The URL can be used to link to this page

Home My WebLink About0111 PATRIOT WAY - Health 111 PATRIOTS WAY, CENTERVILLE A = 192-225 No. 42101/3 ORA 1p a n da 2v D S-K ESSELTE 10% o a a o TOWN OF BARNSTABLE , ?_{3CATION _ ��c- t_1.Ji--c--'� SEWAGE # a � 1 �!ILLAGE -e� �� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.. SEPTIC TANK CAPACITY `S ,t w 01Z) LEACHING FACIL=: (t� ) ��'i5 (size) NO.OF BEDROOMS �''S �`'G�""®�d� BUILDER OR OWNE PERMUDATE: OMPLLkN 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 �� 'r � TOWN OF BARNSTABLE LOCATION �ftldt w�Z SEWAGE # VILLAGE ASSESSOR'S MAP & LOT IN 'S NAME&PHONE 4! fgt iC.k ®CoArtjl q?6-177 SEPTIC TANK CAPACITY LEACHING FACILITY: (type)` r Al? (size) NO.OF BEDROOMS BUILDER OR Q30FEk + ►11 PERMITDATE: CO P+ C-' DATE: y/D� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f Z° qo yq I� No. �DS s 5 Fee (/( � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for 30igo5al bpetem Conotruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. I/ T/_r) V07— (Alp Owner's Name,Address and Tel.No. Assessor's Map/Parcel117- S��vlY�/ Installer's TAd �ssand Tel.No. Designer's Name, dress and Tel.No. a. Q 6lC S� 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 �2 a#ct S CY7r- (3 DU C.)d w Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) -T'N Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has d d Health. / Signed Date Application Approved by c Date 6 G! Application Disapproved for the following reasons Permit No. 9 00 05— Date Issued -7-t r _ t � t • ±f No. OU S 1 S Fee 10 - THE COMMONWEALTH OF MASS'ACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN O,F BARNSTABLE, MASSACHUSET7TS' } ZIpprtcation for Migpogal 6peum Congtruction Termit. Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessors Map/Parcel C..-,�'�- VC-), J ck r r Installer's Name ddres,s,and Tel.No. Designer's Name,Address and Tel.No. 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 �L>C t n coc-, w Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement:' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been-issued by<rms-B,oard of ealth_. t Signed Date . Application Approved by Date - Application Disapproved for the following reasons T— Permit No. a Do 5 3 t Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance � ,or`� THIS IS TO CERTIFY-tip t e On-site Sewage Disposal System Constructed ( )Repaired Upgraded{ ) Abandoned,(., )by lS C�.� at u'T w\A has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2 u,C-�?,I dated 7- —r) Installer�c� .�C Designer _ The issuance of this permit shall o be c nstrued as a guarantee that the sy em nc 'o as designed. Date 7 Inspector No. Fee -?WS"��5� THE COMMONWEALTH OF MASSACHUSETTS �CA- PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS igogaYpgtetn Co gtructionern�it Permission is hereby granted to Construct( )Repair( pgrade( )Abandon( ) System located at _. 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: Constructs7n /st be completed within three years of the date of this ermi . Date:_.� S Approved by 1`�• 6� _ i °F THE l Town of Barnstable BARNSTABLE, * Regulatory Services 039. Thomas F. Geiler,Director ArFD MA't A Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 July 13, 2005 Mr&Mrs William Seaward 18 Quaker Meetinghouse Road Forestdale, MA 02644 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 111 Patriot Way, Centerville,MA was inspected on June 9th, 2005 by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has Conditionally Passed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) DUE TO THE FOLLOWING: Outlet baffle in septic tank needs to be replaced. You have two years from the date of the system inspection to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE H AL DEPARTMENT a COMMONWEALTH OF MASSACHUSETTS 4 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS A'. y a d DEPARTMENT OF ENVIRONMENTAL PROTECTION F' A 3 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION CD Property Address: 111 Patriot Way Centerville MA 02632 f= ' Owner's Name: Paige& Bill Seaward Owner's Address: 18 Quaker Meetinghouse Road css Forestdale MA 02644 B co y Date of Inspection:June 9,2005 Job#05-156 Name of Inspector: PATRICK M.O'CONNELL ~1 Company Name: SEPTIC INSPECTION SERVICES CO. a M Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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 I)t approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ��ttH Passes _X_ Conditionally Passes PA RIC N Needs Further Evaluation by the Lo 1 Approving Authority = M. ; __ Fa' 'C ~ Inspector's Signature: Date: 6/9/05 � • .� •�OQ��`�� NSPE� it The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heafi or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Outlet baffle in septic tank needs to be replaced. ****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: 111 Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: XX _XX_ 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. Outlet baffle in tank is deteriorated and beginning to fall off.Baffle should have been replaced with a PVC tee when new leaching system was installed. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. _N_The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: _N 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: Ti to 1;inc—rtinn Fnrm f1l IV»nnn 2 i Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION(continued) Property Address: 111 Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 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. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria 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: Title C Oil Vnnnn 3 Page 4 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 111 Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 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 cesspool is less than 6"below invert or available volume is less than 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 water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X— 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 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.] _No_(Yes/No)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. 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 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. T;rIP S T"vnPnt;n"Rn—Aii;i,)nnn 4 i Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: I I I Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 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 up? _X_ _ Was the site inspected for signs of break out? _X_ _ 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 15.302(3)(b)] T41.f Tncn—tinn T7^n Ail ai,)nnn 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 111 Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 FLOW CONDITIONS RESIDENTIAL 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:0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2003—28,000 gal.2004—28,000 gal.=76 gpd. Sump pump(yes or no): No Last date of occupancy: One month prior to inspection. COMMERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(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: None Source of information: Was system pumped as part of the inspection(yes or no): No 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 age of all components,date installed(if known)and,source of information: 1996 Were sewage odors detected when arriving at the site(yes or no): No Titlo G inenartinn Anrm All ei')nnn 6 r Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: III Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' 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.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 3" Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8.5'long x 5.2'wide—1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Liquid level at bottom of outlet invert outlet baffle deteriorated and needs to be replaced. 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.): Titles G T"onontinn T7n Oil ci,)nnn 7 i Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 111 Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 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.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Liquid level at bottom of single outlet pipe with no high stains,observed traces of solids carryover most likely getting through cracks in tank baffle. 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.): Titles G inanortinn Rnr All G/IAnO 8 I I Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 111 Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _X_leaching chambers,number: Four infiltrators. leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): No access to interior of infiltrators,probed stone around SAS and found stone clean&dry. 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.): 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.): Title G Tno..artinn Pnrm A/i ciinnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: III Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 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 wells within 100 feet. Locate where public water supply enters the building. Patriot Way Driveway Water service #111 Deck 20 40 30 49 Four infiltrators 9' x 26' SAS Titla G lnenartinn Anrm ail,;mnon 10 r Page 1 I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 111 Patriot Way,Centerville Owner: Paige&Bill Seaward Date of Inspection: June 9,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.35 and topo map shows property at el.70. T41.S Tncnarfinn Fnrm 4/1;iinnn 11 i No..- e 'V14 o Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for Digpogal *p.5tem Construction Permit Application for a Permit to Construct( )Repair(/pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (075 6-14'K Owner's Name,Address and Tel.No. Assessor's Map/Parcel )ya i cftI— Inst ler's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. aV Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 r gallons per day. Calculated daily flow —33 C) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 4� Nature of Repairs or Alterations(Answer when appl' able) ( 3 I On- St oy S 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 th nvironmental Cod and not to place the system in operation until a Certifi- cate of Compliance has,�e�-iest�et�-l� of He Signed Date 0 Application Approved by ate /y 7 oor Application Disapproved for the following reasons Permit No. 9t 6 D Date Issued �r }Nod ' �v — y Fee y Entered in computer: j THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -.TOWN OF BARNSTABLES MASSACHUSETTS ,. 2pplication for Migooar 6potem Cottgtruction Permit = Application for a Permit to Construct( )Repair(/Upgrade( )Abandon( ) ❑Complete System ❑Individual Components a Location Address or Lot No. /'Q'� Owner's Name,Address and Tel.No. Assessor's.MapfEarcel j�� .r(,�' �� G�. � � a'� .,�,✓ Inst er's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: j Dwelling No.of Bedrooms Lot Size 1 sq,ft. Garbage Grinder( ) li Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow 33 gallons per day: Calculated daily flow gallons. ' Plan Date Number of sheets Revision Date Title 'N Size of Septic Tank Type of S.A.S. Description of Soil t v t t= !`�A 5vsAccr� Nature of Repairs or Alterations(Answer when applicable) -��C �� ✓+r�+�-�U�t''�-�v��c �j W( .3 pri- SI�(�"� —t- 1''�tt Vu-r o s E'�c S`r N� S c�Yri7 f i r"iU t Date last inspected: - Agreement: The undersigned agrees to ensure to construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of tnvironmental Cod and not to place the system in operation until a Certifi- cate of Compliance has_,beon-issued-by-tea-. q fd of ea.th. Signed Date Jd Application Approved by ate Application Disapproved for to following reasons Permit No. 9l • 660 Date Issued 44 S'G ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE t t the On-site Sewage Disposal System Constructed ( )Repaired (V )Upgraded( ) Abandoned( )byc 1 at iFCTr", �t.C1 fti`Cc has been constructed in accordance with the provisions of Title 5 and to for Disposal System Construction Permit No. 7 6 `t, 6e dated I-)-/ 2 -fit Installer Designer The issuance of this pernut shall not be construed as a guarantee that the sy_stel, ilk-function as designed. Date 1 �/ 6 Inspector:' No. / 6-— —————————————————————————— —Fee � THE COMMONWEALTH.OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mwiopoal *p6tem Congtruction Permit - Permission is hereby granted to Construct( )Repair(0/)Upgrade( )Abandon( ) System located at �A' v`l o1 S to IA w-/ and as described in to 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 p rMit, �/ Date: ,� �` �7— �� Approved by L/lil�C �� l / v NOTICE:This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated f `��L�,(� , concerning the property located at �f/ &r r b i s 1A KV f t4-f meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: 1 DATE: U� LICENSED SEPTIC STEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j xert �j 0 ,� TOWN OF BARNSTABLE LOCATION r�/�(/!1 sin ie kS 09V SEWAGE# VIYLAGE �t�P�2�/Z�e ASSESSOR'S MAP&LOT . INSTALLER'S NAME&PHONE NO. �?/U �<427L� 7 OG SEPTIC TANK CAPACITY /,0 0 O / LEACHING FACILITY: (type) „� R)Mq f0 S (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: �~,P' —7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 - v r m� ~ t qb 0 3 3 (,a, I ,LOCATION SEWAGE PERMIT NO. �,ialj s,;-A A Cc 716 VILLAGE INSTA LLER'S NAME & ADDRESS C,-1�2�e UJOLA)et B U I'L D E R OR OWNER 134, A)A) g- DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� --27_�r r _ . .. - � �,, r /� T V\ � .,, >�' y �� iT� `� 7 ` No......... _... .......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............ .........OF.... .s &cs.L1 .......................... , ppliration for Dispoii ai Works Tomitrurtion runfit Application is hereby made for a Permit to Construct 0>16 or Repair ( ) an Individual Sewage Disposal System �°T---.. ,j 'Y :-(Fk. v L L --------•--.....---•---•-•-- Location-Addr ••••--or rZt No. /1y .!'1 ..._. _ .P................. C�4 .: �I.��.I.. !!�l.�.SL. Owner ress atf?y W�a �-RR tC►�_ N .R.ln� ............................. Instal r Address dType of Building Size Lot.,_P4A_q_.3_......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (� Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ................................. W Design Flow............................................gallons per person per day. Total daily flow.............. ..............gallons. WSeptic Tank—Liquid'capacityt 0 gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No� Other Distribution box (�Diameter....... Dosi0n^tank Depth th)below inlet__.:'�.?...... Total leaching area._—>,��.. ._sq�t. z�� y - _ - �► mac, /- Percolation Test Results Performed by._. 1�v*.F.... 11 °............. Date_..-..1.07 �?'...._.. �a Test Pit No. 1----Z .....minutes per inch Depth of Test Pit.....9 -._' _ Depth to ground water....../._1/1Q--- . Test Pit No. 2-__---..._---_minutes per inch Depth of Test Pit.................... Depth to ground water-----................... P5 . Description of Soil..............••-- ►�U ......!.rss.0 L == W --------------------------- �` )� ��eaJF - 511�_6......_..--------•------------•------•-•••--•----•-••--•-••-•••-•-.....--••------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------- -----------------------------------------------•------------------------.....-•-•--_----------•---•-•-•-----••••---•--•-•-----•--------------•--------•••-•---•••--•--•---•-.....--••.--•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I'L i p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ' su by�ebo�rd o ealth. Signed :... ----------------•- ..... •.ti_�..:-.3.1-?_ Date ApplicationApproved By..................................... .......................................................... ........................................ Date Application Disapproved for the following reasons-------------------------------------•--.....------------------------------------------......................... ------..._..•---------•-••••--•----•-----------•-•---•--•--•----••----•••••••-•••••-----•--•-•--•--••----I--•••••-----••-•-----•-••--••••---•--------------------•-------•----•••----- Date PermitNo......................................................... Issued_...1.:2�.�+?�-772-r..................... Date t �y> FEs...... ...":" • No.. ... THE COMMONWEALTH OF MASSACHUSETTS BOAR®�.OF HEALTH Appliration for tisposal Works Tonstrnrtiun rnmit Application is hereby made fora "Permit to Construct ) or Repair ( ) an Individual Sewage .Disposal System at: 1-u�............................ \---- .1.' ....................... c tion-tYddress or Lot No. .....4,-� t'-------•---•--------- ...~. , ---____1,4,1c.... _�1.� --•----t U�../ �J1_�.1-t.. ----•---- �Wner Address 4 1 1 • .1�'( �� ni�.i _a ---•----•----'�A.r'1-�.................................. _ st er Address UType of Building Size LOtI_,j_l_!_3_________Sq. feet Dwelling—No. of Bedrooms.__..._.______________________________Expansion Attic js�) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons....................._...... Showers ( ) — Cafeteria ( ) Q, Other fixtures ..---....--••••-•-••---•••----••-- - •--- W Design Flow.................:..........................gallons per person per day. Total daily flow-------- ................gallons. WSeptic Tank—Liquid capacit j{)C }gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------r----------- Diameter__-__ Depth below inlet_-!-- ........ Total leaching area.>__L„(._____sq. ft. Z Other Distribution box k) Dosing tank ( ) Percolation Test Results Performed ------ .................. Date----- .......... �. Test Pit No. I.._ __.____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........................ -------------------------------------•;•- •-•------•-••-•----••-••-._............._..._..-••---•-•---•---•••••-•.......•-•••--...._._...............--_---- DDescription of Soil............0 2------- ...S 13-VS S-Lza-L-----------------------------------------------------------•--------------___________--___ x W -- ---------------- t 2 � ------------------------------------------------------------------------------------ UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ -•---•-•---•••-•------------•••••-••-••-----••--•••----•-•-•-•••••--•-----•--•-••--•...............•----••-----•--------•--------•••-•-••---•--•-•-•••---•-••-•••--••-••-•---••-....................... Agreement r The ttnderiigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT?.i�. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been •issiyd byyl! board o tealth. Signed ._ .. ? ,1�- �1_..�a.�..: Date ApplicationApproved By....................................._/.......................................................... ........................................ Date Application Disapproved for the following reasons-------------------------------------•------------------•----------------------------------------------•--••-•-•- -••------•................•---•-----_.__...--•-_._....--••---•-•----•••-------••-•---.......•-•-•-------- Date PermitNo......................................................... Issued....................................................... Date 1 �,.,.. r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF...... ��. (v's+�:•`�-,/ L. .............................. (9rdifiratp of Toutpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed >< or Repaired ( ) Installer at...............�,� ). Al��.�-d_1 ........................---- has been installed in accordance with the provisions of TI j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..-___ :_____' `_____________ da.ted.__ `ray., /`_.__ . ..._..________ .., t THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �-DATE.::::_l... ....`--�-•� --- Inspector__..__, ----- G ---•--__-- ---•-------•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 P,1 E�.. \..ax,<:,J .......OF......t�:fC �1. F3.L.:E,..................... No._. �........... FEE........................ Disposal Works Tonotnulin rrmit Permission is hereby granted..... < � �� to Construct or Repair ( ) a Individual Sewage Disposal System � � at No..... E �'�-....r -1 o G 1----EW�ly.-------- 1.'1E_/ 1�1- .1,. --•-•----==== .................... Street as shown on the application for Disposal Works Construction Permit No___________________ Dated_._;��j�.��___._.._. -•--...••• - ---r--•--•--__--•---- - rd oie ,� "•Board o�I�alth •��"'^ DATE...........�r3�-..-_7� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS v.A' :: ..1. & + r. 1 t,. � .a �""',.. - - � n:a 4 ��, ! } js{�arj a�l •� 4'" y�IW:. �� 5,T y � + v .. { '. ,. 5. .. '•� Z q W ty t itFt,,1�.' V if # f , ��b.�� ♦ + i r :rr r �2 7 h 4 114 r i / � I,• ,� -xt � `1 2'+'R" S � . r L f �F _f t .+r,,, '',a ICI I �^'�-�•' •v10 y F "d k rA 40�0 •�' ._ LEIF µ 'C Q_ F al > ' C+ l � ,h is '',. �cP/?/✓S/� v[rtS ti c', r y L , � x , N Or14 rq �� * t t" Al rr x s: + _ •.t �^. ( l 0 � OF a � , ROBEUT $ P. ,, �rF I i t�7 . r 7�, T f lr{ R t " a .{�., _ D , H ` y ft 't, '}, r!� c� BUNIK S No.22162,0 jij /STF, EG EN D X; 3`TIAIG .'SPOT ELEVATI®N Ox0 sERTIFIEC).� F LOT �`N' a �" 'I$TIN CONTOUR —— = p — L T ' 04L 4 IFtINI•SHED', SPOT ELEVATION PA 2/0 T vi y ,FI•Nr. �D: coNTouR — p j { •r 't4 , .err.>. A4PPROVED BOARD OF- HEALTH i�kc k�r !'z�--._.�T' JI,.SF - . • e a��•�1�I��®� ��® ��fJ� .: 0 P Y.., '"A T E{; AGENT — SCALE _ � /'�,,TD SATE �! r ._.---- -- -- _ +� � tE®GE E/VGIhIEERIAIG CO. lIVG l.✓c2A/c y _ CLIENT _ � ^ ^ F F _ _..f -- I CERTIFY THAT THE: 4PR®'ROSI '!C�G E( IStERI: REGISTERED �� 'U BUILDING SHOWN (JN 'THIS"T,PLx�AA? .A J08 N0. __ CIVIL LAND -- — �� r:. � r COS FORMS TO THE ZONINQ L' % ,Ir:IV�QINE',ER `SURVEYOR DR. BY.' OF BARNST BL E MASS s R,s j'N`0 �M'A1N ST. 712 MAIN ST. CH. BY 8 �(`d1F2MQt;Tk ; MASS. HYANNIS, MASS. SHEET 01= 2 { DATE . EG LAND S ft ;•, 6--Q r w2 7 P z r/C, 4,All< OR A WIA, - &A. 41se v/rcN I 7. co Cl-,EAIV -5*ANAO &A L CA Z'L.AYER AP A p 4w LIED OA It. MIN.P171C11 WASNPO 570IV4L- DIST SeP77C rAAO'/< 0- :0 ® o A90)e WASNEP STONE tsO 1 0 0 0 6 votf A PRECA 5 r 5,Fj 6,=A 4r P17 OR AEVZ//V. -IAIV,CAPT 44Z&1A7'1,0,Vs p rr 40 /,'IVY.-,R7- A7- Zr4//,LD/Al& P/,A)6?. C(l hV4E-T SC-PrIC TANK F77 1,71AJW. 4�4174-6- 7-SZP771C TANK 9S13 ,FZ .. ;- BOX 95-c' 97- oRov vo wA-rEw wAai-E. 0U7LZrV15TRf,90r101V BOX '?*,9 =7-1 hV4,E 7- 4--A CH/Ma ,-IT 9 -rA49t&:A77401V P/7' LEACH11VCw OIAMW.Sl 0 A/ A DES164V CRITERIA TCALZ Yo /�-o� FT. A14VAf 5-=R OF AMAR00.04.S D -C%A R49A G.=,P15jP05A.&&,V I r SOIL. /-oC7 *2 M5,r TOTAL E��rlmA-r 330 V SOIL 7-EST #/ , �601L. 7r-577A?--,, -7r NUMBER OF UfAcMva p/r3 ?7.0 9, /;�-2- -jCP_=At P,"r R-rs- 5W. Pr SIAE 4&ACNIAOCr 0 2- aorrom za4cq1A(&jC'JFJ?P/r so. *yt TOTAL LZ4CHIAler' ARC-A -2-6�S49. FT.- 5,L./6 So/ P�,eCOLAWIDAI RA'rr AL-2 lijv.11Ncy SOP. =;r SA 10 7777;,��A A4�1� 0�F V�-&Z-F— ROBERT 1p. ISUNIKIS Cl) 162 7-, �v -T 9 l0t '5 + 4 �-Xz P-