Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0132 PARK AVENUE - Health
132 PARK AVENUE, CENTERVILLE A=207-031 Illl UPC 12534 No. 2� 1� 53LOR °Aosr.coNS°� HASTINGS, MN t TOWN OF BARNSTABLE tLOCATION 1 3a �k(k, A Vc SEWAGE# QOOg'-,R y C VILLAGE.-0 La-6cyAIL ASSESSOR'S MAP&PARCEL Q0 - O3 l INSTALLER'S NAME&PHONE NO.'T C h �L,-tet'� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) r (size) NO. OF BEDROOMS .OWNER. PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) — feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY pj ff �f �/ r ' p� 1 ci � ry r� a 2 SEWAGE# LOCATION ����` /4tJ e VILLAGE iCeAfewU;(� — ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. t SEPTIC TANK CAPACTPY LEACHING FACILITY: (type) /" i 7 j (size) l� !. NO.OF BEDROOMS BUILDER OR OWNER ort �✓��/ f PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: �} Maximum Adjusted,Groundwater Table to the Bottum of Leaching Facility Feet Private Water Supply Well and Leaching Facility'(If any wells exist on site or within 200 feet of leaching facility)f Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 2100 feet %-leaching f tlity) 1 Feet Furnished by c�` r � o ' O � A- F- 15' q6` o )0119 �_ No. 2C30�j T 2 �/� I �f , Fee f THE C MONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Di!6po5ar qPpgtem Construction permit Application for a Permit to Construct V("Repair( ) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. t`�ark Avc Owner's Name,Address,and Tel.No. 6ary &'Wgy Assessor's Map/Parcel A 134 Patt* 4 /P , Installer's Name,Address,and Tel. o. (50 fS) 4y6—yao74 De si ner;s Name,Address and Tel.No. e�q�c' �c.�ac1N //cQ�-�,CItM, r�, l . Type of Building[:/ I °mewd't ic d• ai Dwelling No.of Bedrooms Lot Size Q p 9 3 sq. ft. Garbage Grinder ( ) Other Type of Building 1Sfv biaA Frew No.of Persons 3 Showers( / ) Cafeteria( ) Other Fixtures Design Flow(min./�q fired) gpd Design flow provided 3 3n gpd Plan Date 6 tv O Number of sheets Revision Date Title °t sot/- nadc- Size of"Septic Tank Type of S.A.S. 3 Description of Soil jV 1,69 -76 Inc d Saes Nature of Repairs or Alterations(Answer when applicable) e e 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 Hea h. / Signed Date Application Approved by Date (z /2 A6 Application Disapproved by: Date for the following reasons Permit No. ZU 15715 . Z y Date Issued 1 Z' 7—006 -- ————— — — — - — — —————————— No. �— (4 1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS �Diqoal �§pgtem Construction Permit Permission is hereby granted to Construct ( ✓} Repair ( Upgrade ( ) Abandon ( ) System located at �A VL and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. /2f Date (6a Approved by J No. 2Y'O 2 �� f I V�� "� Fee J Q THE COMMONWEALTH OF MASSACHUSETTS f Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppfication for Migpogal *p.5tem Con0trUction Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components „ Location Address or Lot No. k A VL Owner's Name Address,and Tel.No. (flary co-wcty Assessor's Map/Parcel ��Vr N, AAve- / } Installer's Name,Address,and Tel.,No.(50 fs) ny6' d 07G DeS�gner.'s Name, kj Adds an_ Tel.No. 70•-� e�q n �a v�a ��n�7 0�1�n �i� Gvl Yh ccr r'H _• o•r.v�� u y O qcj Y Id, �{07 hype of Building: j Dwelling No.of Bedrooms 3 Lot Size /a 09 3 sq.ft. Garbage Grinder ( ) Other Type of Building sry WOdd FtoY4 No.of Persons Showers( / ) Cafeteria( ) » Other Fixtures -330 Design Flow(min.required) - gpd Design flow provided 33O gpd Plan Date (� (o%fj Number of sheets Revision Date _ Title S sim ra Size of,Septic Tank f��� 0. 1 Type of S.A.S. 3 ro W 5 . Yn i fYatorS S .� S S/ Description of Soil iYt.tJ lQq W1 36 r I / c J .Saa l Nature of Repairs or Alterations(Answer when applicable) iy$fc r'I Fa i I , f 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 �� Sig 6.�1� Date a// - _ Application Approved by -< l�/_' i. w Date LApplication Disapproved,by: �_.. _ _. _ _, __._ _ _ _ _ ; Date -_ --_ *for the following reasons Permit No. ZU OO5 " 2-y Date Issued------------- O THE COMMONWEALTH OF MASSACHUSETTS # BARNSTABLE, MASSACHUSETTS Certificate of Complianc�) Repaired THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Upgraded g p Y ( ( ) ( ) Abandoned( )by 75; Olahc d1Qaet1 leHf/aefre� t� at 13 7 PQ 2 le A V e >#YZ v/C-1 C has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �o5. 2 eee dated Installer T0A In% ,P, Designer �119�A`ctthy �rks,,/ #bedrooms "� Approved design-flow 33a1 /�4 gpd a— 9 The issuance of this permits all not bE construed as a guarantee that the system wil unc ion as,designed. Date Inspector ��s� P Y u, — �. -----------_------ ------- No. o ZG o L"q Fee 2— 2 -C> THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Di5pont �&pgtem Cougtruction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(Complete System ❑Individual Components Location Address or Lot No. Ave Owner's Name,Address,and Tel.No. CkA+ez-v`1 k-e— I &LCA- 6 co n C.v Cq Assessor's Map/Parcel b 11 ®3` 3 a e,�yCo f— 1 (5a8) 5 LI6-o�-o?� g > 'f 5.3/3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.C&5 � Lj7 T'6f,\C C-i 10 C10_q O ej a)6/`KS M t 0 r 3 .6 119 W,GLosS XeA C06 y y. Type of Building: Dwelling No.of Bedrooms 3 Lot Size 093 sq.ft. Garbage Grinder ( ) Other Type of Building I S-I-d 6a100d RkMt No.of Persons 3 Showers( ' ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 gpd Plan Date (,o Co © Number of sheets p Revision Date ° Title P $Q 5�2�A-L G Sys'�l U 46-t c— P✓0 PDo-P� i006 L, Size of Septic Tank Type of S.A.S. Description of Soil 50W&.A4 I.D&Jvl 3 0 9t C� Srt�✓ Nature of Repairs or Alterations(Answer when applicable) 5 4!��_rQ 1 L-e— w4 Date last inspected: a D J 0 - Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date b Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. � Date Issued No. .2 ��d 2j - I1F It(/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 'pptication for Digoal *p5tem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(Complete System ❑Individual Components Location Address or Lot No. Pvz 14 A V ee— Owner's Name,Address,and Tel.No. Assessor's Map/ParceCkA+eA—V 1,�` ( &'G` 6 GO n W CA. Installer's Name,Address,and Tel.No.(50$) 1 1.1 D-7(4- Designer's Name,Address and Tel.No.C60 8) 1"�77 S3I3 1OM JG 4 C 1t�. j 1 O G1o�-�O rJ tz- � �C �?j tAA(-V /iUl6 AP( ate(, Y 7 Type of Building: r Dwelling No.of Bedrooms ? Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building I e-l. nn�"Aj( No.of Persons Showers(f ) Cafeteria( ) Other Fixtures -. Design Flow(min.required) gpd Design flow provided •3.13 0 gpd Plan Date ( Number of sheets Revision Date t Title P r 1) 0 S-"D:� t L ry!5 1." Size of.Septic Tank Type of S.A.S. Description of Soil <A40 Aj A4tt Nature of Repairs or Alterations(Answer when applicable) \[!�7,_ -41 f5r, 1 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 p Date ���� Application Approved by ( (Q Date Application Disapproved by: ,/ Date �. for the following reasons t. Permit No. ' Date Issued ----------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certifirate of (compliance THIS IS TO CERTIFY,that the On-site to Sewage Dis osal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by //�► 1p at ,D ,� f —- has been constructed dance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer �/ / / Designer #bedrooms Approved design flow gpd The issuance of this'permit ,hall (nno o be construed as a guarantee that the system will funct. n as designed. 7S o Date / �J{ Inspector m__ ___w--- No. 20 O 5— Z 4( Fee 2 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS li5po5al 4p5tem Con5truction Permit .Permission is hereby granted to Construct ( nn) Repair ( ) Upgrade ( ) Abandon (✓ ) System located at Z (Z-k A VC and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thiI perm Date y — /�— G Approved by �. 1)6W Town of Barnstable ' Regulatory Services z ; Thomas F. Geiler,Director Pubiic Health Division Thomas.McKean,Director 200 Main;Street,Hyannis,MA:02.601 r Office 508 862-4644 Fax: 508-790-63.04 Installer.&Dessnex;Certifcahon Form Date: ? Sewage Permit#c tlo —g Assessor's Map\Parcet SO 7 �0 j Gl Hesg3ner: z✓1 (`nc, C � Installer: avl.�, Address l 2 (y &_0 S S" fJ "Address: ot On Q o (2cL'^�Y vas issued a permit to install.a (date) (installer) 13 Z Pox VVI�. septie system;,at based-on a design drawn by (address) dated 0 (designer) I certify;that the septic system referenced above was installed substantially according,to the;.lest which may include,�, y minor approved changes such as lateral relocation of the d 000ition box and/or septic tank. I eertify 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 cert fiedAs-built by designer to follow. OF M4801 PETER t McENTEE (InSG'Jer'S: ) CIVIL �.. No.351"09 e" FFSSION A�-�N� w+v�crovy (Denier's Signature) (Affix Designer's Stamp Here) PLEASE&E3fIJRN TO BARNSTABLE PUBLIC HEALTH DI_ &.1ON CEitTI ICATE 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:Health/Septic/Designer Certification Form 3-26-04.doe Town of Barnstable P# Department of Regulatory Services s = Public Health Division Date 411119 � s639.h 200 Main Street,Hyannis MA 02601 -,g f0 Date Scheduled_ Q 0 Time Fee Pd. b Soil Suitability Assessment for Sewage Disposal Performed By: pt4--cf C ✓` ,S Witnessed By: _�r q �^�. t• S LOCATION& GENERAL INFORMATION Location Address /)13 z 'Pa lay— ,GtwrJ Owners Name C-Vda j �0 W �--`z'h►TE,=J1 t..LF- Address 13Z- FAgaL &&1, ^ Assessor's Map/Parcel: Z©7. &'-3 l / Engineer's Name t=`k_0_ r �.•} NEW CONSTRUCTION REPAIR �• Telephone# Land Use 'S t c 4✓\y" O, ( Slopes(%) Surface Stones Distances from: Open Water Body Z ft Possible Wet Area L�U ft Drinking Water Well 150 its" S Drainage Way 7 0 ft Property Line �—' ft Other {t Cn t�t SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands in proximity to holes) ��. 4- 13 Z J i Q,,AA A.-Q- I � Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: J N/A Weeping from Pit Face N� Estimated Seasonal High Groundwater 3 3 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: __ _ In. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level,�, ,; Adj.factor Adj.Groundwater bevel,� o PERCOLATION TEST bate . Thne.� Observation Hole# ` Time at 9" Depth of Pere' o Time at 6" Start Pre-soak Time — 'rime(91'4") End Pre-soak `� M Rate MinJlnch Site Suitability Assessment: Site Passed C2� — Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICU'ERCFORM.DOC e ' DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Can i ten Gravel) Z. 30 —138 C 1"� Sam. 2 �,5'�( �'�y • DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel 12,y1Z y to t2 s/8 J' 3 y -)35 2C5'y CAI rr o - , DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other tot Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. 1 Consistency. Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No V Yes Depth of Naturally Occurring Pervious Material 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? ..� Certi_ fication I certify that on l� `� � (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 trainin expertise and experience described.in 310 CMR 15.017. Signature Date J Q:\SEpnMERCFORM.DOC I { Barnstable ow Town of Barnstable Regulatory Services Department 8f1c8 j EAaN9rAB[E pq, Public Health Division �EbA 200 Main Street,.Hyannis MA 02601 2007 Office: 508-862-4644 _ Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO April 11, 2008 Gary Conway 132 Park Avenue Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 132 Park Avenue, Centerville MA was last inspected on April 8, 2008,by Shawn Meelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS You are ordered to repair or replace the septic system within Sixty (60) from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF BOARD OF HEALTH i omas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL#7006 2150 0002 1038 7190 Q:\SEPTIC\Letters Septic Inspection Failures\132 Park Avenue.doc 101VT Commonwealth of Massachusetts Title 5 Officialo Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 132 Park Ave ��� D-3 Property Address Gary Conway' Owner Owne€s Name information is required far Centerville MA 02632 4-"7 - every page. Cityrrown state Zip Code Bate of Inspection Inspection restates most be submitted on this form.Inspection forms may not be altered in any way. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Shawn Mcelroy Enterprises Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 Cityrrown State Zip Code 1-508-495-0905 S13971 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. B am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes Fails. ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature Cate The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or®EP)within 30 days of completing this inspection. 9 the system is a shared system or has a design flows of 10,000 gpd or greater,the inspector and the system owner shalt submit the report to the appropriate regional office of the DER 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 Bender the conditions of use at that time.This inspection does not address how the:system will}reform in the future under the:same or different condifions of use. t5insp.06106 Ta—*--5 Offimej hmpectw.[ism:Subsw4ace Sewage D-�posa!Sin-Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 132 Park Ave Property Address Gary Conway Owner Owner's Name information is Centerville MA 02632 4-8-07 required for every page. Cityrrown State Zip Code Date of inspection B. �C� liC� Qr C if i Cont.Inspection Summary: Check A,B,C,D or E I ahwys 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: 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 exfittration 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 t5insp-Q8M6 Ttt1e 5 official Lzspection Form:Subsurface Smage Disposal Systern^Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 4-8-07 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. t5insp-OWN Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Park Ave Property Address Gary Conway Owner Owner's(dame information is required for Centerville MA 02632 4-8-07 every page. City/Town State Zip Code Date of Inspection B. Certification (font.) 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: ** asses if the well water analysis, performed at a DEP certified laboratory,This system p y , p 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 overioaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 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. t5insp•08/06 Trlte 5 Official Inspeclim Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Park Ave Property Address Gary Conway Owner Owners Name information is Centerville MA 02632 4-8-07 required for . every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cunt.): 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. t5insp•08/06 Title 5 Official Insp ection Forth: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 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 44-07 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(f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp-OWN Title 5 Official Umpection Form:Subsurface Sewage Disposal System-Page 6 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 4-8-07 every page. City/Town state Zip Code Date of Inspection 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 Number of current residents: 2 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 Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 4-8-08 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): t5insp-08/06 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 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 4-8-07 every page. City1rown State Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: Source of information: Owner pump 3 mos ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (rf yes, attach previous inspection records, if any) ElInnovative/Altemative 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(f known)and source of information: 1988 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 4-8-07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 24"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: 18"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: 0 Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 0 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 16" How were dimensions determined? Tape t5insp•08106 Tote 5 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 4-8-07 every page. CitytTown 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.): Good condition with baffles in place. 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 ❑ other(explain): t5insp•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 15 ` Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 4-8-07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Tight or Holding Tank(cunt.) 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): 1n Depth of liquid level above outlet 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.): Good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp•08/06 Title 5 Official inspection Form_Subsurface Sewage Disposal System-Page 11 of 15 i Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °r 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 4-8-07 every page. City/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: Type: , ® teaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number. ❑ innovative/aftemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach pit was filled beyond capacity at inspection. t5insp-08106 Title 5 Official Inspection Form_Subsurface Sewage Disposal System•Page 12 of 15 i ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 4-8-07 every page. CityrTown State Zip Code Date of Inspection D. System Information (cunt.) 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.): t5insp-08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 132 Park Ave Property Address Gary Conway Owner Owner's Dame information is Centerville MA. 02632 4 -Q7 required for every page. Cityfrown State Zip Code date of Inspection D. System Information (cola.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. locate all welts within 100 feet. Locate where public water supply esters the be>i ing. 1 D A'--- t5insp-08M TMe 5 ia;firiVe�i-m-n-Sins=ace Sewage Dmpvsat System•Page 14 of 15 i ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G1 132 Park Ave Property Address Gary Conway Owner Owner's Name information is required for Centerville MA 02632 4-8-07 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to 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: You must describe how you established the high ground water elevation: Town maps show groundwater at greater than 15'. t5insp•08M Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 15 of 15 • ° Town of Barnstable �oFt�ram, Regulatory Services BARNSTABLE ; Thomas F. Geiler,Director 1MASS. . � AIFD��p Public Health.Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. �j r .No. / �'- ��Q _ ;?07- O "' I Fee—y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for ]igpogal 6p5tem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System 0 Individual Components Location Address or Lot No./.3e� Owucr's Name,Address and Tel.No. d2n� Assessor's Map/Parcel Installer's Name,Address, d Tel. ..- a Jg6 Designer's Name,Address and Tel.No. ootm Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of RepaiCp or Iterations(Answer when applicable). �e,-NVYF Q1p a6h, &X/ e3o .194D AVAe� tti 1t 4 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 Title 5 of the nvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d t ' Health. D Signed Date 3 Application Approved by Date 3_3a Application Disapproved for Me following reasons Permit No. 6 tJ Date Issued I G' No. / l d Fee yS THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogal *pgtem Con!tructton 3permit Permission is hereby granted to Construct )Repair Upgrade( )Abandon System located at x* .if �.. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: 3 �717- 9 Approved by , r .. No. I ��©'� - �_ ':w� �o � � � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: n es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z(pplication for �Ngbnl *p$tem Comarurtton Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No./�7 A OwWr's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Q Hrtf /""v Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures. ' Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title J Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repai or Iterations(Answer when applicable) t-i)piw1, `IP (1/S h144,T/Zn2 0�0> 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 Title 5 of the nvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss M b, t ' o o Health. 2 Signed Date ✓ 3� Application Approved by Date -3a ?'cl Application Disapproved for We following reasons 4 Permit No. T Y — 16 G Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired><)Upgraded ( ) Abandoned( )by k+ 7-e.e L at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. /�?9 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system w' function as designed. Date 3 —�0 Inspector - r. C0N NION E-ALTH OF WSSACHt SETTS Ex CUTIVE OFFICE'OF"'ENVIRONMENTAL AFF� IRS DEPART IE T OF ENVIRONMENTAL PR' CTION- -� `" ONE WINTER STREET. BOSTON. NIA 02105 617-292-' BAN 1998 - "WN OF HEALTH DEPTABLE V1ILLIA�'F.WELD :: t, ; TR-I'Dl'CO?r ARGEO PALL CELLI'CCI - - _ �_ ^L_ DAVID B STRL'I--, Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Comrnissionc PART A �CER71F)CATION Property Address,)1?'Z_ViR�¢�L v�.t ►-�T��V1��`t Address of Owner: , c V01,V Date of Inspection: tZ�%71`g'1n (If different) Name of Inspector: N o 1 am a DEP ap roved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: ±/ er Mailing Address: -�Q A.=,< e_339�j H AgdoP Q H I9-0 2-.C4-q Telephone Number: r CA" Z !6$1- L,& o CERTIFICAT1O% STATEMENT I cent. that I have personally arspected the sewage d:sposa! systern ai"this address and that the information reported be!o%, is true. accurate and complete as OF the time of inspec:oo•-. The inspection was Wormed baser on My training and experience in the proper funcior, and maintenance o�on sewage disposa; systems The system r _ _. 7. Passes _ Concit-onaiiy Passes Neecs Furthe- Evaluation Sy the Local Approving Authortit _.... Fa.- -_._. . . „.. Inspector's Signature: _ Date: T:ie Svs:e r lnsaecto• sha!' submit a copy of this inspection reoor, to the Approving Authoriry within them (30) days of completing this inspection. If the system is a share' system o• has a design flow of 10,000 god or greater, the inspector and the.systeT owner shall submit the repor, to the appropriate-regional office of the De;anment of Environmenta� Protectoor.. The orig!na! should be sent to the system owne- and copies t-nr to the buyer, if applicable, and the approving authorirt.- INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PA55E5: v I have not found any information'which indicates that the system violates eny of the failure criteria as defined in 310 C.MR 15.303. Any failure criteria not evaluated are indicated below. _ COMMENTS: `6I SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y. N. or NDi. Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (artache•d) indicating that the tank was installed within twenty (201 years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank. as approved by the Board of Health, (revised 04/25!97) Page 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '. , PART A . ; . = �'4 CERTIFICATION (continued) - =- t Property Address: Owner: Date of Inspection: Bj SYSTEM COND ITI ONALLYj PASSES (coni,n,h' _ Sewage,badcup orbreakout or high static water level observed in the distribution box is a to broken or obstructed pipe;sf or due to a broken, se*tled or uneven distribution box. The system will pass ins ion if(with approval of the Board of Healthi. Describe observations: broken pipe(s) are replaced - obstruction is removed distribution box is levelled or replaced The system requited pumping more,than four times a year due to broken or o trusted pipe(s). The system will pass inspection.if twith approval of the Board of Health): - - f broken pipets; are replaces obstruction is removed _ i - _. �,y._�-_ C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require fui4her evaluation by the Board of Health i order to determine if the system is failing to protect the public health. safer•and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES T T THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AN THE ENVIRONMENT: Cesspool or prn-� is within 50 feet of a surface water _, - - Cesspool or pn ,. - is within 50 feet of a bordering v tated wetland or'a'salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (A D PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT P OTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The systern has a septic tank and soil abso tion system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil a orption system and the SAS is within a Zone I of a public water supply will. The system has a septic tank and soil sorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soi absorption system and the SAS is less than•100 feet but 50 feet or more from a private water supply we11. uniess ell water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution fr that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used o determine distance (approximation not valid). 3) _ OTHER 6. (rwiiod 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL_SYSTEM INSPECTION FORM PART A: - - CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DI SYSTEM FAILS: You must indicate either "Yes" or "No' as to each of the following I have determined that the system violates one or more of the following failure criteria as defined i 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine hat will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an`overloaded or'clo ed 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. Start hquid level in the distribution boa above outlet invert due to an ov loaded or clogged SAS or cesspool. _ Liquid depth in cesspool is less than 6" below invert or available voles a is less than 1/2 day flov.. Required pumping more than 4 times in the last year NOT due to ogged or obstructed pipes:. Number of times pumped Anv portion or the Soil Absorption System, cesspool or privy i low'the�high groundwater elevation Am por„on of a cesspool or privy is''withir. 100 feet of a s ace"water supply or tributan to arsurface water supply. Any portion of.a cesspoo' or pr»y is within a Zone I'of public well. An,. perzior• o*a cesspool_or privy is within 50 feet of private water supply well Any por,,gr o'a cesspool or pray is less than 100 eet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has n analyzed to be acceptable. attach cop\,• of well water analysis for coliforrn bacteria. volatile organic compounds, monia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: ' )rou must indicate either "Yes" or "No" as to each of the Poll ing: The follow:ng criter.ta appi% to large systems in ad ition to the criteria above: The system serves a facilin with a design flow f 10,000 gpd or greater (Large System; and the system is a significant threat to public health and safety and the environmen cause one or more of the following conditions exist: Yes No . the system is within 400 feet f a surface drinking water supply the system is within 200 t of a tributary to a surface drinking water supply the system is located i a nitrogen sensitive area (Interim Wellhead Protection Area -IWPA) or a mapped Zone ll of a public water supply ell) The owner or operator of any such s stem shall bring the system and facility into full compliance with the groundwater treatment p►ogram requirements of 314 CMR 5.00 an 6.00. Please consult the local regional office of the Department for further information. (reviled 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARI B CHECKLIST Proper" A drxss: Owner: V%jq kAr ) Date of Inspection: :, ,.... Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner,occupant, or Board of Health. .None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been ob-tained and examined. Note if they are not available with N/A. _ The fac:li,% or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. A. The site was inspected for signs of breakout. ='r _ `., zAll sv5tem components. excluding the Soil Aosorption System, have been located on the site. .. 4 _ The septic tank manholes were uncovered. opened. and the interior of the septic tank was inspected for condition of bafiies or tees. materiai o' construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption Svstem on the'site has been determined based on: The facilit, ovine, tano occupants. if difteren: from owner were provided with information on the proper maintenance of Sub Surface Disposal Svsterr. 1% Existing information. Ex. Plan at B.O.H. x Determined in the field !ifam of the failure criteria related to Part C is at issue, approximation of distance is _ --C unacceptabie [15.302.3);bil I (revised 04/25/97) fags 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR..M :PART C - SYSTEM INFORMATION Property A/yd�d Pft9X K�ress: CJ • Owner: Date of Ihspection: FLOW CONDITIONS RESIDENTIAL: Design flow, AR 0 e.p.d./bedroom for S..A 5 Number of bedrooms. 03 " Number o'current residents- Garbage g•; der (yes or no): L }. Laundry co-•erected to system (yes or,no) Seasonal use Ives or no,:T--) '-'- Water meter readings, if available (last two Q; year usage (gpd): /V j Sump Pump Ives or na:_.bj Lai: date o*'occupancy�2.►S a� -____. ____..____._. ._._. ..__._.�_.._._._ .._..__._.__...,.__. _..__...... COMMERCi4UINDUSTRIAL• - Type of establishmemt Design fio%% _ltallonsida,. Grease trap present. tees or no Industrial.k%aste Holding Tani; present. eyes or no_ ".on-sanitan v�aste discharged to the Tale 5 system. ,ves or-no i , dater meter readings. if aya;labie Las:Pa,e o: o ccpancti �.._•. M tea,._._ � . OTHER. De:cnbe Last oare of occuoanc. _ GENERAL INFORMATION PUMPING RECORDS and source of m;pr atior, ':': System pumped as par, of inspection:-wes or_no:_L30 - - If yes, volume pumped-. gallons - Reason for-pumping TY�F SYSTEM ... .:...... .:. Septic tank/distribution boxrsoil absorption system Single cesspool Overflow cesspool r Shared system (yes or no)-(if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: l�t� Sewage'odors detected when arriving at the site. (yes or no) - (revised 04/25/9'7) page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .!1 PART C SYSTEM INFORMAT10% (continued) Property Address: 13Z� � �— ~' Date of Inspection: BUILDING SEWER: - (Locate on site plan) P00 _..._..:;. Depth below grade. Material of construction: _cast iron _40 PVC _other (explain( Distance from private water supply well or suction Irc Diameter . Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:IdA (locate on site p an Depth below grade- alik Material of construction �concre:e _me:a _F;oerglas� _Polyethvlene _othertexplam - - If tank is metal, Its- age _ Is age comirmec b\ Cen;ficate of Compiiance _(YesNo Dimensions , 1Qb6S1Wr Sludge depth zr/ Disiance from top o: sludge to bottom of outie: tee o, ba^;e�iLl Scum thickness_ -_.. .. .._ Distance from top of scum to top of outlet tee or bade t h Distance from bottom of scum to bo-. c-n o;outlet tee e, bane How:dimensions were determined t�lf�iro►e►119n Comments. trecommendation for pumping. Lond;t:on of inlet and outlet tees or baffles, depth of liquid level in relation too le invert, structural integrity, evidence of leakage, etc,i GREASE TRAP: (locate on site plan) .' Depth below grade: Material of construction: _concrete _metal Fiberglass _Polyethylene _other(exptain) Dimensions: �: f ;�•h, . .._.. _... ... .... 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles. depth of liquid level in relation.to outlet invert, structural w integrity, evidence of leakage, etc.,- (revised 04/25:97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION,(continued) Properh A dress: Owner: t/9 K Date of Inspection: TIGHT OR HOLDING TANK: 'Tank must be pumped prior to,or at time, of inspections w V. (locate on site plan, -Depth below grade. _._.�._ ... .__. _ __._. . ..._... • ,. _.._.a .,. _. --Material of construction... concrete _metal _Fiberglass _Polyethylene _other(explain).w_,_^, Dimensions: Capacm- gallons _. Dessg^ floe. galsons'da, Alarm level Alarm in "ork+ng order_ Yes: _ No Date of previous pu;np+ng Comments (condition of inlet tee. condition o- alarm and float switches, etc.) ,1 a + _ ._!........,..__ _._ ... DISTRIBUTION BOXW docate on site par, w+_ Depth of licuid level aoove outle: snore^ (Jtltl.C:� Comments mote if leve! a-Ld distribute r s, eaua'. evidence of solids carryover, evidence of leakage into or out of box, etc.) .,QX s t o u C,-V2 l a w 2a, t I C,� K rQ:!== nr= PUMP CHAMBER:___..__ __... ,. _-----._W. --(locate on site plan. ------_ __......... _w Pumps in working order: (Yes or No' Alarms in working order (Yes or No Comments: —•• _..(note condition of pump chamber, condition of pumps and appurtenances,.etc.) (revised 04/25/97) Pigi'7 of 10 r — a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /� SYSTEM INFORMATION (continued) Property Addr-ss: 9 3Z P�r.*Q, Owner: Date of Inspection: Z t 7 SOIL ABSORPTION SYSTEM (SAS): (locate on sue.plan, if possible; exca,.Jh6n not required, but may be approximated by.non-intrusive methods. - _.;•_ a, If not determined to be present, explain: leaching pits. number. I_�vfG leaching chambers, number:_ leaching galleries, number: , leaching trenches, number,length: leaching fields, number, dimensions. overflow cesspool, number Alternative system ----_-____ Name of Tecnnoiogv __ Comments. mote.c ndition of soli signs of by raulic failure, Iev • of ponding: c di on, etc.t - _ — NO CESSPOOLS: Ab (locate on site plar. Number and configura:.on Depth-top of liquid to inlet rnver, Depth of solids layer Depth of scum layer. Dimensions of cesspool Materials of constructior — - Indication of groundwate- inflow tcesspool must oe pumpec as par, of inspection:! Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) _ (locate on site plan) _. ........,.._v._.__._�....,_.,.�___._..__..-._..... __.,..: __ _____.._... Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/1S/97) ?ag�xl,oi 10 �r, c I SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 fAvy,A-Ili" Owner: V( ' Date of InepeAi ; � r Q11( 7 f SKETCH OF SEWAGE DISPOSAL SYSTEM. include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) fiAct* 3 � �11 t7t��� (revised 04/25/57) Page .S of.10 t SUBSURFACE SEWAGE(DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propertv�Ad/dress Owner: V J Date of Inspection: ( , Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater-Elevation: " Obtained irom Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Cnec'K %%ith loca! Board o- nea!tn Chec'K FE.NAA slaps 1 Check pumping recordd :: _ Check Iota( excavators. installers Ise LSCS Da:a . _ ..• `: Describe in voir.o�% v.oras no•.+ o:: es:abhshed the High Groundwater Elevation. (Must be completed: UPS. � a c S: P (rev-sod 04,2"9-. Page 10 of 10 DEED RESTRICTION WHEREAS, GARY R. CONWAY AND LISA HALL CONWAY, of 132 Park Avenue, Centerville, Massachusetts, are the owners of land and buildings thereon located at 132 Park Avenue, Centerville, Barnstable County Massachusetts, and being shown as Lot 17 on a plan entitled"Centerville Estates, Centerville, Mass., Teel Realty Trust, Owner,Nelson Bearse, Surveyor, Centerville, Mass., September 1927" duly recorded in Barnstable County Registry of Deeds in Plan Book 21, Page 133; WHEREAS, Gary R. Conway and Lisa Hall Conway, as the owners of said lot have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can-be included in any home built on said lot as a.pre- condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V. Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition,to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document; NOW, THEREFORE, Gary R. Conway and Lisa Hall Conway, do hereby place the following restriction on their above-referenced land in accordance with their agreement with the Town of Barnstable Board of Health, which restriction shall run v�th r the land and be binding upon successors in title: d'i ry Z CD CD =? 1. 132 Park Avenue, Centerville, Massachusetts, may have constructed upon theco ` lot a house containing no more than three (3) bedrooms. If the Con ways orb a their successors in interest desire to have a house constructed on the lot containing more than three (3) bedrooms, they will have to first seek the approval of the Town of Barnstable Board of Health. GARY R. CONWAY AND LISA HALL CONWAY agree that this shall be a permanent deed restriction affecting Lot 17, as shown on the plan recorded in Plan Book 21., Page 133. For title of Gary R. Conway and Lisa Hall Conway, see the following deed: Book 11147, Page 326. Executed as a sealed instrument this day of / , 2007. V (j (Owner'sSignature) cane �ig.ature �� COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this 16 day of 4f 2007, before me, the undersigned notary public, personally appeared Gary R. Conway,proved to me through satisfactory evidence of identification, Atf.. ,�,pt x ,-,�C . ,to be the person whose name is signed on the preceding or attached document, and acknow dged e that he signed it voluntarily for its stated purpose. ol Not u ic: ission ex p JEFFREY KENDZIOR colson"am d Wmadt"ft MY 0W *%&n EVAOS June 28,2013 COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this /-S-- day of P1,-:,U , 2007, before me, the undersigned notary public, personally appeared Lisa Hall Conway,proved to me through satisfactory evidence of identification, rr,i ®p i v, Lj c , to be the person whose name is signed on the preceding or attached document, and acknowledged to me that she signed it voluntarily for its stated purpose. Notary Pu lic: My commission ex ' es: C3CXU -8 A.KNAr P Nctaiy Pu`�is CQmmon4ec�:,i f o`��`assuchuseCs My Cor;tmissio,-"csr es to NOTE. WINDOW DESIGNATIONS ARE WINDOWANDERSEND SIG SERIES WINDOWS. CONTRACTOR SHALL VERIFT LOCATIONS!DIMENSIONS PRIOR - n TO WIN.ORDER!.INSTALLATION 20'-0' 21'-0' Iq_p•• NEW WALL O REMOVED WALL B'O" H STEP m EXISTING WALL O Z $.k�., BOOKS -SEAT,�� K K SEAT,"--tBOOKS 7 ' 212 WH 6061 _ J W!D 4 24 2- REMOVE DOOR ADDITION AND INFILL rN` 3'-0' o REMOVE SLIDER AND CREATE - POCKET DOOR OPENING EXISTING GARAGE s f # l + ' ....rr �i#�Y� I Z FLUSH TRAP DOOR O OVER EXISTING REMOVE WINDOW BULKHEAD CRE ATE PA55 THROUGH Q LL .J J Ld LLI F-" z LU Fmqv z W 3 EXISTING RESIDENCE 0°zp j L Q Y Q IL 1-0 SHEET 2 OF 3 0Z 911V IODc 20 0 40'-0' 1,0- 10'-0" FIIIRST' FLOOR PLAN JOB: 0705 SCALE: I/4" . P-O" DRAWN BT: KW DATE: 4/II/07 Z PIT.SILL ANCHORED 4'-W O.C. 1 SLL SEAL COPPER FOIL TERMITE BARRIER APPLIED TO TOP OF WALL 6"x3'-9"CONCRETE WALL 1 CONTINUOUS FOOTING DAMP PROOF BELOW GRADE 816 _- -- -- -Z. VENT VENT U u� O �jla !------1 - - --Ir=� % J KO ' 2)9 1/2"LVL GIRDER GALV.METAL POST BASE 30"x30"x12"CONCRETE PAD EXISTING Q EXISTING EXISTING ' GARAGE BULK LEAD BASEMENT CRAWL SPACE 2" DUST CAP 6 MIL VAPOR BARRIER Ill J J U1 EXISTING z BASEMENT W U LU LU3 z (.O > 0. L U Q Q IL N m SHEET 3 OF 3 FOUNDATION PLAN SCALE: 114" I'-O" JOB: 0705 DRAWN BY: KW DATE: 4/II/07 qw '1�' W / V TYP ROOF y( FABLE /S FIELD VERIFY 2x12'.P 16"O.C. f t lT l l j, �� =;a !A B L E HEIGHT IN RAFTERS R30 F.G.INSUL./ */ ' DETERMINED BY EXISTING SKYLITE 5/8'PLYW D SHEATHING/ LOCATION 1/2"ROOFING UNDERLAYMENT RUBBER MEMBRANE (- PITCH ROOF 1/4'IN 12' RUN RUBBER MEMBRANE UP EXISTING W/TAPERED SLEEPERS ROOF PITCH 15"AND SHINGLE OVER 1'wl ---------------------------- .._ --------..--------- .__._.._. ------ _____ INSTALL AIR BAffLES V TO PROVIDE VENTILATION TYP.EAVES 2x12's®Ib"O.C. FROM SOFFIT TO ATTIC 1.6 FASCIA/1.4 SECOND MEMBER CONTINUOUS VENTING SOFFIT 1[5 FRIEZE BD.W/BED MOULDING ALUMINUM GUTTER<DOWN SPOUTS _ 1x3 5TRAPPING� 1/2"GYP.BOARD Z ul TYP. EXTERIOR WALL 114 EST.STUDS 16"O.0/ R1 7{ 3 F.G. I 1/1/2"PLYWOODD 9 .E SHEATHING/ TTV EK WRAP/W.C.SHINGLES S"TW E%ISTING ADDITION FIRST FLOOR N X u'�t1 Z 1'MAHAGONT DECKING OVER O PT WOOD FRAME STEPS OAK FINISH FLOORING 3/4"T!G OSB SUBFLCOR Q NAILED!GLUED TO JOIST FIRST FLOOR nUST HATCH EXISTING VERIFT IN FIELD 2.5'.6'16'O.G. I LL J J COPPER FOIL LEDGER BD TERMITE BARRIER APPLIED RI9 FG INSUL. (2)q 1/2+LVL GIRDER 'I W/GALV JOIST HANGERS TO TOP OF WALL GALV.METAL POST BASE 2"CONCRETE SLAB �-- 6 MIL VAPOR BLAB I W I _ Z z LL Q V Q V w 3 O z W LLJ T .FOUNDATIO W N ALL d Q YP Q P.T.SILL ANCHORED W-0'O.C. 8"xV-q"CONCRETE WALL EXISTING DAMP PROOF BELOW GRADE BASEMENT 10'xl6"CONTINUOUS FOOTING Q N m SECTION 5NEET 4 OF 4 SCALE: 3/4" I'-0" JOB 0705 DRAWN BY KW DATE: 4/''/07 Z -- -- -- 2842 FWH 60611 2042PEI 1 1 I I FIRST FIOORti�O � 1 J ADDITION w z uQ V REAR ELEVATION o z w Q SCALE: 1/4" 1'-0" (3 > 1 IL U Q w J w Q N m SHEET 1 OF 3 JOB: 070B DRAWN BY: KN DATE: 4/I I/07 =�+ TOWN OF BARNSTABLE LOCATION �32 ��-�- 111f�.- SEWAGE # VU,LAGE t"` ASSESSOR'S MAP & LOT b bid INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) Q` , (size) ®®0 NO.OF BEDROOMS O BUII.DER OR OWNER 4E MMATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 1� 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 o leaching facility) Feet Furnished by�.C�� \ •E �3Z 2 ' L qq '4 TOWN OF BARNSTABLE ' `'I.CsCATION X v��__� SEWAGE.' #� � VILLAGE / ( ASSESSOR'S MAP & LOT c� INSTALLER`S NAME & PHONE NOta? I �,I�GYI� � ?�• t. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �� fi (size)_ I NO.'OF BEDROOMS PRIVATE WELL OR PUBLId4ATER 13ll1LDER OR OWNER atr_.. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED VA 'IRNCE GRANTED:\;Yes No'�. V"` A.J, . 1 ' � a 1' v r 20 00 THE COMMONWEALTH-OF MASSACHUSETTS BOAR® OF. HEALTH ...........Twwn...................OF........Barnstable Appliration for Disposal Works Tonstriirtinn rrntit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: X$XXX 132 Park Ave. Centerville •-•-•-----------.................................•-•------------...........---............._..... .._...........•---•------...------••--....-•-------........-•------........--------------------•-- Location-Address or Lot No. �►X tc}a1J X...�.:._.. Q..a L1S kla lle........................................... Owner Address r...------... ...... :.. ............ Installer Address Type of Building Size Lot............................Sq. feet V Dwelling X-XNo. of Bedrooms.............3............................Expansion Attic ( ) Garbage Grinder ( ) paa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures .-•--------------•--•-•....---...---........... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-_.-----__-_•-_•--_-_.. Test Pit No. 2................minutes per inch Depth of Test Pit.................•.. Depth to ground water........................ ------•---------------------------•-------------------------------......---•-•••••----•-•-.._....------.....---------•-----•---••--•--._.......-••-•-•------ 0 Description of Soil......................................................................................................................................................................... v •••••-•••-------•--•---•------••..................S.and---&...G.z.a ea-----...-----•---...--•-•---------------•--------•-----•-------•-•------------•------------------••-------------• W V Nature of Repairs or Alterations—Answer when applicable.........1--1IlD D-...g allaa...t ank.................................... -•------------ ------------•------...-•--•---.....-----------------...........................................l.-1 Q 0 0...g•a.l 1 x1.•_1 e a qt...p i t......•-•---•-•--••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT TIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue byhie board of alth. Signe � ' ! -- _.......--••••..••--• ..... �n Date Application Approved By............ .. :..1�� .......... ............ Date Application Disapproved for the following reasons:........................---..................----------------•-•----------------------------------------------- ------•------•----•------•••-•-•------•-•----•••--•••--•-••-••---•................•••------•--........ Date Permit No.......1'.g Date � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH B�ruetal�Ie -_-'����--_ ...... � Applirotmon for� DiiiVasal Works Tanstrurtion Prratit | Application is hereby made for u Permit to ConStruct or Repair ZKX\ an Individual SowuQc Disposal | System at: XXXXX 133 Park Ave, Centerville---------------'---'------------'--------'-----'- ------------------------------'-'-------'--''-- Location-Address or Lots" Arthur----------------__- _ -_- ------.--'-'----_--'___ -----------_------'-_---_---'-'---_-_-__'-_-_-' 'J'.P.lMac=ber ' Owner Address-------_------------------_____ __ _________________________ Ins tauer Address Type of Building Size Lut_.--------------------------So feet;gWo of Bedr000�u------��-'---_----_-..Expansion Attic ( ) Garbage Grinder ) � PLI Other—Type of Building ............................ No. ofpecuoos---.-------- Showers ( ) -- Cafeteria ( ) ~~ Other fixtures Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. Septic Tank—Liquid ............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench--No..................... Width.................-' Total Length.................... Total leaching area-.---------sq. ft. Seepage Pit No--------------------- I)iaoetcr----.---' Depth below inlet.................... Total leaching area.--..'----og. ft. Other Distribution box / ) Dosing tank ( ) � Pe�nu�oT�t ���� Performedl� cm '.......................................................................... Date........................................ Test Pit No. l................minutes per inch Z)optb of Test Pit.................... Depth to ground vvutec---.---',- Teo Pit No. 2................minutes per inch Depth of Test I'ic-------- Depth to ground water........................ . �� --__.-'-_-'-_-_'-'__-__-_--__---'---'-'_-'-'-_-----'-'------'- '-----'_--� Deocc�ti000fB�L--------'____---'--.----- --------------___________________._______ ' Sand �� Grave� ---------- -----'--'--'--'--''------'-----''--------'------'---''--------------'-'------'------ -_-_'''''''---'''-__----'-----''----__._._--'---__-----__--- . U Nature of Repairs or Alterations--Answer when upplicu6�_.__���9�� ��lloo tank ''-_--__'---__.__.___._______________.______..l.�.1�QO.. a1lmn_Ie��b_�1t..________. Agreement: The undersigned agrees to install the uforedescribed Individual Sewage Disposal System inaccordance withwithde provisions of the�of � StateStateSanitary Codc— The furthefurtherfurther ` o not to place the system in | operation until u Certificate,of Compliance 6 b � \ -' | ___________ __6.../37/88____ LEGEND N BENCHMARK -- - mm EXISTING CONTOUR TOP OF CONCRETE BOUND x 100.98 EXISTING SPOT GRADE PG 3 EL.=100.00 (Assumed) W EXISTING WATER SERVICE Bumps River Rd � (� EXISTING GAS SERVICE P'qe 9' en 2 TEST PIT C `�- EXISTING LEACH PIT a �'c�� TO BE PUMPED, FILLED W/ BENCHMARK SAND AND ABANDONED, a o OR REMOVED 0 EXISTING SEPTIC TANK EL N/F TO `BE REMOVED ?LOCUS JOHN F. COX NSF EXISTING SHED Bacon Lane Hill Rd MATCH CONCRETE DECK BONNIE J. OLIPHINT REMOVE & RESET TO EXISTING PATIO 4'x8' RAD FOR AC CONDENSOR EQUIPM'ENT { PROVIDE CLEANOUT 1 512012'00'W 1. I I 97.76 �,-0 130.00' -- _ . '0��4 I '% LOCUO SCAP ALE 1 28 , PROP. W 3' CONCRETE DECK ..::.: : '; x GATE FENCE d GENERAL NOTES: PROPOSED BRICK - POOL I� I Z 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL EXISTING FENCE PATIO I�' �N / / l I (TO REMAIN) ': �I- (,(..� BOARD OF HEALTH AND THE DESIGN ENGINEER. PROP. ° I 2, ALL WORK AND MATERIALS SHALL CONFORM TO THE R-EQUIREMENTS 2. .. I I FENCE > OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE /'/ ! ;' SEWER NO 1' SEWER NO 2 ( " - Z LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: wF �o ; / / ; i / } - GATE' f 310 CMR 15.405(1)(b): i ! / " �/ / ; % / ! / f' j f4 I 1) A 2' variance to the 3' Maximum rover requirement, for 5' of MICHAEL J. MINOT �� / / / ! / / / r ��' max. cover. S.A.S. shall be vented and H-20 Rated. ` ; / / ; i / , PROPOSED SEPTIC TANK ii � , i ; �. I 2) A 9' variance, S.A.S. to crawl space, for on 11' setback. Garage,% 1 i,/ ', ';� , ;//"j' '/i'/:% ; / ��Q o I / , /! j O W 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR / / TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE (SLAB)/ , ; j ; / ,/ ; 10� •—� DESIGN ENGINEER. ;NO. � 32�/ j j ,/ (DRAWL SPACE)'` I I (L 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING / I 5t/. WGI. fr./ FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN OUSe% f / j % / / / ,; ,�1,^ i ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. /(FULL CELLAR)/ ~� j Q^j r gTSj 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF i i i / ' ' /,/, > f THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ' f 6,VA, ; TP-2 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. , 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 1� , tl< RICHARD / // �7� i�.i,qiy "� ;' j $ � 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. f ' / / I < ��< o J. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS i / VENT+� 21' �Q< i \� :� H000 N AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE ( 1 O� 9,��6 No. 35031 DIRECTED BY THE APPROVING AUTHORITIES. RFC/STE��� 10. fT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE S�`� THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING } BIT. COP1C. X ^- ._ �O, v t1 ,F �q! LANO CONSTRUCTION 1 DRIVEWAY 3 0 -." ca o 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS i ' r IN THE AREA BENEATH AND ON ALL SIDES OF THE S.A.S. AND REPLACE c APN ,?07- 3 a �F WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). II I 12. 093i' SF P��� ASS9C 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 1 �f INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 1l, J.001 -., o PETER T. N1212'OOuE "--- `��� MCIVILEE PROPOSED POOL & SEPTIC SYSTEM UPGRADE No. 35109 �Fc?s�E��° 132 PARK AVENUE, CENTERVILLE, MA i f-0 { "00 EDGE OF PAVEMENT 700 40 MIL POLY LINER E FSSlO lE � Prepared for: Gary Conway, 132 Park Avenue, Centerville, MA 02632 �� A `�� SET BETWEEN EL.=98.0 & EL.=96.0 Engineering by: Surveying by: SCALE DRAWN JOB. NO. f En ineedn Works HOOD SURVEY GROUP 1"=20' P.T.M. 169-08 } PARK AVENUE �` 12 gWest Crosssfield Rood 18 Route 6A NOTE: EXISTING LOT COVERAGE = 25.7% i' Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET N0. PROPOSED LOT COVERAGE = 27.8% +_ (508) 477-5313 (508) 888-1090 6/6/08 P.T.M. 1 of 2 t i , NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 97.0 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. PROPOSED TANK PROPOSED D—BOX PROPOSED S.A.S. 21° 5-4POLYSEAL " INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT 2" ,g t T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE I EXISTING F.G. EL:' 100.5-102.0(MAX.) JCHARCOAL VENT -T F.G. EL.=101.5t F.G. EL: 100.8f S. 36" MAX. COVER MAINTAIN 2% GRADE (MIN.) OVER S.A.S. 14. Ntn INSPECTION Ci L = 60'(MAX.) L = 11' L = 6'(MAX) PORT S=1% (MIN.) C S=1% (MIN.) @ S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC �p g g N Top View p �/ Section 10 ta^ e" I8" TONVERT , D—BOX INV.=97.35 48" LIQUID LEVEL ABA 3 ROWS OF 8 UNITS AT 4'/UNIT + 2'(END CAPS)= 34.00' GAS BAFFLE INV.=96.90 INV.=96.73 INV.=97.10 INV.=96.67 SOIL ABSORPTION SYSTEM (PROFILE) PROPOSED D—BOX „T$ PROPOSED 1500 GALLON SEPTIC TANK 4 OUTLETS (MIN.) ESTABLISH VEGETATIVE COVER CONNECT TO EXISTING SEWERS BACKFILL WITH CLEAN SAND 16" SEWER NO.1 — INV.=98.OU MIN. (NATIVE OR PERC SAND) SEWER NO.2 — INV.=97.70 MIN. BREAKOUT EL.=TOP OF UNIT p TOP OF CHAMBER EL.=97.0 a NOTES: 1) SEPTIC TANK & D—BOX SHALL BE SET LEVEL AND INV.ELEV.=96.67 :;,.; o O SIDE VIEW TRUE TO GRADE ON A MECHANICALLY COMPACTED BOTTOM ELEV.=96.00 SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN i— -yi III®IIII®III®u-�- 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF 2 83 SUITABLE RIT 2) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=8.5' SOILS 52„ INSPECTION Po 3 GAS BAFFLE TO BE INSTALLED ON OUTLET TEE uSE 3 ROWS OF B-QUICK4 STANDARD INFILTRATOR CHAMBERS 10P VIEW AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. NO GROUNDWATER, EL.=89.3 (TP-2) r WITH NO SEPARATION BETWEEN EACH ROW & NO STONE 4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TYPICAL SECTION INVERTS PRIOR TO CONSTRUCTION. SEPTIC SYSTEM PROFILE 83NVERT 48" END CAP (EFFECTIVE LENGTH) P/N: Q4STDE N.T.S. END VIEW MULTIPORT END CAP SOIL LOG DATE: MAY 2, 2008 (REF#12,193) SIDE VIEW NOMINAL CHAMBER SPECIFICATIONS SOIL EVALUATOR: PETER McENTEE PE SIZE (W x L x H)....... ...........34" x 48" x 12" _ EFFECTIVE LEACHING AREA: \ \\\ WITNESS: DONNA MIORANDI IRS DESIGN CRITERIA N N \ HEALTH AGENT BED................................. ................PER CODE ELEV. TP 1 DEPTH ELEV. TP-2 DEPTH TRENCH.............................................—PER CODE NUMBER OF BEDROOMS: 3 BEDROOMS ` A 34 INVERT ELEVATION..... ....... 8" \ 101.2 O 100.8 O., 24,4' A SANDY LOAM FRONT VIEW STORAGE CAPACITY PER UNIT.. 44.4 GAL SOIL TEXTURAL CLASS: CLASS I ; ♦ SANDY LOAM DESIGN PERCOLATION RATE: <2 MIN/IN —��29�' 10YR 4/2 100.3 10YR 4/2 6 100.7 6" a QUICK 4 STANDARD INFILTRATOR CHAMBER DAILY FLOW: 330 G.P.D. ♦♦�♦ O ♦ ♦♦ a' � B SANDY LOAM SANDY LOAM % �� �' 10YR 5/8 INFILTRATOR CHAMBERS DESIGN FLOW: 330 G.P.D. O ♦ t / 10YR 5/8 'h// 98.0 34" GARBAGE GRINDER: NO �Q��,Sqs N♦ 98.7 C 30" C . PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY ♦�� .�` 36" N.T.S. LEACHING AREA REQUIRED: (330) = 445.9 S.F. ♦♦ LAYOUT PERC 48" PROPOSED POOL & SEPTIC SYSTEM UPGRADE .74 USE 3 ROWS OF 8—QUICK4 STANDARD CHAMBER UNITS W/ NO MED. SAND MED. SAND 132 PARK AVENUE, CENTERVILLE, MA STONE FOR AN S.A.S. HAVING THE DIMENSIONS: 8.5' x 34.0'. 2.5Y 6/4 2.5Y 6/4 Prepared for: Gary Conway, 132 Park Avenue, Centerville, MA 02632 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.72 SF/LF OF INFILTRATOR) Engineering by; Surveying by: SCALE DRAWN JOB, NO. 8 UNITS + 2 END CAPS PER ROW = 34.0 FT 89.7 138" 89.3 138" Engineer9ngWorks HOOD 5URVEY GROUP NTS P.T.M. 169-08 3 ROWS x 34.0' x 4.72 SF/LF = 481.4 SF 12 West Crossfield Road 18 Route 6A PERC RATE <2 MIN/ IN. ("C" HORIZON) Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(481.4 S.F.) = 3561 G.P.D. NO GROUNDWATER ENCOUNTERED (508) 477-5313 (508) 888-1090 6/6/08 P.T.M. 2 of 2