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HomeMy WebLinkAbout0111 LONGFELLOW DRIVE - Health 1�1 Longfellow Drive Centerville �\ A = 189 110 I a I No. 4210 1/3 ORA PendaflexAIX f 1 0% ;4 a n. ,e , .w y't fi f o it TOWN OF BARNSTABLE a. 1 LOCATION PC\�%"� �� SEWAGE# yZd 7 ® C) VILLAGE CSt—,kTSvk\\Q ASSESSOR'S MAP&PARCEL /kQ /I 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY `C ZQb LEACHING FACILITY:(type) (� `L C 0 Ed X;:5-0, NO.OF BEDROOMS OWNER PERMIT DATE:' 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 A A :? A4 z �5 c4� 3® , . P� \ k Co erg 0 No. 9D` 7—69 3 C Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for -Mispo8al 6pstrm Cunstruttion Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System I dividual Components Location Address or Lot No. 1 �,ONI�e k` ,0 W Qj Ow is N e,Addre�s`s`apd�T`i�� Assessor's Map/Parcel 1 !;' I taller's Nark,Add ss and Tel No. Designer's Name,Address and Tel.No. r;;� %7 X i 3 Q%a W r tiau1'1�• 6,1660 r� 6661CK Type of Building: Dwelling No.of Bedrooms 1 Lot Size L O bob sq.ft. Garbage Grinder(� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) %.AS O gpd Design flow provided 4 gpd Plan Date (Z'1 1 '? Number of sheets Revision Date Title Size of Septic Tank S?T C S� ®� Type of . . '(A L t= G C�,cyM 6— :! 1,. -NV Description of Soil �k a 0 OX C kd��o /0 X 5 0 X QeG� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. / )) —7 Signed Date"`/ / / 1 / Application Approved by Date Application Disapproved by Date for the following reasons - Permit No. � J)7 ^ c Date Issued " [,, *- y..,= ',i` ..,.. N ,,.-.. .. �... ,., .,,...•.R'l ..T,,,a^c, .� -,.,. .. r ,n:f+'....^"x'7`..t.,F' w•'t , , .,.7: °71 No. 20 ! —0 3 0 Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for 33isposaf p tuft Constru>rtiou Verntit Application for a Permit to Construct( ) Repair(AjUpgr de( ) Abandon( ) [:]Complete System ❑I /ividual Components Location Address or Lot No. �� \�4w`� J O er's Name,Address,_apd Tel.No. Assessor's Map/Parcel t Ci I t o C-e— Installer's Na e,Add�es"s,and Tel.No. J Designer's Name,Address,and Tel.No. �\f ti0v�'�. � S-�vc. t�tiSS �•U QoyG �� �jk 3t03 3a r r\n�ti t� .6I Mi 66 6q Type of Building: Dwelling No.of Bedrooms- V Lot Size c® b04 sq.ft. Garbage Grinder,(4 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.trequired) yk4 O gpd Design flow provided gpd Plan Date ` { + Number of sheets Revision Date Title j Size of Septic Tank Type of .R.9. uc (, C�,WN,6V S U\'ran Description of Soil �"1')Lb 03C ��-d,���O X S y X i DZZ p M,?., S CN\j Nature of Repairs or Alterations(Answer when applicable)Q n X( C&S_k_ P 5C\5�1-n G S VSk[V<\ Date last inspected: Agreement: ✓f 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. J Signed Z DatAll ! 17 Application Approved by Date,�>- Application Disapproved by Date for the following reasons e Permit No. L,:�D 1 7 "CD 3 61 Date Issued ------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by �(- 8 t1 V-cTr✓ y— at - - V L nS q r_k16 f .0 f L - has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No?D/7'If,�30 dated J 1 J Installer r c-, � Designer S � ' g � '�"� "\ �.Cam. #bedrooms W Approved design flow L gpd The issuance of thi pe it shall not be construed as a guarantee that the system willffun tion as designed. Date Inspector F No. ;JtO/ 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstrm Construction 3derinit Permission is hereby granted to Construct( ) Repair(V� Upgrade( ) Abandon( ) System located at C 1 1 , I� o W r 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. R Provided:Construction must b co leted within three years of the date of this pe�rltiit- Date a ) )T/� Approved by,,, Town of Barnstable Regulatory Services Richard V. Scali,Interim Director L►ar�ar�su. Public Health Division +' Thomas McKean,Director 260 Main'Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 II ( Installer&Designer Certification Form Date: 1�I t� Sewage Permit# of CN /03 16 Assessor's Map\Parcel �_) ( D Designer: !;:M1P REt,3 a. 11 A�S.T>E Installer: 5445 " 1 A- 'F Address: 0. '3O�( 16 Address: WS OL,%%�, YALWO T14 Rhi C�y?'N k�tyJoJtS , i4lk ggkoQ t S . k A. c)2_Cac O ZfoloO On � � 1^] sear ►-t- K was issued a permit to install a (date) (installer) septic system at �\ Wh� e,��pw �� C.v c\Z based on a design drawn by (address) SAP E�e=),3 k • P AA&I dated�'1 2 7 ll 7 (designer) —1/6 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 ' ce with the terms of the IAA approval letters(if applicable) Installer's Signature) , AL (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:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P lS Z� Department of Regulatory Services iq I Public Health Division DateZ. HAM 1439. 200 Main Street,Hyannis MA 02601 rEn n�x<� Date Scheduled 1 Time Fee Pd._ Soil Suitability Assessment for Sewage Disposal Performed-By, � � �`' �� Witnessed By:_ ",i,( b, LOC�TION&.G RAL INFORMATION Locallon Address \,� C)nG L�,�v� Owner's Name 1 � V�c, Address , Assessor's Map/Parcel: " S(� (� b Engineer's Name ``SI,-,,,x_ NEW CONSTRUCTION UREPAIR Telephone# ��� ������ Slo es 96 Land Uso p ( ) Surface Stones Distances from: Open Water Body ft Possible Wet-Area ft Drinking Water Well ft Dralhage Way i ft Property Une ry ft Other ft SIMTCHI(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands-In proximity to holes) w Parent material(geologic) 6L'�c��t'S /. Depth to Bedrock Depth to Groundwater. Standing Water in Hole: �r. Weeping fran Pit Fnaa Estimated Seasonal High Oroundwnter /�l DETERMINATION FOR SgSONAL'HIGI1 WATER TABLE -Method Used:• ��Wit= c�vsJ'�—+t-� Depth Observed standing in obs.hole: In, Depth to loll mottles: Do�th to weeping from side of obs.hole: in, Groundwater AdjuAthtant Index Well-# Reading Dato: Index Well level „ Adj,•factor— Adj.Groundwater•I.evai,.,_, PERCOLATION TEST Date / 9 Time G� Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pro-soak Time @ v Time(9"-611) Hnd Pro-soak N Rate Min./Inch . 1"2•— Site Suitability Assessment. Sito Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(i)week prior to beginning. Q:\SEPTIC\PERCPORM.DOC lq �t6 DEEP.OBSERVATION HOLE LOG Hole# Depth from Soli.Horizon Soil Texture Sdil Color Soil. Other Surface(In.) (USDA) (Munsell) Moteling (Stnucture,Stones,Boulders. Consistency.%'aravol) DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. le Ls ' /6 r-C 313 Z12— DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color 8011 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency. Flood Insurance Rate Man: Above 500 year Mood boundary No— Yes . Within 500 year boundary No Yes Within 100 year flood boundary No. Yes,,^,.,_ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorptibn system? YL� If not,what is the depth of naturally occurring pervious material? Certi� / I certify that on /'yF (date)I have passed the soil evaluator examination approved by the Department of Environme tal Protection and that the above analysis was performed by me consistent with . the required trainin a and experience described in�10 CNM 15.017. Signature Date Z7 Zit? • Q;�BpTIC�PBRCPORM.DOC T'OW OlF BAItNSTA BLE. SON- �l.� C..G�► V'e�/c„_„_�?�r�_�_�___,_. SEWA,G� # ,_._... .______�.,....-. ` E C ev►T'eru e ASSESSORS INSTA,LI.E S NA, S - PiHOI,TE NO EPC TA cRJPA►c]Tx 0p0 I I - —�-"w 1 Cu l fee s (size) 8UjLt)EIk DAL ONI R FTft3i/�dTAf ' w:.O01bCaIV4 X7�T}d,. .: .....:Y-- -`` J. sep�aratioeiigtGc;Fs�tweeta S?�C feet Maximum! )usted GioutiJwater Table to tl a Bottom.al Ching Lyaday ;--��-�--�-�-�--�-. Frio ae Pat4r du k� Jc,RI ikii(�e I~ea�.hitig cality my.�vetls Cx�st fi q ss3e iae within° tlt1 feet of leaching aeiliq, -- Ecita;c��1fl/ tRas►d acid Leac�ui��1"461ity any wet (l5 exist � ec i<r49ia�ia.3(1(1 fi et p i ding facl.cy) p f' �- LQJ G 4 i TQ.WN OF BARNSTABLE ATION /Q/t 11 ow SEWAGE # S LAG E C.2/�TP�fv� ASSESSOR'S MAP & LOT 9' NO INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY OW //++ / LEACHING FACILITY: (type) S' 30S S 14 to AP PJ (size) 410 X 10 x of NO.OF BEDROOMS y l BUILDER OR OWNER PERMITDATE: 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 leachi g facility) Feet Furnished by Tit SSD_P.i� W 1 J FD/ j 1 (3ALk O 1 a � Q / 3y Commonwealth of Massachusetts ' Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Eval "on by the Local Approving Authority 2-4-13 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11110 Title 5 OfficilInspectVFSbrrfiace Sewage Disposal System-Page 1 of 17 I r � Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complyingse i t c tank as approved b the Board of P 9 P P pP Y Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts o Title 5 Official Inspection Form Subsurface Sewage,Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of'a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville• MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other II� D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: ^ r Yes No* El ® . 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 El ® 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- ' 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply' ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in nitrogen r ❑ ❑ y a dr gen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ E Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the Feld (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 12-2012 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day Y(gPd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ I Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Centerville MA 02632 2-4-13 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): . Depth below grade:. 42"feet Material of construction: , ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition-of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 36"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic-Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" ` Scum thickness 2° Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle ; 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle . . Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts , i Title 5 Official ,Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) a Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: pate Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Rage 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) - Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Cultec 3050's 40'x10'x2' ❑ 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.): Leach field in good working order with no sign of back-up into d-box or surrounding stone. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments ,M 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form ,g Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s m 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately k a _j0 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 2-4-13 page. City/Town . State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ' Estimated depth to high ground water: 12'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed- Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with-local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans on file show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 111 Longfellow Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) t Owner Owner's Name 6 information is required for every Centerville MA 02632 2-4-13 s page. CityfTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed d ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file '4 f E ru t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Certified mail#7008 1830 0002 0500 8253 Town of Barnstable tVEr , Regulatory Services Thomas F. Geiler,Director 'j •' BARN a'CABLE. "A i53g.. Public Health Division s �p 1�� FA M A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 l Fax: 508-790-6304 November 18, 2010 Jose Gonzalez 111 Longfellow Drive Centerville, MA 02632 . NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you located at 111 Longfellow Drive, Centerville was inspected on November 18, 2010 by Town of Barnstable Health Inspector Timothy B. O'Connell, R.S because of a complaint. The following violation of the Town of Barnstable Board Code was observed: § 353-1 Responsibilities of Owners: Observed old rotten stove and small refrigerator,. - along with broken furniture within back yard of said property. You are directed to remove said rubbish from your property and dispose of it properly within 7 days of your receipt of this notice. You may-request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Failure to comply with an order will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Q:\Order letters\Refuse\23 brookshire Hyannis 2.doc i Citizen Web Request Page 1 of 2 ,ri�i'r�yr � „�,`r' t d € Citizen Request Management - Internal Use E i _ _---------- _-.------- _ ----------_..__-..._..._..... ._..___.._._.. ..... ......._...._ _ ____--._._..._._....._-__............_._._._ F Request ID: . 32786 Created: 11/9/2010 9:09:36 AN O'Connell,Timothy Status: Assigned To Staff Assigned To: Health Office Anonymous: Yes Category: Section 353-1 GarbagE -- � and. Rubbish E.C. Date: 11/24/2010 y�J Created By: Parvin, Lindsay Citations: Health.Office ._...................... ....... Time Worked: 0 Response Time: 0 Requestor Details: Email: ............_..._..........._......._....... _...._...__....._.._a.-.___.............__.----_.._.- Request Location:. 111 LONGFELLOW DRIVE Centerville, Ma .02632 Parcel Number: Map: ....................`189 Block: 110 Lot: 000 ..................._._....__.._......_._._.._._._._....__...._..._...-_-.--.-......_...........__..............._......_............ 'Request: Requestor reports garbage and debris(including a refrigerator and stove)scattered around 'the yard. ' Request Work History: Internal Note History: System entry on 11/9/2010 9:09:36 AM: Assigned to O'Connell, Timothy http://issgl2/lntemaIWRS/WRequestPrint.aspx?ID=32786 11/9/2010 I _ 1 %Health Master Detail Page 1 of 1 l._ogced In As; rJWN\oconne!t Health Master I Appiicat on Center ?arcel Lookups Selection Items Parcel 8eptac Perc Well Fuel Tank t Parcel: 189-110 Location: i11 LON FELLOW DRIVE, C NT R ILL Owner: GONZALEZ,JOSE Business name: Business phone Rental property: ` Deed restricted: Number of bedrooms 4 Contaminant released: Fuel storage tank permit: 'Save-,ParcelxChanges k.,ef" r 461Lo#okup Parcel Info Parcel ID: 189-110 Developer lot: LOT 29 �T Location: 111 LONGFELLOW DRIVE Primary frontage: 100 - Secondary road: Secondary frontage: Village:CENTERVILLE Fire district:C--O-MM Sewer acct: Road index:0916 Interactive map Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner: GONZALEZ, JOSE Co-Owner: Streets:295 OLD STRAWBERRY HILL RD Street2: City: HYANNIS State: MA Zip: 02601 Cc Deed date: 11/22/2005 Deed reference:C178612 Lard Into Acres: 0.23 Use: Single Fa€n MDL-01. Zoning: RD-1 Neighborhood: Topography: 1....evel Road: Paved Utilities: Public Water,Gas,Septic: Location: Construction Info Building N yea"a€ it.l">> Ar_,. 11::rG .?'t'*edrooms sathroo"'ms 1 11971 2632 1400 14 Bedroom 2 Full Buildings value: 9135,700.00 Extra features: o14,700.00 Land value: s;151,300.00 http://Issgl/Intranet/healthMaster/HealthMasterDetail.aspx?ID=189110 11/18/2010 Doc: 1P026P857 012-23-2006 11 :0S BARNSTABLE LAND COURT REGISTRN Town of Barnstable ' Regulatory Services • BAMRrABL& • Thomas F.Geiler,Director MAW A,Fo ,, Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 AGREEMENT FOR FAMII,Y APARTMENT I(We), the undersigned, being the owner(s) of property situated at 111 LONGFELLOW DRIVE in ►U CENTERVILLE, MA, holding title under a deed recorded with the Barnstable County Registry of Deeds or Barnstable County District Registry of the Land Court in Book . Page , or as Document No. being shown on Assessors' Map 189 as Parcel 110, hereby agree, certify, warrant and represent to the Town of Barnstable that the accessory attached apartment,which contains living quarters, is intended for use as a family apartment,for year-round occupancy. The intended and authorized use is for LEONOR & JOSE LEMA, NIECE AND NEPHEW-IN-LAW OF OWNERS JOSE AND MARIA GONZALES associated with the residential use on the same premises. This unit shall be used for a"Family Apartment"(as defined in Zoning Ordinances)which would require compliance with the Family Apartment Rules and Regulations. This unit shall not be rented as an apartment or as a single room,or in any fashion,which rental would be a violation of the Town of Barnstable's rules,regulations,and zoning ordinances. Prior to occupancy of this unit, affidavits reciting the names of occupants are to be recorded with the building S department. This agreement shall be updated whenever a change occurs or every calendar year. This Agreement shall be duly recorded or filed at the Barnstable County Registry of Deeds/Land Court for the purpose of alerting future owners of the property of this binding Agreement concerning the use of the property as herein stated. J The consideration for this Agreement is the issuance of a building permit and/or certificate of occupancy by the Town of Barnstable Building Department. WITNESS our hands and seals this 2 day of �P (�,.ocr�`( 200_(p TOWN OF BARNSTABLE O R(S) By. uilding Commissioner THE COMMONWEALTH OF MASSACHUSETT BARNSTABLE COUNTY,SS Date Z 0 Z— Then personally appeared the above-named (owner), 3DV.. IG 74111 C.•Q1L�- and made oath as to the truth of the foregoing instrument,before in Notary Public My CQi nit res: r 310 1 y' BARNSTABLE COUNTY ��,`� gLongfellowDrlll REGISTRYOFOEEDS 'a0'.4yOf (' A T RUE COPY,ATTEST i;����••�;,.�. Y OFDEEDS ��� gp�'(pgLEREGISTR JOHN F.MEADE;REGISTER T! R YOU WISH TO-OPEN A BUSINESS? e- 6u For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which �P you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, V FL.,367 Main Street,Hyannis,MA 02601 (Town Hall) 7121� DATE:-21-0 - 0 6 Fill in please: APPLICANT'S YOUR NAME: BUSINESS YOUR HOME ADDRESS: K TELEPHONE # Home Telephone Number g'oQ- L`AS'-y;-/0 NAME OF NEW BUSINESS .[. T G'c�»S / cJc 7i otv o TiPE OF BUSINESS S HOME ME QOCUP�#TION' .:. YES } _._„i111l . . IS THI.:..A. O �.� Have Vdu baen given.appr val from.the buildkn .dii isiorly. YI=S NO ApDRf=59 flF BUSINESS MAP/PARCEL NUMBER When starting a'new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business—in this town. 1. BUILDING COMMISSIONER'S OFFIC This individual has be to this tined• any permit requirements that pertain type of business. r Authorized Signature** COMMENTS: C-cx O a' 2. BOARD OF HEALTH. This-individual has bee for f t rmit requirements that pertain to this type of business. horized Signature** \ COMMENTS: �'�Dvr fll 4YI uG� �Y 1 3. CONSUMER-AFFAIRS(LICENSING AUTHORITY) This individual ha en info f the li si r r ents that pertain to this type of business. Authorized Signature* COMMENTS: Y Date: 7 /2O© . TOWN OF BARNSTABLE a TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 4 ,�• Cn 4 S l�0 e / 2)" CZo 14 h BUSINESS LOCATION:4L Lo H I/ncj V Vo ME X 0 s 63ANVENTORY ' MAILING ADDRESS: zl/ TOTAL AMOUNT: TELEPHONE NUMBER: Eo _ G a —3i L6 IS CONTACT PERSON: ZE2 IC t'n EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: r1l' INFORMATION/RECO MEND TIONS: S'MreO OY-1 `h Uc Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes a olishes Fertilizers Asphalt &=roofing PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil& stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r d COMMONWEALTH OF MASSACHUSETTS ' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ` DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: III Longfellow Drive Centerville, MA 02632 Owner's Name: Rita Heidemann Owner's Address: Ilh _ Date of Inspection: November 17. 2005 C5 a w Name of Inspector: (Please Print) James M. Ford �' CD > _ Company Name: James M. Ford . Mailing Address: P.O.Box 49 Osterville.MA 02655-0049 Telephone Number: (508) 862-9400 r r*t 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 Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Ne ds Further Evaluation by the Local Approving Authority F is Inspector's Signature: Date: November 20, 2005 The system inspector shall sub. t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. 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 _ I I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: III Longfellow Drive Centerville, MA Owner: Rita Heidemann Date of Inspection: November 17, 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. -The system,.upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the.Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3.of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 'k CERTIFICATION (continued) Property Address: III Longfellow Drive Centerville, MA Owner: Rita Heidemann Date of Inspection: November 17, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CAM 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 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 i Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: III Longfellow Drive Centerville, AM Owner: Rita Heidemann Date of Inspection: November 17, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/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.] No (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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: I I I Lonlrtellow Drive Centerville, MA Owner: Rita Heidemann Date of Inspection: November 17, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: t Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health E — ✓ 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? f ✓. Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? — Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: 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 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 111 Longfellow Drive Centerville, MA Owner: Rita Heidemann Date of Inspection: November 17, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank, distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 1018103-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: III Longfellow Drive Centerville, MA Owner: Rita Heidemann Date of Inspection: November 17, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 3' 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) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffles 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. Recommend installing risers. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 0 • Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: III Lonefellow Drive Centerville MA Owner: Rita Heidemann Date of Inspection: November 17 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: sallons Design Flow: Qallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(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: Even 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.): The D-box was level. No solids were Present PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: III Lonefellow Drive Centerville, MA Owner: Rita Heidemann Date of Inspection: November 17, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 5-3050s infiltrators(40'x 10'x 29-per as built card 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.): The infltrators were dry. There did not appear to be anv signs of failure The bottom to grade was 6 5' A video cmnera was used for the inspection. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 w Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART C SYSTEM INFORMATION(continued) Property Address: III Longfellow Drive _ Centerville. MA Owner: Rita Heidemann Date of Inspection: November 17, 2005 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. f3qLk � 1 O a � Q i a36 �y �y 3y 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: III Longfellow Drive Centerville, MA Owner: Rita Heidemann Date of Inspection: November 17, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- 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: topographic and water contours maps Checked.with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the mans were showing approximately 25'+/ to-around water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report. 11 Town of Barnstable Health Inspector { t Office Hours Regulatory Services 8:30-9:30 ' hcc' TA=LE Thomas F.Geiler,Director 1:00—2:00 * �STABM 4 0 23 39 Public Health Division /Thomas McKean,Director ; 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT- SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: Map Parcel Name: f Phone#: S -D S 7 q/ a3 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? If yes,how many? ` 2c. How man bedrooms total are proposed at this roe (including the amnesty unit ? Y p P property rtY� g tY ) �:. 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO fedwellwgasonriectedtopub�c�se�uexaPqueons#4thrah#9lelowfu � k4 ? 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? r _ YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. f 7. Were'Po' building permits obtained for construction of additional bedrooms? C YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or• NO FOR OFFICE USE ON � The Public Health Divisio has no objection to Brooms at this property. Special Conditions: k Signed: Date: Q;/health/wpfiles/amnestyapp r - I Notice to Terminate Tenancy ....................... ...................................... ............................................................................. To: (Tenant) (Address) You are hereby notified that the tenancy of the premises occupied by you as tenant of the undersigned landlord, described as follows,to wit: in the County of State of is hereby terminated on or before,and not later than midnight of the day of 20 which is the last day of the rent period,and that on said day you be required by these presents to surrender the possession of said premises to said landlord or his agent named below. Upon your failure to do so, proceedings will be commenced to dispos- sess you and to gain possession of said premises together with such costs as may be allowed by law. Dated at County,State of, this day of ,20 LANDLORD BY(AGENT) ADDRESS CITY, STATE, ZIP V` -fir TL � i 40 I T10,0-r ov,4- rTO O,F^BIARNSTABLE j i:JCATION L_�N r�` N -- SEWAGE # V!LAGE ASSESSOR'S MAP & LOT�g�'�I o INSTALLER'S NAME&PHONE NO. �� SEPTIC TANK CAPACITY ;FICC 5`T" 0 D LEACHING FACIL=: T_(ty ) D�t�s = iC• (size) --NO. OF BEDROOMS .i BUILDER OR OWNER �� �7`�9C1<</✓t��c� r PERMTTDATE: Q Z2 U 3 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 i o r s No. 200 3— !- l -( Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Migpogal bpgtem Congtruction Permit Application for a Permit to Construct( . )Repair( Apgrade( )Abandon( ) El Complete System Vndividual Components Location Address or Lot No.I Owner's Narpe,Address and T 1. o. Assessor's Map/Parcel 1 CeA4,wrat, / , e�i P/an n InstTls Name, dress d Tel, o, Designer's Name,Address and Tel. 2 �a a OZ-5. Type of Building: Dwelling No.of Bedrooms _ 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 t Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 1^aauir7�1+1�a IE=NGIN MR MUST s►Jp�r�+• Nature of Repairs or Alterations(Answer when applicable) VVSTALLATION ANta r-j=ta,,, . .. ' sr5rr=1V! WAS INSTALL&_r) 1^a 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 y 's oard of H Signed Date LApplicatio ation Approved by -�' . Date 2 9 n Disapprove for the following reasons Permit No. Ztro3— Date Issued No. G(/V " "I 1 ! _ a Fee THE COMMONWEALTH`OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pprication for Migoal *p5tem Congtruction Permit Application for a Permit to Construct( . )Repair(Upgrade( )Abandon( ) O Complete System Vindividual Components Location Address or Lot No.�' ,/��� ���l U owner's N e,Address and T 1.No. ' woYric r 14e"1d rv)�;L nn Assessor's Map/Parcel Installer's Name,Address and Tel.Nq. V Designer's Name,Address and Tel.N . M 4 O Z& b I K Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r / Design Flow LiQ gallons per day. Calculated daily flow gallons. Plan Date J Number of sheets j Revision Date Title Size of Septic Tank _ Type of S.A.S. Description of Soil 6 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(by this oard of Hea, Signed / Date C Application Approved by �_ /P• —S' . Date 2 g A Application Disapprove for the following reasons r" Permit No. ZC;(O3- 4/77 Date Issued THE COMMONWEALTH OF MASSACHUSETTS 1 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO.GE TIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( Upgraded( ) 4bandoned( )b3 O 5 at ) i2 l V t R i has been constructe in a 6ordance with the p visi o Title�Jand a or is osal ystem Construction Permit No.203-4-l71 dated 2`3 0-3 Installerr=. ��J/ � Designer The issuance of qs p rmit shall not be construed.as a guarantee that the system w°Tl fu c io �� igned r-, Date 10 12 6,3 Inspector --� --------------------------------------- No.700 Fee -5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLES MASSACHUSETTS Miopogaf *pMem Con.5truction Permit Permission is hereby granted to Construct( Repa)( U grade( ) bando ( ) System located at iT� L"1 � �.��1�J ,l(� �Q f� ,� 1) 1 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:Constru 'on m st be completed within three years of the date of this pe Date: 4' 0 3 Approved by . >` Alf OF BARNSTABLE av SEWAGE # LOCATION Lrl ',, VII LAGS CENT — `- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHO- SEPTIC TANK CAPACITY ;Etcf 5:T t'a—� LEACHING FACII.ITY:T ) s � �-' (size) 7� jtJ' !. NO.OF BEDROOMS BUILDER OR OWNE ]`c-L �`�G�cSCi Nc PERMITDATE: Q Zq To3 COMPLIANCE DATE: g D� 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by` _ ..... _ 1g� � , l� .4 ---- e Sep - 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087)06304 N • UL i s�" Si25;01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systerns Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM OrRiw ' � � herebycertify that the engineered ian signed by me Y W o uctec �a5W, concerning the property located at �, i�t�ts���•� C-M�,—a'.meecs all of the icl:ow;ng , Mena: • This failed system is connected to a residential dwelling only. There are no :ommerzia1 or business uses associated with the dwelling. • TF.e so,l is ciasst,�'ed as CLASS l and the ?ercolation rave is less than or equa co -ri.nutes er inch. The applicant may use histoncal data co conclude this f3c: or may :onduc t are!imit.ar,- tests at the site without a health agent present • There :s no ,ncrel:;e in now and/or change in use proposed • There are ,to variances requested or needed. The bottom of the proposed leaching facility will not be located less than fourteen 1,) ieet aoove the maximum adjusted groundwater table elevation. (Adiusc the )unc!'Yater cable using the Frimptor method when applicable) Please complete the following: fop -DI Ground Surface Elevation (using GIS informauon) G.W Elc�at:or, _ ad,,us(men( for high G.W. = 1 >'Ft1 REt�CF BETWEEN and B S 6�,rED _ DATE: OL,5)i C) 3asec jron t,--e atone r.formation, a (eoair permit wil! be issued for )edrooms Ta<.,r-.um `:o ;dc.ttionat bedrooms are authorized to ctie future withoue engtneerec !.c iyscem plans. �c_iin!r,:Ou PUCCAMP Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: 1 e 0 L p2C N aK,L cu) �P ,�Qn�. �NQ Lot No. `';�q Owner: Wex-1ac- Address: rrgyw— Contractor: Address: h[)-,l fagL�_ 4:�_,1fho-A gA ®0153-L Notes: v -- STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date ( � month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... © Water level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to I ��• water level for index well .................•......... I month/year STEP 4 Using Table of Water level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 213) determine water-level adjustment ....................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ............•................................................................................................ Figure 13.--Reproducible computation form. 15 CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL SERVICES, INC. P.O.Box 627,East Falmouth,MA 02536 October 8, 2003 RE: Certification of Title V Septic System Installation: Residential Property 111 Longfellow Drive, Centerville, MA Dear Sir or Madam: On October 6, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at I I I Longfellow Drive, Centerville, MA, based on a design drawn by Shay Environmental Services on September 30, 2003. I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions,please do not hesitate to call the undersigned at(508)-548-0796. Sincerely, CARMENE. SHAY ENVIRONMENTAL SERVICES,INC. OF � SK, h y � CA r•,r:,c 1V GJ, ca n.Y u, No. 1181 armen E. Shay, R.S., C. President S�% '7AR\O f Health Complaints 03-May-06 Time: 11:00:00 AM Date: 4/18/2006 Complaint Number: 18758 Referred To: DAVID STANTON Taken By: TINA FONTAINE Complaint Type: CHAPTER II HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: Number: 111 Street: LONG FELLOW Drive Village: CENTERVILLE Assessors Map_Parcel: Actions Taken/Results: This house is owner occupied and has been approved by amnesty. It is a family that has just arrived from Brazil. DON'T KNOW WHO ENTERED PREVIOUS STATEMENT. DS WENT TO SAID LOCATION. THERE WAS ONLY ONE VEHICLE AT SAID LOCATION, WITH LICENSE PLATES. IT WAS A SMALL PIMPED OUT PURPLE PICK UP TRUCK WITH THE NAME"VEHICLE VIBES" WRITTEN ON IT. NO HEALTH VIOLATIONS OBSERVED. NO FURTHER ACTION REQUIRED. Investigation Date: 4/20/2006 Investigation Time: 2:44:00 PM 1 lad ell-ttc Li 7 i . (7, S P � klo - -s re Cll- ir S Yvwi z Of 3 u IJ d2 y� Q _ Fzcs, �:�........ THE COMMONWEALTH OF MASSACHUSETTS 8arrw91 E�9kVmtment BOARD OF HEALTH 9 TOWN OF BARNSTABLE App tratft for Diripooal Work.5 Toutitxurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (..<) an Individual Sewage Disposal System at: - - L e ition-Address or Lot No. ..................................... .........................................................................................w........ Owner Addre .4.......T� �_fl ............... Installer Address d Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms---------------------------------------- ...Expansion Attic ( ) Garbage Grinder ( ) 0.4., Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter..:-............ Depth................ x Disposal Trench— No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter......-------------- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date------...-- ............................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ pr' ......................................................--•-----------•--•-------•------...................................................................... 0 Description of Soil.........:-��.----••------•-------------------------------------------------------------------------------------------•---........---.......---•------ V ---------------••------------•------•--------------...••-•-•---•----------•-••----•-----------------------------•----- ................................................................................ W x •----•-•---•--------------------------------------------------•----•----•-------------•---....•••-------------------------------------•--•-----•-------------•-----------••-•--•--•-------------•--•---- U Nature of Repairs or Alterations—Answer when applicable............................--.................................................................. , i.. '.--•-----•--------------------------------------------------------••----------............._.........---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed -------------------------------------------------------------------------------------------------------- ......................................... Dare Application Approved By ....................................... Dace Application Disapproved for the following reasons: ..................................................... ......... ................................................................................. ....................................... ........................................ Date Permit No. .......... ............................ Issued . -- ---- --. . Dace J No... ........ r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,c ppliration for Ditiptiml 10nrk,i Tonstrurtion Permit r Application is hereby made for a Permit to Construct ( ) or Repair (1< an Individual Sewage Disposal. System at: an, , // I PR Cq.rrr'uvd/.-............................................................................. L ¢ttion-Address or Lot No. ..................................... .•--•-•----•------......•••...................•-••--•----.._....••---•......•..................._. �j `S�P (C !^ ..__ ��_:...�3O.Y.I .Q.. ..Addre ............... Installer Address d Type of Building Size Lot............................Sq. feet V�. �Dwelling— No. of Bedrooms------- ----------------- ._.-Expansion Attic Garbage Grinder ( ) aOther—Type of Building ---.--------_.............. No. of persons............................ Showers ( ) — Cafeteria ( ) sd Other fixtures ---------------- ------------------------------------------•------...............................----------------------••••••..........---......•.... W Design Flow.................. ......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width.........--.---- Diameter_------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.................. Diameter................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................••-••-•-••-•....--•----•••-•----••-••------••-----• Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gr. Test Pit No. 2................minutes per inch Depth of Test Pit.....--.....--...... Depth to ground water........................ G4 ODescription of Soil ----------------------------------------------------------------------------------•--_- U ----•--•--•-•-••••••---••••----•••••-••-••-•-•--•--- ----------------------------••----------------•-•-•--------------------------------•......••---•••-•--•-•-••--.-•-•-•..•--•-•••......... kW ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ...... .......................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE'S of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ............................................................... . . .... --..... ........ ........................................ Date ApplicationApproved By ................... . ................................ ... -- ...................................................•-- --. --...................................... D,te Application Disapproved for the following reasons:reasons: ............................................................................+�......................-........... .......-.......... ... . ...................... . ... . . ................................ ............................... . . ..................................................... ........................................ Date Permit No. ---------.-7_L7-'....-J1-------------------------- Issued ............--- ----...... . ........... ... ........ Dare ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired /t'j by.�..�..G- .��Q.._/I'/SSO..vI......,.S�.,,�o.7`/L.. .•�_vr'u�c.�--..... ..._......................... ........_......... - - ......- ........) Installer at .--- ........ P ................ ( �C.U./ 1..�-......................... has been installed in accordance with the provisions of TITLE 5 o The State Environmental Code as described in the application for Disposal Works Construction Permit No. ---- ............... dated ...........__..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. jDATE........................_....................................._...............................__.. Inspector ------------------- ....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Dis;iowd Mork,5 Tomitrurtuan Permit Permission is hereby granted-lv'--"�.--... ------ - v`------------------------------------------------ to Construct ( ) or Repair ( ) an Individual Sewage Disposal $,ystem at No/41-----�.:d•/?• e r!/��� �/y`// - as shown on the application for Disposal Works Construction Permit Street ..................... Dated........................................... Board of Health DATE.................%.... 1 - : y FORM 36508 HOBBS R WARREN.INC..PUBLISHERS f TOWN OF BARNSTABLE LO'tA'f10N j! Lo Evd w P2, SEWAGE # VILLAGE ���f/l���` ASSESSOR'S MAP & LOT INSTALLER'S NAME 61 PHONE NO. SEPTIC TANK CAPACITY 4, SRO C� LEACHING FACILITY:(type) (size) 40 0 NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC?WATEBUILDER OR OWNER x L�/Dp DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ��FTC ti 0 �Ir r k /oo f'T TOWN OF BARNSTABLE LOr'ATION 016 J rz- SEWAGE # VILLAGE ASSESSOR'S MAP & LOT I - . INSTALLER'S NAME & PHONE NO. Rol,t"Sd : 1 SEPTIC TANK CAPACITY d— LEACHING FACILITY:(type) j (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR,OWNER DATE PERMIT ISSUED:�� DATE COMPLIANCE ISSUED: "!� C/ VARIANCE GRANTED: Yes No Lr ,_-4_ w fir? 3 I s ACCESS COVERS MUST BE WITHIN 9- MINIMUM. INVERT ELEVATIONS : DESIGN CR I TER I A : GENERAL NO TES : 6- OF FINISH GRADE 6' MAXIMUM COVER W/ INVERT OUT SEPTIC TANK: 108.0 DESIGN FLOW: FIRST 2' TO 4-VENT BE LEVEL IB CHARCOAL FILTER MIN 2' OF PEASTONE INVERT IN DIST. BOX: 107.37 4 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION " MINOR FILTER FABRIC INVERT OUT DIST. BOX: 107.2 BEDROOM EQUALS 440 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 4" 0/AM PIPE 1o7.s 3/4' - 1 1/2- DIA. INVERT IN LEACH CHAMBER: 107. 1 108.0 107.2 12" H-20 v DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 106. 1 NO GARBAGE GRINDER 2. VERTICAL DATUM /S ASSUMED. FOR BENCH MARKS l 07.37 l 07. 1 106. 1 ADJUSTED GROUND WA TER: N/A SET. SEE S/TE PLAN. BAFFLE) SEPTIC TANK REQUIRED: 3 OUTLET 6 LC-6 LEACHING CHAMBERS OBSERVED GROUND WATER: lV/A 440 G.P.D. X 200K - 880 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND EXISTING D-BOX W/3.5' STONE AROUND. 10'w x 50.1 x 12-d BOTTOM OF TEST HOLE *2: 10/• l SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1000 GAL H-20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6' CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DESIGN PERC RATE C S M I N/INCH N PROF I L E : NOT TO SCALE SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 440 GPD / 0.74 GPD/SF - 595 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. PROVIDED: 6 LC-6 LEACHING CHAMBERS W/3.5' STONE AROUND. A-620 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 620 S.F. x 0.74 - 458 G.P.D. APPROVED EQUAL. SOIL TEST PIT DA TAB 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED PRECAST CONCRETE OR APPROVED POLYETHYLENE. PE I CA TESRCOLATION !Bro/CAED BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER PERCOLATfON = OBSERVED `\ TEST = GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE \\ TP •I P#15243 TP #2 OUTLET. HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR \ o" rr3.s o" 1l3.I 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE". LOAMY IOYR LOAMY IOYR A $4AV 3/3 A SAND 3/3 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. Po�F 2�"OAK 1 +114.9 18- - - - - - - - - - - - - - - - 112.0 /B- - - - - - - - - - - - - - - - 111.6 FOR LOCATION OF UNDERGROUND UTILITIES. LOAMY IOYR LOAMY IOYR +1 14 5 \\ -- / \ B SAND 516 B SAND 516 � \ 6p a 42• - - - - -ME01 UM- - - - - - - IOYR- - - 110.0 42" - - - - -MEDIUM- - - - - - -IOYR- - - 109.6 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE \ qF. Cl SAND 614 C l SAND 614 DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION `\V + OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE �y 12 PINE CONSTRUCTION INSPECTIONS. \ y4\a �� VENT \ TP#I 2 6"P 1 S i so 6 L-C-6 PRECAST CHAMBERS ! \1 TP#2 D-BOX W/3.5'-STONE AROUND NO WATER NO WATER ' ( / _ 24"OAK 131 102.5 144" /0/.1 1 / \ 113. 1 ( ( +112.4 \ __ 2.7 DATE:JANUARY 9. 2017 G d ,; ✓.'.'. TEST BY: STEP11EN HAAS WITNESSED BY: DAVID STANTON \\ EX l ST I NG JQQp BM. TOF I l 2. \\'/ PERC RATE: ( 1 MIN/I NCH \ SEPT./ 9 q EL-I l3.sf •• \ \ �� Opp 05 c •\p Q \\ �\ • Rp� UP 7 G 112. 1 O,W VARIANCE REQUIRED : �\ GQk TITLE 5. MAXIMUM FEASIBLE COMPLIANCE L 0 T 29 /11,4 SECTION 15.221:/7) GENERAL CONSTRUCTION REQUIREMENTS FOR ALL SYSTEM COMPONENTS t/'�� /0, 000+ S.F. THE TOP OF ALL SYSTEM COMPONENTS SHALL BE NO DEEPER THAN 36- BELOW GRADE. A VARIANCE IS REQUIRED FOR THE SAS TO BE BETWEEN 3' AND 6* DEEP. Vv v'� , \ � ,�• O 9 1vI O�6 Zl z SEP T / C SYSTEM LDES l GN L ONGFEL L OW OR / VE , MAP 189 , PARCEL l / 0 BARNS TABL E . CCEN7-E-RV / LIE ) MA N� PREPARED FOR : p0 LEGEND S C O T T W l l N l K A l N E N ROUTE 28 0 CB CONCRETE BOUND -w WATER LINE SCALE : / 20 JANUARY 27 , 2017 O HYDRANT L OC/S ' -G GAS L I NE OHW- OVER HEAD WIRES S T E P H E N /� A . H A A S -0 LIGHT POST ENGINEERING , INC BUMPS RIVER R -f- UNDERGROUND ELECTRIC LINE P . O . Box 16 -T- UNDERGROUND TELEPHONE LINE //, ��� / ���� South D e n n i s , MA 02660 -CTV- UNDERGROUND CABLEVlS/ON LINE �j�\� \ ( 508 ) 362-8 1 32 / +40.4 SPOT ELEVATION 0 /0 20 40 -•--•40------- EXISTING CONTOUR LOCUS MAP 40 I PROPOSED CONTOUR ,JOB NO: l 6-064 2000. �---10' min. from *NOTE: ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. SECTION d A ALLp1BFT PM FROM 11IE Existing Foundation 1 house to septic tank _PROFILE VIEW OF LEACHING SYSTEM SET ja fOR T LEAST 2 FT. t2' CONCRETE oovElt p 10P OF FOtIPDATiON ELEV. 100.00 (Assumed) � `�»�e o eft o er SAS- nl,%- 62.00 Not to Scale a Oriole ever Sgffc Tait- 6.00 Ooae oMer ll 6mx- 97.00 3-8`OU11Er a �. •.a.. A\ I _Z _ , I . I Is-y t/+r•- t/s- rwui J% in� : l tcnocxouls RaU;c N 1 t/u • r..k.a&WA"strw. ""'" as• ot1nET tr ''� S- 0.02 3 HOIX 0--10 DIET. Box 3' Maximum Cover .Top Load ELty. P93A0 f t~ Qood t1�r.nlrr 'n Ir 1.000 CAL s.-O.O1 a Greeter S- 001' Top of SAS-[lev�A230 +• ¢� L �°p N S �, o« toot 1S6• 4• - Scat. 4o T SITE z 9d FROM►DLRDATIDI 4 SEPTIC TANK n t.YS' o Nr o H-10 .. a EfMctJw .._. 1 P_LAN SECTION CROSS--SECTION 0 0 - e a / 7- 35' `111deeaN tJ r.-1 6 Ia of 3/4-1 1/2' / i r ..�„ 5 Units 0 `- BU A SYSTEM PROFILE carnpacteA*tame a - r 3 ; 3' $ HOLE H�--10 DISTRIBUTION BOX Not to Scab Zo Z i 1" •-+- 5' c NOT Ta SCALE l�f G' R R� LOCUS MAP 6 "3/4•-111r Effective L noa, , GENERAL NOTES 00"Poew'tame SOIL. ABS PTION SYSTEM (SAS) NOTE: ALL Cd TlTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE >� - 1.''Contractor is resp onsible .for. �gsafe notification INFILTRATOR MODEL 3050 (H-10 LOADING)/ SUMNER & DUNBAR and protection of all underground utilib'es and pipes. Battorn w Tent Hale 1 Uev._As,N)o (OR EQUIVALENT) 2. level septic"tank and dist t�tion' box shall be set .__ ._. __.,_. _ on 6 of .3/4 -1 1172 stone. NOWT OVERALL HEIGHT OF INFlLTRATOR IS 30" /EFFECTIVE HEIGHT IS 24 3. Sockfiil should be dean sand or grovel with no - stones over .3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. p T 5. The contractor shall install this`'system in accordance PERCOLATION TEST i with Title V of the Massachusetts state code, the approved plan and Local Regulations Dote of Percolation Test: September 23. 2003 6. If, during installation the contractor encounters any Test Performed By. CARMEN E. SHAY. R.S., C.S.E. soil conditions or site conditions that are different Results Witnessed By. WAIVER ( per Barnstable B.O.H.) LOT #10 LOT #9 from those shown on the sot log.or in.our;design SHAY ENVIRONMENTAL SERVICES, INC. installation triust halt do-immediate notification be Percolation Rate: Less Than 2 MPI 0 36" made to Carmen E. Shay Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the Failed �6 septic system unless noted as H-20 septic components. „ Leach Plt 8. Install Tuf-rite as baffles or equals on all outlet tee ends. Test Hole S 45d 43 30 W 9 q No. 1 , 1 9. All Distribution Lines shall be 4' diameter Schedule 40 NSF PVC pipes. D&TH sass Foiled t i if 10. All solid piping, tees do fittings shall be 4" diameter 0 97.00 Leach Plt 1 0' 8.6' Schedule 40 NSF PVC pipes with water tight joints. �y ! ,. x 11. Municipal`Water is Connected to ALL OF The Residence and Abutting j ;, •; t ,: .. s Properties Within 150 Feet. {{ t THE PROPERTY LINES ARE APPROXIMATE AND 1 0•-8- A, 97.25 •r .� Sandy p i ` COMPILED FROM THE SURVEY PLAN GENERATED BY - Loam .. 0M. loon go. I TEST HOLE 1 PROJECT BENCH MARK � ED KELLOG, CIVIL ENGINEER. OF OSIERVILLE, MA 10 VR a/u `SWUC Took D-BOX ELEV.= 97.00 t - TOP OF FOUNDATION ENTITLED PLAN of LAND IN BARNSTABLE, MA a'- 34' s, 94.2o ELEV. = 100.00 (Assumed) DATED.FEBRUARY 14, 1958, LCC 24614-E, SHEET 2 Medium 1 AND IS'NOT INTENDED TO BE A SURVEY PLOT PLAN Sand DECK 3 SFAseN PORCH O IT SHOULD BE USED FOR NO PURPOSE OTHER THAN zs r 7/6 On t Sonotu O THE SEPTIC SYSTEM INSTALLATION. 34-- 144 .00 CO .► EXISTING LEACH PITS TO BE PUMPED OUT AND EXISTING FILLED IN PLACE. 4 BEDROOM LOT_ 30 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE _-- --- --- ----- _--- _ LOT #28 - HOUSE - -- -- - - fROM THE EXISTING LEACH PITS TO BE DISPOSED OF AS PER BOARD OF HEALTH SPECIFICATIONS. _ I NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY Perc Depthlto Perc: 40' to 58" j- _ - LOT #29 ASSESSORS MAP 189, PARCEL 110 Perc Rate- Less Than 2 MPI t LEGEND No Observed ESHWT I ��_, N 10,0c0 Square Feet +/- > No Groundwater Observed 0132" . 6 C13 - .� ; i co 104X 1 DENOTES PROPOSED ! ASPHALT •c1 SPOT GRADE t DRIVEWAY .° �\ D V, X 104.46 DENOTES EXISTING SPOT GRADE oil PL PROPERTY LINE S 45d 43' 30" lI , __-y'�' ��,_-_- a9yr \`��•� 96I�'--- PROPOSED CONTOUR - - - - - -97 EXISTING CONTOUR L O_ZVGFELL O Ttr .DR.I VE TYPICAL 1000 GALLON SEPTIC TANK DEEP TEST HOLE & NOT TO SCALE (40 FOOT RIGHT OF WAY) PERCOLATION TEST LOCATION 2-1Nt-ouu+. ANxEss MANHOI.Es �-----�+-� 6 'FOOT STOCKADE FENCE. ' �`- •emu• "i'��S:. �..aa. �. _ c�R P LOT P LAN OUTr l \ r�r';r nl:•rO E�ICI CCTIr`r F'.I , OF PROPOSED SEPTIC . SYSTEM UPGRADE " r LLF>i,�'a'aV'VA 1e13TALLL� I:� i THE ACCESS covElts Fn,t THE sEPT�c TAW. Via; T,o Pt_ANy (` DISIRMUMN WX AM LEACHING COMPONENT U-:::;,+T SET Df.FPER THAN 6 NCtES BELOW nNISNED ..•• - - PREPARED FOR .. - "''F R.• R GRADE GRAM BE RAISED 10 IM1l6N W E R N E R 8c R I TA H E I D M A N N sTm REINFORCED tsREGLsr eoNCRETE FT,«s,m GRADE PLAN VIEW INSTAL. TUF-TiTE GAS BAFFLES OR EQUALS AT # 111 LONGFELLOW DRIVE 3-24'REMOVABLE COVERS a,h.atea,nn m CENTERVILLE, MA INLET r � r et,. k+w to Guest ,. ' OUTLET s ..,. Design Calculations tau- a� - _ °�ie' Number of Bedrooms: 4 Existing, ,. Equivalent to 440 Gal./Day (440 Gol./Day Min. per Title V) PREPARED BY: s -T5 s' -7- Garbage Grinder. No E _ 4'-0•on%. ' • Leaching Capacity Proposed. 440 Gal./Day Minimum (Min. Per Title A N G CAR�IE� E. ASHY Y „4 ' bs d°aPZ'' Septic 'Tank 2 x 440 Gal./Day =`880� USE 1,500 GAL Septic Tank. SOIL ABSORPTION AREA: using percolation rate'of <2'min./'Inch 0 20 40 50 A ENVIRONMENTAL SERVICES, INC. ILI ,..•• •• ,,.L', .. r i Bottom Area: 0.74 gal/sq ,ft. x 400sq. ft. _ 296 gallons N a•-0- 4' -,o• Sidewall Area: 0.74 gal./sq. ft. x 200 sq..ft.' - 148.00 gallons �F �o P.O. BOX 627 `. Providing: - 444.00 gallons S tgTE�� -EAST FALMOUTH, MA 02536 CROSS SECTION END-SECTION ANITA?I\ "==20' TEL/FAX 508 SCALE: 1 -54$--0796 Use: (5) HIGH CAPACITY INFILTRATOR CHAMBERS, HAYING A 2' EFFECTIVE DEPTH, „_=20 ., - (4' W x 7' L) TO BE USED WITH 3'.OF WASHED STGNE ON THE SIDES AN:, SCALE: .1 DRAWN BY: CES DATE: SEPT. 25,` 2003 2.5' OF WASHED'STONE.ON ,THE ENDS. PROJECT#SD477 FILENAME: SD477PP.DWG SHEET 1 OF, 1