HomeMy WebLinkAbout0009 MANNI CIRCLE - Health 9 MAN N 1 CIRCLE
CENTERVILLE 169-121
UPC 12543 a
No.53
HASTINGS, MN
P
$50 .00
No. god � � ,�/. Fee
I THE COMMONWEALTH OF MASSACHUSETTS Entered in compute
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
,r
ZIpplication for 30i9;po$o1 &p.5tem Construction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.4 2 8—5 4 0 2
Assessor's9Mai Circle, Centerville Brian & Christine Baker
16 -121 9 Manni Circle, Centerville
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4
Wm Robinson Sr Septic Eco-Tech
PO Box 1089, Centerville 43 Triangle Circle, Sandwich
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Install new Title 5 leach system
to plans of Eco-Tech #ETE-1644
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 Board o He th.
Signed Date I " L �
Application Approved by Date
Application Disapproved fo the following reasons
Permit No. Date Issued 0 �'
Fee$50.00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
Yes
-- PUBLIC HEALTH DIVISION -TOWN'OF BARNSTABLES MASSACHUSETTS
2pplication for Mi000l *pgtem Con!gtructiow.Permit
r .
Application for a Permit to Construct( . )Repair(X )Upgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.,No.4 2 8—5 4 0'2
�Vlap ?'a-mai Circle Centerville Brian & Christine BakerI (P
Assessor's —121 9 Manni Cirele, Centerville
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4
Wm Robinson Sr Septic Eco—Tech
PO Box 1089, Centerville 43 Triangle Circle, Sandwich
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(net
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan. Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Install new Title 5 leach System
to plans of EcoOTech #ETE-1644
Date last inspected:
r Y 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 Board of Health.
Signed r\ -:�� Date 44 ' b-
Application Approved by v Date r,L
Application Disapproved fo the following reasons
Permit No. 2 Lvq— _?j ` Date Issued h 7A i-/
Baker THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( )
Abandoned( )by Wm E Robinson Sr Seotie Service
at 9. Manni Circle, Centerville has been constructed in accordance .
with the provisi{o�ns of Title 5 and the for Disposal System Construction Permit No. ` o Q— �/. dated !_ / �o
Installer lJi1� 1,,:. Designer r -Ay,t�
The issuance o t/his p rmit shall not be construed as a guarantee that the sy,s��tem,, will function as designed.
, Date Inspectorr� �,.
. . - - --------------
No. r J 0 Fe%5 0.0 0
Baker THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mit pozal *pgtem Conotruction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at Man i Ci r_le; Center_vi.11P
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:Construc 'on must be completed within three years of the date of thi
Date: U Y - Approved by 4jv
TOWN OF BARNSTABLE
L )CATION 3 /4A-A,-I' Cr k SEWAGE # OV—0
VILLAGE C t%'� G�°R ��l�[:� ASSESSOR'S MAP & LOT
li1STALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 2=— (size)
NO.OF BEDROOMS 3
BUILDER OR OWNER 8,0,1<e►�
PERMIT DATE: a `7-0ff 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
ON
1
I
TOWN OF BARNSTABLE
LOCATION nJA 4 SEWAGE # QV'�6!
VILLAGE C Li A. !&A v 111/LCI ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.®b i r�►s o ate' d �`?S 7
SEPTIC TANK CAPACITY l �/
LEACHING FACILITY:(T
) --- � `- G (size)
NO.OF BEDROOMS ,
BUILDER OR OWNER Rd<c=14
PERMIIDATE: —D COMPLIANCE DATE: Z
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
t
y '
a .
I
r
. a
J.
I
Town of Barnstable
114E ram, Regulatory Services
yP ��
Thomas F. Geiler,Director
4� * BARNSTABLE,
MASS' $ Public Health Division
i639. �0
ArEo `,�A Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: '508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 7Vne .17, Z004-
Designer: Eco-Tech Installer: Wm E Robinson Sr Septic
Address: . 43 Triangle Circle Address: PO Box 1089
Sandwich, MA Centerville, MA
On Wm Robinson Septic was issued a permit to install a
(date) (installer)
septic system at 9 Manni Cir, Centerville based on a design drawn by
(address)
Eco-Tech dated 05/05/04
/ (designer)
L I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
OF
DAVIDF)
S�
(Installer's Signatur C' "'J j '"'
9, v
'��►ITAP�P
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
MAP
PARCEL PL 520 G
LOB` RECEIVED
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR MAY 19 2004
DEPARTMENT OF ENVIRONMENTAL PROTECTI l N
W TOWN OF BARNSTABLE
HEALTH DEPT.
' FAILED INSPECTION
,o
�M 5�0 M1
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATIOJ,,�
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632 cj I
Owner's Name: BRIAN BAKER
Owner's Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Date of Inspection: 4/22/04
Name of Inspector: (please print) JOHN GRACI,INC.
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
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
_ Needs Further Evaluation by the Local Approving Authority
X Fails ;a
§e
Inspector's Signature: V� Date: 4/22/04
v
The system inspector shall submit a copy othis inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspection.If theisystem 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
SYSTEM FAILED TITLE V INSPECTION.LEACH PIT WAS FULL AT TIME OF INSPECTION AND IN HYDRAULIC
FAILURE AND D-BOX HAD SOME SOLIDS CARRYOVER.
****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 Incnertinn Fnrm F/i S1?nn l 1
Page 2 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
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 FAILED TITLE V INSPECTION. LEACH PIT WAS FULL AT TIME OF INSPECTION AND D-BOX
HAS SOME SOLIDS IN IT. RECOMMEND REPLACING BOTH.
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.
n/a 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: n/a
n/a 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: n/a
n/a 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: n/a
Page 3 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
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(l)(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 I 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 n/a
"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:
n/a
z
Page 4 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped n[a.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
_ X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with
no acceptable water quality analysis. ]This system passes if the well water analysis,performed at a DEP
certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.]
YES (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in
310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E. Large Systems:
To 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
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X 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.
a
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
Check if the following have been done. You must indicate"yes"or"no" as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period`?
X Have large volumes of water been introduced to the system recently or as part of this inspection'?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up'?
X _ Was the site inspected for signs of break out
X _ Were all system components,excluding the SAS, located on site?
X _ 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?
X _ 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
X _ Existing information.For example,a plan at the Board of Health.
X _ 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)]
I
5
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
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: 4
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [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)):iff
Sump pump(yes or no): NO f^ p�
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X 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): n/a
Approximate age of all components,date installed(if known)and source of information:
1989 PER OWNER
Were sewage odors detected when arriving at the site(yes or no): NO
F
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 12"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: L 8' 6" H 5' 7" W 4' 10""
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle:31"
Scum thickness:3"
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: 15"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL SEPTIC TANK COMPONENTS ARE STRCTURALLY SOUND AND FUNCTIONING
PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP:_(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/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.):
n/a
7
Page 8of11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: n/a
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.):
D-BOX HAS SOME SOLIDS IN IT.
PUMP CHAMBER: _(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
R
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 1
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
LEACH PIT WAS FULL AT TIME OF INSPECTION.THE PIT HAD NO VISABLE LEACHING LEFT AT THE
TIME OF THE INSPECTION-PIT IS IN HYDRAULIC FAILURE.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
4
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
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.
A �(
AA
Q
C
k a
in
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 MANNI CIRCLE CENTERVILLE,MA 02632
Owner: BRIAN BAKER
Date of Inspection: 4/22/04
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 12+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
HAND AUGER- 12+FT.
ti
/ TOWN OIL BARNSTABLE
LOCATION_ ' �t z'�U�LI t, I NMI QQ-2-SEWAGE #_
V),)LLAGE O- UIuL , ASSESSOR'S MAP & LOT
.INSTALLER'S NAME Sz PHONE NO�(�\���(SY11�1i�
SEPTIC TANK CAPACITY WO
LEACHING FACILITY:(tgpe)� t r i� (vixe) Q��e'A
NO. OF BEDROOMS_. PRIVATE WELL OREPBL:I'7CWATER)
� \^ `,
BUILDER OR OWNER j RAN,
DATE PERMIT ISSUED: to
DATE COMPLIANCE ISSUED: L
VARIANCE GRANTED: Yes �v No_ ,
fit•:
f ti;
----ASSESSORS MAP NO: /6,
PARCEL NO.-
No... Fmc.... t`)...-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ . ......... ...OF.........................--------------------------------------------...................
Appliratiun for Disposal Workii Tontitrnr#run Prrmit
Application is hereby made for a Permit to Construct (/or Repair ( ) an Individual Sewage Disposal
System at: Zu
-••-•-•-•-------------------'`....`-!JAI•-----------...............-•-•--.........--------... .................. . ................................... .........................
Y Iyzc tioiE Adjr� bo or Lot ..
/�l ..................................... ........................ .. ..
�C �6 Owner Address
----•--•----------•.............................. ...........
Installer Address
Q Type of Building Size Lot.;.e�---Sq. feet
U Dwelling—No. of Bedrooms............3 .__..Expansion Attic ( ) Garbage Grinder (44
�+
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ----------------------------•--- .
W Design Flow..........._r�_._5......................gallons per person peg- day. Total daily flow_..........; -----____-_•_--_-__gallons.
04 Septic Tank—Liquid capacity4/6tX-_tallons Length.O..!�! .l�.... Width.L/ _.. Diameter________________ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
�
Seepage Pit No._-_--_�_.__._.__.. Diameter------v--P..... Depth below inlet.....&......... Total leaching area. ......sq. ft.
Z Other Distribution box Dosing tank ( ) k q
'-' Percolation Test Results Performed by....� 2 1 ....<._�� Date......17- Y=. --.
`4a Test Pit No. 1___-Z------minutes per inch Depth of Test Pit....�a5--........ Depth to ground water.._.._.0 _W_47 —
(T, Test Pit No. 2.....�.......minutes per inch Depth of Test Pit..... 3...._... Depth to ground water...A(0...........
a --------------------•---•---••-----------•----•------------••-••••-••----•-----•-----------------•-•.........................................................
O Description of Soil....0.'-2. .._.....4 � ......... _`-� j�-........__
v .........................../7-•�-----....--C�-`� l ` w x`1 `.. .......................................................
W ................................................... n � q -U Nature of Repairs or Alterations—Answer when applicable_____________________________________________•-____-__-___-_-__.--.--_._.---_--•----------•-__.
----------------------------•---------•-----•--------------•-•---•--•--•---•---•--•----..............•-•.....•-----------••-------------•--------------•---------•---------------•------•--•--..........
Agreement:
The undersigned agrees to install the aforedescribede1ndial Sewage Disposal System in accordance with
the provisions of ii":1.E ;of the State Sanitary.Code— signed further agrees not to place the system in
operation until a Certificate of Compliance has been issuerd of health.
Signed---------------- --- ------------------•------•---••-••-•--•----•• ...
¢, - Date
Application Approved By...........
�...-.�.c.�vx., J ..._...-.-.• -•--•---
Date
Application Disapproved for the following reasons---------------••----•---......------•------------------•------------------------------------------•---•.........
------------------------•-••---------------------------------•---------------------•-•-•.._..-------••-•-•-•--•-•-----•-••-•---•-•---••----------•-------------•--••-•------•-•-----------••------------
,r Date
Permit No......fS 4._. .6_�t_c---------------•-------- Issued.......................................................
Date
FRic....7.51=....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................... ---------------------OF............................._..........---..............................................
Apphratiou for Uispoiial Works Toustrurtion Prrmit
Application is hereby made for a Permit to Construct /) or Repair an Individual Sewage Disposal
System at:
.................................................................................................. ........... ...............................................................
or Lot No.
................................... ..........................................._V.
.......................................................
Owner Address
.......... .........
Instal!er Address
Type of Building Size --------Sq. feet
U
Dwelling—No. of Bedrooms___..........-.__._.__ .._..Expansion Attic Garbage Grinder (k116T
PL4 Other—Type of Building ............................ No. of persons--------------_-----_---- Showers Cafeteria
Otherfixtures ......................................................................................................................................................
Design Flow............:� .......................gallons per person per day. Total daily flow.........:.� ....................gallons.
04 Septic Tank—Liquid capacity'?<I-K- gallons Length Width/.'/4!�,'.' Diameter________________ Depth................
Disposal Trench—NTo..................... With.................... Total Length.___................ Total leaching area-------_----------sq. f t.
Seepage Pit No..._._ ------------ Diameter-----0--------- Depth below inlet......_.......... Total leaching area:? sq. f t.
Z Other Distribution box elo'), Dosing tank ( ) ' 1 Percolation Test Results Performed by, ...................................................................... Date--- -----------
Test Pit No. I_.- .......minutesperinch Depth of Test Pit---1_5.......... Depth to ground water-AZK--L I AM7"e rt-
1-4 _7 X
44 Test Pit No. 2....f:=........minutes per inch Depth of Test Pit-__Z.............. Depth to ground water-_--� ............
P4 .............................................................................................................................................................
0 Description of Soil. C�
.. .......... ......... ...........
---------------*-------------------------------
U ............................................ ................................../....... .........................................................................
--------------------------------------------------------A)...... -------- . j;;=':�.........................................--------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
.......................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribDed Indi id I Sewage Disposal System in accordance with
c' - C'v"
V,
A
f ITI", 1 0 _
the provisions o 5 of the State Sanitary Code- The ersigned further agrees not to place the system in
is SU b 0
operation until a Certificate of Compliance has been issu �l board of health.
Signed............ ..... ................................................................ ... ................. ...
Date
Application Approved By........... .............................. .........
Date
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo.----Ea.........6.Y'.0........................ Issued....................7----------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
17,
.......... ...........0 F....... ..............(I.....................................
Tntifirate of Tompliana
THIS IS TQ CERTIFY, That the Individual Sewage Disposal System constructed 4,,-) or Repaired
by........................X.....6.1...C-n.I ..................................
.........................................................................................................................................
Installer
at.................... ....... ....... --—---------CiL........... ...................................................
has been installed in accordance with the provisions of TTILTIE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit ............... dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF, HEALTH
OF.............../1.1) ..............................
NO.. . FEE.25:..........Disposal Workii TDonstrwfivit firrmit
Permission is hereby granted..........P..--�...ala-4,21...........__....................................................................................
to Construct (�<) or Repair an Individual Sewage Disposal System
-.t No......../_.',-7- -5-1........../L __6
..................1. 1-2 .... ......................................................
Street
as shown on the application for Disposal Works Construction Permit No .... Dated..........................................
............................. ..........................................................
.DATE............... ............................. Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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PLAN REFERENCE CONTOURS CENTERV2LE. MA
a PLAN BOOK 392 PAGE 30 EXISTING - - - - - - - 40 °O^Fc N
ASSESSOR'S MAP: 169 " MINIMAL GRADING PROPOSED
o<w •" ". ' '` F'� LOT: 121
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m VVi v}i o N R^Nnp R r� �
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W 3s.3 25 f t x 13 fi x 2 ft Lows- A
o-jQ LEACHING GALLERY
r WITH CUT CORNER LOCUS M A P
w ��, o o z a - SEE DETAL ON BACK
4 \ NOT TO SCALE
w Sr crqu woo
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N U 3 u 1 > BENCH MARK 36.3 l 34
�
J '� TOP OF CONC BOON 32
Iry \
ELEVATION - 40.65 \
a J 'n L J USGS DATUI ASSLMED 1
z 1 Z Off + i'
1- MANNI �,
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I LOT \
51
O CIRCLE
AREA - 20004 s f
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LEGEND \
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W EXo GA 1 PL A N
z vSEP IC TAW
A�N OF
SCALE: 1 in - 30 ft
z J (D OJ Q D-aox o
H - a oLL
TEST PIT ® SEWAGE DISPOSAL SYSTEM PLAN
Q LL (� EXIST9JG -TO SERVE EXISTING DWELLING
X O P= LEACH PIT ���% .�HOF
4 , I� u-' O w TREE 2� �,�,,o BRIAN & CHRISTINE BAKER
Q 1 6 O L TREE
PEFERS TO LYMETFR
o — �, ,� 9 MANNI CIRCLE CENTERVILLE. MA
Z b C0UC�U93�p y
M ( 9�a ECO—TECH ENVIRONMENTAL
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5
a SANDWICH MA 0256,
d a� � 43 TRIANGLE CIRCLE
Q L 1 1TA�
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CL w
g X 508 364-0894
H W ETE-1644 MAY 5. 2004 I/2
THIS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT
BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER
1 ORIGINAL PLANS INTENDED FOR SUBMITTAL TO TFC BOARD
, ,OF HEALTH WILL BE SIGNED N BLUE AND STAW N RED.
k
S
SOIL TEST LOG
-} DEStGN CALCULATIONS
DATE OF TEST: MAY 12004
i
SOIL EVALUATOR: DAVID D. COUGHANOWR. RS
WITNESS REQUIREMENT WAIVED - NO VARIANCES REQUESTED DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD
GROUNDWATER
TEST PIT I PAORENTT MATERIAL: E ROGLACIALDOUTWASH SEPTIC TANK:, 330 GPD X 2 DAYS - 660 GALLONS
ELEVATION - 39,4 +- PERC AT 78 -in : 2 MIN/INCH IN C SOILS
USE EXISTING 1000 GALLON SEPTIC TANK IF IS SOUND STRUCTURAL
CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
DEPTH SOIL USDA SOIL SOIL COLOR SOL OTHER
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DISTRIBUTION BOX: USE 3 OUTLET D-BOX.
0-4 A LOAMY SAND 10 YR 4/4 NONE FRIABLE SOIL ABSORBTION SYSTEM: THE LEACHING GALLERY DEPICTED BELOW CAN LEACH
4-36 B LOAMY SAND 10 YR 5/6 NONE FRIABLE A b o t - ( 25 x 13 ) - ( 7 x 5 x 0.5 ) - 307.5 s f
Asdw - ( 25 - 20 + 13 + 7 8 ) x 2 - 146 sf
36-146 C MEDIUM SAND 10 YR 6/3 NONE LOOSE A t o t - 453.5 s f
Vt 0,74 x 446 - 335.6 GPD
USE LEACHING GALLERY DEPICTED BELOW. Vt - 355.6 GPD > 330 GPD REQUIRED
GROUNDWATER
ADJUSTMENT
EXISTING GROUNDWATER LEVEL LEACHING GALLERY
BASED ON BARNSTABLE GIS
DEPARTMENT RECORDS
INDICATED GW: 25.0 CONSTRUCTION DETAIL
INDEX WELL: SDW-25.2 DRYWELL UNIT STONE
ZONE: D 8'-6'x 5'-O•X 2•-9'
READING: APRIL 2004 2 ft EFF. DEPTH
LEVEL: 47.2 ` 25 ft .
ADJUSTMENT: 3.3 f t
ADJUSTED GW: 28.3
NOTES 00 -
_ in M
1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN
2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM.
v
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 5 ft Il 7.5 ft �, 8.5 ft 4 ft
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15)
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES NOT TO
SCALE
BEFORE EXCAVATING FOR SYSTEM. 25 ft
5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED
5) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE
7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN
8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES SEWAGE DISPOSAL SYSTEM PLAN
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK
9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT -TO SERVE EXISTING DWELLING
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM,
10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. BRIAN & CHRISTINE BAKER
II) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 9 MANNI CIRCLE CENTERVILLE. MA
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH
SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING ECO-TECH ENVIRONMENTAL
12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED
FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 43 TRIANGLE CIRCLE SANDWICH MA 02563
44 21ETE= 2