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0066 STONEY CLIFF ROAD - Health
66 Stoney Cliff Road, Centerville 140.ECrclFDCo UPC 12543 o- No. 53LOR •�f�n-coNS'�` HASTINGS. MN 13 -lqy Town of Barnstable P# Departinent of Regulatory,services -AmIar,-tom i ]Public Health Division Date � � 200 Main Street,Hyannis MA 02601 • l.FD Date Scheduled I ime Fee Pd. 4100 ►Soi aitabiiity Assessment for ,Sew 'fie as osar C/ Q Performed By: Witnessed By: , LOCATION& GENERAL INFORMATION Location Address / /'_ `c. C+iGf_ M Owner's Name 'Dye ` GRID�t V t T "U Address / Assessor's Map/Parcel: 1 q Oro Engineer's Name Dow1') -afx&)8 t' NEW CONSTRUCTION �yy REPAIR � Telephone# �����l� _� Land Use: lau/1-1 Slopes(96) v "S Surface Stones /"(/0/ e Distances from: Open Water Body 71'UU R possible Wet Area �(� R Drinking Water Well ft Drainage Way f[ Property Line ft Other ft SIMTCII:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands•in proximity to holes) " 714�®eft� �� �'�;� • � ry w GJ � N t� �J NJ M " NJ Parent material(geologic) G 44 wa Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /V�L� Weeping from Pit Fnee _ Estimated Seasonal nigh Groundwater — DET ATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: lu, Depth to soil mottles: jtt Depth to weeping from side of obs.hole: In. ©roundwater Adjustment & Index Well# Reading Date: Index Well level Adj,factor ,^ Adj.Groundwater Level Observation ]PERCOLATION T +'ST Dille /?� Time Hole# Tlmo at 9" Depth of Pere Tlme at 6" J Start Pre-soak Time Q Time(9"G") End Pre-soak i t•�� " Rate Min.Jlnch 4 - Site Suitability Assessment. Site Passed V Sitq Falled: Addldonal Testing Needcd(Y/N) / Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must First notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\S EPTIC\PERCFORM.DO C 1 DEEP•OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, ti onsistrnpy,%'Gravel) A to y p 3 ,Y.Y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis en, %Gravel) c, j /cs ,S C? CS QIA It C DEEP OBSERVATION HOLE LOG Hole 9. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories,Boulders. o 't to c G e +. r - f" ]DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other „ Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Co si ten Flood Insurance Rate Map: Above 500 year flood boundary Now Within 500 year boundary No"';+ Yes ' Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious matorlal? Certifleation / I certify that on /� // _(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me,consistent with . the required,training,,expertise and experience described in�10 CMR 15.017. / Signature 6�1l "�� Datt Q:\S.EPTIaPERCF0RM.D0C TOWN OF BARNSTABLE LOCATION� ., �n,ni L-'`� L t Fr t= R _SEWAGE# c313 • P 9 -VILLAGE ASSESSOR'S MAP./&�PAR�CEEL / Q— INSTALLER'S NAME&PHONE NO. �2.�"P SEPTIC TANK CAPACITY C,k P C•-'i LEACHING FACILITY-(type)[C+4-- (size) �O K •b'3 NO.OF BEDROOMS , OWNER _b�fCl PERMIT DATE: Z,60 o tx 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 ori:` ".. site or within 200 feet of leaching facility) H Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Q Feet FURNISHED BY �� !► ,�* �•�ro �� _ ,. 1 � �� � ,, �� �, � � i � a ���..LL ��- �o�� C�-� �� � � No. Q r 1 1 r 7 Fee Idd THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es ftPhLatlon for VonaY 6pstem Construction permit Application for a Permit to Construct( ) Repair(,� Upgrade( ) Abandon( ) ❑Complete System �Individual Components Location Address or Lot No.Ze4 r7�� OwE4-�=us ' aess,and Tel.No. b v 9-'7`7s= Sb1'4 Assessor's Map/Parcel p t1! ��' 01 st ex 46 Sli-ne C.j, 'jam/&/ Installer's Name Address,arfd Tel.No. J ors-cjn-dm, a esigner's Name,Address,and Tel.No. )Pe- `d G�DO�s1� /O/) 7�'$ -iXlUS ,QC X rJ>7 e/ i` �J mal;��/� D �$ Type of Building: Dwelling No.of Bedrooms Lot Size /C 531 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided (p gpd Plan Date AV usf 1 6-1613 Number of sheets / Revision Date Title i i �t�P"6 oQ (,,(u vpnir Qjt' jW 690kaA, 2 Size of Septic Tank S•'fT°y /e"no!,,- e Type of S.A.S. co • �jyc,g� Description of Soil�Pz P,g Nature of Repairs or Alterations(Answer when applicable V)I,V )-J(� ,i1 In Pit 9�L2�aC �• !? X at k amle 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�Cedee d not t lace the system in operation until a Certificate of Compliance has been issued by this Board of Health. .� Signed - Date Application Approved by Date i Application Disapproved by Date for the following reasons Permit No. �,--d �, — �� Date Issued o 1 7' -y-i..,,,c.:.�.a _w-ar^w..^..+^-.r.-+s..,.v...�.*w-. ...:w _-.•""M'``:�M=�v;row.ri.w.aM"-x'�r*v.*.y�.iwwa'v:nWtc<:�'.+v"w;v`iii"„�"°""".4:...e:.-•.-.;.�-. .,-.ti ....-.,..,,�_..�-,. ..� v�^--y----"..-'.......,-.-��. -r y „S7 M g Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS e, ,r application for Misposal Opstent Construction 30ermit Application for a Permit to Construct( ) Repair(sty Upgrade( ) Abandon( ) ❑Complete System HIIndividual Components Location Address or Lot No.&w -N-0► ea( 1W Owner's Name,Address,and Tel.No. S"a 02(cr) 4G.514�ney Assessor'sMap/Parcel �g'p�ya. �►� �t ,rv�/lam` A ���� Installer's Name,Address,and Tel.No. `J IDs-�a- c�t�• Designer's Name,Address,and Tel.No. % r fo i C�oi�st lion VS x '05 /�f k r� C��k, 1r7e&ri� Nvl&t.g� 5 !i� ��r l� �tt7Cx ,7 o. S"" Type of Building: Dwelling "No.of Bedrooms J Lot Size i S 3� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 350 gpd Design flow provided -S36 gpd Plan Date A1/S vS+ 1, gaol 3 Number of sheets p / Revision Date Title i;;,-k �� Fe plat,4 1,& S-lonvL, f!t W)' 061�k,-blll', &1A Q,;k-.,T; Size of Septic Tank v e;�,e Type of S.A.S. r") j;, 9,,%tp Description of Soil Nature of Repairs ofr��Alterations(Answerwhen applicable) 4er Q 1 KR d411 CJGY� in 9 4L) X .I{ �l- X Date last inspected: i Agreement: - J The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disp al/system in accordance with the provisions of Title 5 of the Environmental Code and oft place the system in operation until a Certificate of Compliance has been issued by this Board of Health _ Signed , 1'`�' Date Application Approved by Xn/ Date—(flJ / Application Disapproved by Date 1 for the following reasons Permit No. d Date Issued o t 7 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 85 f C�Gr {r t-*,(! /''Sn -Ln C at (I j o S{ p_ , Qji"�t j�� - t t �g has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Noo2 o i 7 ��dated ,� Installer t� �0 �t��?5 l(C t t�a� :L l c, Designer 17)-- on (9 f C,rc #bedrooms Approved design flow 3 3 rr. ( �,�,� gpd The issuance of this permit shall not be con"strued.as a guarantee that the system wil 'c,on.4s designed. 1 Y ' Date t ) / _� f . Inspector No.2 d f] -,3 'f1 _-•---------___----•-,----------• ----__._-__.__�.�____--�__._•---------------------.--=-Fee `lQ(/J-----------___,_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal Opstem Construction J)ermit Permission is hereby granted to Construct( ) Repair()) Upgrade( ) Abandon( ) System located at C s(1P l<lI - Oek"�-rid,' 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 ust be completed within three years of the date of this permit. r Date r� y/r' Approved FROM :down cape engineering inc FAX NO. : 15083629880 Aug. 30 2013 09:15AN P3 B-AYIN WARU. $ Director.' '5 no maim Ls offjr,z: 509.F,62-464,1 6304 LmbaHex &Ns.v. TjLL-'(r-rdk Ufi0P.1lYV14 Date: De LLA�A �41 0 13 vtZ j AfMrcm: tooa e70 'd tip On d SPP-11C.SY5LEla at based on a-dc-sigil dravril'by 1. cutify-ffiat.tba sopftc; sySb7lm.r.efey�mrcd above was installed 511h,9tknfi2,J-1Y to e2, t)ie w-bich:nay IllUILldf. min.L)i app.cowd challFe5 Surjj, ,Ljs j,,)f.eTalv�JQGaLi0-a 0-fLhP distributior,box ond/oi septic,"aak.- fhat thc: -,-.Iytl(', SY-Ielll I'del'ERCCLI AQV6 Wjjs b3sitalrA )vl'.tla ma.inr 10, lateral ic.loca-bon of tb.e SAS ar,-m-y of qys l, iflaccor dance wiffi St,-W, Local kc,,g-1141fiolls. Plan--t;-visirm oi, cutiEed q13- ' j t b erigu,(z to fnil-ow, 0 1 OF 144$"S, OANISLA. L " 0JALA C,, q i:� 1 7 CIVIL o No.46502 i3L 'UIS7 "L ON L atur M _ EqF -Vvm - - 'y"l ME DI TRY Official Website of The Town of Barnstablel- Property Lookup Page 1 of 3 Select Language Assessing Division Property Lookup Results - 2013 367 Main Street,Hyannis,MA.02601 «BACK TO SEARCH« ���P�int Friendly r— — Owner Information-Map/Block/Lot:190/0421-Use Code:1010 j Owner { Owner Name as of 111112 DYER,THOMAS F&BRIDGET Map/Block/Lot G/S MAPS 66 STONEY CLIFF RD 190/0421 CENTERVILLE,MA.02632 Property Address Co-owner Name 66 STONEY CLIFF ROAD Village:Centerville j i Town Sewer At Address:No { GIS Zoning Value:RC Assessed Values 2013-Map/Block/Lot:190 1 042/-Use Code:1010 2013 Appraised Value2013 Assessed Value Past Comparisons Building Value: $86,300 $86,300 Year Total Assessed Value I Extra Features: $34,200 $34,200 2012-$227,900 Outbuildings: $3,400 $3,400 2011-$222,900 I Land Value: $1115,400 $105,400 2010-$222,800 2009-$287,200 2008-$321,100 2013 Totals $229,300 $229,300 2007-$320,300 Residential Exemption Received=$87,244 f Tax Information 2013-Map/Block/Lot:190 1 042/-Use Code:1010 � Taxes I i C.O.M.M.FD Tax(Residential) $339.36 i Community Preservation Act Tax $37.33 Fiscal Year 2013 TAX RATES HERE Town Tax(Residential) $1,244.41 $1,621.10 I Sales History-Map/Block/Lot:190/042/-Use Code:1010 i— History: Owner: Sale Date Book/Page: Sale Price: i DYER,THOMAS F&BRIDGET 7/31/1997 10879/181 $114900 j CRAWFORD,RICHARD E&NIELSON,NANCY J6/14/1993 8623/024 $1 SWEENEY,ROSE A 9/21/1987 5935/271 $1 SWEENEY,JOHN F&ROSE A 6/26/1967 1370f75 $0 i Photos 190 1 0421-Use Code:1010 i I I i t i Sketches-Map/Block/Lot:190/042/-Use Code:1010 i 1 i GAP, _ 9 4 Best 15 As Built Cards:Click card#to view:Card#11 http://www.town.barnstable.ma.us/Assessing/propertydisplay screen 13.asp?ap=0&searchpa... 8/20/2013 Official Website of The Town of Barnstable - Property Lookup Page 2 of 3 1" 'Constructions Details-MapBlock/Lot:190 1 042/-Use Code:1010 _.�_........_......_..�___._.._ Building i Details Land --- Building value $86,300 Bedrooms 3 Bedrooms USE CODE 1010 j Replacement Cost $102,741 Bathrooms 1 Full+1 H Lot Size(Acres) 0.35 Model Residential Total Rooms 6 Rooms Appraised Value $105,400 Style Ranch Heat Fuel Oil Assessed Value $105,400 jGrade Average Heat Type Hot Water Year Built 1967 AC Type None Effective depreciation 16 Interior Floors Hardwood 1 1 I Stories 1 Story Interior Walls Drywall i Living Area sq/ft 1,154 Exterior Wails Wood Shingle j Gross Area sq/ft 2,868 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp i i Outbuildings&Extra Features-Map/Block/Lot:190/042/-Use Code:1010 -- --_--------------_---..._____...._._.__._._.___.__._._....__..__ —._.—, Code Description Units/SO ft Appraised Value Assessed Value GAR Attached Garage 336 $9,100 $9,100 BMT Basement-Unfinished 1154 $21,700 $21,700 WDCK Wood Decking 224 $3,400 $3,400 j w/railings I FPL1 Fireplace 1 story 1 $3,400 $3,400 l Sketch Legend I 1 Property Sketch Legend f B2N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only i BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium j BMT Basement Area(Unfinished)FUS Second Story Living Area MS Three Quarters Story(Finished) i (Finished) BRN Barn GAR Garage UAT Attic Area(Unfinished) j CAN Canopy GAZ Gazebo UHS Half Story(Unfinished) CLP Loading Platform GRN Greenhouse UST Utility Area(Unfinished) 1 FAT Attic Area(Finished) GXT Garage Extension Front UTQ Three Quarters Story (Unfinished) I FCP Carport KEN Kennel UUA Unfinished Utility Attic FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUS Full Upper 2nd Story (Unfinished) FHS Half Story(Finished) PRG Pergola WDK Wood Deck FOP Open or Screened in Porch PTO Patio L-_.............------....... __...._..------- ._... -------_— .__._.........._.._.....__...._._...__......_.__............... ._._. ! Print-FPiendly Contact Director of Assessing Jeffrey Rudziak P 508-862-4022 F 508-862-4722 8:30a.m.to 4:30p.m. Helpful Links to Downloads Abatements FY 2013 SALES LISTINGS Barnstable FD Residential C.O.M.M FD Residential Commercial-Industrial-Mixed Use Cotuit FD Residential Hyannis FD Residential Townwide Condominium W.Barnstable FD Residential http://www.town.barnstable.ma.us/Assessing/propertydisplayscreen 13.asp?ap=0&searchpa... 8/20/2013 Official Website of The Town of Barnstable - Property Lookup Page 3 of 3 Department of Revenue Exemptions Parcel Consolidation Questions about values Town Tax Rates-FY13 Town Land Use Codes Helpful Maps All Town Maps Flood Insurance Maps Property Maps Contact Director of Assessing Jeffrey Rudziak P 508-862-4022 F 508-862-4722 8:30a.m.to 4:30p.m. Related Boards Board of Assessors TOW[' PROPERTY DATABASE ❑ !S MAPS Owned and Operated by The Town of Barnstable-Information Technology Home Departments&Services I Boards&Committees lResidents&Visitors IDoing Business I Town Calendar 1 Phone Directory Employment I Email Town Hall http://www.town.barnstable.ma.us/Assessing/propertydispi4yscreen 13.asp?ap=0&searchpa... 8/20/2013 COi"1ONI EALTH OF MASSACHL;SETTS _ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ta F DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREE7. BOSTON bLA 0210r t617) 292.550u TRL DY CON: Secreta--% ARGEO PAUL CELLUCCI DAVID B STP.:.'uS Governor Corurussioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 5 6 S t o ne y C l i f f Rd . Der.. Name of Owner y Centerville Address of Owner: Date of Inspection: Name of Inspector:(Please Print)Wm. E . Robinson Sr. 1 am a DEP approved systen)inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) CorripanyName: Wm. E . Robinson eptic Service Mailing Address: PO Box 1069, Centerville . MA Telephone Number: 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: `,Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: 6, . 6 Date: Z` 3- The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)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 tfre system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS fA R • �A � M �01°00 G tia� - A revised 9/2/ 89 page I or ii n `. wr^!ed o,Recvdrd Pane, �.w- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) lop"Address: 66 S'toneyC.liffy Rd.. , Centerville Jwrw: Dyer Date of Inspection: INSPECTION SUMMARY: Check( ,1 B, C, or D: A. 7'lhanve PASSES: �J not found any information which indicates that•any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. YSTEM 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. Indicate es, no, or not determined (Y, N, or NO). 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 complying septic tank as approved by the Board of Health. 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). 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 pipels). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Pa .P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icorrtinued) Prop"Address:66 StoneyCl ff Rd.. , Centerville Owner: Date of Inspecti� <' 3—6—6 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W'ACCORDANCE WITH 310 CMR 15.303 0)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. 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 for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revise 5/2/58 Page 3of11 r,. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Nop"Address: 66 StoneytiCli:ff Rd.. , Centerville owner: Dyer Date of.Inspection: 6—3 D. SYSTEM FAILS: You mus indicate either "Yes" or "No" to each of the following: have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this etermination is identified below. The Board of Health should be contacted to determine what will bi necessary to correct the failure. Yes No 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 distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 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_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater.elevation. 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. LAR E SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: he following criteria apply to large systems in addition to the criteria above: he 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 ealth and safety and the environment because one or more of the following conditions exist: 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 11 of a public water supply well) The bw er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/96 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST Prop"Address:66 Stone%1 ff.,e,' Rd.. , Centerville Owner: Dyer ` ' Date of Inspection: 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, excluding 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: Existing information. For example, Plan at B.O.H. ✓ _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (1.5.302(3)(b)) - _ The facility owner (and occupants,if different from owner) were provided with information on the proper maintenancs of SubSurface Disposal Systems. rev se(a 9i 2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION rrop"Address: 66 StoneyCl. ffff `Rd.. , Centerville Owner: Dyer ' #j Date of Inspection: ^3 FLOW CONDITIONS RESIDENTIAL: Design flow: ;,sa g.p.d./bedroom. Number of bedrooms(design); -3 Number of bedrooms(actual): '3 Total DESIGN flow Number of current residents: Garbage grinder(yes or Laundry(separate system) (yes or no):A,0; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no): /L O Water meter readings,if available (last two year's usage(gpd): 1; q 20 , 000 gal, Sump Pump(yes or no):1�U 1998 73 , 000 gal Last date of occupancy: L°�0— CO ERCIALIINDUSTRIAL: Type f establishment: Design flow: qpd 1 Based on 15.203) Basis design flow Grease trap present: (yes or no)_ Industri I Waste Holding Tank present: (yes or no)_ Non-sa itary waste discharged to the Title 5 system: (yes or no)_ Water eter readings, if available: Last to of occupancy: O R:(Describe) Last ate of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System purRfed as part of inspection: (yes or no)�p If yes, volume pumped: gallons -- ll Reason for pumping: ✓✓✓✓✓✓ TY.E F 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)x® revised 9/2/9-c Page 6ofII II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contimmd) 'rop"Address: 66 StoneyCl-1ff!�Rd.. , Centerville owner: Dyer Date of Inspection: BUILDI G SEWER: (Locate o site plan) Depth bel w grade:_ Material o construction:_cast iron_40 PVC_other(explain) Distance rom private water supply well or suction line Diamet Commen s. (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) 1I Depth below grade: /0 Material of construction: L concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: .e Sludge depth: ;L" 1 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: ?`i,`� c� Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: O &t- p+ 1 comments: (recommendation for pumping, condition of inlet and outlet tees or baffles/ ept L of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) l6 la--t1 G2 A!' �� �� 0�e -Fl � J'*- 427; C L� GR TRAP: (locate o site plan) Depth bel w grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions Scum thick ass: Distance fr m top of scum to top of outlet tee or baffle: Distance fr m bottom of scum to bottom of outlet tee or baffle: Date of las pumping: Comment (recomm ndation 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.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontinued) -IropertyAddress: 66 StoneX1liff:`-Rd.. , Centerville y Owner: Dver Date of Inspection: TIG OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (local on site plan) Depth elow grade:_ Materi I of construction:_concrete_metal_Fiberglass_Polyethylene_otherlexplain) Dimans ons: Capacit gallons Design ow: gallons/day Alarm resent Alarm evel: Alarm in working order:Yes_ No Date f previous pumping: Com ents: Ico ition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence f solids carryover, evidence of leakage into or out of box, etc.) - PUMP CHA)sitelan) :_ (locate on Pumps in gorder: (Yes or No) Alarms in g order(Yes or No) CommentsInote condf pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/9a Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address: 66 Stone% iff Rd.. , Centerville Owner: Dyer Date of Inspection: G _gyp / SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number: 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, evel of ponding, damp soil, condition of vegetation, etc.) �� CESS OLS:_ (locate site plan) Number a d configuration: Depth-top f liquid to inlet invert: Depth of s ids layer: Depth of sc m layer: Dimensions f cesspool: Materials of onstruction: Indication of roundwater: infl w (cesspool must be pumped as part of inspection', Comments: (note condit on of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on ite plan) Materials of construction: Depth of so ids: Dimensions: Comments: (note condi ion of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) �evsez' 5/2/ Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) NopertyAddress: 66 StoneyCliff Rd.. , Centerville Jwner: Dyer Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) I 12 • �7� o `T� ' 3 5 4 3� l revised 9/2/98 Page 10of11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontirwed) mp"Add.ess: 66 Stone%l_iff,l Rd.. , Centerville Owner: Dyer Hate of Inspection: ^tea NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited . Observation Wells checked Groundwater depth: Shallow. Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 2Z)Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record V Observed Site(Abutting property. observation hole.basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) l`a (3 e'7_ Q a- 72a A revise 9/2/95 Page 11 of 11 IRECEI Commonwealth of Massachusetts goes Executive Office of Environmental Affairs MAY 1 9 1997 Department of TOWN OF C411 Environmental Protection William F.Weld Trudy Coxe Governor s-rd y Argeo Paul Celluccl David B.Struhs U.Governor Canmhdoo.r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Address: 66 Stoney Cliff Rd, Centerville AddreseofOwner. Richard Crawford Date of Inspection: +" 1�` ! 7 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA 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: —/ `asses Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: 6" Date. The System Inspector 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 the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: A] SY�31'EjK PASSES: ,have not found any 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. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yea, 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, cracked, structurally unsound, shows substantial infiltration or enfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 a FAX(617)556-1049 • Telephone(617)292-5500 ice,Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 66 Stoney Cliff Rd, Centerville Owner. Richard Crawford Date of Inspection: S" "1-9 1 B]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pips(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): 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(a). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FUR ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: nditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the blic health,safety and the environment. 1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) ETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND AFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for eoliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) O ER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 66 Stoney Cliff Rd, Centerville Owner. Richard Crawford Date of Inspection: 7 DIITEMAILS: determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for etermination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the . 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 distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of tunes pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. P _ 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 ooliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE YSTEM FAILS: following criteria apply to large systems in addition to the criteria above: 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 ea� and safety and the environment because one or more of the following conditions exist: 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) The owner or rator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements f 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 66 Stoney Cliff Rd, Centerville Owner. Richard Crawford Date of Inspection Check if the following have been done: lumping information was requested of the owner,occupant,and 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 yThe site was inspected for signs of breakout. All system components, excluding 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. V The size and location of the Soil Absorption System on the site has been determined based on existing information or /approximated by non-intrusive methods. (/The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 66 Stoney Cliff Rd, Centerville Owner. Richard Crawford Date of Inspection: FLOW CONDITIONS RESMENTIA . Design flow:3.3 D gallons Number of bedrooms: 3 Number of current residents: .2. Garbage grinder(yes or no):ti o _ Laundry connected to system(yes or no) L S Seasonal use(yes or no):k o 1995 5 0 , 0 0 0 g a 1 s. Water meter readings, if available: 1996 52, 000gals - Last date of occupancy: —1`t—t' COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_ gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: h.-L:, rti ?. l(�- I C+"l '3 System pumped as part of inspection: (yes or no) A.- b If yes,•volume pumped: gallons Reason for pumping: TYPE 0PSYSTEM /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) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: .3 j S Sewage odors detected when arriving at the site: (yes or no)—,ej,.' (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 Stoney Cliff Rd, Centerville Owner. Richard Crawford Date of Inspection: 5 / `/ 7 SEPTIC TANK:✓ (locate on site plan) Depth below grade:I Material of construction: Zcconcrete_metal_FRP—other(explain) Dimensions: Sludge depth: `'Y' Distance from top of sludge to bottom of outlet tee or baffle: 4/ d s scum thickness: 3, Distance from top of scum to top of outlet tee or baffler i Distance from bottom of scum to bottom of outlet tee or baffle:_ Comments: (recommendation for pumping, condition of inle>d outlet tees or baffles,depth of liquid�vel in relation to.°}�tlet invert,structural integrity, evidence of leakage,etc.) /�' �' ® / +1. K �'j c, o �/ G E TRAP:_ (locate n site plan) Depth bel w grade: Material o construction:_concrete_metal_FRP_other(ezplain) Dimensio Scum Distance m top of scum to top of outlet tee or baffle: Distance m bottom of scum to bottom of outlet tee or baffle: Comments (reoomme tion for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of ,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address. 66 Stoney Cliff Rd, Centerville Owner. Richard Crawford Date of Inspection: TIG OR HOLDING TANK_ ocst�s site plan) Depth w grade: Material of construction:_concrete_metal_FRP_other(explam) ns: Ca gallons Design ow: gallons/day Alarm 1 1: Commen : (oonditi of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: b Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) d-e,-al PUMP C BER:_ (locate on he plan) Pumps in rking order:(yes or no) Comments: (note condi ' n of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 Stoney Cliff Rd, Centerville Owner. Richard Crawford Date of Inspection: $ —111-9 7 SOIL ABSORPTION SYSTEM(SAS):_ (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: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: / Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) '3 .S Y b h L� �.d e.1 %a'?o l O A- / c O 8�-�f , 2--3 CESS OLS:_ (locate o site plan) Number an configuration: Depth-top o liquid to inlet invert: Depth of so' layer. Depth of layer: Dimensions o cesspool: Materials of c nstruction: Indication of water: (cesspool must be pumped as part of inspection) Comments: condition of soil,sighs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY:(locate on_site Ian) Materials of natruction: Dimensions: Depth of so' Comments: ( ote condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) propertyAddross: 66 Stoney Cliff Rd, Centerville Owner. Richard Crawford Date of Inspection: ,S-1 91— q 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' t7A<, r tq d DEPTH TO GROUNDWATER Depth to groundwater: ) :Z-- feet method of determination or approximation: 4 J (revised 11/03/95) 9 No.- s 3::- 6 F�a... ............... THE COMMONWEALTH OF MASSACHUSETTS /qO Q L�a APPROVED BOARD OF HEALTH / 98lnst8b10 Conservation DePartment TOWN OF BA R N STA B L E t=t�t�=FYti' �1� rid triptiml Modes Tontitrurtion ramit pplication is hereby made for a Permit to Construct ( ) or Repair b4) an Individual Sewage Disposal System at: CL� ,t_ G�ovsviG� ...... ............................................•- -®-••--•------•---------- ........................................ ..... /� $. ......... �Location `'-©l��l ��vZ o t o. ..n..^..�....v��1 ......................_.._........ ---------••-.......-•••-----._........................ •-------------------•••-........................... ... /f (�T '�-�AJ � O�cner ,r Address a L GF//� Gfj71��v �lD Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_________________ ------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons-__----------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------------------------------------- ----------------------------------------------------•.------- W Design Flow............... J-�........._.._.gallons per person per day. Total daily flow.___..._..._._._� �-.-_-----•--__.gallons. W Septic Tank—Liquid capacity ..gallons Length-___--_--•.___.- Width................ Diameter................ Depth................ x Disposal Trench—No. .........f...._.. Width.......7.__...._. Total Length__��4 7�otal leaching area....................sq. ft. Seepage Pit No--------.-_------.- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................�ninutes 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........................ P4 x -----------------------------•. _.•�-••-••••--•-•--•----••...--••-••-••--•••...............••-------..................................... Description of Soil................... �.--- .. --•---------•-•-------�-.-.- •.�.....*.....f�...... W U Nature of Repairs,4 Alterations—Answer when applicable.- ...... .O/5 � � G ..:...._•.................• -•-•- .............. •...........................................................•-•......................._. 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 Compliance s en issu by t e board of health. Signed -------- ---------------- ----- - --- .. ............_.......... ...... - .. .........:...... Dare Application Approved By .......... . .... ........... .. . .... ...... :.. �.P. ...-----................................. Dace Application Disapproved for the following reasons: ..................... ............................................................................... ........................ ...... .................................. ............. ... . ............................................................ ................................................ ........................................ gDate PermitNo. - J,3---'----- ...................... Issued ......................................................... a........ Date No__9,�•-_ 8 ,,.- Flts._.�?Q...-- ..... _ THE COMMONWEALTH OF MASSACHUSETTS / �p BOARD OF HEALTH / TOWN OF BARNSTABLE �' ,��.�ltrttttttYt fur`�i���11�tt1 �nrl;� C�a��t,��r�r�tun- eruti# Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ,l i<�' l/' .......�.,. - _ ---•------------------•--•--------__...-- ........................--------•--------•--•---------••---r----....----•-----...._.._....-•---- ot --© �✓.......C..�........[� . ,�G • �' L N ..............�1- owner - Address a N �� �Z- - --------- -- - ---- Installer Address UType of Building Size Lot..........._................Sq. feet Dwelling—No. of Bedrooms----------------------,_`�.------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons___________________-_-____.. Showers ( ) — Cafeteria ( ) dOther fixtures .................................................................................................................... W Design Flow..................�s...______......gallons per person per day. Total daily flow----------------............................gallons. WSeptic Tank—Liquid capacity v_.galIons Length________________ Width---------------- Diameter................ Depth................ x Disposal Trench--No. .........�....... Width.......7---____.. Total Length_-�_ _1_75'Total leaching area....................sq. ft. Seepage Pit No--------.-_--_--._- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) f aPercolation Test Results Performed by____________ ............................................................. Date........................................ Test Pit No. I................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........................ a --•------•-•----------------------••--------................................................................................................................ 0 Description of Soil................... (.-� 4' ==�--. tea..-SQLC_:_...j / --- x W U Nature of Repairs or Alterations—Answer when applicable--Z ....... �!?S7 w.-•-i-,N,( .__........!,S..._.,:_.... _..�.?L__.ir._.__.._............................... /G4..'zt!C------------------------------------------•--•--._..____.....-------------............-•--- 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 Compliance.has been issued by the board of health. - Signed f/?:�� ✓(., - / ....-y�-----'Dace................ ApplicationApproved By ............. _ ....... ....................................................--................ -. �..- Da[e Application Disapproved for the following reasons: ........................ ......... ....................... ..--.................................... .....--.................. . . . ................. ................. . ......... .. ........................--.....--. gDa[e PermitNo. ..--/-..3---------- -------------------- Issued ..............................................--.................... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ TOWN OF BARNSTABLE �Erti irate of Ofamplianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System_constructed ( ) or Repaired (�) Gi�L�—'JCG� L'G�1silL�i�> ior� Installer ^ 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 Nu- ------------7.3- ......FaZ.3.-6 dated ---.... .............._.......... .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION cSATISFACTORY. DATE............_-..� ''�' l l :�- ---........_................. ...... Inspector .--------.Q0.. _..-....-.-.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH "� TOWN OF BARNSTABLE No._1._�.... -3,( FEE. r a i stt1 orkii Tonotru#ivia "amit ou� 'UGd U1GST/[_ciC�77U�1 Permission is hereby granted---------------_- �. -- to Construct ( ) or Repair (. 4 an Individual Sewage Disposal System �..� 1-! C:_L./ =---`-�-- .. y _rVT L1 at No. t ... i Street —� as shown on the application for Disposal Works Construction Permit No.� ._� Dated........................................... _ F� ...................................................... Board of Health DATE--- J -+- FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION SEWAGE # ,9,3 VI4LLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) ? / v�' 7s_j NO. OF BEDROOMS —3 PRIVATE WELL O PUBLIC WATE BUILDER O DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: v VARIANCE GRANTED: Yes No O i a®e�P oi=i t.;,— i TOWN OF BARNSTABLE LOCATION S' T&A it v G f'a Y!� 1 c SEWAGE # C5-G .5 VILLAGE C'��.. tT ASSESSOR'S MAP & LOT _ A % INSTALLER'S NAME&PHONE N0. Wei h i c c G t.- '9 7-s--13`7-2 SEPTIC TANK CAPACITY e LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER -9616I ZxI, 4. PERMIT DATE: :5�.,S COMPLIANCE DATE: e Separation Distance Between the: Maximum Adjusted Groundwater Table to the Botto f Leaching Facility Feet Private Water Supply Well and Leaching Facili (If any wells exist on site or within 200 feet of leaching faci ' ) Feet Edge of Wetland and Leaching Facility(If y wetlands exist within.300 feet of leaching facility) Feet Furnished by ` 4 ,� a$kk SYSTEM PROFILE MALL ARKED SYSTEM COMPONENTS SHALL BE NOTES WITNOT TO SCALE COMPARABLE ME/,NS FOR FUTURE LOCATION. ASSUMED OR PROVIDE MIN. 20" DIAM. WATERTIGHT � � 1. DATUM IS � ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS AVAILABLE \ TOP FOUND. EL. 46.67' FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 44.0 W W W 4. DESIGN LOADING FOR ALL PROPOSED PRECAST ch ePaP PRECAST H-10 BLOCKS OR UNITS TO BE AASHO H-LQ R2'0 ' 4"OSCH40 PVC PRECAST RISERS 9° °� rn 45.0 MORTAR ALL H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. ow e ° t; PIPES LEVEL 1ST 2 �ENDS 4, COMPONENTS (TP.) 17' HS16ds41.0' Locus Z 10" EXISTING 14" WITH Route TEE SEPTIC TANK** TEE '°°°° J Rd. 43.6± * ®El�O ®®®0 0000 o 0®rq® -In °�00000 310 CMR 15.000 (TITLE V.) d Pos o ° ° ° o0 0 0 0 o e Q:. OOOOO oOOOOOO >O°O°O°O°< ®®®®®®I�®®®® 00°O°O LJ®®®®®®®® �O°°°o°°°~ C S� v� 01 ti p� °000°o°o°o°o 'o°o°o°o° 0 0 0 0°°0°o O O 0 o°oo°o°GQGAS BAFFLE::: _000°O„0"0? N >°°°°°°°° Ill®®I�I�I�I�®®®® oo°O ° 1-I�®®®E3E2E I �o°o°°°°°r'� JullrR . � 0�0®®®�®®®m o i]0�000�0� 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND ' °° NOT TO BE USED FOR LOT LINE STAKING OR ANY >°o°o°o°o .°p°oo° 0000°°°o 40.49 40.32 °_°_° ° o°° °_°_o_o 38.17 OTHER PURPOSE. ':::..... ':.... .:.....: 6" MIN. SUMP 12" MIN. INT. DIM. LH-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8. PIPE FOR SEP11C SYSTEM TO SCH. 40-4" PVC. 6 f 3/4"-1-1/2" DOUBLE WASHED STONE (2) UNITS REQUIRED 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9.83' * 9. COMPONENTS NOT TO BE BACKFILLED OR �'o COMPACTION. (15.221 [2]) ^ CONCEALED WITHOUT INSPECTION BY BOARD OF i- HEALTH AND PERMISSION OBTAINED FROM BOARD Rood ( 4.2% SLOPE) ( 1 % SLOPE) 00 OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION EXIST. SEPTIC TANK 74' D' B LEACHING CALLING DIGSAFE1 888-344-7233OX 17' FACILITY VERIFYING THE LOCATION OF ALL AND UNDERGROUND & 33.5' BOTTOM TH-1 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF LOCUS MAP *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL "INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT NO GROUNDWATER FOUND WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE ***GROUNDWATER EXPECTED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE AT EL. 30't PER TOWN MAP 11. ANY UNSUITABLE MATERIAL ENCOUNTERED NOT TO SCALE CONDITIONS IF NOT SUITABLE SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. ASSESSORS MAP 190 PARCEL 42 12. EXISTING LEACHING FACILITY SHALL BE PUMPED �/ AND REMOVED OR PUMPED AND FILLED WITH CLEAN VARIANCES REQUESTED UNDER TITLE 5 15.405 LEGEND / � SAND. (MAX. FEASIBLE COMPLIANCE) AND TOWN OF / BARNSTABLE REGULATIONS: 99- EXISTING CONTOUR X 991 EXIST. SPOT ELEV. / � \ (1)(b): REDUCTION IN SETBACK, SAS TO FNDN. \ (20 TO 10 ), PROPOSED CONTOUR / \ SYSTEM DESIGN: 198.41 PROPOSED SPOT EL. TH 1 \ . � TEST HOLE \ PAVED \ YYY � DRIVE 2� SLOPE OF GROUND � /// �'��'��' A_ \\ /> GARBAGE DISPOSER IS NOT ALLOWED DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD UTILITY POLE USE A 330 GPD DESIGN FLOW FIRE HYDRANT NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING GAF:. 'o SEPTIC TANK: 330 GPD, (2) = 660 SLAB 0' / **RE-USE EXISTING 1000 GAL. SEPTIC TANK TEST HOLE LOGS LEACHING: / W EXISTING SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD ENGINEER: DANIEL E. GONSALVES, SE #13587 / DWELLING TOP STANK fef / ¢o TOP FNDN. EL.=45.0' BOTTOM 30 x 9.83 (.74) = 218 GPD WITNESS: DONNA MIORANDI, RS �i EL.=46.67' N liti DBOX DATE: 7/30/13 TOTAL: 454 S.F. 336 GPD /� � o• F� ;, � PERC. RATE _ < 2 MIN/INCH �\ \ 1 DECK ,' ,j USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) i/' i WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' CLASS I SOILS P# 14085 o c�QG' � BETWEEN UNITS TH2 1 1 ELEV. ELEV. \ / �% � jOqT 41 'o opt4 43.5 0,� 43.5 ? � // \ 40 °' A A PROVIDE 34' OF 40 MIL 4j SL SL LINER AT 5' OFF SAS IN / MA 1 OYR 4/3 1 OYR 4/3 AREA SHOWN. TOP AT , �,� APPROVED DATE BOARD OF HEALTH 131' 12" ELEV. 40.5', BOTTOM AT BENCHMARK / 0P EL. 36.5 t COR BLKHD EL. B B EL.=46.7' 4� Q p� i , ' TITLE 5 SITE PLAN ,gyp SL SL OF „ 1 OYR 6/6 1 OYR 6/6 SAS \ter, / p� 30 41 .0 28 41 .2 huh \�% 66 STONEY CLIFF ROAD CENTERVILLE, MA C1 C1 LOT 6 � 0 PERC M/CS M/CS 15,531 SF / / QFM4SSq NO'-OF PREPARED FOR�r 2.5Y 4/6 2.5Y 4/6 gORTOLOTTI/DYER / oyG� , DANIEL 84" 36.5' 84" 36.5' DANlSLA. o OJALA �+ ro A. �a CIVIL % i" OJALA 46502 No.40 DATE: AUGUST 1, 2013 / o 2 2 C C F��i ��' ° P / � \� "' off 508-362-4541 CS CS c+ qc /�� fax 508-362-9880 �� DANIuLA. ti� /� DANIEL ti� 1OYR 6/4 10YR 6/4 / ��+ downcape.com / /� A. U OJVI1 OJALA � " 120" 33.5' 120" 33.5' 1 �No,4650 O No.409 0 VOWS cape e17 lfteeri/!g, 10C. „ OX, FGIS ��0 ��� j ESS oa , civil engineers NO GROUNDWATER ENCOUNTERED Scole: 1 = 20, SION�S N Alsurvey SUR'J ° land ors / J 939 Main Street ( R to 6A) DCE # > 3- > 44 0 �10 �2O �30 �40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 13-144 BORT_DYER.DWG