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HomeMy WebLinkAbout0051 WESTMINSTER ROAD - Health •�_ 51 WESTMINSTER RD. , CENTERVILLE _ A=168-078 No. 42101/3 ®RA ------------- � p ESSELTE 10%U& O O O O y } F � u n No. 17�V �j Fee �r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS RppYication for Misposal 9,)pstrm Construction 3permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Z41hdividual Components Location Address or Lot No.S/�l%-S���� - O er's Name, ddress d Tel.No. Assessor's Map/Parcel/6g'-07 Installer's N g,Address,and Tel.No.fdB^ 5773 F Designer's Name, ddress and Tel.No f D�""36®—.33// S ! rSTGhs 1411/�s' ` h i Type of Building: Dwelling No.of Bedrooms 3 Lot Size I!J&00 0 sq.ft. Garbage Grinder( ) Other Type of Building �51 [—.0—' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Desigu Flow(min.required) 3: 7j f) gpd Design flow provided 2j((a gpd Plan Date L( —� Number of sheets Revision Date Title Size of Septic Tank `_ [� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4 /�L4 Ll Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board f Health. c �/ Signed Date © f Application Approved by C-1'�'— Dated Application Disapproved by Date for the following reasons Permit No. Date Issued to — a- No. } v S" , � / �. . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yew PUBLIC HEALTH DIVISION - TOW OF BARNSTABLE, MASSACHUSETTS NI; lication for Dis a 16 stern Construction Permit ` Application'for aPermit to Construct( ) Repair( Upgra e9( ) Abandon( ) ❑Complete System �Yridividual Components Location Address or Lot No.5-//e _rl e Owner's Name,Address,and Tel.No. �i�rt/t'Er!/if1� lQr�i,avc� Assessor's Map/Parcel/, _o•7 Stq Installer's Name,Address,and Tel.No;j-033 ;7;; /-9/'7 3-T Designer's Name,Address,and Tel.No;,0?ii',36 Type of Building: / Dwelling No.of Bedrooms Lot Size I G,bv D sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) j ?j gpd Design flow provided gpd Plan Date �( "( Number of sheets Revision Date Title,, + Size of Septic Tank ( 1 r )0 Type of S.A.S. ��. , � x5 Description of Soil Nature of Repairs or Alterations(Answer when applicable) /Ye. Cl/ /i1c// 7/7 ! IG�,•-J ° Date last inspected: 1 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance ith 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 f Health. Signed �/��:y��'�'!? ��. G�2,J �'' Date o I Application Approved•=l?yl (/�.�..`7 C.F.- , -"� Date Application Disapproved,by Date'' for the following reasons Permit No. Date Issued h THE COMMONWEALTH OF MASSACHUSETTS ` BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(v) Upgraded Abandoned( )by, QS at a/ U,11: S?iwie sTi' t2 r , /_�//`'���V��/alias been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoaQ (k d�a^ted Installerk/D.S_ !.7�Ao U� e V S Designer #bedrooms _ Approved design flow gpd The issuance of this p/e{ t shall not be construed as a guarantee that the syst mwillfiz coon as es'gn d. /"`"" Date f(/ 4 Inspect�Or ,�\r r ------------ --- ---- ----------------------------- -------------------------------------------- ------ ---=- ---------------- NO. � " Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( L)' Upgrade O' _Abandon( ) System located lit and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be 9oommpleted within three years of the date of this permit. �y�y� / Date °" -" /7 Approved by ' ._ 10/19/2018 03:48PM 17744139468 MEYER AND SONS PAGE 01/01 Town of Barnstable Regulatory Services • Richard'V. Scaly Interim Director • ensl�i►s�, _ a& Public Health Division Thomas McKean,Director 200 Maio Street,Hyannis,MA 02601 Office; 508-862-4644 Fax. 508-790-6304 Installer&Deshmer Certification Form c, Date: b �°��l� Sewage Permit# O _Assessor's Map\Parcel 079 Designer: C)[�/)S (in e,, Instauer: - Address: � j Address: crz.S 3� on (date) was issued a pcniait to install a (installer) septic system at E 1 M 1 IJ • based on a design drawn by r^`� M dated � 2 (designer) —X— I certify that khe 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of th6 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms . of the IAA approval letters(if applicable) CARREN (I er's Signature) No. l esigner's Signature) ( ere PLEASE RETURN TO BARNS LE PUBLIC HEALTH D N. CEATIF](CATE OF COMPLIANCE RML NOT BE ISSUED UNTIL, BOTH THIS FORM AND AS- BUMT CARD ANZ RECEIVED BY THE BARNSTABLE PUBLIC HEAL'I`H DIVISION. THANK YOU. "`— QASeptic\D"1per Certification Fonn Rev 8-14-13.doc i. . I Town of BAmstable P# Department ofRegulatoty Seivices Public Health Division Date l `" i �q tee$ 200 Main Street.Hyannis MA 02601 �1• Z� Fee Pd. . Date Scheduled Time� � � i _ X oil ,Suitabili Assessment,for tS g e Disposal t Performed By: v� Witnessed By: i LOCATION&GENERAL INFORMATION Location Address VvESr� 1 NSTeq_ R _ ! Owner'sNatrie �G(� j SEC�,I�q C EN 1 F_P_ 1 L L L I„t f� I Address S ABM 1. c l Y)G Assessor's Map/Nreel: I�p g I Q 7 Q t I Engineer's Name M 1✓�f tom- �+a�S ` / tv 6bW3W - 331 ) NEW CONSIRU�'T70N REPAIR � Tel^ephone# Land Use _��? � kl/ _ Slopes(%)�L—y /; Surface Stones 1-4 Distances from; ()pen Water Body R Possible Wee Area U O ft Drinking Water Well��ft Drainage Way>/D 0 ft. Property Line ft Other fr SKETCH:(Street name,dimensiods'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Sel � s i Parent material(geologic) v t't " A^ L\ I Depth t0 Bedrock Depth to Groundwaker. Standing Water in Hole: I Weeping from Pit Face • I Estimated Seasonal"igh Groundwater I DR5T! TION FOR SEASONAL HIGH WATER T"LE _Method Used: Depth dbperve obs.hole: In. Depth to boll mottles: Depth toiweeping from side of obs.holes I in. oroundwt►ter Adjuettnent fr• c Index Well# Reading Date Index Well levtl A�.'factor.�.._____ Adj.OroUndwater Level • I PERCOLATrON TEST! Data 7r'l Observation I 'Tin "to at 9 w`�.1�.... Note# N A i Depth of Pere 2 ,• 0 171me at 6" /i�---Start Pre-soak Time.@ 'rime(9"41 ) End Pre-soak `7 I Rate MinJlnch Site Suitability Assc$sment Site Passed Site Failed I Additional Testing Needed(,Y/N) original:.Public 1441th Division Observation Hole Data To Be Completed on Back— If percolafii0n test is to be conducted within 100'of wetland,you must first notify the Barnstable N#servation Division at least one(1) wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other De Boulders P Structure,Stones, Mottling Surface(in.) (USDA) (Mansell) g onsistency.R'o Gravel 1► o`' �aa rvl. aM� DYR 3�� ►� d c � S b o �2 2`' lam' C- eZ 2, DEEP OBSERVATION HOLE LOG Hole# Ey�� Depth from —SeWHorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 0"- 1a" 42�I G 2 ' 6� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,3'o Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consist n ra Flood Insurance Rate Map: Above 500 ye r'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 ial exist,in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervi s material? Certification hh /y�rA I certify that on V ` (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 requir rat 'n expertisen�d�experience described in 3.10 CMR 15.01 Signature Date � 1', l% Q:ISEPTICVERCFORM.DOC r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PRO TECTIO coil k°� David B.Mason,RS,Certified Title V Inspector,508-833-2177 Lt-' 3 2005Jr t,VSTABLETITLE 5 . TH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION n Property Address: 51 Westminster Road,Centerville,MA Owner's Name: Sally Warren,Trustee Owner's Address:P.O.Box 51,Centerville,MA 02632,MA �-- Date of Inspection: February 16,2005 Name of Inspector: (please print)David B.Mason Company Name:- N.A.--Mailing Address:4 Glacier Path East Sandwich,MA 02537 Telephone Number:508-833-2177 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 Conditionally Passes Needs Further Evaluation by the Local Approving o Fails Inspector's Signatu e: Z79FYA ate: �7 The system inspector shall submit a copy of this inspection report to the Approving uthori (Board of Health or DEP)within 30 days of completing this inspection If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: System as inspected appears to have operated based on occupancy level. Tank should be pumped as a matter of maintenance. The information as identified represents only the condition of the system on February 16,2005 at 12 Noon. Increase in occupancy may result in hydraulic failure. ****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. i Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:51 Westminster Road Owner:Warren Date of Inspection:February 16,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ inX I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments:Parking area should be defined to prevent parking on septic tank and pump chamber. B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. _N_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_ 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_ 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: OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 3 of 11 PART A CERTIFICATION(continued) Property Address: 51 Westminster Road Owner:Warren Date of Inspection: February 16,2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i Page 4 of 11 CERTIFICATION(continued) Property Address:51 Westminster Road Owner:Warren Date of Inspection:February 16,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for AA inspections: 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 NA Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool NA_ 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 due to clogged or obstructed pipe(s). Number of times pumped 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 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 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. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B Page 5 of 11 Property Address: 51 Westminster Road Owner:Warren Date of Inspection:February 16,2005 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?(INCLUDING THE SAS) _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)] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 6 of 11 PART C SYSTEM INFORMATION Property Address: 51 Westminster Road Owner: Warren Date of Inspection: February 16,2005 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:_0 Does residence have a garbage grinder(yes or no):NO(Not Allowed) Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no):NA Seasonal use: (yes or no):NO Water meter readings,if available(last 2 years usage(gpd)):No Water Records Due to Abandonment of Dwelling Sump pump(yes or no):NO Last date of occupancy:Unknown COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:Barnstable Sewage Treatment Plant Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping:No pumping records on file. 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): With pump chamber Approximate age of all components,date installed(if known)and source of information:approx. 15 years Were sewage odors detected when arriving at the site(yes or no):NO OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 7 of 11 PART C SYSTEM INFORMATION(continued) Property Address:51 Westminster Road Owner:Warren Date of Inspection:February 16,2005 BUILDING SEWER(locate on site plan) Depth below grade:Approx.20 Inches Materials of construction:—cast iron _X_40 PVC—other(explain): Distance from private water supply well or suction line: NA Comments(on condition of joints,venting,evidence of leakage,etc.): Appears in good condition. SEPTIC TANK: N.A.(locate on site plan) Depth below grade: 23 Inches Material of construction:—X— —concrete—metal fiberglass—polyethylene _other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: Typical 1000 gal. Sludge depth:4 inches Distance from top of sludge to bottom of outlet tee or baffle: 28inches Scum thickness:variable 0 inches to 6 inches Distance from top of scum to top of outlet tee or baffle:0 inches Distance from bottom of scum to bottom of outlet tee or baffle:Not applicable no scum at outlet tee How were dimensions determined:actual measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.)inlet tee is Precast.Outlet tee is PVC and appears in good condition. No evidence of leakage. Structure of tank appears adequate.Effluent level with outlet tee. Maintenance pumping s required. g i � GREASE TRAP: N.A. Depth below grade:— Material of construction:— — —concrete metal fiberglass—polyethylene—other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 8 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 51 Westminster Road Owner:Warren Date of Inspection:February 16,2005 TIGHT or HOLDING TANK:—N.A.—(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: \ gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_NO_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 9 of 11 PART C SYSTEM INFORMATION(continued) Property Address:51 Westminster Owner:Warren Date of Inspection: February 16,2005 SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: 1 Pit;6 foot depth leach pit with approx, 2 feet stone. leaching chambers,number: _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.):Pit is 23 inches below grade. Riser is present.No observed indication of staining in the pit. No indication of backup into the risers. Bottom of Pit is approx. 108 inches below grade. Pit is only an H10 rate pit. No indication of ponding nor increase growth of vegetation CESSPOOLS:_NA (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 constriction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_N.A._(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.): OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 10 of 11 PART C SYSTEM INFORMATION(continued) Property Address:51 Westminster Road Owner:Warren Date of Inspection: February 16,2005 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. I i i - I i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 11 of 11 PART C SYSTEM INFORMATION(continued) Property Address:51 Westminster Road Owner:Warren Date of Inspection: February 16,2005 SITE EXAM Slope . Surface water Check cellar (crawl space) Shallow wells Estimated depth to ground water_20 feet Please indicate(check)all methods used to determine the high ground water elevation: _X_Obtained from system design plans on record-If checked,date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) _X_Checked with local Board of Health-explain:Recent Test Holes, Existing engineer records with BOH X Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Utilized existing site design information on file with the Board of Health. Additionally,existing site and abutting site topography does not indicate ground water to be within 4 feet of bottom of leaching facility. Test holes in the area on file do not indicate ground water within 20 feet of grade. Barnstable Assessing Search Results Page 1 of 2 } 2 2 u< Home: Departments:Assessors Division: Property Assessment Search Results 51 WIES7�C'14 1NST1vLj1M 'jR0AD Owner: WARREN, SALLY,TRUSTEE Property Sketch Legend Map/Parcel/Parcel Extension 168 /078/ Mailing Address ' WARREN, SALLY,TRUSTEE PO BOX 51 CENTERVILLE, MA. 02632 2005 Assessed Values: Appraised Value Assessed Value Building Value: $94,500 $94,500 Extra Features: $2,000 $2,000 Outbuildings: $0 $0 Land Value: $135,100 $ 135,100 Interactive Property Map: Map requires Plug in: Totals:$231,600 $231,600 I have visited the maps before Ai L Show Me The Map April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: WARREN, SALLY, TRUSTEE 6/15/1992 P0964-T2 $1 KENYON, BERTHA EST OF 12/15/1985 4851/251 $1 KENYON, BERTHA EST OF 12/15/1985 4849/252 $ 1 KENYON, BERTHA 8/15/1985 P0964-El $1 KENYON, BERTHA 1519/846 $0 2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $42.04 Town Fire District Rates Other I $6.05 Barnstable-Residential $2.12 Land B Barnstable-Commercial $2.80 C.O.M.M. FD Tax(Residential) $233.92 C.O.M.M. -All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $1,401.18 Hyannis-Residential $1.52 Hyannis-Commercial $2.39 W Barnstable-Residential $1.44 http://www.town.bamstable.ma.us/tobO2/Depts/AdministrativeServices/Finance/Assessin... 02/21/2005 i'To: Mary Fleming 13957 Ketch Cove Place Jacksonville,-FL 32224 • t k ?mbr.A Palo IN ! • J ' t -•a .. u a pair..,-wlu '4``I . 0, f(A k i�a ill Ss. ! �"'. �%€ i -. r i _ ( .. iyy. .• �.� ._s,=i VT'7'3 1k �A_ tr.�. fi �.� \' 3l �r':..� �y S.jT}Z�f� .b- ..sl,'j;N r t t, '� __,rf''• <, ,r '• k `L '�[, i'6511,.}ij ��• .t..� ,. > .. 'r.� , t Telflf,y{.1' �/S�J�+_I'ft���,� �� k' j:�4t.'.)�r'l S�,tt{it, Barnstable Assessing Search Results Page 2 of 2 W Barnstable-Commercial $2.10 Total: $ 1,677.14 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.34 Year Built 1971 Appraised Value$135,100 Living Area 1152 Assessed Value $135,100 Replacement Cost$ 139,035 Depreciation 32 Building Value 94,500 Construction Details Style Ranch Interior Floors Carpet Model Residential Interior Walls Drywall Grade Average Heat Fuel Gas Stories 1 Story Heat Type Hot Water Exterior Walls Wood ShingleClapboard AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,000 $2,000 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tobO2/Depts/Admini strativeServices/Finance/Assessin... 02/21/2005 i f ' l — . _ TF1, : I � n / � sff ` Did .. •4 ��n .,..,..,1:, I - � � - 1 CD � `° 1 w� � I 07 IL e i G, i i I +�—� •� �J Jo g OL41 i 1 _z i C C C� l Ne i -roLl R_S� 160 1 � s�OFFr T f' f Z P11<0 YN�" - - - - - - - _ ✓ F�ti ___ yXra LACr.90` �......_.,. �X/STnly �'F/ /N/o filC T}{d wP � N\I-- CENTERMLLE 1 t ROUTE 28 Eo . ES T N P Pq l WESTMINSTER RD. ESTM LOCUS 43 _, R O4 EXISTING 1,000G LEACH PIT 44-1- �G -----_— 00Qo � �O G 1,000G _ —SEPTI TANK PAVED 19RIVEWAY t LOCUS MAP 45 o . LOCUS INFORMATION PLAN REF: 243/097 i TITLE REF: 21744/293 \ i'i43 PARCEL ID: MAP 168 PAR. 078 G D X/S7`/NG \�� a FLOOD ZONE: NOT IN FLOOD ZONE Tel LLING rop - SEPTIC SYSTEM oF- FNc> REPAIR PLAN '�o �5 �N ;44 t LOCATED AT: o,ft 0 51 WESTMINSTER ROAD CENTERVILLE, MA PREPARED FOR � I f RICHARD J. SEGURA SEPTEMBER 24, 2018 45 VENT O 46, or DA E M TP-2 LOT 20 fa SIyE� — -46 AREA = 15,000 sf+— VVV PLAN BOOK 243 PACE 97 ` ASSR MAPS 68 PCL78 47 SCALE: 1~=20' MEYER & SONS, INC. -------- LEGEND P.O. BOX 981 PROP T GRADE PROPOSED CONTOUR EAST SANDWICH, MA. 02537 lo,P 1 Gal PROPOSED S PH: (508)360-3311 --98 -- EXISTING CONTOUR FAX: (774)413-9468 + 96.52 EXISTING SPOT GRADE meyerandsonstitle5@gmail.com W— EXISTING WATER SERVICE TEST PIT SHEET 1 OF 2 J 2024 f ELEV. TOP fFOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS DROP FND. BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE (Existing) FINISHED GRADE (45.50) = 45.61 F.G.EL• 45.0 F.G.EL: 44.2 F.G. EL• 45.50 VENT a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA w• 2" OF 3/8" DOUBLE WASHED 3 4 - 1-1 F.G.EL 43.35 STONE OR FILTER FABRIC / " WASHED = •••• • •� DOUBLE WASHED STONE " 4" SCH 40 PVC 10"1 14 ® S= 1% aaa� MOMM ' TEE'S ARE TO BE (MIN.) BeBBB HB8®e :r 4" SCH 40 PVC INV.41 .0 2' EFF. DEPTH ®®a®eases®a INV.42.05 INV. 40.80 J GAS PROPOSED DB-3 4' 2 X 8.5' 4' EXIsnNG OUTLET INV. 42.30 BAFFLE EFFECTIVE LENGTH = 25' •. « •. . . . • DISTRIBUTION BOX dm (1-120) INV. ELEV.= 40.55 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ���� �F 'ass BREAKOUT OUTLET TEE AS MANUFACTURED BY �``' NOTES: TUF-TITS, ZABEL, OR EQUAL o DA��1�M. ' �, TOP CONC. ELEV.= 41.55 ELEV.= 41 .55 1) CONTRACTOR SHALL VERIFY ALL EXISTING �E PIPE INVERTS PRIOR TO CONSTRUCTION o. 1140 "' INV. ELEV.= 40.55 BBB 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX / Bt9 B 886B INCH CRUSHED STONE BASE, AS SPECIFIED IN �NITAR�p� BOTTOM EL.= 38.55 eaeeeea 310 CMR 15.221(2) „vv` 3.75 5 FT. 3.75' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK WITH 1500 GALLON SEPTIC TANK IF FAILED, EFFECTIVE WIDTH = 12.5' DAMAGED OR UNDERSIZED. SEPARATION 5.05 FT. 4) INSTALL BAFFLE T REQUIRED S W/ SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 33.50 SOIL ABSORPTION SYSTEM (SECTION) GAS (500 GALLON H2O LEACH CHAMBER) GENERAL NOTES: SOIL LOGS P#: 15763 DESIGN CRITERIA I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL DATE: AUGUST 29, 2018 NUMBER OF BEDROOMS: 3 BEDROOM DESIGN BOARD OF HEALTH AND THE DESIGN ENGINEER. SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS WITNESS: DON DESMARAIS, BARNSTABLE HEALTH DEPT. DESIGN PERCOLATION RATE: <2 MIN/IN OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DAILY FLOW: 110 G.P.D. X 3 BR = 330 G.P.D. LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: - 310 CMR 15.405 (1) (e): per, GARBAGE GRINDER: NO (not designed for garbage grinder) 1)A 0.95 Fr. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACWNG TP--1 Depth Elev. TP-2 TO BE 3.95 Fr (MAX) BELOW GRADE VS REWD 3 FT. (H20/MM PROMM) 50 A �, SAND 0" '45.90 A 0" SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,000 GAL SEPTIC TANK 1OYR 3/2 " LOAMY 1OYR�D LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFlLLEO PRIOR 44.67 10 45.07 13 10" D INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE BUSE TWO (2) 500 GALLON H2O PRECAST LEACH CHAMBERS W/ 4' DESIGN ENGINEER. LOAMY 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING IOYR 8%6° LOAMY 11OYR s%s° STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 42.00 42" 42.40 42" 1A ENGINEER BEFORE CONSTRUCTION CONTINUES. C. C BOTTOM AREA 25 x 12.5= 312.5 SF 5. ALL.ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF PERC TEST MEDIUM MEDIUM SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 0 E].. 40.50 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SAND SAND TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE 2 SY 6/4 2.5Y 6/4 DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.F.D. vs. 330 G.P.D.. req'd .. 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 33.50 144" 33.90 144" PROPOSED SEPTIC SYSTEM UPGRADE PLAN CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. PERC RATE <2 MIN/IN. CC1" HORIZON) 51 WESTMINSTER ROAD, CENTERVILLE, MA 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION NO GROUNDWATER OBSERVED 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY Prepared for: Richard J. Se Ura AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY Design and Side Plan by: SCALE DRAWN DATE 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. _ � 1, Doman M. Mayer, R.S., CSE, MEYER&SONS,INC. DMM 09 24 18 hereby certify that-I-am--cu►rsntly approved by MADEP Pursuant to 310 CMR 15.017 N.T.S. 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. to conduct son evaluations and that the above analysis has been Pert m-d by me consistent with the PO SOX 9181 SHEET NO. 15. ALL PIPING TO BE 4' SCH 40 • 1/8-/FT (UNLESS SPECIFIED) requirements of 310 CMR 15.017. 1 further certify that 1 F have passed the Son Evai. Exam in October, 1999. EAST SANDWICH,MA 02537 REV DATE CHECKED 508.952--2s22 DMM 2 of 2