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HomeMy WebLinkAbout0270 NYE ROAD - Health E YE RD. ERVILLE 47 027 i j No. _ Oo Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ve, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for 30isspagaY 6pgtem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ZIC) PIE lz0" Owner's Name,Address and Tel.No. Assessor's Map/Parcel CENTC-T—V 1 L.LIF I w Installer's Name,Address,and Tel.No. Lf",j) °�, Designer's Name,Address and Tel. o. `801C 7o7- thIS ��— Type of Building: Dwelling No.of Bedrooms 13 Lot Size e 23i rea sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date ZL, 6 2-00a Number of sheets I Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) PJlEF� LFAeA Rrauvr Date last inspected: ry i m k v .0 0 D (See F* -w e c &Pv jam( 1 Agreement: J 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 Enviro ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this Board of H th. Signe Date 7-Z .7-op9 Application Approved 4:7Date S:F Application Disapproved for the following reasons Permit No. —,C�7 Date Issued TOWN OF BARNSTABLE LOCATION SEWAGE # AN� -�D VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER D C/ PERMIT DATE:=106 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 7t,\i o- 6� 0- ➢L Q=Lb 1' i t f No. G/y" ^►✓ 0Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es'; - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rppricatfon for Mfopogar *pgtem Cow5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ZO7Q 011` ',�OA.b Owner'sName,Address and Tel.No. Assessor's Map/Parcel GFNTeiLd I U e, '-If to ' "�j (n 11417 f o '7o 2-b Installer's Name,Address,and Tel No. 47—o,02 � Designer's Name,Address and Tel. o. Q glut r s 1-fit"eery... #__ pox -roz.. IVLAgm ►u J Type of Building: Dwelling No.of Bedrooms .3 Lot Size 23fi5wsq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures _-_ Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date $ Zlo t -GD U Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) A316 4_4 Ekot. T 1 ` Date last inspected: All M A V Z.b b 0 (SEt PA I L N gX Ji?ePID Agreement: J! -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 Enviro mental Code and not to place the system in'operation until a Certifi- cate of Compliance has been issut by this Board of lth. Signe46 Date r6 ► 2-006 Application Approved ryl Date �j! !Z 191- Application Disapproved for the following reasons Permit No. ewc !J Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERXIFY,that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( ) Abandoned( )by .e-, at 2 - has been constructed in accordance `; r. t f •. with the provisions Title 5 and the for Disposal System Construction Permit No. l ed 2�- _ Z: Installer Designer h _ The issuance of this permit s�19 A b co .,true as a guarantee that the l unet/io as si w Date p g Inspector / / l --------�-------------------- -------- No. 1✓0' /s' Fey- d- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS, Mf 6 pout *pztem Con5tructiou Permit Permission is hereby granted to Construct( )Repair )nUpgrade( )Abandon( ) System located at _f►� , and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: f`f = ? R, --:0— Approved,b p 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I---- , l I, &M e5 H o Urt , hereby certify that the application for disposal works construction permit signed by me dated $ ,i-g, -2-� , concerning the property located at 9 7 r3 N a F 2 P<b _ aJ9L Vl 1,L meets all of the following criteria: t,/- This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system 1/• There is no increase in flow and/or change in use proposed There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] t/ If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen (14).feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) `7b B) G.W.Elevation 2�. 3 +the MAX.High G.W. Adjustment. i DIFFERENCE BETWEEN A and B /� S SIGNED : Yf'a DATE: 0 24- Do [Please Sketc pr posed plan of system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert eI "rO J 4a , h IPD 14-7 Uv7l MA r TOWN OF BARNS ,• ,LOCA'I'ION , SEWAGE # 629 VII.LAGE ASSESSOR'S MAP & LOT IN- .LER'S NAME PHONE NO. SEP� TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNFER PERMIT DATE:FW106 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) AN Feet Furnished b TOWN OF BARNSTABLE L• ATIbM, SEWAGE # VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. v _ SE1pI'IC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMUDATE: 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 Ai 2- 4 �ld -o TOWN OF BARNSTABLE �'t' LOCATION ` SEWAGE # AWV VILLAGE ASSESSOR'S6 MAP & LOT INStALLER'S NAME&PHONE NO. � 0 SEPTIC TANK CAPACITY 1 �D //� LEACHING FACILITY: (type l-�' 91(size) NO.OF BEDROOMS BUILDER OR O® R 10 PERMITDATE:O D� 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 Z S�~D �17-0 3 �9'0 4 -7d—o r TOWN OF BARNSTABLE `r - L0C.A;:I tA:,; "/Q /Vll )&A') SEWAGE # , VILLAGE C�.�IK o__ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACII.TTY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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 �c O AO 6�L D� I .a i t o`y FQ y loge /� COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS ,tom DEPARTMENT OF ENVIRONMENTAL PROTECTION N ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 270 NYE RD CENTERVILLE, MA 02632 L50 Name of Owner JOHN FOLEY Address of Owner: 270 NYE RD CENTERVILLE,MA 02632 Date of Inspection: 6/26/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 508-564-6813 FAX 608-664-7270 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-sfte sewage disposal systems.The system: _ Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority X Fails Inspector's Signature: Date:6/29/00 The System Inspector shall sub lilt a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the systim>is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate'regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buye{if applicable,and the approving authority. NOTES AND COMMENTS "The Inspection Is based on criteria defined In Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM FAILS TITLE V INSPECTION. THE LEACH PIT IS FULL OVER THE PIPE.THE PITS HAVE NO EFFECTIVE LEACHING LEFT. revised 9/2/98 Page 1 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 270 NYE RD CENTERVILLE, MA 02632 L60 Name of Owner JOHN FOLEY Date of Inspection: 6/26/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.if"not determined",explain why not. n& The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nLa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced DIA The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed pit revised 9/2198 Page 2 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 270 NYE RD CENTERVILLE, MA 02632 L50 Name of Owner JOHN FOLEY Date of Inspection: 6/26/00 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance nLd(approximation not valid). 3) OTHER n/a I revised 9/2198 Page 3 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 270 NYE RD CENTERVILLE, MA 02632 L50 Name of Owner JOHN FOLEY Date of Inspection: 6/26/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: X I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X _ Backup of sewage into facility or system component due to an 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 1/2 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 0. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a 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 I 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 270 NYE RD CENTERVILLE, MA 02632 L50 Name of Owner: JOHN FOLEY Date of Inspection: 6/26/00 Check if the following have been done:You must indicate either"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 None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. - X As built plans have been obtained and examined.Note if they are not available with N/A. X - The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X - The site was inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on.the site has been determined based on: X - Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)t 5.302(3)(b)] X - The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 270 NYE RD CENTERVILLE, MA 02632 L50 Name of Owner JOHN FOLEY Date of Inspection: 6/26/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate 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 two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COM M ERCIALIINDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow: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:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: 1997 System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date Installed(if known)and source of information: 1987 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 ;, Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 270 NYE RD CENTERVILLE, MA 02632 1-50 Name of Owner JOHN FOLEY Date of Inspection: 6/26/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 18" Material of construction: _ cast iron _ 40 Pvc X other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 6'7"W 4'10 Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 4" 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: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SYSTEM FAILS,THE LEACH PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING.PROPER MAINTENANCE FOR SEPTIC SYSTEM IS TO PUMP EVERY TWO YEARS. 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: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nla revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continu°:d) Property Address: 270 NYE RD CENTERVILLE, MA 02632 L50 Name of Owner JOHN FOLEY Date of Inspection: 5/26/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or 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: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: OVER PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS BROKEN AND NEEDS TO BE REPLACED. 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 revised 912/98 . Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 270 NYE RD CENTERVILLE, MA 02632 L50 Name of Owner JOHN FOLEY Date of Inspection: 6/26/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6' 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,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SYSTEM FAILS TITLE V INSPECTION.THE LEACH PIT IS FULL OVER THE PIPES,THE PIT HAS NO EFFECTIVE LEACHING LEFT. CESSPOOLS: _ (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: n/a inflow(cesspool must be pumped as part of Inspection)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 revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 270 NYE RD CENTERVILLE, MA 02632 L60 Name of Owner JOHN FOLEY Date of Inspection: 6126/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) �t1c1� v A� R 6 O AA �1 �3�G AO 6aL revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 270 NYE RD CENTERVILLE, MA 02632 L5O Name of Owner JOHN FOLEY Date of Inspection: 6/26100 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health Checked FEMA Maps _ Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET revised 9/2/98 Page 11 of 11 No.. --. � ,-FEE.............................. TFAE COMMONWEALTH OF MASSACHUSETTS S BOARD OF HEALTH ..........................................O F.......................................----.............................................. App iration for Biopnoal Works Towitrurtiun ".truth Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .....�Sl�� ...RA.......... .................. �T nL ca'on-Address or Lot No. ...._.. .......Rol. 1C)----------------------------------------- . .............--------.......�...-- --- ---------...............-------- -•-- a � `•(I �! ` ddress'Tkoq.---•-•----•-....-•-•-- ......1-� h ..... ! . Installer Address d Type of Building - Size Lot_.._.1-�OA o....Sq. feet U Dwelling—No. of Bedrooms..........:3..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ...................................................... W Design Flow...... _,�/..........................gallons per person per day. Total daily flow........ .........................gallons. WSeptic Tank—Liquid capacity/O.P.a..gallons Length.............•.. Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage.Pit No......... . Diameter.... r........ Depth below inlet.._,;%.�4u......... 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----------------------- G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •---•-•-----------•-•--------•-••--••---------------------------------------------------------------......................................................... 0 Description of Soil.........................................................-.............................................................................................................. LFd I !/___ ...............................................................g"'_ - -- _ ! `. . U ..._.. ..-........t.............................................. TLLY.�....... ..---•---------•••-•------.... °Z• .......................... «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 iI'LIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Complian a has been issued by the board of health. kigned.._. ._...:�/' _.. �J------------------ ------------D......._..._..._ Application Approved By.............. .............:. Date Date Application Disapproved for th f ollowing reasons:......................................................••------•-•--------------.....-----•....----•----.....---- ..........................................•--._.....----••--•--------•.........-------------------••.....--------------------------------------------•--•--------•---.....-------••....-------•--------- Date Permit No..--- ......... -•------------------------------- IssuecL---=--- ... - .................. ....._ Date No....................... ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ..............................OF.......................................................................................... Appliration" for Disposal Works Tonstrurtiolt Flermit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ......AAA!...Rh..........$w...56fAls.......-•...•... .............................Z........4F ....... ........................... ........... 1, t, A4d s or Lot No. ...... . .................................... ................................................................................................ -30_04�------------------------------ ... Q.. ... .... Installer Address Type of Building Size Lot I. QAO...Sq. feet Dwelling—No. of Bedrooms..........3.............................Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 OthaIxtures ...................................................................................................................................................... Design Flow_...._=0........................gallons per person per day. Total daily flow........ ...._....................gallons. 04 Septic Tank—Liquid capacity/jOAA.gallons Length................ Width................ Diameter..._............ Depth................ Disposal Trench—No. .................... Width ....... Total Length........_......__... Total leaching area....................sq. ft. Seepage Pit No........./......... Diameter.... ----- Depth below inlet....4-!4....... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date-----------....:......-----------------. MTest Pit No. I................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......_............._... ..............I................................................................................................................................................. 0 Description of Soil....................I..,.*................................................................................................................................................... ell ............... .............. -------------I---------------7-.7 *--/ I '�i E.................................... .............................4_;� ................. ....................................... t )�---------------------- U Nature of Repairs or Alterations—Answer when applicable Al.......� Ze.r............................................................................. .................. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the-State Sanitary.,Code The undersigned further agrees not to place the system in operation until a Certificate of Compliafite:has been,issaed'by,,the,.,board,'6f h6alih. ig, ................. ................................ igned.,j�.� Date Application Approved By.............. ..............% 0*�co e� .................................................................... ........................................ Date ollowin Application Disapproved for theIg reasons:......................................m..................................................................... ...................................................................................................................................................................................................... Date Permit No...... sr --------------------------------------- Issued....--.... ....................................... Date THE� OMMONWEALTH OF MASSACHUSETTS C: BOARD OP HEALTH ................................. ........OF.................................................................I........... Trrfifiratp of Toutplitturt THISeIS TO CERTIFY, Thit,.the Individual Sewage Disposal System constructed (,-so or Repaired _T by---------------- ............E".L ........................................................................ ," Installer at............ . ....... . ........................................................................... ry e s 7. n the..........d 'be has been installed in accordance with the provisions of TITLE 5 of The State Sanitary cri,d i application for Disposal Works Construction Permit.No....... ......... dated--- ...Cod THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. ..................... .............................. Inspector........... .......................... .... ..... J THE COMMONWEALTH OF MASSACHUSETTS L f R BOARD OF HEALTH lr .............. .................OF..................................................................................... No......................... Ficz........................ Disposal Works Tonstrudion frrutit "7i, Permission is hereby granted..::.....{-. X.014.011).......t.a.ap....................................................... to Construct 2() or Re .4,.r an Individu V at Sewage Disposal Syst ....... . ................0.. ........................No..Ir-ra, ........... 1. ...... ...... . ......... Street as shown on the ap'ol"i'6'at'i6ii'tor,'DisposaI Works Construction Permit No. Dated.......................................... ............................... ............................... Boa ea tK' I DATE.......10-.n...7• =--•----_........................... F0 RM 1255 A. M. SULKIN, INC., BOSTON f R. J. O'HEARN, INC. REGISTERED LAND SURVEYORS cSwan cRtvr t �__P[aza gnit 2 REGISTERED SANITARIANS 35 eRoute 134 eSout�z 1�ennts, Jl�a. 02660 394-1265 April 10 , 1986 Board of Health Barnstable, MA Re : Lot #50 Nye. Road Centerville Gentlemen: This office inspected the installation of the sanitary facility on the above referenced project. Based on our observa- tions it is our opinion that this system was installed in accord- ance with the approved plans. Very truly yours, R.J. W HEARN, NC./ / V Richard J. 0 earn President L.C . A T. ION �� 'il E W A G E PE RMITw NO.. J�,r c� LD VILLAGE a-7GU y I N S T A LLER'S NAME a ADDRESS /U Q C� S U I L D E R OR OWNER (dui ci/� S' DATE PERMIT ISSUED DATE 'COMPLIANCE ISSUED -J f 12- 3 z 62� 2J 12 1 LOCATION SEWAGE PERMIT- No. S �,� .f VILLAGE Is- Inll/ S I I N S T A LLER S NAME, A ADDRESS Iva vl:4 6 U I L D E R OR OwmER aoi ✓ _ DATE PERMIT ISSUED OAT E COMPLIANCE 1SSUED 26i /f I 7 O2 7 � I . 93 , h' .. w , r 20 FT. MIN, TOP OF FOUND: ---_ _ f F EL = / 10 FT MIN. ` CONCRETE �,•, t - COVERS 4" SCH. 40 PVC CLEAN SAND .7 ell ff PIPE- MIN. PITCH CONCRETE E''T - -/-/// I/8 � PER FT. COVER r�'��- .r; '►, ° 4" CAST IRON 2 „LAYER OF PIPE - MIN. PIN 12 1/8 - 1/2 WASHED tv 1/4" PER FT. STONE. o , .:'. FLOW LINE—,*. _z 10 _ EL - N MIN. EL. EL EL - -- . K DI ST EL.= w LOCATION MAP BOX Gpa ' � z 3/4"- 1 1/2" ,� P�'p I w a e WASHED STONE �� �'° o o�po 0 PRECAST LEACHING w `a"oU " f EL.= GAL• BASIN OR EQUIV. t SEPTIC s.o' TANK BOTTOM OF TEST HOLE OR U, SSQS QROBABLE WATER TABLE EL. _ 970 PROFILE OF GROUND WATER TABLE( EL.-= /� -/4 ) _ SEWAGE DISPOSAL SYSTEM 97, 4 Nth 1 TO SCALE ;sg r C SIGN CALCULATIONS SOIL TEST ` =' 9., NUMBER BEDROOMS . . . . . . . . . . . . . . . . _ DATE OF SOIL TEST ' w T GARBAGE )ISPOSAL UNIT WITNESSED BY TOTAL E (I MAT ED FLOW ( GAL /BR./DAY x BR. ) .. . . . . . GAL./DAY PERCOLATION RATE .-- MIN. INCH 1 - _ REQUIRED SEPTIC TANK CAPACITY..,. . '' ' .- r GAL OBSERVATION HOLE I OBSERVATION HOLE 2 UAL 'F OF SEPTIC TANK. GAL. ELEVATION - ELEVATION = `� ACT LEACHING AREA REQUIREMENTS -1 SIDEWALL AREA GAL./S.F. BOTTOM AREA _ GAL./S-F. iocr� ^ ` OM + S WAL ) GAL i -��yf ¢, + , ,_ � .. ,.,•- LEACHING CAPACITY BOTTOM IDE L 1 x vr � f y a't9 i+�i lad' RESERVE LEACHING CAPACITY ............._ . ..... GAL. fit NOTES - f. I. ALL WORKMANSHIP AND MATERIALS SHALL , CONFORM - TO D.E Q.E. TITLE 5 AND THE TOWN OF RULES AND REGULATIONS FOR SUBSURFACE DISPOSAL ? ' OF SANITARY SE WAGE y 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO } - WITHIN 12" OF FINISHED GRADE. 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY MIN. FRONT SETBACK -t ' THE SAME. ' MIN. REAR SETBACK 4. NO DETERMINATION HAS BEEN MADE BY THIS OFFICE AS TO MIN. SIDE SETBACK COMPLIANCE W;TH TOWN ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. APPROVED BOARD OF HEALTH DATE AGENT PROJECT LOCATION: -0 MASS ✓ �i_1 M4 ,,« W RICHARD RICHARD ��,�\�; APPLICANT : g3, f ti S r', e694i¢ ' LEGEND r: GALE R. BYDATE; �. S 0 EXISTING SPOT ELEVATIONS 00 0• -. • ., - JOB N0� APP 0 BYE REV EXISTING CONTOUR - -- - - - 00- - - - FNAL SPOT ELEVATIONS 00.0 FINAL CONTOUR 00 R. J Q HEARN, /NC. DRAWING 4 SITEI- n! n' b SOIL TEST LOCATION REG. 4�4H0 SU/;r•VEYORS- RREG. SAN/TsIR/ANS NO PL)A V 35 ROUTE /34 -- UN/T 2 SIDUM DENNIS , MASS.