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HomeMy WebLinkAbout0069 SHEAFFER ROAD - Health 69 Sheaffer Road Centerville A = 172 072 UPC 10259 �J� ro2� No. H163OR �` � �` N�$TI r TOWN OF BARNSTABLE ' LOCATION � Z .S l e A AV'e/1 E k( o SEWAGE # 2D61 '-A VILLAGE C e/V 1 efT V 111e ASSESSOR'S MAP & LOT lea 0 Z INSTALLER'S NAME&PHONE NO._ A C ® SEPTIC TANK CAPACITY _ , 0 00 0 L LEACHING FACILITY: (type) D R U W eL L S (size) 1 3— 9 3— NO. OF BEDROOMS BUILDER OR OWNER La f"'4`''� II PERMITDATE: I aI a,161 COMPLIANCE DATE: 1,Z h1 b) Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet 'Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1/01 r L Commonwealth,of Massachusetts W Title 5 Official Inspection ForrnvLt�R t yr. ,, r Le Subsurface Sewage Disposal System Form - Not for Voluntary Assessment's ,M 69 Sheaffer Road Zf� A gulf 1 PPI Property Address 1� J07, Mathew& Erin Meagher Owner Owner's Name j�ff „-- information is Centerville Ma. 02632 6/b6 N 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 Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name � P.O.Box 763 Company Address Centerville Ma. 02632 iemm City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the ® 'nfoimation 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 seyvage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Ti e 5 (310 CMR 15.000).The system: 0 ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority c/✓ "' 6/06/2008 Inspe or's Sigkfit 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. 69 Sheaffer Rd.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 every 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: The septic 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: ❑ 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 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Sheaffer Road M Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 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: 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. a ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. I J 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 3 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 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 Y2 day flow El ® 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 ❑ ❑ 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. 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 5 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 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) ® ❑ 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)] 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 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): 2 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2006:106,000 2007:108,000 Sump pump? ❑ Yes ® No Last date of occupancy: 6/06/2008 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: Last date of occupancy/use: Date Other(describe): 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 7 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is Centerville Ma. 02632 6/06/2008 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General 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) ❑ 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): Approximate age of all components, date installed (if known) and source of information: New Leaching Chambers installed 12/20/2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): 20'+ Distance from private water supply well or suction line: 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): Depth below grade: 16"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: 1000 gallon Sludge depth: 4„ Distance from top of sludge to bottom of outlet tee or baffle 28 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 13" How were dimensions determined? Measured 69 Sheaffer Rd. 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 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 septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. 4 Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: 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): 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 10 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 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.): Box is Ievel.Box has one outlet Iateral.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 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner's Name information is required for Centerville Ma. 02632 6/06/2008 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: 2-500 LC ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Chambers had 9" of water at time of inspection with no stain line above this point. 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 69 Sheaffer Road Property Address Mathew& Erin Meagher Owner Owner'.s Name information is required for Centerville Ma. 02632 6/06/2008 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 t 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.): 69 Sheaffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size E] E] zoom OutJJJJJflJJJIn • 1 ,r h f I 0 20 Feet Set Scale 1" = 20 " I Aerial Photos _! (`—,rinhf )oncz-onnQ Tn...n of Qn—cfnhln RA4 All rinhfc rn,nr.e http://www.town.bamstable.ma.us/arcims/appgeo*app/map.aspx?propertyID=172072&mapp... 6/6/2008 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 69 Sheaffer Road M Property Address Mathew& Erin Meagher Owner Owner's Name information is Centerville Ma. 02632 6/06/2008 required for every 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: Bottom of leaching 60' 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: As-Built Card ❑I Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Obsevration Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. 69 Shaeffer Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Palrnstable opIME r �P' o Regulatory Services 1ARNSTABLE,' Thomas F. Geiler, Director y MAS& g i639• Public Health Division ATF���A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER 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 or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations 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 «ed at a articular property w PP p p p y would be listed on the Disposal Works Construction,Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Disclaimer Private Septic Inspections.DOC Fee$50.00 No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for ;M gpogal Opgtem Congtruction Permit Application for a Permit to Construct( )Repair(XX)upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 69 Sheaffer Road Owner's Name,Address and Tel.No. Lorraine Lajoie Centervillle,Mass.02632 69 Sheaffer Road Assessor'sMap/Parce Centerville,MaSS 02632 Ila o Installer's Name,Address,and Tel.Nos 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—9 7 0 0 J.P.Macomber & Son Inc. Ronald J. Cadillac,PLS,RS Box 66 Centerville,Mass.02632 P.O.Box 258 W.Y. Mass.02673 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building &Q S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow t_� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ;Z== 6i t7i h Type of S.A.S. "Z � G -vim -t�� S Description of Soil; SPP Elan Adding two 500 gallon r Nature of Repairs or Alterations(Answer when applicable) leaching rc tQ thQ OXiStI13jseptiG system. 25 ' X1 2 ' 1 n"X2 ' 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 iss d by thi B d of ealth. SigneFrthe Date 1 2/2 0/01 Application Approved by Date 2 -20 E Application Disapproved following reasons Permit No. Date Issued vz -?-C1 d ;: (�� A—.—" � O l 3 L-- Fee$5 0.0 0 ffi THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for �Bigooal *potern Construction Permit- Application for a Permit to Construct( )Repair(XX)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 69 Sheaffer Road Owner's Name,Address and Tel.No. Lorraine Lajoie Centerville,Mass.02632, 69 Sheaffer Road Assessor'sMap/Parcel 1 1D- & Centerville,Maas.02632 Installer's Name,Address,and Tel.No rj 0 8-;7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—9 7 0 0 J.P.Macomber & Son Inc. Ronald J. Cadillac,PLS,RS Box 66 Centerviile,Mass.02632 P.O.Box 258 W.Y. Mass.02673 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S.• No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow :1,1`� gallons per day. Calculated daily flow C gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank , 01�b 17 ?X41br Type of S.A.S. Description of Soil See PA$.D 2a'x �2. 1y"x2 ' Adding two 500 gallon Nature of Repairs or Alterations(Answer when applicable) leaching c^rhamharc to the existing sgptic systom. 25 'X1 2' 1 0"X2 ' 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 issiled by thi B�d of ealth. Signed %' Date 12/2 0/01 Application Approved by C . _ Date \"L -2 6 U Application Disapproved or the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Conmpliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )RepairedXXX)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. at 69 Sheaffer Road Centerville,Mass. has been constructed in accor ance with the provisions of Title 5 and the for Disposal System Construction Permit No.I ^^ dated 1�l a d Installer J.P.Macomber & Son Inc. Designer Ronald J. Cadillac R$ The issuance ofts permit shall not be construed as a guarantee that the sy t will unction as esi ned. Date 19r-3, 1 ,") I Inspector , �� tKJ. No. L ----- --------------------------- — r-- Fee $50.00 THE COMMONWEALTH OF MASSACHUSETTS - - PUBLIC�HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogal bpg;tem Conotruction Permit Permission ids hereby granted to Construct( )Repair�X�Upgrade( )Abandon( ) Systemlocatedat 69 Sheaffer Road Centerville,Mass. 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. I Provided: Construction must be completed within three years of the date of this permit. Date: C� 'U Approved by �.�_�- iTOWN OF BARNSTABLE LOCATION � 9.S/7 e A /&,&L9/'i j/' ,(�o SEWAGE # VILLAGE_ C eidJ YTV&/!9 ASSESSOR'S.MAP & LOT INSTALLER'S NAME&PHONE N0. _ ,A ® A4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) - R v istJ�L L.� (size) NO. OF BEDROOMS .� BUILDER OR OWNER L4 frAi'-AL PERMITDATE: 1 a:I��'6 I COMPLIANCE DATE: 1 A Separation Distance Between the: —_--� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f® i No....... ------- Finc .................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........OF............................................................... - -- Apphralilan -for Di!ipmal Workii Towitrurtion Pprutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. c4 � ' C�.. ,13.t�'.rY. .D.E�r�/..................... ...t1'Ai��c.,A'pk 1 -...✓�'��t� A.00A._ _'041A 'F Owner Address alrv,--- ------ 4 ----------------------------•------------ ------. -�-------- 1-3-j6.......� ��....-14,2ArX, Insta er Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.....- .. ..-.-----.Expansion Attic ( ) Garbage Grinder ( ) �+ per, Other—Type of Building ............................ No. of persons-----.--------------..------ Showers ( ) — Cafeteria ( ) W Other fixtures ------------------------------------------------------ W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity------------gallons Length---------------- Width_ _-.-----.-_-- Diameter--..-----_--.- Depth..-.. --------- xDisposal Trench—No. .................... Width.............------- Total Length-------------------. Total leaching area.-------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet--------:-...... .DTotal leaching area------------------Sq. It. Z Other Distribution box ( ) Dosing tank ( ) - d,0e - J_'z ;1 `7,� aPercolation Test Results Performed by---------- ............................................................... Date-------•-------------------------------- ,a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit...-.--.-------_--- Depth to ground water_---------------------- LT. Test Pit No. 2.......:........minutes per inch Depth of Test Pit................---. Depth to ground water.------..----------.-... ----------- ------ -- ------------ Description ofDkoil------ - -- �-`---- ------� - - -4R ------------------- W V Nature of Repairs or Alterations—Answer when applicable....-........................................................................................... ..-•-----•----------------------------------------------------------•-----------------------------------•------•--------------------•-------....-..---.----•----------......-------------------------... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Stgn � l9� s' 7 S' Date Application Approved By---- .. - ---------------- �..'.�.P...� 5 Date Application Disapproved for the following reasons-------------------------------------------------------------------•-•--•--------•--•------ •--------•-•------ --••••-•---•--•-•-••-------•-----•--•-------•----•--•- ------------------------------------------------------------ -----------•-•--......--...----------------•--------••--•......-----•------••----... q.f Date PermitNo......................................................... Issued--•• .................................................. Date 1J No...... ... FRs.. ......�..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ . .. ._ _................OF.............................I............................ ApV iraflun -for M-4puiittl lVarkii Tottfitrurtiott Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........_ .�F _v� c���'j r -------.................lJ / �/ ------------ ----------- -- Location.Address or Lot No. _t?`7,�,�..................... tl l r . z------• Owner Address ----------------------------------------- Instiller Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms-----k,-?----------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures -----------•...•--------------------------------•---- W Design Flow............................................gallons per person per day. Total daily flow---------------------------------------.....gallons. G; Septic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter-----_.-------- Depth.--.---__-.--_. Disposal Trench—No.---_______________ Width-------------------- Total Length_._______-..._-_--_ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet...... ....-__ T _ _otal leaching area---------------- ft. Z Other Distribution box ( ) Dosing tank ( ) v�_ �___.Z I _ S- " ?- 71— aPercolation Test Results Performed bY-----------.............................................................. Date--------------------------- ------- Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-----.--..-..--------- (� Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water....................... - •---f --- escription ofoil.. ,/1 x ------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable..---------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign ,1. ✓�i / j"-�-t � .... ...3�.7 S ---- Date Application Approved BY . ••-•----------•-•--- •- Date Application Disapproved for the following reasons:................................................................................................................ ..••-•--•••--••--•---•-•--•-••--••----------•-----••••-------••-•--------•--•----•-------------------------------------•-•--------------•-----•----•---------•-••-----------•-•-------••••-•---•-----•.. 7 Date Permit No.---------.............................................. Issued--------fC_.'_..1. ...."..7 1..__. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ...............OF..... .. ... . .................. ........ If Qwrtifiratr of f�lImphtturr TH S O CERTI Th t Individual Sewage Disposal System constructed ( ) or Repaired ( ) by S at...m... ....... - ----- . . ....................... ................................................................... ................�e has been installed in a cordance with the rovisions of Article XI of The State Sanitary e as described imthe application for Disposal Works Construction Permit No.-------Y,?---r__________________ dated...._:--3_.._.. � J THE ISSUANCE OF THIS CERTIFICATE SHALE, NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM VPLL FUNCTION SATISFACTORY. -DATE...... ! Inspector -......... ....•--- ` THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTFJ. No. 1- ......OF.--..... . -- . .. ...... /� FEE./L!............... � �t iutt �rrtnit �i� Permission i hereby granted.-- N__. _ --------- -----•-- --- ---- -- ---- -- •........................................................ Construct or Repair (I') an ndivid 1 ewag i posaI em v` -----------•----- Street /' as shown on the application for Disposal Works Construction er it __------- ADaatted_-!J._.v- .7 _ •-_--•-.._- �X t•-- }-----•-----------•-- 7 � DATE.....-- - -------------------/2-------------------------------------------•-- oard of Health FORM 1255 HOB & WARREN. INC.. PUBLISHERS t c. W ��o goo s E o 3 (3�BED E1o�on f 00 N \ h a (IF 144. 1.3 7 8� �- �`� may. oZ JAMES GJ, JO o A �Y v Is �fsS100%. PLOT PLAN SHOWING PROPOSED CONST T 1 0 �4 S A L E /' _ ��"' ' DAT E �`: G L ,, N D S U R V E Y O R DEFERENCE Z G A E OF Alq 7-/2y Z / C� �— 3 Z_ JOSEPH M. i o MONAHAN,JR. ti v BARNSTABLE SURVEY CONSULTANTS , INC . �F ° STE�,�O� R E G I STE RED ENGINE ER 5 rl LAND 5 U R VE YORS �NpSURV� WEST YA R M O U T H MASS Z61� / s� (Alooll, LOCATIOKA ' SEW&C;E PERMIT--MO.- -YV VILLAGE IWSTQLLER S 1J&ME ADDRESS '- -BUILDER 'S DINTE -PERMIT ISSUED DATE COMPLI &KICE ISSUED : � �. i --�, �, ,�: � p � u ! /)/ 4��.. \ �' .i� Qr+��� II �� � � �I I '� � �� - t� � 1' \��' �.�, I t ""�• ��� �. \� s ,, ��� z �s ��� f ;, ��� . f�.. __ .. __ _ .:.i. �'� , JOB NO. B01-17 N S Lea k%ie.dwa NOT T SCALE N/F CONSTRUCTION 6�`StrTIN NOTES 1. LOCUS IS A.M. 172, PARCEL 72. t% F EL HAT 2• ELEVATIONS SHOWN ARE TOWN GIB; ±; , ; , ' C , , ., 3. LOCAJS IS I•N FLOOD ZONE C ON FIRM DATED AUGUST 1;;' 1'.:?t'.`.:�. �� r �' I @:SE Or EXIStING 'SEPTIC; TANK IS PROBLEMATICAL: F r >, " ' �Z � 4. ALL F%IFE..> T;.. BE 4 SCH 4^, AND PITCHED AT 1/4 PER FOOT. ;!..!NLE`.�>`? Nt::TE[=j �%• �<` "',v 1. VERIFY THAT TANK IS 1000 GALLON. F;, MI UNICIPAL WATER I S AVAILABLE. LOTS WITHIN 1;,`8' ARE N TOWN WATER. fi 2. VERIFY L-OCATIC:IN OF TANK. IS IT 'UNDER � r, UNLESS � �.• �� L•� r:�. i.,�?MF't.;NENT�� T,s� BE AA,>HTO H-1r;;, .,,NLE..``> N�;TE[:. CORNER `�!eF'�'C?I T FOR ENC;LCr:�EGa CaEC:K:r 7. INLET TEE TO F'ROJEC:T [:%OWN 13", OUTLET TEE DOWN 14", k� k r r ) O rn t; SITUATION 8. IF TWO OR MORE LINES, WATER TEST [r—BC,X FOR EQUAL FLOW � BENCH MARK--T.;F F W„�,;[ EN I�5 PRESENT :SAFE.' STAKE= 70.22 GIB•:,' ±C;..M ` � t+ D—BOX EXIT PIPES TO BE LEVEL Fr%R FIRST TWO FEET. n�' 70.6 CONTACT HEALTH AGENT OR R.J. ,.,ADILLA� , r, ;.t � r MUST , r•, WITH ANY QUESTION. [;EF TH OF COMPONENTS NOT TO EXCEED 3% ,,R VENTING M T BE F R� VI[7E[i. Bl!IL[> LW COVERS TO WITHIN 1' OF GRADE. MORTAR CHIMNEY;.'; IN PLACE. ONE COVER OF TANK TO BE WITHIN E," OF GRADE. n r r LOCATION GAF' 1 '. STONE TO BE DOUBLE WA.-SHED 7/4 TO 1 1/2 WITH � MIN. 1/8 TO 1/L PEA :�T...,NE ,)N T P. 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, N/F 12CONTAC;T THE BOARD OF HEALTH, CR R.J. CADILLAC. . IF AN OVERGIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING TEST HOLE I IN TITI�E 69. ----- IS TO BE CLEAN GRANULAR SAND MEETING: SPECIFICATIONS, OF ,'..>1!;' C'MR 15.25 (,'5 . MAY BENCH MARK--S.W. 0 rl; ''NER OF '13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY C:L;G,GED `;OIL, BLOCK, ANC:: STONE IN >, LEACH AREA, AND DI".:�POSE OF AS DIRECTED BY HEALTH AGENT, DEPTH (inches) {'feet`• t�s ♦ 70.22 C;;NG'. `'iTCDF' = 71 3 (GIS I t,tj , ELEV„ 14. ALL CONSTRr r;TIG N TO MEET TITLE `� AND LOCAL REC>I!LAT!ON`. 70.6 ti• r�`+•e,��.�• r A layer 10yr 2/2 TEST HOLE [:SATE: October 10, 2r!:1 6 sondy to-am FIE RFf'RMEG BY: Ron G',fac:Iilla.'::, `..c;il EV, -3tor =`» N/� WITNESSED' BY: F-?r Exemption F,;;rrri 71.t>1 t > '~—{nr+." (t B layer 1 [+ u �ry�p g ye PERC FATE: �2 /in+.sri 2 l.`ayer'` Y, Yr ../t. .C"t'"'� "v {'r� •4 T° ' PS`� T i�'7 Ff}r,l Y1 i�SJ�1?iYi t.%IL s'`!...r RVEY"'I"+" Hinckley sandy li:.. rri S�:an C:ly I±��;:i rYl kr Y �. T 1 �.J�3 `'' r-1.r >i• '..•6Barnstable .kl y , e t:,y S<; � �`�� .. •a G. TH flp " •9 c r t= I MAF 1,:a .; nrr =t a I plain, deposits t y., " [Y `'/ EOL• G: B l'. wit° .1 layer 6 69, 4 �t Iotarny fine sand Invert �; r. Invert 68.7c� 6`�.1`: �7 > {3,0% grovel) �p � r• U ITEM? 20,7' •61 B �.s,� 55 ...�.F. 4� N°_, cs 0" 66.3 ....... RASE �,HAN�-E,..� 4,. ETHt�le3l�T is AKE RC�PCI��EL� Exi:;,. 4o lror; 1= Exist. Or{anpBtaUrfia DRY WELLC> HURCH °. Invert ?>t>.1,..> „a C2 !sayer 2.-y 6/4 * LOCATION o G= Fro rti;ed G c r I_ • ,ATI.N F EXISTING K ire to coarse Bond 69.6 '1 3 X 9 9`'EPTI�M TANK UNCERTAIN 71,0 7wG> C:ono.=t,i .8 ('10% gravel' ��S�c�r x 9,8 ,�c`. . Toga Pe��ar;+one=66.5 (firm on side of hole'; \ `�' �71,08 Exi >+ina — t —��,%"/ff. �GF - 71.0 \ �I;+i+., Teink ( —� 12 3" C3 layer �.8 0 ,.,4„ y 69.7 ( L 14� rned. (loose`..: song D 69,7 �` COVER no wta.er 57.4 FOUND , t' Invert t CF. S. I t-> Bottom Proposed I t Proposed ORANGEBURC PIPE FCiI!N[> W ed- 71,3 ( 2 7•a'--� I �. ?>' Bottom. TH1=57,4 X 70,9 71,40 9 DESIGN DATA F n�v�� �� k 70. N Leo Op 70,57 x 70.3 BE[.ROC,MS; 3 F'AULIN�: 68,26 GARBAGE GRINDER: N+.. LEASH AREA \ �LG REQUIRE[:' CAPACITY: >3'U GpD !...!` E 2 [ RY WELL.` WITH 4' ! F \\ 9� _ ` TCINE ALL ARO!!ND -;,R A69.6 EXISTING SEPTIC TANK: 1C GAL.6941 BOTTOM LEACHING. AREA: 32u.7 `>F 25 — r E ' L,aNG BY BY .12' 1i" WIC; 68,04 [,2`' X 12.8,. >`: BY 2' [:EEP LEACH AREA. 69,62 .`.:I[:>E LEACHING AREA: 1`1.3 SF 2 1 r� 69.6 t / 2�12.8�'+ 2`' X 2' P`' � [ , [:EE ;] %, , 7 DESIGN G:APAC�:ITY: 3 `� G 0.0 a 4 ,PC' F 1�3 [(32;,.7 SF + 151.3 SF; X .74 GF'D/.`.tiF] 69.9 C,a x 69.2 68.9 6 68 x 68 / 00, 96 f 67.42 SITE PLAN 067.26 '® FOR THI; FLAN I; A VALID (_' SPY ;ONLY IF IT BEAR"-,' AN ORICSINAL REC; STAMP AND SIto NAT!..:)RE. ' I E UJ R A I N E L A J\C) MA 9c p o hfgc T 1 , ROAD, CENTERVILLE, MA •! TH 1 TEST HOLE LOCATION, N!.!MBER Ir�� RO CIE� y a 13 RON SCAL A�I� tiG� � �(� q � sa® �`3 � WATER LINE MARKINGS , Ujn, NOVEMBER , ��JJ1 1 ®� E OVERHEAD ELECTRIC: WIRES (IF SHCIWN j 1 41 ei0 �. #35779 G GA`:? LINE MARKING;;: /IF SHOWN ��cas� �` 0 F s x9.5 x 8.7 EXISTING & PROPOSE[ ELEVATIONS i.'X' MARK; PrINT � ff qSURDAN{T pp CADILLAC, F>'` — EXISTING '';C;NT CiLIR ` ( I•ZQ "` AL J. L 3, 9 8— PR0P0"-,ED C.ONT01.,!R PROFESSIONAL LANE) SURVEYOR & REGISTERED SANITARIAN Rf lJTILITY POLE CIF SHOWN, P.O. BOX 258 � EXISTING DRAINAGE CATG:H BASIN WESTYARM UTH, MA 02673 x — FENCE (IF SHOWN, NOT ALL SH0;WN) r � TREE /IF SHOWN, Nr.";T ALL SHOWN? HEALTH AGENT APPROVAL DATE FjAI.. E 1 I::+F l BY R.;!. C:AC ILLAC