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HomeMy WebLinkAbout0016 SHEAFFER ROAD - Health 16 Sheaffer Road Centerville. P A _ 172 037 f Qr�® NO. 1521/3 0RA �;�, 10% TOWN OF BARNSTABLE LOCATION %(v S e_1QPe_,r SEWAGE# Z6ta 11 Z VILLAGE ASSESSOR'S MAP&PARCEL l INSTALLER'S NAME&PHONE NO. cmi? Q7(,0 SEPTIC TANK CAPACITY �gva £x LEACHING FACILITY:(type) �;p (15) (size) .'$.yq NO.OF BEDROOMS R OWNER �Y►�_` �a�zt�S PERMIT DATE: COMPLIANCE DATE: Y—a 7'10 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leach' Feet FURNISHED BY 13v 83 A 4, sy 4 . l y.k iq Q P � a� r i i I ' 11 � � x 1 { i �a e I Town of B• rnstable P# of�� • Department of Regulatory Services -' Public ifealih]Division Date 3 � 9 v i AM& ,bsq tee$ 200 Main Street,Hyannis MA 02601 • AjFD hAA't� i � - Date Scheduled 4 o- 0 ' Time Fee Pd. 0 I 'oil' Suitability Assessm" 'for Sewage isposal Performed Byy \ M ilv l / r _ Witnessed LOCATION & G-ENERXL INFORMATION_ Location Address l(p C1 GtT r61M � Owner's Name O R-P EL C.0►ATE fLV t L� AAA� Address S A A Assessor's Map/Parcel: Engineer's Name �Y NEW CO ON REPAIR Telephone# SO$ 3(oZ,2�122 Land Use Res`✓Et�Tl n L, Slopes(%) Surface Stones 200 Distances from: Open Water Body > ft Possible Wet!Area � ft Drinking Water Well ? q6 ft � y�� ft Other ft Drainage Way > �Q ft. Property Line . SKETCH:(Street name,dimensioris'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) N50'41'00"W 150.00' ASPHALT DRIVEWAY "......% .. I I ii i w p Ile 1 Y ;i w L) o _JJI I / LL 3 _ G o, 6 Q I i z ry 1 � 0 LLJ v . (n O 70 JoGrQ\ti ' '1 � - � f T AS----\ j r -rtGK t I S50'41'00"E 150.00' Parent material(geologic) lQC(�( U aS� i Depth to Bedrock N /� I Weeping from Pit FAc Depth to Groundwater. Standing Water in Hole:' I P g Estimated Seasonal Vigh Groundwater ! DtT- E ATION FOR SEASONAL HIGH WATLR T"LD+ Method Used: _in. Depth to soil matUrs: In. Depth dbperved standingp obs.hole: P ft.Depth toiweeping from side of obs.hole: in. Groundwnter Adjustment ! _ Act.factor.�,._.�.- Ad1.C3raundwnterla:vrl,,,,e, Index Well# _ - Reading Date Index Well leVO - - I PERCOLATIjON TEST • Date— T4UL_.___-- Observation I j Time At 9" WA -- -- . Hole# �yr� Time at6" Depth of Pere 10 Start Pre-soak Time.@ t _ Time(9"-6") End Pre-soak Rate MinAnch Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(YIN) Observation Hole Data To Be Completed on Original:,Public I;e$Ith Division Back— Original: ***If percolatyibn testis to be conducted within 100' of wetland,,'you must first notify the rior to beginning. Barnstable Conservation Division at least one (1)week p DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel (,oq-Nl Said f vy 2��Y • If 6 -7f' 14f!' CZ Med .Sand 2-5y 714 DEEP.,OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil, Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consis enc %Gravel) 0t1 2711. Pulp. : Z�I ' I% n M at1 fbY�31 1(0,' 1'- q,,. L� Med SQIf4 2'sy 7/ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.). (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency, ra I .t Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No v Yes Within 100 year flood boundary No Yes Depth of Natural(y'Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? Certification oa I certify that on 1 (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with the requir I in' ,expertise and experience described in 3.10 CMR 15.017. Signature Y Date Q:X.SEPTICIPERCFORM.DOC i t / / No. ;t 0 1 Q '— Fee s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �N!6pogar *pgtem Cow6tructiou Permit Application for a Permit to Construct( ) Repair/ Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. I f p 56,.- ra- '�^��t-y r��, Owner's Name,Address,and Tel.No. aril �p�j _kS Ito Sl C,�e r- '�Z. Ce.-\"&\k Assessor's Map/Parcel 1 �� Q Installer's Name,Address,and Tel.No. he.VS Designer's Name,Address and Tel.No. 106rw,v\ Wv-%Clr P-4 box -n M�6,, Vvti.11s VWA, P_6. fox �81 Ut36Z--ZUZ Type of Building: Dwelling No.of Bedrooms S Lot Size 64-n6Cj sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 o gpd Design flow provided____ 33,$9 gpd Plan Date Ll I i'Z I 1© Number of sheets 2 Revision Date ' Title Size of Septic Tank /pG� Type of S.A.S. Beddg g, Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo rd of Health. Signed Date /1Z0f CS Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. go l o — 11�L— Date Issued 1 0 Fee THECOMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes r i. 2pplicatiori for MissPogal �&pgtem Conmruction Permit g Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑ Complete System p y ❑Individual Components Location Address or Lot No. �lp S�btt�✓ �� � y i��q„ Owner's Name,Address,and Tel.No. V f t t ' KC�tr S �1P S4Qaer ��. �trvi,� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. eiL S T£,JC.M% Designer's Name,Address and Tel.No. Dom`*Wr PP_6. e>bx 71 Mkv-SE0,5, MikkS tAkA. P_6. 6oX cl$) 5eQj36L-Z9Z7 Type of Building: Y Dwelling No.of Bedrooms Lot Size /5�annC% sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 13 0 gpd Design flow provided 3 ,$ gpd Plan Date 1 1-1 I(6 Number of sheets 2. Revision Date Title J Size of Septic Tank /O G C� Type of S.A.S. [�A-Zse-V 5 f m1 $.,l X 3-x 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 Application Approved by _ J/ Date ��A(y Application-Disapproved by: Date i Y 5 j. • , for the following reasons' Permit No. o`Z O o I I `� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired �X) Upgraded ( ) Abandoned( . )by at I(0 6hpz•f sr% r- QA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. (90I0 II�-- dated 9 Installer tC sm�\Ie,u S Designer `(YVD_A f_N- #bedrooms 3 Approved design flowd gpd The issuance of this pe it shall not be construed as a guarantee that the system Wj)lI RA_o t/ion as desi ned. Date ��� /J InspectorNo. 10 , (J kv / r Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Mi!gpo!6al *r5tem Cow6truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must becompleted within three years of the date of this permit.Date �-6 1 [/ Approved by �- A) 4 1 Town of Barnstable '"E''��.� Regulatory Services Thomas F. Geiler, Director • MUMSrne[.s. 9�AMAM ®� Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fast: 508-790-6304 Installer & Designer Certification Form Date: 2�' lD Sewage Permit# 2atn-ir2 Assessor's Map\Parcel 17 Designer: 1 {�`��_�� �(� Installer: Iffli-c- Skeart.1_,, Address: Address: AC). dog -t A5— SAIyY)VV I(iH Vkv4(2�IVN.S Vko�LS 1MW. On was issued a permit to install a date (installer) septic system at I � �I ���_ based on a design drawn by ri�,V��'1 V"l ►�"l� dated 117//o (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the- distribution box ancL'or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation o"any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. QF Mgss9c 0 MEM y sta er s Signature) " No. 1140 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARINSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COiNIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU Q: Health/Septic/Designer Certification Form 3-26-04:.doc DATE : 9/23/02 PROPERTY ADDRESS: 16 Sheaffer Road m ---------------------- . � g Centerville,Mass. . ------------------------ 02632 LSEP7, 5 2002 ------------------------ F BARNSTABLE LTH DEPT. On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank. `� `� 2. No distribution box. 3. 1 -6 ' X8 ' block cesspool. Based on my inspection, I certify the following conditions: 4 . This is a title five septic system. ( 78 Code, ) 5. The septic system is in proper working order :at the present time. 6 . The 6 ' X8 ' block cesspool was dry at time of inspection.. 9. House has been vacant. 10. Has had little water useage in the past two years. SIGNATUR Name:_ J .- P . -Macomber-jr . ____ Cotp any : Jose ph P._ Macomber & Son, Inc . Address :__Bq: _E_Cz___-__--_--_ Phone :--508-775- 3338 ------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY rMwAva"M JOSEPH P. MACOMBER & SO,N, INC. Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-00 66 775-3338 775-6412 L . COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL, AFFAIRS DEPARTMENT OF ENVIRONMENTAL., PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 16 Sheaffer Road Centerville,Mass. 02632 Owner's Name: Estate Of Pauline Pierce Owner's Address:4 Maynard Road Topsham,Maine Date of Inspection: 9/2 3/0 2 Name of Inspector: (please print) Joseph P.Macomber Jr. Company Name:J.P.Macomber & Son Inc. Mailing Address-.Box 66 C-Pntprui nL-,MasS 02632 Telephone Number:50$_7'75_3338 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 rrainine and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP appt oved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: . tj1Passes ,f�-- Conditionally Passes — Needs Funher Evaluation by the Local Approving Authoriry Fails Inspector's Signature; t Date: The system inspector shall mit 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 authoriry. Notes and Cornments ****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 r - conditions of use. - —� Title 5 Inspection Form 6/15/2000 page I Page 2 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Sheaffer Road Centerville,Mass. Owner state Of Pauline fierce Date of Inspection: 9 2 3 02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D S s m Pass I have not found any information hich indicates that any of the failure criteria described in 310 CMR 15.303 or to 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: V The se tic .system ,is in proper working order at the.,. preSent time. B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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 or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 41� e Observation of sewage backup or break out or high static water level in the istribtition bo ue to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: AThe 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: 2 I Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 16 Sheaf fer Road Centervilie,Mass. 0263-2 Owner:Estate Of Pauline Pierce Date of Inspection: 9 23 02 C. Further Evaluation is Required by the Board of Health: Ab 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. I. 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: ,GYM 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: .t;M 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. �D The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply 40 The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. .t6 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 supple well". Method used to determine distance �LQ "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. Other: None 3 L Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Sheaffer Road Centerville Mass. Owner:Estate Pau ine ierce Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No _ aup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ckischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool td Static liquid level in the distribution box bove outlet invert due to an overloaded or clogged SAS or — � cesspool squid depth in cesspool is less than 6" below invert or available volume is less than 'A day now Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number — � of times pumped �. ny 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. d/Any port ton of a cesspool or privy is within a Zone I of a public well, t//.�\: 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma 1010_ (Yes'No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd. You must indicate either"yes" or"no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply Z/ the system is within 200 feet of a tributary to a surface drinking water supply v the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IW'PA) 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 eves" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15 304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 1 OFFICIAL INSPECTION FO DISPOSOAL SOR VOLUNTY YSTEM INSPECTION FORMNTS SUBSURFACE SEWAGE PART B CHECKLIST Properry Address:l 6 Sheaffer Rnarl Centerville 2632 Owner:Estate Of Paul ine Pierce Date of lospectioo: Check if the following have been done. You must indicate -yes" or"no" as to each of the following: Yes >vo 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 rwo week period ? ZHave large volumes of water been introduced to the system recently or as part of this inspection ? zWere 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 'Alas the site inspected for signs of break out '. Were all system com pone nts,I,�/�cluding 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 Yes YExisling information. For example, a plan at the Board of Health. !1 _ 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)) 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:16 Sheaffer Road en ervi e, ass. 02632 Owner: Estate Ot Pau ine Pierce Date of Inspection: 9/23/02 FLOW CONDITIONS RESIDENTIAL 2 Number of bedrooms(design): +3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): Oov 6'AQ Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (gees or no):.10 [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): 40 Water meter readings, if available (last 2 years usage(gpd)): 2000-28, 000 gal lops=76. 72 GPD Sump pump(yes or no): Xk) 2001 —26, 000 gallons=71 . 24 GPD Last date of occupancy:7 COMMERCIAL/INDUSTRIAL Type of establishment: �¢ Design flow(based on 310 CMR 15.203): /1 _gpd- Basis of design flow(seats/persons/sgft,etc.): 40 Grease trap present(yes or no):M Industrial waste holding tank present (yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no):y�/Q Water meter readings, if available: �J Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records .'11 Source of information, Was system pumped as pan of the inspection (yes or no): _ If yes, volume pumped: 0 gallons-- How was quantity pumped determined?iOw Reason for pumping: TYPE OF SYSTEM Septic tank, ��x-, soil absorption system AP 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 ATight ined from system owner) tank , Attach a copy of the DEP approval /Other(describe): Appr ximate ate of all c ponents, date installed (if known)and source of information: l Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address.: 16 Sheaffer Road Centerville,Mass. 02632 OwnerEstate Of Pauline Pierce Date of Inspection: 9/2-1/o 2 BUILDING SEWER(locate on site plan) Depth below grade: W� Materials of construction: _cast iron 40 PVC mother(explain): Distance from private water supply well or suction line: /,�"y Comments(on condition of joints, venting, evidence of leakage,etc.): Joints appear tight No evidence of l eaka e.The system is vented through the house vents. SEPTIC TANK: Zlocate on site plan) Depth below grade: -'Xg , Material of construction: J/concrete metal eb fiberglass, I polyethylene other(explain) a If tank is metal list age:,ed is age confirmed by a Certificate of Compliance (yes or no):,ib(attach a copy of certificate) Dimensions: Sludge depth:::?� Distance from top�ludge to bottom of outlet tee or baffle:/.- � 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: How were dimensions determined: Aliy 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 the SP_pt-J c- tank e-VPr_= 2_3 )ears Inlet. & outlet tees are in place.The tank is structurally sound and shows no evidence of leakage.The liquid level at the outlet invert is fifty orip inches. GREASE TRAIX (locate on site plan) Depth below grade:, 4 Material of constructionconcrete/4�PmetaWAfiberglass49�olyethyleneA�other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: leo Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: A,14 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Grease trap is not present- 7 I Page 8 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address; 16 Sheaffer Road C_entervi e,Mass. 02632 Owner: P,- ,tate Of Pauline Pierce Date of lospectioo:9/23/02 TIGHT or HOLDING TANK. +(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: ,0jconcrete,,,_,/AmetalAA4 fiberglass 4&Polycthylene�,4other(explain): �wZ Dimensions I Capaciry. gallons Desien Flo,: /f� gallons/day Alarm present (yes or no): Alarm level: _9i¢ Alarm in working order(yes or no): Date of last pumping: 412 Comments (condition of alarm and float switches, etc.): Tight or holding tanks are noll DISTRIBUTION BOX4kC (if present must be opened)(locate on site plan) Depm,of liquid level above outlet invert: _ 4-0 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.): Distribution box is not presen . PUMP CHA:MBER1(locare on site plan) Pumps in working order(yes or no): y,4 Alarms in working order(yes or no): � � Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not resen . 8 Page 9 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:l 6 Sheaffer Road Centervi e, ass. Owner:Estate Of Pauline Pierce Date of Inspection: 9/23 02 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) 1 -6 ' X8 ' block cesspool. ( Dry ) If SAS not located explain why: Located: See page 10 Type .Bleaching pits. number: _ AV leaching chambers, number:0 _ i(IO leaching galleries, number: _0 X leaching trenches, number, length: � leaching fields, number, dimensions: Q overflow cesspool, number: 1 innovative/alternative system Type/name of technology: r/yG Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.). Lnamv sand to boney medium sand to fine sand.No signs of hydraulic failure nr pondinci Soils are dry Ve eta ion isnormai. CESSPOOL': Zcesspool 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: Q , Depth of scum laver �� Dimensions of cesspool: Materials of construction: M;j, AiAck Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Same as above PRIVY,�(locate on site plan) Materials of construction: Dimensions: yip Depth of solids: ,UjQ Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present. 9 f Pdg( 10 0/I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORKY, PART C SYSTEM INFOR/vi.ATION (cominvco) ➢foPfrT� Aoaf(„ 16 Sheaf fer Road Mass. 02632 0"o(1'Estate Of Pau in-e fierce ��i� of Inipcci oo: 9!2_/02 SKrTCH OF SCWACE DISPOSAL. SYSTEM Ao. of i �IIIcn of inc icwi(c oi,poiil IXII(m InclvOLng IIc1 to 11 4171 fw0 permtncnl rcrcrcncc IlJ�Cmiiz, o• 0 •�crmvki loci iu ..,u ..I nin 100 (M. Locci( wf1(r( public wmr Ivpply cnIM inc Dviloin, I .OF pk y to Page 11 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:Estate Of Pauline Pierce 16 Sheaffer Road Owner: Centerville,M ss. 02632 Date of Inspection: 9/2 3/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water, 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: NA yam_Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: NA yam_Checked with local excavators, installers- (attach documentation) y,_Accessed USGS database-explainhttp: //town.barns table.ma. us. You must describe how you established the high ground water elevation: Jsed: GahertyKMiller Mnr3P1 12/1F/94 Ground water elevations above sea level. USG-2: �b2Qrvatlnn well-da.ta +?une 1 QQ2 USES. Teehnle-al Bulletin 92-000-2 Plate #2 Annual ranges of ground Leaching Pit %d 'eet � r Groundwater: f'eet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is J 4 feet. 11 y •rrnr+r.—rs+ra—.rr•♦rnrmr•ntrr rr�+r..zc•r.rr..r.:•.�rr-'•arr:•rrrcr:m m-�v*rYvrc.n-s ���_ 1 'TOWN OF Barnstable BOARD OF HEALTH 0..._,ry_r..,_.•.,__, SIJ(1SU(iFACF 3F,NAGR DISPOSAL SYSTEM IN�911FCTION FORM - PART D^- CERTIFICATION -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS16 Sheaffer Road Centerville Mass. 02632 ASSESSORS MAP , BLOCK AND PARCEL # hd OWNER' s NAME Estate Of Pauline Pierce PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inc:"* COMPANY ADDRESS Box 66 Centerville Mass. 02632 Street Town or City Stat• ZIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal, system at this address and that the information reported is true , accurate , and omplete as of the time of :inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one ; ��System PASSED The inspection which I have conducted has not found any information which indicates that the system . fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have conaircted has found that the system fails to Protect the ilublic health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signatur Date __ -- - - =-F-- ne copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF 11RALT'II, * If the inspection FAILED, the owner or"'operator shall upgrade • the aystem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3,10 Chjn 16 , 305 . partd .doc TOWN OF BAMSTABLE a '� OCATION �/� SEWAGE # \ .VT-LAGE &7ke/a i4� ASSESSOR'S MAP & LOT SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS B TJMDER OR OWNER 25S nMPLIAN '- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet. Private Water Supply Well and Leaching Facility'(lf any wells exist ' on site or within 200 feet of leaching facility) F et Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet opeard f ty) Feet Furnished b - 4 tea-.... ..-.�-t!.�,.i � i�,- -� � _ K � . . ~�� . M � v r CENTERVILLE LEGEND AGBOLT=71.40' PROPOSED CONTOUR ;' f RACE LANE ® PROPOSED SPOT GRADE O<O —— 98 —— EXISTING CONTOUR Q %'> . �, LOCUS ST + 96.52 EXISTING SPOT GRADE N W— EXISTING WATER SERVICE O �'` �9�,A \. '` % � 0 � 9 TEST PIT LAMF`�,� �lyq .\O,S�y ��� SOst 4,' ZO O / , V 1 ♦\ �, I l� N Z wnc 0 T —2jTH-ll W � Inep Portz LOCUS MAP EXIST. Existing Leachpit �� �� 10000AL. = LOCUS INFORMATION (Note 10) ;' // I TANK = _ _ PLAN REF: 247/84 PARCEL ID: TITLE REF: 17992/289 172/051 PARCEL ID: MAP 172 PAR. 37 16 — ZONING: "RC" r'o• __ FLOOD ZONE: "C" 3—BEDROOM — — COMMUNITY PANEL: 250015-0001—D DATED:07/02/92 DWELLING SEPTIC SYSTEM TCF=72.62 REPAIR PLAN - - _- - LOCATED AT: -_ 16 SHEAFFER ROAD TBM=72.00 BOTISSTEP --- - .�° CENTERVILLE, MA. GENERAL NOTES: �`,� -_- 0 PREPARED FOR 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 0 R N E L 0. ROBERTS BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS C� `RJ0 APRIL 17, 2010 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS NOTED BELOW: SCALE: 1 = 20 ft. - 310 CMR 15.405 (1) (B): OO 1) A 0.61 FT. VARIANCE FROM 310CMR 15.221(7) TO ALLOW LEACHING TO BE 3.61 FT BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED) PARCEL ID: OF M9s'f9 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 172/037 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE M.AREA=I5,000 S.F. I o AR N ✓+ �, DESIGN ENGINEER. M 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING N.O. 114 "'FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. JS 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 00' PARCEL ID: �4NITAR�a�THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF �� 1 72/050 �� 1 7 l HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. nD� 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED c TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR, 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 1 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PARCEL ID: D AR R E N M. MEYER, R.S. CONSTRUCTION. 1 72/036 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION P.O. B 0 X 981 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY EAST SANDWICH , M A. 0 2 5 3 7 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW PARCEL ID: (508)362- 2922 . FOR THE USE OF A GARBAGE GRINDER 172/049 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 17. PROPERTY IS IN ZONE OF CONTRIBUTION OR NITROGEN SENSITIVE AREA. SHEET 1 OF 2 J#1238 NOTE: TO PREVENT BREAKOUT, THE PROPOSED DESIGN CRITERIA NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:67.39 FOR A DISTANCE OF 15' AROUND THE NUMBER OF BEDROOMS: 3 BR EXIST. PERIMETER OF THE S.A.S. SOIL TEXTURAL CLASS: CLASS I SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER DESIGN PERCOLATION RATE: <2 MIN/IN T.O.F. EL.=72.62 INSTALL A 4" DIAMETER INSPECTION PORT OVER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. DAILY FLOW: 110 G.P.D/BR. �-F.G. EL.=71.75t F.G. EL.=71.5f DESIGN FLOW: 330 G.P.D. /J F.G. EL: 70.80t F.G. EL: 71.0(MAX.) GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) VENT PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY 9" MIN COVER/ LEACHING AREA REQUIRED: (330) = 445.94 S.F. MW • 36" MAX COVER L = 30' L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) ® S=1% (MIN.) ® S=1% (MIN.) ® S=1% (MIN.) 74 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) f0" s 11.3" TO PRIMARY S.A.S. 14 INVERT USE 3 ROWS OF 5 - 16" ADS 160OBD BIODIFFUSER H-20 UNITS-NO STONE \INV.,.= 70.29 48"UOUID INV.=70.04 LEVEL } AND EXTENDED 0.75 W/ CONTOURED WEDGES GAS BAFFLE) PROPOSED INV.=67.80 3 ROWS OF 5 UNITS AT 6.25'/UNIT + 0.75' WEDGE = 32.0'/ROW BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODIFFUSER) D-BOX (BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.70 SF/LF = 440.63 SF AM - DB-3(H-10) INV.= 67.0 INV. - SOIL ABSORPTION SYSTEM (PROFILE) (CONTOURED WEDGE) 3 ROWS x 0.75' x 4.70 SF/LF = 10.58 SF EXISTING 1,000 GALLON SEPTIC TANK TOTAL AREA = 451.21 SF RESTORE VEGETATIVE COVER DESIGN FLOW PROVIDED: 0.74GPD/SF(451.21 SF) = 333.89 GPD > 330 GPD req'd EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS 75" NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ' : PLACE FILTER FABRIC PIPE INVERTS PRIOR TO CONSTRUCTION .�'' '• :'>'• '` ;� . OVER ALL UNITS 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=67.39 (RECOMMENDED) GRADE ON A MECHANICALLY COMPACTED SIX INV. ELEV.= 67.0 INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 66.06 EXISTING SUITABLE 310 CMR 15.221(2) 2.83' MATERIAL 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK 5' MIN. ABOVE BOTTOM OF WITH 1500 GALLON SEPTIC TANK IF FAILED, T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 3 x 2.83' = 8.49' r� 76» _I DAMAGED, OR LESS THAN 1,000G IN CAPACITY. (6.76 PROVIDED) USE 3 ROWS OF 5-HIGH CAPACITY 4) INSTALL INLET & OUTLET TEES AS REQUIRED BOTTOM OF TESTHOLE EL.=59.30-=- ADS 810DIFFUSER UNITS-NO STONE PROFILE W/ CONTOURED WEDGE SEPTIC SYSTEM PROFILE TYPICAL SECTION �- 16" P/ N.T.S. N.T.S. 11.2" SOIL LOG P#: 12888 _L- 34 DATE: APRIL 12, 2010 1-- 34" � 27.27 SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 SECTION END CAP WITNESS: DAVE STANTON, BARNS. BOH TP-1 Depth Elev. TP-2 Depth 16"" HIGH CAPACITY 160OBD H-20) BIODIFFUSER UNIT 99 Elev. � �- 56 71.30 FILL 0" FILL 71.30 0" p 52 9� 69.05 27„ 69.05 27" MODEL 16" HICAP LOAMY SANG LOAMY SAND 1OYR 3/2 1OYR 3/2 LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT {a 68.72 a 31" 1 68.63 a 32" EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LOAMY SAND LOAMY SAND DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. OF Mq 10YR 6/8 IOYR 6/8 SIDE WALL HEIGHT 11.2" s`�9cy 67,22 49" 67.14 50.. OVERALL HEIGHT 16 S 4640 TRUEMAN BLI/D N Ct C1 OVERALL WIDTH 34" NA HILLIARD, OHIO 4JO26 MED. SAND PERC ®65:80 MED. SAND PERC ®65.80 CAPACITY 13.6 CF • No. 1140 "' 2.5Y 6/6 2.5Y 6/6 (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. ciS1 65.14 CZ MED. SAND 74" 64.97 CZ MED. SAND 76" PROPOSED SEPTIC SYSTEM/SITE PLAN QNITWa� 2.5Y7/4 2.5Y7/4 16 SHEAFFER ROAD, CENTERVILLE, MA 59.30 144" 59.30 144°/{� c t oll ties e c •17, kU PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared Ored for: Roberts / / J J NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DARREN M. MEYER, R.S. vaepougeu Survey NTS D.M.M. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 p0 BOX 981 (774) 238-6797 DATE: CHECKED to conduct soil evaluations and that the above analysis has been performed by me consistent with the SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. EAST SANDWICH, MA 02537 rw 508-362-2922 04/17/10 1 D.M.M. 1 2 of 2