HomeMy WebLinkAbout0133 PHINNEY'S LANE - Health (2) 133 PHINNEY'S LANE, CENTERVILLE
A= 209 055.002
rr1Ic -
UPC 12543
No.53LOR
F U'
HASTINGS, HU
TOWN OF BA.RNSTABLE
P �f
wC;:3ON
SS N L& SEWAGE # � _l
�..,�
`�LLAGE_� � 1L�V Fi A(S_SESSOR'S MAP & LOTS 0 9"t2S5
!NS i'ALLER'S NAME&PHONE NO, 0 0e,2—
SEPTIC TANK CAPACITY S`r '� �0
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER 1 ��
PERMITDATE: 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
r - ,
,o
fiL
/ avi re � a°
No. Fee
J-00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppYication for Mi!9pool &POem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ��j Nl�(S Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 0 5S 4 d� ' ,`G�✓k--t—�U
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
4:�- 00_- -L. SA-�
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 �30 gallons per day. C lculated daily flow �� l- gallons.
Plan Date �"Vi Number of sheets Revision Date
Title 1 �-
Size of Septic Tank i�i S Type of S.A.S.
Description of Soil;
Nature of Repairs or Alterations(Answer when applicable) / 1+A"-'S FAT L4,.r_ _Il
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 b of ealth.
Signeo ALI-, Date �� s
Application Approved by Date
Application Disapproved for the following reaso
Permit No. Date Issued
L
No: Fee /00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Application for ;i000nl &pgtem Construction Permit
Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No.'-33 4t-"c Ac Owner's Name,Address and Tel.No.
Assessor's Map/Parcel �I\(i.✓ A.G.L ,,
Z o'f—
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. `
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other 7 pe=ef Building No.of Persons Showers( ) Cafeteria( )
Otheffixtures
Design.Flow* gallons per day. Calculated daily flow �� { gallons.
Plan Date_ �"�r°V "%�1'` Number of sheets Revision Date
Title -���--
Size of Septic Tank V � Type of S.A.S.
/�
Description of Soil L.-v�w^�f � IVY Q_ sq:j k.J
Nature of Repairs or Alterations(Answer when applicable) f-))A' ' 7 A-r-V-A 4�
Date last inspected:
Agreement:
1 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-this Boar of Health _�
Sign d i n /7 Date _
Application Approved by
Application Disapproved for the following reaso r s
Permit No. Date Issued Lit In2f
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY; that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded((Y,,,K
Abandoned( )by ,�..r�S �'� y 1 C
at 77, :r c efF=NrF Vr I I-e ha been constructed in accordance
with the provision of Title 5 and/the for Disposal System Construction Permit No. dated
Installer�_� �-G Designer
The issuance of this permit shall not be rconstrued as a guarantee that thryste 1T)ctio as designed.
Date Inspectors
-- . ` No. ! /, '",! _.,------------------- — Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
30ie;pozat *p$tem Cow5truction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( A'liandon( )
System located at h
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: Approved by
9/16/03
Notice: This Form Is To-Be Used For the Repair Of Failed
Septic Systems. Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
1, T�A;W hereby certify that the engineered plan signed by me
dated=' Cti concerning the property located at
aL E ` 0-4X�+sau�l�c meets all of the
following criteria:
• This failed system is connected to a residential dwelling only. There are no commercial or
business uses,associated with the.dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes
per inch. The applicant may use historical data to conclude this fact or.may conduct deep
test holes and percolation tests at the site without a health agent present.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will-be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the.
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) 'S cc�
B) G.W.Elevation C+adjustment for high G.W. 1.4 _ l 0 .-0
DIFFERENCE BETWEEN A and B
SIGNED : ► e DATE:
NOTICE
Based upon the above information;a repair permit will be issued for bedrooms
maximum.. No additional bedrooms are authorized in the future without engineered septic system
plans.
gASepcic\percexemp.doc
Permit Number: Date:
Completed by:
HIGH GROUND-WATER LEVEL COMPUTATION
r I
Site Location: ` tt1(1� C,A, LZ�1 Lot No,
Owner: \A,0C QQCQ \ Address:
Contractor: `' IQ ��J�-� Address:_ '�(ZAM `h,
Notes:
STEP 1 Measure depth to water table
tonearest 1/1Oft. .............................................................................. .Date o5 to
mo th/day/year
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
site and determine:
OAppropriate index well.................................................... v�l
OBWater-level range zone .....................................................
STEP 3 Using monthly report "Current
Water Resources Conditions"
i determine current depth to _ 4
water level for index well ........................... ---7�,I
month/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 28)
determine water-level adjustment
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) ...........................................
....... ..........................................................
f;
Figure 13.--Reproducible computation form.
15
Town of Barnstwhle
Regulatory Services
Thomas F. Geiler, Director
9� '& �0� Public Health Division
�Fe3�A Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 6/03/05
Designer: _Shay Environmental Services, Inc. Installer: Robert Septic Services.
Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street
MA 02536 Yarmouth, MA
On 6/01/05 Robert Septic Service was issued a permit to install a
(date) (installer)
septic system at 113 PHINNEY'S LANE, CENTERVILLE, MA based on a design drawn by
(address)
Shay Environmental Services, Inc. dated
(designer)
XX I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
�k�- of MgSs9c
o� CARMEN
nst er's Signature E.
SHAY
No. 1181
��G�STER�o
esigner's Signature) (Affix D p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI . K _1
9
DEPARTMENT OF ENVIRONMENTAL PR " TION
? ONE WINTER STREET. BOSTON. MA 02108 617-292-5 �ECEIVEO
L II
yV�y l
N0\1 2 5 1998 ►�
WILLIAM F.WELD TO
INNOFB TRL�� COJCE
Governor S HEALI1♦DAO ecretary
ARGEO PAUL CELLUCCI DAV1D °.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A E
CERTIFICATION
Property Address: 233 Phinn ' s Lane Centervillg Estate of
� Address of Owner: Joseph Eaton
Date of Inspection: (If different) P
Name of Inspector: Odin E Robinson Sr
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: WM E Robinson Septic Servi r-P
Mailing Address: PO Box 1089 , n er ,; 1 1 t-F MA 02632
Telephone Numbera 5 0 8 � 7 7 c,_R 7 7 6
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-silage disposal systems. The system:
_ Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date: -),30—%
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10 000 d or reater, h
g gp , the inspector and the system owner shall submit g Pe Y sub t
the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system"owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
AI SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
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.
Indicate yes, no, or not determined (Y, N, or ND). 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 (attached) indicating that the tank was installed within twenty(20) 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
DEP on the World Wide Web: http:/twww.magnet.state.ma.us/dep
f'J Printed on Recycled Paper
w o i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART-A
CERTIFICATION (continued)
13'3 Phinny"s Lane Centerville
PropertOwner�y Address:
Estate of Josph Eaton
Date of'Inspection:
I
B] SYSTEM CONDITIONALLY PASSES (continued)
► t'�` Sewage.backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s)'or"due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board,of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is.levelled or replaced
The system required pumping more than four 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
C] F RTHER 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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND 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.
SYSTEM WILL.FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption 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 absorption system and the SAS is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid).
3) OTHER
(revised 04/25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM
PART A
CERTIFICATION (continued)
133 Phinny' s Lane Centerville
Property Address: Estate of Joseph -Eaton
Owner: -
Date of Inspection: 'g--�?�•r�S�
D) S STEM FAILS:
You m st indicate ei;!,er "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 in 310 CMR 15.303. The basis
or this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
t e failure.
Yes N
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
I
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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LAR E SYSTEM FAILS:
You mu t indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
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)
The o ner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requi ments of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
133 Phinny' s Lane. Centerville
Property Address: Estate of Joseph Eaton
Owner:
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Ye si 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 obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
✓ _ The system does not receive non-sanitary or industrial waste flow.
./ _ The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
/ The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
z/, _ Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b))
J
(revised 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
•SYSTEM INFORMATION
Property Address: 133 Phinny' s Lane Centerville
Owner: Estate of Joseph Eaton.-:
Date of Inspection: �--✓ —
FLOW CONDITIONS
RESIDENTIAL:
Design flow: g.p.d./bedroom for S.A.S.
Number of bedrooms: d--3
Number of current residents: A,
Garbage grinder.(yes or no):
Laundry connected to system (yes or no)
Seasonal use (yes or no):A d
Water meter readings, if available (last two (2) year usage (gpd): 1998 50, 000 gals
Sump Pump (yes or no): - d 1997 119, 000gals
1996 111 ,000 gals
Last date of occupancy: - G- dj
COMMERCIAUI N DUSTRIAL:
Type o ablishment:
Design flo Gallons/day
Grease trap resent: (yes or no)_
Industrial W ste Holding Tank present: (yes or no)_
Non-sanita waste discharged to the Title 5 system: (yes or no)_
Water mete readings, if available:
Last date of occupancy:
OTHER: (D scribe)
Last date of o ncy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
.tom4
System punl6ed as part of inspection: (yes or no)
If yes, volume pumped: eallons
Reason for pumping:
TYPE OF F SYSTEM
(/Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no) /1, 0
(revised 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: �33 Phinny' s Lane Centerville
Owner: Estate of Joseph Eaton
Date of Inspection:
B DING SEWER:
(Coca a on site plan)
Depth below grade:
Materi I of construction: _cast iron_40 PVC_other (explain)
Distan a from private water supply well or suction line
Diam ter
Corn ents: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:
(locate on site plan)
a'
Depth below grader
Material of construction: oncrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions:—JL � ,7 Z-,
Sludge depth: -- A
Distance from top of sludge to bottom of outlet tee or baffle:1-/4
Scum thickness: 9--G
Distance from top of scum to top of outlet tee or baffle:_ t
Distance from bottom of scum to bottom of outlet tee or baffle
How dimensions were determined: Ci �-
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, di pth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc Oe 0 t
r
GR SE TRAP:
(Iota a on site plan)
Dept below grade:
Mate ial of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Di nsions:
Sc thickness:
tarice from top of scum to top of outlet tee or baffle:
Dis nce from bottom of scum to bottom of outlet tee or baffle:
Dat of last pumping:
Co ments:
(rec mmendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
int rity, evidence of leakage, etc.)
(revised 04/25/97) Page 6 of 10
J I:w
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 133 Phinny' s Lane Centerville
Owner: Estate of Joseph Eaton
Date of Inspection:
TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(lo to on site plan)
Dept below grade:
Materi I.of..construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimens ons:
Capaci gallons
Design flow: gallons/day
Alarm evel: Alarm in working order_Yes; _ No
Date f previous pumping:
Com ents:
(condi ion of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level.above outlet invert: 6
Comments:
(note if level and distribution is equal, evidence of solid carryover, evidence of leaks a into or out of box, etc.)
PUM CHAMBER:_
(locat on site plan)
Pumps in working order: (Yes or No)
Alarm in working order (Yes or No)
Com ents:
(not condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/2S/97) Page 7 of 10
I
J �
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 133 Phinny' s Lane Centerville
Owner: Estate of Joseph Eaton
Date of Inspection: --je -`3 �/
SOIL ABSORPTION SYSTEM (SAS):—
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of veg tion, etc.) E r
/6 ZS-«� C�J /��O L. 1'�, �' ID �_ •;' �a
CES COOLS: _
(locat on site plan)
Num rand configuration:
Depth-op of liquid to inlet invert:
Depth f solids layer:
Depth f scum layer:
Dimens ons of cesspool:
Materia s of construction:
Indicat' ,n of groundwater:
inflow (cesspool must be pumped as part of inspection)
Co ments:
(no condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:_
(locat on site plan)
Mate als of construction: Dimensions:
Dep of solids:
Co ments:
(note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 04/25/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 133 Phinny'%s Lane Centerville
Owner: Estate of :Xoseph Eaton
Date of Inspection: 0/-e>
_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)
►
1
U i
E
40
3 ► r
I
(revised 04/25/97) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection: 9 ,"36 —`j
Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
/Obtained from Design Plans on record
,/ Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
'
(revived 04/2S/97) Page 10 of 10
TOWN OF BARNSTABLE
LOCATION 133 SEWAGE# �S'- 37 S
ASSESSOR'S MAP&
INSTALLER'S NAME&PHONE NO.
SBPTiC TANK CAPACITY zany
LEACHING FAClL TY: (type) laV-0 (size)
NO.OF BEDROOMS �-
NJELIHLR OR OWNER
PERMIT DATE: 3_/3-1 S-- 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
f��
...+'" f
/ !
_ _ r �6,�
�'` 3
'20� �
Y�ouJ t
a��
o fit.
No........� 3 7-S— F�s.....3 . ..
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Aliptiration for Di-nVitittl Worlai Tomitrnr#inn Permit
Application is hereby made for a Permit to Coristruct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
/ ss
..............................--•------------------ -•--•- .......................... _____ ____
ocation-i ddrrss
or Lot No.
.................... ... ... .._..._. .... .----_-•.'..- .............._................
.-- O r d Address
W
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.__...3---------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures -----------------••-------------------------------------------------------------------- -----------------------------------------------..---.-•-•----
w Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter---------------- Depth................
x Disposal 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 ( )
Percolation Test Results Performed by........ -----------------•-••-•--•----....-----------•-•-•-••-----------• Date........................................
a
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rZq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water....._..................
P4 ---••-•---•----------------------••-------•....-•••••...--------•••-----•-•-•••-•---'-------•.......................................... --------------------
0 Description of Soil...................................................................................... ....------------....------------------------•---•----------......................
x
U ...........--•---....---•---•----•----•------•--------•----••-•--------•--...------•----------------•------••------•••••----•-•------...---•---•---•••--•----•-••••••-•---•-••----..............--••----
w
..........................------�-
U Nature� of� Repairs or lter tions—Answer when applicable. ,f0t1ID__a - ..............t--_ .. C..
fir✓! _..•. Z �; �.�,
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance ha e n issued by the b rd of health.
Signed ........................ 3..-..I.e-....`F
..... .......
Dare
Application,Approved By ------------- &---- ----------------------- ---- ...�- /-?- f'---
................."-----..............---' Dace -------
Application Disapproved for the following reasons: .. ............... ............................................. .. ...._.......... .._......... .. .
.. ........................................................ . ..... ............................. ........... ................................................................ . ........ .............. ...
n q Dace
Permit No. ........I. � 7S Issued ...........� 13.-- 1. .......
Dace
A
9S 3 ')--1 3 P-P-
No.... ----•-.......... Fxa....... ..U_..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Diupw3al Mirlw Touiitrnrtiun rantit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Y System at:
..--•-----------------•--- ----------------- ----------------- `------------------------------------------ --
Location-:\rddrr•ss or Lot No.
:... .�- `J -.*-----------
....................:......................
ONVner Address
Installer Address
Type of Building Size Lot............................Sq. feet�-
Dwelling—No, of Bedrooms------- ----------------------------_....Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d Other fixtures ----------------------------------------------------
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity.......-----gallons Length---------------- Width---------------- Diameter---.------------ Depth.-_--_______--_.
x Disposal 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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water----_-._.__---_--_--__--
LXI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
w' -•---•--•-•--•----------•------•--•----••-•-----••-•••--•-•----••-••-•-•--•-•-......-----•-•-.•--•••.........................................................
0 Description of Soil.....................................................................................................................................................................
U .....•••-••------•••--••••-•-----•-••-•-••---••.......-•-•--•---•--•--•-•-••-----•-••----.._..••-----•--•--•--...••----•-•--•..:...--•-••-•-••--•--•--••--••--•-•-•••--•-••••-••••--•--•--•---•--•--••••-
W
x •--•---•----------••------ --------------------------------------------------------------------------- -----=-------------------------------------------------- :---------••--•---•-•-.......
U Nature of Repairs or(Alterations—Answer when applicable. -a _ F .__�_ _. � �! ..................2!2....
.......... `f.... 79�,/ t .,, ...._ hf7 sAE/L,;,Esa.:,+n{a(W.:�.^.�/-_' 'Z...._. !^u.'T'_C!"�!`.-:P...c:.............................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code_—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has/been issued by the board of health.
,Signed ....- - ..... 3 .
ry ------ --'--- ................
Dare
Application.Approved By --------------- ---� ...�..........._----------....>.. ..... -......................................... --------�' 3' �-r
Dare
Application Disapproved for the following reasons- ------- -----------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................
,r� Dare
PermitNo. / Issued ..............................>...5 ��. �.�..................... ------------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
QTWErtifir to of C omplianre
THIS IS. Y'aCERTIFY That-the Individual Sewage Disposal System constructed ( ) or Repaired
b � (// ,I/
y ....................... ...._..._X��l" Cf� ?..............._.....__..................._.................._............................._._..
Installer ............._..................._................_.
�� �/
at ..... 1.. ..:�....... ........_...-------...-... .11._ 4 s_- -- ---- ... ` - '0 `` - ..... ............
f-----------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. _9S ....3 ------------ dated .. ' /_ -_-.�` .........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
firInspector . --..DATE------... .._....------ ----------- =---* ------- ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
75•- TOWN OF BARNSTABLE _3o vc)
No......................... FEE......----.---..........
Elispoonl- urku Tunn#r ion "rrmit
Permission is hereby granted (-------.1 c ,,,... ..�.�,�,,
to Construct ( ) or Repair (�)—an Individual Sewage Disposal System
Yd-•••••-----••-••-•-•••••-----•----••............•.............
Street
as shown on the application for Disposal Works Construction Permit No ------: Dated____--/��a ...:3.':�S
- ' ---------------------------
Board of Health
DATE................................•...........•--------------------•-------------
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
OT400 NNW
VENT PIP (® Least 24 inches toll SECTION A -A
+ H 4 P.V. h Schedule PVC w Charcoal Odor ALL OUTLET PIPES FROM THE e r
10 min: from NOTE. ALL PIPES ARE TO BE 4 SC HE 0 P.V.C. Sc e / DISTRIBUTION BOX SHALL BE 12` -
Existing Foundation house to septic tank Septic tank covers must be CHAMPERcover must be
PROFILE VIEW OF LEACHING SYSTEM SET LEVEL FOR AT LEAST 2 FT. CONCRETE covER
D-BOX cover must be
within 6 in. of finished grade within'�6 in. of finished grade , t `'
TOF ELEV 100.00 AT finished grade ,.,!'• '' •r.w•,6 .,..., q ' *
With Steel Cover odd o SAS - ELEV- 96.00 .. `' 3 - 5'OUTLET " rr j.
Grade over Septic Tank - 98.00 Grade over D-Box- 96.DO x
to 1 f/2 ' wash.4 CMuA•d 86M, a f/d'- t/2" F.W d P•a•f°n. ': �i '��\ _ KNOCKOUTS .• .i9+'akf'Rd y'
r
i
INSPECTION cover must be - - 5.5" •�' } 12" INLET
4t of finished'grade Wt H STEEL COVER ::\ //.• OUTLET
S 0.02 3 HOLE H-20 _
n
0 of SAS-EIev.=93J5 r n n+S 113 lYi44reys In ' ' v
3 Maximum Cover P "i` a, 2 t i € 3..r r';,
DIST. BOX { > P
u) 10' EXIST. 5=0.01 or Greater S� 0.010" per foot � 15.5"----
rxlcTPIPE t' 1,000 GAL f o c3 4" - SCH. 40 Te
.ate ,1 3 •z.
FRDM EXIST. FUUNDATIDN p SEPTIC TANK �� 20'Uri in 20 7 (� C7 O a j , µ
Q Effective Depth o o PLAN S TION CROSS-SECTION
11 m o•.e•+n• d N o 0 B.5' = 17 x F 1 "
r
CONCRETE FULL fOUN0ATi0N y N H-10 II ri rn p 14- 71
r -
o ll N 3.5' , 5 3.5 o iy f (v € IV or t
- 3 HOLE H-20 DISTRIBUTION BOX �, .•q i ;,
SYSTEM PROFILE 6 In.of 3 4"-1 1 2" ' > > 12' U Effective Length NOT TO SCALE
compacted y stone y $ n4u r n ,_fit rxa u `.r
c C a�. . Effective Width j li•gV' fa?".yW=4 RAM '".�``,.
Not to Scale - _ ® 6k Rs,a sic a
'c c SOIL ABSORPTION SYSTEM <SAS
5' PROVIDED 500 - C H-20 LEACHING UNITS / WIGGINS PRECAST GENERAL NOTES
compacted stone l -
NOTE: ALL COMPONENTS MUST HAVE RISERS TO GRADE WITH STEEL COVERS Bottom of Test Hole 1 Elev.- 85.00 Not to Scale 1. Contractor is responsible for Digsofe notification
------------_-------------------------- and protection of all underground utilities and pipes.
Obs. Groundwater - Test Hole 1 EIev.= NONE OBSERVED 2. The septic tank and distribution box shall be set
level 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
with Title V of the Massachusetts state code, the approved plan
and Local Regulations.
6. If, during installation the contractor encounters any
soil conditions or site conditions that are different
from those shown on the soil log or in our design
.installation must halt & immediate notification be
mode to Carmen E. Shay Environmentol Services, Inc.
7. No vehicle or heavy machinery shall drive over the
septic system unless noted as H-20 septic components.
RO n T (O TC�� 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends;
I /-i I [_ 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
Date of Percolation Test: APRIL 25, 2005
10. All solid piping, tees &.fittings shall be 4" diameter
Test Performed By. Carmen E. Shay, R.S., C.S.E.
Witnessed By. WAIVER (per BARNSTABLE B4O.H) Schedule 40 NSF PVC pipes with water tight joints.
EXCAVATOR: Shay Environmental Srvcs., Inc. 11. Municipal Water is Connected to The Residence and Abutting
Percolation Rate: 2 MPI 0 36" Properties Within 150 Feet.
THE PROPERTY LINES ARE APPROXIMATE AND
Test Hole COMPILED FROM THE SURVEY PLAN GENERATED BY
No. 1 198 SCOTT ASSOCIATES, LAND SURVEYOR, ENTITLED
DEPTH SOILS ELEV. MAP 309 Parcel 055/002 78. 14' "PLAN OF LAND of GERTRUDE & NOEL SABATT,
0 96,00 \���5,748 Square Feet +/- MA" DATED JAN. 20, 1953 (PLAN BOOK 914, PAGE 239)
Sandy Loam `�\ & THE DEED DESCRIPTION ( BOOK 9472 PAGE 187)
IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
10.YR 3/2 - EXIST. 1000 �41LLON - THE SEPTIC SYSTEM INSTALLATION. -
0"-9" A, 95.25 SEPTIC TANK
Sandy _ EXISTING EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE OR
Loam I j-O 1�� 2 BEDROOM REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION
10 YR 5/6 I- t i HOUSE NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
Medium L';TJ GRAVEL #-133 O FROM r,1E EXISTING LEACH r l TO BE vISPCaEv
i OF AS PER BOARD OF HEALTH SPECIFICATIONS.
Sanco
10 YR d/4 ! , DRIVWAYi t I NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY
! � l `i
38'- 132 c, J -+, l ASSESSORS MAP 209 LOT 055/002
,- 5 T- 1 --�--98 END
i I i• ., }
I
i•,. LEG
1 EACHIN 11z
! . I
AR -�- DENOTES PROPOSED
94--4„ PVc r 25, _-g6F104XII SPOT GRADE
V nt t 1 94p\ `.,_ TEST 'HOLE #1 --�
ELEV.1= 96.00 110:00 X 104.46 DENOTES EXISTING
-------- -------- SPOT GRADE
Pero #1 i t -oil--__-- ---- -----94
Depth to Perc: 36" to 56" t ed
Perc Rate= 2 MPI __1_
� � Leach. Plt _____ PL PROPERTY LINE
-------------
Groundwater. Not Observed --�---- �
No Observed. ESHWT `� S'�n PROPOSED CONTOUR
�
ADJUSTED H2O Elev. = None ��f1 v 1 v -E Y .� �A L ®' �.
PROJECT BENCH MARK - - - - - -97 EXISTING CONTOUR
(40 FOOT RIGHT OF WAY) TOP OF FOUNDATION
ELEV. 100.00 (Assumed) DEEP TEST HOLE &
2-16` DiAM. ACCESS MANHOLES 40 POLYETHYLENE LINER FROM ELEV: PERCOLATION TEST LOCATION
$• 93.00 to 95.00 AND TO EXTEND 10 BEYOND SAS - 6 FOOT STOCKADE FENCE
P LOT P LAN
INLET
/ -OUTET
:I L r'' THE ACCESS COVERS FOR THE SEPTIC TANK, O PROPOSEDSEPTIC SYSTEM UPGRADE
DISTRIBUTION BOX AND LEACHING COMPONENT
+�. r +^• * r- - �''• SET DEEPER THAN 6 INCHES BELOW FINISHED PREPARED FOR
,n'ate' F^' • �' �' "~ GRADE SHALL BE RAISED TO WITHIN 6' OF
STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE.PLAN VIEW INSTALL TUF-TITS GAS BAFFLES OR EQUALS M R . MARK H U I}r--
N A G E 1.
/^3-24. REMOVABLE COVERS AT
f # 133 PHINNEYS LANE
4. ,
3 min. clearance 'S".. NLET Y (/ E R //I
B' min T jj 2 min inlet to outlet ��^rrrppp���... lJ N T E I \ V L L E 1 A
INLET --1----- s"min.
.t -10" min. Liquid level -OUTLET '
Design Calculations
5' -7" �: -- +_ '' " 5' -r PREPARED BY:
t
E } '� 4'-0" min. Number of Bedrooms: 2 Equivalent to 220 Gal./Day (330 Gal./Day Min. per Title V) -�HOF qs (/��Y/ /Tj177 /��j Y
cv eo s• Liquid depth ,A C5 CA l V lJ 1 I lJ a S l A 1
o� Garbage Grinder: No E
.r' Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V)
e
"4 - 'r �, a Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST 1,000 GAL. Septic Tank. 0 20 40 SO 0
o SIINVIRONMENTAL SERVICES, INC.
.• Bottom Area: 0.74 gal/sq g ft. x 300sq. ft. = 222.00 gall y
6'<0 4' -"10" SOIL ABSORPTION AREA: Using ercolotion rate of <2 min, inch
u ns No, 1 a P.O. 80X 627
CROSS SECTION END-SECTION - Sidewall Area: 0.74 gal./sq. ft. x 148 sq. ft. = 109.50 gallons ,. �STE�� EAST FALMOUTH, MA 02536
Providing: = 331.50 gallons �..
SCALE: 1 =20' ,.S 4NITAR\P TEL/FAX 508-539-7966
TYPICAL 1000 GALLON SEPTIC TANK Use: (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, DRAWN BY: CES - DATE: APRfL 26, 2005
NOT TO SCALE TO BE USED WITH 3.5'"OF WASHED STONE ON THE SIDES AND SCAL 1 =20
4' of WASHED STONE ON THE ENDS. PROJECT#SD728 FILENAME: SD728PP.DWG SHEET 1 OF 1
,