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HomeMy WebLinkAbout0026 VICTORIA STREET - Health -W 26 Victoria Street ` Centerville P A 148 062 No. 4210 1/3 ORA Pendaflexe 10% i v p A030 30 SGN3 ANb'1 OIld3S ' „Z/l l ONVH2J3n0 N030 3anSN3 Ol N30 H1IM do 3NI-1 I SIHl 30 831N30 09,0Z 09'8l 0.68 0'96 „8Z SZ'Z17l .11 „9l L'Cl 3SnOH 30 dove r 37.0 13.75 28" 7 96.0 89.0^ 94.7 40.2 18.50 20.50 CENTER OF THIS JOIST MUST LINE UP WITH CENTER OF DECK TO ENSURE DECKING BOARDS 0 SEPTIC TANK - OVERHANG 1 1/2" OFF BOTH ENDS OF DECK 20'-4 1/2" l 57.0 TO END OF HOUSE 31'-9" JOIST AND BEAM LAYOUT No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for �Btzponl 6potem Con.otrurtton VCrmtt Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. Z(C i( C I a 4 i A s'z S'e-cT Owner's Name,Address,and Tel.No. av"u> v (Lc'co,r�P Ce✓�T-GC�1)E. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CA-PiE�,J,J_k_ tThke'r65e-C P•C,- 3e7,ac -7 3 /Z wt5-r Dale. Type of Building: _ t Dwelling No.of Bedrooms —..> Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `3 3 0 gpd Design flow provided -3 gpd Plan Date Number of sheets 2. Revision Date Title 2 b V i C.j-Uou A Size of Septic Tank WOO Exsl l 6 Type of S.A.S. C�:0,"y Description of Soil 4 plgat 1%,c-// w 30`e r��Z+ Nature of Repairs or Alterations(Answer when applicable -rb /UA-,v �1 (5 i9 fC a �7�m.'el�e�3 •Z��,�,°k rI, Date last inspected: 2_6c% 7 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. SignedN"LIcDate D® Application Approved by Date Application Disapproved by: Date for the following reasons d .o Permit No. "v 9— 030 Date Issued ——————— ————— ———————————————— —————— � �� I �o0 03o ` No. . 6 i Fee THE COMMON WEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Ytcattott for Mt000zal 6- racm Cou0truction Permit _ Application for a Permit to Construct( ) Repair(\ Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. 2(p S;i c c eT Owner's Name,Address,and Tel.No. 61 u✓ Or Rec o rd Assessor's Map/Parcel '0 io Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel No. C�rek r �f W,V2VtS G�aPec.l�J­e &•Ifc��r yes P•o 13V c -7(a3 /Z We5r` tr�ss�.il� /4)wd i�i-.i,vase �.tr p, k\` r 57%7 ti y L$ 4 o v L/7 7" 95 /3 Type of Building: G Dwelling No.of Bedrooms Lot Size �� 6 , sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 b gpd Design flow provided 3�3. 3 gpd F . Plan Date I'2 5% ZO of Number of sheets —2.. Revision Date Title 76 ViL6w,oA Size of Septic Tank C_1000 Cx5 5t anti_ Type of S.A.S. 4110,u5 Description of Soil !Sep— o1A,4 "C" e(} 3o,' rr-L Nature of Repairs or Alterations(Answer when applicable) Tb rttA l W-0 0 1C Date last inspected: 7.0o-7 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date a' "' �' G 00 Application Approved-by - �j - Date'"•/ Application Disapproved by: Date for the following reasons 1 .� Permit No. 900 9 0 30 Date Issued 1 ^ ° ——————— ———————-—— ———————————"= -- THE COMMONWEALTH OF MASSACHUSETTS ~ BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (� Upgraded ( ) Abandoned( )by �14,0 W,It 1,; � ,! t S L L L at Zlo Uil. e,R.14 -C --fl�e l—� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. O 0 g — 30 dated ` 1g a Installer 4n4. --,1LJU 0K4e 0,-$e5 Designer 6-�►`uta 1 Lr, l,Jo2k•,s If #bedrooms 3 Approved design ow [ gpd The issuance of this permit shall nJt be ons e&as a guarantee that the system w' 1 JI/W/ s design e . Date ( Inspector /f/� _- �i ,� f m d cl ems. t No. 00g ' 03 u-� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1=t$po$a16potem Co .5tructtou Permit Permission is hereby granted to Construct ( ) Repair ( U grade ( ) Abandon GtOt ( ) System located at. 2(0 J1 Ay\ S�'d PST CnAA vial... and as described in the above Application for Disposal System Construction Permit.The applicant cfco` iz s his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date z `O Approved by L" '1 I 02/07/2008 23:00 5084775313 i ENGINEERCNG WORKS _ PAGE 01 own of j jRe 9u4t, rvices t Thomas� mAs F,1Pubhe �►�i�er, ' < 1��tor F t ; 'Y'bama$11lEesltt,lDir ter Mau Str � / �Hyphn{�MA U2601 ; Fax; 508-79..0 ,. � r e ' DaUl ILIA , ew> a Form* �di—t 301 A►s ':g M +�T A1 �t sor ir'ar r �� 2 4*er n � Add r1eil E; wt3s issued a petmit to iastail a s j (instakl@r i (address) seed on a desip,dmvm by G'" er} -- - _ •alat the aepfsa syr§tem refer ' ahicl :met Ln Bncod Above was .installed aul�atetttialty: I elude r approved ch es sue t0 br�x uidJar septic'tank � has latexat t loea On theil the septic'8ystcira re reread above was ilzstalled with pr �t In 1� feral tglocation the SAS ar auy vaegtaal r�elaeataon.of beat in acco. cc with Star$& L�,cal ate ati a �►iult by desigsier to follow. ,it. Qns. Ply rsei on or -PETS s - i T. fVTEF i ! " CIVIL. (AI x Designer S tamp Ire)— PILL Agatiaw 1 I Q.HrltlsiSgptiq Ccrtftice�Qn Aorrti 3.26-04.doc s i ' i x Town of Barnstable P# to / Departinent of Regulatory Services Public Health Division Date 1 G � MAM 039.��� 200 Main Street,Hyannis MA 02601 0�p Mla Date Scheduled 1 33 011; - UD Time ��� Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: �� �� Witnessed By: IJo�,4t A LOCATION& GENERAL INFORMATION Location Address Z(�P V j.G+0,zfV1 Owner's Name C 0 C LOr-%t 33 Address Assessor's Mapmarcel: j �/o�2 Engineer's Name 6aL.yU,-j ij/�u`�G`j NEW CONSTRUCTION REPAIR `' Telephone# SoE Div i o 2,8 Land Use 1 c-e '%Slopes �Z'^� P ( ) Surface Stones!�_ Distances from: Open Water Body U0 ft Possible Wet Area� ft Drinking Water Well I SU ft Drainage Way '7 Z-" ft Property Line, U ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I w �� ti,- y p - Hawk 2� U ►C.i� a2�,�-- ST►2� Parent material(geologic) CA +�'0.1 Depth to Bedrock "` Depth to Groundwater. Standing Water in Hole: /" Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: ___— in. Depth to Soil mottlgs: Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well levcl - -, Adj.fhetor, a� Adj.Groundwater Level,.,e PERCOLATION TEST Date, Thne,� Observation 2 i Hole# tltl Time at 9" Depth of Perc U 00 g Time at 6" Start Pre-soak Time @ t( i (P — Time(9"-691) 2�1 �GI cn2s End Pre-soak 1►.• 2"`�( Rate MinJlnch LPL V Site Suitability Assessment: Site Passed V111 Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conseirvation Division at least one(1)week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# ._ Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) - -- (USDA) (Munsell) Mottling (Structure,Stones;Boulders. ConsistcnM%Gravel) -Z;7 A 30 (CCj 0 `t ►�� DEEP OBSERVATION HOLE LOG Hole# Z- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% S/ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cosistency.%Gravel) f •• DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, t Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes ___ Within 500 year boundary No Yes Within 100 year flood boundary No�,, Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? - y e5 If not,what is the depth of naturally occurring pervious material? Certification `1 otS I certify that on _ (date)I have passed the soil evaluator examination approved'by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature , _ Date Q:\SEPTIC�PERCFORM.DOC <sl COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTIQN! copy m w 9 tl C 0W DEC 2 2003 p^M SJev TMN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP r �� Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 PARCEL Owner's Name: MULLIGAN LOT Owner's Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 `-- - Date of Inspection: 11/15/03 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 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: X Passes It _ Conditionall P sses _ Needs Furt r valuation by the Local Approving Authority Fails Inspector's Signature: Date: 11/15/03 The system inspector shall submit rn py of this inspection report to the Approving Authority(.Board of Health or DEP)within 30 days of completing this inspect 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. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****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. Titles. 5 TncnPctinn Fnrm 6/1 5/?nOn 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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 PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, — p P Y , 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. n/a 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: n/a n/a 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: n/a n/a 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: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 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 n/a "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: n/a 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: 1 Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow X Required pumping more than 4 times in the last year NOT to clogged or Y gg obstructed pipe(s) .Number of times pumped._ . TF.M WASP iMPF.D i.AST Si1MMRR PFR n�xJNFA. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X L Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone It 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. d Page 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS, located on site? X _ 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 ? X _ 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 X _ Existing information. For example, a plan at the Board of Health. X _ 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)] 5 I Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 2 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): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)):,U1j, 6 2- 0 3i Sump pump(yes or no): NO �',' Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no):NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: SYSTEM WAS PUMPED LAST SUMMER PER OWNER Was system pumped as part of the inspection(yes or no): NO If yes, volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X 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): n/a Approximate age of all components, date installed(if known)and source of information: 1983 PER OWNER,NEW PIT IN 1994 Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10`1 Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 1" 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: 17" 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.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 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: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 2 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF FAILURE. DID NOT EXPOSE OLD PIT. NEW PIT HAD 4' OF LIQUID IN IT AT TIME OF INSPECTION. BOTTOM IS AT 10'6". ESTIMATE 2' OF STONE CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 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. Inr A 107 , o C D a 6C �� . in Page 1 I of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 VICTORIA STREET CENTERVILLE,MA 02632 M148 P062 Owner: MULLIGAN Date of Inspection: 11/15/03 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. it RfC�f� BORTOLOTTI CONSTRUCTION,INC. . 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508428-8926 FAX: 508428-9399 s' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: Date of Inspection: — — Inspector's ame: f ,, 16 D�- er's Name and Address: S s t O CERTIFICATION STATEMENT. I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection.The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal/stems. The System: Passes Conditionally Passes Needs Further E luation By the Local Aproving Authority Fails Inspector's Signature: Date: % The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION iMMARV• A)SYSTF,M PASSES: _V I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair,passes inspection. Indicate yes, nor,or not determined(Y,N,OR ND).Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): -1 - 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced m required pumping more than four times a year due to broken or obstructed pipe(s). The System p g Y eq P The system will pass inspection if with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HE ALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if r tect the public health safe and the environment. o ,failing to t3'i fai e syst em s the P sy g P 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year hm due to clogged or obstructed pipe(s). Number of times pumped -2- i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 Feet of a•private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: The system is within 400 Feet of a surface drinking water supply The system is within 200 Feet of a tributary to a surface drinking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: f Pumping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As-built plans have been obtained and examined. Note if they are not available with N/A. /'The facility or dwelling was inspected for signs of sewage back-up. The.system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System,have been located on site. _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- - 1 SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) , The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL:, Design Flow: P allons Number of Bedrooms: Number of Current Residents: Garbage Grinder: U Laundry Connected To System: y&s Seasonal Use: Water Meter Readings, if available: Last Date of Occupancy:_ le&7— COMMERCLALANDL1STRIAL:/V 0 Type of Establishment: Design Flow: gallonstday Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GE NERAL INFORMATION PUMPING RECORDS and source'of informa ion:A �JJF'V �- � A� System Pumped as part of inspection:./6 If yes,volume pumped: gallons Reason for pumping: TYPE SYSTEM: ✓Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records,if any) Other(explain): AFFROXIMA E AGE of all com ents date installed(if known)and our a of information: Sewage odors detect d when arriving at the si e: -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK:_ Depth below grader Material of Construction: ✓concrete metal FRP Other (explain) Dimisions: �,s',Y(2!X 5­1 Sludge Depth: ,��� Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: 36'� Distance from bottom of scum to bottom of outlet tee or baffle: /L Comments:(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid l level in relation to outlet invert,structural integrity,evidence of leakage,etc.) 2 /Ooo �iCl7� e CGJ� cS -77�r� i ►� C�OUtl� e eA vt I�' .►L P �� Q/I GREASE TRAP: Depth Below Grade: Material of Construction:—concrete metal_FRP_Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or bale: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:—concrete—metal FRP_Other(explain) Dimensions: Capacity: gallons Design Flow: �allons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: I Depth of liquid level above outlet invert: -f /�oe/ Comments: (note if evel and distribution is,,Cwl,evidence of solids carryover,evidence of le0kagei to or ut of box,etc. 104 / 10 C r ?. PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -5- l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches,number, length: Leaching fields,number,dimensions: Overflow cesspool,number: Comments: (note condition of soil, si s of hydraulic failure level of nding,con*on'on of vegetation, f et gel - CESSPOOLS: 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(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials o construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6- r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references,landmarks or benchmarks. Locate all wells within 100 Feet. 0 0 , DEPTH TO GROUNDWATER:, Depth to groundwater: 1,6 Feet Method of Determination or Ap roximation: -7- TOWN OF BARNSTABLE LO( ATION J(„ V�e forl e- -SF SEWAGE# ©�"030 VILLAGE ASSESSOR'S MAP&PARCEL `.- INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY loco LEACHING FACILITY.(type) (24) ( ,_��� (size) /2 X Z (B NO.OF BEDROOMS 3 OWNER Ma4,k �, vnQ el PERMIT DATE: 1 Z9— Z00% COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY eApeidr(.� �1�1���4✓��@S �(..� V { ftq �5•� 61 sco .v t�a�r TOWN OF BARNSTABLE SEWAGE# VILLAGE aa,41-cl,,`I ASSES 'S MAP& OT AtPERMERYNAME&PHONE N6,�ri O/�0 7 77 SEPTIC TANK CAPACITY f000 C; I/&P.0V`i r T LEACHING FACILITY: (type)�8:o2 -A f�i r�. C//J (size) /600 NO.OF BEDROOMS BUILDER PERMTTDATE: 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 III Edge of Wetland.and Leaching Facility any wetlands exist within 300 fe of le hing facili Feet Furnished by 0 /0 q/, III - TOWN OF BA STABLE~ ' �. 'S a LO�..ATION r �'. SEWAGE # VILLAGEkQVN',4 �' _ ASSESS R'S MAP & LOT/qf-- L)� INSTALLER'S NAME & PHONE N SEPTIC TANK CAPACITY ' LEACHING FACILITY:(type) h Vol (size) 4. NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 1°11J6 BUILDER OR OWNER fW4 4E 0 e— C-e-4�a—Vre— DATE PERMIT ISSUED: ` DATE COMPLIANCE ISSUED: t t VARIANCE GRANTED: Yes No r 37 ' ` �9 96 AW a " a� 0 �tx� ® F�s.� ....�.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinii for Divj-Vn!3tt1 Wnrk,6 Cnnntrur#inn Permit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ............:! ............. ....c�� ---- --- , Locatiom�\ddress "' � or Lo`No t�J..........................................................� .... -----•...... d�­-- ........................................ flICner � Ad"Al Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ---------------------------- No. of persons_-----.-..-_-_-._--.------. Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------------------------------------------------- ----------- WDesign Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length------------------ Width....-..--.------ Diameter.--------.-.-.-- Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..._..--_--_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- ----------------------------------------------------------------- Date........................................ �---1 .� Test Pit No. l........:.......minutes per inch Depth of Test Pit.................--- Depth to ground water...---------.------..... fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................--.. ----------------------------------------------------------- •---------------------------------------- -------------- •---.---------------------------- ---------- O Description of Soil.......... .t,y,' . --------------------------------------------------------------------------------------------------------------------------- (xj --- • --------•-- ------------------------------------------•--•---- ------------------•-----------------•----•----•----------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- U Nature of Repairs or Alterations—Answer when applicable.-------..: ,,_ .i- -----------------�-Q o......._. e --------•---------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------......--------- 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 CompliaCC as been issued by the board of health. Signedh -` gip` :.......... .�1 -�-- Dare Application Approved By ........... ` :tti�.,..-=�-�... ....................................:.................................... ---- DateI..'..p'1 Application Disapproved for the following reasons: ... . ........................................................................... .. ... . ...................................... -------t:.l... .----------�' Permit No. .............�!..:--.... .. �j----------------- Issued l...t............... Dare - arm._ •. p' T w , No.�/�- �CZY` FEB.�Q.:.�©...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apli iratiutt for Di-nVuuttl Work Tamitrurfiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair k_')"an Individual Sewage Disposal System a t: ------------� . r Locatiot - lddress 1 or Lot No. �net Ad -------- ------------------ Installer Address UType of Building Size Lot............................Sq. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------• No. of persons------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------•------------...------------------------. -----•-------•-•-••-••••••••-••-•--••-----......•...---••-... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacitv------------gallons Length---------------- Width---------------- Diameter................ Depth................ W Disposal Trench—No. .................... Width.................... Total Length_------------------ Total leaching area....................sq. ft. x Seepage Pit No:.-_-_--.--_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) �-' Percolation Test Results Performed by........................................................................... Date........................................ 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........................ ............................•----......---•--....._......---•-•--...--•----•-•--•---....---.._...............-----------------------...........----•-----•--- 0 Description of Soil............ -- _N ---------------------------•-------------------------------.---•----------------•------------------------------------------ U .................................................... - . --•-- •--------- ----------------------------•-•--------•--------....-----------.....---------------------------••-----•-•••- W --•--•-•--••-------------- ----------------------------------------------------- ------------------------------------------------------------------- ---------------• 1, U Nature of Repairs or Alterations—Answer when applicable._-.-._--.::_ ,._ �--- -----------------(..Q0.0........... . ---- ------------•----------------------_---------------------.----•--------- 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 of issued by the board of health.system In operation until a Certificate Signed p la�e as een� �\ � C�` v``-�... - t�lJ�x(� ` M 1 1 Date 1( Application Approved B p `� .�..:�...:.=.,. .. - �1 .. PP PP Y --------- -----------------*----........ ..-� .. Application Disapproved for the following reasons- -------------------------------------------_---------------------......--------------------------- a.... --- .......1.I .. ...-. Permit No. Date �- -��. - r..�.._`��.� I Issued - -- -.�..... 2........... ... .. Date ----------------------------------------------------- �,`..-.—.._,----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifirate of CIIIIiptiance TIQ IS TO E\ZTIFY, That tke ndividual Swage Disposal ypZm constructed ( ) or Repaired (L._< -------------------------------------------------------------- at ------------------ .��.._.....Q-----�---- - -p r � - --._- 1 --------------------�:..,P. .. .Y..�1..i...1.... .. .. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..._..-� f...-.... _ dated .------------------------.............. _-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL FUN ,SON SATISFACTORY. 1 L ------------- DATE Ins ect -, .. --- G ...- .. .._..._... ...--------- P :w y ----------- 4------------ _-_ ----------------------- -------� " THE COMMONWEALTH OF MASSACHUSETTS lfJ BOARD OF HEALTH 'G� f TOWN OF BARNSTABLE (�Ct C� No.-•--.\................. FEE. ............................... uiuvu� �v5� Tun `trurinPrumi# a � ,t s- Permission is hereby granted-------- -- -------- � --...•.--. . ......-. --------------------------------••-----......_.... to Construct ( ) or Repair an Individual Sewa e isposal System i, . at No..-----•..cg_ .........-_ ------.... ` ......-•--.. _-•--.• ------------------- ----------- .......-----....-------------•--•••--......-•-'-- Street q r,. �,.• � hh as shown on the application for Disposal Works Construction Permit No.-/-1/n l�.y� �. Dated...�_�._c�C_"��_ ............... 9 ---------------------••••--•......-- �--•---•-•-----------------------•--------•------ / ,� [ � �Bo�of Health DATE ..-•----......•�-•-•-----...-•--------------------•-•-- FORM 36508 HOBBS♦!t WARREN,INC.,PUBLISHERS i C !kgION � SEWAGE PERMIT NO. Lr, 33 Victoria St. 83-317 VILLAGE M Centerville , I N S T A LLER'S NAME & ADDRESS Q Robert B. Our Co. . Inc. Gteat Westg Rd North Harwich. Mass. d U i l D E R OR OWNER Lewis Gordon DATE PERMIT ISSUED l DATE COMPLIANCE ISSUED �3 � � r Cl CA C 0 LPL a A 3T I � ` Sol A - A - �f2 ' J3 _3 1 Jo..Aa� 3/7. Fms.............................. THE COMMONWEALTH OF MASSACHUSETTS �• BOAR® OF HEALTH ��....----....OF......... �} ./4�. ............................ ApplirFa#ilin for Uispoii al Works Tumtrnrtinn Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: / \ ......... •. ......-7��@/ ---......~ .A....-----•-•----•-•---• -•-•-•...._•--•-•-•--••-•.....--••- ®--�----•-��-•--------•-•-•--.....--•--•---.•. _ oca' Address or Lot No. U2 - ... ........ ...... .. .. ..................................... .................................... .............................. O r _ Address a ..................YZ?............... ........... ....................................... ........••-•.......•---••----••-••------•-•-•--••......••-•-•-•••-•..........................._... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--_----.--__...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow................. .................gallons per person per day. Total dailyy flo ......... �� .....................gallons. WSeptic Tank—Liquid capacity`90�?.gallons Length----- ....... Width....... (...... Diameter________________ Depth.....4....... x Disposal Trench—No-------------------- Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.......l........... Diameter...... Qst Depth below inlet.... a...`........ Total leaching area6-z/-�•..sq �'� Z Other Distribution box Dosing tank ( ) '-' Percolation Test Results Performed by........ .vl... ._._..k1. _:Z .9 ...�/� Date.... b .......... - 7. Test Pit No. 1._C ?-_.minutes per inch Depth of Test Pit..f.lf..^�__. ..__.. Depth to ground water�® Z� . �� fx, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil-----------------. -------- -•----•--•--•-----...------------------------ --------•---.---------.--•-•----.------ x U ••••................••-----•-•----------•-•••-••-•---•--••••-•••----•-----•-•-------•--•••-----•--••••••--•-•---------•••-••-•-••-•----•----------•--•-----•-----------•---...---•--•-••--•...----....._ W -------••-------------•----------•••--------------------------------------------------••----•-•----------- ...... 0 Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------- --------------------•-••....-•-...---......•-•••••••••••-•••----...••-•••-••-.-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. gned .-•••---•---------••-•-•..............•-••----•-•--•...-••---••---•............... .....--•••. ......... Application Approved B�or �t?e -•--- .-•-- -••••••----•---••-•--•-.....•---•---•-•--------•--.....--•-•--••--•• S �� Date Application Disapproved following reasons---------------------------------------------------------------------------------------------------------------- .........................•-•------•---------•------------------------•-•-------------------•------........--•-----....---------------------------------------------------------------------------------•- Date emit No......................................................... Issued....................................................... 1 g (/ Date WO.. .I-• -•�/.�.. ................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......." D d` .--.....OF....... -� - �.............................. App iratiou for Disposal Works Tonstru.rtion Frrmit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: /C ................. ..._...?"R _ •••_._... -----•-••--•---------- --------------•-----------•�"-- 7",------"��--------------_--__-.---•-........ /'may oca n-Address or Lot No. a .......................................... 7�" Address �--- --------•• .. ............................•-..._..._ .....-•---•--•-•••-...__._......_...--••-•-•-----••-••---........_..-•-----.....••••--•••.....--•- Installer Address Type of Building Size Lot____________________________Sq. feet Dwelling—No. of Bedrooms..................'.__.___.___.______._..__Expansion Attic ( ) Garbage Grinder ( ) .a'.I Other—Type of Building No. of ersons____________________________ Showers — YP g ------- P ( ) Cafeteria, ( ) Otherfixtures .................. -------------------------------------------• •••--•-••-_..._ _-----• - W Design Flow_________________ t'�____ _gallons per person per day Total dall flow.___._._ d __.__gallons . .__ Diameter_____::___:__:_ Depth # W Septic Tank—Liquid capacit}�a0�.gallons Length.__�_�.___ Width... !_._ p �...... x Disposal Trench—No_____________________ Width.................... Total Length__________ Total leaching area....................sq.-ft. Seepage _._���S_'__-Depth below inlet____fae _:.____ Total leaching area; /.._See e Pit No.______1_.._.______ Diameter + __sq,4,t.t-o,,p Z Other Distribution box ( •. Dosing tank ( ) Percolation Test Results Performed by __.. .W___ . t,1f _ '_r...Z Date___ �'�' ........ a Test Pit No. I.. X minutes per inch Depth of Test Pit l •••••-•. Depth to ground watevt ¢ r. rAO rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground Ovate U .. ------------ - ...:.. D Description of Soil_________________�`'5! .............. __ , . "'_d-�:� .___... U -•••••••-•••••••-•••---••••--•••••--••••.:..•••-•----•---•••••'--•-•-=":r ---•- --- -----••------------------......................................... ------------------ ---•.•-........................... ------._.._.......-------------. ---------••---- -------------------------------------------•-••• --- -------.____---------------------------------------- U Nature of Repairs or Alterations—, Answer,,when!applicable.............................................................. ------------------•------------------------------------------------------...................................... Agreement `l The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TITIL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. >gne ry ::µme ...M� Application Approved BY=�:.. .....................1` ------------•-------- � �C ;' �;, .... "''-- -------•---•---------------•----•------------------------•._ Date-------•------ Application Disapproved or t e following reasonsf _____________"_: =_____ ........................................................... _.., Date Permit No. ._ " „--- 1 a � Issued-....................................................... 4. ty i+ p h . Date THE COMMONWEALTH OF-M`ASSACHUSETTS F` t:..:.r ...j ..... .. ..... ..-.......... T S,IS, CEY, That the Individual Sewage Disposal System constructed or Repaired ( ) by ... ' - ; ....._..... V;,: - 7 ........... ....... ... ............................ - Installer ..................................................................----------------------..................--------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Co��described in the application for Disposal Works Construction Permit No.tt 3._-___ ____ _________ dated`',_✓, .,... THE ISSyjF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILION SATISFACTORY. DATE..•••6 •-� ----•---•--..........•...............••-••••-•_. Inspector........ ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH fi ...........................................O F......................................:..:. No.:. ...jf............. FEE.YQ............... Permission "s ereb ranted_. _._. ...0 .a..'._._..-•--------------•------------=------...----- Y g - ................... to Constru ( or Re it dive al Sep s isposal System at No.: Street _ as shown on the application for Disposal Works Construction Permit No. --------_ ._ ated_.l` ............................... __ Board of Health DATE----- ................................................ FORM 1255 A. M. SULKIN, INC.. BOSTON LEGEND N N0346'50'W { ti Its. ° � _ gg —--- EXISTING CONTOUR 55.28' 9T. 9-a EXISTING WATER SERVICE 96.32 _ 94.40 x 100.98 EXISTING SPOT GRADE ��ec1n` Rd Pteoinct Rd o a N BRE'4K0 T-gE7B -- .__x 3.49 S 030 0 �e q CK- _ _ W �x � 7.43 PB 350 PG 55 ( �1 TEST PIT oro� Rd LOCUS l�o VENT TP-2 bra � � �- BENCHMARK 5 pre t S� w -•�, ender � I CD COO 26' EXISTING LEACH PITS 113 TP-1 TO BE PUMPED, FILLED W/ 6 R' 9.66 ; SAND AND ABANDONED EXISTING SEPTIC TANK TOP OF TANK, EL.=98.60 LOCUS MAP INV,(OUT)=97.25t NOT TO SCALE \9 7.55 > 9 5.96 GENERAL NOTES: 100 5 BENCHMARK 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ( BOARD OF HEALTH AND THE DESIGN ENGINEER. - _. TOP OF SONOTUBE 2•EL.=100.00 Assumed ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DEr:•I p LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 31 b CMR 15.405(1)(b): 5.88 1) A 2' variance to the 3' maximum cover requirement, for 5' of 1 100.13 x g8.62 � �s max. cover. S.A,S. shall be vented and H-20 Rated. � 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 0 No... 26 cp. 0 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE �P DESIGN ENGINEER. SN• D. M. '0 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING TOF 10 i .46 �' FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 100.03 x 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF GARAGE UNDER 94.15 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. x 93.45 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 171 o DIRECTED BY THE APPROVING AUTHORITIES. a ya C�� 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE o I5IT. CONC. o PETER T. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING DI41}''Ei, .` McENTEE CONSTRUCTION. o CIVIL ' 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS APN 148 - 062` o. 35109 IN THE AREA BENEATH AND ON ALL SIDES OF THE S.A.S. AND REPLACE JJ ARC WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE ® 1.. INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. �� ��, � �2�� (0` PROPOSED SEPTIC SYSTEM UPGRADE PLAN NO3°46'5aW NoQ°i5'40"UV ° �. 26 VICTORIA STREET, CENTERVILLE, MA f— Prepared for: Capewide Enterprises, LLC, P.O. Box 763, Centerville, MA 02632 9.._ ©. � 4 ... _ .. .. ....__._- _ .. _.. _ OWNER OF RECORD Engineering by: Surveying by: SCALE DRAWN JOB. NO, S Es> 96� EDGE 961 -Q I L EN ,) LIBERMAN, MARK & MARILYN En ineerin Forks HOOD 5URVEY GROUP 1"=20' P.T.M. 108-08 � 66 C/o US BANK NATIONAL ASSOC. g 9 VICTORIA p �� � I 10790 RANCHO BERNARD ROAD 12 West Crossfield Road 18 Route 6A DATE CHECKED =SHEETN /'� SAN DIEGO, CA 92127 Forestdale, MA 02644 Sandwich, MA 02563 1 2rJ OSP.T.M. i' (508) 477-5313 (508) 888-1090 i l i NOTE: F NISH GRADE BREAKOUT SHALL UNOT BE PROPOSED 0 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. 5-4"4POLYSEALUINLETS PROPOSED TANK PROPOSED D—BOX PROPOSED S.A.S 21" INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT pOVER END UNIT 2" ,g 1 OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE VENT T.O.F. EXISTING F.G. EL.=99.7t F.G. EL: 97.9t F.G. EL: 99.0(MAX.) 4" n MW MOW f_ 36" MAX. COVER MAINTAIN 2% GRADE (MIN.) OVER S.A.S. cv INSPECTION ._.-LL L 36, L 6'(MAX) PORT ® S=1`u (MIN.) @ S=1% (MIN.) 4'SCH40 PVC 4"SCH40 PVC ® ® 04 Top View (� �[ Section t o" 6' 8" TO D—B O'` t 4" INVERT EXISTING 48" LIQUID LEVEL ADD 4 ROWS OF 6 UNITS AT 4'/UNIT + 2'(END CAPS)= 26,00' GAS BAFFLE INV.=93.90 INV.=93.73 INV.=97.25t PROPOSED 0-BOX INV.=93.67 SOIL ABSORPTION—SYSTEM (PROBW (EXISTING) I OUTLETS L ( TEE nT.a EXISTING 1000 GALLON SEPTIC TANK ESTABLISH VEGETATIVE COVER 16" BACKFILL WITH CLEAN SAND (NATIVE OR PERC SAND) SET LEVEL AND TRUE TO BREAKOUT EL.=TOP OF UNIT NOTES: 1) D BOx SHALL BE TOP OF CHAMBER EL.=94.0 ° GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN INV.ELEV.=93.67 SIDE VIEW ;',:';,.; ° 0 310 CMR 15.221(2). BOTTOM ELEV.=93.00 I I t-t- 2) INSTALL INLET & OUTLET TEES AS REQUIRED. 2- 8' EXISTING 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH=11.2' SUITABLE INSPECTION PORT AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. T.P. EXCAVATION OR G.W. SOILS 52" 4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE USE 4 ROWS OF 6—QUICK4 STANDARD INFILTRATOR CHAMBERS TOP VIEWJim INVERTS PRIOR TO CONSTRUCTION. NO GROUNDWATER, EL.=86.5 (TP-2) 4 WITH NO SEPARATION BETWEEN EACH ROW & NO STONE o0 TYPICAL SECTION 34" SEPTIC SYSTEM PROFILE $ INVERT 48 P/N: Q4STDE * (EFFECTIVE LENGTH) END VIEW N.T.S. e g SOIL LOG � ® �_ � 9 I� MULTIPORT END CAP DATE:JANUARY 23, 2008 (REF#12,091) SIDE VIEW NOMINAL CHAMBER SPECIFICATIONS SOIL EVALUATOR:' PETER McENTEE PE SIZE (W x L x H)...........................34" X 48" x 12" WITNESS: DONNA MIORANDI IRS CN EFFECTIVE LEACHING AREA: DESIGN CRITERIA HEALTH AGENT BED....................................................PER CODE ELEV. TP-2 DEPTH TRENCH..................................... .........PER CODE ELEV. TP- 1 DEPTH NUMBER OF BEDROOMS: 3 BEDROOMS 98 0 0 97 5 O" 3 INVERT ELEVATION............ .................... ..... SOIL TEXTURAL CLASS: CLASS I FILL � FILL FRONTT VIEW STORAGE CAPACITY PER UNIT NIT....................4444.4 GAL 96.3 14" DESIGN PERCOLATION RATE: <2 MIN/IN 95•8 q 27 A ioYR 3%3M QUICK 4 STANDARD INFILTRATOR CHAMBER DAILY FLOW: 330 G.P.D. SANDY LOAM 96.1 17" DESIGN FLOW: 330 G.P.D. 10YR 3/3 INFILTRATOR CHAMBERS 95.5 30" B SANDY LOAM GARBAGE GRINDER: NO B SANDY LOAM 10YR 5/8 EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 10YR 5/8 95.0 C 36 3 " N.T.S. „ LEACHING AREA REQUIRED: (330) = 445.9 S.F. 93.0 C 60" I PERC PROPOSED SEPTIC SYSTEM UPGRADE PLAN .74 USE 4 ROWS OF 6—QUICK4 STANDARD CHAMBER UNITS W/ NO MED. SAND MED. SAND 48 26 VICTORIA STREET, CENTERVILLE, MA STONE FOR AN S.A.S. HAVING THE DIMENSIONS: 11 .2' x 26.0'. 2.5Y 6/4 2.5Y 6/4 Prepared for: Capewide Enterprises, LLC, P.O. Box 763, Centerville, MA 02632 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.72 SF/LF OF INFILTRATOR) Engineering by: Surveying by: SCALE DRAWN JOB. NO. 6 UNITS + 2 END CAPS PER ROW = 26.0 FT 87.0 132 86.5 132" EngineedngWorks HOOD SURVEY GROUP NTS P.T.M. 108-08 4 ROWS x 26.0' x 4.72 SF/LF = 490.9 SF i 12 West Crossfield Road 18 Route 6A DATE CHECKED SHEET NO. PERC RATE <2 MIN/IN. ("C" HORIZON) Forestdole, MA 02644 Sandwich, MA 02563 3 NO GROUNDWATER ENCOUNTERED 1/25/08 P.T.M. 2 of 3 0.74 490.9 S.F. - 36�.3 G.P.D. (sob) 477-5313 (sos) ass—loco W PROVIDED: DESIGN FLO ( ) � / /O 80� /08- /02 .57 ,0AJE 98 - 001 !o4,i 104. 9�; - t o o _ i & © FE . EX7-C- ../D HL PC_/CFI 3 HOF�IZ SCi9L E / iO — C I / Cam' I�_! ,^�A/VN4L E c C� VE,25 TO !nJ/TH1/lJ —o — °—o—o — P--oPOsed c�rovnd Prof, e V ESE' SLHLE / - % O / F (SA2AL) E . 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