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HomeMy WebLinkAbout0045 LOOMIS LANE - Health 45 Loomis Lane Centerville A=230 104 S. llll UPC 12534 No.2 1�53 ORS qua*u+os.wi i � .� s� _. ___ _ f����_- Ap-._.,` TOWN OF BARNSTABLE LOCATION/1L45 konm Im n4?-,- SEWAGE #o�O VILLAGE den-�e,�L�°III ASSESSOR'S MAP & LOT t INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY ,' ©© 60.1/0 ►) LEACHING FACILITY: (type) t) ;(size) a) / Y 2 'NO.OF.BEDROOMS .5 0 ` S BUILDER OR OWNER Er0, C J. + PERMIT DATE: g LJ4 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist t- on site or within 200 feet of leaching facility) ;' Feet Edge of Wetland and Leac ' g Facility(If W wetlands exist within 300 feet of lea ' Feet Furnished by PDA- cexio 2 � ,? c c a � : Lz �!e 7® i , 1 r - 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9iplication for disposal *pstem Construction Permit Application for a Permit to Construct/ Repair( ) Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. 'T !� Owner's Name,Address,and Tel.No. &ri"L + 6,, rune F'scher Assessor's Map/Parcel 12,3O .1 r 17 r_" 14 ® 01/ Installer's Name,Address,and Tel. o. a � yYlc, aa esigner's Name,Address,and Tel.No. X 1A/� ��/3o77S" �AsTb Sct 1,"►fir► Eh ir�rerr' Z�tc• rA � ' 3N 3 Type of Building: . 8 3 Dwelling No.of Bedrooms .3 Lot Size 9.60 sq.ft. Garbage Grinder(jot?& Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 gpd Plan Date—zQjIl jq, oi4 Number of sheets Revision Date Title:50k le Pramred__Tm 02lb-,ferbenk ga 46 ,:S La Ay, , ff Size of Septic Tank %$Cad C7ajlo 77 Type of S.A.S. 16"iiy 010pbLf ,21 Description of Soil ry�4J1 I 'Yk °da, _ t Sa /O 4'L4" W f f-r 1nYR Y,6, u���e�ish ;brae°, If� N s M4a-f 2y -#&1 I lats�r 1,0ye !di brnanA WiIN coa me- :4" 9- 1 ' YID. ell Y Rctiw4a . NatQre ofdit�a"fc q&Wion #e pp icable) 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 th nvironm tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this R and f H It ll� <_ Si Date ((( Application Approved by Date L Application Disapproved by ( �'� Date for the following reasons Permit No. (1 2 Date Issued 0 ,.i No: Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in co"mputer: C,.•/" PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes f Al . appliLat[on for Oisposal 6pstem Construction Vermit ❑Individual Components om lete System for a Permit to Constru Re air Upg ade Abandon( )1 Location Address or Lot No. L f,6 L00 / �,, �j Owners Name,Address,and rT�el.No. �.. art G 1• a�r�rAil ! te5t�7Pf Assessor's Map/Parcel �.�7A �(,� Qn �Y�( 0ini� bodrW ka iu , t4b le InIl 0AM t Installer's Name,Address,and Tel. o. ffl,°., esigner's Name,Address,and Tel.No. /0G 13ex7�S ;��z �u !�'l cn /n erri, 7r. Type of Building: Dwelling No.of Bedrooms Lot Size sa 9p q�6a sq.ft. Garbage Grinder Other Type of Building No.o Persons Showers( ) Cafeteria( ) Other Fixtures - Design.Flow(min.required) %® gpd Design flow provided 3 �1 gpd . Plan' Date XU l �014 Number of sheets j Revision Date„ Title�a#"kC P&n Pro,�t-d_TM jQrarCrne_nt a- `'`a ) +J, 4 krLe. Size of Septic Tank /500 ga.•!le n Type of S.A.S. .I�'(lf jj I w.ahAt-7kers r-Q 0 a `V Description of oil i 0 ` n law G r I n'Y 2 `q(0-1, �Sa n14 1 r6�8 � q"Z.4" F W, r toYX YZIO 16m)"114 brwn I ca mti er l oy/z lw�e brnjj-)A wi1no coal-Le-�p�an2 • W. 1�2�oy" P-a 1 it er !�Y4 e/� ycrft i*6 6folon nr,f Cqryaram. Nature of upa rs o�A`Iterahons nsweii whe'n ap icable�— 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 oft nvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boardaft SiFed Date Application Approved by / Date Application Disapproved by Date i for the following reasons Permit No. G : Date Issued 0 ' --------------------------------------------------------------- - -------------- ----- --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewagee D' posal system Constructed ) s Repa' ed( ) Upgraded( ) Abandoned( )I- Y' ' at j �OJ��� n �rr�Jl° has been constructed/in accordance p� with the provisions of Title 5 and the for Disposal System Construction Permit No. U! / '�7Sdated 0 � ' � `/ Installer Designer #bedrooms Approved design flow gpd The issuance of t o is p rmit shall not be construed as a guarantee that the system will c'Oil designed. Date ( Inspector --------------------------------------------------=------------------------------------------------------------------------------------ No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS his,posal 6pstem Construction permit Permission is hereby granted to Construct(Y) Repair( ) Upgrade( ) Abandon( ) System located at koiqm/.,( Lan f' 6o17#,r✓! 1P_ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. 1 Date 1 y — L/ Approved by 41" t 1• 1 Town of Barnstable .°�j"Etio . Regulatory Services Richard V. Scall,Interim Director • anxxsTaeLE, • 9�AMAM: Public Health Division TfDMo'tA Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: C dLZOr Sewage Permit# oAl-27 S Assessor's Map\Parcel 23,0 /6Cl Designer: Ju(l,V gA Installer: Address: 7 Rar Rd I Po 13ox Address: � %/fig ce..'0,46 e-1 xo✓ ✓h.4 6'S'g- G mil On � ?�� ,,zas issued a permit to install a (date) (installer) septic system at Ls&A;S Lgn.e— based on a design drawn by (address) SU 11,4-9y �iC 1`heer;h dated 710 9 2ofY designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils. were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I\A approval letters(if applicable) �&OFOD y nstaller s Signature) i 0 CIV!L' No.48168 A) 6:=� ° .,-% (Designer's Signature) (Affix 116&r 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 ® g� creened Porch S f I --_=b� { Covered Porch - - III'ir 11 i i / ♦ , �. b13- ail, =x-r 'R1rom I lug" I ✓ r-• = Dining �' 1't o"I I 41.o i I D Entry I O Mas er Be room I ��IIIIII Kitchen , t — / M.Bath M.Close - r L--- --- -- - nl LN 4 1 Bed( o \ Y •�: ./--_..� �'` , fsa� i-�i#2� Patio t-- I ath /I I ! arage/Worksh9p OF 9 Parking FISCVR RESIDENCE Sch• tc C—First Floor flan mc: inru �� M " Architectural Design Incurpuralc0 mnno: ao,ao �\.1 �p 62 Routc 6A•Orleans,MA 02653 ��:� �` - D �^ , m ` a cbhY Be,room I kk \ Storage ho __ All 'i ap Y. + FISCHCR REST UI'sNCC / I _I C; Scheme C—Second Floor Plan s- �wr: Architectural Design Incorporated mn N.. uns. I •� k' - 62 Route 6A-Orleans,MA 02653 Y �,tt5►eye Tow tabloi �se . , LK � 1lepartlrieut of Reguhitory Servit.es �' Publ><c Ilealth Divis><on C> Dote 3 " AIAM ed 200 Main Street,Hyanuis MA 02601 I Dale Scheduled, '.; ji ':J iuo Fee 1'd. Q t' F ►S ►i :;�uitca�i ity ANNdsuaent for i 's os PedounedBy�LLr�./Val) ... /"��I/7�r:!J ✓�':i L�l� ^witnessed By; LOCATION & GENERAL INI'ORMATION Locallon Address /•4,� CJC1/)')/J. Owner's Name r J` ��../7>�. �j /G.J� S,ia,OnE �Sc�F� CC d'i �'I 11 E Address :$ Assessor's Map/Parcei J f 0. 1?ngineer s Nan,c sctl l iVa l� t7�!'N f E d r NEW CONSMU.CT1ON RBPNR q. Telepit'onelk hb' � Und Use" �2f q l. Slopes(46) �5 Suiiacc Siones. Distances from: Open Water Body l�l�/✓ ft Possible Wel Areti y R Drinking Water Well ft Drahiage Way ft, Property Llne- 2S ft Other it SIMTCIIe(street name,dlmensloris of lot,exact Idcatlods of test Boles&pare tests,locate wetlands�n p-bxhrdly to holes) #q5 Parent material(geolog )lc) J Depth to Belrwe Depth to GrouudWater standing\Paler hi Flole ('hf } [o„` Weeping ftntri Pit Paea 37.0.S, ro Hstiniated Seasonal High aroundWater /4) *iz.; r3ya�J ]DETEI IIoT TION TOR SEASONALMIGH WATER P BLE Method Used: Depth Observed standing in obs.hole: _ In, :Depth to sell mottlem!. : fit, Depth to weeping from side of ohs.bole: 4L t3rtlttitdwath r Adf UNttutint ft. - hidex Wbll i." Reading Date; Index Well level._. �,r. Atu,thetor Adj.Clreundv llterLavel;." PER OIa ,TzoN THST die. :Z zr:,n,l,e _-�"� Observation Eiole It 'Ime at tJ" , Depth of Perri ' i% - 30 • Tune at 6 Start Pre-soak Tiros @ Time(9"IT End Pre-soakdn Rate Min./ludi Shc Suhabhity Assessment: Site Passed V Site Palled Additional Testing Needed(Y1.H) . Odgind:"Public Health Division Observation Hole Data To Be.Completed on Back -- --- r i` It percolaliou test irk td be coititducted�vithiu 100' of wetland,��ou zriust first>uolify the Barnstable Consei}vation Division at least one (1) Week prior to begiluliug. Q:\SP-VrlwHRCVbftMIDOC JUIi;JC1D.d�I3uJLItvtrl'ION IIOJ[, LOG Hola3 ^� Depth from 5vil 1lotizon Soil Twote Sdil Color. Soil Surface(lu.) Other (USDA) (Mansell) Modihtg (Stnuclvre;.Stones;Dqulders.: - �, ottstatencv °U arrival) ° . ,¢ � _col wAD Y8 C°r IlL]LP OBS i IBVATION HOLL LOG Ilolet_ r3eptit frput Soll}[orlian . : : 5oll'rexture Soil Color S011 Oilier Surface(iu) (USDA] (Ntoatiell) ivtoltling (Sttuoture,Stones;Dvulders: ottstslen` 'Po tnv 0. • � 22- r9 � ��t.�s� fin: to�� � � 1orL=e G���e�' boa rl P (U. Z JdLLI'OIs�I';Itvr�,TION LiOLI+;L(�G II010#. . Depth from Sup Ilodwn Soil rexture 5oi1 Color Soil Older SurfRee(iu.) (USDA) (Mansell) MOltlhlg (S"t;tnro�StonCs,Elnaldats:r; 4 ^ Co all 13 161 c to p Q C s �a • �' : . Cry- � �.e'� G�- y�-.,��" C �ol� I)l;P' ' OLiSIi;RVA.TI(JN HOLELOGP61e , .: : Depth from 5vll 11Udzon Solt Texture Soil Color 8011 Otlrtir Surface(in) (USDA) (iviunseli) Moltllag (Slruclure,8tottcs;Booldets, Cons tau " 6 Ce ,�v� Co R G G S -(2Gl"arueSy„� ``10 hlouil.lusur.unce lithe 1114.00 tiu: Above 5UD year(IooJ bb ndsry No Yes WitlJti 500 year Uaundary' t•!o� Yes Wlthi�i LD0 year flood boundary rlo:�; .Yes lieilth of iValii i►llY-.0cc tr1up,Pervious Material Does at host four feet of naturally occurring pervious ntaterlal exist in all areas observed throughout the area proposed for theI soil absorption systenr't �' S If not;what isahe depth of itaturally oeCurripg pervious rnataflal'� Certifiicatlnll 1 ceci'ify that on 7-I( (2 (dale)1 have passed the soil evaluator exttilunalioti approved by lho Department of Eitvlroiirrieiltal Protection aid.that the above..analysis was pci'for►iied by ina conslstaitt`viih • Llie requited trainin a tt;rtjse an ex en ell described in�10(AM 15:017. Signature Z Datti r q:NsPrrtCt ACfORM.noc TOWN OF BASTBLECq LOG ;TION nM1-S 1A A- A SEWAGE # �riLLAGE CQ/crGN, ASSESSOR'S MAP & LOT 0 /0 ' STALLER'S NAME&PHONE NO. AID SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �� �1�,OA /s (size) NO. OF BEDROOMS 3 BUILDER OR OWNER CAro SWAT Z 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 leaching facility) Feet Furnished by ! 31 3a a 3a 3�G . 3 3(� 3a Q 3 e . A-7 �-A &OMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION pip NA`' TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION cgyo Property Address: 45 Loomis Lane Centerville, MA 02632 Owner's Name: Carol Swartz Sir �ll/�S Owner's Address: Date of Inspection: December 1, 2005 r Name of Inspector: (Please Print) James M. Ford 1s Company Name: James M. Ford i <: Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 � Telephone Number: (508)862-9400 E ca ct? � CERTIFICATION STATEMENT CD I certify that I have personally inspected the sewage disposal system at this address and that the info nation rgorted; below is true,accurate and complete as of the time of the inspection. The inspection was performed based onr�*f--ny GR training and experience in the proper function and maintenance of on site sewage disposal systems. am a 195P approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste ✓ Passes Conditionally Passes Ne Further Evaluation by the Local Approving Authority Fa is Inspector's Signature: A.Ab Date: December 11, 2005 The system inspector shall subi ' 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 I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 45 Loomis Lane Centerville, MA Owner: Carol Swartz Date of Inspection: December 1, 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 CERTIFICATION (continued) Property Address: 45 Loomis Lane Centerville, MA Owner: Carol Swartz Date of Inspection: December 1, 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 CM 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 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 45 Loomis Lane Centerville, MA Owner: Carol Swartz Date of Inspection: December 1, 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'/s 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 11 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: 45 Loomis Lane Centerville, MA Owner: Carol Swartz Date of Inspection: December 1, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: 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 I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 45 Loomis Lane Centerville, MA Owner: Carol Swartz Date of Inspection: December 1, 2005 FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design): n/a Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No 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): Yes Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Summer use COMMERCIAL/INDUSTRIAL 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 infonnation: Never dumped-per owner 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 in 1992-per owner 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: 45 Loomis Lane Centerville, MA Owner: Carol Swartz Date of Inspection: December 1, 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 Qal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" 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: 10" How were dimensions detennined: Measurinz stick Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert There did not appear to be anv signs of leakaze. 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 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 Loomis Lane _ Centerville. MA Owner: Carol Swartz Date of Inspection: December 1, 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: gallons Design Flow: gallons/day Alann 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: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: 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: 45 Loomis Lane Centerville, MA Owner: Carol Swartz Date of Inspection: December 1, 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: Infiltrators 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 infiltrators were dry and clean There did not appear to be any si ns of failure The bottom to Qr ade was 3' 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 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 Loomis Lane Centerville, MA Owner: Carol Swartz Date of Inspection: December 1, 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. J7 - 1 31 3a a 3a: 3i6 3 3(o 3a A g O O 3 r a e 10 Page 11 of 11 OFFICIAL 1NSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 Loomis Lane Centerville, MA Owner: Carol Swartz Date of Inspection: December 1, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4' feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: ✓ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the infiltrators to wade was 3'. 1 hand auzered down beside the infiltrators to groundwater which was 4'below grade. Due to the proximity to the lake, no high around water adjustment needs to be taken 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 OVERLAY DISTRICT: � a$ � nngg GP - Groundwater Protection District � k . Vent - Final Location to be As Shown on Plan Entitled Determined at Time of Installation so » + . DESIGN DATA as to be as Inconspicuous as Possible Revised Groundwater Protection ' Single Family-3Bedrooms Overlay Districts" - April, 1993 No Garbage Grinder SEPTIC NOTES Provide Charcoal Filter Daily Flow=3 X 110 GPD=330 GPD 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours A rr Septic Tank:330 GPD x 200%=660 Gallons Prior to Any Excavation For This Project the Contractor Shall Make F.F. EL. 42:00b z �.• » ' /1 e • • 1 the Required Notification to Di Safe 1 888-344-7233 e Use 1,500 Gallon Septic Tank �l g ( - )• 2.The Contractor is Required to Secure Appropriate Permits From Town Agencies For Construction Defined b This Plan. F.G. EL. 41.00 F.G. EL. 43.00 F.G. EL. 42.50 F.G. EL 51.00 ZONE. LEACHING AREA g y : 3.The Water Line Shall be Constructed in Coordination With See Note 4 (typ.) 3 Min. 330 GPD/0.74=446 SF Required RD-1 ; COMM Water,and Shall be in Accordance With 248 CMR 1.00-7.00 11 Sidewall=2(12'+25')2'=148 SF k• ' + ( ) &310 CMR 1with Area (min.) 87120 SF (RPOD) Bottom Area= 12'x 25' =300 SF , 4.Install Risers with Cover to Within 6"of Finished Grade(5 Required). SEE NOTE 7 (TYP.) Tee For 448 SF Total Provideds � • x:' Cover Over Pump Shall be to Grade(1 Required). Baffle Fran t a g e (min) 125 5.All Structures Buried Three Feet or More or Subject Width (min) a ) t to Vehicular Traffic to be H-20 Loading.It is the Engineer's EL. 39.00 n LEACHING CHAMBER DESIGN Setbacks: ' All Pipes to be Schedule 40. Use Recommendation that H-20 Always be Used. EL. 37.5o Top FL. 48.00 p y Installer To EL. 48.50 H-20 Front 30' Location Ma 2-500 Gal.Leaching Chambers in a 6.Septic System to be Installed in Accordance With 310 CMR 15.00& Con firm Prior 1000 Gallon ►►'�'11 EL 38.00 H-20 D-Box EL. 48.33 I 15' Side 10 - 12'X 25'Washed Stone Fields a Shown. 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable 1500 Gallon � � '' To Any Work EL 37.75 Pump Chamber Min. , Board of Health Regulations. H-20 Waterpoofed/seoled EL. 47.00 H-20 Rear 10 1 =2,000E 7.All Piping to be Sch.40 PVC. Septic Tank w/Two (2) coats of Approved Sealant Leaching 8.Met Tees Shall Extend a Minimum of 10" Waterproofed/Sealed Flow Chamber Below the Flow Line. - w/Two (2) coats of Approved sealant Equalizers �. � "`� Bot. EL. 45.00 9.An Outlet Tee Shall Extend 14"Below the Flow Line, 1 f Required ASSESSORS REF: . and Shall be Equiped With a Zabel Filter or Approved Equal. ` ' 1 f Encountered Remove & Replace r F All Unsuitable Soils Within 5' of o FLOOD ZONE. 10' Bedding,"T"s, & Boffels The Outer Perimeter of The System o Map 230, Parcel 104 Min. as Per Title 5 zone B &� C (See Notes 8 & 9) 10' Min. - slab Community Panel No. BOUYANCY CALCS 20' Min. Foundation FL. 34.8 #250001 0005 C 1,500 Gallon H-20 Septic Tank / Assumed Lake Groundwater At 19 1985 Dry Dead Weight=21,230 LBS Per B.O.H. August ' Uplift=64 LBS/FT3(6-2"X 11)=4,341 LBS/FT ( EL. 31.5 1.55 FT'X 4,341 LBS/FT=6,728 LBS ` / 1 Deloped Profile Of Proposed Septic System Groundwater Encountered 1,000 Gallon H-20 Pump Chamber ve JJ See Test Hole 3 Dry Dead Weight=14,500 LBS Uplift=64 LBS/FT3(4'-10"X 9)=2,784 LBS/FT II 2.05FTX2,784 LBS/FT=5,702LBS Not to Scale DIRECTIONS. From Hyannis Follow Route 28 West �h Finish Grade towards Centerville; Take a right otno 3' Max. I ' [ (li [ , 1I „ 1 _ 1 ;;((i I Phinney's Lane; Take a left onto v 1 1 < 3 �� Loomis Lane; Site is on the left, #45. 9 ' % 1 A FEMA Zone Line " Mtn Compacted Fill As Shown on FIRM Filter a1Q, �' k rn�� �' Panel 250001 005 C And/or ` / / . A k % # k k �' f r Revised 191AUG185 2» . 118 a sto% k k C> 1 2"0 Goly. Pie o ('n' �� :� k x k k ��p. t, 3 LEACHING , 3/4" - 1 1/2" For Float Support �o V k� k '� k © CHAMBER Double Washed Locate Junction Box Q ` '° .h Stone Outside of Tank f ���1 �' 1 1_ Q O k k � . 9 4 - /� QNQO i k k k k k ` k r 10 I _V _ I Pum Power & Float Control ' A6 t 12 / 1 k ! k \ Cables Installed In Accordance / -',((\ With Federal, State & Local To D-Box Jrk Bldg. & Elec. Codes in. 2' Cover ( 1 k k k k ` kAr k k Cross Section Of Chamber ` Not to Scale PERC TEST: 14,431 4"0 From Se tic / Edge Of Lake / ft ' ; k k k PERFORMED BY:CHUCK ROWLAND,E.I.T.- SULLIVAN ENGINEERING Tank. Sch: 40 PVC Located 301SEP105 k A". k Lot 4 SOIL EVALUATOR NO.13,586 / r r, , k k ` WITNESSED BY:DONNA MIORANDI,R.S.-TOWN OF BARNSTABLE Precast Pump El e v= 33.8 JULY 21,2014 ' Chamber �:,... TEST HOLE- I EL.44.5 TEST HOLE-2 EL.45.. A LAYER 10YR 3/1 A LAYER 10YR 3/1 VERY DARK 39io 4" SAND LY OAM Y 44.2 6" SAND LOAM OAM VERY DARK Y 44.0 BW LAYER 10YR 4/6 BW LAYER 10YR 4/6 1000 Gallon Oro { �\\ \R f .j A4 / QO O(VcZ GJ y� ( .ROVIDE DRYWELLS I I DARK YELLOWISH BROWN DARK YELLOWISH BROWN Pump Chamber Plan View O o O 24" LOAMY SAND 42.5 22" LOAMY SAND 42.7 o� f Q Q O Q FOR RDOF RUNOFF I i V I 1 Cl LAYER 10YR 6/6 Cl LAYER 10`R 6/6 p /� ° OR DR ED YP.) i i "eo I ! j Ir BROWNISH YELLOW BROWNISH YELLOW �+ `:Q <v �•:�e' 1 1 COARSE SAND COARSE SAND Not to Scale l // Lot 3 Q / ` 1 t i / Mil , 26" PERC TEST 42.3 LJ Q O ` yo \. « 1 25 GALLONS IN<15 MIN a n / r 29,950fSF To Water Line � t` .,� ^``a, ` 4 Og, / p et t 4 Q©,. 1 1 Y s V. 48 �. C2 LAYER 10YR 8/2 4 40.5 48" .OZ'S:AYER 10YR 8/2 41.5 26,950 SF U land G� \ �� bO°� 7 'S '° / f \ QO 7/ 1 VERY PALE BROWN VERY PALE BROWN { 2 t 1 ; O 120" MED-COARSE SAND 34.5 120" MED-COARSE SAND 45.5 24"0 C.I. Cover A3 k k k 0 O OJ y Sty 11.Q' NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED Or 9" Min. Finished f t `� k t `�..,,� 6F % lv/�r �� � / ,,. �. 4"0 Sch. 40 PVC 240 C.1. Approved Equal Cover Grade From Septic Tank _ �ry O k k k kk y O �FM 9 O `�Y Wit, 1 14 Rim & Cover ` O Y` -` - -I / Q 0 / i �. / o TEST HOLE- 3 EL.41.5 TEST HOLE-4 EL:42. k k O C� � , °� �� A LAYER 10YR 3/1 A LAYER 10YR 3/1 � C 1 / (x i D.' o aF,_k 't Q Q � t //. � q / z v � VERY DARK GRAY VERY DARK GRAY O� A2 k Q 1/ Q 1 f' ? I a° 18" SANDY LOAM 40.0 16" SANDY LOAM 40.7 r� I 9 J �^ ? Cv !' W x BW LAYER 10YR 4 6 o v 1 / BW LAYER 10YR 4/6 Conduit Thru Chamber For Drill 1 8"0 Hole Power & Float Cables Goly. Chaff ' k �l Q O ! ,�� �� ; W DARK YELLOWISH BROWN DARK YELLOWISH BROWN For Drain ` ��2 k k k Q �1 �� W f w 30" LOAMY SAND 39.0 30" LOAMY SAND 39.5 Emergency Storage nv. 37.50 To D-Box Q rr Q 1 + �z 4 °'ono t� ,y / ' r `` y1 W C1 LAYER 10YR 6/6 C1 LAYER IOYR 6/6 Min. 2' Cover k Al' a ° o" BROWNISH YELLOW BROWNISH YELLOW Volume 330 Gal. k l o /Y o rr J� w f �a 1 A r n A N_ COARSE SAND COARSE SAND Float Switches k XISTI r r 4'"= ��, 30" PERC TEST 39.0 Alarm On El. 36.20 k T ` ! _ F 2 Req d "q1 k / r,. ` _ 25 GALLONS IN<15 MIN Lead Pump On El. 35.70 g k k REM VE W -- " "� - _ s s ;f O , t N 48' <2MINAN LTAR=0.74 37.5 46" 38.2 Ede o f Wetland as k k n9 1 PR,OPOS I' f o` u C2 LAYER IOYR 8/2 C2 LAYER 10YR 8/2 153 Gal. Pump Flagged by ENSR 181OCT105 k k t k 00 SEPTIC TA VERY PALE BROWN VERY PALE BROWN Pumps Off El, 35.10 - � k B1°R MovE <v r' < ��y1 Q Secure Pipe at Top & Fr % ti / \ co 120" MED-COARSE SAND 31.5 120" MED-COARSE SAND 32.0 2"� Sch. 4O PVC f S7 k O j' 1 GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED Bottom of Chamber S' k I'lT'0 Q QPOD 12' o Threaded Pipe k 112 H.P. Myers Pump J� �k k \ r J PUMP Ct' BLR/' Check Valve k k i \ SITE PASSED or pprove qua Ala S7 ! Lai r f m . Bottom El. 32.75 -- - } I roc 11' D-B X < r cS'� I ; �� � / O /_ % ! ROP r' 't r, 26' f O 0 h0 1 k ar'\ 1�4 D r` Or o MITIGATION CALCULATIONS ��ao, Oj, t . 6' Washed ° i' QO °� onv 1. Stone Min. e - ,l 0-50' BUFFER - Alb s°°*.o ' # 7N 3 -4 A $ �� G5� -;3 1 000 Gallon EXISTING HARDSCAPE 0 S,F. _ -o PROPOSED HARDSCAPE = 0 S.F. @°o B.M. TSB. ,` _ _r'_._ _ 'o CP C� PumpChamber Section Detail 50-100' BUFFER ° \ EL. 46.00 _f/ 11'S' Fence o C7 EXISTING HARDSCAPE = 1,230 S.F. - }__ 5 CD r r 19,'0}0 PROPOSED \ Not to Scale PROPOSED HARDSCAPE = 2,595 S.F. (+1,365 S.F.) r / 9t / 1 1 VENT MITIGATION REQUIRED - 1,365 S.F. X 3 = 4,095 S.F. A1o' g" \ Legend: MITIGATION PROVIDED = 4,095 S.F. ` s PROVIDE CONCRETE pouINRFTo31i ` fa+o� ��PLSN[1rAngS" 16245�II THRUST BLOCKS Bk AS REQUIRED JOHN\ �, \° s' O., A Holly Tree I 1 `` cl' C6, t i 4?-68 v' ("/STER�� Deciduous Tree S/DNAL ENG\ Coniferous Tree O Guy Wire NOTES: PREPARED FOR: PREPARED BY. TITLE: IDCB/DH Site Plan 4 Utility Pole Light Post 1.) The property line information shown was Sullivan Engineering, Inc. Ca eSury Proposed Improvements ® Water Manhole compiled from available record information. Eric J. & Simone S. Fischer m PO Box 659 7 Parker Road oHw Over Head Wires 2.) The topographic information was obtained 48 Homeward Lane Osterville, MA 02655 Osterville MA 02655 At ~ E Electric Line (underground) from an on the round survey performed on pq ( ) ( ) ( 45 Loomis Lane in •.j �--G Gas Line (underground) 9 y p Walpole MA O2OU 1 508 428-3344 508 428-3115 fax 508)420-3994 (508)420-3995 fax - or between 30/SEP/05 and 12/JAN/06. -'35- - --Elevation Contour (1' interval) L�:, Wetland Flag 3. The datum used is NGVD '29, a fixed mean Bamstable (Centerville) Mass. Water Meter sea level datum based on the elevation 20 0 10 20 40 80 Draft: JOD Field: WHK/JPkl j of Lake Wequoquet = 33.8' (30/SEP/05). Review: PS Comp/Draft: WHK/RRL DATE: SCALE: Proj. # 25048 Drawing # C6f6G1 July 29, 2014 1 11=201