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HomeMy WebLinkAbout0027 LIMERICK COURT - Health CA= RICK COURT, CENTERVILLE 078 IN 1 S/ate UPC 17534 No. 21�53COR 'terr k ASTINOS. MN "���'� �� -.�� �1,�,� �,l I� t ._ -_ .. r� i ,--+� � � 1 �_ -. TOWN OF BARNSTABLE LOCATION ;),77 Lin t i i dC SEWAGE# V ,LAGEC ell),�('IViDyP ASSESSOR'S MAP&PARCEL - 0 7 INSTALLER'S NAME&PHONE NO. ra � is (rxy�JNC SEPTIC TANK CAPACITY LEACHING FACILITY: (typed C6 C _ (size) J 0.,f X 2.5-J 2— NO. OF BEDROOMS OWNER ���, ,a` PERMIT DATE: ►��' s/ COMPLIANCE DATE: Separation Distance Between the: N} a —t 1M L". 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 � �� AWN OACIC D 2 2,1 2 f r,�e( -6ox bVj- feria p)� i Town of Barnstable WE � Regulatory Services Richard V. Scali,Interim Director EMPO ABTA M'S- Public Health Division 59. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 2, i r) t Sewage Permit# Assessor's Map\Parcel rag ��� Designer: Pp er- crr n�e e jopfj Installer: , Pr. 3ra 4 A 1 n L Address: 1 Z t4--,-. Cro s r'E4&" R4 Address: P 0 • i-44 x 1 u.S f:;-MS4-0a z MA- jZ4, 6evLke-J1tL*- MPS Z ;2 On 1P,4,Ica C. was issued a permit to install a (date) (installer) septic system at 2? L`�"��'��� �rh" w}. based on a design drawn by (address) M LC^4-e e P.-. dated 1` 7 1 +5— (designer) 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. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co Hance with the terms of the RA approval letters(if applicable) of Mgss9�y� PETER T. ' eYs ignatur ))e -- o McE stall CIVVIL No. 35109 r1sjF.��G\ (Designer's Signature) (Affix Desi 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:1Septic\Designer Certification Form Rev 8-14-13.doc C,(--,f-- Lf6.13 No. V l ' Fee I � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye 4plitation for Disposal *pstrm Cunstruttiun permit Application for a Permit to Construct( ) Repair(61-1*U'pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or L o. A 7 Lime✓t c k 601 %- Owner's Name,Address,and Tel.No. �^ - A Assessor's M p/P el /G`j —0jib ,a5 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. PC"-,4C-% Type of Building: Dwelling No.of Bedrooms Lot Size I C60 5— sq.ft. Garbage Grinder( ) Other Type of Building ( fin!//C�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3�fff- 7 gpd Plan Date Number of sheets 2 Revision Date Title Size of Septic Tank V5iJ/K Type of S.A.S. J/M) Description of Soil Nature of Repairs or Alterations(Answer when applicable) INOSN-c, 7.. -�C'�C� G,C..- Date last inspected: Agreement: e The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date :L Application Approved by Date l [,. Application Disapproved by Date for the following reasons Permit No. D-lJ j Lt Date Issued — —f�j ClC-0- L(643 t No. d ! � k�x Fee �ye ,. p THE COMMONWEALTH OF MASSACHUSETTS Entered in com ater:PUBLIC HEALTH DIVISION' - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Misposar .pstem (Construction Permit Application for a Permit to Construct( ) Repair(e�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or t t No A-7 c k Cc-v v Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel /G°( Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. � `�'-'z7'��.'/ ,1 !i r✓ I N Y��l n✓s 9 U�/G��I� Type of Building: Dwelling, No.of Bedrooms +W t s .ft.-'% Garba e Grinder�. Lot Size /�G?$'" q g_ ( ) Other Type of Building /^(( ,pnl//G/ No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) gpd Design flow provided ` !M 7 gpd Plan Date /7 5 Number of sheets Revision Date Title Size of Septic Tank �C_Xi5 fJrS Type of S.A.S. ,51 Lv Description of Soil Nature of Repairs or Alterations(Answer when applicable) t ND,::61 c,,,1 �2_ "5C-70 J c II r„O om Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in d" accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed p{--- Date /2A Application Approved by Date Application Disapproved by Date for the following reasons Permit No. -)_6 1 Date Issued_f •-` -------------------------------------------- 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 at a-7 has been constructed in accordance -with the-�rovisions of Title 5 and the for Disposal System Construction Permit No. dated Install�c/51G u�i✓S /JfO _rVC. Designer r ,�c/ f� #bedrooms Approved desi flow gpd r The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector -------------------------/--------------------------------- ----- _--=----- ---------------------------------------- --- ---- No. �)o 15 `!-� Fee V —.-.— THE COMMONWEALTH OF MASSACHUSETTS ` PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6 stel Construction Permit Permission is hereby granted to'Construct( ) Repair ) Upgrade( ) Abandon( Y) System located at -9 -7 �iM �riCIG ����� ��i✓1�/��1�� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructioi must be completed within three years of the date of this permit. Date [J Approved by i I i r Town of Barnstable P# FTC c Department of Regulatory Services * flARNSTAflLE, i Public Health Division Date 7 MASS. 1679• 200 Main Street,Hyannis MA 02601 ^7 7 ArfD MAI A �� �,,�,, a Date Scheduled Time' Fee Pd. Soil Suitability Assessment for Sewe Disposal Performed By: p�4e r-d 'v� � Sl— Witnessed By: �.v J LOCATION & GENERAL INFORMATION Location Address -27 LN M.er Owner's Name g� �,ti �C99\✓�S j Cep, e r`.r:112 Address z 7 Ll y—R Assessor's Map/Parcel: t(P�_d-7 Engineer's Name NEW CONSTRUCTION REPAIR X Telephone# 6U�8r -3-7 -!{_7 Ca.v Land Use PCeS�'� P'Ct 1 Slopes Surface Stones Ajo'-e_ i Distances from: Open Water Body IV , ft P6'sJle Wet Area AJ114 ft Drinking Water Well 71s 43 Draina e Wa �g y W� - ft Property Line ft Other ft i i SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I i 1 i i I i • L�M�i21 ctL cfi NIa Parent material(geologic)�F �T c � Depth to Bedrock i Depth to Groundwater: Standing Water in Hole: Weeping from Pit Facie N//I- jEstimated Seasonal High Groundwater 1> I DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _ in. Depth to soil mottles: in. i?er th to weeping from SA-tc of ohs.h ._---.._.-- nl�; ir.. Ctro:mOwater Ad;ustnw:nt R. — ---- ... -- - ----- — Index Weil# Reading Dote: — Index Well level_ Adj.factor _ Adj.Groundwater Leval_ PERCOLATION TEST Date _ Time j Observation Hole# T�'/ Time at 9" i i Depth of Pere Time • Start Pre-soak Time @ Time(9"-V) End Pre-soak i Rate Min./Inch Z_ Site Suitability-Assessment: Site Passed L.�� Site Failed: Additional Testing Needed(Y/N) __— t Original: Public Health Division Observation Hole Data To Be Completed on Back----------- i � ***If percolation test is to be conducted within 100' of wetland,you must first notify the I Barnstable Conservation Division at least one(1) week prior to beginning. i Q:\SEPTIC\PERCFORM.DOC / VS L U DEEP-OBSERVATION HOLE LOG Hole# # Depth from Soil Horizon Soil Texture .Soil Color Soil Other Sluface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. _ onsisk:ncv.%Graved 5 to R-`1 z YjZ 40 DEEP OBSERVATION HOLE LOG Hole:#�- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ ons ency.%Gravel) �. F(LL - a S Lo R,% 1 - DEEP OBSERVATION HOLE LOG Hole#_ Depthce(in.)from Soil Horizon Soil Texture Soil Color. Soil Other Surfa USDA) (Munsell) Mottling, (Structure,Stones,Boulders- I _ Cgnsiste;ncv.96 Gravei9_,� I I DEEP OBSERVATION HOLE LOG Hole# D pth from Soil Horizon Soil Texture Soil Color Soil Other S'rface(in,) (USDA) (Munsell) Mottling _(structure,Stones`,Boulders. • o,�r sis e•n�v.96 Oravel), i I Flood insurance Rate Ma : p Above 500 year flood boundary No_ Yes � Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally occurring Pervious Material DIbIes at least four feet of naturally occurring pervious material exist in all areas observed throughout the All,ea proposed for the soil absorption system? `��S Ifj not,what is the depth of naturally occurring pervious material? .�. CIedification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by nie consistent:with . le required tr ' ing,expertise and experience described in 310 CMR 15.017. Signature Date(�^ QI\.SFFnCTERCFORM.DOC r � COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEFVFn MAY 2 9 2001 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 27 Limerick Court Centerville, MA Owner's Name: Chris Joseph Owner's Address: Date of Inspection: v ^ Name of Inspector:(please print) Wi 1 1 i am E_ • Robi_nson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (5 0 8 ) 7 7 5—8 7 7.6 CERTIFICATION STATEMENT 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 Sect' n 15.340 of Title 5(310 CMR 15.000). The system: [passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: mil/4 V� e�- �� Date: —a The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaRhvr 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 approxing authority. Notes and Comments ****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 5 Inspection Form 6/15/2000 page 1 Page 2 of l l i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 Limerick Court Centerville Owner. Date of Inspection: —! _0 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy em 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 rep - ed.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Ans er yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please expl The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unso d,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the exis g tank is replaced with a complying septic tank as approved by the Board of Health. •A etal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance ind' ating that the tank is less than 20 years old is available. N 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 pproval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will p s inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 4 of I 1 ' 4 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 Limerik Court Centerville Owner: Joselph Date of Inspection: $ —/ —0 System Failure Criteria applicable to all systems: kindicate"yes"or"no"to each of the following for all inspections: 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'/2 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. 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 coliform bacteria and volatile organic compounds indicates that.the well is free from pollution from that facility 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.] (Yes/No)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 a considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd Yo must indicate either"yes"or"no"to each of the following: ( e following criteria apply to large systems in addition to the criteria above) ye 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 drinldng 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 ou have answered"yes"to any question in Section E the system is considered a significant threat,or answered "y s"in Section D above the large system has failed.The owner or operator of arty large system considered a si nificant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 1 304.The system owner should contact the appropriate regional office of the Department. 4 Page 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Addre?s? Limerick Court Centerville Owner: Joseph Date of Inspection: ,S l — O 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 fai ing 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 sy tem is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet.of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance *"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: 3 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 27 Limerick Court Centerville Owner: Joseph Date of Inspection: S°—I 7-0 Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes o /Pumping information was provided by the owner,occupant,or Board of Health Y 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? 1/ 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? V/_ 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: Yes no 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(3)(b)] 5 Page 6 of 11 <Y OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 27 Limerick Court Centerville Owner: Joseph Date of Inspection: S —/-7--a / FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: 31 Does residence have a garbage grinder(yes or no): A Is laundry on a separate sewage system(yes or no):_ [if yes separate inspection required] Laundry system inspected(yes or no): /L d Seasonal use: (yes or no):Ifid Water meter readings,if available(last 2 years usage(gpd)): 2000 90, 000 gal. Sump pump(yes or no):4-'� 1999 53,000 gal. Last date of occupancy: .g— C MERCIAUINDIJSTRIAL Typ of establishment: Desi n flow(based on 310 CMR 15.203): gpd Basi of design flow(seats/persons/sgft,etc.): Gre a trap present(yes or no):_ Ir . trial waste holding tank present(yes or no):_ Non sanitary waste discharged to the Title 5 system(yes or no): Wat r meter readings,if available: Las date of occupancy/use: O HER(describe): GENERAL INFORMATION Pumping Records Source of information: /9 9y 1� Was system pumped as part of the inspection(yes or no):,d,., � If yes,volume pumped: gallons--How was quantity pumped determined? /6 6---0 Reason for pumping: TF SYSTEM _Septicic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool —ivy _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: Were sewage odors detected when arriving at the site(yes or no):A CU 6 • Page 7 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Limerick Court Centerville Owner: Date of Inspection: ILDING SEWER(locate on site plan) Dep below grade: Mat rials of construction:_cast iron _40 PVC_other(explain): Dis nce from private water supply well or suction line: Co ents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: /- (locate on site lan) P 1 Depth below grade: Material of construction: concrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) / ) v Dimensions: G Sludge depth: / Distance from top of sludge to bottom of outlet tee or baffle: G-Z C7/' Scum thickness:_6 I J Distance from top of scum to top of outlet tee or baffle: d Distance from bottom of scum to bottom o outlet tee or bad/ L_� How were dimensions determined: �/�-- Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage etc.): EASE TRAP:_(locate on site plan) Dep below grade:_ Mate 'al of construction:_concrete_metal_fiberglass_polyethylene_other (expl in): Dime sions: Scum thickness: Dis ce from top of scum to top of outlet tee or baffle: Dis nce from bottom of scum to bottom of outlet tee or baffle: Dat of last pumping: C ents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as r lated to outlet invert,evidence of leakage,etc.): 7 Page 8 of l l ' i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Limerick Court entervi le Owner: Joseph Date of Inspection: ✓ TI HT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Dep below grade: Mat ial of construction: concrete metal fiberglass polyethylene other(explain): Dim nsions: Cap ity: gallons Desi n Flow: gallons/day Al present(yes or no): Al level: Alarm in working order(yes or no): Da of last pumping: Co ents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 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.): PUM CHAMBER: (locate on site plan) Pump in working order(yes or no): Al s in working order(yes or no): Co ents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Li mer; rk Court Centerville Owner: Josh Date of Inspection:—6 o I ) I 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.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: i Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PR (locate on site plan) Mate ials of construction: Dim nsions: Dep h of solids: Co ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Limerick Court Centervi e Owner: Joseph Date of Inspection: S'I P ® , 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. U�d 35� V Q j P 10 ' Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Limerick Court Centerville Owner: Joseph J Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 2­0 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: You must de cribe,how you�gstablished the high ground water elevation: � t6 ) D S t M. 11 \�+, TOWN OF BA.RNSTABLE �- LOCATION � � � 41 ,�� 1 � l� C-01' SEWAGE # �iII LAGE �"�c / • ��z LeF+ ^ ASSESSOR'S MAP & LOT��®� INSTALLER'S NAME&PHONE NO. I& 14' a-to ime i �J`�2�-7`7 6 SEPTIC TANK CAPACITY /6 4--1:2 LEACHING FACILITY: (type) �-- .�t '4 a L 4 (size) 13����� NO. OF BEDROOMS BUILDER OR OWNER ® PERMITDATE: COMPLIANCE DATE: 'pl-t[7► l Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leacling Facility Feet Private Water Supply Well and Leaching Facility Y' pp y g ty (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) C Feet Furnished by ' , ' S\\\�r �•` , � ,rye � _.� 7 t4 1 \ ' f e .. r s TOWN OF BARNSTABLE .._ 7 La n t,,L,!C C-ov,;k SEWAGE# VILLAGE C e^`�`es J v��e.- ASSESSOR'S MAP & LOT i�Slr ,q� e,P 3- �S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) OQ0 G CA ` NO.OF BEDROOMS �a BUILDER OR OWNER 1- Jdt A 0200-6- CCLJ PERMIT DATE: COMPLIANCE DATE: 1 ! Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by „.�. �� �© I� .. 1 q -,,-0- No. AM a ((// Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(ppYication for ;Miquar *pgtem 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. 27 Limerick Court, Centerville Chris Joseph Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service PO Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 1 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system consisting of a D-box and 2 precast leach chambers with stone all around 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 t ' Bo d of Hea Signe �^"" /1 Date Application Approved by Date Application Disapproved for the following reasons V r Permit No. Date Issued r TNt I Y� 9 rn o. / D Fee THE.COMMONWEALTH OF MASSACHUSETTS Entered in computer: .....................--.. " _.. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ' ZIP 'Yication for Digogar*pgtem Congtruction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components V v Location Address or Lot No. - Owner's Name,Address and Tel.No. As2k7or'Aa )pX4ck Court, Centerville Chris Joseph Installer's Name,Address,and Tel.No. ( Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service PO Box 1089 Centerville Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures : „�M t Design Flow gallons per day. Calculated daily4flow 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) Tit]e_5--1 A ch sus t m—r cztl si s t i aag preeast leaeh ehambers . 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 this Bo of Heat Signed Dat Application Approved by Date p Application Disapproved h -following reasons Permit No. Date Issued - -——————————————————————————— —————————— THE COMMONWEALTH OF MASSACHUSETTS `a BARNSTABLE, MASSACHUSETTS Joseph Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( ) Abandoned( )by Wm. 9. Ro—bIns—®n Septic Seryisa at 27 T.i meri ck roiirt , renteryi I I e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ® ated Installer Designer or The issuance of this permit shall not be construed as a guarantee that the syste 11 function-as designed. Date Inspector / '4 S --------------------------------------- ,i No. OV_/ Fee F $ COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Joseph lizpoal *p!5tem Construction Permit t Permission is hereby ranted to Construct Repair' y g ( ) p ( X)Upgrade( )Abandon( ) System located at 27 rLimcar.; okCraur_A;, ter�ill� 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: Construction must be completed within three years of the date of this p t Date: i Approved by t / � v �s i th t� NOTICE: This Form Is To Be Used For the Repair Of Foiled Septic Systems Only. CER rMCAMON OF SKETCH AM APPUCAIZON FOR A MSPOSAL WORKS CONSTRUCTION PERII►I1T(WITHOUT DESIGNED PLANS1 L William E_ Robinson.!%cebycmifydmtlrapokationfjrdLVOWworics. consrtuc Lion permit igned by me dated -" �� , concerning the FroY locatedat 27 Limerick Court, Centerville meets all Of the Mowing criteria: The failed system is to a Teaden1W dwelling only_ That are no commercial or business uses associated with the ' & • The soil is cf-mi tied as l and the percolaum rue is ten man or equal io a ainatm per inch There are no wedands 100 feet of the proposed sgmc s'�-tem — There are no pri wells within 150[eet of the proposed septic s}1sww There is no i in flaw andlor CbMze in use puVesed • 'there are variances vgaested or needed- - The of the propct4od>rachiog fapyry will nit be bcmed less than five fcer above the mast adjusted groundwater table elevation:(Adjust the groundwater table using the Frimpior when applkablej the S-A-S_will be beard with 250 feet of any vested waiatds,the bottom of the proposed leaching facility will W-be located kss than fwuteea(la)feet above the mammum adjusted groundwater table elevation Pkase complue tlae Mlo ring: A) top of Ground Surface E (ttsisg CIS L B) G_W.Elevation +the MAX. high G.w. _ 6 . p DIFFERENCE BETWEEN and r SIGNED: tl q�v� DATE: (Sketch proposed plan'ot system on backl_ sr hcW&foldta-ren ate' 1 �,: �� (z - L � �l°G�/� r - TOWN OF BARNSTABLE LOCATION a 7 L < 9 a9- SEWAGE # 0I VILLAGE_ ASSESSOR'S MAP & LOT,4L2_::0-7 2T ��J = r. INSTALLER'S NAME&PHONE NO. fC 1.*,=f 4 i_7 .5 —�r -7 SEPTIC TANK CAPACITY /o LEACHING FACILITY: (type) S��t� '°� �— �= (size) f' � NO. OF BEDROOMS • .r BUILDER.OR OWNER J PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leading 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 . Li.. .. .... , .�:.`1•d1 tom/ '� 77 r - 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMZNT OF ENVIRONMENTAL PIZOTEC'NON ONE WIIQTER STREET,BOSTON IdA 02108 (617)292-MM MTRLMY COXE D 7 K sonst.ty ARGEO PAUL CELLUCCI DAVID 11. STRUNS Govemor Cohhtsaiss oast StA1119MACE SEWAGE MPOSAL SYSTBI NNECTww FORM PART A CWIiTWCATfOM fkopasW Addraeoe: +� 7 �'awt Ott C�r`� Manse of O.nterS;yCoW ,c, ,r.�►c i &S Address of owner: 3 Z( (�' 4 c .. as of lMtsgostfotl: 1 a.l��'t� (;�*.or 'ma.s s D l4gv Ewsne of wr.seor:Wasson pdw n%L I sae a ow eTslstrtt mesa$swo h 15.3E0 of Thle S 1310 CM tg.000) Caatv.nI wwa: ;p1�._ —4L Cdt%0 ilia Mod"Addtaos: iOa Vt t T&IwMn»Nsl&wr — i son"that I have perseneliy intpented the sewogs disposal system at thb address and that the information reported below is taw, ataurate and complete as of the time of imploction. The inapsctien was performed based on my training and experience In the proper function end maintenance of on-site,sewage disposal systems. The system: passes _ CandkiOn8111V Mssaa _ Needs Further Evaluation By the Local Approving Authority _ Fos Q inepsessr's Sigrw®rrr 04c- Dees: 4 'The System Inspector$hall submit 11 copy Of this inspection report to the Approving Authothy(board of Hoeft or DEMwithin ttdrty(201 days of oempieting this inspection. If the system is a$hared system or has a design flow of 10.000 gpd or greater,the inspector and the syattrm owner "t haM submit the report to the approltrifto regional offies of the Departrrhwht 0fYrnvk0r4Vhona0 hota con. The osonal should-be saw tor" system owner and oopios sent to thl buyer.if applicable,end the approving outhwfty. NOTES AND COMMENTS revised 9/2/98 r.�t orit ►hnt�d en IIlIyCNd P�plr f $U@rJ V42 SWAM ioMlrOSAI 111rsT1M1 MGP6CTMN FOAM iAQT A C�I1'IfICAT1DI1 Isorrrrawdl pr pR1► a 7�ivnrick C�ou�t Owner: u55 C,a,J oss D of VAPNOW t�'kb�q , mi iCT m summAn: aaab A. R. C, .. D A. sYSTM VMess: I have not found any infowwoon whieh)ndiasiss that any of the failwo conditions described in 210 CMA 1i.203 exin. Any failure adowls not evokaoad are I kabd below. COUNNINTS! L $Vs M colbmONAu.Y►Asks: Ono or mwe system eomnm opts as deoarlbod in.the'Conditional pass"section need to replaced m repaired. The sriton,upon oonrpotion of tie ropla ce nsM or repair,as approved by to Dowd of Medth.will I n6cow yes,no,or not determined(Y.N.or AID). Describe basis of dete ntinallen in s. if"not determined',explain why nirt. _ The"pile tank is motel,wiles the owner or operator has t>rovi the system Inspector with o copy of s Cerdllm*of Compliance leftechad)indiesting that rho tank woo Installed two rty(201 years prig tr the date of the i o"Mon;or the septic tank,whether at not metal,Is creaked,stru v unoound, shows substantial ItMltradon or oxfNMO x►.of tank failure is im+minrtrt. The system will Woo Inspection existing septic tank is replaced with a cornplying soplic tank as approved by ON eased of Wealth. Sewage backup or brookout or high aria water level observed In rho distribution box is due to broken or obstructed Opals) or due to s broken, settled or un on distribution box. The system will pus inspection if lwith approval of the Board of Masl111l. brokon s)we replaced n Is removed bee is IovsMad or replaced s The sVotanm r ad pumpblemwre than fouHbnea a Was rAue to bmitan or eaatracted pipels). The *to i will v—lw- inspwden I with Opp roval of the Beard of Mookht, - -- broken pipalsl are rplarked r"_"", obstruction is rorrrovod revised 9/2/98 papr7oflt 17 SUBSURFACE SEWAAE DISPOSAL SYSTEM NWECTIOIM FOAM PART A CBIYgICAT10N teertllraredl PMaperly a 7 �• i M e:T%C\ �jb;PTAOarnwer: �p V SSe.ac. Dome ku6m r iat 6h8 C. PURIM IEVALUATIOM E W211,1BISD BY THE SOAIW OF HEALTH: Conditions sates which raiprirs fur&w avokielion by the of Hoi in order to doarmkw if the system is falling a protsat tM plrblit hsslth, safety and 1M�. 11 SYSTUM WILL PAU MISS BOARD OF DETBIAWM N ACCORDANCE WffN 310 CUR 16.20 1101 THAT TH!SYSTfMi •NOT WNCT1lMA N A MANMRN !RQ=CT TMIE PUK=lIF"TbLA11W SAFETY AND THE WMORIIIIIIIIIIIIII2: Cesspool or privy Is SO feet et ataftes wow Coewooal or privy i n 10 feet of a bo►dst"vogstated wnland or a ash metah. 21 SYtTW WILL PAL NNLSSS THE BOARD OF HEALTH LAND PUSLJC WA UPPLER,IF AIM DETWISAMS THAT THE 81'9TIRSA IS FiJNCTI0NN0 N A MANiYEIt THAT PROTECTS THE PUKX HEALTH SAFETY AND THE 8WRONMENT: The system has a septic teMk and"I aboorodsn sywt S)end the SAS Is within 100 feat of a swface water auppiy er .... trtbuary to a surfats wear supply. The system has a septio tank and sell oboe yetem end the W is within a Zone I of a public water supply wal. _ The system has a split tank and soil oboe n system end the SAS is wltMn SO feet of a prhrato water wooly with. The system has a sptle tank and&W rplion system end the SAS is lees then 100 feet but 90 feet or more from a privaa water supply won,uniess s water analyois far coliform bacteria and volatile oresnit compounds inditsq,s that the Wiwi is free from pollution from feeNity end the presence of swinonis nitrogen and nitrate nhrogwn Is equal to ter less then g ppm, fylu w ppr thed used detertniM distaeoe (ees' when not vdd1. 91 OTHER revised 9/2/98 hyr�sttl i S111111SURFACE SMA49 ONPOSAL SYSTM MISP ECT>Iopl hOIIM PAM A COfllICATM IeoaMftwdl ,,apr,y A�iutaa: O� L, Yin i" cu C,o cwt ownw- e0.v Dam of bteposill"I l'a` D. BY87 I!PAU: You must Indicate either"Yes"or "No" to oath of the fallowing: J have determined that efts 0r more of the fallowing failure ew+di4ians lot u described in 310 CMR 16.303. The basis for this detormination is idend od below. The Seats of Me"should be led to determine what wig be necessary to coeeet Zits hAra. Yes No _ lookup of sewage IwahtiReyrerggen+ doete on overloaMd ereksggod16"oreeaspa(. p Discharge or ponding of effluent to the of the ground or surface wetwe due to an overloaded or clogged SAS or cesspool. Static liquid l000l in the distribute above outlet invert due to an ovedeaded or clogged SAS or cesspool. Liquid depth In coaspool Is I then S" below Invert or avail"valuate is We then 112 day flow. _ Required pumping more n 4 times in the last year no due to clogged or obstructed Dipole). Number of tirmrs Any portion of Sam Absorption System, cosepool or privy Is below the high groundwater elevation. Any portion a cosspool or privy is within 100 feet of a surface water supply or tdbutory to a surface water malty. Any of a cesspool or privy Is-within a Zone I of a public well. _ Any on of a cesspool or privy is within 60 test of a private water supply well. y portion of a cesspool or privy is leas-then 100 feet but greater then 60 feet from a private water supply well with no cooptable water quality analysis. If the well has been analysed to be acceptable.attach copy of well water analysis for +coolorm bacteria,voWdle erganio oompounde, emm"o nitrogen and nitrate nitrogen. E. LAMS SYST>Elk PALS: You must indicate either "Yes"or ' No" ath of the following: The following criteria ap systems In oddltion to critarle above: The system serves a fooi design flow of 10 gpd or greeter(Large System) end the system is s significant threat to pubk health and safety and thaenvironment because a +Here of the following conditions aslet: Yes No tiro sysam is rf a surface drinkifq water supply the system k" few 00 8 opgawery4a• *irppl+�the system is lu nitrogen serahtive arts(interim wellhead►rotection Area-IW'A)or a mopped Zene 1101 a public water supply ar The owner or operetar of any the system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the ioeea r MWW office of the DepoRntent for r lidwentlon. revised 912198 Pap 4of11 r SgiiSlawlsACR SMAM 01111/OSAL f;iTSM I148INrCT1011111 P01160A PART. CNNCKLMT Prepf>*trA��°o tlwnar: 1�0• SbeG-J 06"a+bfa�•�e•rf: taA b`�� Check if the toiiowing have bean dins:You must indicate ofther was" or'No" as to each of the ta0owing: Yes No Pumping Inforrnstion was provided by the owner,occupant.or Board of Heath. v •liens of P119lef6baIDMiaasl9wo7Maabs&AUG trystallt ban etawsll flow rafts during chat Varied. Large voluffas of wafts have not bs- bttroduced into the System recently or ae Hall of Mlle inspection. As built plans Move boon obtained and examined. Note If they are not ovaisble with NIA. The facility or 4weikng was impacted for signs of sowage back-up. R The system does not receive non•sanitery or Industrial waste flow. s The site was k"pooted for signs of brsokout. All system ewnlronsnts.excluding the Uil Absorption System,have been located on the site. The septic tank manholes wore uncovered,opened.and the Interior of the septic tank was inspected for condi ion of bathes or lose,mateft 04 conotnl om,dimaalotrs,depth of Hasid,depth of sludge,depth of scum. The size and location of the Soil Absorption System an the site has been deterrninsd based oar: r f:xia"infenlfation. for axernos.Pion at S.O.N. Detannined In the field Of any of the failure criteria related to Port C is at issue.approximation of distance is unacceptable) 11 5-302(2)fbli Y _ The focWty swam WW.osauposu.if di"aas bawl or J.w wa4wanidad-wJ&h kdamooda&on nsf SubSurfees Qbrwsal Systems. revised 9f 2i 98 Tgelertf wras XMCE SWAM OGVMAL SYBTfilil/- MCTION FOW PART C SYSTM tMAf1>rAT10N ` '•(� caot- foal10 of iwlo.6ora !a 1 �•'4�1 i ROMf a OMM"Wift Deep tow: 110 S.p•d./befte". Numbw of bo&oorns(dealpl:, j. Number of bad►ooms lactuaq:3 Tonal OEfM-1 flow _3`2 Nnrnbor of"mom►Aments: a- 6,-8t vbww I"a w nel:,�, la Laundry(separate syeto) lyres OP no): If yes,*apaws impe*tlon required _ LVA*Y etnlsm--V—Nd pie a not Soaorial use Iyes a ne):� -$ Water mate►roodlngs,M hr W lion two year's we"(file Swap"lyee or no)*, Lost date of eaetlpeneY:SaaZI-G 1►t Type of a- I Ishment:+,_„__,,, Design New: and 1 Iwiw on IS, fools at chip►flew Grasso trod present: IVM w me). industrial wore me"Tank pre- (yes or no)_ Non•sankary waste 406chargedjAho TMs 6 system:(yes or no)_.., Water I eta►rasdMgs.N _ Last dots of oce OTIIfBt:fDao ) Last date cupency: GOGUL SPO11MAT)ON PUMPMG 11ECOOM sand rc*of infor fy-tam pumped as can of inspection:(Yes w no N yes. volume pumped:„ gollons Manson for Pumping:,a IV OF GVISTW �! Septic absorption system Single oaspool Ova cosep" POVY Shared system Iva or nol Of yes.attach previous ins"ClIon records.If any) I/A Technology ato.Attach Copy of uP to dote werotion OW maintenance contract Tight TOM Coon,of DIP Aw roves Other APPROXNAT!AGE of oil Compomints.dew in isli"41f known)ww**ores a 6wo l dw ..•�.s�[e?- Towage edible detected when-arriving st the ante:(yes or no) revised 9/2/98 *�„ slJsfiURPACE WWAat OrpOi"S"TW NMUWClfOM1 FOOS PAW C ova I11164IMTtOp fowdbo m w...�► �7 ��w►a•�,�k t,o���t oWA. syrw Dome of owpo.r.a fflfRfnsr ff>lweo: floosie on oft Ow) DaptA Naiaw rsM:,�t t ' MstsrW of oonslruodon: cost kiM I'm PVC`other Ioawla") Oise"tilrtwa wow supply wor or%Wow fine lu mw Conrrram:iosndtlon of joints,%wMno.sddanse Oftairooe,-ses.l so'1'IC TAft: poem on sla plan) t� Depth bolos.Omer Matww of eonsimtion:le". prate_mow,, mberfloss .,,,,rolyourowra—ot *xpmn) t tank Is p»W.llst toe_ /eats.as&WkMW ay Conifloste of Complioneo_ IYaslNo) D)mMNtena: I shwoo dspdr:! ; Olownee thin Up of aydoe to boa m of outlet no otleffls:j_� 6 sown tdakness. 2 - —h# Disatme bom top of oasn to top OW oudel toe ow Asffle: D i l Disume from botlom of sown to loaom of Wrist s or bafe:_�,,�, Now drra ta n*ww were doneirrad:, Comnrsna: Ireeom""WANion for Pwrnpin'LAOndltlen oI t outaf,twee w- th of agwd lewol in relation tei oudat invert.atnlotweb4ft y� Ovid snee of leeke/e,etc.) e,r V. L d�i1sE Tw11h•: Ilsesa on oho plan) Depth NaLft , raft:_,,,... McWal of eansUmellon:_coneret,t_metal_FIbwgItee _"othoons! rlaxplain) Oinranalens: swum tMsknoss: Oistowme from ao of sown to top of outlet two srXbOlk*,Watence frorrr kotam of scum to Os4+iOrn of auils Date,of lost pwrow: Cerrntwrra: Ireeonowidation for I;- a j ns.oandhhon of t and outlet toss wr esffles.depth of liquid love)in reation to outlet invert,atruwswal intrtrtty. eeldenes of Isokeoe.oft.) revised 9/2/98 Pop Iof11 SUBSURFAM$WAGE Ol UMM ST87M iMipKCTlolll PORM tr"T C oval■ll rr�alil�tlAT�lu barerb.n4 �..: ; tDwe ere ap�Itla� l�-�b��s3 JOW an NOUMI TANK- 1Toek must be pune0ad prier to. w Ome of,inswdon) 111ssaea on ogle ptont ®op1A bolero raft: Ma row of o"Motlon:,_owame—nww—PAW I opolyederMno,Potlarlexplainl capaft--�poem tl`ow.-�t1p1ft' Alarm Wo"M_ Alwyn W40:.,,,,,,_e_Akerrn IKictnp order:Yes poeo of prOwNwe pumpwv: . Cwrweenls: IoenMtion M iniot qo, on of Mom Iced floes IwItoMl,tRo.l =710VTM NX-- flsaate on aft pktn) popih of pauid heal obeds ouuet Ir-V@M:_,_..,, Coo"IMMrel: .. hate If load SOW dblrlbutlon is squ ."dows of solilds corrywyer, wwonoe of took@."into or out of box stc.) J �- tit o PUMP OMAft=-_ (iossts on on plan) pump in wa tft wdw:lyea w N)1__, Alenwl In wwkft wdw(Yes or Nul Con+r WO: Into condMM of PWM aL-01 A I ,eendkiwe and eppurtonwreess,ore.1 revised 9/2/96 ry.�otlt SU MMACE sffAMAAff DsposAL srsTW VWW ON FOIN DART c STW M VNCFAFATfAM Iautrfrwd! fheparW Ad4�l� o� 7 C,c�v,r tneiat1 : oeds st f�tsDaeliw� ��`�,�4�t f�Alro�lon st►Is�r aAsr��, I- , I an do pM&if pos",.sseaVrtlon net► *Wed.loos*m test'be spprorinwted by non4m"wd%*nwdwftl of not Masud.ate: Type: MradlMt�pib,rwrrlbM: showtbors.5VA16w:— Issdd I�9090".-m as►:_ lessor,@ aerwMe,nueabsr.lenph: works eseap".nr+ndw:.— Ahsrnatlro oyatsRl:— Nwns of Toohnskly: Csrrpewrrb: mote gpgdtMert of sdl. s M lid►�Ajc�V iur w l of pen#nO dsnw soil.eendltlon of vpsestlon.mac. G0.� �� L � w LA poesto an flla/hnl fWrodtar and Oarlfl�tMatlOn:�„r.. DopthOtsp Of 0"to Wet rows":— — Depth of 6"low: .001 Depth of eet+m ww:..s..^� DMnsndom of eoaspod: Materiels of eonsavetlen:"tot"of rowwwator: �,,_ inllsMr ioesspooi must be a part of lnspaodonl Cerrwrwnq: on, Ins,oor�tion of is ,ei/ne of hvdrrsrlia taAwo.level 0/f ^fa,�andidor+of Pw W 1: J&,.—s an sks pMMtl Mateo*of esrwauajn:�...� Depth of sadM:.� Conwn m. .Iowa of gap Sm@.eendhien of vo*eotion:ate.} Inow son~of&A sine sf� revised 9/2/98 p'�eeof 11 sUBBURFACE MWAQ&OEIi MM•YSTSM EI FWTWM iPOM MAT ST97M EEI'011MATIO I loattMrtoa a owrtar: V S!OCC.v 991IM t Of 111EMIAOE 01N/OM SYSIM: inehrdo ties to at leant two pawmt refaanea Wsdnwks or Oanehoomm o Ioosi all wells within 100'(Looato whtro pubNe wata►Supply corms Into houaa) r r 3� 3° co���s� w revised 9/2/98 h1f10of11 StAEtMACE UWAGE ORMOB I SYSM WSPIC7=POlk 1 FAINT C sysum oram m7m laesrmmoo o Sw v.Co NNCS Rw..l�penyM►w^,,,_,_ Set T _ Typical depth to groundwlsta USGS pets webelts visited observotton Wets ahookad Ofetmndwota►depth: Shollow Moderone Doep SITE EXAM Sktpe Su►fece wow Check Ceto► shallow wags Estinmad Depth to Omoidwate► fast Moose indkete aM the mnhods 0801 to deaWhine NO Gfeurldwear Eisystion: Obtaktsd horn Design Plans em mead Obsarvod Site iAbutting property.oboornolon hale,beset"wat sump etc.) DNsrmkred 1►an local aondW as Chocked with local Dowd of Iwehh Checked f1EMA Maps Checked pumping racords Chocked k►cel aXcawetors.W tate►s L Used U806 Date Describe how you astablishod tho!high Groundwater Ehvotion. (NM be completed) revised 9/2/98 Poll 11orll a ` Aw &Lc� At- 4'r TOWN OF BARNSTABLE 06461 LOCATION e,'7 `1 iG -CO%J)vr SEWAGE#' VILLAGE4f //� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �� (size) � ® G•¢L NO. OF BEDROOMS 7i PRIVATE WELL OR PUBLIC WATER BUILDER O OWNE & �5A'yi DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: VARIANCE GRANTED: Yes No �,�gA - I EXISTING SEPTIC TANK -gg --EXISTING CONTOUR ellde'o W N TOP OF TANK, EL.=104.60 1. �_r BENCHMARK �/ INV.(OUT)=103.25f(VERIFY) 1 x 100.98 EXISTING SPOT GRADE o � RoSemorY OUTSIDE COR./BULKHEAD I. W EXISTING WATER SERVICE c EL.=106.45 EXISTING S.A.S. �/ -$.H.btu OVERHEAD WIRES o OJnoo� � CD TO BE ABANDONED � � TEST PIT a X 104,9 S 34'49'25" W � BENCHMARK t LOCUS G� o0 _ LEGEND f � J�e``� of c^ fence line 105.72 -d�-- ryyY d Rd F r- -� pB To�oToo �ti� SHED X - �3Q6, i TP-1 10 •12 + �� X i ® O I a� 105.44 ( I ;;,: _ --i$6- Route 28 c 10d.09 EX. S.A.S. -J TP-2< J 1 5.94 LOCUS MAP ® 06.18 �'\' .1. NOT TO SCALE 6,08 f' .: :O X1 GENERAL NOTES: G 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �� BOARD OF HEALTH AND THE DESIGN ENGINEER. 105 26 f DECK DECK 12 F--12.8-�i \ 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS � OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(1)(b): + •10 •,0 1 5.12 EXISTING HOUSE(#27) fence 1) An 8' variance, S.A.S. to cellar wall, for a 12' setback. in can, 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ) o W T.O.F.=106.88-+ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE o U) o • � _ o DESIGN ENGINEER. CV -. 1$6- O Ln 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN z -F 105.96 m ENGINEER BEFORE CONSTRUCTION CONTINUES. 104.96 105, 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 106.37 / Z X 105.68 - 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 1 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF i- 105.43 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 105.34 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 194:10 PAVED-iQg!eo`; y�P 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. VEWAY.; 1�A 10 ,23.' ;.':':• ,.> g `D _ 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS - o' AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 0 104.65 -" DIRECTED BY THE APPROVING AUTHORITIES. X Q. x 10 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY _ _ THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING G) . ' -40 - LO- r 61- 1104 CONSTRUCTION. 15,625±SF -C7 -- r 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 102.59 x 103,3 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 00 X PARCEL ID: 169.-078�{ REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 103.5 \ _ _ - -49-22-- ----3 0c� -: OF Mq 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 1�5-00--- { � SS�C INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 101. ' S 34'49'25" W _ �� �G 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 00,00 x 101.55 -_---1$0-=-�- o PETER T. �_ NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. --�� ----- 0,00 McENTEE edge of pavement ]99,10CIVIL 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 100,26 100.07 9 P 99.37 U No. 35109 SYSTEM COMPONENTS NOT SHOWN ON THE PLAN 4 �F s�I51- PROPOSED SEPTIC SYSTEM UPGRADE PLAN LIMERICK COU��1 � � 27 LIMERICK COURT, CENTERVILLE, MA e! Z < <-� Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. HIGGINS, BRIAN E & LORI A Engineering Works, Inc. 1"=20' P.T.M. 224-15 27 LIMERICK COURT 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE. MA 02632 (508) 477-5313 11/7/15 P.T.M. 1 Of 2 1 NOTE: FINISH GRADE S PREVENT H ALL BE <HE UNOT EOOSED 0 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" INSTALL WATERTIGHT RISER & OF FINISH GRADE FOR INSPECTION PURPOSES T.O.F.=106.88t COVER SET TO 6" OF GRADE F.G. EL.=105.6t F.G. EL.=106.2t F.G. EL.=106.0f F.G. EL.=106.0t /EXISTING MAINTAIN 2% GRADE (MIN.) OVER S.A.S. °j HOUSE(#27) Aj°' N T.O.F. 106.881 L 26' L 5' ® S=1% (MIN.) ® S=1% (MIN.) 24.3' DEC s 4"SCH40 PVC 4"SCH40 PVC DECK 10° as $ ar2.8' ��_ 11.6 14" B' BB6aBB EXISTING 48" LIQUID LEVEL 4' 4.8' 0 GASABAFFLE INV.=102.77 PROPOSED INV.=102.60 EFFECTVE WIDTH ti -0 ^ 6$ INEXISTTING 5t � ✓INV.=102.50 Ni �OI N 6 Gj EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS I > SURROUNDED WITH STONE AS SHOWN ( ' H-10 RATED JTOP CONC. ELEV.=103.3f BREAKOUT ELEV.=103.00 aaaa SEPTIC LAYOUT NOTES: INV. ELEV.=102.50 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aBaaar).13aa� a INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=100.50 4' 2 X 8.5'=17.0' 4' OF NATURALLY OCCURRING' MIN. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4 PERVIOUS MATERIAL EFFECTIVE LENGTH 25.0' ON A MECHANICALLY COMPACTED SIX INCH CRUSHED / ®®®® (0 E3 STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). ✓ 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION ®®®®®®® ® ®®® 33" 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TP, EL.=94.5 - w ® 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON 3/4" TO 1-1/2" DOUBLE CV > ®ka-E3 THE OUTLET TEE. I WASHED STONE ? 3" LAYER OF 1/8" TO 1/2" „ SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE 102 (OR APPROVED FILTER FABRIC) SOIL LOG 4" KNOCKOUT DESIGN ,CRITERIA 20" DIA. COVER l DATE: SEPTEMBER 25, 2015 (REF#14,832) / NUMBER OF BEDROOMS; 2 r SOIL EVALUATOR: PETER McENTEE PE(SE#1542) 4" KNOCKOUT 4" KNOCKOUT 58" SOIL TEXTURAL CLASS: \,-, CLASS I WITNESS: DAVID STANTON R.S. HEALTH AGENT 0 DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH (0.74 GPD/SF LOADING RATE) 106.0 FILL 0 106.0 FILL 011 4" KNOCKOUT DAILY FLOW: 220 GPD 105.5 6" 105.6 5" DESIGN FLOW: 330 GPD A A GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM 500 GALLON CAPACITY, H-10 LOADING 10YR 4/2 d 10YR 4/2 LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 105.2 e 10" 105.2 B 10" CHAMBERS 74 GPD/SF SANDY LOAM SANDY LOAM / 10YR 5/8 10YR 5/8 N.T.S. EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 103.0 36" .103.1 35" PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS C1 PERC C1 P 36" " SYSTEM UPGRADE LAN _ 54 PROPOSED SEPTIC G USE 2 500 GALLON LEACHING CHAMBERS IN SERIES / SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES M-C SAND M—C SAND 27 LIMERICK COURT, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. 2.5Y 6/6 2.5Y 6/6 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. N0. TOTAL AREA:..............................................................471.2 S.F. Engineering Works, Inc. NTS P.T.M. 224-15 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471 .2 SF) = 348.7 GPD 1 5 138" 94.5 138" 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. .. NO GROUNDWATER, PERC RATE: <2 MIN./IN. (508) 477-5313 1 1/7/15 P.T.M. 2 Of 2