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HomeMy WebLinkAbout0401 OAK STREET (CENT./W.BARN) - Health (2) 401 Oak Street Centerville A= 194-028 /// SMEAD No.2453LOR UPC 12534 smead.com • Made In USA 10H a1FESNPi000ANYVYVYYSFiNOfiRlWtow 2` No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplitation for VspoBal OpBtem Construction 3pPrrait Application for a Permit to Construct( ) Repair( <'upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.if`®� Q 1/_ $�•4— Owner's Name,Address,and Tel.No. Assessor's Map/Parcel/y Oz r co /4 5,e� ! �, Installer's Name,Address,and Tel.No.S -7(1/ rj S Q"7 `De-signer's Name,Address,and Tel.No. � aa Szocx- G�,� ��,.� rn �`s�,t'2J",�: rv;;/ y� "� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min..required) gpd Design flow provided 3 gpd Plan Date /�"— Z '"�% Number of sheets Z Revision Date Title Size of Septic Tank Type of S.A.S. 2 / 5D(_) Description of Soil Nature of Repairs or Alterations(Answer when applicable) G� Ze el a Xe111K X^(/�'� � 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 pot to the system in operation until a Certificate of Compliance has been issued by this Board of Health:--�-�"""���lrI Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. L �� Date Issued TOWN OF BARNSTABLE LOCATION �� / � � SEWAGE /� VILLAGE CC4V'teJ&1,T/1e ASSESSOR'S MAP&PARCEL Jr1�u ��r INSTALLER'S NAME&PHONE NO. 0 r6iA u4C, �J� ­ok O fcK SEPTIC TANK CAPACITY �X>�,S ©✓lp LEACHING FACILITY.(type) Z /T76 &� CtiK `stze) /3� NO.OF BEDROOMS OWNER PERMIT DATE: — m I f 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 P FURNISHED BY r. 2, - C , j No. Fee dd THE COMMONWEALTH OF MASSACHUSETTS Entered in compuier: xw.._� _ . .� Yes PUBLIC HEALTH DIVISION - TOW-' OF BARNSTABLE, MASSACHUSETTS Application for BispoSal 6pstem Construction permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.fl©f (/_ S-f" Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 19 Y 0Z f ��'� C4�LO y L f. a 1,4e Installer's Name,Address,and Tel.No.&Z 26�e j 4�_(? Designer's Name,Address,and Tel.No. �ktguU0o Scu)c"-� cj �r�,-- o� :Hee/,� L✓�ius tiG Tfpe of Building: Dwelling No.of Bedrooms ? Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 J`^/ • ,� gpd Plan Date //— Z �-�� Number of sheets Z Revision Date Title Size of Septic Tank �/,Ouo Type of S.A.S. 2 /1z o S-oV Description of Soil Nature of Repairs or Alterations(Answer when applicable) ✓� LC a 64 K C/,,t/ r, i - 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 tpllacethe system in operation until a Certificate of Compliance has been issued by this Board of He tk�-- Signed Date Application Approved by Date Application Disapproved by �~ - Date for.the following'reasons A Permit No. f�� -- 7 Date Issued A21 3111 -'f P� THE COMMONWEALTH OF MASSACHUSETTS 17 F ,7/ f^ U BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ,�' Upgraded( ) Abandoned( )by DI y, M-o-7 o at lU/ �Q V. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No4CY?-417 D dated /_t / >] L /�tf �Installer f f t d P o g h , #bedrooms Approved design flow 3��f/ gpd The issuance of this ermi#shall not be construed as a guarantee that the system will Mctior)s designed. Q/� Date Inspector 1 (.+i ---- ----- - I---------------------------- - -- -- - - ---------- --------------- ------------------------------- -------- No Jh/ .fit-'` Fee /l THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 33ispoBal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( �-)� Upgrade( ) Abandon( ) System located at tZ o l /w4 IL and 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 coo pleted within three years of the date of this permit. Date , 1/, /�/ Approved bCy F i x •w,y a!r x GF;,K ,� Regulatar� S°e;l v;lc±L�. Rtchad �..S, air ittrlt?I."Dtrectat w. �'��StAtLnS7AliLE. � ' f M.1s$ I3tvtsfn + �'EVMa4" : holtlas; tFc-Kean, I?IrCctot- �t3(? \latn 5,l,� ]Eiy;tnnts, , 02GU`.1 Uic 1-ax =5l13 79f1=G`Jt)'a Lnstal]`er&L1esI�) er Cert1lieafan f�ortt�' Date iz. =Sewage 1'ermlt#. �/qy'7� Assessol'sz 1Prt<cel ( ' 1)esY Pew: '�Crt �� ( u P nst Address..H 3Zr ifs ��I fdaee) — Nvas us Es, ed a peimlt to iiastall-a;. 4 ' r,) " Sept"je Syster 1.at bacdora:a design drtttyii b)` trtcldtcssj i certty that'thc sepuc system referenced a6o�e`v s In"t '� s ailed subst<m�ta�ly accotdatz� to:the de�tg�iY�htcit rriay 7�cludd rnrnar apl��raved changes-such �s .latest �elocaCsan of-'the3; dzst�iluf)oLi Tax tlniar sel"tIc t�bl. Strip cut.(.if retYtria>ed} tva tnspccted ai7'cl tn� so1s tvele�faundsahsfactory:, -`�` .. M I that she SePtle system rg(e)enceci Above,ttias t )tastalled tt ttii ry:a�ot E hii greater than tt?' IntcGEt Fvlo�at�otl oftt�St1�or buy vertiial'telacatton�:o,€any compotcrtf of the.tiel�ttic systetri} but tn�acco)�1nc4 c�%itl� Stattw& La,,p�l Re�ulat.�alzs. 1'lazl re�r)srai or:!cettEfi'ed rts.,�izatlt by designer to fallow S"tnl�out(�f°reejured�� as t�3s �cteci ntd tii,���i(: ;were Eotlnd"s�t)sPaetbl}; A' Y c6lli'fy that tl�c s, sCc:n teteiencecl �t�otr�ttas .constrttG�ed Al � oftlt alb': :let if1 �i.cibl } tvitti the i4ri;.i5 leRT nstltllei s Slglaatu�'e) 5�` sN+cE, Mutt:, N© 35109 �. (—es]gn r°s Si )iattltc); tlifix I)estgne PLEASIr REX'TURI�'xTO I"AI2'I�rL AI;LI? t'UBL IC THf<T1I I5TUN. .<C R 1;Xi .If A7 E; OF CU1jIi'.T=;XAIV�:-E '4'G'TL�1.. 1\01` BF:,ISSU�r3 L.rIYT`LL B(3T�i Tl*I-LS FQR34T"A`+VL) •AS-: BL'ZLT CARD hI�GkLt��IC�l;D`B�r TFIL=', F3�R�IST't�:13LT.P..,,tJL3L,�C;' [�IvAL.TII,Di<'�TS.IC:1�4 (� �et) ,;.y�„�igncrC.�rttficatwn�ui�nl�cv,� -j�,d"oc;. r Eng+neets note T�+s eerGticaGon+s Iirh tic to ari as u IE Ins a c U P Aon cf ystwtrcomponisjets as+nsEalleo onor o back+I!'T*hL engine z;d+d nol sut eu+se cda SLrycl:on gf cj�e sy"stem Theit�p, Ilex ass[�r^as respotrre+tty+or�11 o1aEsn,l&,1,16rdnansip backi+ljt�g_ to spaaited gra�es,.W�tn propnr ccmpac+on and�etl+ng,risers cotters as Shown p+�tt-e da�ign,plan... _ � Commonwealth of Massachusetts Title-5 Official Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 401 Oak Street Property Address Celine Barfoot Owner Owner's Name information is required for every Centerville MA 02632 12/11/2013 page. Cityrrown - State Zip Code Date of Inspection - Inspection results must be submitted on this form. Inspection forms may not be altered in any _ n way.-Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector:key to move your cursor-do not Patrick K. McDowell U (3 use the return key. Name of Inspector PKM Contractors, Inc. ICI Company Name P.O. Box 775 Company Address East Dennis - ,:,s MA 02641 City/Town F c. State Zip Code 508-385-5993 SI 13023 Telephone Number License Number - B. Certification. _ .a- --.I certify.that l=have personally-inspected the sewage disposal system at this adgrgjs and thOtIthe Q information reported below is Prue, 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 A, intenance-of orF!lte -sewage disposal sy"stems.1 am a DEP-approved system inspector pursuant to,, ection 16:340 0 Title 5(310 CMR 15.000). The system: t - r�y Passes,_ ❑ Conditionally Passes ❑ Fail r /'❑-weds Further Evaluation by they Local Approving Authority ,— Insp or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or =.. has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the _ report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will,perform in the future under the same or different conditions of use. t5ins•11110 Title 5 Official Inspection Form u rface Sewage Disposal System•Page 1 of 17 .m Commonwealth of Massachusetts . : Title- 5 Official Inspection FOrr a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 401 Oak Street _ Property Address Celine Barfoot Owner Owner's Name information is Centerville - MA 02632 12/11/2013 required for every page. Citylrown v, State Zip Code Date of Inspection B. Certification (cont.) Inspection-Summary: Check A;B,G,D or E always complete all of Section D A) System Passes: 1.have not found any.information which indicates that any of the failure criteria described .a s. in 310 CMR-15:303°orin 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.. 2_ Comments: _ B) System Conditionally Passes: V ❑-:`One ormore system-components as described in the"Conditional Pass" section need to be T?-• f;; =t, r . r., -.replaced or:repaired.The:systerh upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box forges" "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," pleaseexplain. »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 _ t'•• 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5,Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 .p _ 1 Commonwealth of Massachusetts - a t Title_ 5 Official Inspection Form Subsurface.Sewage Disposal System Form-Not for Voluntary Assessments 401 Oak Street Property Address Celine Barfoot Owner Owner's Name information is. required for every. Centerville _ ! MA 02632 12/11/2013 page. =M City/Town State Zip Code Date of Inspection B.. Certification (cont.) B) . System Conditionally Passes (cont.): 1=1; I,IR Observation of sewage backup-or-break out or high static water level in the distribution box due 0,o_-, ,_ to-broken_or_obstructed pipe(s)or:due to a broken, settled or uneven distribution box. System will Z. pass inspection if(with approval.of Board of Health): _ ❑ = broken pipes) are.replaced ❑ Y ❑ N ❑ ND (Explain below): . r--.� ❑ 1 3 obstruction is removed ❑ Y ❑ N ❑ ND,(Explain below): Eldistribution.box-is leveled or replaced . ❑ Y ❑ N ❑ ND (Explain below): t ti' , f ::. .� rF= ❑--The system required pumping,more,than 4 times a year due to broken or obstructed pipe(s). The _it ref system will pass inspection if(with approval of the Board of Health): Elbroken pipes)arereplaced ❑ Y ❑ N ❑ ND (Explain below): . ❑ .,_..obstruction is removed ❑ Y . ❑ N ❑ ND (Explain below): — C) Further Evaluation is Required by the Board of Health: !❑Conditions exist which require further evaluation by the Board of Health in order to determine if ?the system is failing to protect public health, safety or the environment. w r. I System will pass unless Board of Health determines in accordance_ with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 a Commonwealth of Massachusetts wIMEEMEMIW : Title 5 Official Inspection For _ -Subsurface.Sewage Disposal System Form-Not for Voluntary Assessments _ 401 Oak Street Property Address Celine Barfoot Owner Owner's Name information is required for every Centerville MA 02632 12/11/2013 a page. Cityrrown __ State Zip Code Date of Inspection - B. Certification (cont.) _.2. System.will fall,unless the Board of Health (and Public Water Supplier, if any) t €_ It r. _ _ determines that the Systemiis 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. - t>>_ V. w _ �,TheFsystem;hasa_septic tank and SAS and the SAS is within a Zone 1 of a public water' supply. system:has a septic.tank and SAS and the SAS is within 50 feet of a private water ' supply well. ..: 0 The sy§terrr,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: t er ,-**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal -to or less than 5 ppm ,provided,that�no other failure criteria are triggered. A copy of the analysis must ; be attached to this form. 3. Other: a _� .. D) System Failure Criteria Applicable to All Systems: - --You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool EEO . 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 %day.flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 0 Commonwealth of Massachusetts -- - . : Title: 5 Official Inspection Form , - Subsurface.Sewage Disposal System Form-Not for Voluntary Assessments - wM 401 Oak Street Property Address Celine Barfoot Owner Owner's Name information is required for every Centerville. MA 02632 12/11/2013 � - page. City[Town --- - State Zip Code Date of Inspection — - B. Certification (cont.) . . . . . Yes No p. ,f [ 14!�} Required pumping more than 4 times in the last year NOT due to clogged or ' t ._ -_ rl :. - ' i obstructed pipe(s). Number of times pumped: 14 + _ , ❑ ® �;F 4;.-Any,Lportion of the SAS, cesspool or privy is below high ground water elevation. s u 5. 3 si'Any portion;of.:cesspool or privy is within 100 feet of a surface water supply or =Y ;� - �o, EF; ® tributary to a surface water supply. W., ❑ ® rAny,portion of a cesspool or privy is within a Zone 1 of a public well. a k:4r'. ❑zu Z :Fes_,Any portion;of a cesspool or privy is within 50 feet of a private water supply well. ❑ `tic ®: 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 I _S :f ,' . _;fir _; . *s r t;system-passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, #;= !,. wri 4: Marc_;. provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this forma } 1 azS -i N, ; El' 5. ;® .,.if_ .The'system:is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® :r f ..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 r;= system owner-should contact the Board of Health to determine what will be t ° necessary to correct the failure. E) ,Large Systems: To.be-considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. - For large systems,.you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No s• ❑­ y=}t'the system is within.400 feet of a surface drinking water supply - ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system,is located in a nitrogen sensitive area(Interim Wellhead Protection �. ❑ Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered'a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form :Subsurface_Sewage Disposal System Form -Not for Voluntary Assessments 401 Oak Street .Property Address. Celine Barfoot Owner Owner's Name information is required for every Centerville, MA 02632 12/11/2013-:�%': = +' page. Cityrrown. State Zip Code Date of Inspection - C. Checklist - Check if the.following have been,done.You must indicate"yes"or"no"as to each of the following: Yes No e":�'jf:;t"i- + •ir I :)- D.,e. .;®-.ip, :Aril 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? � ,. :{ ® ;a. 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) ' r x w Z _t s,0- ice, Was.the facility or dwelling inspected for signs of sewage back up? 0 El Was the.site inspected for signs of breakout? ® ,.El,*t. %`Were all system components, excluding the SAS, located on site? Ac Ey ;�,,:0,;-1 -#:Y Were the`septic tank manholes uncovered, opened, and.the interior of the tank f tr =a� ,r inspected for the condition of the baffles or tees, material of construction, dirriensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with informatidn.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: ® . L n,El, ` -=v Existing information. For example;a plan at the Board of Health. `� ; n 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(5)] D. System Information Residential Flow Conditions: - 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): n/a i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 0 Commonwealth of Massachusetts T TitleZ Official Inspection For Subsurface Sewage Disposal System Form Not for Voluntary Assessments 401 Oak Street 4 M Property Address Celine Barfoot Owner Owners Name information is_ required for every Centerville MA 02632 12/11/2013 page. City/Town State Zip Code Date of Inspection _ - D. System Information Description: _ _ ,• Plans and install of components not available in town records. Number of current residents=' Does residence have a garbage grinder? El Yes ® No Is laundry.on.a separate sewage`system?[if yes separate inspection required] El Yes ® No Laundry system inspected? r e ; iT a =`? ❑ Yes ®_ No Seasonal use? ❑ Yes ® No a 'all ` ;_ j=ti z ?'�Water meter readings, if available (last 2 years usage(gpd)): - Detail: 2013- 10,000 2012 9,000 Sump pump? - .- ❑ Yes ® No Last date of occupancy:j'sF' 8/2013 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): canons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present?. ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i =s Commonwealth of Massachusetts Title 5 official Inspection Form -Subsurface-Sewage Disposal System form-Not for Voluntary Assessments M 401 Oak Street Property Address Celine Barfoot Owner Owner's Name information is required for every Centerville MA 02632 12/11/2013 : page. = Cityrrown State Zip Code Date of Inspection :.; D. System Information (cont.) Last date of occupancy/use:- Date Other(describe below): General Information Pumping Records: = Source o n/af information: - {' r M.t::, Was system pumped as=part.of the inspection? ElYes ® 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 .c� ❑i Shared system (yes or no) (if yes, attach previous inspection records, if any) s: a ~�_❑"f Innovative/Alternative technology. Attach a copy of the current operation and r,,,' maintenance contract(to be obtained from system owner)and a copy of latest _ - inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. Other(describe): I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 0 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 401 Oak Street Property Address Celine Barfoot Owner Owner's Name information is required for every Centerville MA 02632 12/11/2013 page. Cityrrown t:z -* State Zip Code Date of Inspection -. D. System Information (cost.) }: r,-f _I Approximate age of all:.components, date installed(if known)and source of information: .- . n/a _srnv-n -: 3 '1 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): r -:rt— less than one foot Depth below grade: feet Material of construction: orangeburg pipe '._ ":� ' r' +'f❑ cast Iron ❑ 40 PVC - ❑ other(explain): Distance from private water-supply well or suction line: feet Ys - Comments (on condition.ofjoints, venting, evidence of leakage, etc.): - I Septic Tank(locate on site plan): a= less than 1 foot Depth,below grade:` feet Material of construction: Z.concrete, 0 metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1000 Gallon Precast Tank Dimensions: Sludge depth: 4° 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 e Commonwealth of Massachusetts _ q W : Title. 5 Official Inspection Form ,Subsurface Selvage Disposal System Form-Not for Voluntary Assessments y 401 Oak Street 4 M - Property Address Celine Barfoot Owner Owner's Name _ information is Centerville '; MA02632 12/11/2013 required for every page.=' .Cityrrown T:n}: n ,„, -r,r, State Zip Cod_a Date of Inspection -F - M. System Information (coat.) - - Septic Tank(cont.) A:,�.n �5f`ic Distance from top of sludge to bottom of outlet tee or baffle 26 2" Scum thickness 411 Distance from top of scum to top of outlet tee or baffle t a - 15" _ r ba:`tdDistance from bottom of scum to bottom of outlet tee or baffle 't : a How were dimensions determined? as built tape —A'�,r tComments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, =liquid levels as related to.outlet invert, evidence of leakage, etc.): Tank appears in good order Grease Trap (locate on site plan): Depth below grade: feet Material of construction: " ❑ concrete yw ❑metal s ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 e = r_ Commonwealth of Massachusetts -; . - Title:--5 Official Inspection For - -Subsurface Sewage Disposal System Form Not for Voluntary Assessments 401 Oak Street Property Address Celine Barfoot Owner Owner's Name" information is Centerville ,.`..:y MA 02632 12/11/2013 f%n S .4 required for every , page.= t, Citylrown _ _,.: State Zip Code Date of Inspection D. System Information (cont.) ;Comments(on"pumping-recoryimendations, inlet and outlet tee or baffle condition, structural integrity, :liquid levels as related to outlet invert, evidence of leakage, etc.): !r£=Tight or;Hold ing-.Tank--(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: . I Material of construction: ❑.concrete 4, - []—metal ❑fiberglass El polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day :. * Alarm present: ❑ Yes ❑ No WAlarm level: Alarm in working order: ❑ Yes ❑ No r Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No L15ins1/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts f W Title-5 Official Inspection Form- Subsurface-.Sewage Disposal System Form Not for Voluntary Assessments 401 Oak Street Property Address Celine Barfoot Owner Owner's Name information is MA 02632 12/11/2013 required for every Centerville " _ page. Cityr Fown. State Zip Code Date of Inspection - - D. System Information (cont.) s,•:Distribution Box(if present must be opened) (locate on site plan): ' Depth of liquid level above outlet invert N/A - , r -:i:,Comments note if box•is level,and distribution to outlets equal, an evidence of solids carryover, an ( q Y �Y Y evidence of leakage into or out of box, etc.): DBox appears to be in good order a Pump Chamber(locate on site plan): - -- - Pumps in w6rking.-order:7' "In ❑ Yes ❑ No - Alarms in working=order:, ❑ Yes El No. Comments_(note•condition,of pump chamber, condition of pumps and appurtenances; etc.): • - -Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins�11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 0 Commonwealth of Massachusetts W , Title 5 ®fficial Lnspetion Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 401 Oak Street - Property Address Celine Barfoot Owner Owners Name information is MA 02632 12/11/2013 required for every Centerville i~� "�> page. ;r City/Town er - State Zip Code Date of Inspection D. System Information (coat.) - Type: leaching pits - number: ,T .❑ leaching chambers number: ,f ❑ . leaching galleries number: a f t r El. leaching trenches number, length: ❑ ,; ; ::-° leaching fields number, dimensions: ;PUIZTF�1:- overflow cesspool - number: _ ._ ❑ innovative/alternative system Type/name of technology: `Comments(notecoridition.of_soil, signs of Hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Appears in good order r r 1:.Cesspools (cesspool must be pumped as part of inspection),(locate on site plan): Number and configuration Depth—top of Liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r ,S := Commonwealth of Massachusetts W T'itle. �5 Official Insecti®n ®rrn 'Pr; a �: Subsiurface:Sewage Disposal System Form-Not for Voluntary Assessments = 401 Oak Street Property Address _. Celine Barfoot Owner Owner's Name information is Centerville `w: wf MA 02632 12/11/2013 required for every page. - Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Fr_<,t .r;u,-- cr ' - -Comments-(note condition,of soillisigns of hydraulic failure, level of ponding, condition of vegetation-,_ etc.): a. Privy(locate on site plan): -Materials-of construction: - - Dimensions - - Depth of solids =_. ;ti r r Comments (note.condition:of soil Isigns of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 .. Commonwealth of Massachusetts ¢ : . m Title,:5 Official Inspection Form �;• s m .Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 401 Oak Street Property Address Celine Barfoot Owner Owner's Name information is Centerville ?L. r i" MA 02632 12M 1/2013 required for every _ page. City/Town State Zip Code Date of Inspection _ D. System Information (cont.) Sketch Of Sewage Disposal System:.Provide a view of the sewage disposal system, including ties to _ ,. =at least twot permanent"reference-landmarks or benchmarks. Locate all wells within 100 feet. Locate _. • '�r {where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 4 { I s e 41 - _O� a Y 1 i 1-3 3o r 10 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 s - ,m. µ Commoriwealth of Massachusetts - � _ x Title-.5 Official Inspection Form .j Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - r 401 Oak Street - Property Address Celine Barfoot -• Owner Owner's Name information is • required for every Centerville " C MA 02632 12/11/2013 page. °-'= City/Town :at:•:_: -°+ State Zip Code Date of Inspection D. System Information (cont.) _ Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells -2 Estimated depth to high ground water: feet - r -e _{ ;j-uPlease,indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: - Date bi',Observed`site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: r- - ,1!;'-;❑c .., E 1::Checked with local excavators, installers-(attach documentation) ElAccessed USGS database-explain: You-must describe how you established the high ground water elevation: No information available at Board of Health. r Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17.,.,.„ ~ Commonwealth of Massachusetts Title,-5 Official Inspection Form - Subsurface-Sewage Disposal System Form-Not for„Voluntary.Assessments �M 401 Oak Street Property Address - Celine Barfoot Owner Owner's Name information is Centerville MA 02632 12/11/2013 required for every � '='+'<� - `- page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist .'_i _T ® Inspection Summary:A, B, C, D, or E checked °rY: h� >_•�`.' _; �ji3'.� ® rInspection''Summary--D=(System Failure Criteria Applicable to All Systems)completed ,.=® System Information—Estimated depth to high groundwater of,Sewage--Disposal System either drawn on page 15 or attached in separate file t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 LEGEND * x 100.98 EXISTING SPOT GRADE N 90 -- EXISTING CONTOUR G 9 W EXISTING WATER SERVICE aAK SSRE� a ,Q G EXISTING GAS SERVICE 1 `on9boo �° .H-yyL- OVERHEAD WIRES Crosby P TEST PIT Coon LOCUS a Pen Ln BENCHMARK 0 mG P'tchi t M1 ost Cn a �µc _c MO O O d / O o / LOCUS MAP NOT TO SCALE GENERAL NOTES: / 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 116.01 115.86 /, / / \ BOARD OF HEALTH AND THE DESIGN ENGINEER. 114,94 �/ / 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS x 119,80 l r - - `- _ _ _ _ ��• / OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 105.87 0� LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: ` tic09�� 110. ��/ � /( [Z- -310 CMR 15.405(1)(b): 1) A 5' variance, S.A.S. to garage slab, for a 5' setback. / 110.88 / � �� 10712 x x 110.as / / / 2) A 3' variance to the 3' maximum cover requirement, for o7.e9 7•ea / 109. _ 111 \ up to 6' of max. cover. S.A.S. shall be H-20 and vented. '14 \ \� TP-2 +1 ,04 / 104.92 `1 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 107.12 x / O� TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE / u x 107.38 107,01 x / DESIGN ENGINEER. / x 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING PROPOSED S.A.S. `_�91116.13 hed 107.37 8 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 2-500 GALLON CHAMBERS / '107.2 x x 106.79 v ENGINEER BEFORE CONSTRUCTION CONTINUES. SURROUNDED W/\ \TONE / �3`•�130_7�oox GARAGE EX/STING Tp_� // 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. `�--- -°� VENT ""-� HOUSE(#401) Q1 -J 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF / E ) T.O.F.=107.6f/ v THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ( TP 41` :1 105.35 J3.94 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. ' o•. 5' `106.69 x / 102.33 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 111.73 x O .;:j 106,11 •�,,/ �•• � 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. Tf� 3t; /� 10 .19 x 06.69 x 1T1Y17 V 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS LOT 1 _ 10570 _ -, G CB AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE x 10 ,2 BENCHMARK DIRECTED BY THE APPROVING AUTHORITIES. 16,717t S.F. los.3o los.7s 104,69 OUTS/DE COR./BOTT. STEP O +104.84 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY PAVED":: / 100.73 EL.=106.69 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING L=92.00' w�B /N :`DR/VEWAY 1 4.35 �^ . / CONSTRUCTION. _ o f - _R�921�8 / 1oa.a ' 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS C5 - 106.5 y IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 1� REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 44"04 3 CATCH Basin• 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 103.31 B2 102 .36 101.34 99.37110 INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. +104,6e i 99.38 13. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDUCUMENTED SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. 104.30- 103.54 102.86 1102.07 101.39 100.15 EXISTING LEACH PIT OF Mgssq�ti o , I E CONTRACTOR PARCEL ID: 194-028 PETER T. SAW CUT DRIVEWAY OAK ARET � W � ND & ABANDON PROPOSED SEPTIC SYSTEM UPGRADE PLAN McENTEE EXISTING SEPTIC TANK v CIVIL "' TOP OF TANK, EL.=103.79 401 OAK STREET, CENTERVILLE, MA . 35109 INV.(OUT)=102.45t Prepared for: DiBuono Sewer & Drain, 35 Content Lane Cotuit, MA 02635 Engineering by: SCALE DRAWN JOB. NO. ' ALTF OWARF OF RECORD Engineering Works, Inc. 1"=20' P.T.M. 287-19 401 OAK STREET 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE. MA 02932 (508) 477-5313 11/27/19 P.T.M. 1 Of 2 i1 NOTE: TO'PREVENT BREAKOUT, THE PROPOSED ' FINISH GRADE SHALL NOT BE < EL. 101.5 FOR A DISTANCE OF 15' AROUND THE PROPOSED SEPTIC TANK PERIMETER OF THE S.A.S. PROVIDE RISER WITH COVER OVER THE INLET PROPOSED D-BOX SOIL LOG & OUTLET MANHOLES AND SET 3" OF GRADE. INSTALL RISER & COVER PROPOSED S.A.S. SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F=107.6t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT DATE: NOVEMBER 27, 2019 (REF#TPT-19-215) F.G. EL.=106.Ot to 108.0t SOIL EVALUATOR: PETER McENTEE SE#1542 F.G. EL.=106.7t F.G. EL.=104.7t F.G. EL.=105.9t VENT WITNESS: DAVID STANTON R.S. HEALTH AGENT MAINTAIN 2% SLOPE OVER S.A.S. ' ELEV. TP- DEPTH ELEV. TP-2 DEPTH L = 60' 11 L = 5't 106.0 q 0 o7.1 1 q 0 "SC (MIN.) p SC (MIN.) SCH4H40 PVC 4'SCH4H40 PVC 2" LAYER OF 1/8" TO 1/2" =SANDY LOAM =SANDY LOAM 4 6" DOUBLE WASHED STONE 105.7 10YR 4/2 6„ 106.6 10YR 4/2 6' 1p"I 6' Ba®Baas (OR APPROVED FILTER FABRIC) B B 14" 2' EFF. MOROOOR EXISTING 48" LIQUID DEPTH as®ease --3/4" TO 1-1/2" DOUBLE SANDY LOAM =SANDY LOAM WASHED STONE 10YR 5/4 10YR 5/4 LEVEL ADD GAS J�ROPOSED 2.6' 4.8' 2.6' 104.2 24" 105.1 24" BAFFLE INV.=101.27 _ INV.=101.10 INV.=102.45t D"BO EFFECTIVE WIDTH = 10' C PERC C VERIFY 3 OUTLETS INV.=101.00 34"/52" EXISTING SEPTIC TANK (VERIFY) H-10 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN SILT LOAM SILT LOAM H-20 RATED 2.5Y 5/3 2.5Y 5/3 COMPACT COMPACT TOP CONC. ELEV.=102.1 t (UNSUITABLE) (UNSUITABLE) NOTES: BREAKOUT ELEV.=101.50 INV. ELEV.=101.00 V-1-ase 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & MMMI. aaa 94.5 138" 97.1 120" INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. MOORMOM 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND BOTTOM ELEV.= 99.00 4' 1 2 X 8.5'=17.0' 4' PERCOLATION TEST NOT PERFORMED TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING NO GROUNDWATER ENCOUNTERED SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL EFFECTIVE LENGTH = 25.0' IN 310 CMR 15.221(2). 5' ABOVE GROUNDWATER 3) INSTALL INLET & OUTLET TEES AS REQUIRED. I LEACHING SYSTEM SECTION 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO GROUNDWATER, EL.=94.5 - ELEV. TP-3 DEPTH ELEV. TP-4 DEPTH AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 107.2 A 0" 107.3 q 0" SEPTIC SYSTEM PROFILE SANDY LOAM SANDY LOAM 106.7 10YR 4/2 10YR 4/2 B g" 106.6 B g" SANDY LOAM SANDY LOAM 10YR 5/8 10YR 5/8 105.5 20" 105.5 22" C1 C1 DESIGN CRITERIA SILT LOAM 34"/52" SILT LOAM 2.5Y 6/4 2.5Y 6/4 101.7 66" 101.6 68" NUMBER OF BEDROOMS: 3 BEDROOMS C2 C2 PERC SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) he 66"/84" MED. SAND MED. SAND DESIGN PERCOLATION RATE: <2 MIN/IN �/10h GARAGE EXISTING 2.5Y 7/3 2.5Y 7/3 DAILY FLOW: 330 GPD \1,-13 / HOUSE(#40l) DESIGN FLOW: 330 GPD 1 19. 11 . T.O.F.=107.6±1 95.7 138" 95.8 138" GARBAGE GRINDER: NO-not allowed with design Tj 4�4� PERC RATE <2 MIN/IN. "C2" HORIZON LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF Ln PROP.1S NO GROUNDWATER ENCOUNTERED .74 GPD/SF I i S.A.S.I EXISTING SEPTIC TANK: 1000 GALLON CAPACITY L---� PROPOSED D-BOX: 1 INLET, 3 OUTLET (MIN.), H-20 RATED USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED S.A.S. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 2-500 GALLON CHAMBERS SURROUNDED BY DOUBLE WASHED STONE-ALL SIDES SURROUNDED W/4' STONE 401 OAK STREET, CENTERVILLE, MA SIDEWALL AREA: 2(13.2' + 25.0') X 2 = 152.8 S.F. Prepared for: DiBuono Sewer & Drain, 35 Content Lane Cotuit, MA 02635 BOTTOM AREA: 13.2' x 25.0' = 330.0 S.F. TOTAL AREA:..............................................................482.8 S.F. Engineering by: SCALE DRAWN JOB. NO. SEPTIC LAYOUT Engineering Works, Inc. N.T.S. P.T.M. 287-19 DESIGN FLOW PROVIDED: 0.74(482.8) = 357.3 G.P.D. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 11/27/19 P.T.M. 2 Of 2