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HomeMy WebLinkAbout0101 STONEY CLIFF ROAD - Health 101 Stoney Cliff Road Centerville 190 011 inn z UPC 12M No-53Lv0�� J� 1 i TOWN OF BARNSTABLE l tON ��t' S r� �fd 'f—Y` SEWAGE k Ace meµ f�/y r f e Asssso��s LOT-- A' gas rAL>.E s Nam plarlE too. IEPTIC TANK CAPACITY .FACI ING F,A.f'11 rrY: (type)�r��7�' (size) �0,OF I3EDltOC11�fS_...� . MILDER OR OWNER, 'E I'TDA'TE:.W__ CC7WLIANCE DATE: separation distance Between the: Aaximarn Adjusted Groundwater"fable to the Bottom of Leaching Facility eet Yivate Water Supply Well and Leaching Facility (If any wells exist on site or witkun 200 feet of leaching facility) scut dge of Wedand and Leaching Facility(if any wetlands exist ItWn 30 fer �ieaclw n u2 / feet vaished by 4' r a-Q- SJ � EE Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information �Nj 1. Inspector: L L) V Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 .. =� Telephone Number License Number '7 ;I r}0 Co B. Certification I certify that I have personally inspected the sewage disposal system at this address and tFit theU information reported below is true, accurate and complete as of the time of the inpection.i-he inspection; was performed based on my training and experience in the proper function and aintenanse of vti9-slte - sewage disposal systems. I am a DEP approved system inspector pursuant to Sectio645.34"of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Need Further valuation by the Local Approving Authority 2-18-10 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l� v 6b t5insp official document•03/08 Title 5 Official Inspection Form:Subs de Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1=800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced' ❑ obstruction is removed t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448): Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is.Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass.unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and-the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet:of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/ 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 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. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No , . ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either`yes" or"no"to each of the following, in addition to the questions in'Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area'— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwea lth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real.Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No . ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information.on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts F Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 1-10 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate'1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 14 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.): . Good condition. Septic Tank(locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed.by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000gal Sludge depth: 12 Distance from top of sludge.to bottom of outlet tee or.baffle 20" Scum thickness 0 Distance;.from top.;of scum to-top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. ^M 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) j 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 is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions:- K I Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Good condition with water at working level. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate'1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 7-infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number:' ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Infiltrators in good condition with no sign of back-up into d-box orsurrounding stone t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes: ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp official document•03108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. F-�S t IIG f I i t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 101 Stoney Cliff Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02632 2-18-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope , ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local. Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database -explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. t5insp official document•03/08 Title.5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable Health Inspector oFtH¢tp� Office Hours do Regulatory Services 8:00—9:30 „ Thomas F.Geiler,Director 3:30—4:30 anxxsTns ., Only [E MASS. Public Health Division Thomas McKean,Director- 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT QUESTIONNAIRE 1. General Information: Address: 101 Stoney Cliff Road Centerville Map 190 Parcel 011 Name: Myrna K. Rios Phone: 508-534-9097 0 2. How many bedrooms exist on your property now? 4 Are you planning to add an bedrooms?NO X- r-, 2a. Please include a copy of your floor plans for the entire property. co 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer, skip questions 4-9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an PUBLIC WATER 6. Is a disposal works construction permit on file? YES or NO 6a.If yes, how many bedrooms were approved according to this permit? 4 Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? 8. Is there an engineered septic system plan on file at the Health Division? YES 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES -------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY The Public Health Division has no objection to bedrooms at this property. Signed: //�° Date: / tj C) Inspector(Print): Q;/health/wpfiles/amnestyapp Y "Z.. C� C) Town of Barnstable Health Inspector �tNE Tp� Office Hours do Regulatory Services 8:00—9:30 Thomas F.Geiler,Director 3:30—4:30 snxrrsrnsi E Only r 9� 1639. `e� Public Health Division �fD MA'S A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT QUESTIONNAIRE 1. General Information: Address: 101 Stoney Cliff Road Centerville Map 190 Parcel 011 Name: Myrna K. Rios Phone: 508-534-9097 2. How many bedrooms exist on your property now? 4 Are you planning to add any bedrooms?NO 2a. Please include a copy of your floor plans for the entire property. 3. Is the dwelling connected to public sewer? NO ]-cc If the dwelling is connected to public sewer, skip questions 4-9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to p lic supply wells? r*�►n 5. Is the dwelling connected to an PUBLIC WATER ' -, 6. Is a disposal works construction permit on file? YES or NO to 6a.If yes, how many bedrooms were approved according to this permit? 4 Bedrooms. rn rn 7. Were any building permits obtained for construction of additional bedrooms? 8. Is there an engineered septic system plan on file at the Health Division? YES 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES -------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY The Public Health Division has o objection to bedrooms at this property. Signe 44 Date: Inspector(Print): M ems,,, Q;/health/wpfiles/amn estyapp SC5 - 3\A 1 I V 1� IC` I ,a F f COMMONWEALTH OF MASSACHUSETTS Z W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS + d DEPARTMENT OF ENVIRONMENTAL PROTECTION h I� � W � V o,�M Ste TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION "711,33 ; = Property Address: #101 Stoney Cliff Road Centerville,MA `, Owner's Name: Jordan McAdams Owner's Address: 101 Stoney Cliff Road Centerville,MA , S Date of Inspection: 12/21/06 Name of Inspector: (please print) Mr.Carmen E.Shay Company Name: Shav Environmental Services, Inc. Mailing Address: P.O.Box 627 East Falmouth,MA 02536 Telephone Number: (508)-539-7966 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: XX Passes x Conditionally Passes tf�J�NOF;spq Needs Further Evaluation by the Local Approving Authority ' �`� 5� Fails I o CARMEN sG Inspector's Signature: Date: 12/21/06 SHAY �pTlF\��Q The system inspector shall submit a copy of this inspection repo7tthe Approving Authority(Board of /NSP�� DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 1 , gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments No evidence of hydraulic failure observed in SAS. ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX 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: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool XX Liquid depth in cesspool is less than 6"below invert or available volume is less than '/s day flow XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped XX Any portion of the SAS,cesspool or privy is below high ground water elevation. XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. XX Any portion of a cesspool or privy is within a Zone 1 of a public well. XX Any portion of a cesspool or privy is within 50 feet of a private water supply well. XX Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. .„1,,,,.,.,. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No XX Pumping information was provided by the owner,occupant,or Board of Health XX Were any of the system components pumped out in the previous two weeks XX _ Has the system received normal flows in the previous two week period? XX Have large volumes of water been introduced to the system recently or as part of this inspection`.> XX _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up`:' XX _ Was the site inspected for signs of break out? XX _ Were all system components,excluding the SAS, located on site'.) XX 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? XX _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no XX _ Existing information.For example,a plan at the Board of Health. XX _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): no Water meter readings, if available(last 2 years usage(gpd)): Last date of occupancy: Currently occupied CO MMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM XX 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) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 9-14-2004-per Owner Records&BOH Records Were sewage odors detected when arriving at the site(yes or no): No 1 . r .„.,,.,,- 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 BUILDING SEWER(locate on site plan) Depth below grade: 30" Materials of construction: XX cast iron XX 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 18" Material of construction: XX concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 5' deep x 5'wide by 8' long (1000 gallon) Sludge depth: 4. 751 Distance from top of sludge to bottom of outlet tee or baffle: 3.00' Scum thickness: '/2"Scum Laver Noted Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Structural integrity of tank was ok. No evidence of cracks, leaks, or water infiltration/exfiltration Inlet TEE present and in good condition. Outlet Tee also in good condition. Liquid level equal with outlet invert. GREASE TRAP:_(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): -.11 . . I. — .,,.,. 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Present (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): 3 HOLE D-BOX No cracks noted—distribution appears to be equal. Top of D-box is 1.5 feet deep. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):_ Comments(note condition of pump chamber,condition of pumps and appurtenances,etch Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: XX leaching trenches,number, length: 1 Trench—12 wide by 37 feet long, I' deep. 5 INFILTRATORS leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of hydraulic failure, ponding damp soil or stressed vegetation. SAS is 3.0 feet to top. Probed stone with no evidence of hydraulic failure. 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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): .,. ,. 9 Page 10 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #101 Stoney Cliff Road Centerville,MA Owner: Jordan McAdams Date of Inspection: 12/21/06 SITE EXAM Slope Surface water - None Check cellar -Yes Shallow wells—None Estimated depth to ground water 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: XX Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) XX Accessed USGS database-explain: You must describe how you established the high ground water elevation: Checked with Quadrangle of USGS Map. 4' Separation from water table to bottom of SAS from perc info. Refer to engineered plan on file. P 6�- /.�/G �♦/��y N/J��'/'}/� i/- f , lZ� eALO}y C/4,j � 1-E AGH' �� a Z L- f rrt' J r. e e)t ,zr3 , No.. FEa.-....C'&I- )...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .._._ .ra w w. ..........OF...... .. .T..C.-./ v4�f-..... ................... Appliratiun -fur Disposal Works Tottstrurtiutt Urruift Application is hereby made for a Permit to Construct (u) or Repair ( ) an Individual Sewage Disposal System at: �ad---------- -------------------------------- ...................................T .� - ........................... Lo tion-Address or Lot No. ---------------- ° �� = ,/°:..S�!4�1r1 w----- -------------" �__---:- nE _ CG/F/ W Ow r Addre s -------------------------------------------------------------------------------------------------- Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms____ _____________________°____-__-_-__-Expansion Attic ( ) Garbage Grinder ( ) pa Other—Type of Building ____________________________ No.`of persons---------------------------- Showers ( ) — Cafeteria ( ) n' Other fixtures --------------------------------- W Design Flow............ _____________________gallons per person per day. Total daily flow-------------------------------------------.gallons. Septic Tank—Liquid capacity gallons Length-............... Width.._.__-._....... Diameter---------------- Depth................ xDisposal Trench—No-__________- 'Width____________________ Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No._�_____ Diameter_____________________Depth below inlet.................... Total leaching area------------------sq. ft. z Other Distribution ox ( ) Dosing tank ( . •" Percolation Test Results Performed by---- --- --- ------------------------------------------------------------- Date_.------------- --------------------.... a Test Pit No. 1-------------___minutes per inch Depth of Test Pit.................... Depth to ground water---______________-__--- f� Test Pit No. 2.................minutes per inch Depth of Test Pit____________________ Depth to ground water..._..______________---- 0 Description of Soil------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- x C+ V -- -------------- ='--------- ------------------------------ -••- U Nature of Repairs or Alterations—A s�ver whe applicable.-____________________________________________________________________________.................. -'------. ��0/Tl��"6r�--=------------- -------d .------- c-- ------ tr ---'f.--arc------' ----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the s stem in operation until a Certificate of Compliance has bee s d y and of health. Signed-- �. V Date Application Approved By___.. ___'��__________________________ ----------------------------------------------------= ----------------------- ---------------- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------•------------------- ----•-••---------------••--•-•-••-•••-••--••------------------•---•---------------------------•---------------------------•----••-••------------•••-- ................................................. Date Permit No........;1Y_?•---=-------•------------------------ Issued..........hj_ y --73-- ................... Date �f ­�7 No..... ._.__... FE$.....,c .rfJ.o...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH jatLw ............OF..... C:t y"# Appiiratiun -fur Btupuutti Workii Cnunutrurttun Vrrm t. Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: f4/• m aw -' � CGS v/4� k' L atron�1Add?oss 'Y v. `? or Lot No Owner Address W V Installer s.* `„' «.i Size ......................... Typeg ______________________________E ansion Attic ize Lot-Garbage Grinderq of Building n`; feet I Dwelling No. of Bedrooms .__! p ( ) g ( ) pi Other—Type of Buikding ---------------, No. of persons.--,--__-_-- ?_'h kt�Tngwers�( '") — Cafeteria ( ) Design Flo''L Q' -- ------------ gallons. + � �Tlb = d +' Ofher fixtures -------------------------- W g y .. •._ � _ f g ' rs''per person.per zlay NTaalrI by 4V .?k -_ .-•-. --gallons. WSeptic Tank capacitvgalloiis Length----- --------- Wfdt1L =...._..... T�lameter-_--- .--- ---._ Deptll. -_--_-_-- -- x Disposal Trench—No ____________________ �/idth_-__----_-_----__--- Total Length.-_._.......__.___.. Total leaching area....----..-----.-_..sq. ft. Seepage Pit No. I.I . .---- Diameter____________________ Depth below inlet_,___-_______.__.___ Total leaching area.....:_:;:>-------sq. tt. Z Other Distribution ox ( ) ` *Dosingtank ( ) ~" Percolation Test Results Performed by-------------------------------------------------------------------------- Date--------------.------------------_._._. a Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water-------------------------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-.-.-------.-_-- -- -----------------------------••• •'•-'•---•--------•• ••••----_•---'....................................... ----- Description of Soil u1s ----- -------------------- ------------------------- --------------- - ¢, U .............................. ------ fi x 4' .1S1d°DA +f --- ------ U Nature of Repaj.rs-or Alterations er whS&applicable _-------------- .--.-__ .--.----_.-------------------- -------------trs -ch+L------------- --- ✓dC ------!?Gt'IFdatG --'---- ------------------•------ Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary x.Cgde-<The,undersigned further agrees not to place the s stem in operation until a Certificate of Compliance hasAbee s-?'de y t dry°, oar;.d of health. • - �y Signedr - '- ---- -------•• --------------------- Date y Date Applicazion4' �roe`d By- `G 'l :lk nti �r � xtrulf; I,�;r;P .; -----._..••••------- ---------------- 4 4 Date Application Disapproved for the following reasons_______________________________________________________________-•=--------------------••-•---_ ----••-------- ................................... ------•------•------•-----------•--••------------ Date Permit No------- ' Issued. ' �3 . Date As <yaM tf•IE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' Tatifirute of f ompitaurr THIS IS T•:O.CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -•-------•.............•----------•---------•-•••••••••---.... .--••- --- Installer -----G��T�R_�/---��-------- ha's been installed in accordance with the provisions of Article,XI of The State Sanitary Code as described in the application for Disposal WorlUCorstruction Per m>t duo ----------------------- dated.... _ + THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WIL FUNCTION SATISFACTORY. DATE. / ..�-_7 •- ---• ........ Inspector -----' -'-• ............ [. -,'s•1k�L.., 'k..,•,; airy yi a. .. .�y l4, "'Oor Y THE COMMONWEALTH• OF.?MASSACHUSETTS r BOARD OF `rHEALTH I{ ` No. ---•••-•• FEE........................ Biri:Vu,itti Workii Cnunutrurttun Vrrmit Permission is hereby granted...............................................................................................-•--......-'--•---'---••-•••......-••..__:... to Construct ( ) or Repair (X ) an Individual Sewage D,sposal System at No.. f d ...... 10.k` rGIiC1` A..r .. L--t-----'r-`------------�------- ------ ----------- ---------------- Street � + / /3 as shown}on the application for Disspio�SWIiWorks Cons at ppr; ?ei it No---7yT------ Dated.....l/._ 9' ........................................................................................................ '• Board of Health DATE..........................................:.................................. t - 'FORM 1255 H BBS &,,WARRENa INC:.- PUf3 L-ISHERS °�+-+sW �+ - ., ',lam•• a - ,3"y� }'r_rFy� �ry'f �iC''�.P_54 t•iI"R'�'� �ti. `y::� �����''t'�..i��H:�'a��•'*�r�'�t b`-' A .. �. g i TOWN OF BARNSTABLE LOCATION G 1 'Z- ail �C1t' '� t�(� SEWAGE # �i ,VILLAGE C-fn-*V' ASSESSOR'S MAP & LOT J 6.O G(. INSTALLER'S NAME & PHONE NO. '�}il�ccnCc, 04 SEPTIC TANK CAPACITY , I Q0 (bAL- tv LEACHING FACILITY:(type)4 t y l-y0+dc'i F L60 NO.'OF.BEDROOMS PRIVATE WELL OR PUBLIC'WATER' BUILDER OR OWNERc�i��.t- DATE PERMIT ISSUED: DATE 'COMPLIANCE ISSUED: VARIANCE GRANTED:.-Yes No, y ' f1 r 74 1 �Nt ry . o i o t 50 t: No.. _.. Fxs.....,; ................ APPROVE THE COMMONWEALTH OF MASSACHUSETTS ms e C nserva ' Depa ent O A R D OF HEALTH ? F TOWN OF BARNSTABLE fined Date Appliration for Diripntial Wurlw Tonfitrnrtiun 11frMit Application is hereby made for a Permit to Construct ( ) or,Repair (�an Individual Sewage Disposal System at: LG �lLj ................................C�1�.�-------- - -------- -------- ------.....................................Lon- [dress •_._ or Lo..._O ia /� ✓ ----------------------------- Ja--------6AtY.4.t.---�.9? ........._ e 6"..MO. Ou nee •--•..._.Address IustalIer 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............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity........--..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.....-.------.------ Total leaching area....................sq. ft. Seepage Pit No--------_-_------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Test pi o.Percolation t N I Tnu es pe Results Performed r nch Depth of Test Pit.................... Depth to ground water........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------------- ------------------------------------------------------- ---•---------------- ---------- •... ......... ...-•••-•.--------------------- ••- 0 Description of Soil.........................--••-••--•------•-•-•---------•-••--------------••--------------------------------.....----------------------------------.........-•---.---••- x w UNature of-RR�epair t r A�era-ion—Answe when applicable....�C?��.....�.�.-..�........1_.-..-.� r-- y�J�-----•-- .. ------------------------------------------------------•-----•........----......----•------ 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 e n iss by ql board of health. Ofollowing igned o.../f �; p' -- . . .. .......... ........ ...... ...... Application Approved By .... . . - --- ---- ... . . ............. .� . ..... .. .... ate Application Disapproved fore reason - ------------------ -------------------------------------------------------- .. ............................. ---- 801... .... ......... .............................................................. . ............................... ................ Permit No. . . Issued ............. / ..f a v ../ ...............Date...... • 1`, '� s'—�. a ' +f � ;(//�,� / fit`/,uh No. Faa. . — .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iratiun for Diri.pniu1 Wur1w Tomitrurtinn Prrntit Application is hereby made for a Permit to Construct ( ) or'l.tepair (-l"an Individual Sewage Disposal System at: - (2 �� �� C4..* .t a lion- ,ddress /c%....._.....[ .!�c P-�-g----------------•-----•-- 'S'1�------ .4�t'/e�f or Lott-No J7�. 0�l��G O-ncf Address 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 ( ) p" Other fixtures ...............................•--------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity._.__......gallons Length................ Width--___._---____- Diameter................ Depth................ x Disposal Trench— No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..._...":.f...... 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................minutes per inch Depth of Test Pit--------_........... Depth to ground water........................ �r4 Test"Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground.water........................ 9 •--••---••-•--....---•--••------•--•--•••--•-•-•----•-•-------•--•--••-••----••--------•---•................................................................. 0 Description of Soil........................................................................................................................................................................ =V -----------•---• ------•-••-•---•••--•----•-•-..................................................... W ---•---•-••••-------------------•----------••---•----------•--......._.._........-•----•-•---------•-----------•---........._...-----•--------•---•---•--•-••-••---•--•-----•- .4_ - 7 -•••--.._.._..--- U Nature of Repairs or Alterations—Answer when applicable....10 0...._ -.... - .__..._.I...__.��".�G k............ 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 has6bben issued by 5e, board of health. { Signed ............. .. � . ..�........1�� � - e Application Approved B /%�'�/'.�./,�......... C r?.....- �./�,.....�/.C�..................... 1.:=(.-L- .-......-...... PP PP Y .... ,�.. _ `...r F Date Application Disapproved for the following reason'J�.. . .......... ............. ............................................---....--....._............................ . .. _ --... ... . ................... . . Date Permit No. ..y......................�"�.�/ Z� .... Issued /.....,.. % . t 1 ......._........... / Daiex � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (gQ>CtIfiCatE of (fIIZYCpliMxiCP THIS IS TO CERTIFY,That the Individual Sewage Disposal System constructed ( ) or lRepaired ( ems) by ...................... , 4.I7.f-.c ............................ _.... .......-...---.-------------- ---.....................__ ------------------------- ....------ ..-----..........................-_....... (��/ /f 1 ,Mtn, J at ...-f. . .............J..1� .Y -......_( ..1.a.' ? .. -f t l -r - ' �.v.1�---- ..... . .................. . ........... has been installed in accordance with the provisions of TITLE q55f yne State vironmental Code as described in the application for Disposal Works Construction Permit No. ... "-' -�.._.. -9... dated .--......._.....--...-__.....---...._....-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTI�U, A AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �G DATE.............�/.......-~ �G'...--./-. ..........._.. .--... ...... _. inspector ---....- _...-... ...__............. .....--..... .. f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C1 -� TOWN OF BARNSTABLE No.• • FEE.....: .......... �i� gntt1 rkn Tonotrurtilan antit Permissionis hereby granted 7 .U----------•----••------•------•-•--------•---••-...................... ............................ to Construct (' ) or Repair ( e�an Indjvirival Se.wa e Disposal System J at No... 9_l � _ �� T�--------_--�--r :---- -('ems v-- -------------------------- --------------- Street /�j as shown on the application for Disposal Works Construction Permit No� � �atedin.__Vt...................n............... I�oard of FIcalth- 1 DATE.............. / / f -- --------.. ....----•-------------•-•---- FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS t000 Ica) Le-- � TOWN OF BARNSTABLE LOCATION �Q � 5'1anP.,LClt � SEWAGE VILLAGE_ ASSESSOR'S MAP & LOT INSTALLER'S NAME. 6z PHONE NO. t cc SEPTIC TANK CAPACITY 1600 (0,4L- D - B LEACHING ]FACILITY-.(type n- '{��01 Qs ti ) NO. OF BEDROOMS PRIVATE WELL OR,PUBLIC WATER BUILDER OR OWNER cCAi'''6(* .i � DATE PERMIT ISSUED: DATE COMPLIANCE I .SUED: —7'�pZ� VARIANCE GRANTED: Yes No j/ lqlo I , _ 1 it TOWN OF BARNSTABLE iF,C .00ATION 1—\ SEWAGE # S JII,LAGE '^��fv SESSOR'S MAP & LOT 160`00 INSTALLER'S NAME&PHONE NO, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) -NO.OF BEDROOMS t BUILDER OR OWNER n PERMITDATE: ' V- COMPLIANCE DATE: ^� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private.Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �_ _ __ G. �� � � oZ��� . � No. O�©� L O �=� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Miopooar *pq;tem Com6tructton Vermtt Application for a Permit to Construct( )Repair Q%<Upgrade( )Abandon( ) O Complete System, hdividual Components Location Address or Lot No. 101 S 1 ON EY C i-1 FF I Owner's Name,Address and Tel.No. (2Eij-rEc \)kL-L� MA LiAN�� Coe'3i oe-�oS- Qio Assessor's Map/Parcel O A M Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S�4A1r" (ZA L)1,rbr*r')Q!r)`y0.\ Type of Building: Dwelling No.of Bedrooms 4 Lot Size PLO,8[ S sq.ft. Garbage Grinder(I�A Other Type of Building No.of Persons a Showers Cafeteria( ✓) Other Fixtures La.,a-1-- Q y. lK.Tc ti CN S N lc . "O M MY Design Flow "n gallons per day. Calculated daily flow 443.'V0 gallons. Plan Date �6 4- Number of sheets Revision Date Title u S� SAet'h Size of Septic Tank Type of S.A.S. la' xSb' Xtec>C�N /NFII_TeA4'o2S), Description of Soil CN- A DL50 8 "-W,'( ZW (t S) 2M i tat" - 1 A4" Me6 Since Gnc%,rNALNXX\q- Nature of Repairs or Alterations(Answer when applicable) r�k_(�r 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 provisi is of Title 5 of the Environmental Code and not to place the system in opera 'on until a Certifi- cate of Compliance has been is ed by his Boaz ealt Signed Dat Application Approved by Date Application Disapproved for the following reasons Permit No. Q00 4 — 5�? Date Issued .,.-:_..,�,.„,_.:;.r--+5:..i"c-.---�.-rti.^•a. w. . .. .,...ww..va.�,-w•x.�+.w.yv:y�.n�'s�'--•••.^4.-a`i... ,,....-..- ,....-`---v-^�. ..�_ .._�. •— r..,.-..w..r„--�. .d . .. No. Fee / THE COMMONWEALTH OF MASSACHUSETTS" Entered in computer: ✓ °'" Yes <` PUBLIC HEALTH DIVISIONS TOWN OF BARNSTABLE, MASSACHUSETTS - ,n 2pplicatiou for,]Di9;po.5ar 6pztem Cok6tructiou Permit Application for a Permit to Construct( )Repair(/"<Upgrade( )Abandon`( ) ❑Complete System Aindividual Components ti Location Address or Lot No. ,:A 01 ' 1 o+r EY C L)FF (� Owner's Name+Address and Tel.No. CE.QTEfZV1t-L� i 1'�A IANNE. C0Z_-B1E`_E Assessor's Map/Parcel ' 0 O` SQ M 5�8 �Ocl CIO Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3 M©253(0 Type of Building: 'Dwelling No.of Bedrooms 4 Lot Size ZO B 65 sq.ft. Garbage Grinder( tyA r Other Type of Building N No.of Person Showers( � Cafeteria Other Fixtures L.a T' R Y, K 1-T C H EN t>N k 1 (_A U N owe Design Flow 44 O gallons per day. Calculated daily flow 44 6,'-j p gallons. _. Plan Date d 4- Number of sheets Revision DatT, N - ,.. Title ' Size of Septic Tank 1006 Vic. X15�. Type of S.A.S. lo' XSd' Tcec-, h C w�'It7QA'r0es)' Description of Soil C�-g � A LSt-) `� 16 -too" C 75,14 Coo Gti„ _ I A 4-" MRLA Sand Nco 144" Nature of Repairs or Alterations(Answer when applicable) �C♦n 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 provisio s of Title 5 of the Environmental Code and not to place the system in operati n until a Certifi- 'sate of Compliance has been iss ed y is Board's ealt Signed Dat Application Approved by Date If 0 L, Application Disapproved for the following reasons Permit No. 001 a Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE ICY that th n-s'te ewage Disposal System Constructed ( )Repaired ( )Upgraded(N) a Bandon,6 �r (U�u r P x e v I / has been constructeclll i cc rdance with the provi t*0 o T;tle,5 nd the for Disposal System Construction Permit No. A li)� ���? dated �1� ��s Installer /�ll � Designer The issuance of his p tmi shall not be construed as a guarantee that the sy em wfl f nction a designe Date a D Inspector �� - No. ------------•------,-------:Fee f 00T , o THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Wpogal 6pztem Congtructiou Permit Permission is hereby ra tod,So Constr/lust ) e a} ( (Yd nradre�W), don( ) System located at w� �� and as described in the above Application fordDisposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Con tructi n must be completed within three years of the ,ate` e of this Date:_. ' Approved by O TOWN OF BARNSTABLE LOCATION ` `� �� /� SEWAGE # VILLAGE r�.�c✓v`, SESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.-' /� SEPTIC TANK CAPACITY ] LEACHING FACILITY: (type) /✓/d` .G` (— (size) 0 NO.OF BEDROOMS t BUILDER OR OWNER PERMIT DATE: 11qT0 COMPLIANCE DATE: C Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching'facility) Feet Edge of Wgtland and Leaching Facility(If any wetlands exist within 360 feet of leaching facility) Feet Furnished by �j vet, e P Town of Barnstable °FINE rO''' Regulatory Services Thomas F. Geiler, Director snxivsznsi E 9MAS& Public Health Division 1619. RFD A4°r' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 9 jo-1z) -6 Designer: 2ffialCt, Installer: \ _C Address: Address: S+ On n a 4 7�i�_Vls SeA3� was issued a permit to install a (da ) (instal�� septic system at based on a design drawn by (ad ess) �`k tc tics-oe> ` S dated �T� T p (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. cti of�S ( er ature) oo CA�Eft c u SHAY Cn No 1181 �7 esigner's Signature) (Affix De 0 ' ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIS N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form SECTION A -A •u�Ttr,>Ur min. from *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE ((o Least 24 Inches toll) ALL ou1tET""Es FRow "'E Exi•tw rourdation )House to septic tank Schedule 40 PVC w/Chorcoal odor Filter PROFILE �EW OF ADDITION TO LEACHING SYSTEM o,�.u„a,Box SMALL BE ! 1 ,t,,,,, � TOP Or FnUNDATVIM ■ El" MW(Asstned) Septic tank MNrs must be SET LEVEL FOR AT LEAST 2 FT. 12` CONCREIE COVER t f We Irithin 6 In. of WWahed grade Y. / I J Q Grade over Septic Tenn- 99.00 Oa&ow D-Box- 96.00 over SAS- 9&60 3' of 1/8" - 1/2" Washed Peastone 3-6.OUTLET . "`••!�•- �. °o•!ML b 3/4' to 1 1/2 ' Washed Crushed Stan , KNOO(OUTS • SS• 1r MET •.Fa e�./�„\ �t eirl • �. 3 HOLE H-10 Tep toed -E1ev. -94.25 �� eFsA ounET o S � 0.02 a•pv�c(CAPPED)INSPECTION PORT TO BE f OEsr. Box s Nmrlmem cars . H�STALlID AND m BE r9TlIN s•of GRADE s` t •� •^ 1t i ~ 10, EXIST. S-0.01 or Greater Top of SAS-Ekw, -9175 -�• a'+` lerbl� N Ex>S�tpE V) 1,000 GAL to �, s- o.rn'pK foot or gate, • Las• ., FROM DM. r(ILMAT� LJ 5R SEPTIC TANK t` O EMeetivs Depth 4' - SCH. 40 T t.Ty- 4 CONCRETE IRUFoy 0 1 H-10 e.e.b a. PVC TEE ,o $ lNtlts a � ' _ 4400' PLAN SECTION CROSS-SECTION tl ��e• ' f``� REQUIRED TO m 0.83 (10 inches) Qr • r o REDUCE VELOCITY 1 SYSTEM PROFILE 6 In.of 3/4'-1 1/r -6 o N y s 4 a 3 HOLE H-10 DISTRIBUTION BOX 1 �` �• `� � r Not to Scab catpaeted stone c $ b m 0' NOT TO SCALE A4 2 r t 4' 4' r Effective Length I•2L"terwlaCrrsei 4JW4^AM tea„^nxd mow- 0 In.of 3/4'-I 1/r 0 , o SOIL ABSORPTION SYSTEM (SAS) GENERAL NOTES compacted starve Efsecttve Vldtfi INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN NOTE. ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE o • m 1. Contractor is responsible for Digsofe notification Bottom of Test Hole 1 Elev.-66.00 (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. Obs. Groundwater Test Hole 1 Elev.= NONE OBSERVED NOTE:` OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 10' 2. The septic tank o tih distn ulion box shall be set level on 6" of 3/ -�1 1 p2 stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. C4. This system is subject to inspection during installation I by Carmen E. Shay - Environmental Services, Inc. PERCOLATION TEST �,-' 1 5. The contractor shall install this system in accordance 65.01' 1 with Title V of the Massachusetts state code, the approved plan I Dote of Percolation Test: SEPTEMBER 7, 2004 ^ i � and Local Regulations.I Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 9 ` E 6. if, during installation the contractor encounters any Results Witnessed By. WAIVER (per BARNSTABLE B.O.H.) 1111 �fj• of ► soil conditions or site conditions that are different Excavated By. SHAY ENVIRONMENTAL SERVICES, INC. I` ���\ from those shown on the soil log or in our design Percolation Rate: Less Than <2 MPI 0 installation must halt & immediate notification be t,t made to Carmen E. Shay - Environmental Services, Inc. 1Yd 7. No vehicle or heavy machinery shall drive over the y % LOT #39 t septic system unless noted as H-20 septic components. \ 8. Install Tuf-rite as baffles or equals on all outlet tee ends. Test Hole \ 3 � 9 q � 20,Bs5 Square Feet +/- E No. 1 c0 t 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. DEPTH SOILS ELEV. /' �\ 10. All solid piping, tees do fittings shall be 4" diameter 0 98.00 Schedule 40 NSF PVC pipes with water tight joints. I sandy y P1 i \ \� �\ v 11. Municipal Water is Connected to ALL OF The Residence and Abutting t 10 YR 3/2 ( ) ,� �� \ p Properties Within 150 Feet. 0. Loam V -00 THE PROPERTY LINES ARE APPROXIMATE AND Sandy ASPHALT EXISTING COMPILED FROM THE SURVEY PLAN 1 i 10 YR 5/6 DRIVEWAY �� 4 BEDROOM i LOT #40 ENTITLED - "PLAN OF LAND OF CENTERVILLE HIGHLANDS -SEC. 4, 6•- �• Be 95.50 �� �� �\ HOUSE i BARNSTABLE, MA" DATED 1965, PLAN BOK 204 PAGE 117 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN LOOM o �\ � (FULL FOUNDATION) PROJECT BENCH MARK IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 2s r 7/4 #fOf ; TOP OF FOUNDATION THE SEPTIC SYSTEM INSTALLATION. 30"- so 3.00 \`\ ELEV. = 100.00 (Assumed) SAND 0 f EXISTING LEACHTRENCH TO BE PUMPED OUT AND 2•5 Y 7/4 FILLED IN PLACE OR REMOVED TO FACILITATE INSTALLATION OF NEW SAS. i60"- 144 00 ' i � OQ EXISTING i NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE GARAGE i FROM THE EXISTING LEACH TRENCH TO BE DISPOSED "f ' -_ ------- .__OF_AS_PER -BOARD-OF HEALTH SPECIFICATIONS. EXIST. 1000 GALL¢N SEPTIC TANK i NO WETLANDS ARE PRE-SENT WITHIN 200. OF THE PROPERTY i O ASSESSORS MA� P 190, PARCEL 011 Perc , ,� ,,-,, ;a ; L E N D Depth to Perc: 60" to 78" Perc Rate= Less Than 2 MPI , E� SPA- ,� Observed ESHWT® - NONE OBS.- 144' Assumed ADJUSTED H2O Elev. = NONE OBS. - 144` Assumed �\ 1 4" PVC 104X 1 DENSPOOTES PROPOSED Vent Pipe DENOTES EXISTING x 104.46 SPOT GRADE I �- ' t.:x D-Box . ;r- s' PL PROPERTY LINE 9r P PROPOSED CONTOUR yT-ti " TEST HOLE #1 - - - - - -97 EXISTING CONTOUR ram. • f ? ° 0 ELEV.= 98.00 2-16• DIAM. ACCESS MANHOLES \1\0' ���a}=x' 1, ® DEEP TEST HOLE & 6• PERCOLATION TEST LOCATION 4. •�:_•�-�=sue-. _.- _.y:f.. .:.: � .----• 6 FOOT STOCKADE FENCE '1 L' 5' 6l ou T LOT #38 - -- t` LOT #34 PLOT PLAN THE ACCESSCOVERS FM COV FOR THE SEPTIC TANK DRADE SHALL BOX AND LEACHING TOWIT COMPONENT OF it 0 F PROPOSED SEPTIC SYSTEM:1.�. �- -.- = SET DEEPER THAN 6 �HESBELOW t,N�D STEM UPGRADE J .• ..• .• •..' � .•n ; ' �,. .�"•. GRADE SHALL BE RAISED TO 1M71iIN 6. OF STEEL REINFORCED PRECAST CONCRETE �� GRADE PLAN VIEW INSTALL Tur-nTE GAS BAFFLES OR EQUALS PREPARED FOR 3-24' REMOVABLE MS . L I A N N E C O R B I E R E /- I � LOT #35 AT mh~deoronce tY MET 101 STONEY CLIFF ROAD WET 6• minT�2'mh. filet to outlet 6. ,�b I. OUTLET CENTERVILLE, MA s 's -r Desian Calculations 4•-0-.min. _ OF 40,4 PREPARED BY: Llpuid depth Number of Bedrooms: 4 Equivalent to 440 Gal./Day qN Garbage Grinder: No � 9 :i Leaching Capacity Proposed: 440 Gal./Day Minimum o`er G�L(L AR1 EAT E. SffA Y Septic Tank - 2 x 44-0 Gal./Day = 880 USE EXIST. 1,000 GAL. Septic Tank. E 6-0• 4 -10• SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 0 20 40 50 c3 ENVIRONMENTAL SERVICES, INC. CROSS SECTION END-SECTION Bottom Area: 0.74 gal/sq. ft. x 500 sq. ft. - 370 gallons 81 P.O. BOX 627 Sidewoll Area: 0.74 gal./sq. ft. x 99.6 sq. Ott. - 73.7 gallons �a TYPICAL 1000 GALLON SEPTIC TANK Providing: = 443.70 gallons �GiSTf EAST FALMOUTH, MA 02536 NOT TO SCALE Use: (7) INFILTRATOR HIGH CAPACITY H-20 UNITS; HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE: 1 =20' SaaFtAR\ TEL/FAX 508-539-7966 TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3. OF WASHED STONE SCALE: 1„=20' DRAWN BY: CES DATE: SEPT. 9, 2004 ON THE ENDS. No STONE UNDER. �_PROJECT#SD630 FILENAME: SD630PP.DWG SHEET 1 OF 1