HomeMy WebLinkAbout0101 SACHEM DRIVE - Health _ Lot 20- #101 Sachem Dr., Centerville
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No. 42101/3 ORA
ESSELTE
10%
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TOWN OF BARNSTABLE �►
LOCATIOA/_asAr, x SEWAGE #
VILLAGE C A ASSESSOR'S MAP
INSTALLER'S NAME&PHONE NO. ._v-A
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) —(size)
(size)
NO.OF BEDROOMS
Bb OR OWNER ✓�'1%i:' �-�'ri o�s , (° i+7
PERMITDATE: Aol- IZX-- 9,Z�`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 aching facility) Feet
Furnished by / "
F/a/N
od �
S 3 �
j �
- � 1
q�12-'—C W'
No. L " Fee
l
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION o TOWN OF BARNSTABLE., MASSACHUSETTS
2pplication for Migozal *pztem Construction Permit
Application for a Permit to Construct(V.*)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. O n s]`�a�Afir�and Tel.No.
Assessor's Map/Pazcel��`�, � /����� ��� � � �f• � (�Ap�
I Ue N Address,and Tel.No. J�'F. �I�gs is N e,Ad{h�and Tel.No.
1q7" c�uy 6'�p nkJ
P.G•�uiC� ���l� Gam/ s
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(AX-)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3.?Gpo gallons per day. Calculated daily flow allons.
Plan Date '� Number of sheets Revision Date 7 ¢
Title S,Ma r U Y4T d)RfW114j+ # 4410194014010
Size of Septic Tank / Type of S.A.S.
Description of Soil &Qric fle a
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue b is Board of alth.
Signed Date 1(2—
Application Approved by Date
Application Disapproved for—the following reason 7
Permit No: Date Issued _
--- -- ------ --. ._ ------------------- -- I
No, ; ,,_ . N- _ 4. Fee
THE COMMONWEALTH OF MASSACHUSETTS'' Entered in computer:
' Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for Migpogar,*p! tem Conmruction Permit
(Application for a Permit to Construct Repair,( )Upgrade( )Abandon( ) O Complete System O Individual Components
Location Address br Lot No. h CCU h Owner's ame,Add ss and Tel.No.
�ltU! SW//I/I YI //'�,/l, c x j C� /
Assessor's Map/Parcel —�� ,, ff I X/M
(Ahi1' IU In,
l Iqse a N Address,and Tel.No. $ -�����J signer's ,A ess and.Tel.No. quIl
((
l� e f4c,,& X T
P�. �a� �'�.�• �� Gl� GPI
Type of Building: r
Dwelling No.of Bedrooms Lot Size /'d' Q Y sq.ft. Garbage Grinder(kp
Other Type of Building No. of Persons Showers( .) Cafeteria( )
Other Fixturessi-/�
Design Flow 3�t 00 gallons per day. Calculated daily flow gallons.
Plan Date 6-_?_ , Number of sheets l Revision Date
ti Title 5,k P6 ► Y.r rr t-P&A WA S-01019 8b5NO
Size of Septic Tankk /(60 r Type of S.A.S.
Description of Soil l,(4 n,
Nature of Repairs or Alterations(Answer when applicable)
F
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance w}t�h 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 issue'. b/ is Board of �alth.
Signed*1loN
Date �U'�-7 ,
Application Approved by. a Date
Application Disapproved foing reasons 7
f _ i Permit No. l Date Issued
- .- .-- ----------------=------------ — ————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERT, that the On-site Sewage Disposal System Constructed( Repaired ( )Upgraded
Abandoned( )by
at 0 � e= 42�- . /,4�&been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. — dated
Installer -76�sj6 a ,y P*4- Designer
The issuance of this permit shall not bbe^-construed as a guarantee that the syste.. 'lilt.function as des}gned.
Date , '" �'' 14
Inspecto _.,,,
—�4-- — ——— —————— -- — --
No. Fee / )
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
mig0$al * otem Congtruction Permit
Permission is hereby granted to Construct epair
( )Upgrade( )Abandon_( ) t
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this,p
Date: Approved b
i
3
' Commonwealth of Massachusetts °7
W Title 5 Official Inspection Form �`�
Subsurface Sewage Disposal System Form -Not for Voluntary Assessment
i - 9 p Y rY
101 Sachem Drive
Property Address
Herbert Sunderman r
Owner Owner's Name
information is Centerville Ma. 02632 7/12/2007
required for
every 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.
Important: A. General Information
When filling out
forms on the
computer,use 1. Inspector:
only the tab key ,
to move your Robert Paolini'
cursor do not use the return Name of Inspector 4 C N
key. Capewide Enterprises,LLCa-
Company Name
r� P.O.Box 763
Company Address I - w
Centerville Ma. 02'632
ICI City/Town State Zip Code
(508)428-4028 S 14454
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 0 Conditionally Passes ❑ Fails
El Needs Further Evaluation by the Local Approving Authority
7/12/2007 /
Inspect6fs Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health br 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.
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
T /
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 101 Sachem Drive
Property Address
Herbert Sunderman
Owner Owner's Name
information is required for Centerville Ma. 02632 7/12/2007
every page. City/Town State, Zip Code Date of Inspection
i
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
4
i ® 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 septic system is in proper working order at the present time.
B) System Conditionally Passes:
IF One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not
determined," please explain.
❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration orexfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
1
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or.uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
' Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
101 Sachem Drive
Property Address
Herbert Sunderman
Owner . Owner's Name
information is required for Centerville Ma. 02632 7/12/2007
,'
every page. City/Town State Zip Code .Date of Inspection
B. Certification (cont.)_
B) System Conditionally Passes (cont.):
❑ distribution box is leveled.or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass.inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
ND Explain:
f
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form t ,,
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
° 101 Sachem Drive
M
Property Address
Herbert Sunderman
Owner Owner's Name
information is required for Centerville Ma. 02632 7/12/2007.
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
*"This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform
bacteria 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
® Required pumping more than 4 times in the last year NOT due to clogged or
EJ 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.
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
m, Subsurface Sewage Disposal System Form,- Not for Voluntary Assessments
,M 101 Sachem Drive
Property Address
Herbert Sunderman -
Owner Owner's Name
information Centerville Ma. 02632 7/12/2007
required for
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.j
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of,a cesspool or privy is within 50 feet of a private.water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
0 a 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.
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 101 Sachem Drive
Property Address
Herbert Sunderman
Owner Owner's Name
information is required for Centerville Ma. 02632 7/12/2007
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes"or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant,'Or.Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system-received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
❑ ® this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® 0 Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ -Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 101 Sachem Drive
Property Address
Herbert Sunderman
Owner Owner's Name
information is required for Centerville Ma. 02632 7/12/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual). 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 .
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)): 2005:57,000
2006:31,000
Sump pump? ❑ Yes ® No
Last date of occupancy: 7/12/2007
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? 1 ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5.system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
101 sachem dr.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
I
�M 101 Sachem Drive
_Property Address
Herbert Sunderman r
Owner Owner's Name
information is required for Centerville Ma. 02632 7/12/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Gen'eral Information
Pumping Records:
Source of information:
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)
ElInnovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank.Attach a copy of the DEP approval.
Y
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
1996
Were sewage odors detected when arriving at the site? ❑ Yes ® No
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 101 Sachem Drive
Property Address
Herbert Sunderman
Owner Owner's Name
information is required for Centerville Ma. 02632 7/12/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
. 2'
Depth below grade: 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.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank(locate on site plan):
r
Depth below grade: 18"feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list,age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
-------------------------------------------------------------------------------------------------------------------------.
Dimensions: 1 0'6"x5'1 0"x57'
Sludge'depth: 311
Distance from top of sludge to bottom of outlet tee or baffle
27"
Scum thickness 0
911
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
16"
How were dimensions determined? measured
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°wM 101 Sachem Drive
Property Address
Herbert Sunderman
Owner Owner's Name
information is . Centerville Ma. 02632 7/12/2007
required for
every 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.):
Pump tank every 2-3 years.lnlet and outlet tees are in place.Tank appears structurally sound.No
evidence of leakage.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
r I
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to'bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank,(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
I
' Commonwealth of Massachusetts
W Title 5 Official Inspection- Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,4M 101 Sachem Drive
Property Address
Herbert Sunderman
Owner Owner's Name
information is Centerville t Ma. 02632 7/12/2007
required for
every page. City/Town, State Zip Code Date of Inspection
D. System. Information (cont.)
Tight or Holding Tank (cont.)
Dimensions:
Capacity: gallons
Design Flow- 1
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert No
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.): i
r
Box is Ievel.Box has 4 outlet laterals with equal distribution.No evidence of solids carryover.No
evidence of leakage into or out of box.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
' I
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 101 Sachem Drive
Property Address
Herbert Sunderman
Owner Owner's Name
information is required for Centerville Ma: 02632 7/12/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 10-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.):
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 101 Sachem Drive.
Property Address
Herbert Sunderman
Owner Owner's Name
information is required for Centerville Ma. 02632 7/12/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑_ Yes ❑ No
Comments (note condition.of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
101 sachem dr.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15
� Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
101 Sachem Drive
Property Address _
Herbert Sunderman
Owner Owner's Name
information is required for Centerville Ma. 02632 7/12/2007
every page. City/Town State Zip Code Date of Inspection
i
D. System Information (cont.)
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.
i I
1 5N
t p s-- yy,
//C
Ya i
I
101 sachem dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
101 Sachem Drive
Property Address
Herbert Sunderman
Owner Owner's Name
information is required forCenterville Ma. 02632 7/12/2007 "
every page. City/Town State Zip Code. Date of Inspection
D. System Information (cont.)
Site,Exam:
® Check Slope
® Surface water
® Check cellar
• I
❑ Shallow wells
Estimated depth to ground water: Bottom of leaching 5'to 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: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain: r
plan on file
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Used:Gaherty and miller model 12/16/94 ground water.elevations.Used:USGS observation well data
June 1992.Used:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations.
101 sachem dr.•08/06 Title 5 Official Inspection Form:(Subsurface Sewage Disposal System•Page 15 of 15
Town of Barnstable
OF 1NE Tp�
yP� ti� Regulatory Services
sAiuvsrAsi a Thomas F. Geiler, Director
9 MASS. g
1639. Public Health Division
ArEp��p
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
nor does this Division agree with any technical observation s and interpretations
contained within this report.
In addition,by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the"Disposal
Work Construction Permit".
If you should have any questions regarding this report,please contact the certified Septic
System Inspector who conducted the inspection.
.... _...--
N
P�
ROUTE 28 FS
LOCUS �q/�
QG�O ST
PINE STREET
LOCUS MAP
SCALE 1 : 25,000 3 .1 r� BENCH MARK
ASSESSORS -FL. = 34.7 N.G.V.D.
MAP 229 PARCEL 91
AQUIFER PROTECTION OVERLAY DISTRICT
A.P. o \
off• \
ZONE 35.0
-
R D 1
MINIMUMS
AREA = 43,560 S.F.
FRONTAGE = 20' 12.00
WIDTH = 125' 34. - U� \
FRONT SETBACK = 30'
SIDE SETBACKS = 10'
REAR SETBACK = 10' / 28.
BUILDING HEIGHT = 30' ���134•7
(OR 2.5 STORIES IF LESS) �° / 28.6 -0 \ 7
29.7,
P
o.
DIST. o
BOX
x'34 2
o --A
Z
c�' r 32.7
290 G
�000 QRoQ o�� �o����6 0
34.4 x d(4' NO• , x 31-
31.5 5F
• x PLOP •GF D
x 3.1
31.1
31.6-
x
BgEA
x 34.2 N
x 32.6 °, fl
N
X �4_
30.7 DESIGN DATA
NN x 31:4. - .
Q x 27.•3 25.2
00 pQ� LOT,- 20 6 Al SINGLE FAMILY- 3 BEDROOMS
o °�
18,270 S.F•UPLAND j� NO GARBAGE GRINDER
6�
33.0 404' S•F,WETLAND A2•7 i a5,� DAILY FLOW = 110 X 3 = 330 G.P.D.
• \ USE 1500 GAL. SEPTIC TANK
• •I8,674 S.F. TOTAL / o Q� .
x 27.4 �e
3 INFILTRATOR CHAMBER SYSTEMS
STANDARD INFILTRATOR
o � -
•5 ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED
4 WITH CAPPED ENDS
x 27.3
�, USE 10 - 6' X 3' INFILTRATORS IN 1
e\,' p 12'X 38' WASHED STONE FIELD
QO� AS SHOWN
2 . o PLAN 330 G.P.D./ E.74 = 446 S.F. OF LEACHING AREA
1 �O� REQUIRED
Y (12 X 38) = 456 S.F. BOTTOM AREA PROVIDE:
SCALE: 1" = 20'
PERCOLATION RATE; 1" IN 2 MIN. OR LESS f
ELEVATIONS ARE BASED ON N.G.V.D.
-' - 38.00'
4 6 6' 6' 6' 6' 4'
- �,.� 00000v000vvv000vvov00000000v000vovoovoo
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vvvvvovvvvvvvvvvvvvvvvvvvvvvvvvvvvvvavv
FINISHED GRADE vvvv vvv v
vvvv
1 vvv
\3• VVVV VVVV 12.00'
vvv vvv
�. / /1_�'•�� _. vvvvA
v v v c•v_-v�__-------=--•-----_�..___�-.-�.__�-__���r�. vv vvvvvvvvov v vvvvvvv V V V v V
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vvvvvvvvv o vv v vv vvvvvVv vvv
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vvc vvvv
1 " 12» V v c v v w 4ASHED STONE
vc '- vv
7" v c v
v
�. DO-11
1. " 75" 34" BOX
ELEVATION END SECTION DETAIL OF DISPOSAL FIELD
NO SCALE NO SCALE NO SCALE
STANDARD INFILTRATOR CHAMBER
u!7-11"=/ 711,61- rWL:-- i crxs 0 % �„T.c c✓
i
-�Gvi,r2�tii�NT.� Of= n,�c TC�v�/ c% ,�?•
a,c�✓sj',•48C�
Ah-) IS Ab- Y-611-7111.1
1 n NOTE:
LAG Cr L'�' FOR ALL ASPECTS OF THE SEPTIC SYSTEM THE CONTRACTOR
SHALL COMPLY WITH ALL GOVERNING CODES AND REGULATIONS.
IN PARTICULAR 310CMR 15.000 THE STATE ENVIRONMENTAL CODE TITLE 5,
THE TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS PART VIII:
ON-SITE SEWAGE DISPOSAL REGULATIONS AND THE BOARD OF HEALTH
1 COMPONENTS LOCATED IN POTENTIAL
RECOMMENDATIONS FOR ACCEPTED PRACTICE.
,
1CLE TRAFFIC AREAS OR BURIED 4 FEET '
REATER SHALL BE H-20 LOAD CAPACITY.
COVERS LOCATED TO WITHIN ' I T E PLAN Q LAND
12 OF F.G. TEST HOLE
SPLIT ENTRY j 3`
Z� n 's5't MAY 23NYE INC. IN
F 7- BAXTER & NYE I
1•� ` F.G.-34.5 (CENTERVILLE)
Top of P-8692
FOUNDATION
PIT #2 r
3 3.5 INV. - t5oo cA� y 4' DI T _ ELEV. = 32.3' BARNSTABLE MASS .
33.3 SCHEDULE INFILTRATOR CHAMBERS _ FOR
SEPTIC TANK INV. -� WOOD LOAM A
33.1 olst ._ 40 ;.vc. INV. = 32.5 _� -6'
INV. =329 Box --
INV. a 32.7 BROWN SAND B
t
law .�:��:� =�=-�-�•• - HERBERT J. & DRUSILLA A. SUNI)ERMAN
MIN. SCALE: AS NOTED DATE: JUNE 3,1996
IF i
-4 PERK TEST 2}=1/• DATE: JULY 15,1996 (1400sE Loc'&T10Q
BAXTER & NYE INC,
32.0 BOTTOM ELEV. EL = 31.5 �Ey•�o�y 2� ig4�(
REGISTERED LAND SURVEYORS
••' •� _
H°f COARSE CIVIL ENGINEERS
C
5.0 ❑STERVILLE, MASS.
°�"""t' PETER MEDIUM
8 A. � SULLNAH rt+ ::
w+ M0.29733 y LONG POND FLUME SAND
1 _ " '
ss EL. 26.5
cNIL
PROFILE
NO SCALE -8.5' WATER EL. = 23.8
-� 11
96054-46 `
r,� _