HomeMy WebLinkAbout0589 OLD STAGE ROAD - Health 589 Old Stage Road
Centerville
A = 191-004
/// S M E A D®
No.2-153LOR
UPC 12534
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SOIraCMG MJINW.SI�ROC,RANLOtlG
TOWN OF BARNSTABLE
LOCATION �� SEWAGE
VILLAGE ASSESSOR'S MAP & LOT j Y
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INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY /000
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LEACHING FACILITY:(type)��fW=&27Q (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNERA ,Q jj
jcjWq,,J1mf
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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0
No. Fee /S_0
THE COMMONWEALTH OF MASSACHUSETTS Entered in compute
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitation for Misposal �&pstrm ConeftuLtlon 3permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) Complete System ❑Individual Components
Location Address or Lot No.-3W a' Owner's Name,Address,and Tel.No.
C�ss�l�//c �i�r a2�1c/li
Assessor's Map/Parcel / R
In ler's Name,Address,and Tel.No.,510g' Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size 6-?, ovo sq.8. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ��'� gpd Design flow provided �6�. gpd
Plan Date y�?�iZ-/ Number of sheets 17 Revision Date
Title
Size of Septic Tank /,j®® Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
f•�.i'a /'3—? /,7®X �•�,� �3=✓'od Cat/ .�!—�� r'.��.�,c�5 ����
"A-
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 Certificate of
Compliance has been issued by this Board of Health. /
Signed Date /q
Application Approved by Date / Z
Application Disapproved by Date
for the following reasons
Permit No. �,/f j� Z(Z Date Issued Q Z
x z1Vo~ � G 6,.;-. t �A §' 1 Fee .��
" �r Entered in compute
TH
, sr E COMMONWEALTH OF MASSACHUSETTS -
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplitation for bispos' aY *pstetn ConstrUttion 3permit ry
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) Complete System ❑Individual Components "Y
Location Address or Lot No,3' f a/ s'` Owner's Name Address,and Tel.No. �y7/
Assessor's Map/Parcel
Installer's Na'mje,Address,and Tel.No.4_-- - ?70�-� Designer's Name,Address,and Tel.No.JV_4,�7='
'-�, �.1'!i'�.t.�a./`�' .ST Gr/. /��'�.�'�'ai/C' ,[ d��e!sr` G/P.Sf'�iceL7� /�e.rA ./�•✓"r.Sr�.'ssd"a/.�i_„
Type of Building:
Dwelling No.of Bedrooms Lot Size 6-?,' sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers(. ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ��'d gpd Design flow provided �65 T gpd
Plan Date ?��/ Number of sheets Revision Date
Title
Size of Septic Tank /}ad Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)- .// /.j�- �d /sx�e� 6:;-/ Try
.�d a��' 3� 9 /,$rJ"PY �-•!c✓ �"� �i"00 Cs rsl /�/�i+'d r"�G•�y� i_�.°•i 7'r�/
r
1 .Date last inspected:
Fl¢ . ..... 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 Certificate of
Compliance has been issued by this Board of Health. _
Signed _ Date �s�q'�/
Application Approved by Date I
. r
Application Disal4proved by Date
for the following reasons
4,,.„,..✓,,..a;�C'� �r f.. ';.-<�':t.s:.A•-'`� ,.r-� —_..�-.�.,.. _ !'f��i:" `-='C. ,,,r —Ar
Z?ermit'No. �, Date Issued
_
THE COMMONWEALTH OF MASSACHUSETTS
`` fBARNSTABLE,.MASSACHUSETTS
r: P Certificated Cofti liar E
THIS IS TO CERTIFY,that the`;On site°Sewage Disposal system Constructed( ) Repaired(��� Upgraded
Abandoned( )by /
at been construeted:in accordance
with the provisions of Title 5 and the for Disposal System Construction,Permit No. Zt�-Z 1 2dated.
^� P
.'�'-
Installer �y-''`�„ %�� �- Designer
#bedrooms G Approved design flow gpd
The issuance of this permit` shall of be construed as a guarantee that the system wi,1 f inctio.`as�`designed'
.
Date `` ) Inspector ----�= -�
r
No. �i®�.-� " �.(� __ Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem CDIIBtrUttion j3ermit
Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( )
System located at ✓�`�'`�" G�/ Sr'��y� /�' l' {e-��i!/l�?
and as described in the above Application for Disposal System Construction Permit.'.The applicant recognized his/her duty to comply with
Title 5.and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date.of this permit.
Date - Approved by
r l r +
Town of Barnstable
Of SHE P
� 0 Regulatory Services
Richard V.Scali,_lnterim,Director
RARNSTABLE, - - -
p'o 1639. ,0� Public Health Division
Thomas McKean,:Director
20.6 Main Street,Hyannis,-MA 02601
Office: 508-862-4644 Fax: 505-790-6304
Installer& Designer Certification Form
Date: ` -� �2I , Sewage Permit# Assessor's 1VIap\Parcel 1 � ®d
P�+e c- N e CV+ee
Designer: j�Las-e r;.ramL,96,Aks lviC Installer: CV(_ ��- JAL S_Q,—TA Cam;!'
Address: 12. in1, C sie e l.cl fZt Address: 357) S+-
F Flu Le M a z&yq
On 641--2-e- 61/ 547 Zk Z J vas issued a permit to install a -
(date) (installer)
septic system at (If Sf G,5,12 12J (Imt based on a design drawn by
(address) r—
Cng;'r�ICI—I 4.^ fV cs si L(s,Jk( dated T/Z,q-z -t
(designer)
1 certify that the'septic system referenced above was installed,substantially according to
the design, which may include minor approved changes such as lateral relocation. of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the.septic system referenced above was installed with major changes (i.e:
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in. with the terms
of the I\A approval letters (if applicable) �a ► ss�ti
PEEN
{Instialler's Signature) U NkL
4
(Designer's Signature) (Affix.Designe ere)
PLEASE RETURN TO BARNSTABLE PUBLIC:HEALTH DIVISION. CERTIFICATE
OF..COMPLIANCE WILL NOT. BE ISSUED UNTIL.BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Septic-Designer'Certification.Form Rev 3-d4-13.doc
Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfill.The
engineer did not supervise construction of the system.The installer assumes responsibility for all materials,workmanship,backlilling
to specified grades with proper compaction and setting risers,covers as shown on the design plan.
Commonwealth of Massachusetts
f . Tithe 5 Official Inspection Form --
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
,M eF 589 Old Stage Rd.
Property Address:.
David Neal
Owner
Owner's Name
information is required for every Centerville MA 02632 11-19-13
..
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 A. General Information
filling out forms
on the computer,
use only the tab
1. Inspector:
key to move your
cursor-do not Matthew Gilfoy
use the return
key Name of Inspector
B & B Excavation,lnc.
r� Company Name
14 Teaberry Lane
Company Address
Forestdale MA : 02644
City/Town State Zip Code
508-477-0653 S 113640
Telephone Number License.Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience,in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
El Needs Further Evaluation by the Local Approving.Authority
11-19-13
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 ame or different:conditions of use.
�5
t5ins•11/10 Title 5 Official InspectjFoubsurface Sewage Disposal System.-.Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,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
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
c,M 589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. CitylTown 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 FIND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
� I
❑ 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
589 Old Stage Rd.
Property Address
David Neal
Owner
Owner's Name i
information is required for every Centerville MA 02632 11-19-13
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. City/Town 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 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for 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
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
1 0,000g pd.
❑ ® 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 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
L Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
589 Old Stage Rd.
Property Address:
David Neal
Owner Owner's Name
information is Centerville MA 02632 11-19-13
required for every
page: -- City/Town - State Zip Code Date of Inspection
i
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
❑ 0 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
El ® this inspection?
El 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?
El
® 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.
El
® 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
t5ins•11/10:: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. CitylTown State Zip Code Date of Inspection
D. System Information
Description:
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
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d n/a
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 2011
Date
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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
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:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)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):
Septic tank-SAS(no d-box)
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Unknown
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
1'
Depth below grade: feet
Material of construction:
® cast iron ❑ 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >10'
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
At time of inspection building sewer appeared to be in working order no sign of leakage or blockage.
Septic Tank(locate on site plan):
Depth below grade: 4
feet
Material of construction:
® concrete ❑ 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
Dimensions: 1000 gal
Sludge depth: no sludge
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. CitylTown 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 no sludge
Scum thickness no scum
Distance from top of scum to top of outlet tee or baffle no scum
Distance from bottom of scum to bottom of outlet tee or baffle no scum
How were dimensions determined? scour stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
At time of inspection septic tank appears to be structurally sound. No sign of back-up.
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
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
GSM ,a''y 589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert NA
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 D-box
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)(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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number:
1
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
At time of inspection leaching appears to be in working condition. No sign of hydraulic failure. Leach
pit was dry.
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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
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:
Z hand-sketch in the area below w
❑ drawing attached separately
Rec�� 551 Old S6.n`1.•t, Kd.
5 ii day
A g
O
I- ly. O
A
35,
O
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�., 589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: >15'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: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers -(attach documentation)
® Accessed USGS database-explain:
Ground water greater than 15' per usgs database
You must describe how you established the high ground water elevation:
see above.
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 589 Old Stage Rd.
Property Address
David Neal
Owner Owner's Name
information is required for every Centerville MA 02632 11-19-13
page. City/Town 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
TOWN OF BARNSTABLE
LOCATION SEWAGE ,#
VILLAGE ASSESSOR'S MAP & LOT &
INSTALLER'S NAME & PHONE NO. j �� �
SEPTIC TANK CAPACITY /'G'rf,�C>
L'`C'itir_`�1t
LEACHING FACILITY:(type)j,� yn ,� (size)
NO. OF BEDROOMS—_:3' PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER,24,,,t Llleeaq
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
e
1
e
e
'
A g - 2635
EV:
589 ow
PA
C2J{t2NUgMA 02632
p
p
LOCUS MAP
Pe 94 PG 23 PARCEL ID: 151 -004
LOT 1
69,000 ±SF
1.60 ±Ac.
a
moo.
4 a
o
%) CID
o� o
SEE SHEET 2
20 SCALE WINDOW =
I I
OF
� 614, � I �� M4
`rs9cy�
o PETER T.
McENTEE
SHED v CIVIL "'
PROPOSED DECK No. 35109
EXISTING DECK
(REMOVE)
0.8' '��°�MAssgcy
° DECK p=� G'f�n FLOOD HAZARD DESIGNATION
EXISTING G �S.tAgR1E MAP NO. 25001 CO561 J
HOUSE EFFECTIVE DATE: JULY 16, 2014
GARAGE CONVERT TO I v N0.40039 rt ZONE X
(1589) LIVING SPACE �GIS-T WIND EXPOSURE CATEGORY: Exposure B
3231 OVERLAY DISTRICTS
RESOURCE PROTECTION
SALTWATER ESTUARY PROTECTION
GRAVEL GARA ZONING CLASSIFICATION: ZONE RC
.p OWNER OF RECORD SETBACKS: FRONT YARD=20'
GIANNELLI, JAMES & TINA M SIDE/REAR YARD=10'
.6, 589 OLD STAGE ROAD LOT AREA = 87,120 SF (PRE—EXISTING)
CENTERVILLE, MA 02632 MAXIMUM BUILDING HEIGHT = 30'
c.�
PROPOSED SEPTIC SYSTEM/SITE PLAN
130.27' 589 OLD STAGE ROAD, CENTERVILLE, MA
S 04'27'00" E Prepared for: James Giannelli, 589 Old Stage Road, Centerville, MA 02632
SIDEWALK Engineers: Surveyors: SCALE DRAWN JOB. NO.
Engineering Works,Inc. Warwick&Assoc.,Inc. 1"=20' P.T.M. 151-21
_ 12 West Crossfield Road Box 801-63 County Road
OLD STAGE ROAD DATE
Forestdole, MA 02644 North Falmouth, MA 02556 CHECKED_ SHEET NO.
(508) 477-5313 (508) 563-7777 4/22/21 P.T.M. 1 of 3
F
�1
-- 30 -- EXISTING CONTOUR
x 30.98 EXISTING.SPOT GRADE c
28 PROPOSED CONTOUR + 34.87
W PROPOSED WATER SVC. '
G EXISTING GAS SERVICE
-UGW- UNDERGROUND WIRES + 35.54
TEST PIT t
BENCHMARK \ x 36,11
LEGEND
'+ 34.81 LOT 1
69,000 ±SF
1.60 ±Ac.
34� 0 35.72 X
Q TP-5
v �
00 34.91 INSTALL A 40 'M POLY LINER
00 35.46 TOP OF LINER, EL.=40.0
BOTTOM 0r LINER, EL.=38.0
X 36.18
PB 94 PG 23
CARD PROPOSED S.A.S.
35,18 X 36.29 5-500 GALLON CHAMBERS
+ 36 SURROUNDED W/4' STONE
/ 38 ---- -- -------I SHED �6- 36.29 I 36.82 38 _ _ -.- _r-
40 ERVE AREA
PROPOSED SEPTIC TANK - 38.76
\- �8_ x 3 7.3 7 2--- 4p X38_48� X
(1500 GALLON CAPACITY) -----
EXISTING LEACH PIT 41.56 x ( 3 8 42 _ 76'
TO BE PUMPED, FILLED WI TH 41.5 4 - I r;�' T -^�,.• +-+-• �j
TP-3 "
SAND & ABANDONED � I �80 � !�` • O O O O TP-F4
EXISTING SEPTIC TANK 04
TO BE REMOVED M 1 _ _ -'�'�-Ah. '
TOP OF TANK, EL.=42.42 X 40.8 �- _ -
TP-1 Q 12
INV..(IN)=41.34 43.18 p P-2
INV.(OUT)=41.09 - +4�5 73 N PR co X 44.30 --
P I ECK 44,17 +45.64
BENCHMARK-2 (rem�vv
WALKOUT THRESHOLD
EL.=43.29
,
BENCHMARK-1 EXISTING STRIPOUT BOUNDARY
TOP/SONOTUBE HOUSE589 T.O.F.=50.6f/ GARAGE A & B HORIZONS �
EL.=42.75 AS REQUIRED 0)
EL.=51.8 DECK O
Cellar Floor EL.=43.3t ^�
48.46 X
X 48.49 2
49,24
CONVERT TO 50. 4
o LIVING SPACE
48.48 X 49.47
49.14
49.07
GRgVE�
GARAGE
49.93 49,63
-'}- - - -5-8- •49.78•-
0 0
50.40 51.32
o /
130.27'
cZ 5174 51 2 S O43Z'0_0" E -52 - 51,
52.57
SIDEWALK 52,82
52.39 52,39
52.52 edge 52.71 of 52.78 pavement 52.96 53.19
OLD STAGE ROAD
of Af4S o PARCEL ID: 151 -004
PETER T. �, PROPOSED SEPTIC SYSTEM/SITE PLAN
McENTEE
CIVIL N 589 OLD STAGE ROAD, CENTERVILLE, MA
No. 35109
CIS1 Prepared for: James Giannelli, 589 Old Stage Road, Centerville, MA 02632
SSI Engineers: Surveyors: SCALE DRAWN JOB. NO.
OWNER OF RECORD Engineering Works,Inc. Warwick&Assoc.,Inc. 1"=20' P.T.M. 151-21
-Z l GIANNELLI, JAMES & TINA M 12 West Crossfield Road Box 801-63 County Road
589 OLD STAGE ROAD Forestdole, MA 02644 North Falmouth, MA 02556 DATE CHECKED SHEET NO.
CENTERVILLE, MA 02632 (508) 477-5313 (508) 563-7777 4/22/21 P.T.M. 2 Of 3
TO PREVENT BREAKOUT INSTALL A 40
CELLAR FLOOR EL.=43.3t MIL POLY LINER 5' OUTSIDE THE S.A.S.
TOP OF LINER, EL.=40.0
T.O.F.=50.6t SEPTIC TANK BOTTOM OF LINER, EL.=38.0
PROPOSED D-BOX PROPOSED S.A.S.
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER AND COVER
OUTLET AND SET TO 6" OF FINISH GRADE SET TO WITHIN 6" OF FINISH INSTALL RISER & COVER OVER ONE CHAMBER AND
GRADE SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT
�F.G•EXISTING 0± F.G. EL.=42.4t F.G. EL.=42.5t M 0t AINTAIN 2% SLOPE OVER S.A.S.
L = 2( L = 17' L = 40' 2" LAYER OF 1/8" TO 1/2-
FLt C� S=1� (MIN.)
4"SCH40 PVC ® S=1% (MIN.) p S=1% (MIN.) DOUBLE WASHED STONE
4"SCH40 PVC 4'SCH40 PVC (OR APPROVED FILTER FABRIC)
s�
00
is I 14" s 2' EFF. aaaa�aaaa
INV.=40.50 48" LIQUID INV.=40.25 DEPTH aaaaaaa 3/4" TO 1-1/2" DOUBLE
LEVEL 4' 4 8' 4' WASHED STONE
PROPOSED INV.=39.90
GAS BAFFLE D-BOX EFFECTIVE WIDTH = 12.8'
INV.=40.07
H-20 RATED INV.=39.50
PROPOSED SEPTIC TANK 5-500 GALLON LEACHING CHAMBERS
H-10 RATED SURROUNDED WITH STONE AS SHOWN
�
CONNECT TO EXISTING SEWER H-20 RATED 'L
OUTSIDE HOUSE, INV.=41.4t TOP CONC. ELEV.=40.6t
BREAKOUT ELEV.=40.00
NOTES: INV. ELEV.=39.50 aaaa
aaaaa
aaaaaaaaaaa
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aaaaaaaaaaa
INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=37.50
4' S x 8.5' = 42.5 4'
2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 50.5
TRUE TO GRADE ON A MECHANICALLY COMPACTED PERVIOUS MATERIAL
STABLE BASE OR OR SIX INCH AGGREGATE BASE, AS 5' (MIN.) ABOVE G.W.
SPECIFIED IN 310 CMR 15.221(2). LEACHING SYSTEM SECTION
3) INSTALL INLET & OUTLET TEES AS REQUIRED.
EST. HIGH GW TP EL.=32.2 -
4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE i t-L
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL.
SEPTIC SYSTEM PROFILE
N.T.S.
SOIL LOG
GENERAL NOTES: DATE: MARCH Yr, 2021 (TPT-21-73)
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL EVALUATOR: PETER McENTEE PE, SE-1542
BOARD OF HEALTH AND THE DESIGN ENGINEER. WITNESS: DAVID STANTON RS HEALTH AGENT
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH
LOCAL RULES AND REGULATIONS.
43.2 A O 43.2 A 0"
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR LOAMY SAND LOAMY SAND
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 10YR 4/2 10YR 4/2
DESIGN ENGINEER. 42.7 6" 42.7 B 6"
B
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SAND LOAMY SAND
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10YR 5/8 10YR 5/8
ENGINEER BEFORE CONSTRUCTION ..-..41_.
: CONTINUES.,_ __.,_� .3 2.3„_
-_ -- -
5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. - 2 24" 41C C
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF PERC PERC
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 30"/48" 30"/48"
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY PROVIDED BY TOWN WATER.
8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. MED. SAND MED. SAND
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 2.5Y 6/6 2.5Y 6/6
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
DIRECTED BY THE APPROVING AUTHORITIES.
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY FAINT FAINT
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 32.2 REDOX 105" 32.2 REDOX = 105"
CONSTRUCTION. 7.5YR 5/8 7.5YR 5/8
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 31.9 136" 31.9 135"
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND PERC RATE <2 MIN/IN. ("C" HORIZON)
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). NO STANDING GROUNDWATER OBSERVED
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE ESTIMATED HIGH GROUNDWATER, EL.=32.2 (REDOX)
INSPECTED BY A LICENSED SOIL EVALUATOR PRIOR TO BACKFILL. ELEV. TP-3 DEPTH ELEV. TP-4 DEPTH ELEV. TP-5 DEPTH
13. ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC
SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. 40.4 A O 40.4 A O 34.7 A 0
ll
LOAMY SAND LOAMY SAND LOAMY SAND
39.9 B IOYR 4/2 6" 39.9 B 10YR 4/2 6" 34.2 B 10YR 4/2
6"
LOAMY SAND LOAMY SAND LOAMY SAND
10YR 5/8 10YR 5/8 10YR 5/8
38.4 24" 38.4 24" 32.2 30"
C C C
DESIGN CRITERIA HEAVY REDOX
31.7 & STG. GW = 36"
NUMBER OF BEDROOMS: 6, 3 EXISTING + 3 PROPOSED 7.5YR 5/8
SOIL TEXTURAL CLASS: CLASS I
MED. SAND MED. SAND MED. SAND
DESIGN PERCOLATION RATE: <2 MIN/IN 2.5Y 6/6 2.5Y 6/6 2.5Y 6/6
(0.74 GPD/SF LOADING RATE)
DAILY FLOW: 660 GPD
29.7 60"
DESIGN FLOW: 660 GPD
GARBAGE GRINDER: NO 31.7 STG. GW = 105" 31.7 STG. GW - 105" STANDING GW & REDOX
AT 36" (EL.=31.7)
LEACHING AREA REQUIRED: (660 GPD) = 891.9 SF %
27.5 27.5
.74 GPD/SF PERC RATE <2 MIN/IN. ("C" HORIZON)
PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY (H-10) STANDING GROUNDWATER, EL.=31.7
PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS (H-20) PROPOSED SEPTIC SYSTEM/SITE PLAN
USE 5-500 GALLON LEACHING (H-20) CHAMBERS IN SERIES 589 OLD STAGE ROAD, CENTERVILLE, MA
SURROUNDED WITH DOUBLE.WASHED STONE ON ALL SIDES
SIDEWALL AREA: 2(12.8' + 50.5') x 2 = 253.2 SF Prepared for: James Giannelli, 589 Old Stage Road, Centerville, MA 02632
BOTTOM AREA: 12.8' x 50.5' = 646.4 SF Engineers: Surveyors: SCALE DRAWN JOB. NO.
Engineering Works,Inc. Warwick&Assoc.,Inc. N.T.S. P.T.M. 151-21
TOTAL AREA:..............................................................899.6 SF ,12 West Crossfield Road Box 801-63 County Road DATE CHECKED SHEET N0.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(899.6 SF) = 665.7 GPD Forestdole, MA 02644 North Falmouth, MA 02556
(508) 477-5313 (508) 563-7777 4/22/21 P.T.M. 3 of 3