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HomeMy WebLinkAbout0107 KNOTTY PINE LANE - Health 107 Knotty Pine Lane Centerville F/R A = 191 079 v No.cQ� Fee 50 .00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Oie;pozat *pg;tem Cott!truction Permit Application for a Permit to Construct( , )Repair(X )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 7 71 —1 5 3 5 107 , ttly Pine Ln, Centerville Jennifer Lawrence Assessor's ap arce 1 91 -079 107 Knotty Pine ln, Centerville Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 8 3 3—21 7 7 Wm E Robinson Sr Septic David Mason PO Box 1089, Centerville DBC Environmental Des, E Sandwich Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(nc) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 55o gallons per day. Calculated daily flow (P gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil, Nature of Repairs or Alterations(Answer when applicable) Title 5 upgrade to leach system for 5 bedroom including 1500 gal tank to plans of Dave Mason revise12-28-03 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 Certifi- cate of Compliance has been issued by s Boarq of al igned Date -C� Application Approved Date J®' Application Disapproved for the following reasons Permit No. L4 5 Date Issued Feed 5 0.0 0 _.... . * +a. •¢ THE COMMONWEALTH OF MASSACHUSETTS y Entered in computer.. es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zlpprication for Mi5pozar *pztem Congtruction Permit Application for a Permit to Construct( , )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 7 71—1 5 3 5 107 ' nPtty Pine Ln, Centerville Jennifer Lawrence Assessor's a'?arcel 191 -079 107 Knotty Pine ln, Centerville Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 8 3 3—21 7 7 Wm E Robinson Sr Septic David Mason PO Bopx1089, Centerville DBC Environmental Des, E Sandwich Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(nc) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �.�4 gallons per day. Calculated daily flow J 5 (,a gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ' Description of Soil Nature of Repairs or Alterations(Answer when appplicable) Title 5 upgrade to leach system + for 5 bedroom including 1500 gal tank' to plans of Dave Iason Revisecl 7 - -03 Datd last inspected: Agreement: TT re 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 Certifi- cate of Compliance has been issued by this Board of : alth� igned Date _ Application Approved`by---.—. Date cl,l Application Disapproved for the following reasons Permit No. ZU:z'�O L-I / R Date Issued L 0�j --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Lawrence . BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired C X)Upgraded( ) Abandoned( )by Wm E Rohi n-,nn �r F,Pni i - SPrvi (-P at 1 07" Knotty Pigs Ln, Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of s pe t shall not be construed as a guarantee{that the sys � r 1 ftiinctto as destg'n"e� . Date Inspector 1_ N. -- ----------------------- --------- No. Fee Lawrence THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lk;po$al 6potem Con$truction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 107 Knotty Pine Ln, Centerville and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Const'ru/ctiof mus be completed within three years of the date of this penrut. Date: L/ _Approved by Town of Barnstable o Regulatory Services Thomas F. Geiler, Director BARNSTABLE, 09. `m� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Dave R Ma Gc)n Installer: Wm E Robinson Sr Address: DBC Environmental Desian Address: PO Box 1089 E. Sandwich Centerville On Wm E RobinsonSr was issued a permit to install a (date) (installer) septic system at1 07 Knotty Pine Ln, Centervillebased on a design drawn by (address) Dave B. Mason dated 12-28-03 (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 of the distribution box and/or 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 any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. (Installer's Signature) (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form TO OF BARNSTABLE LOCATION � K'L ��� �'� SEWAGE # Q2 V,O,LAGE eih ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 9U ''-.-v y 77 S 6 '72 SEPTIC TANK CAPACITY IS 6 �' /G f7 LEACHING FACILITY: (type) T (size) NO.OF BEDROOMS BUILDER OR OWNER L,4 I'CL PERMIT DATE: y/ COMPLIANCE DATE: ;�— Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet=of leaching facility) Feet Furnished by � � �, � r� j i k / q 7 �� .�� �g- _ �� � � � � � ® � i� r Y � TTOWt OF BARNSTABLE LOCATION Z fJ A"G SEWAGE # Q 7 _ VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE N0. v d ,5 y- SEPTIC TANK CAPACITY S I6 e7 � � . _ : LEACHING FACILITY: (type) _ (size) NO.OF BEDROOMS BUILDER OR OWt�NER Z— PERMIT.DATE: / �/ COMPLIANCE DATE: �� lZ G��_ Separation Distance Betweenlhe� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist P 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 ------------- 07 7 Town of Barnstable ' .�s"E' .� Regulatory Services Thomas F. Geiler,Director . saiwsrasts, « 9� MA S. �0� Public Health Division ArE 639. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Z-/ —G Designer: David B. Mason Installer: Wm E Robinson Sr Address: DBC Environmental Designs Address: PO Box 1089 E. Sandwich, MA Centerville, MA `) Wm E Robinson Sr was issued a permit to install a On 1 �'�. (date) (installer) septic system at 1 07 Knotty Pine Ln, Centervilldiased on a design drawn by (address) David B. Mason dated 1 2/28/03 (revised) (designer) '/ I certifythat the septic stem referenced above was installed substantially c p y i y according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or 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 any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. 41 o� DAVID tier Installer's Signature) N couO�NOWR ' 9 #1093�z IT 0 " (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:HealtWSeptic/Designer Certification Form ° f l TOWN OF BARNSTABLE UVIAT?ON /�-7 � �.dc /_� SEWAGE # �Oo3 -oG✓� VILLAGE C��r`+�✓/ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /�000 LEACHING FACILITY: (type) t`Gd L�� � .,ab, s l.�J (size) 3 X 0% �0 NO.OF BEDROO -BUILDER OR WNERc PERMIT DATE: -1/d .3 COMPLIANCE DATE: fZ e 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 fa7*1i ) Feet Furnished by /, °� So� G��r 1// ,` ., �3> �b�� 3�. �g �/1'6 . TOWN OF BARNSTABLE LOCATIO!t,21: � � �'e SEWAGE # AaO) OG� VILLAGE �// ASSESSOR'S MAP & LOT f q l"0'71 Al I a J Div ✓ &PHONE NO. 1 b�Y9f'G INSTALLER'SNAME -g✓ SEPTIC TANk.CAPACITY LEACHING FACiLrry: (type) l-0d 4-1 Cha r-J LEJ (size) /3 NO.OF BEDROO BUILDER.OR WNER � Ol/<� d . COMPLIANCE DATE: ('y C PERMIT DATE' 7/ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f' Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) �— Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facilii Furnished by 3G. A j � No. Feel l THE COMMONWEALTROF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYicatton for 30iopozar *potem Construction Verna Application for a Permit to Construct( )Repair( )Upgrade/Abandon( ) ❑Complete System "dividual Components Location Address or Lot No. 4 Owner's Name,Address and Tel.No. Assessor's Map/Parcel C�� 9f-o Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -771- Sera Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(b Other Type of Building Ge No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 373a gallons. Plan Date 149 Vd Number of sheets Revision Date Title b�,f)/-0 10�7 YzP,' Y 49 `! e Size of Septic Tank ,��'/S Ito Type of S.A.S. / zt .751 lo,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 Certifi- cate of Compliance has been issued b is o o ol Z���3 Signed - Date Application Approved by k Date Z ro o 3 Application Disapproved for the following reasons Permit No. Date Issued 2 /d 63 Fee THE COMMONWEALTH OF MASSACHUSETTS { Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Mgaal *pgtem Conttruction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. ye Assessor's Map,ar9ce1 /��' / Y-�r fy% Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5. 7 3,4" Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other; Type of Building & 4tCWd_e No.of Persons Showers( ) Cafeteria( ) Other Fixtures /� z Design Flow l!ri' gallons per day. Calculated daily flow ✓� gallons. Plan Date Number of sheets Revision Date Title S/ �e ltV/2PI h27 .(!yfo%:v - Size of Septic Tank Aft)?al Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuedb,'� is oard ol. alth-: ` Signed 1J Date Application Approved by Date Z Ifv b 3 Application Disapproved for the following reasons ,. Permit No. 2v0 3 '—o(o S- Date Issued_ 2-7/0 G 3 ——————————————————————————————————THE COMMONWEALTH OF MASSACHUSETTS ` BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERT Y, that th On-site Sewage Disposal System Constructed( ) Repaired( )Upgraded Abandoned( )by o �7,F/ at ,�GJd V �l f' del f6, has been constructeo injaccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2003—U 6 S dated 'Z t u o 3 Installer Designer The issuance of thi pe awet t shall not be construed as a guarantee that the syste esigned. Date 2- Inspector, * --------------------------------------- No. 2003 C:)L,6_ Fee SO THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi5 potaf *p5tem Con5tructton Permit Permission is hereby granted to Construct( )Repair,( )Upgrade((/A�bandon( ) System located at /d 7 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Co struction must be completed within three years of the date of this pe it. Date:_ 0 3 Approved by 0 f'i"���r�.^rvk a��,ir �txd`�svk"' `A��i"�'k' :u •a $W`�'.` ��"4.� �.- r 't">�7�w,►.tiE'y�j#` _`, .< ks, "�'�t, -.G7.a�n$� r s.-�', T z, <Corx�morweotth ir mein oMossoctu�setts _ __ x � ohn Grad— -X . TT r. . Teaticket,MA 02536- �19VII�'�� �Q' �!`Qf (508} 564-6813 - — _ `• z _.' _ .: SUBSURFACE SEWAGE.DISPOSLCLSISI EM INSPEGTIONFORM �'p ,� R$r��r *? a l Property Address: 107 Knotty Pine Lane Centerville Address of Owner: NO G Date of Inspection:10/30196 . (if Aiff ere nt) V_ Z Name of Inspector:John Gracl _ Brad EatonC�`` Company Name, Address and Telephone Number: CERTIFICATION STATEMENT J I.certify that I_have personally inspected the sewage disposal system at this address and that the information rep 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 function and maintenance of on-site sewage disposal systems. The system: X Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 10131196 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes. no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not.) _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115/95) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 � m ' tr x �4 '�t��TM�"s+''� ��,.�t` ry+�;'`..�.�3`� �.y i �afi� "P``�•. ���t"-�q�`.., � �.r' �� �.a�'f, f ..� 1's k Y _w6 . „ .a "' i V ,3- S�','�,�r .~ x •FJ'R.R,C �._.•� ir : SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM R _ PART A tZTiFiAT1ON Pro.pertyAddress -1D7KnottyPlneCane'CenterVllte = - = - Own@f 10130f96r ( evea�dist o stem wi Cpass lnspecfi00EMiith F .rep laced— -_- - distribution 6`oz is feveted=orreplaced _The system required pumping more than four 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 - C] FURT HER 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 the public health, safety and the environment. NES THAT THE SYSTEM 1) NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT.THE IS SYSTEM WI LL PASS UNLESS BOARD OF HEALTH HE PUBLIC HEALTH AND 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 EISYSTEIMtIS FUNCTION NGpIN A MANNER THAT PROTECT, ATER S THAT TH HE PUBLIC HEALTH AND SAFETYEAND THE MINES ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ nd is less than 100 feet but 50 feet or more from a private The system has a septic tank and soil absorption system a water supply well. unless a well water analysis.for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ Backup of sewage in facility 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 clogged cesspool. SAS is in hydraulic failure. i"3-,(revised 11115195) �- _.. i — ___ —___ _._..� r � --- ... ._--_ � '�mom•.. k ` it-ya�,F� �'' �� _ R. s"' •`� w .u.�•':s'n� ,�,•„",ea:'": ..�.•�'Pt` : .? z...:. �y ,:; ,. 4,kWr*f ., 4;.�'rnt ..,ts.�'�"^�-�,�xmac"-�'a»*„"g?,r�,�'�.'3F�f*�=�'�'` ._'"�`--", "_E'__"'¢r'r'��--c — -s�-�^z.� ^�-_r---„s_ ��'�.',�.�'„�"-.�:'=j•:'�'� Y -SUBSORF�CE SEWAG£DISPOSAL�SYSTENtINSPET10tV FiJRM t fitTt %rd ----r•. - _-- —- —'ter PropertyAddress -1o7KnottyPlne,LaneCern�ervlue _ _ _ _ �: �� Static liquid'level`iri 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 1/2 day flow.— _ Required pumping more than 4 times in the last year r NOT due to clogged or obstructed pipe(s). Numbers of times pumped _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1-of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 101000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. e (revised 11115195) c 1 sugIvIrl-EO /3Y T 0 W N OF BARNSTABLECE�,T�,�vit�E,�o�6'S < , LU:rATION /0J .f�iy®TT%//N� �i�/ SEWAGE # VILLAGE r—IylT�/lllzeC-- ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. l��T©�//S/O�S 3�,2- 6 3 Y SEPTIC TANK CAPACITY /000 6�l4l/011l .LEACHING FACILITY:(type) STONEAreFo 16wag%!T(size) /OOZE C4(- NO. OF BEDROOMS 3 PRIVATE WELL OltqUBLIC WATER BUILDER OR OWNER 4-, 16;PPOF0iei) DATE PERMIT ISSUED: �98J DATE COMPLIANCE ISSUED: ��� r� VARIANCE GRANTED: Yes No Ex!ay"/a/G ;yc�cvsc yam, • z ; c r }K .r a-" _ r ..Y �:�t•�' 1'�r'l�+'�"t�.'�g�•,,,,��q !`49�`'.-"5« :.. i s :5�' ta` ' r�£ �� r`ii c�' it rszT 'a'r a.S.`�x� :F' i ..z. ""r.... k. "�`..."e"� - +t�SU$F.fL �3YYAr�-0ISPQ ��9_1CSTC-iU1 INSPE�TIOMEQRM C �-�^ _ -'^' -4._ram.-a^s ..,�.^-.�"'. - '�f #T '_3x•6- 3�,' a e'er ,_ -'r - _�• „�_m -LL - tTraperty Address"r 10�7 Knotty Plne Lane Centewllle - _ � = .��:.-�*' �r -Ru '�'" +g�-�^' �.�x�a��'_k�`_�+'� _Check-if the-following have been done: - — X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have-not been-introduced into the system recently or as part of this inspection. rdaAs built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. x The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on_the site. X The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. x The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195). ,. A " � 1 �T�°`���'� -�`x a�ia y .✓ F ,a ii�-4d�� �m a�'�`i�ye-k�'�Y"'��r''•,:'t"S^-�1'IF4'�'+3;s'^#"�°.t�a" •�`�r�e�,.tv��a':a'�:ef z�'i" �. iEf�•�3i.s'�c�k -- - V _rB SUgy4C�S)~YJA DI3POSP� SYSFEMJ" ECTLdN Ffl.EfiM= - - - -rPropertyAddress- 1D7KnottyPlne.CaneCentervllle �_ - _ - F ��` � OFI-�-Ql�3�B - _.�� �� _ �__,. may. -�"'-- �---a s �-•.- _-..�_�' �a -�#'�'.n, re v — R. W_d0NDLTK_W' r E�:Y. !` ---RESIDENTaAL —� —�_- ....... =-B®B ra flaw aa 2`'—a- lions - _ - _ ai tSitt bet-o'f-biedrooms _-- Number of current residents Z - - - - - - _ Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes - - -Seasonal use(yes or no): No Water meter readings, if available: n1a _ Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: n1a Last date of occupancy: n1a OTHER: (Describe) nla Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped two years ago System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n1a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source information: Approximately 15 years. Sewage odors detected when arriving at the site: (yes or no) No (revised;11115195) - -, - - 5 X_ I. WN 7' _.._ ��-�-_�.' �$:+i_�.-,r.._ .L'^ tom'_•_,..,. '' -�_- '.�.a-ift r ..- e � ',�;, '�# .•, �.,.^r a: �" In," a:x� t t'�, .._. �z....-_ _-w.b u r-tti._..,..•Xac-_a .ar"L. ;_: SUBS17;k�EACE SEWAGE DISP,,QSAL SYSTEM�INSPEC_T.ION:FORM s � — � t {; ,E-_.�.Y�-s--'ram -- -� ---��__- ��_,,_��� -�-= .�'•�_-�-�- •�a --� - - _ -�Rro ert -AckdrBsS'1QTKnott�PineCaneCenterville=` �_ _ �3 --- — --- r_"w._,. �� .�_-=.,--,..� ^-xa?���'�_. �-..--ram"•=.. =.�-v.�C.a_ T.�-�-"���=: -Depth below grade: Material of'construction.X concreate_metal_FRP_other(explain) Dimensions: L 8'6'H 5'7"W 4'10' - Sludge depth:2' Distance from top of sludge to bottom of outlet tee or baffle: 25" Scum thickness 0 Distance from'top of scum to top of outlet tee or baffle:6' Distance form bottom of scum to bottom of outlet tee or baffle: 0 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are structurally sound.Recommend pumping system every one to two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: Na Material of construction: _concrete_metal_FRP_other(explain) Dimensions: rda Scum thickness:Na Distance from top of scum to top of outlet tee or baffle:Na Distance from bottom of scum to bottom of outlet tee or baffle: n/a Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Na e (revised 11115195) ` _ _. ,. may., ASK .f�.�'.'M Win'"• :z AN 'kAJI— s T 'kx xt a. � ,'ei e— 'bt "�4�,a' a :. -'+ -' 'w -ae-'ee K�. ��Jew'-K.S? ..•.'.w - P'�.c•.'a•�'J'�'P4. yrnMd' 1M1 4 aYv Ta•'�•^yv Y.+5 �- 1I..aua�,✓�_.. _ n si - U:RAGE:SEWAGEDISPOSAL S`kSE�iINSP€G710NtFORM � T _ Property Address:10TKnotlyPlnejta�neCenterville � - - _ � :�� - ,�,�a•,ao �.�yap tAf3o ��- --� --� •� -.-� — = - _� �.... .�....d.��.< ,.,�.,. -. _ Depth-below grade:_ _ •- --- _._ .. �_. -_ ___> -_,.-� -� , ... .. _-�-; _ __. _.... _. _ Material of construction:_concrete_metal_FRP_other(explain) - - t Dimensions: Na Capacity: nla gallons _ Design flow: nla. gallons/day Alarm level: Na Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Na DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Na Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) Na PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)_ Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Na (revised 11115/95) d J Yc ti F' »»" ' 77'�` — SUBSURFACESEWAGE_DISPOSAL SYSTEM INSPECTION FORM .'a ,�: .^s.,,z.�. ".�._.-- `. -M-^. -• - -._ .xs,. - -�— - _ ,,1 .,.z-;�.a....�c.•'. - YT-fig _— � .'"�""'"�".`��S�+S-z-s'"`1=' `�t'P�-`'IUI?k"fl"f7't��c87Et# ie3d��•a,-�-=--- _�'�.. `•a'�,-- - - —{ =propertyAddcess 1o7Knott�cPlneLaneCehtervllfe OwnOf — Brad Eaton ��-• _-��� -.>..s-d-.�-__�=a= =�� '-____`_"---�=- -.,.--t� �- �.��_-.� — =`-�.ram -�t�-, ._-.�,...,_,•,..Q-���=-ate"- .^^- -� :,.e.,-,.-, .m..��,,-e-e^� ¢_.., - _ SOI .A SO P_TJQ S�'STEM - -_-M(locafe on=stte piarl I€possible excavation=•not required bumay be_approximated by non-int�usiVe;m_ Ifnotde'tetminedto-b'e-present;_explaln n7a Type: leaching pits, number: one 1,000 gallon leach pft leaching chambers,number:nla leaching galleries, number: nta leaching trenches,number, length: nla leaching fields, number, dimensions:nla overflow cesspool, number:nla Comments`.(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) The leachp it was 112 full at time of inspection It is structurally sound and functioning properly. CESSPOOLS:_ (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n1a Depth of solids layer: n1a Depth of scum layer: n1a Dimensions of cesspool: n1a Materials of construction: n1a Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) n1a Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) n1a PRIVY:_ (locate on site plan) Materials of construction: nla Dimensions: n1a Depth of solids: n1a Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PrivyComments (revised 11/15195) N t �;. r RIMINI '° k• �.�... x ,.:..a�.,�- ..» ._An'�` _A{iK....... ....,.. ��� —�R9 ��i�-�.,. -+.�-�� -'�-�s�.-��s� ,..-�{` �t"��-"�st''-•„� ~����_"-�_1�'��1 _ - _ r SUBSURFACE SEWAGE DISPOSAU-SYSTEM INSPECTION FORM_ - _ '' �.�"-�-' �-�-�.....s�.�'�- �s`�� -;�.-�a,F:.. .�SYS�EM hXFO-M•Ft N C�tlrTued�} _ _ - ... ----.--s-=—�'�-���- : E�apErty Addiess.�laZ"Kno[fy Pine_Lane Centerville � �, -- � - _ _ _ _ r Date�ftrispel'dl� �'�` include fiessta,af feas�fwosperma�ne�refie�ences la`nd�mar.Rs or"ben�F�marts �.�.�z �� w _ ;- 0 � 0 4A6 rts 31 e DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination orp�oxir - - -= IYSGSMlaps-and Charts �'��`rrevis ed 11115?95� — � _,,,.`'�``- "�` �.".< `-� r"�r'�,.-ssr. sue€ �� � � - ���� .� k �?.:.r•�-�„"="� --.- __T'L _ro.L< -_=tea. 3K.-:�.r ._.."`�^"�'"'�'�` 3'i& r�.a�' � :� � -:fr -�- ^�F '-.^_•c.- _ -'�.r"F,-„'-_a.�a-,.' �`�' -may`_--. q ASSESSORS MAP : TEST HOLD LOGS —* PARCEL: ���_�_._.�.�..� _ _ FLOOD ZONE: !ti/CS t f�G+/C` SOIL EVALUATOR aVi"U 22 G _ _._r c WITNESS : - ;10--r" PalC.. � NOTES: REFERENCE: `� u!o'i � �L;G / ?�99 - DATE: 0 Cep t tf C ,--•-.- 3 PERCOLAT I N RATE• (, Ali 1) The installation shall comply with Title V and Town of Barnstable Board of �`� TH- 1 _ TH-2 Health Regulations. by , 2) The installer shall verify the location of utilities, sewer inverts and septic r � � components prior to installation. 3) All septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. r. 4) Existing leach pit to be pumped and backfilled per Title V abandonment '. If Procedures. LOCATION MAP Ci r(.6.> ' _ 1; � 5) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. �5 lt7 Y 6) All septic components must meet Title V specifications. 7) Parking shall not be ccnstructed over H10 septic components. i>as 8 The roe is bounded b property corners and roe lines as depicted. r ) property YP P Y property P I: 9) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. SEPTIC ' SYSTEM DES I GN Of ow ESTIMATE . �' � •, ->� -=- ......... � - /..��-=.t!���� l �`/� �' �,� � _ `S _ 5-t'�bEDROOMS AT GALJDAY/BEDROOM AL/DAY V SEPTIC TANK �GA!/DAY x 2 DAYS - U GAL ,. � `' USE 10,DDGALLON SEPTIC TANK `Ti_t"..t __ �1 __ J -fa/G - f Vic,L �rz _ - .. Wiz , - 0 ASSORPT ON S;'STEM -- `-/t'L,/ . _j -_a cam; lt. > 44C a.�... j j v - r 17 1-2 S; uE AREA: 2- -t /3 X Z X o 09v�v� •� , o AG YV BOTTOM ip AREA; : X / C C�•-7L f� C? _.. SEPT I C SYSTEM SECT I ON ►��;r,5, l jop 09ID� O D-sox —� ----- - I .= PEIL SEPTIC TANK S 1 TE AND SEWAGE PLAN 77 , C CI. T ! ON PREPARED FOR : L'�"�;u� w'I� a o SCALE: DAV I D B . MASON fZ5 DATE: I ID o3 _ DBC ENVIRONMENTAL DESIGNS 4 w EAST SANDWICH . MA W DATE HEALTH AGENT ( 50$ ) 833- 21 77 Z , o 3 _. ASSESSORS MAP : TEST HOLE LOGS PARCEL : r' FLOOD ZONE: �./ t'f 'G��'�'r� SOIL EVALUATOR: WITNESS ,10-r REFERENCE: R��(o �GL;C, � 7�9 DATE: _1Ai,,.1U K-a - f�'L —I ,L,, C � ► . , PERCOLATI N RATE: Z. lMln.�r l a , � I 1 The installation shall� ;� (o 1, ��" L ) comply with Title V and Town of Barnstable Board of v� TH- ! TH-2 Health Regulations. s 2 � ).,The installer shall verify the location of utilities, sewer inverts and septic �-CK1 /d ✓l Z �, components prior to installation. 3).' All septic piping to be inch Sch 40 PVC at 1/8"per foot, 4) ;Existing leach pit to be pumped and backfilled per Title V abandonment mamma d 2 procedures. LOCATION MAP ?fi i0 L �� - 5) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. ` 6) All septic components must meet Title V specifications, ; Glb 7) Parking shall not be constructed over H10 septic components. 8), The property is bounded by property corners and property lines as depicted. Z," t I 9) =The property owner shall review design considerations to approve of total number a 1 of bedrooms to be considered for design. r . j� SEPTIC SYSTEM DES 1 G N . . FLOW ES"r I MATE �. 22 LBEDf?OOMS AT 1Ib GAL/DAY/BEDROOM' - % GAL/DAY 1 SEPTIC 'TANK GALIDAY x 2 DAYS - L-,(00 GAL SE CDr ALLON'SEPT 1 C TANK Z�'4-kt571 L^4C: ►� ID S I L�ABSORPTION SYSTEM O v S! DE AREA Zx BOTTOM AREA: i�l 2DB lzl SEPT I C, SYSTEM SECT 1ON . riaaF tea, r1 r` toyGAL, 17 � G� . - SEPT I C TANK , .F U.A7 1 +'' •4-'e q..yyds�:.il; `�,. yp,C•e_ ✓C y, "�, ,,a--• -4 spy": � '� ,�.#' — AaPu3�. ?�,''e i., 05* d. ' , i2 bp�r2 T - ; S 1 TE AND SEWAGE PLAN /�./�/'V t-/ "/- A....�,.+ /""'.! R✓ .svtir'' 4c. .v! d�y.., ,.,, e°� , > �'1 ��� /1J1�4 tf �It ..,�, . n. 1 .. 4 LOCATION � y e /E `( I : PREPARED FOR : - � - SCALE: a DAV i D B . MASON >Z5 oATE: I Io p w z DBC ENVIRONI�EN�AL DESIGNS EAST SANDWICH .- A HATE HEALTH AGENT csOB ) 833- 2177 W