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HomeMy WebLinkAbout0070 SOUTH PRECINCT ROAD - Health 70 SO. PRECINCT RD. CENTERVILLE :A=11448-146-3 No. 42101/3 ORA ESSELTE 10% ® O O 0 'TOWN OF BARNSTABLE S 01.1 a t� SEWAGE AQ � VILLAGE`t� (, A`SSESSOR�'S MAP&LOT I V —31 INSTALLER'S NAME&PHONE NO. \ t U Cn�l 11 bY1�' )83: q SEPTIC TANK CAPACITY LEACHING FACILITY: (type) I Yl$I I�ir'(� (4) . (size) f�)C; NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE:� ' Q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility 11f any wetlands exist within 300 feet of leaching facility) Feet Furnished by r(Li'1+ k A o to r IA2 P�3 5 33 = 55 �► IA�' 4 1, i No. '? w Fee 75 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftptiLation for MispoBal 6pBtem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System .Individual Components Location Address or Lot No.`70 56VTFf &(C<WCi RA Owner's Name,Address,and Tel.No. Assessor's Ma /Parcel �oujAkl> � cAVLOL- FD%t_ p lye f c�v C,�Le,c�' "?6 S®,. P0.(kctMc.T'RD CC-:tjT Jt Installer's Name,A dress,and Tel.No. J®$—4-77—*RT7 Designer's Name,Address,and Tel.No. cAP4FLc.9LDe'iP.&4wr ib aorLcc. { 1 A p lv l 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) — O S 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 Healt 1 Si Date Y�� Id ^cl oO Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ! & Date Issued (� — s Fee 75 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLation for Misposaf ,pstem Construction permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.10 $av-T f p0(Ecl1/C* Rb Owner's Name,address,and Tel.No. Assessor's Map/Parcel C.�Ut 3 So ECJAIRLrT Installer's Name,Address,and Tel.No. Mpg_4-tT Designer'sName,Address,and Tel.No. CAPE t. M c.1 t=c>6 W_ - Q, dv IZ cz, 0 t/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 r Nature of Repairs or Alterations(Answer when applicable) T�� A F'14 _ -(y,_����i �, + 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 Si d_._., .�"., Date Application Approved by Date Application Disapproved by Date _. 4. for the following reasons Permit No. /� - ���p ( Date Issued 17. - (b - --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by (ZqGt0 t n T 1�� � lb 1)c1� 1 at -74) 1:; R' -.i u _ has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit N_. -4 dated Installer C � lr-� �h,�72 Designer IA- #bedrooms Approved design flow gpd The issuance of this permit shall not be co strued as a guarantee that the system will functio/n.as designed. Date /��//ram if Inspector - ---------------------------------------------------------------------------- ------------------------------------- ---------------------- No 1! hrp - Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction VPrmit Permission is hereby granted to Construct( ) Repair(A Upgrade( ) Abandon( ) System located at 14) Soc imW P4 _1 h K;" 1! 6 D C6�)_a jCX I I d' 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 b)compl tedd,}within three years of the date of this pe it. Date Approved by Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � r 70 South Precinct Road Property Address ; Howard Fogle Owner Owner's Name / r information is required for every Centerville / MA 02632 12-11-19 r" page. City/Town State Zip Code Date of Inspection r, 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. P�0 ,6 OF Np;;1 Important:When A. Inspector Information # rya �`o�� qcy filling out forms on the computer, James D.Sears JAMES use only the tab key to move your Name of Inspector ;r„ cursor-do not Capewide Enterprises �'•_o o . �� use the return Company Name key. 153 Commercial Street �i rt S INS? q lNhtuJlttltVR�� � company Address Mashpee MA 02649 Clty/Town State Tip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that; I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 12-11-19 spectfx'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 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 form should be sent to the system owner and copies sent to the buyer, If applicable,and the approving authority. Please note: 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. 15insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 6 abed xed did LZ:S 1, 61,02 Z I• 080 Commonwealth of Massachusetts Title 5 Official Inspection Form w� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �5p, 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is Centerville MA 02632 12-11-19 required for every page. CityfTown State Zip Code Date of Inspectlon C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 12-2019 New D Box. The System is a 1500 Gal.Tank D Box and four infiltrators. 2) 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): tbinsp.doc•rev.7/2612018 Title 5 Official Inspection form:subsurface Sewage Disposal System-Page 2 of 18 Z a5ed xeJ dH LZ:9 6 5 60Z Z 6 aaQ c Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page, CityfTcwn State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): 3) 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. a. 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: t5insp.doc•rev.V2612018 Tine 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 £ a5ed xed did LZ:q 6 6 L02 Z 6 320 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle C+wner Owners Name information is required for every Centerville MA 02632 12-11-19 page. Clty/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7126f2M Title 5 Official Inspecllon Form:Subsurface Sewage Disposal System•Page 4 of 10 abed xed dH LZ:9 6 6 60Z 2 6 D@0 c Commonwealth of Massachusetts vVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than '/2 day flow C1411iwc ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 C.4. 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 t5insp.doc-rev.712 612 01 8 TItle 5 Oifidal Inspection Fort:Subsurface Sewage Disposal System-Page 5 or 18 g a5ed xeJ dH LZ:g 1• 6 60Z Z 6 3<1 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cunt.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes"or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7/2e/2098 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-page 6 of 1s 9 a5ed xed dH LZ:91• 61.0Z Z I• 0B0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 South Precinct Road v Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page. Cityfrown State Zip Code Date of Inspection D. System Information 1. 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 Description: 1500 Gal.Tank D Box and four infiltrators. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2017-70,000Gals g y g (gp )�' 201 B-81,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date 15insp.doc•rev.712612018 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 7 of 18 L abed xed dH LZ:96 61.0Z Z6 �Q,0 Commonwealth of Massachusetts r Title 5 Official Inspection Form li Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personslsq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 812 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 9 a5ed xed dH K:96 ME Z6 OaG Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name required o r e Centerville MA 02632 12-11-19 required For every page. Cityrrown State Zip Code Date of Inspection D. System Information (conQ 4. 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: 1999 permit # 99- 52 12-2019 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 33"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. t6insp.doo-rev.712 612 01 8 TIUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 a5ed 6 Xed dH SZ:S l• 6l•OZ Z 6 D@0 i c Commonwealth of Massachusetts Title 5 Official Inspection Form v�-' ` Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle Owner Owners Name information is required for every Centerville MA 02632 12-11-19 per. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 23"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: 1500 Gal. Precast H-20 Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle g" Distance from bottom of scum to bottom of outlet tee or baffle 18 How were dimensions determined? Asbuilt-TapeSludge 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 at 23" below grade w/inlet cover at 4"and outlet at 17". In and outlet Tee's. No sign of leakage or over loading. t5insp.doc rev.7/2612018 Tige 5 Official Inspectlon Form:Subsurface Sewage Disposal System-Page to of la 0� abed xed dH 82:9 4 6 60Z Z t n0 Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page. City/Tom State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. 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 t5insp.doc-rev.7126/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 1, a6ed xed dH W91, 6 60E Z 6 D80 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments L 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page, City/Tcwn State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cunt,) 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 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-20 D Box is 20"x 24%32" Below grade wlfour line's out. Box is New 12-2019 w/cover at 6". t5insp.doc-rev.H2612019 Title 5 Offic al Inspectlon Form:Subsurface Sewage 01spossi System•Page 12 of 18 Z l, abed xed dH 6Z:9 1 6 602 Z I• Oaa Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :1 p 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page. City/Town State Zip Code Date of I nspectlon D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS)(locate on site plan,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: t5lnsp,doc-rev.7/2612018 Tltle 5 Official Inspection Form;Subsurface Sewage Disposal System Page 13 of 18 £ abed xed dH 6Z:9 6 6 60Z Z I, Da0 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 70 South Precinct Road Property Address Howard Fogie Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page. CitylTcwn State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is four infiltrators. Chamber's at 42"below grade. Check D Box Prob area and camera out line's. No sign of over loading-solid carry over or holding water. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.dcc•rev.7l26=16 Title 5 016clal Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 �� a5ed xed dH U:9 6 6 60Z 2 L Dao Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 South Precinct Road L Property Address Howard Fo le Owner Owner's Name requinform r on is Centerville MA 02632 12-11-19 requiredd for every page. Cityffown State Zip Code Date of Inspection D. System Information (cant.) 13. 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.): t5insp.doc•rev.W20018 Tille 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 0118 5 abed xed dH 62:9 6 6 60Z Z 1• DGIO Dec 1.2 2019 17:00 HP Fax page 1 •, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .1— 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 14. 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: Mhand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 TIVe 5 Metal Inspection Forth Subsurlace Sewage Disposal System•Page 16 of 18 Dec 12 2019 17:00 HP Fax page 2 Dec02 19,11:22a Capewide Enterprises 508-477-4977 p,4 +.i.nbr,at,v r ft%.N.a• a. lq lam) i :.I I k L 1 L A - ' tslzc) ... NO.OF;BmROOMS ODUMER oR OWNER FEFtMITDATE• Z '8 'U C� COMPLLkNCE DATE: Sopasation Distance Between the: Maximum Adjusted Croundwreter Fable to the Bottom of leaching Facility Feet Pdvate Rater Supply Well and Leaching Fecitity (if any wens evict an site or witNa 200 fat of leaching facility) Fed Edge of Wetland attd Leaching Facility(lf any walands exist within 300 feat of leaching facility) Feet Purnishsd by f(:n+ uN L15 3 R d! o c b a A t ' 5`, 162 3-1'15 3� la►' i°y 31' 1�5= 6T b' A5 .A1" fib- 114, 7 A,v k- S �v Commonwealth of Massachusetts W:r Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is Centerville MA 02632 12-11-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 9-4' 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: 5-6-97 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS). ❑ Checked with local Board of Health explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H.on Design plan 5-6-97 9'-4" G.W.. Bottom of chambers at 4'-4"below grade.Bottom of chamber's at 5' above G.W.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. ISinsp.doc rev.712612018 Title 5 Offical Inspecdon Farm:Subsurface Sewage Disposal System-Page 17 of 18 9l• a5ed xej dH 0&SI• 61.0Z ZI, D-'G c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 South Precinct Road Property Address Howard Fogle Owner Owner's Name information is required for every Centerville MA 02632 12-11-19 page, City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed &Dated and 1,2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included ,p may- t5insp.doc-rev.7/262018 Tllle S OMdal Inapedon Form:Subsurfaos Sewage Disposal System-Page 18 of 18 61, abed xed dH 0£:9 1, 61.02 Z I• Daa . No. `ia- \ Fee fCLtO 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYtcation for Migogar *pgtem Construction pernnt Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot N 70 SCUT# l�'JLT 1gj9)9XWe,Adc ess_Wo. 7 —U Assessor's Map/Parcel CJ C� Installer's�T�nr s, d Tel.No. .]f gn�s am Address and Tel.No. S �J Type of Building: S Dwelling No.of Bedrooms Lot Size VVoC sq.ft. Garbage Grinder(lt�7j Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3.70 gallons per day. Calculated daily flow 3—Z> gallons. Plan Date «���-`s 7 Number q she s ! Revision Date_7Jb f 7 v ; Title SITtKnO �nijO 1h CC.17 .� Size of Septic Tank / w Type of S.A.S. Jr�y > s Description of Soil GCS 0(.4n 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 jLtBoard the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue of Health. Signed Date J� Application Approved by Date 2 — R- Application Disapproved for thl following reasons Permit No. �/g' ,_'2 Date Issued _��. j y,, .. r p.. .:. .`. r w _ - •Aa' .+.- '..Y,., �7I'i•Yi�FIlS.. �..-__....... \ -:.�,,.MM1`tv._ - - +�.'.�:.. T p. { + No. �j�• ( f �.. - Fee �lrJ� {ryry ~ THE COMMON AL"TH OF`MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zippficationlfor ig oar *pgtem, Conotruction Permit Application for a Permit to Construct( V'Repair Upgrade(E )Abandon( ) ❑Complete System ❑Individual Components { Location Address or Lot No'O SCUT 4 p�4lfC 0C 7- Owner's {RKW,Ad�yess aQd;F l 10. 77�U7 C // ( yJ ' ssessor's Map/Parcel Installer's c 4d s, $Tel.No. "Designer's Name,Address and Tel.No. .S (� 1l L7 J(ndG�t W. a. Type of Building: - 11 Dwelling No.of Bedrooms Lot Size 6Z)oC sq.ft. Garbage Grinder(/00) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow M gallons per day. Calculated daily flow 3 gallons. Plan Date ����o-�i 7 Number o she s Revision Date �-b4F 7-r5-F Title S I T1 TM V F- G 4 W b l h t%�O It_ y It Size of Septic Tank Type of S.A.S. Y Zn i ; 4!/13. Description of Soil GC, (eY1 • r it Nature of Repairs or Alterations(Answer when applicable) •� r Date last inspected: Agreement: a r- The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance'with the provisions of Tie of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b t Board of Health. '• Signed Date 7 V i Application Approved by Date 1.1 Application Disapproved for thY following reasons Permit No. ICY , 'x Date Issued - ---------------------------- —--— — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by •Z f�'- at has been constructed in accordance with the proons of Title 5 and the for Disposal System Construction Permit No. -�a- dated Installer _5' 174-1, e4 dl4;4,1 4Q Designer The issuance of this permit shall not be construed as a guarantee that the sy*etii will function as designed. Date -- Inspector4 .z�� � .4-,-'--4✓I --------------------------------------- No. Fee 1,9 cJ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi5poe al *psstem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at r and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by 1 PROFILE OF SEWAGE DISPOSAL SYSTEM ---��---:—�- 1) 0 Po. :o r _. r WI a�. .0, rr NOT TO SCALE NOTES: ' �', ,t ;Q. \�• i . 1� ZONING DISTRICT RF 'o� �'✓� • I i7 TOP FOUND. EL AI.O ' ZONING SETBACKS: �L '` FRONT 30' o f u1 y SIDE 15' Clanbc! 3 REAR 15' v »S REFERENCE 7 o �� r _ � �• � 3t.b � PLAN: � BOOK 333 PAGE 41 oxrh! Coif ) .�p ,y LOCUS ADDRESS: � 3�" MAY.. Cs►v�R � � Q • soo � t' 3�." Nwx cssv�Iz, } 70 SOUTH PRECINCT ROAD -' iNV. EL- '3T MbNtJt lipNT OOVOt `r MARSTONS MILLS MA USGS LOCUS SCALE: 1: 25,000 FLOW LINE I FEMA DATA: le UIN. lM INV. EL 't.ZZ r UVM LOCUS DOES NOT LIE. IN A .FLOOD HAZARD ZONE �'�2�4v�t-rp "PVd--'r'N2ouQu(- LHang�R ; 4 LOCUS LIES IN ZONE "C" MIN. *' L*J&D a" ( a��lilP 4) ItVI=1�1�UC�1R Wf Mty-0 PLACZS 2- MIN. - 1/8" TO 1/2- WASHED STONE I WETLAND DELINEATION BY. �'"' (C' •�- � AS v. CR ENVIRONMENTAL INV. EL 3�•4'1 aurIr H �, ' `1 ASSESSORS DATA.- MAP 148 PARCEL 146-3 V INV. EL .3 L INV. El. INFILTRATOR ' 3/4" - 1 1/2" WASH f.O STONE T OVERLAY DISTRICT: GP 1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK Mk c2�.f y5 PRECAST REINFORCED CONCRETE MINIMUM CONSTRUCTION MATERIALS PER 310CIAR 15.226(2) DISTRIBUTION BOX TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND T_rz-\r- V=-� SHALL EXTEND A MINIMUM -OF 6' ABOVE THE FLOW LINE INSTALL ON A LEVEL BASE Nt'V4 c`r2Z"KI VvA OF THE SEPTIC TANK AND BE ON THE CENTERLINE OF THE N SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN-OUT MINIMUM WAIT. THICKNESS • 2' MANHOLE. MINIMUM INSIDE DIMENSION 12' r ELEVATION SHALL BE NO LESS THAN 2' NOR \ N THE INLET PIPE MORE THAN 3" ABOVE THE INVERT ELEVATION OF THE OUTLET OTHER AND ATS2SHALL�I E EQUALBELO O ETNVERT. OUTLET PIPE. T GRADE THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX r SEPTIC TANK SHALL BE INSTALLED LEVEL AND 'TRUE 0 SHALL ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODINO BVW 1p ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY THE DISTRIBUTION BOX 10 THE HEIGHT OF THE DISTRIBUTION WHICH SIX INCHES OF CRUSHED STONE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. � COMPACTED AND ON TO LINE M , HAS BEEN PLACED TO 'ENSURE STABILITY AND TO PREVENT INVERT ADJUSTMENTS SHAD. BE MADE 8Y F1WNG.1MTH DURABLE 2 'W` 5 �� SETTLING. AND NON-DEFORMABLE MATERIAL PERMANENTLY FAS7END TO THE BVW LINE OR RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE Of SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 90. EQUAL ELEVATION. 3 � � � Note: 8VW '�` ••' All • ,IVY. • ' i ' ,.''�#'' / i � • Approximately 400 square feet o+'area encroaching into the 50' � � ' 46 / THREE 20' MANHOLES WITH READIL'.Y.REMOVABLE IMPERMEABLE / A COvERS OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS - buffer zone will be disturbed during dwr.�•in ' excavation. Upon completion of Bvw - / PORTS BEING PLACED AT THE CENTER .AND'OVER THE INLET AND b4 , BV)Y � a excavation the disturbed area shall be ref,anted with a woody indigenous OUTLET 'LEES • �► �I 'ME OUTLET TEE SHALL` BE_gQUIPPED WITH GAS BAFFLE. vegetation before removal or straw bale4 �,•• _ / i s Bvy 6 _ QVW - VW BVW BVW ILL 50 �IJ4 '� / / / BVW B VW L / �/ % / / �� O i GENERAL CONSTRUCTION -NOTES , 51' DESIGN DATA: .� BVW .^a D.E.P. in 5 ,9 , i •,� / / MATERIALS SHALL CONFORM TO 10 ' I. ALL WORKMANSHIP AND M REGULATIONS FOR STRUCTURE `R�s. 3 �Q - / / / . �. RULES AND evw �1►,� I , - ; . 1.�5�8 Gti AND THE TOWN) OF "�' �►4'r '@I`�.. NO. BEDROOMS GARBAGE DISPOSAL � % THE SUBSURFACE DISPOSAL OF SEWAGE. 'E , - DESIGN FLOW 3►__►►n a -��n s_V,_ �, .r 610 S SHALL BE ACCESSIBL ....... / . AT LEAST ONE ACCESS PORT OVER TANK TEE �°� - `�, n ,7A ` A'7•�'�`: sliz j"'�_�'`A BVW .� '�` • ' S6-• _ _ �55 `�� - �B� 2 WITH ANY REMAINING ACCESS. -' ----�-�'� WHITHIN SIX INCHES OF FINISH GRADEn� �► �s� ,.r 3�7 ab �cY'�- > '�` • ' BVW�- - " �Bvw BROUGHT TO WITHIN 11NELVE INCHES OF FINISH GRADE. �`- .. .c4-c a,-rs 'I2l,'a l �T� 1211 / 0, PORTS Q .��� .,.n,� �,�a t s. �.►,o,.rw, - __- SHALL BE CAPABLE OF BVW -'-1 ' / •/�� BVW -_ 3. ALL COMPONENTS OF THE SANITARY SYSTEM UNDER OR WITHIN 10 SEPTIC TANK �-�o x zQov �GQ y ►' ► ► ..N 1a-zn t.naz-� �it� WITHSTANDING H-10 LOADING UNLESS THEY ARE U WITHIN f? • LOADING SHALL 8E USED UNDER OR • �� _ � .�. ,�,. _ OF DRIVES OR PARKING. H-20 LOAD _ BVW 6d 10, OF DRIVES OR PARKING UNLESS NOTED. LEACHING FACWTY ►, r � ,- �: :L �4 ��� r�-�-=� BVW _Q THE LOCATION OF ALL _,--,aI�I��k' o,� -�d'_:.123 .�1e�25 1-=A Z o►, � &0 4. THE, EXCAVATOR/CONTRACTOR SHALL VERIFY -- --'-- <,►�nrEs �y �,-�.•�� �bN�10•v,ec '�• 14 � � •� � storm drain b m SITE UTILITIES PRIOR TO ANY EXCAVATION. %'. BVW 10 40 PVC LAID'AT 0.02 SLOPE. / s'ed dr oil (?typ.) % 5. SEWER PIPES SHALL BE 4" SCHEDULE "� �' ek' , _ ,% ' , .�Z _ GRAPHIC SCALE ' `I storm drain TO GRADE SHALL BE ev5w f ��rl AVM �lll r. ,_ _ .�o � w a 20 40 so t� 6 ANY MASONRY UNITS USED TO BRING COVERS ADE ' Q��, __-- f MORTARED IN i PLACE. '< / / evw / .,�"'`"u // t 3� =+�; f 0. 2 FEET PER 6 / ,,ropoeed HAVE A MIN OF 0 FOOT. '� 16 Q c.,y r 'A`- / IN FEET ) 7. FINISH GRADE SHALL MINIMUM SLOPE r bocjroor�t - J 1 iach 40 1t BVW • � i ��; � � � � •a, � dw�nlling .� / � -8M: top hyd. spindle e1.4294� #� / X '" �L• Datum: NGV'D l •'5� / '�`% 63 / nab ,r"r - / - ='.:�' / ��� limit of work line / / •,,� BVW of \ Ala • / limit f staked o / .* ••/ / .y:..._.,. . o A) gravel or gravel d- ay ��,: .17 / / /64 str vl bales 39 �e' /0, �h SOIL 08SERYATION DATA: BVW BVW , �, S( �.� o �ILk>Fr'.trl• '/ i ►/� CO A i c� ,,III. / .�� p � :� � ►».. � •# ; BVW �O proposed 1500'gallon tank ' 't'}:. . Po��\ST� .' proposed dlst/box a ,l`<'I•S,h �G.. TEST OATS '1 BVW ' / 'TOTAL LOT AREA - +.3,502 sq.1t. - 1.8Ft scree -- o � - v/ � proposed S.A.S. expansion area Z; � WETLAND AREA i= 35,302 sq.it.± SOIL EVALUATOR �•pfaa _.; - - *• � � /.�• � ,UPLAND AREA • 45,200 9q.rt.t SITE PLAN O F LAND B.O.H. AGENT �ta2"-5_1 o.tz►9_ 66 / `? --- BVW /;% BVW e i IN EXCAVATOR �,; / / i �o _ 36p, «� proposed S.A.S. Infiltrator system p 410 PERC/RATE 2. ?�N\� 'Pt1rEL 11.W�_ A � '� �� / ;�•qa0 E �' i� � ---C=� --�-�/11. ..� , �1 A S.S , 20 3' B / N g0 67 dWe111r•9 BVW 1L / •► 0X DEPICTING THE PROPOSED DWELLING AT LOT 31 SOUTH PRECINCT ROAD AL 1� i � PREPARED FOR 'kitA^ SL L.3$.Q� 68 -bit, ho» 8VW dWe111n4 dW el\1n9 eXlet I «z!, .$ ,�� ,�►.•- »►4 PRESTIGE PROPERTIES INC . k►c�N '�q..+.�1►'Dv»)r►'G">ER MoKVILS 01�i1LiNlLli 1�'C'1�1�� " M�'P' prvr w.r$ A►ssnck�'o �►T `cM►�►•►Nw 1w SCALE: AS SHOWN DATE: DECEMBER 16, 1997 C-. L, sxlt'•jd �r �v . 31�0�98 (Rs�ccATt? 'aVW FlA:�S� PREPARED BY: 7-zo-9a� f�E Mo W�CZ R Duch� ur�u� t► STEPHEN J. DOYLE AND ASSOCIATES ►'-� N 61'Ze: S `RGv• �(o�� 1.7M►T l;�y� 42 CANTERBURY LA14E, EAST FALMOUTH, MASSACHUSETTS 02536 TELEPHONE: 508 540-2534