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Home My WebLink About0036 SYLVIA LANE - Health 36 Sylvia Lane Centerville A = 189 077 I oscvaEo 1: UPC 12543 IVo. 53LOR HASTINGS. MJ i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'X> M 36 Sylvia Lane 071 Property Address N'l CID Dominic Slowey Owner Owner's Name information is required for Centerville i/ MA 02632 12-26-1;7N every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. ImpWhen A. General Information SL O to-fga- When filling out ' forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 Cityrrown State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-26-17 nssppect 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 ;2 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° M , 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 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 met or exceeded all passing requirements at time of inspection. Tank was pumped in fall of 2017 for maintenance. This report does not predict the future performance under the same or increased usage. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® 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/z day flow l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: according to design plan system consists of a 1500 gallon septic tank , d-box, and 2 500 gallon leaching chambers in a 25x12.2 ft area. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 16- 112 17-68 gpd. System is not designed for use with a garbage disposal I was not able to enter the house but I am asuming that laundry goes into the septic and there is not a disposal. Sump pump? ❑ Yes ❑ No Last date of occupancy: seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system. ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: fall of 2017 by Debarros Septic Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 20004 per permit Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon per as-built Sludge depth: very light L15ins3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness trace 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 were dimensions determined? 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 was pumped in the fall of 2017 so no pumping is needed at this time. It is recommended that the tank should be pumped every 2-3 yrs depending on usage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sylvia Lane Property Address Dominic Slowey Owner Owners Name information is required for Centerville MA 02632 12-26-17 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box was functioning properly at time of inspection. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): Chambers were empty at time of inspection with no signs of 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 ❑ No L15in. 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I � Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System,Form-Not for Voluntary Assessments M 36 Sylvia Lane Property Address P Y Dominic SI0 we Y Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts uTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Cityrrown 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: none encountered at time of perc test/ 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: 12-2017 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: design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments b 36 Sylvia Lane Property Address Dominic Slowey Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ,1 :TOWN OF BARNSTABLE LOCATION 1 f5rf.yio SEWAGE# V,f - VILLAGE C-?r-'it*✓,4t1+e ASSESSOR'S MAP&LOT` ?'2� INSTALLER'S NAME&PHONE NO. Pli"rdi-Ir' fir' 'q-?00 SEPTIC TANK CAPAC=.- — a LEACHING FACILITY: (type) �� .s��G�.� (size) a Ir X I. - NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: f/-,,2-3 COMPLIANCE DATE: O 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 i 4 ,� I f :TOWN OF BARNSTABLE LOCATION _:f y400 LA' SEWAGE # CY " C' 6 VILLAGE 04-T'*-1-4��°a ASSESSOR'S MAP&LOT/J?-; INSTALLER'S NAME&PHONE NO. ?441.� e Y�'q 30e SEPTIC TANK CAPACITY �'� % LEACHING FACILITY: (type);� -foe 6,0&0- (size) 5' X NO.OF BEDROOMS .3 BUILDER OR OWNER l3l PERMTTDATE: //—,Z 3 sop 5/ COMPLIANCE DATE: O 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 Ja � y � I ,,'SOWN OF BARNSTABLE LC;CA`Ii6t A' &L VJ O '-A-- SEWAGE # 0Y VILLAGE G a w��.� C e ASSESSOR'S MAP &LOT9' � INSTALLER'S NAME&PHONE NO. 0 g300 SEPTIC TANK CAPACITY `f00 � LEACHING FACILITY: (type) �1►�6' 6,Aei0 (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: LO�Z3LOY_ 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 L ,,4 3 � q 63 6 -3 9 11 01 �. TOWN OF BARNSTABLE LOCATION c f r1 A �� SEWAGE # VILLAGE C e�l P.-, ASSESSOR'S MAP& LOT/ f—," L 1 INSTALLER'S NAME&PHONE NO.)PXJT0.�e 44- 4/,2�'' 91017 SEPTIC TANK CAPACITY /J�0O "i LEACHING FACILITY: (type) &OZI U'S (size)Artr�6A � NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE:— Separation Distance.Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a _ 3j 30, j ,6 4 44 No. �5D FEE ®O COMMONWEALTH OF MASSACHMTTS' Board of Health, MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT r Application for a Permit to Construct( ,) Repai",,Z-Upgrade(, Abandon( - 'J Complete System ❑Individual Components Location Owner's Name Map/Parcel# Address Lot# Telephone# Installer's Name Designer's Name C Address T`U` , �� GZ��yAddress s d k2A Telephone# Telephone# qq � Type of Building C1 cJn Ito,,1 i � � ,9 I � Lot Size Z -- sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building ^j No.of persons Showers ( ),Cafeteria ( ) Other Fixtures AJ-1 0---- Design Flow (min.required) 3 77-d gpd Calculated design flow `Y �>Q Design flow provided 1>1> gpd Plan: Date Number of sheets rL Revision Date Title i Description of Soil(s) O-'1 0 A��y :��1 6 � Soil Evaluator Form No. Name of Soil Evaluator rZrtQDate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree not to c e sys in operation until a Certificate of Coomnpliance has been issued by the Board of Health. i Si ed Date 0!1 Inspections No. C900 ^ \ �Y' - FEE Board of Health, r n MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT *. Application for a Permit to Construct( ) RepairV-Upgrade(X Abandon( ) - Complete System ❑Individual Components [Address ation �N�,,�t Owner's Name p/,Parcel# ��C Address CJ r / # Telephone# taller's Name A �fG T�C Designer's Name 1 .i-R✓ C ` r*".M e GUQl'' Address �'z we CV0 S Telephone# ,`5 'Z _ 00 Telephone# Type of Building C1 16 t C'N 5 K 0"c1 1^ t �! Lot Size Z a sq.ft. Dwelling-No.of Bedrooms 3 Garbage grinder ( ) Other-Type of Building /\J 14. No.,of persons Showers ( ).,Cafeteria ( ) Other Fixtures !j j A- y Design Flow (min.required) 5?r2�7 CJ gpd Calculated design flow Q Design flow provided gpd Plan: Date j I Number of sheets 2- Revision Date I Title }ie S.iSkt�M ac i✓ � ( � rnfc.[�lQ ��o St� �ViG� wQ (vXk V-,/ekV�r�� Description of Soil(s) Q::Al " A , S—e it-y'2l_;,�t L L)Z. -ZtiC4 M-CG� Gtt1d Soil Evaluator Form No. Name of Soil Evaluator a�M L&_V Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5..and further agree ,to not to a sm in operation until a Certificate of Compliance has been issued by the Board of Health. Si ed Date Inspections '` r ' No.cJzlJ� FEE �/ O Board of Health, �dY-n 3 FY.. VLI�, , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired Upgraded (9,Abandoned ( ) by: S at Sv wr �✓tc �� has been installed in accordance with the revisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. U�7 - 6, dated II �3 �� Ap roved Design Flow (gpd) Installer // / Designer: Inspector ,: Date: i/ iJ �'7 'The of-tltis per-mit shall-not be-eonstrued as a. arantee that the s stem will function as designed. No. V c� FEE /00 COMMONWEALTH OF MASSAC14USETTS Board of Health, t - DISPOSAL SYSTEM*CONSTRUCTION PERMIT x 1 Permission is hereby granted to; Construct( ) Repair( Upgradq'( ��- Abandon an individual sewage disposal system at --�) (��A C,QMJJI�' as described in,the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the da c-Vf tfi`i's'p r�:t APl ocal conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date I� / `1 Board of Heal' ---� 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated i concerning the property located at 3(, S y J V i c. (Lyr GvK k,�V i i meets all of the ---- I f following criteria: This failed system is connected to a residential dwelling only. There aree no commercial-w -- business uses associated with the.dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep / test holes and percolation tests at the site without a health agent present. v® There is no increase in flow and/or change in use proposed There are no variances requested or needed. The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using.the 1~rimptor method when applicable] Please complete the following: V0 UJ ✓�- A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +adjustment for high G.W.- DIFFERENCE BETWEEN A and B SIGNED: DATE: �— NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. q:\Se0c*a =mW.doc is Town of Barnstable Regulatory Services Thomas F.Geiler,Director anuvsra C MAW Public Health Division 39. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 12I Sewage Permit# 014 Assessor's Map\Parcel $ - J Designer: v.lt.zf:11 tA► Installer: U Address: \2- uJ , Gri s s Q,-t� Address: 0. \?Q Y. Z 7 fu-T- "l On was issued a permit to install a (date) (installer) septic system at CA LCA nq_ based on a design drawn by (address) 5► re!ten W e 5 dated P I IS�� d y y (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. H OF M4S S7cy PETER T. G (Installer's Signature) o McENTEE Civic y 9 No.351090 Q �Q/STEAD Fss (Designer's Signature) (Affix Desi s u p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. 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 3-26-04.doc r �a LEGEND z GrLot M c° °ash R a �--- 99 PROPOSED CONTOUR 99 PROPOSED SPOT GRADE �� o EXISTING CONTOUR a o�P�s' BENCHMARK: 5/T 5ET 110 EXISTING SPOT GRADE ELEV. = 100.00 (A55UMED) TEST PIT100, Ga 574°2 '40"E BENCHMARK x-90, 0 k I f W------------- EXISTING WATER SERVICE Route 28 LOCUS — EXI5TING CE55FOOL5 $.A:S., (TO BE PUMPED, FILLED W/ sywia L� CO i" SAND, AND ABANDONED) W9 28' `� �? , . LOCUS MAP N.T.S. wt 91 GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL r i y gER10C BOARD OF HEALTH AND THE DESIGN ENGINEER.-21 � 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS K �'- -- — TANK OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE Cmm , I JCY\ ( _ `� N LOCAL RULES AND REGULATIONS. 2 GAGE I PATIO 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR _ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE D 5EWM OUTLET I SEWER OUTLET 2 — �Y� DESIGN ENGINEER. Q x INV.-98h INV.-98.0 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING EX15TING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN O 3 BEDROOM ENGINEER BEFORE CONSTRUCTION CONTINUES. HOU5E (No. 36) 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. BfT, T.O.F. = 101 ,39 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF GONG, THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF UDRIVE HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. LU 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. •...i ¢ 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. �+-•• Z I U' e PN _ 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED < /'1 1V 89 �7 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. R =23.01'14.09' 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE L = (LOT I ) 1 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING Z 12s7 1 O+SF CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. i AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). N7205_6'20'W t I gPETER T. MCENTEE CIVIL SEPTIC SYSTEM REPAIR UPGRADE N0. 35109 5YLVIA LANE ��G/SZF.-``� QEForestdole, 36 SYLVIA LANE, CENTERVILLE, MA SIUNA E� red for: Cecelia Lynch, 36 Sylvia Lane, Centerville, MA y: Surveying by: SCALE DRAWN JOB. NO. g Works HOOD SURVEY GROUP 1"=2o' P.T.M. 100'-04 ssfield Road 18 Route 6A A 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. 313 (508) 888-1090 11/15/04 P.T.M. 1 of 2 J I� NOTE: TO PREVENT BREAKOUT, THE PROPOSED TOP OF FOUNDATION F.G. EL: 99.8t FINISH GRADE SHALL NOT BE < EL:96.5 TOF = 101.39 -� FOR A DISTANCE OF 15' AROUND THE EXISTING F.G.EL: 99.3t F.G. EL: 99.5t PERIMETER OF THE S.A.S. MAINTAIN 2% MIN SLOPE OVER S.A.S. 36" MAX. COVER INSTALL RISER OVER D-BOX TO 2-500 GALLON LEACHING CHAMBERS IN SERIES INSTALL RISER OVER CHAMBER/S INSTALL RISERS OVER INLET & OUTLET WITHIN 6" OF FINISH GRADE SHOWN ON PLAN AND SET COVER/S L1 =15' TO WITHIN 6" OF FINISH GRADE SURROUNDED WITH STONE - ALL SIDES WITHIN 6" OF FINISH GRADE L2 =13 OUTLET PIPES SHALL BE SET LEVEL OVER L =13'(MAx) 4" SCH 40 PVC - ••.•..• .; . L 76' FIRST 2 FEET 4" SCH 40 PVC 4" SCH 40 PVC 2" LAYER OF 1/8" TO 1/2" 0 S= 2% (MIN.) ,D' a ®a ®a DOUBLE WASHED STONE Q; T4" ® S= 1% (MIN.) 0 S= 1% (MIN.) �®a®®ea PROPOSED 2' EFF. DEPTH aB®®a9B :0 3/4"-1 1/2" �. INV.EL: 97.25 1500 GALLON INV. ELEV.=96.30 SEPTIC TANK D-BOX INV. ELEV.=96.13 3.5' 5.2' 3.5' DOUBLE WASHED INV.EL: 97.Ob W/ RISER EFFECTIVE WIDTH = 12.2' STONE (EXISTING) PROVIDE COUPLING INSTALL INLET & OUTLET TEES INV. ELEV.=96.00 INV(outlet 1): 98.8t GAS BAFFLE TO BE INSTALLED ON INV(outlet 2): 98.0f OUTLET TEE AS MANUFACTURED BY TOP CONC. ELEV.=96.8 ----BREAKOUT ELEV.=96.5 TUF-TITS, ZABEL, OR EQUAL INV. ELEV.=96.00NJ ®e®® emsam SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=94.00 4' 2 x 8.5' = 17' �4' GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF L EFFECTIVE LENGTH = 25' _ T.P. EXCAVATION OR G.W. (3) 5" DIA.OUTLETS SEPTIC SYSTEM PROFILE BOTTOM OF TP , EL.=88.6 LEACHING SYSTEM SECTION N.T.S. i o PETER T. 0 �- DESIGN CRITERIA 6 McENTEE 10'-6" SOIL LOG NUMBER OF BEDROOMS: 3 BEDROOMS v NoC1VIL 35109 N 2 N.T.S.DATE: NOVEMBER 10, 2004 SOIL TYPE: CLASS i D—BOX 3 - 20" Dia. Covers DESIGN PERCOLATION RATE. 2 MIN./IN. N.T.S. 1C SOIL EVALUATOR: PETER MCENTEE C.S.E. /�� DAILY FLOW: 330 G.P.D. INSPECTOR: NOT REQUIRED f 5'-8" I ( ) I CLASS 1 SOILS DESIGN FLOW: 330 G.P.D. / GARBAGE GRINDER: NO Elev, TP Depth LEACHING AREA REQUIRED: (330) = 445.9 S.F. 9I A SANDY LOAM 0 11 .74 ®®®®® ®®®® Top View 99 2 10YR 3/3 4„ SEPTIC TANK PROVIDED: 1000 GALLON (EXISTING) ®®®®®®®®®®® 33" B INVERT, ®®®®®®®®®®® SANDY LOAM 24' E3 EaE3®®®®®® 4" Dia. Inlets 4" 10YR 5/8 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 102" 0 96.1 C 42" SIDEWALL AREA: 2(12.2' + 25.0') X 2 = 148.8 S.F. BOTTOM AREA: 12.2' x 25.0' = 305.0 S.F. 4"KNOCKOUT TOTAL AREA: 453.8 S.F. 20" DIA. COVER 5'-8" 4'-7' 48" Liquid Level 4" KNOCKOUT z 4" KNOCKOUT 62" MEDIUM SAND DESIGN FLOW PROVIDED: 0.74(453.8) = 335.8 G.P.D. O 4„ 3„ T 2.5Y 6/4 i 4" KNOCKOUT SEPTIC SYSTEM REPAIR UPGRADE Section 36 SYLVIA LANE, CENTERVILLE, MA 500 GALLON CAPACITY, H-10 LOADING 1500 GALLON CAPACITY, H-10 LOADING 88.6 132" Prepared for: Cecelia Lynch, 36 Sylvia Lane, Centerville, MA CHAMBERS SEPTIC TANK NO G.W. ENCOUNTERED Engineering by: Surveying by: SCALE DRAWN JOB. NO. N.LS N.T.S PERC RATE: <2 MIN/IN. ("C" HORIZON) EngineeringWorks HOOD SURVEY GROUP N.T.S. P.T.M. 1 0-04 12 West Crossfield Rood 18 Route 6A Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. (508) 477-5313 (508) 888-1090 1 1/15/04 P.T.M. 2 of 2 �r