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HomeMy WebLinkAbout0160 POND VIEW DRIVE - Health O, VIEW , CENTERVILLE A= 29=035 -� 1 QW �r "` �REGYC(EpCo UPC 12534 No. -153LOR HASTINGS, MN I TOWN OF BARNSTABLE ��' �► LOCATION / ® Fm nrl () ciA as SEWAGE # VILLAGE/ �, "/ ASSESSOR'S MAP & LOT-:�,A V-03 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) (size) NO. OF BEDROOMS BUILDER OR OWNER I? o fit: PERMPTDATE: %Ih -�.this- q COMPLIANCE DATE: ,, Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of beaching 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 � ,� :T 1 . . . . � �� ��.. - , . . '. � a 91 w 4 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposai *pstem Construction permit Application for a Permit to Construct( ) Repair(V1/U,_Pgrade( ) Abandon( ) [:]Complete System Vndividual Components Location Address or Lot No. (� Popsa V��c.t� �' Owner's Name,Address,and Tel.No.C(l5 Assessor'sMap/Parcel a ©3 e- © cs2. cQ-.) %br Installer's Name Address,and Tel.No. Q'T7`6� Designer's Name,Address,and Tel.No. Stn`i-- .3 C-6 3Jq Type of Building: Dwelling No.of Bedrooms 7_1 Lot Size '7'©sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _ gpd Design flowprovided ? gpd Plan Date `�'Uv� p_ `�, o�®�, ( Number of sheets oC Revision Date Title Size of Septic Tank P �-' ypeofS.A.S.�,���..�..�-��� C�b��1�s� �� t�� 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 Certificate of Compliance has been issued by this Board of Health. Signed Date �L Application Approved by c Date Application Disapproved by F Date for the following reasons Permit No. 20 — '��� Date Issued ..:t..., -«,.F K+•a+.-^..'"aR"/.:x�'s.'rs�,"rsd'.wr,a. .,M�, .r. , .� .f' 'r� r .f� k�. - .r^ .G.,:\.�'ti• .. w �r�,R•.y'•«..� r 5 No. w Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: LOO ;d PUBLIC.HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETT&., . Yes 2pplication for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System NXndividuaf.Components Location Address or Lot No. d 1 \?`� k P�u�, `/��t.t7 �' Owner's Name,Address,and Tel.No. ((5_ � ";�� a.. Assessor's Map/Parcel 6 Q „��. �,ca_ �A r •,�o Installer's Name Address,and Tel.No.$'a`�-�'Tf'~ � Designer's Name,Address,and Tel.No. Ct=-7-- 3 C-C� %r -4ru-- e �.J ors► n.G Type of Building: Dwelling No.of Bedrooms Lot Size ( � ®sq.ft. Garbage Grinder( ) Other Type of Building �� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �Z gpd Design flow provided gpd Plan Date�t w� �Q, �Q�, (, Number of sheets lz� Revision Date Title Size of Septic Tank' t Type of S.A.S. C t'a J��a C qua w��'a•t'j 4�/� py�� Description of Soil a Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: .A The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in i accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed / Date IG J x Application Approved b -Z pp pp y Date Application Disapproved by Date r for the following reasons n Permit No. ,�U/� — Date Issued f - - ----._._-_.___-_�. - ----------- --- _ - --- --- --- ---- --- - v- -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifi>rate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(' ) Repaired(1/r Upgraded( ) eAbandoned( 'mot © `'`c.�.� V `G c� �►� has been constructed in accordance ith the provisions of Title 5 and the for Disposal System Construction Permit No.:9 O;Ll ;:2-4ated 2 Installer�)110 aC$n ' ate` r R� RpC�-til Designer �� �, �r, t #bedrooms Approved design flow -gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ! 1 r No. O.�-� " j ..' ... Fee��_ ,J► - � . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Mispo$al 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at \ \ C'�v.�-S! y`, �, �� Qx " and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constrrruction must be completed within three years of the date of this permit.�� j Date ln l Approved by t' a QI •' 'Town of Barnstable Regulatory Services Richard V. Sea% Interim Director SUMMABM Public Health Division t63¢ A� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit#aoQ k- Assessor's Map\Parcel Designer: \P_f- 1yk(_,, Installer: Address: Tt Address: 7Y:n�23z5�A 'ra \AA 4,� CYJ On g R-zt�� w> as issued a permit to install a (dat ) (installer) septic system at 1t0 V arijV 1,�/VJ ��_ C 0''lf-based on a design drawn by .(address) -cl dated �1 (designer) I ce&ithaNttetep is'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. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters (if applicable) DARREN (Installer's Signature) NO. 19 (Designer s Signature) (Affix PLEASE RETURN TO B ABLE PUBLIC HEALTH D N. 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. QASeptic\Desiper Certification Form Rev 8-14-13.doc TOWN` OF BARNSTABLE LOCATION bt, SEWAGE#DOQ l VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY cryYwr \ �7'r .;,y� LEACHING FACILITY: (type) NO.OF BEDROOMS OWNER 5&enk a PERMIT DATE: w COMPLIANCE DATE: ?/a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility e�", S 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 .p[']6� �,���,J-- �G s( .k� I � i ,. II . J � C{ 1V •3 � ' � o � v 1 � l 9-09(5 Commonwealth of Massachusetts -- 1� Title 5 Official Inspection Form e s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 160 Pond View Dr. Centerville MA 02632 GSM Property Address P Jill Macredie 16 Constitution Cir. y Owner Owner's Name '°` information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, J use only the tab 1. Inspector: key to move your cursor-do not Paul Martin use the return Inspector Name of Ins key. P Cape Cod Septic Services Company Name 350 Main St Company Address W.Yarmouth MA 02673 City/Town State Zip Code 508-775-2825 S15016 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority eL---� —j 6/27/2018 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 17 I Commonwealth of Massachusetts A Title 5 Official Inspection Form aS Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection.Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Systerm in working condition. 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 Y p completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): i 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts to Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y °Mr bvay 160 Pond View Dr. Centerville, MA 02632 Property Address, Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts v w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •' 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes s uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x3= 330gpd t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments N 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 2016=477gpd Detail: 2017=493gpd Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. information Owner Owner's Name is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No Records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1998 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line was checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): Depth below grade: 16" feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500Ga1 Sludge depth: 6" t5ins-3/13 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts N - v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle 2-3" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500Gal tank in good condition. PVC tees in place and clean. Tank at normal operating level. Covers 16" below grade. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Wins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Officia l Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid.level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 DB-3 with 1 line in and 1 line out in good condition. Box is celan and level with minimal solids carryover. No sign of overloading or hyrdaulic failure. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No*- Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: M t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-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.): 4-Infiltrators with stone. No standing effluent in chambers during inspection. No sign of overloading or hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below drawing attached separately I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1998 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data per plan on file at BOH indicates a minimum of 4' separation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 160 Pond View Dr. Centerville, MA 02632 Property Address Jill Macredie 16 Constitution Cir. Owner Owner's Name information is required for every Holliston MA 01745 6/15/2018 page. Cltyrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Page 1 of 2 TOWN OF BARNSTABLE LOCATION__1i�® SEWAGE g VII.LAGE i ASSESSOR'S MAP&LOT 'G INSTALLER'S NAME&PHONE NO. G SEPTIC TANK CAFACrrY LEACHING FACILITY:(type) (sue) NO.OF BEDROOMS__a_ BUILDER OR OWNER ad 1e M PERMrrDATE: 40•2� - 96 COMPLIANCE DATE•--IJ_.3-gu 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by `i 10, i O Z � �� .mod✓� �f .�,�' i'-` 3 3I I http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=229035&seq=1 6/6/2018 COMMONWEALTH OF MASSACHUS E TTS ; ` ? EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ¢ ` DEPARTMENT OF,ENVIRONMENTAL PROTECTION s A /.� 4- vev #. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM G PART A CERTIFICATION Property Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 ' +. Owner's Name: BOB ROCHETTE Owner's Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 Date of Inspection:3/17/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS ;= f' Mailing Address: P.O'. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 ;. 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 „e i,. Y inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes _ Needs Further luation by the Local Approving Authority Fails ' Inspector's Signature: Date: 3/17/01 The system inspector shall submit a c py of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be _. sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL IFE. h�t ****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. p" Tit1P 5 lncnPrtinn Form 6/1 S/'Jnnn 1 ,,s P,ige 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 'ry'w4, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' ` PART A r;,f CERTIFICATION (continued) Property Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 Owner: BOB ROCHETTE Date of Inspection: 3/17/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: ' THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO �K� PROLONG THE SYSTEM'S USEFULL LIFE. " a� a�?r' B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, M 4 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. n n/a The septic tank is metal and over'20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibitsUr 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. a li ND explain: n/a r n/a 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 pipes)are replaced _ obstruction is removed 3 "' _ distributionlbox is leveled or replaced ND explain: n/a yN, n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass �'g inspection if(with approval of the1Board of Health): _broken pipe(s)are replaced _obstruction is removed 5 r ND explain: n/a '+ „ s . n t.. 1 Y19't P4e3ofII };t A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS ' °`` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r,. r PART A CERTIFICATION(continued) Property Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 Owner: BOB ROCHETTE '4° zR a k ' Date of Inspection: 3/17/01 �;;.;��t•i 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. dl. rY% 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 k _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh '' 3 P P �'Y g g 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-de'termine distance n/a i ri1� iq "This system passes if the°well water analysis,performed at a DEP certified laboratory,for coliform bacteria and +1 ` volatile organic coin ounds indicates that the well is free from pollution from that facility and the presence of ammonia !'g P P Y P 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. y r 3. Other: 1 n/a „r. t •. t KJ 5�...r 'M l 1 S r Paje 4 of 11 '4 f,ytS`cq.+ OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 Owner: BOB ROCHETTE Date of Inspection: 3/17/01 i (" �g a D. System Failure Criteria applicable to all systems: . You must indicate"yes"or"no"to each of the following for aminspections: ' 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 /2 day flow X Required pumping more than 4 times in the last year NQ'Ldue to clogged or obstructed pipe(s).Number of times r i' pumped nLa. 4 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 s; certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free , from pollution from ithat 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.] (Yes/No)The system'falls. f have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the systemi,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 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 4; 1 X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped �,_.: Zone 11 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 large3system has failed.The owner or operator of any large system considered a significant threat z a 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 160 PONDVIEW,,DR CENTERVILLE,MA 02632 Owner: BOB ROCHETTE a Date of Inspection: 3/17/01 " ,;u= Check if the following have been done.You,,must indicate"yes"or"no"as to each of the following:' , s 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? f X _ Has the system received normal flows in the previous two week period? „{A!4+' _ 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? ,v 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: { f*.1 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)] F F (i 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM kY; ..1. PART C SYSTEM INFORMATION Property Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 y; ,° Owner: BOB ROCHETTE "' ,'., Date of Inspection: 3/17/01 y< 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 per.• Number of current residents:2 4w0 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] t Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO '`} Last date of occupancy: n/a w , COMMERCIAL/INDUSTRIAL 1 , R"O Type of establishment: n/a � Design flow(based on 310 CMR 15.203) n/agpd �F Basis of designflow seats/ ersons/s ft,etc. : n/a ( P q ) t�:t Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Z rk Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records F Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons`=-How was quantity pumped determined?n/a Reason for pumping: n/a 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.Attachja 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): n/a Approximate age of all components,date installed(if known)and source of information: :x l 1998 NEW SYSTEM Were sewage odors detected when arriving at the site(yes or no): NO ;,r=, Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) i Property Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 Owner: BOB ROCHETTE Date of Inspection: 3/17/01 BUILDING SEWER(locate on site plan) Depth below grade:30" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a ` Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER I. SEPTIC TANK: X(locate on site plan) Depth below grade: 24" f Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L10' 6" H5' 10"FW5' 8" H20" Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING EVERY 3 TWO YEARS TO PROLONG THE SY'STEM'S USEFULL LIFE. t GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage„etc.): n/a _ k� 7 t Page 8 of 11 r: i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 160 PONDVIEW DR CENTERVILLE,MA 026N _. Owner: BOB ROCHETTE E , Date of Inspection: 3/17/01 i TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a ; Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float,switches etc.): DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Y�l Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE P 9 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.): = F4 THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO r, Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a i; Ypp. t. 1 3 N lEti 1 1 R Page 9 of 11j.; j OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ua^, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM y` PART C SYSTEM INFORMATION(continued) Property Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 'Owner: BOB ROCHETTE Date of Inspection: 3/17/01 SOIL ABSORPTION SYSTEM(SAS): -X (locate on site plan,excavation not required) � s If SAS not located explain why: Type <' 7 n/a leaching pits, number: n/a INFULTRATORS leaching chambers, number: 4 n/a leaching galleries, number: n/a ~�rF} n/a leaching trenches, number, length: n/a `. n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a _. ; innovative/alternative system t: • Type/name of technology: n/a '; s a Comments(note condition of soil,'s'igns'of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a {' to� Depth—top of liquid to inlet invert: n/a {tv . Depth of solids layer: n/a ' Depth of scum layer: n/a5 Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): E n/a PRIVY: (locate on site plan) ! t.jt y •i Materials of construction: n/a t. Dimensions: n/a ! Depth of solids: n/a :. Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM +' PART C ''°' SYSTEM INFORMATION(continued) Property Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 Owner: BOB ROCHETTE Date of Inspection: 3/17/01 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. ..;, »�is • ka.Y gp { v g AAAO ay r 3� AO O 41 Q� �g gp 21 x sl' �n Page 11 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 160 PONDVIEW DR CENTERVILLE,MA 02632 Owner: BOB ROCHETTE Date of Inspection: 3/17/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet ` ` Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- if checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,installers-(attach documentation) , YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 10+FEET q.t 'C P i { aura " 1 j Y., No. c , Fee_L2? THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i%/ Yes / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for Mi_qpo!6a1 *potetn Construction Permit Application a Pernut to Construct( )Repair( )Upgrade(�Abandon( ) e�Lomplete System El Individual Components Location Address or Lo .` �� �L'CrIJ Owner's Name,Address and Tel.No. Assessor's Map/Parcel . Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f i�0,0F_5E tL 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 �338 gallons per day. Calculated daily flow —3�a gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil &ea S i_�) Nature of Repairs or Alterations(Answer when applicable) —0-B Tza" 4 L ctr a < or 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 provision of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has b It issued by this B eat . Signe X A Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued F w l No. .. '' _ . ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Y rfcatfori for Mf-4pogal 6potem Construction j3ermit Application for a Pen it to Construct( )Repair(' )Upgrade(�Abandon( ) 4'6omplete System El Individual Components Location Address or Lot No., 60 vb7 �u('ErA-� °q— Owner's Name,Address`and Tel.No. Assessor's Map/Parcel T� Yt-T 3` O 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 Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow :-:330 gallons per day. Calculated daily flow �t-�C1 gallons. Plan Date`,,- } Number of sheets I'd, . ;' # ,Revision Date Title Size of Septic Tank TypeaoUS.A.S. i'( ( Description of Soil - Q Ck�un ti Nature of Repairs or Alterations(Answer when applicable) L' C/D S JT, -D,6 a � li - 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 o .' 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has b e issued by`this B a ieaith. Signed Date Za- Application Approved by Date r v Application Disapproved for the following reasons , t rv-- Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(�V Abandoned( )by 1 :)—C- Z- ',-EMXC at `ter aV n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �l dated Installer Designer / The issuance of this permit shall not b c strued as a guarantee that the syste willunction as designed. Date - Inspector �) ------�------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mfgpogal *patent Construction 30ermit Permission is hereby granted to Construct( )Repair( )Upgrade Abandon( ) System located at CZ v'n ( it"o c, �(� jf 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 his permit. C. A) Date: Approved by 10/9197 i K P •� � - n J ' Yi I .k E: This Form Is To Be Used For the Repair Of Failed NOTICE: Septic Systems lm ystes Only. ! iCERTIFICATION OF SKETCH AND'APPLICATION FOR A kg DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT V ENGINEERED PLANS) Ja 5 •r co ✓�S hereby certify that the application for disposal works 4x, o. .Edtastrut tion permit signed by we dated b a�:�� „concerning the v� V _ meets all of the <t f ; I Pope located at . ` 0 D, y e.w following criteria: are ne wet1w-A Dated within l0o feet of the proposed leaching facility ere an if'pri wens within I Sn feet of the proposed septic system k There is no increase In A**and/or change in use proposed i1 yygg 11" ro R6 y� ted'or heeded. �-T7,yM'.V.N /il� •r � J, 1AA9 f fi '� �� . ` ,~ If the proposed IeaEhiitt ity will'be located within 250 feet of any wetlands,the bottom of the "proposed itaching facility►will nm be located less than fourteen(14)feet above the maximum adjusted groundwater table elevaCtatt. ,.r .�M MM6 cnmpl'M tlx'e!'�'h ► ls` : G r t as r A)Trop of tottt►d Eltvation(according to the Engineering Division G.1.S.map) b)Ubsertr Gt nttdwate tabie Elevation(according to Health Division well map) T 1 ,. y Sid`NED DATE: _ 4 H} V l LI'CEi�1SEb SEP"C 9YS 1`Etwt NST°ALLER IN THE TOWN OF BARNSTABLE NUMBER . i'dMeh Mein t idw pmoasad sy�.Also if the licensed installer posesses a certified plot plan, x ,r4 ttiu phM should be trnbtinitWo.At x { ,ice �v��U�-k�yM �`'f "5,.�'�"���•',h��1101�.�` � 4✓� � p �' .. .. 7 .�' n'c A111.16 11 n�L.mYr!wdn..::•.r ..tii W t T ...A-'. .y�V�" aa � TOWN OF BARNSTABLE LOCATION �� P� —ot Ci^7 SEWAGE # �g- S�3 VILLAGE � - -� ASSESSOR'S MAP &LOT-�- r� n . INSTALLER'S NAME&PHONE NO. �'''��� SEPTIC TANK CAPACM LEACHING FACILITY: (type) (size) NO.OF BEDROOMS ,7 • BUILDER OR OWNER rwd PERMTTDATE: JM 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) - Furnished by a o 9 19'8 T2 8'4 �F— 412 --�I illtZ2114 Existing T-T 0 (D Utility Room 00 00 `-S4 Future Bath 00 zo UP i Co co n ti 0o CO N N e- Bedroom Addition 0o a N Closet . Closet Z\ 2'6 6'8 216 4 1118 4'4 20IN a V \\ LEGEND CENTERVILLE 40� --� \\ PROPOSED CONTOUR ROUTE 28 ® PROPOSED SPOT GRADE 41 - \\ —— 98 —— EXISTING CONTOUR 5 /\ \ + 96.52 EXISTING SPOT GRADE ���� LONG ` \ W— EXISTING WATER SERVICE TEST PIT LOCUS \ o \ SCALE: 1"=20' S� PINE STREET 4 _ _------___ ,� ��' -i-------t-----�----�--- � LOCUS MAP LOT 26 i i i rr s ' I r LOCUS INFORMATION AREA =19870 sf+— i , PAVED (DRIVEWAY I PLAN eooK 108 PAGE 9 I I I I PLAN REF: 108/009 /0261 ASSR MAP229 PcL 35 I----` '� --- I --- TITLE REF: 3 AP 229 I PARCEL ID: MAP 229 PAR. 035 _ — PROPERTY IS IN ESTUARIES PROT. - ---'-—'� ��\ FLOOD ZONE: PROPERTY NOT IN FLOOD ZONE �4 Q I ' SEPTIC SYSTEM zz Lo �� REPAIR PLAN _j L It , \� ', it I LOCATED AT: G x � a �� �I �� ', ; 160 POND VIEW DRIVE w °W CENTERVILLE, MA r � PREPARED FOR � r` I+ ; BRIAN TUTTLE READY ROOTER EXC. / 4� —/� �\ 'I i 40;� JUNE 10, 2021 4 2 ', \ II 41 i ` \ OF S DARE M. c o M i / S4NITAR\ Yd TP- / 4�i i \� MEYER & SONS, INC. -0- P.O. BOX 981 43 ' BENCH MARK - % EAST SANDWICH, MA. 02537 TOP OF FOUNDATION _ _� ,,- PLAN. PH: (508)360-3311 43. 54 B SCALE: 1 in = 20 ft ARNSTABLE GIS DATU FAX: (774)413-9468 43'/ ;/" / F 0 20 40 meyerandsonstitleSQgmail.com OO 0� �' \ 20 40 SHEET 1 OF 2 1 1894 ELEV. TOP NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS i FOUNDATION: BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE (Existing) FINISHED GRADE (43.3) = 43.54�. �F.G.EL: 43.0 F.G.EL• 43.2 F.G. EL: 43.3 a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a F.G.EL 41.53 �,', 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" . „ .. . ,. . t. STONE OR FILTER FABRIC DOUBLE WASHED STONE a 6" 7m" ` 4" SCH 40 PVC IT 14 14 s ® S= 17. (MIN. t ®TEES ARE TO BE INV. 40.10 a®aaa®es4" scH 4o Pvc 2 E F. DEPTH ®® a r INV. 40.25 a INV. 39.90 GAS J _ 4' 2 X 8.5' =4' EXISTING OUTLET BAFFLE PROPOSED DB 3 . « DISTRIBUTION BOX EFFECTIVE LENGTH = 25' INV: 40.50 (1-120) INV. ELEV.= 39.70 EXIST. 1,500 GALLON SEPTIC TANK OF GAS BAFFLE TO BE INSTALLED ON ����� A�gsf9� BREAKOUT OUTLET TEE AS MANUFACTURED BY DA'F N M. y- ELEV.= 40.70 NOTES: TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV.= 40.70 1) CONTRACTOR SHALL VERIFY ALL EXISTING 1 4 INV. ELEV.= 39.70 a ®a PIPE INVERTS PRIOR TO CONSTRUCTION p a a s®a 2) D-BOX SHALL BE SET LEVEL AND TRUE TO C/S1 ®a®aaa®a®®®aaa " GRADE ON A MECHANICALLY COMPACTED SIX $41NITAR�1`� BOTTOM EL.= 37.70 ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN 3.75' 5 FT. 3.75' 310 CMR 15.221(2) C0 1) Z) SEPARATION 5.50 FT. EFFECTIVE WIDTH = 12.5' EXISTING 3) REPLACE EXISTING1,500 GALLON SEPTIC TANK WITH 1500 GALLON SEPTIC TANK IF FAILED,DAMAGED OR UNDERSIZED. SEPTIC SYSTEM PROFILE SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 32.20 GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) SOIL LOGS P#: 21-132 GENERAL NOTES: DESIGN CRITERIA **IN ESTUARIES PROT.** DATE: MAY 12, 2021 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOM DESIGN BOARD OF HEALTH AND THE DESIGN ENGINEER. SOIL EVALUATOR: DARREN MEYER, RS, CSE 1614 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) WITNESS: DAVE STANTON, BARNSTABLE HEALTH DEPT. of THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS. DAILY FLOW: 110 G.P.D. X 3 BR = 330 G.P.D. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE GARBAGE GRINDER: NO (not designed for garbage grinder) Elev. TP-1 Depth Elev. TP-2 Depth DESIGN ENGINEER. SEPTIC TANK: 330 gpd x 20096 = 660 gpd. USE EXISTING 1.500 GAL SEPTIC TANK 43.20 0" 43.25 0" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING A LOAMY SAND A LOAMY SAND FROM TR BEFORE SHOWN HEREON SHALLON B CO NTINUES. REPORTED TO THE DESIGN LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 10YR 3/2 10YR 3/2 42.37 10" 42.33 11" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. LOAMY SAND LOAMY SAND 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' y 10YR 5/8 10YR 5/8 " HEALTH FOR PROPER INSPECTIONSODu DURING CONSTRTRUCTIOO OF STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 40.20 36' 40.33 35 C c 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE BOTTOM AREA: 25 x 12.5= 312.5 SF 8.ALL,AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED MEDIUM MEDIUM TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. PERC TEST SAND SAND 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF OE- 38.70 2.5Y 6/4 2.5Y 6/4 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D CONSTRUCTION. I DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 32.20 132" 32.25 1 132" 12. THIS PLAN IS TO BE USED±FOR SEPTIC SYSTEM PURPOSES ONLY PROPOSED SEPTIC SYSTEM UPGRADE PLAN AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. (•C2" HORIZON) 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 160 POND VIEW DRIVE, CENTERVILLE, MA NO GROUNDWATER OBSERVED 14. NO WETLANDS WITHIN 100' ,OF PROPOSED LEACHING. 15. ALL PIPING TO BE 4" SCH 40 • 1/8"/FT (UNLESS SPECIFIED) Prepared for: Tuttle/Ready Rooter Exc. Design and Site Plan by: SCALE DRAWN DATE MEYER&SONS,INC. N.T.S. DMM 06/10/21 PO Box 981 REV DATE CHECKED SHEET NO. EAST SANDW/CH,MA 02537 508-3622922 DMM 2 of 2