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Home My WebLink About0129 SHEAFFER ROAD - Health 129 SHEAFFER ROAD, CENTERVILLE A= 172 06 14pftYCtFO�o�� UPC 12534 No.2'�R .� HASTINGS, MN T WN OF B STABLE LOCATION A� > � �' SEWAGE # 0 VILILAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �✓ ,�� (size) NO.OF BEDROOMS BUILDER OR OWNER K,-ZAr ;d,,._x PERMITDATE: 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 y within 300 fee(of ac ' facili � `/'� � � � Feet Furnished b} l • h 11. r i No.Pinm Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in co puter: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Disposal *pstem construction 'Permit Application for a Permit to Construct( ) Repair()( Upgrade( ) Abandon( ) ❑Complete System W Individual Components Location Address or Lot No. j P�R 5a6AW6P_ P-a d°yka Owner's Name,Address and Tel.No. M4R-4 46461 Assessor's Map/Parcel r]a 6I; �S �E�PT fG-C Installer's Name,Address,and Tel.No. 5 OR-47'1 -9$7 ] Designer's Name,Address,and Tel.No. Co#aE4dtD6 E&4eKDQIS6S cf-c- /.4 TI pe of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' ed Date jD ' S 0 C Application Approved by Date Application Disapproved by Date for the following reasons Permit No. L 3 y �o_ Date Issued L No. /�/ � 'Z Fee (/V THE COMMONWEALTH OF MASSACHUSETTS Entered in co uteri Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplicatlon for Misposal Opstem Construction Vermit Application for a Permit to Construct( ) Repair(X lUpgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. I ;Lq S't(EpFIrd�;_) Pb d'Vtc[; Owner's Name,Address,and Tel.No. M+kRu 46ANJ BAKElp Assessor's Map/Parcel 1 P] &j & GEA1T fG[.ai� Installer's Name,Address,and Tel.No. 5 p$-"7—8$71 Designer's Name,Address,and Tel.No. G4pEWtD5' E&TrEKDA(.SES (,c,C„ JU A Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 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. r S4 ed Date Application Approved by Date A:� ' Application Disapproved by Date for the following reasons Permit No._� ` 3 `�' Date Issued Nr-- 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 C.4 P-k9(D[ � ��JS (,(.C-- at I a•q S�i4gg; Qb C&172111 L(_�has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No-o-; 3-11 3,ated ldl5l Installer C..�'CO GC>( Designers ALIA n #bedrooms Approved doi w,'dgt0o gpd The issuance of this permit shall not be construed as a guarantee that the system 411 fun tion as desigt}e . Date O Inspecto // ---- ------------------------------------------------ --------------- --------------------------------------- ----------- ------- IS L Fee,/� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair()<) Upgrade( ) Abandon( ) System located at I AP9 S N E A EFAFk j-e_o,E.b I L— and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special"conditions. Provided:Construction must be comp eted wi n three years of the date oft s permit. Date /0 Approv by Commonwealth of Massachusetts /�� /7W' W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Sheaffer Road Property Address t.2� Mary Jean Baker Owner Owner's Name information is cc- required for every Centerville MA 02632 10-10-15 page. City/Town State Zip Code Date of Inspection r..�l Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When ng out forms A. General Information on l the computer, J/ 1 ��Od ��`� ��H OF'MgSS°��,,� use only the tab 1. Inspector: key to move your cursor-do not a g: JAMES :m use the return James D.Sears =�: t= key. Name of Inspector :*: Capewide Enterprises,LLCCompany Name �••.�,�_ o:^Q* y: lyTTr` 153 Commercial Street ''F,5, S,P,Ec` Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority aii2ft¢ 025-- .� 10-10-15 ,ofispector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �ow rs- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is Centerville MA 02632 10-10-15 required for every page. Cityrrown 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 system is a 1000 Gal. Tank D Box and two pits. 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in aaalpW is less than 6" below invert or available volume is less than '/day flow P1T t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is Centerville MA 02632 10-10-15 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. Cityrrown 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)] 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Sheaffer Road . Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and two pit's. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2013-51,000Gais g ( y g (gp )) 2014-69,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 10-13-14-15 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: NA 10-2015 New D Box Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 & SCH 20. Septic Tank(locate on site plan): 91, Depth below grade: 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 Gal.Precast H-10 Sludge depth: 1 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 9" below grade. In and outlet baffles. No sign of leakage or over loading. 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"A 8" below grade w/two line's out. Box is new 10-2015 w/cover at 4". Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type. ® leaching pits number: 2 ❑ leaching chambers number: ❑ 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.): Leachig is two pits. Older pit# 1 Dry, pit and cover at 13" below grade.Pit#2 Newer-H-20, pit and cover at 2' below grade w/30"water in pit. No sign of over loding or solid carry over. No high stain line. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Sheaffer Road �M Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 13-,= 2 =q p s� 134-= AV-3 0 EAR B o O t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells No Estimated depth to high ground water: 32 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: off asbuilt on file at B.O.H. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: G.W. 32' off asbuilt on file at B.O.H.. Bottom of pit at 8' below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 129 Sheaffer Road Property Address Mary Jean Baker Owner Owner's Name information is required for every Centerville MA 02632 10-10-15 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ---------- TOWN OF BARNSTABLE LOCATION ��1Uf1�� SEWAGE # �'� VILLAGE ��:-»'rf"�f f f ASSESSOR'S MAP LOT 7 INSTALLER'S NAME PHONE NO. l� 4L�M J - •frrn .LAC— SEPTIC TANK CAPACITY el LEACHING FACILITY:(type) / (size) ~`NO. OF BEDROOMS_PRIVATE WELL OR PUBLIC WATER. � - BUILDER OR OWNER DATE PERMIT ISSUED: S 16 .�� i DATE COMPLIANCE ISSUED: /VARIANCE GRANTED: Yes No , JL\ '4 I • V 1 DATE: _ .8/.7/9 DL PROPERTY ADDRESS: 1129 &kre4ffer Road. Centerville,Mass. 02632 1 On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -1 000 gallon 'septic tank. 2 . 1 -Distribution box. 3 . 2-1000 gallon precast leaching pits packed in stone. Based bn my Int+cactlon, 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.. . SIGNATURE: Name J P Macomber Jr... i - ------ Company._J. P_Macomber & Son-Inc Address:_-Be,x-bb-----=a------- Cente_rville ,MAss__0.2.632 ' Phone: _50.8.,.J7_S.^ 338------- -- I THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • JOSEPH P, MACOMSER & SON,. INC. Tanks-Ceupoola-LeachfleIds Pump+d & Installed Town Sewer Connectlons P.O. Box 66' Centerville, MA 02632-0066 77.5-3338 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 WILLIAM F.WELD ,9 TR'UDY COaf Governor G !`�� Sccrctar ARGEO PAUL CELLUCCI roy G{� DAV1D B:STRU)i Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM yGo p Commission T PART A s" �9�Ty99 ,l9 CERTIFICATION Property Address:1 29 Sheaffer Road Centerville Address of Owner: Date of Inspection: 8/7/98 1 1Mass. (If different) 6 / Name of Inspector:Joseph P.Macomber Jr. "-- I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J-P.Macomber & Son Inc. Mailing Address: BOX 66 Centerville,Mass_ 09632 Telephone Number: 508-775—_3_j'jft CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ZPasses �- _ Conditionally Passes — Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspecto shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to tfse system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: I have not found iny'information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15:303. Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" senion need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of \. Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection;.or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Pay 1 o1 10 DEP on the World Wide Web: http:Uwww.mapnet.state.ma.usrdep Printed on Recycled Paper • U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 129 Sheaffer Road Centerville,Mass. Owner: Pat Ronco Date of Inspection: 8/7/9 8 B) SYSTEM CONDITIONALLY PASSES (continued) Alp Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: V6 Conditions exist which require funher evaluation by the Board of Health in order to determine if the system is (ailing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ,(�D 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 APPROPRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 426 The system has a septic tank and soil absorption system (S.15) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply, 40 The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. &L5 The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. 426 The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis (or 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 S ppm. Method used to determine distance �09 (approximation not valid). 3) OTHER (revised 04/31/17) Lego 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 129 Sheaffer Road Centerville,Mass . Owner: Pat Ronco Date of Inspection:$/7 9 g D) SYSTEM FAILS: You must indicate ei;i.er "Yes" or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cornea the failure. Yes No / -K/ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool, _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the dist lbution box above outlet invert due to an overloaded or clogged SAS or cesspool. Xt {J� Liquid depth in is less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped D—. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Y Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No i(jB the system is within 400 feet of a surface drinking water supply V!J the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please.consult the local regional office of the Department for further information. (r•vlsed 04/75/$7) Pay• 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 129 Sheaffer Road Centerville,Mass.. Owner: Pat Ronco Date of Inspection: 8/7/98 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No/ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, *cluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if djfferent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. ,k _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (rovl..d 04/25/97) a.y. 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propeny Address: 129 Sheaf fer Road Centerville,Mass. 0.ncr: pat Ronco Date of Inspection: 8/7/98 FLOW CONDITIONS RESIDENTIAL: Design flo�,.'�W p.�Jbedroorn (or S.A.S. lvmtxr of bedrooms: !� .vmber of Current residents: Caroage grinder (yes or nos Laundry Conne0ed 10 syslem (yes Or no). _ OOO9Q� l(o/.(oS Seasonal use (yes of us no). J 9 9��X�1J41�P—D 223 -09 �%•ater meter readings. if available (last two (2) year ag a lgpol: Sump Pump Eyes or no):A115 :ast cite of occvpancy Y-147' COMMERCIAUIN DUSTRIAL: Type of establishment:_ [fa Design flo- 474 Gallons/day Crcase Irap present. (yes or no)A2,4 tr+dusutal Waste Molding Tank present: (yes or no)" -,on•sanaary Neste discharged to the Title 5 system: (yes or no)Ael'- Wattr meter readings, if available._A)19 A2Q last date of OCCupanCy: A _ OTHER; :Desc(ibet 4)14 Last date of occupancy AL GENERAL INFORMATION PU."PING RECORDS and source of information . S 11 System pumped as pan of mspectton: (yes or no)-Vff If yes, volume pumped: 0 gallons Reason lot pumping LIA U67, pl&192 TYPE Septic tank/dislribvttpn box/soil absorption system Single cesspool Am atrflow cesspool Privy ` Shared system (yes or no) (if yes, anach previous inspection records, if any) VA Technology CIC. Copy of up to date contras) Csher .U14 APPROXIMATE AGE of all components. date t talled (i(known) and source of information: Se-age odors detected when arriving at the site: (yes or nos u.�s•.a Os/Js/1J1 ➢.0. $ o! 10 . 5 Customer Data Entry Screen 8111192 Name: Patricia Ronco Address: 129 S heaffer Road pron cc�e g Town: Centerville state:MA zip:02632 Li 911ng 8ddrem: 129 S heaffer Rd Centerville MA 02632 Tel 420-6169 Te12 Notes: 412192 pump TO snake rec 265.00 4117192 612192 system LP pump 1500.00 617192 1195 letter 5113196 pump T 145.00 5114196 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM v PART C SYSTEM INFORMATION (continued) Property Address:129 Sheaffer Road Centerville,Mass . 02632 Owner: Pat Ronco Date of Inspection:8/7/9 8 BUILDING SEWER: (Locate on site plan) Depth below grade: j Material of construction: _cast iron Z40 PVC_other (explain) Distance from rprivate water supply well or suction line /6'7." Diameter Yt Comments: (condition of joints, venting, evidence of leakage, etc.) Joints a ea THT-O—U-9-F the house vent - SEPTIC TANK:/w (locate on site plan) t) Depth below grade: Material of construction: JzConcrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list ageAA Is age confirmed by Certificate of Complianct4L4 (Yes/No) Dimensions: y"�It Sludge depth_ Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness:tr Distance from top of scum to top of outlet tee or baffle: d2_c Distance from bottom of scum to bottom of outlet tes or baffle: How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity evidence of leakage, etc.) Pump tank every 2-3 years ; Tnl et R of at- toes ar'® in pMce;Liquid depth at the oLtlPt- invert is St " rho septic tank is Gtriict-lira 1 1 v S, 11mc] ai3d gh64 r, f36--9 11 P, a�A -- GREASE TRAP: (locate-on site plan) Depth below grade: Material of construct ion:A/l9concrete. metal,(�Fiberglass�Polyethylenother(explain) A)A Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ 64 Distance from bottom of scum to bottom of outlet tee or baffle:—&A) Date of last pumping: -&I Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,-etc.) Grease trap is not present, (revised 0{/3s/97) Pegs 4 of 10 �J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:129 Sheaffer Road Centerville,Mass. 02632 Owner: Pat Ronco Date of Inspection: 8/7/9 8 TIGHT OR HOLDING TANK:, &,(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade:, Material of constructionvV,4concrete/VhmetalNR Fiberglass j&olyethylenei other(explain) AM ' Dimensions: AM Capacity: AA gallons Design flow: gallons/day Alarm level: AJA Alarm in working order Yes;4L9 No Date of previous pumping: —AIR Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tight or holding tanks arp not =rpgpnt- DISTRIBUTION BOX:, (locate on site plan) Depth of liquid level above outlet inven: -t1d Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or,out of box, etc.) Distribution box has two laterals;no evidence of solids carry over; No evidence of leakage into or out of the distribution box_ PUMP CHAMBER:2.Z�2vlel (locate on site plan) Pumps in working order: (Yes"or No) /� Alarms in working order(Yes or No)4 Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Pump Chamber is not present_ (sov1s•d 04/2S/97) P•y• 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 129 Sheaffer Road Centerville,Mass. Owner: Pat Ronco Date of Inspection:g/7 9 g SOIL ABSORPTION SYSTEM (SAS):-k—/ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number:, leaching chambers, number: d leaching galleries, number:= leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Loamy sand o medium coarse sand;No signs of hydraulic failure or ponding; All vegetation is normal Old pit is dry_ ThP nPw pit has waste water At 47" halnw the ; nuArt -lia CESSPOOLS: dity� (locate on site plan) Number and configuration: 8 Depth-top of liquid to inlet invert: Depth of solids layer: 1/4 Depth of scum layer: Dimensions of cesspool: 414 Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) A)A cesspoOis are not present Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Cesspools are not prcccnt PRIVY: A'?b'(1 (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.) Privy is not present (revised 04/25/97) Pag• 6 of 10 SUBSURFACE SEWAGE DISPO STICSYSTEM INSPECTION FORM SYSTEM INFORMATION (continued) Proper Address: 129 Sheaffer Road Centerville,Mass. O..ner: Pat Ronco Dire of Inspcction:8/7/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or comes into locate all wells within 100' (Locate where public water supply s i i C ' a.v• A of so SUBSURFACE SEWAGE DISPt_':S:CL SYSTEM INSPECTION FORM P 1,10' C SYSTEM INFOR',t ,'rION (continued) Property Address.129 Sheaffer Road Centerville,Mass. Owner: Pat Ronco Date of Inspection: 8/7/9 8 i Depth to Groundwater O Feet Please indicate all the methods used to determine High Groundwater Elevation: /Obtained from Design Plans on record l/ Observation of Site (Abuning property, bservation hole, baserr4r*sump etc.) �etermine it from local conditions Check with local Board of health Check FEMA Maps heck pumping records heck local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwa*erElevation. Must be completed) Used Water Contours Map Gahrety & Miller Model 12/16/94 (revlo•d 04/25/37) ,'1Oot 10 •nnn nr.-n•r�r.---arn:mr•ns.nrrn*+awnrnri-.m+rrtrr�rrr.•m.��rwtarrs�rrvmn �*ro+s•-�-arrv.rn-a-rr. 'TOWN OF Barnstable BOARD OF HEALTH 11 SUIlSURFACE SEWAGE DIS NSAL SYSTEM INSPFCTION FORM - PART D •- CEKTIFICATION If�•TT1�T•'.•::t—r.tiR�.T.TTtT T.wl'n.1PI T{RJRI/RI/ITT.r.al nVTwft RRVI-1'�ti/R1wAntR!'f�I1 tnnnYnTnrl'sinTlT:mtr.•.+-.r•,'r•1--�.� -TYPL OR PAINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 129 Sheaffer Road Centerville,Mass. ASSESSORS MAP, BLOCK AND PARCEL # / 7 R O 4g�o;l OWNER' s NAME Pat Ronco PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber JR. COMPANY NAME J.P.Macomber. & Sorf Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State i!P COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system a this address and that the information reported is true , accurate , and complete 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 iiealtll or L`he• environment as defined in 310 CMR 16 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED# The inspection which I have �concted has found that the system fails to protect the jiublic health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . )AW. e Inspector Signature Date -7- One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF IiEALT1I, * If the inspection FAILED, the owner or operator shall upgrade ' the ayetem within o'ne year of the date of the inspection , unless allowed or required otherwise as providdd in 3.10 CMR 16 , 306 . partd .doc w 7 - � s THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. hmc X. IvvS nctany, Dircctt>r of tltc t)' iuit ulf Water Pullutiun C0111r0l LbCAI"ION: Z�f I jr� Z l SEWAGE PERMIT NO. :(`R -55A-.4ye )V VILLAGE: INSTALLER'S NAME & ADDRESS: �./ , _/_� BUILDER'S NAME & ADDRESS: DATE PERMIT/ISSUED: DATE COMPLIANCE ISSUED: __ r ;� Ala f��j�p, �''� .. , ',f 9EyA � .3' r_ v _ �,� ' LOCATION s) �� r SEWAGE PERMIT NO. V-1 l l A G E h INSTALLER'S NAME i ADDRESS .04 A7 i U I-L D E R OR OWNER DA T- E P ERMIT ISSUED �,2-`2m DATE COMPLUANCE ISSUED I�j, � t �0 �7 0 No._---••-•---••••-•-•---- Flcs...... ...................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEA TH 't...__......_.OF..-.. .. ..... __. -........................... Appliration -for UiBpviial Worko Tons#rurtion jJrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst9m at: /' ......G!. . ...........r •.._ � 6/._-�� . ... '= ......---L E 1��41 ..................................... Locatio -A re s oyI)ot No. Ow r Address nstaller Address Q Type of Building Size Lot. ,f Sq. feet U Dwelling—No. of Bedrooms---- --- --------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building __ 121 _ No. of persons___________________________ Showers ( ) — Cafeteria ( ) Q Other fixtures ----- ------ W Design Flow_____ _ __�. 0--.-gallons per person per day. Total daily flow--------- -----_--_..gallons. 04 Septic Tank Liquid capacity eVgalions Length................ Width---------------- Diameter---------------- Deptli._.----_------ xDisposal Trench—No--___-__---_-----__- Width.................... tall Len th___........____.__.. To al lea ping area--------------------sq. ft. Seepage Pit No------- --------- DiameterLaQ---Z��i b '__-- aching area-------.-------._sq. it. Other Distribution box Dosing-tank �� fd-- Z ( ) g. ~" Percolation Test Results Performed by..�, �p. i /_ .__�____�/=_,�_GX_ ______________ Date---------------------------------------- Test �S a Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----._._-_--.-_------ rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-_._---_._-.--_---. i /J Description of foil =` ... ! i � �'7y UA - --------•------------ - ------------------ ------ f' :` r�a �.. .., x ----------------------------------- ------------------------------------------ -------------------------------------------------------------------------------------------- ........................... U 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 furtl r agrees not to place the system in operation until a Certificate of Compliance has been is by the bo rdJ10 ea t ned- ---------6 ..... .- Date Application Approved By-- -- -- -- ------ --- G Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- --•••-•-•••-----•----•••••-------•---••----------------------------------•--•••--•-•-•-•••-•••---•-•----••-•-•....•------------•-••-•---•-•--••---•---------•-•----------------•••••--------•--•-••••-. Date PermitNo......................................................... Issued........................................................ Date No .3 .......... r- • Fuu.....,, ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applirtttiuu -fur Biipuiittl Morks Towitrurtiuu Vrruift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal y _ Location All ess > or.-Lot No. ............................ �Dw r Address 1--i __•_•__\ .................. ------------------------------------- Installer Address d Type of Building Size Loth_ ._ -d...Sq. feet V Dwelling—No. of Bedrooms-_- . ..._-- Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building 1/�7 -- No. of Expansion Attic Showers ( ) Cafeteria ( ) dOther fixtures -----:..�--- ----------------------------•-.---------------•-----••••-------------------•--•----••--------------- ._..... W Design Flow_ Q _._5___ ...gallons per person per day. Total daily flow............ .............gallons. WSeptic "Tank•�Liquid capacity 4-46gallons Length................ Width------.......... Diameter------.--------- Depth........_------- Disposal Trench—No_ ____________________ Width-------------------- Total Lenh__,____.____.._.... To al lea ping area........__._...__.__sq. ft. Seepage PitNo......., ___ h t e-_--- Diameter. ._Q6!--- be 'et _... : %tom ate aching<trea..___.__.____.__sq. it. z Other Distribution box ( ) Dosing tank (, d�' W Percolation Test Results Performed by._R 6t._�a_!_ _a._ ..: .___��--'-_.�11y................. Date----- ------_-_--- Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water---------------.__._____ fZq Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water---_---__--_---__--__. O --------------------- - .........................`+.:. - .......Z r Description of Soil "'....s.? a._... � '"k s x o 1 vA � r -------------------------- W x ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U 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 NI of the State Sanitary Code— The undersigned furt Ier agrees not to place the system in operation until a Certificate of Compliance has been i u"dby the board of ea.th. igned- -• ''---'................. " ��'h�ht��----------. ..... .��_�� Date Application Approved By---"-- -- .� - ",... d Date Application Disapproved for the following reasons------------------------------------------------•-------------------------------..----------•-••--•-•----••'-''- Date PermitNo.................................._...................... A' Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF/ iEALTH f ............oF....- ...... � Trrtifirttte of Tomplitturr T�IIS/IS TO CERTIF17 Thaf f ) or, Individual Sewage Disposal System constructed Repaired ( ) b lad . - •" c G. -_ -----------------------•-• / I staller r at has been installed in accordance with he provisions of A,rtti��@le� XI of The State Sanitary Co e as described in the application for Disposal Works Construction Permit No._(�,;,.,,�___ _1 ................ dated._ ,' _ .~.'....... _.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE___ =`�f�. � = Inspector ._..��____ .z"�` � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT„Li 1.......-o F.......... a C i No.-"--•.................• FEE urk,� �nust�urtiu rrm t Permission isshereby granted----- !.�If >`s J � r -t �,!� r t -st t to Const �ct '( '� or Repair ( ) Knllndividual.6ewaq Disposal!System "I.- at P No.�?.�< " { = !� ',."'-'� 2'.•r..' � Y� =------ -- �f r A� 7 Street + as shown on the application for Disposal Works Construction,Permit 6/`�:__ !•_`.... Dated__1__ __ ------------- 14 ---------- •---_- - ,- --- --- --'••........................... - -- Board of He th DATE''S 7- ~_7 S' •-••-----• � � . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS PLOT PL.AN•SHOWING PROPOSED BUILD' NGy` IN CB/VT.Ei21//L L E B A R N S T A B L E MASS. r FOR t Y " SCALE . / — 30/ . DAT �i�R. 2/, /9zS f s CHARLES N.SAVERY INC. '.REG C,E. aLS. 712 MAIN ST. HYANNIS," MASS. , LOT /70 L.DT /7/' Is G , /5" 2 55 9. . /00D CA4. I LEACH/NGT P/T� �` 1 I '' LEACH/w6 P/T �'-'� •. - _ LOT,. /5•7 • �RoPOSPO , r DI�/ECGL/NCr N •' 36' `14 F tea' I I , tiff m # /oo.ooIt- y. ! �•�, ^\ 11� J•'AAA �`� r l N) ro r�'e ' .t l !tra,rEs I 75 027 PLOT PLAN SHOWING PROPOSED BUILbIN6 IN CE/v-.ERV/«E 6 A R N S T A 8 L E MASS- FO.R SCALE ; /" = 30' UAT�. 2/, �9tS CHARLES N.SAVERY INC, REC. C.E. 8 tLS. 712 MAIN ST. HYANNIS, MASS- LOT LOT /70w /Do.00 j FUTlJRE _ - LEACH/NG -p/T� �,•� � .. F ,� ad, a /000 G9L.., LEAGH/Na P/T • Nam. Ll ., ,„ ' r -. '8r.�/A.M. 6'bEPTN•✓ �"sS►,)%s�Or - � . ' s i,) SCP7/C 7A.V r'Zti i, ' " ' •PRof�OSE� � t ,�� i 36 r. 44 F�Or /00.00 �h 14 ( -� .�.� .way /. ..... \\�_.._ _._i _ __.� _._ _•_�-. 1�-R'��.►. ` U } r • .• • • t C 1,1 l�rsy� 75027ti • TOWN OF BARNSTABLE LOCATION 1jcc- pCl SEWAGE VILLAGE ASSESSOR'S MAP & LOT 17.1jg4 INSTALLER'S NAME & PHONE NO. ( . f��1 l�Go.vi Jos= Irm .L�r SEPTIC TANK CAPACITY. LEACHING FACILITY:(type) /�'� (size) & I a NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: - VARIANCE GRANTED: Yes No._ u / � � Zi \ No....7a�.)J'b.. Fms THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 8arnstaDlo APPROVED TOWN OF BARNSTABLEIAZ fW=rtr=jgt ' -9. Appliratiun for Diupuiial 10orkii TvmitrurflMCWrm1f a Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 129 Sheaffer Road Centerville ................_................................................................................ -••-•••....••-••-•-•-------•-•••-•------•-••-•------------•••.......-----••-••--...............--- Ronc o Location-Address or Lot No. ......................».......................................................................... ..........----------....._......_............_....•-•...--••••--•................................- � J.P.Macomber Jr. Owner Address Installer Address d Type of Build Size Lot............................ USq. feet Dwelling—No. of Bedrooms.•_...•..................................:;.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .................................................! = W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................. Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------_...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by-•------•-••••-------••••--•--------•---••----....-•------•---------•--•- Date........................................ W 14 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ 0 9 .----••----•-----------••--•-•--•------------••-•••-••-----...••----••-•--------•••-•--•-•---•..............•--•--••-•--••--•----•......__........- .....--- Description of Soil...................................................................................................................................................... W Sand & Gravel v .............................................------....•••----•••----------•••--•---•---•...••-----••-----•-•-----------••••--•-----••-•----••---••--•------•-••--•--••--------...-------••------------ W x -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------- U Nature of Repairs or Alterations—Answer when ap l cable.__ _ _ _ :____ __ 1-10 0 0 gal tl o n leaching; p l y----------------------------------------------------------- .............•----•---....------------------------------•-----------------------------------................•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e has ben . sued y the and health. Signed ._:. � :. ....5�2E��2 Date Application Approved By .. ...------- � ....�? u ---�j-----_- -_---------------- vim.... Date Application Disapproved for the following reasons- ----- ------------- -- --------------- -- --------------- ..--------------------------- -------------- --------------------------------------------------------- -------------------------- . . ---------.....----- ---- -------- -----------------.... -- ------------........---------------- ......................................... Date PermitNo. ........ '-a-.-.:'... .��......................... Issued ....................................................... - Dare - . �No.... �... Fims...... ...3 ..:. . THE COMMONWEALTH OF MASSACHUSETTS BOAR® ,OF HEALTH TOWN OF BARNSTABLE 12 ApplirFation for Uiipnsal Works Tongtra.rtioa 'Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 129 Sheaffer Road Centerville ................_ -- - -•-.......... ...... --...... Location-Address or Lot No. Ronco W J.P.Macomber Jr. Owner Address ........ .................... � Installer Address UType of Build Size Lot............................Sq. feet Dwelling—No. of Bedrooms_____________________________...............Expansion Attic ( ) ' Garbage Grinder ( ) `4 Other—TYP e of Building --•-----•----• P______________ No. of persons............................ Showers Cafeteria a ------------- --- ( ) — ( ) P4 Other fixtures ---------.------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter---------------- Depth................ x let__:_____.._..______ Total leaching area___...________....sq. ft. Disposalp Trench—No_ _______________ Width.................... Total Length______.________._._. Total leachingarea....................s ft. Seea e Pit No..................... Diameter-------------------- Depth below Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit_--______.__________ Depth to ground water__-___-_-______________. 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 9 ---------------•------------------........---------.....---•---•••---.....-----.....•--._._..........-----•••--••-------....--.--------.......--•-•-•--_•---- Description of Soil....................................................................---------- --------------------•---------..-------••-----------------------------------------...__. W Sand & Gravel ---------•------------------------------------------------------•---------------------------•------•----------................................................. ------------------------•-------------------------------------------------------------------------- -------------------------------------------------------------•---------------.-•-•-------.......-- U Nature of Repairs or Alterations—Answer when applicable__ ___________ --------------_----------. 1-1000 gallon Yeachiri pig. ---------------------••----------•-•------------ • • . . •--- •--•--•-------------------------------------------------•---------------.-..----------------....._..._------ Agreement: The undersigned agrees to install the aforedescribed Individual'Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian e has been issued,by the board of health. `Signed �t� ' � �: / - 5/26/92 ------------------------ Dace Application Approved By -------------- � ... �,,,r,�.^- L-------------------------------------------------------.... .......`' ................ Application Disapproved for the following reasons- ----------- - ---------------------------------------------------------------------------------------------ate------------------ - -------------.........................................................--- Dace . Permit No. ........�.� --.....: ...I. .......................... Issued .............. Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE TPrtifirak of (11.1-IImyliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX) by ..... J.P.Macomb.er._.-Jr-. 129 Sheaffer Road Centerville """"' at . has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....Z<1.6............ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.-CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. l` r. DATE.................... `-... ......' %............................................ Inspector ------ ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No T GG�� ,r��/ TOWN OF BARNSTABLE No...._!__ .:.. I�?. FEE...�...3(J:O �i��rrrr��a1 �rk� �a��irii.aln rruti� J P.Macomber Jr. Permissionis hereby granted............................. ----------------------------------------------------------------------------••---------••----..._..••---•---•--- to Construct S(he)a?rf e spa o d) one tjit4ij i�i jIld%-wage Disposal System atNo. -•-----•---•••--------------•----.....--- Street as shown on the application for Disposal Works Construction Permit No_AQ_1_6__ Dated.......................................... ------------•--•-••----- ft� ------ V Board DATE............... ��._ f� ._... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS . . i`� y �, ,.�:; I �s_ ,W .�. t� � �� E� , x