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HomeMy WebLinkAbout0187 OLD STAGE ROAD - Health 187 OLD STAGE ROAD - - Centerville A = 189 - 081 5MEAD No.2-153LOR UPC 12534 �d.com • Made In USA I - +�euoMMwm,aw � H �c an�snwoa�w �an+n wiwwwoow�od t S'6 --336 LOCATION SEWAGE PERMIT NO. YI --LAGEILI INSTA LLER'S NAME a ADDRESS A,4 4 �.��• e 4 B U I L D E R OR OWNER DATE PERMIT ISSUED G DATE COMPLIANCE ISSUED ,� - � I a 1 J� of ^ i AG f i ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , ' # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is Centerville r wired for MA 02632 02/20/2012 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. general Information forms on the computer,use 1. Inspector: only the tab key to move your A.Riker cursor-do not Name of Inspector use the return key. R.L.C. Company Name P.O. Box 726 Company Address South Yarmouth MA 02664 City/Town State Zip Code 508-776-6460 SI-4590 Telephone Number License Number w B. Certification Ca I certify that I have personally inspected the sewage disposal system at this address and tha3 the information reported below is true, accurate and complete as of the time of the in#'pection. T-fie inaction was performed based on my training and experience in the proper function and aintenan�l of mite sewage disposal systems. I am a DEP approved system inspector pursuant t Section. .39-of Title 5 (310 CMR 16.000).The system: a rn ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4� 02/20/2012 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins 11110 Title 5 Official Inspec41 : face Sewage Disposal System•F�gge 1 of 17 i Commonwealth of Massachusetts M ow, Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cons) 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: Inspection of septic tank,distribution box and soils above S.A.S. showed no obvious sign of failure . Syetem indicates there were no past back ups observed at septic tank or distribution box. Risers were installed on septic tank outlet and distribution box that was found to be two feet deep with no riser. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a 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 Trite 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 r i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Titles Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. C�yrro` n State Zip Code Date of Inspection B. Certification (coat.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-11110 Title 5 Official Inspection Form:Subsurface Swvage Disposal System-Page 4 of 17 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 10.0 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone If 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 Trtle 5 Official Inspection forth: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 # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: System was installed in 2001 with new 1500 gallon tank ,distribution box and two 500 gallon concrete chambers with stone .Total Leach area 25'Lx13'Wx2' Deep Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No �3� 6®® Water meter readings, if available (last 2 years usage (gpd)): 201 201 a= J b' 6 PD Detail: Records Obtained from COMM water Dept. Sump pump? ❑ Yes ® No Last date of occupancy: unknownDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons 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•11110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M z y # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Barnstable Waste Water Station Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: not required Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (f yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Certificate of compliance 06/04/2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ® 40 PVC other(explain): interior plumbing below floor ❑ Distance from private water supply well or suction line: Town water supplyfeet Comments (on condition of joints, venting, evidence of leakage, etc.): No leakage or stains observed. Septic Tank (locate on site plan): Depth below grade: 1.2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1500 gallon precast concrete tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ,❑ No Dimensions: 10'x5`W Sludge depth: 8" t5ins-11110 Title 5 Official Inspection Form:Subsurface Storage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments #187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank was observed to have PVC TeeYs on inlet and outlet with no obvious failures observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments # 187 Old Stage Road _ Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert equal to invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): no evidence of carry over observed'Concrete riser was installed to bring cover 6"grade Distribution box was 24" deep Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) Qocate on site plan, excavation not required): If SAS not located, explain why: Ltsins11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M sr # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number 2x500 gallon w/4'stone ❑ Teaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: --- ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils were free of effluent stainings or odors above S.A.S. 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 Sevage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments #187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 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 two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Pa✓- 0 3 d s O d 6D_ z So t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form WA Subsurface Sewage Disposal System Form -Not for Voluntary Assessments #187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water. 13.6 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 06/04/2001 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Permit of file from 2001 ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used plan on file and elevations in field were observed to be above ground water adjustment. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11 f10 Title 5 Official Inspection Form:Subsurface Savage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments # 187 Old Stage Road Property Address Fannie-Mac Bank Owner Owner's Name information is required for Centerville MA 02632 02/20/2012 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D,or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 i No. -7 � /- Fee $ 5 0.0 0� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes / PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS v/ 01pplication for �Diopozar bpztem Congtruction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) XXComplete System ❑Individual Components Location Address or Lot No. 187 Old Stage Road Owner's Name,Address and Tel.No. Centerville,Mass. 02632 Thomas J. Primo Assessor'sMap/Parcel l b 6 O e / 187 Old Stage Road Centerville Ma. Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 02632 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 15 n n Type of S.A.S. 2 5 'X 1 3 'X 2 ' ( @-5 0 0 ' s ) Description of Soil Loamy sand to medium fine sand. Nature of Repairs or Alterations(Answer when applicable) Omitting c e s s noo l G T n.C;t a 1 1 i n a one 1500 gallon septic tank 1 -Distribution box and 2-500 cfall on leaching chambers packed in 4 ' of 1;" stone. 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 B 2ar 0 H h. Signed % Date 55/31 01 Application Approved by Date b b Application Disapproved ror the following reasons Permit No. ZvW - y Date Issued b l xo� �iW /- } $ 5 0.0 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . Yes ,k PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYtcatton for Mfigpooar *p5tem Congtructton Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete Systefn ❑Individual Components Location Address or Lot No. 18 7 O d Stage Road Owner's Name,Address and Tel.No. i Centerville,Mass. 02632 Thomas J. Primo Assessor'sMap/Parcel l 9 F ® el 187 Old Stage Road Centerville Ma. Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 02632 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow + gallons per day. Calculated daily flow gallons. Plan Date E Number of sheets Revision Date Title Size of Septic Tank 1 500 Type of S.A.S. 25 X1 3 X2 ' ( @-500 ' s ) Description of Soil Loamy sand to medium !fine sand. Nature of Repairs or Alterations(Answer when applicable) Omitting cesspools. Installing one 1500 gallon septicttank, 1-Distribution box and 2-500 gallon eacning cam ers packs in 4 of 12 stone. 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 issu d by thi ar th. Sign2�, Date 5/31 /01 Application Approved by IZ4 Date 6 Application Disapproved for the following reasons E Permit No. ?� 1 ` 3 y I Date Issued e y b/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 1 terttftcate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(`�' )RepAkid( ' )UpgradedX(XX� Abandoned.( )by J.P.Macomber & Son Inc. at 87 O d Stage Road Centerville.Mass. has been constructeo.iDjaccordance with the provisions of Title 5 and the for Disposal System Construction Permit No.ZM/_ 7 y1 dated 61 Z�Z of J.P.Macomber & San Inc. J.P.Macom er A Son Ink. Installer Designer .- ; The issuance of this p shall not be construed as a guarantee that the syst i11 f Xla��dcsigr Date G �/ �� Inspector No. 3L----------------------------------Fee ---------f----D——-----------Fee $ 50.00 THE COMMONWEALTH OF MASSACHUSETTS < PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1wiopozal Opgtem (Conotruction Permit Permission is hereby granted to Construct( )Repair(X�Upgrade( )Abandon( ) S.ystemlocatedat 187 Old Stage Road Centerville,Mass. 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 ust be completed within three years of the date of this pArmit. Date: o/ Approved by 0 116/99 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, Joseph P.Macomber Jr., hereby certify that the application for disposal works construction permit signed by me dated 5131101 concerning the property located at 187 Old Stage Road Centerville,MA meets all of th'e following criteria: / The failed system is connected to a residential dwellingonly. There are no y 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 There is no increase in flow and/or change in'use proposed There are no variances requested or needed. JThe bottom of the proposed leaching faculty will not located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] 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) F� 3 B) G.W. Elevation %Z d + the MAX. High G.W. Adjustment . • y a .� DD-FERENCE BETWEEN A and B SIGNED : , DATE: 5/31 /01 (Sketch. r sed plan of system on back]. Q'health folder.cent y i - d. O � 0 b ib 1 TOWN OF BARNSTABLE LOCATION OX0 STA 62K 0 .446 SEWAGE 42,f 3 VILLAGE c LoAltPR V/Z/-0 ASSESSOR'S MAP & LOT /7?-08'1 INSTALLER'S NAME&PHONE NO. _1 )0, d A C 014 gee 4 -T D a SEPTIC TANK CAPACITY /3'b LEACHING FACII.ITY: (type)A-4015Z®6U CIMAl&W (size) cS�a NO.OF BEDROOMS j-3 BUILDER OR� ,' fa 1 o PERMITDATE:�Y�D COMPLIANCE DATE: �D D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist 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 �' /� �� IU ® � .`� ��; - �'b� � � � �� s '� "� L �i � NEW 2X6's G,J. 6 16" O.G, ' � 1 NEW I 1 R38 IX3 STRAPPING 1/2" WALLBOARD ' � I I ' I 1 ' � I NEW ' � 1 BEDROOM 1 ' NEW 2X4 KNEE WALL i NEW EXISTIN�s 2X4 KNEE WALL I ' ' I 1 9'-D" 19'-6" 1/2" WALLBOARD ' 2X4's tv 16" O,G, ' I I ' I I �I'-6" CEILING LINE (n 1 i - ----------------- Lu ------ N I 1 1 9'-D" CEILING LINE r' '- 9'-O" CEILING LINE --� -- U -- -----------------� -------------------------- l'1 N ------------------------------ N 1 1 I 4 -5� I I w _ NEW O ; EXISTING 2 `-f' FIRST FLOOR '-6" Z BEDROOM - I ti LU �' NEW 4 -------------- --zl�l, s��� ° o -- ------------ -- ------------- — X I ----- o � 6 -I 4 = X I SEWING ___-- r- S'-O" CEILING LINE N 1 --------- z — ' N ROOM 1O" --------- NEW I I --------- 01 X --------- X --------- BATH 1 1 I (P - - -------- ------- -------- --- --- zQ _ z --------------- 9'-O" CEILING LINE 48 SHOWER z -- t 1 d At ac NEW 2X4 KNEE WALL t EXISTING EXISTINGs 2X4 KNEE WALL f- , BASEMENT a; I 1 a a ' --------- PROPOSED SECOND_ EIXISTING SECOND- FLOOR 1 I PLAN- FLOOR f='�.AN- --------- B ------ I CROSS SECTION (C:) 1 I I Cj -------- EXISTING WALLS NEW WALLS NEW 2X6's G,J, 0 16" O,G, - - NEW 2X6's G,J, -6 16" O,G, NEW NEW IE;XIS R38 INSUL. _ - BATH 6, NEW IX3 STRAPPING IX3 STRAPPING SEWING 1/2 WALLBOARD NEW ® ® 1/2" WALLBOARD EXISTING � � °� ° ROOM BATH EXISTING 0 EXISTING; 2X4'6 DINING KITCHEN EXISTING " NEW Am 16" O.G. WITH NEW 1/2 WALLBOARD BEDROOM EXISTING BOTH SIDES _ 1/2 WALLBOARD NEW 1/2" WALLBOARD 2X4's im 16" O.G. 2X4' 16" O.G. I � II -- II II EXISTING - - - - - - - - ------- FRST FLOOR EXISTING FIRST FLOOR z p EXISTING d' EXISTING EXISTING -- � BEDROOM .° o° —-- _----- - ------ -------- d LIVING --- FOYER .� D> D e -- ----- °e EXISTING --------- BASEMENT EXISTING --------- — 41, BASEMENT EXISTING FIRST °v.d' d' d'. d. FLOOR PLAN- CRO55 SECTION (A)- CROSS SECTION (5)- BUILDER JOB ADDRESS DE JmN(0&1EDES1aHS,,, O DATE REVISION DRAWN BY PAGE SCALE O _ II_ tI� �OMTI1"IOT�-ICI' C�RAY BUILD11�1C� 18-i O�..D ST,4CrtE ROr4D 1=I1�lIS�-I EXISTINCrt03-23 13 � J�3 �oF� 1/4 -1 -0 ,AND REMODELING CENTERV ILLS, MA. SECOND FLOOR W 3 V H S lll PURCHASE OF DRAWINGS LEAVES PURCHASER RESPONSIBLE FOR COMPLIANCE WITH ALL (2) EXACT SIZE AND REINFORCEMENT OF ALL CONCRETE FOOTINGS (3) ALL FOOTINGS SHALL EXTEND BELOW FROSTLIKE VERIFY DEPTH. { LOCAL BUILDING CODES AND ORDINANCES, JIB DESIGNS MAY NOT BE HELD RESPONSIBLE MUST BE DETERMINED BY LOCAL SOIL CONDITIONS AND ACCEPTABLE (4) VERIFY STRUCTURAL ELEMENTS FOR DESIGN 4 SIZE P.O. BOX?B5 (�OBJ 494-95734 FOR SITE CONDITIONS OR FOR THE USE OF THESE DRAWINGS DURING CONSTRUCTION. PRACTICES OF CONSTRUCTION. VERIFY DE51IGsN WITH LOCAL ENGINEER, WITH LOCAL ENGINEER AND BUILDING OFFICIALS. (DEBT BARNBTABLE MA. 0264"