER ROAD - Health 30 Juniper Road Centerville A=210— 116 FTsMEAD No. 53LOR UPC 12543 smead.com - Made to USA TOWN OF BARNSTABLE LOCATION 361 17do SEWAGE# o?O-eT -Z2 VILLAGE t ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) SVO Pe l 4f (size) S—J;4>1 NO.OF BEDROOMS OWNER 4,1, PERMIT DATE: 1p: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist -s within 300 feet of leaching facility). feet FURNISHED BY.f ,,,✓ C r � �6d I`, r Notes'-'y '� •' Fee �® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,`iVIASSACHUSETTS Yes ZIPPrication for 0-5pozar �§pg;tem Conztruction Permit Application for a Permit to Construct( ) Repair V(Upgrade( ) Abandon( ) D? Complete System ❑Individual Components Location Address or Lot No. O �(�(�/ � Own 's Name,Address,and Tel.No. ,p J Assessor's Map/Parcel Gew Installer's Name,Ad ress,and Tel.No. Designer's Name,Address and Tel.No. 77 Type of Building: (� Dwelling No.of Bedrooms Lot Size % 10 sq.ft. Garbage Grinder ( Q Other Type of Building Lo tiGIG{' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requir d) 0) gpd Design flow provided y�cj gpd Plan Date © Number of sheets / Revision Date Title J0 Size of Septic Tank Type of S.A.S. 5, Q �S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this BoaA of H Ith Si ned Date � �lep Application Approved by Date J c3® Application Disapproved by: Date for the following reasons Permit No. �'���' �— Date Issued U ` .: • ...-• v �.._.. T �,.•.f+.a91/s -. -r-Y.+....-+M1v:.". �. ✓- .,.a.•M .'4: ♦r _ r -•�+T 7 :.� .-1. ...'\- �• Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compute; PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE;K,4ASSACHUSETTS Yes, Tfp.pricatiott fbr i�ponl *pgtemc Con!5truction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) U Complete System ❑Individual Components ,.l Location Address oeo r Lot No. 3© �(��/��/� f^ Own 's Nya--me,Address,and Tel.No. Assessor's Map/Parcel �� �l/�^. el Sy [ -aa� Ile Installer's Name,A dress and Tel No. Designe 's Name,Address and Tel No. ' Type of Building: Dwelling No.of Bedrooms Lot Size % yple� sq. ft. Garbage Grinder ( Q Other Type of Building G�7//� !�/�G" 'No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requi ed)_ _-3,jLI; gpd Design flow provided / 7S gpd t i Plan Date , ;12 7 �99' Number of sheets _p/ Revision Date ` Title .a f l ° D' / Size of Septic Tank Type of S.A.S. 4Z6'X Description of Soil g a Nature of Repairs or Alterations(Answer when applicable) .N t 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa d of ft all /� S', ned (� ._ Date 5A, le9 i Application Approved by Date 30 G Application Disapproved by: Date for the following reasons r Permit No. Date Issued U a ----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage.Disposal System Constructed ( ) Repaired (v ) Upgraded ( ) Abandoned( )by ��/'r, /, t!�O�s/ , at 3� �uh/I�L�/� r , C eol-,e/~6-!/-I e has been constructed in acc rdance with the provisions of Title/5 and the for Disposal System Construction Permit No. dated Jam' U Installer D r �!i'!G'�/� Designer ,00 4t"w #bedrooms Approved design,flow / �, C' gpd The issuance of this permit all .© b construed as a guarantee that the system wi I unction as desig ed. \ Date Inspector No. �•os­ �' o`-U /UG———— r•J THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS V x1h5poal i§p.5tem Con,5truction Permit j Permission is hereby granted to Construct ( ) Repair (►��,),Upgrade ( ) Abandon ( ) System located at z5� X(/JJ/~�Z�I" lit' G��Ie and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be c mpleted within three years of the dafe of this pe�il � Date �/� o 0 r ApproMy r. FROM :down cape engineering the FAX NO. :150836213880 Sep. 11 2008 07:53AN P1 Town of Barnstable ��11E Regulatory Services Thomas F. Ceiiler,Director w BARNBTABI.i:. KAM Public Health Diviskin r+Pa °i Tbomas McKean, Th rector 200 Main Street,Hyannis,]VIA 02Q1 Office: 508-862 4644 Tay:: 509-790-6304 Installer&Desizaer Certification Form Date: .11V a� Sewage 1'crYlYit# c�� o�a Assessor's 1�igcplPareel Designer: 0 e '04 Installer: 60,-�1 oe^A Address: Address: / ,0• 0 ..... � iy(}�. 61t /"�1� �a..r✓ Dno l�� �� On. was issued a permit to install a _(elate) - 0nst&1Je.r) septic System at (50 �J V,r)I based on a design drawn by (aress) dated (des gncr) 1. certify that the, Septic systeYn referenced alxwe was installed substanti.Wly according to the design, which m.ay include minor approved changes such as lateral relocation of the distribution box and/or septic tank, tgam, dyrzNc� ( 6j'o'r _ �.r- d 94 l�{i Gtz.� 5,.T I certify that the septic system. mferenced above was installed with major changes (i.e. greater than 1 0' lateral relocation of the SAS or any vertical rekocati.on of any component of the septic system) but in accordance with State & Local. Regulations, Plan revision or _J certified as=built by designer to f.bl.low. Irk na OJALA (1 -11er's Signature) etv;t 1 No. 30792 ss"OMAL FFa� 17a5i. ter s Signature) (Affix Designe.r's Suunp Here) .PLEASE RFRTT7 T— N TO BAItNSTABLE PURLTC HEALTH DiyrSr[)N ("FRTIFIC'ATE OF f;Cfli'0,TAliCE WILL NOT BE ISSUED IMAJ, BOTH TFUS FORM A 13 AS-BUILT CARD ARE RECEW D BY T1-11' iA1<tNS'L'AuL-E,PUBLIC F-TEA14TH[)VISION. THANK XO1J• Q:Hralth/Septic/l)esipper(,egifctUijou Furm 3-26-04.doc Barnstable �oflHiKE w Town of Barnstable Regulatory Services DepartmentcaC RY i• RAFtNSCA[iLE. " 39 Public Health Division �plFD MA'i A, 200.Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 . Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 6, 2008 Betsey Counsell P.O. Box 605 Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 30 Juniper Road, Centerville MA was inspected on January 21, 2008, by Patrick O'Connell, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Any portion of the SAS, cesspool or privy is below high ground water elevation. You are ordered.to repair or replace the septic system within Sixty (60) days from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in future enf6rcement action. PER ORDER OF THE BOARD F HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1038 6568 Q:\SEPTIC\Letters Septic Inspection Failures\30 Juniper Road.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 30 Juniper Road Property Address Betsey Counsel) Q.>5•h�x fj� ��q� �1 O , 11�� Owner Ow Name information is required for Centerville MA 02632 January 21, 2008 every page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name rab 189 Cammett Road Company Address Marstons Mills MA 02648 'w Cityfrown State Zip Code 508-428-1779 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 inspe.gtion 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"40 of; Title 5(310 CMR 15.000). The system: r 't it c*A ❑ Passes ❑ Conditionally Passes ® Fails`I u"t ❑ Needs Further Evaluation by the Local Approving Authority January 21, 2008 t Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 08-16 Counsell.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Juniper Road Property Address Betsey Counsell Owner Owner's Name information is Centerville MA 02632 January 21, 2008 required for ry every page. Citylrown 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 08-16 Counsell.doc•08l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Juniper Road Property Address Betsey Counsell Owner Owner's Name information is Centerville MA 02632 January 21, 2008 required for ry every page. Cityrrown 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 ❑ 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. 08-16 Counsell.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 30 Juniper Road Property Address Betsey Counsel[ Owner Owner's Name information is Centerville MA 02632 .Janus 21, 2008 required for January every page. CitylTown 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 El ® 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. 08-16 Counsell.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is required for Centerville MA 02632 January 21, 2008 every page. City/Town 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. 08-16 Counsell.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is required for Centerville MA 02632 January 21, 2008 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ❑ Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 08-16 Counsell.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is required for Centerville MA 02632 January 21, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Unknown Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A 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 ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 51,000 gal. _ g ( Y 9 (gpd)): 69 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied 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): 08-16 Counsell.doc•08/06 Title 5 Official Inspection Form: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 M 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is required for Centerville MA 02632 January 21, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Cesspool pumped 3 yegrs ago. 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1962 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-16 Counsell.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is required for Centerville MA 02632 January 21, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1' 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.): Septic Tank(locate on site plan): Depth below grade: 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? 08-16 Counsell.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is required for Centerville MA 02632 January 21, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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 El other(explain): 08-16 Counsell.doc•08/06 Title 5 Official Inspection Form: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 °M 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is required for Centerville MA 02632 January 21, 2008 every page. Cltyfrown 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 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-16 Counsell.doc-08/06 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 w 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is required for Centerville MA 02632 January 21, 2008 every page. CitylTown 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: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 08-16 Counsell.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts 71 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is Centerville required for MA 02632 January 21, 2008 every page. Cltyrrown 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 One single Depth—top of liquid to inlet invert 4 Depth of solids layer 0" Depth of scum layer 0" Dimensions of cesspool 4'effective depth x 6' diameter. Materials of construction Block Indication of groundwater inflow ® Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspool had 8-10"of standing water at time of inspection, standing water is believed to be groundwater elevation. Single cesspool is an automatic failure per town standards 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.): 08-16 Counsell.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Juniper Road Property Address Betsey Counsell Owner Owner's Name information is Centerville MA 02632 January 21, 2008 required for y every page. City/Town 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. c / / / J / 1 2/ " " ' Water Service Juniper Road Commonwealth of Massachusetts -W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °.� 30 Juniper Road Property Address Betsey Counsell Owner Owners Name information is required for Centerville MA 02632 January 21, 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 Estimated depth to ground water: 8-9 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: 9 You must describe how you established the high ground water elevation: Mounded systems on adjacent properties at lower elevation indicate groundwater is 8-9' below grade at#30. 08-16 Counsell.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 . Town of Barnstable . Regulatory Services BABNSTABLK ; Thomas F. Geiler, Director MASS. 1639. ��� Public Health .Division rED MA'S A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 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/copy of this report; this Division does not warranty the functionality of the septic system.in the future nor does this Division agree with any technical observation s 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 Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System'Inspector who conducted the inspection. • . a i SYSTEM PROFILE ALL SYSTEM MARKED WITH CMAGNETIC TTAPE OR S SHALL BE ����� (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. APPROXIMATE NGVD o Wequaquet 1. DATUM IS Lake ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE ° 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 45.0' FILTER FABRIC OVER STONE \ , I 11 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 0 W 44.0 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 44. 0 BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Ica RISERS (rrP.�O C ,l �j PRECAST RISERS UNITS TO BE AASHO H-1� a 2'0 4"OSCH40 PVC H-10 TOP SYS, EL 41.0' •.- \ MORTAR ALL \\ PIPES LEVEL 1ST 2' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. d DETAILS TO BE IN ACCORDANCE �*42.6' " 1 0 GAL H 10 14" i )�J�J�4P° aOneO,eO,eO,a V6� CONSTRUCTIONGrea Morshs TY > 0000 t d� u Ph'nn TEE ®®®[� ��®C� � I� L�7I�LL '°°°°°°°° 310 CMR 15 00 (TITLE ) 41.39 TEE S IC T K 41.14' o o ° 0 0 ' ® a °O°O°O°O 0 (TI V. FZ 0 0 0 0 0 0100000000 > o 0 0 0 Cn GAS BAFFLE::: o 0 0 0 0 0 ®®®®®®®®®® ®0®� ®0®®� o 0 0 0 O°O00 0, 0°° )°°°°°°°° I� �0°0°°°0° °••0- ' 100000000 I�®®L.JI�I�®®®®C ®a®ao a®®a® :00000000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Route 28 40.63' 40.46' °o ' °o°o°o°o NOT TO BE USED FOR LOT LINE STAKING OR ANYCb 4 LIQ. LEVE (ACME OR IIAL) .': OTHER PURPOSE. Jpo°o°°°°°°°o °°o°°°o°°°o°o°o°°°oo°°°°°°0p04 " 0 0 0 0 0 ° ° o ° ° o o ° ° ° ° ° ° ° o H-10 500 GAL. LI LEACHING CHAMBER BY ACME PRECAST OR EQUAL. $, plpE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. - 4, ^°°o°°°°"0^4n_•?00000000°°°°`'o"°°o°o,o°o°°00. 3/4"-1-1/2" DOUBLE WASHED STONE DEPTH OF FLOW = (3) UNITS REQUIRED TEE SIZES: 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 40.00' X.10.00* '' 9. COMPONENTS NOT TO BE BACICFILL OR = COMPACTION. (15.221 [21) g 4 N INLET DEPTH 10„ CONCEALED WITHOUT INSPECTION BY BOO ARD OF Sri HEALTH AND PERMISSION OBTAINED FROM BOARD OUTLET DEPTH = 14" OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP 33.0' BOTTOM TH-1 CALLING DIGSAFE (1-888-344-7233) AND MIN. ( 2.5% SLOPE) ( 1 % SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUND VERIFYING THE LOCATION OF ALL UNDERGROUND & SCALE 1"=2000'f OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ' WORK. FOUNDATION 10' SEPTIC TANK 51 D' BOX 28' LEACHING ASSESSORS MAP 210 PARCEL 116 FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL PROPOSED REMOVED LEACHING FACILITY. AND AROUND THE LOCUS IS WITHIN AP OVERLAY DISTRICT UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM AN EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. VARIANCES INSTALL 81't OF 40 MIL POLY 13. DECK TO BE REPOSITIONED IF RESERVE AREA LEGEND LINER WITHIN 20' OFFSET FROM UTILIZED. 99 EXISTING CONTOUR VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH // FOUNDATION X ss MAY BE IMMEDIATELY GRANTED BY THE BOARD OF // ! TOP EL. 40.2' SYSTEM DESIGN. EXIST. SPOT ELEV. HEALTH AGENT OR BY HEALTH INSPECTOR 4 /// ��3 78 OTTOM EL. 36.2' 99 PROPOSED CONTOUR ZO.O O (sa 4 PAPERWORK AND HEARING REDUCTION PROPOSALS // GARBAGE DISPOSER S NOT ALLOWED PROPOSED SPOT EL. APPROVED BY THE BOARD OF HEALTH REVISED DURING A PUBLIC HEARING HELD ON NOVEMBER 'O / p, ,� 5 3 31, - TH1 4 sTo / DESIGN FLOW: _*`BEDROOMS ® 110 GPD - 440 GPD / fi �,'� SMAu TEST HOLE 15, 2005 44 USE A 440 GPD DESIGN FLOW 2� SLOPE OF GROUND 2) FAILED SYSTEMS ONLY SEPTIC SYSTEM SEPTIC TANK: 440 GPD (2) = 880 UTILITY POLE COMPONENT TO FOUNDATION SETBACK, IF AN \ IMPERVIOUS LINER IS DESIGNED AND INSTALLED. / G �0��, USE A 1500 GAL. SEPTIC TANK . FIRE HYDRANT __ _._� NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRANANG _. •••. LEACHING: _ SIDES: 2 (53 + 6.83) 2 (.74) = 177 GPD 44 H �� 9L,4 0 SFf BOTTOM 53 x 6.83 74 = 268 GPD TEST HOLE LOGS ��`// (� ) // TH-1 01 TOTAL: 601 S.F. 445 GPD ENGINEER: DAVID FLAHERTY, R.S., SE2755 // , • ,. USE (4) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) EXISTING 3 BR WITNESS: DAVID STANTON, R.S. INSTALLER TO VERIFY FEASIBILITY DWELLING �lv WITH 1' STONE AT SIDES, 2' AT ENDS AND 5' BETWEEN UNITS MAY 27, 2008 OF RE-ROUTING EXISTING WATER/ TOP FNDN = 45.0' DECK DATE: LINE OR SLEEVE SEWER LINE // 70 r WITHIN 10' OF WATER LINE. PERC. RATE _ < 2 MIN/INCH _ �Q` o `fl o CLASS I SOILS P# 12238 �, GARAGE D MA o s� APPROVED DATE BOARD OF HEALTH I ELEV. I I ELEV. ,'` \ GsF \ 4 44.0' 4 44.0' ; tiFFs \ O / \ 0 0 oN w�REs \\ _ �`L X O LS s \` '� `CP't'� - // ��' // } TITLE 5 SITE PLAN �- ,$ 10YR 3/2 ,v 10YR 4/2 \\\ O :_P/ / OF 1 o B 12 B 4& \\\ > / ���� // 30 JUNIPER RD. \ PAVE / LS LS No� \ DRIVE / \ (CENTERVILLE) BARNSTABLE, MA 10YR 6/6 10YR 5/6 31" 41.4 32" 41.3' "-!/ \\. / PREPARED FOR BORTOLOTTI CONST./ c c BETSY COUNSELL PERC DATE: MAY 27, 2008 MCS MCS BENCHMARK NAIL IN UTILITY POLE_ ELEV = 46.05' off 508-362-4541 2.5Y 7/4 2.5Y 7/4 oF fox�ZN80 OFM,yss 4 I do ncape.com8© ° DANIEL ti� ��' � • ate° °�;�I down cope engineering, hnc. a No.JALA " CIVIL N civil engineers No.4650 132" 33.0' 120" 34.0' �o`�s �o�� 9�� G �� �� land SuweyorS Scale: 1"= 20' 9"fDsu T �� -�--� 9 Main Street ( Rte 6A) S/27/vfi A 93 YARMOUTHPORT MA 02675 NO GROUNDWATER ENCOUNTERED � � '0 LICE 08- '24 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. 08-124 BORTOLOTTI_COUNSELLDWG (DDF)