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HomeMy WebLinkAbout0720 OLD STAGE ROAD - Health 720 Old Stage Road 192-050 Centerville llll UPC 12534 No.2_ 1Rr 'J� aAGTINQ9.dy I ,l/� TOWN CF BARNSTABLE LOCATION �702 /d T�Gi SEWAGE #2e c VILLAGE CW ✓ ,�4-/V �l�/ ASSESSOR'S MAP & LOT r �-0 5;0 INSTALLER'S NAME&PHONE NO. Ga- SEPTIC TANK CAPACITY J O v LEACHING FACILITY: (type (size) �- I NO.OF BEDROOMS BUILDER OR OWNER fAAA A PERMITDATE: m- IgL COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility kFeet 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 � ��°N� ® � !ram 2"��" �� a o .�3 � � � � - �� � t3 � �� � �. Date Scheduled Time ` Fee Pd. s Soil Suitability Assessment for Se age Dis Perfomed By: Witnessed By: 'ni' r LOCATION&O1 NI;ItAL YIVFQRMATI01 Loeailon Address ....•:. >•- ..--.`-... Owner s Name m 7aU Address OC�n ram' �l L `l oA -0 _ Assessor's Map/Pruul /y� `.I yro Engineer•:Name ✓l Ca f 2 NEW CONSTRUCTION l"I REPAIR Telephone 1(60& dk� Land Use Slopes 17%) Surface Stones Distances from: Open Water Body it Po=,ble Wet Area R Drinking Water Well R Drainage Way R Property Una R Other R SKETCH:(Street name,dimensions of lot,axed locations of test holes k Pere tests,locate wetlands in proximity to holes) V C a --i IV .� > t Parent material(geologic) 6% AwA S k Depth to Bedrock Depth to Groundwater Standing Water in Hoie:—N tV weeping from Pit Face Estimated Seasonal High Groundwater *]/A y s DETERMINATION OFz SEASONA HIG1 wATE1L' gLE Method Use* d: :.. .�...., :....:...a,...a Depth Observed standing in obs.hole: in. Depth to soil mctller. ht. Depth to weeping from side of obs.hole: In. Groundwater AdJustrtrertl R Index Welt/ .RndlnR Date: Index Well level Adj.factor Ad).Oroundwner i.erd - PERCOLATION TEST" KDrle ` 2 Observation - Hoia/ Tlme at 9" Depth of Pere So � Time at 6' - Slart Pre-soak Time @ id; I Time(9'6 End Pre-soaks :z 331 - Rate MinAneh Site Suitability Assessment. Site Passed_ _ Site Failed: Additlonal Tealing Needed(Y" Original: Public Health Division - Observation Hole Data To Be Completed on Back---� Copy: Applicant 1 H DEEP OBSERVATION HOLE LOG ote# Depth from P Soil Horizon Soil Texture Color Surface(in.) S it Other (USDA) Soil Co(Munsell) M tling (Structure,Stones,Boulderes. i encv ° vel L S /o y1Zs Cv 0-13 y C �'rNc �Nn 2,5'y s No DEEP OBSERVTIOLOF' BOG Hole:# Depth from Soil Horizon Soil Texture Soil Color Surface(in.; I (USDA )) (�tunsell Soil Other Mottling (Structure,Stones,Boulderes. c °/ avel .r Flood Insurance Rate Maw Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes Within 100 year flood boundary. No_ Yes Depth of Naturally Occurring Pervious iVIaterial Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certifyi 41 that on (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 3 10 CMR 15.017. Signature Date 16 SR0 FROM :down cape engineering inc •FRX N0. : 15083629880 Jun. 28 2007 09:41AM F1 Town of Bamstable IE Re®uiatory Services Thomas F. Geiler, Director Public Health. Division ` Thomas McKean, Director 20(1 Main Street,Hyannis,MA 02601 Offi= 509-862-4644 Faa: 509-790-0(9 lncta➢ler & Desi-ner*Cer°tification Form Date: p ® Sewage Permit* Assessor's Map\Parcel Desigaien v L�O-­ k Installer: �►.ddr�:ss: (� �. Address: wzs issued a permit to install a (date) ler) septic system at �� 0 / instal L]L�, based on a design drawn by (address) dated o 3 certi y that the septic s}stem referenced above was installed substantially according to the design, which may include nr nor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater ihaD )0'. lateral relocation of the SAS or any Yertical relocation of any component -- of the septic system) but in accordance .tiith State Local Regulations. Plan revision or certified as-built by designer to follow. U�4 ARNE H F OJALA e(i ler's Signature) CIVIL. y No 30792 e i\'�1.. iNC� (Desi�ner's Siena re) (l".ffix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. Cf;RTIFICAT'F,. L)j COMPILIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE R.ECE:1yEQ BY THE BAR.NSTABLE PUBLIC HEALTH DIV]SION. ;THANK YOU. Q:Hea1t1V5cpiic1Drsiener Cenificalim Torn,3-26-04.doe Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is required for CENTERVILLE MA 02632 4/21/09 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. i Important: r. When filling out A. General Information w: forms on the computer,use r� r only the tab key 1 Inspector: I r to cursor-do not move your DOUGLAS A. BROWN �- use the return Name of Inspector key. DOUGLAS A. BROWN INC Company Name P.O. BOX 145 - s Company Address CENTERVILLE MA 0 632 City/Town State Zip Code 508-420-4534 S14297 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 ❑ Needs Further Evaluation by the Local Approving Authority 4/21/09 oInsplature Date nspector 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. Title V fnspection Form.doc•08/06 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. Clty/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: HOUSE HAS BEEN VACANT FOR ALMOST TWO YRS , HOUSE IS ONLY THREE YRS OLD B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 2 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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 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. Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 f V Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is required for CENTERVILLE MA 02632 4/21/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cunt.): ❑ 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 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'/a day flow ❑ ® 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. Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts AM�. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 'r 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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- 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 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. Title V Inspection Form.doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. CIty/Town 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)] Title V Inspection Form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments � 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. Cltylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder? Ye❑ s ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 08-0/07-5 Sump pump? ❑ Yes ® No Last date of occupancy: 2006 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: Last date of occupancy/use: Date Other(describe): Title V Inspection Form.doc•0a106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •'�� 720 OLD STAG E RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. Cdy/Town State Zip Code Date of Inspection D. System Information (cont.) 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: SYSTEM INSTALLED IN JUNE OF 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Tide V Inspection Form.doc•08106 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts UJ0Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner information is Owner's Name required for CENTERVILLE MA 02632 4/21/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass g ❑ 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: Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title V Inspection Form.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is required for CENTERVILLE MA 02632 4/21/09 every 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.): SYSTEM HAS HAD VERY LITTLE USE SINCE THE HOUSE WAS BUILT 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 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 y ❑ other(explain): Title V Inspection Form.doc•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. Ctty/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): BOX LEVEL LIQUID IN BOX IS CLEAN Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title V Inspection Fonn.doc•08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. &I /Town State Zip Code Date of Inspection D. System Information (cont.) 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: NOCOVERS WITHIN 1 FT OF GRADE Type: ❑ leaching pits number: ® leaching chambers number: 4-500 GALLON ❑ 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.): Title V Inspection Form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference land arks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters he building. s1Je oG Rty&e ACf - 20-( T3Ci- j2- A _ L.r& .130 - 5-2- A f cl 0 131= - si CI C'L LI Tme V Inspection Form.doc-08106 x Title 5 Official Ins• pection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 720 OLD STAGE RD Property Address SANTOS Owner Owner's Name information is CENTERVILLE required for MA 02632 4/21/09 every page. -di mown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 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 B - oard of Health ex plain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Title V Inspection Fonn.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 N r�No.. � � � J a'�"*'_.;' � Fee THE COMMONWEALTH OFtMASSACHUSETTSt E!Ztered in computer: Yes PUBLIC HEALTH DIVISIGN - TOWN OF BARNSTABLE, MASSACHUSETTS Zipp ration for Di5p0al *pgtem Construction permit Application for a Permit to Construct ) .Repair( ) Upgrade( ) Abandon( ) 9complete System ❑Individual Components Location Address or Lot No. 2 Q Q�\j S^�,Q Owner's Name,Address,and Tel. Assessor's Map/parcel `Ol Q'S70 \%0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CA f e - Q- A A 6/l 40 5 T Type of Building: U�LA � 1 Dwelling No.of Bedrooms Lot Size �a 6 1 sq.ft. Garbage Grinder (��0 Other Type of Building VA cc (V-) _ No.of Persons Showers(2) Cafeteria(fib Other Fixtures Design Flow(min.�equired) gpd Design flow provided gpd Plan Date \ fo 0 Number of sheets O'A G Revision Date Title Size of Septic Tank V 0Q _-ql:!e 7 Type of S.A.S. , Description of Soil Nature of Repairs or Alterations(Answer when applicable) u 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 d of Health. Date Application Approved —�� Date a- Application Disapproved by: Date for the following reasons Permit No. rip �0 5 Date Issued 9 THE-COMMONWEAL�� OF MASSACHUSETTS'"' ` ed m computer: +" ', 1_ �w v n. Yes PUBLIC HEALTH DIVISIU `1'OWN OF`BARNSTABLE,MASSACHUSETTS ' .t, ,.. Z[ppYitation�for' ibe"!6pogar �*2 'pgtem Conottuct on Bermit Application-forYermit to Construct, ) Repair( Upgrade O Abandon( )f Complete System❑Individual Components Location Address or Lot No. '�20 ©\� S� Owner's Name,Address,and Tel. q Assessor's Map/parcelVzo Y Installer's Name,Address,and Tel.No. ° Designer's Name,Address and Tel.No. Q_ A A C i�J to ,,. g j �` �\'3� ,`m'F�'`N •�T y�����\'}��'� -®J2 G `�5 Type of Building: 'S� —'3(.12—US LA Dwelling No.of Bedrooms Lot Size 0 ' �� sq.ft. Garbage Grinder (Wo ` Other Type of Building \PA nt t, No.of Persons Showers Cafeteria( Other Fixtures Design Flow(min.required) 'LA gpd Design flow provided L\ n Cr O . gpd Plan :Date, ? / ,� © Numbe'Vof sheets?.� '�j�1 Revision Date , Title r� Size of Septic Tank \�JUO .�-. P Type of S.A.S. C%14 p , Description of Soil Nature of Repairs or Alterations(Answer when a liable �. PP �e ) . k ,f Date last inspected:' Agreement: Jl The undersigned agrees to ensure the construction and maintenance o" fll e`afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and.noeto place the system in operation until a Certificate of Compliance has been issued by this B a d of Health. (sue Date j f r7 a> - Application Approved b Date ' a' q Application Disapproved by: Date for the following reasons t. Permit No. �& "�S Date Issued `� t ————————————————————————— ! THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,tha the On-site Sewage Disposal System Constructed O Repaired ( ) Upgraded ( ) Abandoned( )by C ' at old s4op (e c e,4,r !2 has been constructed in accordance with the provisions of Title 5 an the for Disposal System Construction Permit No. '-C�5 dated Installer Designer O_Y" L_ft #bedrooms Approved design flow qy a gpd The issuance of this permit s aalllnnot a construed as a guarantee that the system ill cf'on esigned. Date to Inspector , No. C900 W " 0 S Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 15poof:*p.5tem construction hermit Permission is hereby granted to Construct ( x) epair ( ) Upgrade ( ) Abandon ( ) System located at -7)0 Old 4q 9 LP4 6L l 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: Constrruhuc 'on 7ust be completed within three years of the date o this pe i.. Date to _ - Approved by FROM :down cape engineering inc FAX NO. : 15083629880 Jun. 28 2007 09:42AN F2 N to j ir- 1 lT-cif f -lll`T r-+ 9 o+ / QQom ' • t_I JIN.r. pm'I C. O ST r NOT ALLOWED) ZONING f j = 440 GPD �s AM 192 0 YARD $E PCL 50 FRON 120.107t SF SIDE (2.76t AC) REAR FLOOD 147 � TH2 TEST H 312TH� I LISA LY( ;PD o� ENGINEER: D. DESM; ;WITH 3' WITNESS: DATE: 9/22/05 CN PERC. RATE _ < CLASS I S( Z ARDE ELEV, R� 0" 69. � EXIST. A/E e I N� SHED LS 7 1OYR 3/3 I I 1 .� B LS 1OYR 5/6 FOOT. 20" 67.5 3E AASHO H- 20 iERS TO H H-.10 I I I shed DANCE WITH MASS. ��/7' J i �� J PERC C STEM ONLY, AND 'S NOT MCS PVC. b!4,1j1N CE FR1, 51 D>J� �-66-- —r n cv c/Z Z .CONCFALED WITHOUT U)l L lt,)ie - 16�0�� PERMISSION 013TAINED } 1:34" 58. N0 GROUNDN I h I BENCHMARK: NAIL SET IN a 3H g TEST OAK AT ELEV. 66.0' �) �� b16TANCE FROM O1 L��GHI/JCT F�t✓Z.L� @ ENGINEER: A.H. C 4-/ WITNESS: D. DES �¢s 0626 � DATE: 1/ / ` PERC. RATE _ GAR. CLASS I \ PROP. DWELL. TOP FNDN ELEV. g 66.0' 3" 6" 2 Ia 28" 1C ' MA / PERC 3 7 i 2, 132" NO GROUND SI TE Pb ,�''% a� of 720 OLD STAG IN THE TOWN OF: CENTERVILLE B. o� i IlI PREPARED FOR: SIDDHARTH a F n : 2 7 -' - 2a �i� 3w5z S2 , �I 0 ' 1 i a I. -- nP -. 4PI -5ws N tv b I (Z , a _ } t ? i9s vt,,,,� II to f� GEfi..! ptj.-�.t * rl - i. 2p'_ram' t a; I Y : L i.I 6'i �� ;. ...a I ~�i • :` � I ��� _l�`" �� 6 �' n.16�-�: .I�.OJ�;�r g�vY) i I - -- . tl I � , a , 4 f i ate-+ T z , qt j.] 7,j NO- y 5 _ f WV a: - i f �j� 12!>,6.1.fJD3`E1 .� � i�; ; �� _cam i_ ��9 I �n:iy� -o ��}�;t� �� �• 4. E N y t . r . r �. i.- I�•"� {..--. ..€7'r v_ t � F' ��4�J_.;.>-_:.� � .R!,�`t;� , - I .q} ' - � G,` �o_iulJ- ::��':Y�tS �� - L �-- ----- --_ ._ _a___. -... . :__.._ z s .��---- ,-- .. ��_--�, � tom'=a,�--- ----,-- — = -;m,4�:•- '----____--- IL - -- o ? ` - __ -•� p t�dt l..L �' ra __ r. dIJYl �i2 LfLPl - /�l� I i tit fP�4 sl �a r' a ca �Q ,1 �'f "LZ7 .... ._ i ✓.!:..��I-'l�',...�..�`L_. _f1. _'...J ���I 1�!J .� • h REVISED a .... .... ' 1 professiflnul Butldi�ng DesWr 532 - �S` Q` 2� I I ' i i + _ I I I 5 ' I r: • r ul IoL I I eS i "a U I : htiff� a 5' t I I (Zr„y+7ov { ..G:S11.t,i; N . 1 Jv9 j _. ; o 3__ t@.,. I � + �;" � 'fit•. i + a Ll it � I c t N T _ ti �� io acc_Ibio I Id- -o tom`-a` i1' - ' o{ -�o� � t ---- -- _ r rt ¢, GATErol ' . iy Wrr�> Lt i M _ D � . hoftssionaI p.it ngDesigner P .. ... — .. z t DO • Q.:BQ%M 02312 2 DRAM GNU a.s.- 14L 0 ;c3-- 4- 4' : . ........ . . ......... . ............... r. I I Cp i N , I { i : 1.' n �-- _ .. I b 9 i i AP Eli , 1� -. ✓ : rf s 1 I �f• — 1 I � i (Ct Li - _. I �tt,� �. a>.>f,zr, r+' I o � ) i _ 1 QX{2 j •f,j-t+�— �-0-'1.1:� A� �'- `-- r- ( � I , { 4 i Y _ e , LO... AAA D GF PLL� -5,Ti � alb " I a --- - s . . _. Professional Butlritng Eiesgner y.' _ - ,_.'.. -.: 1G3a�...✓_. �_ ___ ` r _ _ POuBOzS3�2 .,D wlw�e MEJ 26 3 e: - = r _ : a � :;.. __..li)• q:�Ur~ or.i�lx3� ._. i ' F� t22.3o _ _ 1 .9�:.._4�LjL12rGaur3 �L tl5 T 5Q I3 , G I i t'vEt� �.rt Cot., f 1 to° O/G --�.. 's-- _ ..,i 12 � � o f}t u.� r I as 2xoLG, - ol. Ll�Q°.:..:P 9:✓n r_i ru � N1. h d+ J s —7V .--_. -_. _.. ./ -- ;-_�PL.rt.o.rrzswt ff .: PFtr.,tamr ? - -' II r U 6� :. �; � off.l � „ ,: - �-� — _ . __ �Z'_'. ;. �kS'2-ec tD:L - G"`_ /u owri 1 ✓� �' fL Nq .-Y 9 _ D ''_ ,•� �✓ti j !rJ-N'� �OoY r.Jn \;�1�� [x4'' �f✓Y t1:(b..••r ,- _ . e l 1 r , 0. 0 . y4 yyBBee 4TE D N D' 1. -fYE REVISED PFO�assionad B'0 ng Designer W 1 P.O.Box 532 _ e 6` irmouth,MA.0 o�w��. -Y 2664 Il J✓' . - .. .. (508)394-5296 uM T 4 I TOP FNDN. AT EL. 66.0' SYSTEM PROFILE ACCESS COVER TO FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN 3 �r ACCESS COVER (WATERTIGHT) TO 6' OF FINISH GRADE o~ Cl) O \��p� F MINIMUM .75' OF COVER OVER PRECAST WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED EVER SYSTEM 65.0' <o a o = 2' DOUBLE WASHED PEAS/TONE 4 O 63V FOR FIRST LEVELRUN PIPE ' r I- LOCUS PROPOSED 1500 Ll 3' MAX. I o �L GALLON SEPTIC - �2.4 ' 62.35' _ TANK (H- 20 ) � � 2 Q JE 61.52' o000 0ED( 2 % SLOPE) 6' CRUSHED STONE OR MECHANICAL o El E3 C- 0 1� � Cl ED COMPACTION. (15.221 [2]) 2' EJ ED o o 0 E3 0 0 0 0 59.52' ^ DEPTH OF FLOW = 4' �o TEE SIZES: (-1--% SLOPE) ( % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE * INLET DEPTH = 10" 1.5' 24.5't GREAT OUTLET DEPTH = 14n 58.*GROUNDWATER O MARSH EXPECTED AT ELEV. 35' AS RD. LEACHING PER TOWN GROUNDWATER ELEVATION MAP `- FOUNDATION- 16' SEPTIC TANK 60' D' BOX 16' - LOCUS MAP NTS FACILITY 4; - ASSESSORS MAP 192 PARCEL 50 SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED) ZONING DISTRICT: RC AM a� YARD SETBACKS: DESIGN FLOW: 4 BEDROOMS ( 110 GPD) = 440 GPD �, PCL 150 Y USE A 440 GPD DESIGN FLOW 9��� FRONT = 20 120,107t SF SIDE = 10' SEPTIC TANK: 440 GPD ( 2 ) = 880 (2.76t AC) REAR = 10' USE A 1500 -- GALLON SEPTIC TANK FLOOD ZONE: C LEACHING: SIDES: 2(39 + 10.83) 2 (.74) = 147 TH2 TH1 TEST HOLE LOGS 39 x 10.83 (.74) = 312 � BOTTOM: 621 459 0 ENGINEER: LISA LYONS, RS ' TOTAL: S.F. GPD "` D DESMARAIS, RS USE (4) 500 GAL. LEACHING CHAMBERS WITH 3' WITNESS: STONE AT SIDES AND 2.5' AT ENDS , DATE: 9/22/05 (V ' ' PERC. RATE _ < 2 MIN/INCH I v ( ^�, I _j ( CLASS SOILS P# 11085 Z ARDE Q ELEV. Q \ °R� 0" 69.2' 0' 69.7' 1 I�� EXIST. A/E A SHED LS LS NOTES: I ► i \��� 7" 1OYR 3/3 5" 1OYR 2/2 I � �\\ B B 1 . DATUM IS .APPROX. NGVD I i I �\\ LS LS 2. MUNICIPAL WATER IS AVAILABLE I I 1OYR 5/6 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 1 e I ` 20" 67.5' 24 10YR 5/6 67 7, 4. DESIGN LOADING FOR SEPTIC TANK TO BE AASHO H- 20 �� I �� Shed DESIGN LOADING FOR D BOX AND CHAMBERS TO BE H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. �i i J ® J C 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. PERC C ' � � � I I i PERC ENVIROiNMEN -AL CODE TITLE V. ! o 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY. AND 'S NOT i `6,- MCS MCS TO BE USED FOR ANY OTHER PURPOSE. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4'' PVC. _ 2.5y 5/J 2.5Y 6/49. COMPONENTS NOT TO BE BACKFILLED OR •CONCEALED WITHOUT INSPECTION BY `BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. I 134" 58.0' 120" 59.7' No GROUNDWATER ENCOUNTERED BENCHMARK: NAIL SET IN W 3H TEST HOLE LOG OAK AT ELEV. 66.0' I � ENGINEER: A.H. OJALA, PE LEGEND O \ WITNESS: D. DESMARAIS, RS fps• 06 100.0 PROPOSED SPOT ELEVATION I\ \ DATE: 1/26/ PERC. RATE - < 2 MIN/INCH s GAR. u I +100.0 EXISTING SPOT ELEVATION CLASS SOILS P# 11211 EL. 100 PROPOSED CONTOUR \ DWEPL. 65.0' TOP FNDN = ELEV. 0 3" - 100 - - EXISTING CONTOUR ss.o 4. E FS 6^ 2.5Y 5/1 BOARD OF HEALTH - - � LS 28" 10YR 5/8 62.7' APPROVED DATE MA 3 PERC C 0 LS i 2.5Y 6/6 off 508-362-4541 / fax 508 362-9880 v� Cb 3 down cape engineering, inc. 1 / 132" 54.0' I CIVIL ENGINEERS J NO GROUNDWATER ENCOUNTERED / --- - LAND SURVEYORS 939 main st. armouth li /�y ma o2675 SITE PLAN of 720 OLD STAGE ROAD i/ IN THE TOWN OF: (CENTERVILLE) BARNSTABLE 13 PREPARED FOR: SIDDHARTH �(NOr OCAS �rtNQF►°a1�r °%� ( `� ARNC `e ., ARNE H ticI,, 0 OJALA H. 60 0 60 120 180 CIVIL OJALA I 30792 o W 2634 `s r o �/oN.aL �� y0 p`� �I SCALE: 1,, = 60' DATE: DECEMBER 20, 2005 ;R � 'C�. r� `p I I REV 2 1 06 TH ARNE OJALA, P.E., P.L.S. DATE \�62� O �I PAVED - 05--296 APRON