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HomeMy WebLinkAbout0028 PATRICIA STREET - Health Z8 Patricia Street Centerville A=246 - 168 SAP, UPC 12534 Na.21 3LOR 1� hL TOWN OF BARNSTABLE LOCATION &T r C SEWAGE VILLAGE ASSESSOR'S MAP & LOT IX INSTALLER'S NA- &PHONE NO. SEPTIC TANK CAPACITY G G LEACHING FACILITY: (type) "- tnr4z-kyRf (size) V ig NO.OF BEDROOMS 14 BUILDER OR OWNFR 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 , t 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) Furnished by T. i � o Z43 � a� TOWN OF,BARNSTABLE LOCATION _Z> A7- 6Low S4(-�� —SEWAGE # ���� VILLAGE R'S MAP & LOT` INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �S072 LEACHING FACILITY: (ty �ilA �f� (size) = 1� NO. OF BEDROOMS BUILDER OR OWNER C� PERMIT DATE: 6—3—0 d COMPLIANCE DATE: L U 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 -A S -00 o I SL r��-- No. o FEE S e � ��Board of Health, AIA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT , Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) -Xcomplete System ❑Individual Components Location V, ' Owner's Name Map/Parcel# p p (. Address Lot# -)Jr* Telephone# Installer's Name �> C i Designer's Name Address S 7 . Address Telephone# iE?� '1��D Telephone# ..� Type of Building Lot Size U sq.ft. Dwelling-No.of Bedrooms Garbage grinder Other-Type of Building No.of persons Showers (V),Cafeteria Q✓� Other Fixtures sue, r, S,nk LADVv1<j�,- Design Flow(min.required) gpd Calculated design flow Design flow provided gpd Plan: Date. L T� Number of sheets Revision Date Title Description of Soils) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation. ca t DESCRIPTION OF REPAIRS OR ALTERATIONS Cdl � utaluryING ENGINEER MUS I SUPERVISE iNSTALLATION AND GERTIP� IN WRITING THE SYSTEM WAS INSTALLED IN STRICT ACCORDANCE TO PLAN. The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furqjeE3gcae&LQ not I ce the m o eration until a Certificate of Compliance has been issued by the Board of Health. Si ned Date 64C,-03 Inspections � ,7... � . ,. ..��. ., ....-.......�.,..._,.. _,,.Y,..'Y""'• =r. -`� . 4 [ ,. .,:.� t�-r-f wr ,.,, .n� �---� .- +. r _. ..-ram^i� , . i -N� ma`s , FEE COMMONWEALTI-I Of MASSAL_.HUSETT . Board of Health, � `p� MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT f Application'for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - Complete System ❑Individual Components Location Owner's Name Map/Parcel# t MA9 Address '5() OL'9% d `(,Q Lot# Telephone# " Installer's Name Designer's Name Al g V1 MJLI� •� Address c:► ' � � Address Telephone# ��(E,_ '2�r,Q yv Telephone# A �Q C� Type of Building �Si ;/ Lot Size: r of sq.ft. Dwelling-No.of Bedrooms �QJ�- �'� I Garbage grinder 4h Other-Type of Building K. fKlo No.of persons Showers p � (1�,Cafeteria (14 Other Fixtures .C..t.)� r Y k2c, S.fA: - Design Flow (min.required) 4D gpd Calculated design flow �}- Design flow provided _gpd ` 4�, it Plan: Date 1 1 � n Number of sheets Revision Date Title -K' SJcI-412&- c�S Description of Soils) G C'�rO Soil Evaluator Form No. Name of Soil Evaluator 1 �s, Date of Evaluation co s DESCRIPTION OF REPAIRS OR ALTERATIONS r'� A--o The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with leprovisions of TITLE 5 and further agr-ees to not oacY' s p ee!i ystem o eradon until a Certificate of Compliance has been issued by tfe Board of Health. Signed Date Inspections _ f No.Eco 3 FEE COMMO1V` V'V' iN. LTII OF MASSAC14USUTS Board of Health; .JQ Q IDS 4 '�� MA. Descnptiori of Work:t O;Individual Component(s) Complete System The undersigned hereb certify that the Sewage Disposal -- System; Constructed ( ),Repaired ( ),Upgraded (VT Abandoned ( ) at a'-573 VAf'r�r.-\c, St v cc'C`- 01f W NN1SGb2'r— o has been installed in accordance with the proviso s of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. �b03' dated 4o -A . Approved Design Flow (gpd) e Installer ' Designer: Inspector: Date: U ZO 16_5�' The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.103 FEE ( NWLALT14 OF ( T S Board of Health, SA L � , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT N Permission is hereby granted to;; Construct( ) Repair( q-1 grade( ) Abandon( ) an individual sewage disposal system at 7- 1t/ �S 1 L r 11+ 15-T &a e-- as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed /within three years of the ate of is r •it. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Y/ /I(v Board of Health TOWN OF BARNSTABLE i LOCATION' f I <1 SEWAGE VILLAGE nl$4- 4 ASSESSOR'S MAP & LOT t IS INSTALLER'S NAME&PHONE NO. !�G SEPTIC TANK CAPACITY �' G LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR O R �e- PERMTr DATE: 3 COMPLIANCE DATE: (p o 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 r i I - _ © 1� 0 IF) lip �SeN 20- 01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 N • u� • � srzs;oc NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM C\4Q-t-- +J hereby ccrtify chat the engineered plan signed by ^.e urtec concerning the property located at all of the f;I:o,ying c;ntena: This failed system is connected to a residential dwelling only. There are no .ommercial or business uses associated with the dwelling, • -F.e soil is ciass:;:ed as CLASS 1 and the percolation rave is less than or equa to �t:nutes Per inch The applicant may use histoncal data to conclude (h)s fac, ur may :or:duCt Dre!irr.war tests ac the site without a health agent present • There :s no increase in flow and/or change in use proposed There are rio vanances requested or needed. • The bottom of the proposed leaching facility will not be located less man fourteen I feet aonve the maximum adjusted goundwater table elevation. rAdiust the nund.vater cable using the Frimptor method when applicable) Please complete the following: DI GrounO Surface E!eyanon (using GIS information) r 5'. G.ti4' F;cvar.on _ �,d,ustmen( for high G.W. - _)'FT"T.kENt-F. BETWEEN and a ............ ---_ .. NOTICE 31asec j (?n t.re above information, a reoair permit will be issued for -)edroorns bedrooms are authorized to (h-. future witow e-i,tneerec ,v;te'n plans. :au P<iccamp Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 2'6 Lot No. Owner: A Address: Contractor: Address:__ co- 4��Ri`��� ) Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date a r month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... OB Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... mont /year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 26) determine water-level adjustment ..............................................:........................................... 0 a STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to.water level at site (STEP 1) J; Figure 13.--Reproducible computation form. 15 CARMEN E. SHA Y (508)-548-0796 ENVIRONMENTAL SERVICES,INC. P.O. Box 627,East Falmouth,MA 02536 June 20, 2003 RE: Certification of Title V Septic System Installation: Residential Property—28 Patricia Street, Hyannis, MA Dear Sir or Madam: On June 17, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 28 Patricia Street, Hyannis, MA, based on a design drawn by Shay Environmental Services, dated, June 13, 2003. XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With'State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions, please do not hesitate to call the undersigned at (508)-548-0796. Sincerely, CARMEN E. SHA Y ENVIRONMENTAL SERVICES,INC. SH OF y ASSgC o CARMEN ; E. SHAY C. Carmen E. Shay, R.S., C. E. No. 1181 President �C'1 8 T ERGO S'INI7AR�0.� DATE 5/26/05 PROPERTY ADDRESS 28 Patricia street Centerville MA 02632 On the above date, the septic system at the address above was Inspected. This system consists of the following:. 1., 1- 1500 ga 2ion tank., 2., 1-Dizta.igut.ion Box. 3., -Kigh Capacity Zn�iQebtatoa.5.1 Based on Inspection, I certify the following conditions: 4.1 7h.iz .i.6 a 7.iUe- T.ive Septic hyztem.' 5.1 Septic zyztem .ins .in paope2 wo2k.ing o zdez at -the paeaent time.. 1 SIGNATURE Name: Robert.A.•Paglini t Company: Joseph P. Macomber & Son Inc Address: P. O. Box 66 '='f Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 rO ,.i JOSEPH P. •MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & .Installed Town Sewer Connections P.O. Box 66 Centerville, MA. 02632-0066 775-3338 775.6412 • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE'OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION e o TITLE 5 OFFICIAL INSPECTION FORM—.NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART-A - CERTIFICATION - Property Address: 28 .Patricia Street Centerville MA 02632 Owner's Name: James O'Reilly Owner's Address: Same Date of Inspection: 5 f 7 h/0 F Nance of Inspectors(please printer rt A P o.l 'n i Company Name: , . p. acom9puz X .S.o.n. Inc.. Mailing Address: Cen e2v.c e, �.sb.-02632 Telephone Number: 5 0 8-7 7 5:3 3 3 8 CERTIFICATION STATEMENT 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 15340 of Title 5(310 CMR M000). The system: XXXPasses - -Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ' Inspector's Signature: _2�_, _ Date: The system inspector shall submit a copy of this inspection reportto the.Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has 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. Notes and Comments ****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 5 Inspection Form 6/15/2000 page 1 I Page 2 of 11 OFFICIAL INSPECTION:.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM !` PART A CERTIFICATION (continued) Property Address: 28 Patricia Street Centerville MA 02632 Owner: James O'Reilly Date of Inspection: 5/2 6/0 6 Inspection Sum`mary:,.Check A,B,C,D or.E/ALwA'1S<.eomplete,al1 of Section D A. System Passes:y£S NO I have not found any information which indieates'that any of the failure criteria described in 3.1-0 CMR 15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Septic bybtem .ins .in /22ope2 wo�tUng...o2de2 at the 'Re-sent. .t.iine., B. System Conditionally Passes: NO One dr 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. NO 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 tankas 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: ~ NO. Observation of sewage backup'or break.out or high static water level in the distribution box due to broken or obstructed pipe(s)or duc 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 distribution box is leveled"or replaced ND explain: NO The system requited 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 28 Patricia Street Centerville MA 02632 Owner: James O'Reilly Date of Inspection: 5/2 6/0 6 C. Further Evaluation is Required by.the Board of Health: No 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: No Cesspool or privy is within 50 feet of a surface water DLa 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 Sapp4er,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: No 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. No The system has a.septic tank and SAS and the SAS is within a Zone 1 of a public water•supply. No The system has aseptic tank and.SAS and.the SAS is within 50 feet of a private water supply well. No 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 visual "This system passes if the.well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A . CERTIFICATION(continued:) Property Address: 28 Patricia Street Centerville MA 02632 Owner: James O'Reilly Date of Inspection: 5/2 6/0 6 D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no".to each of the following for all inspections: Yes No X Backup of sewage into facility or system.component due to overloaded.or clogged SAS or cesspool X Discharge or ponding of effluent to the surface.of the.ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in•eesspool is less than.6"below invert or available volume is less than'/2.day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface wgter supply.or tributary to a surface water supply. X Any portion of a cesspool or privy is within a:Zone 1.of a.public weal. I _ X Any portion of a cesspool or privy is within.50 feet of a privatkwater supply well. �.. I _ X Any portion of a cesspool orprivy 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 coliform bacteria and volatile organic compounds indicates.that.the well is free from pollution.from that facility 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 fort.] No (Yes/No)The system fails. lhave determined that one or more'pf 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 1.0,000 gpd.to 15,000. gPd• You must indicate either"yes"or"no"to,each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 28 Patricia Street Centerville Ma 02632 Owner: James O Reilly Date of Inspection: 5/2 6/0 6 Check if the following have been done.You must indicate"yes"or"no"as to each.of the following: Yes No _X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X — Has the system received normal flows in the previous two week period? - X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X — Was the:facility or dwelling inspected for signs of sewage back lip.I_ Was the site inspected for signs of break out? `" Were all system components,excluding the SAS,located on site? X _ 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? X — 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: Yes no X Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.3020)(b)) 1 • 5 , Page 6 of I 1 OFFICIAL INSPECTI:ON FORM-NOT FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 28 Patricia Street Centerville MA 02632 Owner: James O'Reilly Date of Inspection: 5/2 6/0 6 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number of.bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 Number of current residents: 2 Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage..system(yes or no):rz o [if yes separate inspection required] Laundry system inspected(yes or no): a o Seasonal use:(yes or no): n oo , Water meter readings,if available(last 2 years usage(gpd)):' Sump pump(yes or no): n 0 Last date of occupancy: Ba e h e nt COMMERCIALdr6USTRIAL Type of establislint: N/,4 Design flow(laased on 310 CMR 15.203): gpd Basis of design'&w(seats/persons/sgft,etc.):., Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use:_. OTHER(describe): GENERAL INFORMATION Pumping Records _ Source of information: N/R Was system pumped as part of the inspection(yes or no):n o If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X 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 a e of all components,date installed(if known)and source of information: 6/20/0 f Rogea.tz .se/2t.ic Were sewage odors detected when arriving at the site(yes or no): n 0 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Patricia Street Centerville MA 02632 Owner: James 0'Reilly Date of Inspection: 5 2 6.10 h BUILDING SEWER(locate on site plan) Depth below grade: 1.2" Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): jo.intz appeal Light o No e*akag.e.- Vented thorough a o o -vent SEPTIC TANI(q E S(locate on site plan)' 1500 ga.2 e o n z Depth below grade: 4" Material of construction:X concrete_metal_fiberglass_polyethylene --other(explain) 9 If tank is metal list age:_ 'Is age confirmed by a Certificate of Complianee(yes or no):_(attach a copy of certificate) Dimensions: 2'X 5 10"X 5' 8" '' Sludge depth:__. /tace Distance from top of sludge to bottom of outlet tee or baffle:t 2 a c e Scum thickness:taa ce Distance from top of scum to top of outlet tee or baffle: t a a c e Distance from bottom of scum to bottom of outlet tee or baffle: �m c e How were dimensions determined: m e a z.0 ve d Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid.-levels as related to outlet invert,.evidence of leakage,etc.): um� tank ev,, 9 outiet teen aze .gin /2 ce.i 7ank .iz ztauctuagiiu zound., GREASE TRAP:NO (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): (72eaze t/taR .iz not 12aehemt 7. Page 8ofll OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Patricia Street centerviiie MA 02632 Owner: James O Rei11 Date of Inspection: 5 2 6 0 6 TIGHT or HOLDING TANK:NO (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): Tight olt ho eding. tankz ate not /z2ezent DISTRIBUTION BOX: Y I- (if present must be opened)(locate on sitd"8 an) 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 .i_z .P_evei ha-6 3 .Qate2a.ez., No zo2.id ca2auovea o z eeakage in o/t out fox., No -eekape .in o2 out oe &ox.i PUMP CHAMBER: NO (locate on site plan) 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.): P um/? chamgea iz 'not p/te sent 8 Page 9 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Patricia Street Centerville MA 02632 Owner: James O'Reilly Date of Inspection: 5/2 6/0 6 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located see /gage 10.1 Type leaching pits,number: X leaching chambers,number: 7 leaching galleries,number: t: 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.): -� Loamy to medium sand., No zignz o�e /a.iivae o2 12oad.ing:,So.iRa ate d1ty.1 Vegetatzon tz no2ma CESSPOOLS:NO (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 or no):. Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Cezz12oo ens .ate not /22.e sent PRIVY:NO (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.): l2 ivy .ih not /12ebent • I 9 i Page 10 of 11 OFF�CIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE;DISPOSAL SYSTEM INSPECTION FORM PART C. \, SYSTEM INFORMATION(continued) Property Address: 28 Patricia Street Centerville MA 02632 Owner: ,Tamp- n'R _i 1 1y Date of Inspection: S.1 2 6.1 n ti, t SKETCH OF SEWAGE DISPOSAL SYSTEM Proide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate.where public water supply enters the building, -T i ! 0 r{ -_ i 10 Page 11 of 11 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART.0 SYSTEM INFORMATION(continued) Property Address: 28 Patricia Street Centerville MA 02632 Owner: James O'Reilly Date of Inspection: 5/2 6126 6 SITE EXAM . Slope Surface water Check cellar - Shallow wells Estimated depth to ground water D feet Please indicate(check)all methods used to determine the high ground water elevation: Cl( Obtained from system design lain on record-If check4 date of design plan reviewed: S u e e Observed site(abutting property/observation hole within 130 feet of SAS) w �e sChecked with local Board-of Health-explaimaA clad no Checked'with local excavators,installers-(attach documentation) 1 e6®ccessedUSGSdatabase=explain�;t;6R:iowa.,9uan:5.ta1-ee,-me.-us You must describe how you established the high ground water elevation: Uzed. : Cape Cod Commizion Oate2 7agie Codtoua,3 And Pugti.c 0aie4 Suppiy Oeii head paotect.io.n _;aaeaz map.- Sept 1995 Oaiea ze souace s 0_,e giee cane cod eomm.i s ion.- Leaching Pit feet Groundwater. eet Below Bottom• of Pit' High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the.vertical separation distance between the bottom of the leaching pit and the adjusted groundwater able is feet. ., 11 •mn,•.,.—e,,.r-,.r•.-.n.r-,,.m.nesr+r.r .#TOWN OP BARNSTABLE HOARD QF HEALTH - y -SUBSURFACE SUA09 DISPOSAL OUT$ ItrSPFCTIQN FdRH - DART D-- CERTIFICATION y «•TMI R•Y1st�71g1'eel'AN111u'7tns►r77s11f�/7//'111fTrAR 1T'+rr r —TYPE OR PRINT 01,9440- PRO.PEltTY ,rNSPFCTED STREET ADDRESS 28 :Patricia Street Centerville .02632 ' A-SSESSORS MAP DLWK AND 'PARCE•L OWNER'a NAME James _Q'Reilly- PART"'D - 0RRTZFt0AT30N NAME 'OF •INSPECTOR Roth. Pao�Unl COMPANY NAME =li 'P._rNaeomllat�':._ 'Sen Inc ,_„ „:.._,.. ....._ Box 6 6 ' Czn4mv.ilta Na4b' .02632 , COMPANY AUD.RESS. ' stsr �' Tovn-or 01ty. to • LIP COMPANY TELEPHONE ( 508. Y fi73 3338. -FAX (' 508-1,1790 f 578 wrs srrewiYsrw��i�/��� CURT-I-FICATION. STATEMENT I 'certify that I -havo persotia11y .i,ns.peoted ..the sewage -disposal. eyetem at this address and that. t )$• information reported ,is truep. R.Rcura•tey grid omplete as of the tithe aif.•inspection.,• The inspevtiOrn was per•Forned and any recommendations regarding upgrade•, .ma•intennnee1' and repo-Ir .afie• oon$is'tent with., my training and exp.4prience in the ppoper futTeti.-on- and maintenance of on- site sewage disposal systems • Check one; )6ff-systevi, PAS,92D - The inspection irhic.h •I have -conducted has .,n•ot• •Pound any information . which indicate$ that- the system' fails to ' adeduately. protect .publi-c health or the envi.ropment as defined iti• .310 CMR. 16 30.3-* -Any failu-re criteria *o� evaluated are as stated in the FAILURE' CRI'tMA ;seeti-'n o•f this form. System FAILED* The inspection wh ictr I have co'ncmtited 'has '•found that the system fails to protect the public health and the enV4ronment ' in ao9aVd•anee with Title 61 310 CMR 15 . 303, and as • specifically noted -on .PA:RT• C -. FAILURE FAILURE CRITERIA of this inspection ,form. Ins.pector Signature Data .�, ne copy of this certi f io;t•iob must .be ovided 'to =the .pWNMI 1 ho BUYER where appli•.aa.blo) and thI DQARD OF HZA Tit• „ * It the inspeetrion FAIL-Eb,, thb .ewne1%*.Ox',"gperator •s:hall . upg•r?e►ds'.the eyetem. within o'ne year of the dat-e of the inspection, unless. &I'lowed Qr' required nt.hr:rw{se as Provided i? q;1,O CMR 16 ,30S.t ; . 1 VENT PIPE O Least 24 inches loft j 2000' +/ 10' min, from *NOTE: ALL PIPES ARE TO BE 4 SCHEDULE 40 P.V.C. I SECTION A -A ALL OUTLET PIPES FROM THE tj Schedule 4 PVC w/Charcoal Odor Fitter DISTR�UTION BOX SHALL BE Adr Existing Foundation [house to septic tank PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET LEVEL FOR AT LEAST 2 FT. t2" CONCRETE COVER � ena TOP OF FOUNDATION ELEV. 100.00 (Assumed) Septic lank covers must be within 6 in. of finished grade 3" of 1/8" - 1/^`"Washed Peostone r_',• C od Code over Septic Tank - 95.75 Grode over D-Bo. - 93.50 e over SAS Vories from 94,00 to 92.p0 3- 5"OUtLET t.. :"c,.j�, 2" 3/a" tot 1J2 " washed Crushed Stone r KNocKouts 2 ° 0 I L -15.5" OUAET "'ti I 12• INLET S . 0.02 3 HOLE H-10 C7 12' NEW S.00t or C+eoter DIST. BOX 3' Mo.imum Cover 6" F Top of SAS - Elev. �89.�5 - Ex1sf.PIPE 7,500 GAL. -"•` 2 3 iL U.SITE v FROM EXIST. FOUNDATION n 14' S- 0.01" per foot 15.5" Y 4" - SCH- 40 T• Q rn SEPTIC TANK V Effective Depth t.75' ' rn H-10 '� 6 n a-N.',, Q N �, PLAN SECTION CROSS-SECTION `" a f, > If sr a 7 Units 2 6' 42' C a. CONCRETE FULL FOUNDAT y 1 n Qy W �• ha dwi - W � u 00 n $ 3 3 c e SYSTEM PROFILE 6 n.of 3/4"-1 1/2" v n v Co to 3 HOLE H-10 DISTRIBUTION BOX Crai k c compacted stone } v y fl' 9Vi((E, Not t0 Stole - c NOT TO SCALE Beach E O I (' MAP c Effective Length Ch Poo Ly L11 UJ I` AP c2.5 ---- 6 in.of 3/4--1 1/2' c 10 F� SOIL ABSORPTION SYSTEM (SAS) GENERAL NOTES compacted stone Effective Width p M CULTEC MODEL 125 (H-20 LOADING)/ SHOREY PRECASTE 1. Contractor is responsible for Digsafe notification 114ttsar_4!_Inatn4ts_I_�!E,eJt�,D9____---- and protection of all underground utilities and pipes. (OR EQUIVALENT) Not to Scale 2. The septic tank and distribution box shall be set NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 12" lever on 6" of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size, 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance PERCOLATION TEST with Title V of the Massachusetts state code, the approved pion and Local Regulations. Date of Percolation Test: JUNE 13, 2003 6. If, during installation the contractor encounters any Test Performed By CARMEN E. SHAY, R.S., C.S.E. soil conditions or site conditions that are different Results Witnessed By. WAIVER ( per Barnstable B.O.H.) LOT #29 LOT #30 LOT #31 from those shown on the soil log or in our design Excavator: ROBERTS SEPTIC SERVICE installation must halt & immediate notification be Percolation Rate: Less Than 2 MPI made to Carmen E. Shay Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the '98 septic system unless noted as H-20 septic components. Test Hole i 96 ` -�^ - S 15d 09' 50 W 98 96 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. No. 1 _ _ _ 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 105.00 1 10. All solidpiping, tees & fittings shall be 4" diameter DEPTH SOILS ELEv. _ --- g 0 9a-o0! _ --- Schedule 40 NSF PVC pipes with water tight joints. _'` -------- -"Yr7 5 LOT #25 Sandy g4� 11. Municipal Water is Connected to ALL OF The Residence and Abutting Loom �_ -t3.25'- - - `8' 10,500 Square Feet t/ Properties Within 150 Feet. 10 rR 3/2 2 -96 THE PROPERTY LINES ARE APPROXIMATE AND - TEST HOLE #1 Loamy f `` a•j . +. • ♦h �; EL EV,= 9 4.00 COMPILED FROM THE SURVEY PLAN BOOK 116 PAGE 73 Sand ;a^ ::� o y •��,:,.-.<r,i ...;{�. �.- ,' O AND IS NOT INTENDED TO BE A SURVEY .PLOT PLAN 10 TR 5/6 PVC V NI O IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 6"- 36" B. 91:001 Failed ' O THE SEPTIC SYSTEM INSTALLATION. �-\ �, O, Med-Coorse 1 Cesspool Sand ( NEW 1500 got, 2.5 Y 7/4 I LOT #26 D"X � Septic rank 36"- 62 # 9.90 �A j �� '� LOT 24 - Medium I 28 5 Send EXISTING CESSPOOLS TO BE PUMPED & REMOVED TO FACILITATE p ) '� INSTALLATION OF NEW SEPTIC TANK. 2.5 r 8/4 � 52 132 3 p / DECK NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE .. FROM THE CESSPOOL TO 'BE DISPOSED OF `AS"PER--BOARD OF HEALTH SPECIFICATIONS.- PROJECT BENCHMARK _ TOP OF FOUNDATION % EXISTING o Perc #1 ELEV. = 100.00 (Assumed) 4 4 BEDROOM m _------ I " - Depth to Perc: 38" to 56" / I LEGEND Perc Rote= Less Tho 2 MPI W HOUSE , O Groundwater Not Observed _-- No Observed ESHWT O ADJUSTED H2O Elev. None �- f i 104X 1 DENOTES PROPOSED o i GRAVEL i SPOT GRADE t DRIVEWAY , DENOTES EXISTING i1 X 104.46 SPOT GRADE t � v� \\- - ------- ` PL PROPERTY LINE 105.•00 I - nt`c N 15d 09' 50" E c 9761^l PROPOSED CONTOUR SO- a � •_ �: �.� __ 97- ._ .._.. _.._ .,,.. -.97 EXISTING CONTOUR ------------- -------- ------------------ i-- ! I 11t ------------------------------__ TYPICAL 1500 GALLON SEPTIC TANK DEEP TEST HOLE & � �7 PERCOLATION TEST LOCATION 7r- NOT TO SCALE .l-" A Tl 3-24" DIAM. ACCESS 4ANHOLES 6 .FOOT STOCKADE FENCE (40 FOOT RIGHT OF WAY) - - 44 r INLET P LOT PLAN OUT ET THE ACCESS COVERS FOR THE SEPTIC TANK.DISTRIBUTION BOX AND LEACHING COMPONENT OF PROPOSED SEPTIC SYSTEM UPGRADE �., .,,� ;r T• _ �� SHALL BE RAISED TO WTHIN 6- OF t.1 ,.. FINISHED GRADE. PREPARED FOR STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EOUALS PLAN VIEW ON ALL OUTLET TEE ENDS O L_E G P O M E R A VT Z E F F AT # 28 PATRICIA STREET v HYANNIS , MA 3-24" REMOVABLE 1 BLE COVERS I 4 - Design Calculations me. ifwonce ;, ,r »LET oF,y PREPARED BY: INLET 6' n++ min. Wet to Outlet 6• OUTLET _ Number of Bedrooms: 4 Equivalent to 440 GaL/Doy (440 Gal./Day Min, per Title V) �y 9 - T, Lquia level .::-�; Garbage Grinder: No O m:n. T ,r t-- 5 -7- a r 9 Capacity p /Dot ( ) o C!11 it L 1 Y L . A�l 1 l7 k _ _ LeoChin Ca aCit Pro Proposed: 440`GOI. Minimum Min. Per Title V R w �`- �_p.min. t Septic Tank - 2 x 440 Gal. Da = 880 USE Exist. 1,000 GAL. Septic Tank. E p / y P 0 20 40 50 $H r ENVIRONMENTAL SERVICES, INC. b 6oi°e Lqua depth x I, 7 SOIL ABSORPTION AREA: Using percolation rate of <2 ruin./inch ,2 ., No. 1 P.O. BOX 627 [�`. � Bottom.Area: 0.74 got/sq. ft. x 480 sq. ft. = 355.2 gallonsSid. . � .,.,t -.,. .. ,. ..-••. await.Area: 0.74 gal./sq. ft. x 116 sq. ft. 85.84 gallons 4 r. .. , .,. ........., 01STE EAST FALMOUTH, MA 02536 aat.o4 Providing: = gallons SAN1tARiA CROSS SECTION END-SECTION Use: (7) CULTEC MODEL 135 UNITS, HAVING A 1' EFFECTIVE DEPTH, SCALE: 1 "=20' TEL/FAX 508-54$-0796 TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3' OF WASHED STONE SCALE 1 "=20' DRAWN BY CES DATE: JUNE 13, 2003 ON THE ENDS. No sroruE UNDER. PROJECT#SD433 FILENAME: SD433PP:DWG SHEET 1 OF 1