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HomeMy WebLinkAbout0068 WESTMINSTER ROAD - Health 66 Westminster Road Centerville F A = 168 079 12543 :,STINGS•MN 1 I v L,.,✓^ <C\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Westminster Rd r'roperty Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Service Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certifications-: I certify that I have personally inspected the sewage disposal system at this addr:'ess and#vAt 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 o�q site sewage disposal systems. I am a DEP approved system inspector pursuant to SectionA5.34-d of Title 5(310 CMR 15.000).The system: 00 ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furth r Evaluation by the Local Approving Authority 9-8-11 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 Title 5 Official Inspection Form:Subsurfa4Sewagsal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. City[Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 'Y 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to.each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system.is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet.of a tributary to a surface drinking water supply . ❑ 0 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area=IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �^M 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Centerville MA 02632 9-8-11 required for every II page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Y Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder?. ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6-2011 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ^M 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NIA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (f yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (f known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" 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 16„ How were dimensions determined? Tape Comments on pumping recommendations inlet and outlet tee or baffle condition structural integrity, ( P P 9 9 ty, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required).Is copy attached? ❑ Yes ❑.No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber in good condition with pump and alarm working normally. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/afternative system Type/name of technology: Comments note condition of soil signs of hydraulic failure level of ondin dam soil condition of ( 9 Y P 9, P , vegetation, etc.): Leach chambers in good condition and empty at inspection with stain line at 12" below inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M r 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �< 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A . o c Olt- t5ins•1 MO Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10, feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date t ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 68 Westminster Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-8-11 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABL. ' ei,�OCAT[ON (019 w CS! M�nS�TP/' IU SEWAGE✓ # ASSESSOR'S PAP & L,OT -ti S TAL:.I. PUS NA M-&PHONE NO. 1 .� 1EMC TANK CAPACITY L ,EACH NG FACILITY: (type)_5, e/'S (size) '.S I S io.Or EDROOMs_ 3_WILDER OR OAR f ',ERMIT I)AsT E: COMPUANCE DATE: t; aparation Distance Between the: 4axiniurn Adjusted Groundwater Table to the Bottom of Teaching Facility aet 'rivate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facilityy)� eet ,Age of Wedand and Leaching Facility(If aaiy Wetlands exist et+ithin 300 feet tocW110460) ,,_ „Teat 'urnished b w ` _._. -_ __ ....,._... . O � -c- 71 No. C;w � Z$e1 0 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: v PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpphration for Mi5po5al �bp!tem Construction permit Application for a Permit to Construct( ) Repair()0 Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 2 7 5—9 2 8 5 68 westminster,Rd, Centerville Rbt & Brenda Isaacs Assessor'sMap/Parcel 168/79 68 Westminster Rd, CEnterville Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089 Centerville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder (nc) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 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) Install a new Title 5 leach system to engineer plans, #ETE-2079 . 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 of Health. i Signed Date /I/— e..3 Application Approve Date Application Disapproved by: Date for the following reasons Permit No. O� co 'o Date Issued ` �. �! No:, Fee100.00 f� r . x THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: vYes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpprication for �Bi5poq;al 9Pp tem, Cou5tructton permit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 2 7 5—9 2 8 5 68 Westminste.r,Rd, Centerville Rbt & Brenda Isaacs Assessor'sMap/Parcel 168/79 68 Westminster Rd, CEnterville Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—O 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089, Centerville 143 Trianglp Mr., Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder (nc), Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title 1 " Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to engineer plans, ETE-2079. 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 of Health. t Signed Date Application Approve b _ Date 1\ Application Disapproved by: Date for the following reasons Permit No. OCR:> .—C J f Date Issued$ l ` -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Isaacs (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( X ) Upgraded ( ) Abandoned( )by Wm E Robinson Sr Septic Service at 68 Westminster Road, Centerville has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No. �6 ! dated 1 1 ` )3/b Installer Designer CC,L" /-O #bedrooms s Approved design flowv gpd The issuance of this pe it shalLL l not be construed as a guarantee that the system will fun ion designed. 2 Date i I/ Sl Inspector OPP- ----- (--/---y-------- — No. `7� F4100.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS h Isaacs Ji.5poal *pgtem Con!6tructton Permit Permission is hereby granted to Constrult ( ) Repair (X ) Upgrade ( ) Abandon ( ) System located at 68 Westminster Road Centerville and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this e t. Date Il 13 1� Approv�d by �� Town of Barnstable Regulatory Services P Thomas F. Geiler, Director BARNSPABLE, 9 b9. r Public Health Division �plFDN1A�� Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: l/ ­0G Sewage Permit# Oh yFG Assessor's 1VIap\Parce1168/79 Designer: Eco—Tech Installer: Wm E Robinson Sr Septic Address: 43 Triangle Circle Address: PO Box 1089 Sandwich Centerville On l/'))-010 Wm E Robinson Sr Septivas issued a permit to install a (date) (installer) septic system at 68 Westminster Rd, Centervi1lebased on a design drawn by (address) Eco-Tech dated 08-16-05 / (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �LSN OF MyS DAVID ®� o D. COUGHANOWR N staller's ignature) No. 1093 ��CISTEP�O / `Sq/VI7AR\P� esigner's Signature) D`--- (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORA'I AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: HealthiSeptic/Designer Certification Fomi 3-26-04.doc 1 I 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, D wt D D CouG H[rt O- A,hereby certify that the engineered plan signed by me dated 46 l(;, ��,concerning the property located at , P eI`C (o�rS WEST t 1�51 C� �p�f� meets all of the. ME! TV)W Z!'2&S following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation IS +adjustment for high G.W. 2.0 _ 7-G DIFFERENCE BETWEEN A and B SIGNED �' DATE: +hufruSf �C, 2,006 NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. l q ASepfic\perceXe(Rp.doc TOWN OF BARNSTABLE LOCATION l0 0 tXxAt ` SEWAGE# VILLAGE ASSESSOR'S ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. M^0 SEPTIC TANK CAPACITY lo-OO 44 LEACHING FACILITY:(type) Sda 641 (size) NO.OF BEDROOMS c OWNER PERMIT DATE: 9I-f z-0 G! COMPLIANCE DATE: d J`5 -04P 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 P � o v L �2yt � 1 4" l r1-74- DATE :7126103 - RECEIVED PROPERTY ADDRESS:68 Qea.tm.inzte2 Road AUG 2 3 2003 Cente2v.i.P.Pe, Mazz ------- TOWN OF BARNSTABLE 02632 HEALTH DEPT. ----- FAILED INSPECTION On the above date, I Inspected the septic system at the above address. Tnis system conslsts of the loll,owing: �- 1- 1000 gai.2on zest is tank. '. 1-D-iat2 i9ut ion gox. f. 4-In�.i.Qt2atozz. Baseo on my inspection, I certify the following conditions: MAP PARCEL ; ®� 7hiz .iz a t.it.2e 1-ive ze/2t.ic 6yztem. Syzi-em waz ul2gaaded 12114100 pezmi� #2000-733 LOT 2� The zy.stem .i-s .in hydzaueic la.iiu2e. R new .beaching azea needz to ge inzta-teed, The ze/2tis -6yatem zhouid ge pumped. SIGNATUR , Name _ J__ P., -Macomber-Jr ___-_ Company ,�4���h per_ M��4m¢�r d_ Son, Inc . A a d r 2 S S : @Qx ------------- - - -C121UR YLI`Le-- �ja _ _2Z632- 0066 �none : 508 - 775_ 3l )8 ________ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY IOSEPH P. MACOMBER & SON, INC. Tanks•Cesspools•Leachllelds Pumped & Installed Town Sewer Connectlons p.0 Box 66 Centerville, MA 02632.0066 775.3338 775.6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 68 Road en e2v.Uie, a.a.6. Owner's Name:('1aa.ioaie Leonaad Owner's Address: Same Date of Inspection:7126103 Name of Inspector: (please print) ao-se12h P. Nacom9ea a2. Company Name: a• / • 17acom e2 & 3 on Inc. Mailing Address:130 x 66 Centeavi.e e, ('lass. 02632 Telephone Number: 5 08—77 5—3 3 38 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes ,Needs Further Evaluation by the Local Approving Authority !/Fails Inspector's Signature: A1Date: � r"a ' The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPE CTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:68 Oers .m.inztea Road en eay.Z e, RETT Owner: Naa oa..ie Leona2 Date of Inspection: 7126103 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: �O I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or m 310 CRT)5.304 exist. Any failure criteria not evaluated are indicated below. Comments: The zept is zyztem .iz .in hydaaaiic , a.iiaAe. A New Peach.ing a/tea needz to le .inzta.P2ed B. System Conditionally Passes: _A2a_ 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. MD 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 g p p ying 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: V0 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: 4b 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: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 68 Oe.6tmi.nate2 Road en e zv.c e, M ahb. Owner: Nat Boa ie Leonaad Date of Inspection: 7126103 C. Further Evaluation is Required by the Board of Health: �d 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: �0 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: VQ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of surface water supply or tributary to a surface water supply. ti0 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. .Ve The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ,00 The system has a septic tank and SAS and the SAS is less than 100 feet but 50 et 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 coli form 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 68 0e,6tm.inzi-e�c /2oad Cente/F1311te, 77733. Owner: Na/L oazte e3na2 Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes �-/O �Sckup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or /clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool , 414rVAI7^1190 Y--_,Liquid depth in.cosrpeel- '/2is less than 6"below invert or available volume is less than day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number kyof times pumpedy portion of the SAS, cesspool or privy is below high ground water elevation.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface 44+r ater supply. y portion of a cesspool or privy is within a Zone 1 of a public well. !,/_ /arty portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.] (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 Pthe 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. 4 Page 5 of I I , OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 68 Road en eavt e, a-37 0wner:Na/z oa.ie Leonaad Date of Inspection: 7126103 Check if the following have been done. You must indicate"yes"or"no"as to each of the followint; Yes No Pumping information was provided by the owner, occupant, or Board of Health — / Were any of the system components pumped out in the previous two weeks ? ;/Have as the system received normal flows in the previous two week period ? large volumes of water been introduced to the system recently or as pan of this inspection ? 2/ _ Were as built plans of the system obtained.and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out ? Were all system componen'ts, 'IV 41rcluding the SAS, located on site? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge and depth of scum ? Z_ 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 Soll Absorption System (SAS)on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 68 Glut Ninztea Road en eAD7 e, azz. OwnerOaa oa ie eonaa Date of Inspection: 7/2 6/0 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):—� Number of bedrooms(actual): DESIGN flow based on 310 CM 5.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):A-s Is laundry on a separate sewage system(yes or no)?(�V (if yes separate inspection required) Laundry system inspected(yes or no):� Seasonal use: (yes or no):dd Water meter readings, if available(last 2 years usage(gpd)): 2001-9 9, 000 ga.2.2on.6=271. 24 GP D Sump pump(yes or no): -0G� �n N� _ , ga.2.2o n.s=2 4 6. 5 8 GP D Last date of occupancy: 4 COMMERCIAL NDUSTRIAL AA Type of establishment: /T Design flow(based on 310 CMR 15.203): OTP ep d Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):,gg Industrial waste holding tank present(yes or no): / Non-sanitary waste discharged to the Title 5 syste (yes or no):/J ) Water meter readings, if available: AV Last date of occupancy/use: zN OTHER(describe): /V GENERAL INFORMATION Pumping Records P um ed 7k & Pit 1996 . P. Nacom9ea � Son Inc. Source of information: an a Was system pumped as pan of the inspection(yes or no): If yes, volume pumped: gallons -• How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system W�-49Single cesspool /!/0Overflow cesspool Ald 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) �l ight tank V,4 Attach a copy of the DEP approval ,1200ther(describe): A14 at� e age�of III components, ins II�('f known)and source of information: Were sewage odors detected when arriving at the site (yes or no): 6 Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 68 kleat Minztelt Road Cen e-ay.i.e.Pe, Mazz, Owner: Ma/zjo2.ie Leona/zd Date of Inspection: 7126103 BUILDING SEWER(locate on site plan) i Depth below grade:_ & Materials of construction: _cast iron 40 PVC_other(explain): IVA Distance from private water supply well or suction line: /0Y Comments(on condition of joints,venting, evidence of leakage, etc.): ao 1 4P¢okces,�e The .sy,3tem 1.6 Ventect thlioughe houze ven .6. SEPTIC TANK: Zlocate on site plan) M06 Depth below grade: l7 Material of construction:—concrete,Gd metal&?I�fiberglass NQ polyethylene Vo other(explain) If tank is metal list age:&14 Is age confirmed by a Certificate of Compliance(yes or no);t (attach a copy of certificate) ,, �� � � �� i Dimensions: Sludge depth.,—,�_' �.. Distance from top of sludge to bottom of outlet tee or baffle: � — Scum thickness: ,��Ct� 777 Distance from top of scum to top of outlet tee or baffle: A4e._, Q Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of-leakage,etc.): I)um/1 the zePt.ic tank annuaiiU, 6aagaga d.i,3QoAaP .iA 12aezvn.t_ TnDet 'and out Pet teeh ate\��eace. The' tank IA Ailzu .�nlinnl.Ply Aniinrl rind .6how,3 no .evidence o� eakge. . GREASE TRAi (locate on site plan) Depth below grade: Material of construction:&Z2concrete lkmetaW,±fiberglass.-�olyethylen4tther (explain): 1 / Dimensions: Scum thickness: Im 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:&2 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 o n A 2 f12 ri lJ2 ; A Q O-Z;—�Q P.6 4 Q Q J. 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 68 Qezt Ninztea Road Owner: ftajoa ie Leona,,zd Date of Inspection: 7126103 TIGHT or HOLDING TANKt"(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: " Material of construction: ( concrete metal WM fiberglass i&ipolyethylent 4l ± other(explain): Dimensions: Capacity: gallons Design Flow: allons/day Alarm present(yes or no): A Alarm level:_1L Alarm in working order(yes or no): Date of last pumping:4 Comments(condition of alarm and float switches,etc.): 71ghf nn hnediag irink-6 aae not R2ezent DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: X/2) 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.): e vid e n c e Zb-'3Z;1bLQ.K.tLGltr env hnA ono 0nfo h te,�,_ O .6oiid.6 caaa4, PUMP CHAM BEPA&/C-(locate on site plan) Pumps in working order(yes or no):iUi! Alarms in working order(yes or no): A�O Comments(note condition of pump/chamber,condition of pumps and appurtenances,etc.): 1m 7n n{�a m�o n ;A n nT nn o Agn i 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:68 blezt M-inztea Road CenteaU.i mazz. Owner: Ma,,z o2ie Leonaad Date of Inspection: 7126103 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) �/-In�iPt2ato2.s 11 'X25'X2' If SAS not located explain why: 1=eeri4e4i See Page 10 Type leaching pits, number: 6 � I leaching chambers,number:Yi�T+aid ,jam leaching galleries,number: 0 29 leaching trenches,number, length: O i17 leaching fields,number,dimensions: A)P overflow cesspool,number: d ,W 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.): Loamy sand to medium fine sand Laech.iny and nnnd nrg._o.iib aae t' i-,, Vegetation -ins no2mae. Dug down to .the htone artound the .in?ei.Ptaatozz. Vate2 ways guggi-iny at th.i,3 /2o.int. �e h 'ny a2pa needs to ge in3taiged. L�cesspoo 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: /9 Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Ce.6.312oo2.s ate not Rae.6ent. PRIVY(locate on site plan) Materials of construction: Dimensions: df Depth of solids: fill Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 1P o /2aezent 9 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 ' 01 j i� I ' i r r• �2 31- .83 -- 'au1p11" a4i watua Alddns aast,- a*ngnd »oym altoo-1 •13a) 001 U1411m S113m lit altao-1 •Sxrturyavaa ro s�rturputl aouatajai tuautsuud onU Istal It oI salt 3ulpnlaul wotsAt Itsodslp aEtmas ayI Jo yauxS t apiAoJd W31SAS IIYSOdS1Q 30vM3S d0 HJ13XS :aolwdsal to atcQ pvn :�aamp � va pv'oy a 89 :ssajppv kw3dord (panuiwoo) NOI.LVMO,INI WaISAS 0 J.HYCI MOA NOIJ.OZaSNI N13,LSAS 'IVSOdSIQ 3DYhA as aoYx maf1S SIK21wSS3SSV AVYINn IOA ?IO.d .LON — MOZI NOUDUSNI 7 Y1013.30 1 I Jo 01 28ed TOWN OF BARNSTABLE - L o LOCATION SEWAGE # NULAGE ,o AI%ram y// ASSESSOR'S MAP & LftT , INSTALLER'S NAME&PHONE.NO. I , SEPTIC TANK CAPACITY LEACHING FACILITY: ( ).ter /Ti?.,� Q.S (size) NO- OF BEDROOMS BUILDER OR.OWNER PERMITDATE: COMPLIANCE DATE: 0� 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) Furnished by Feet r I j F Page I I of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 68 lde,st l7.in.6te/z Road Cen; e2v.i.2.Pe, (jazz. Owner: (7a/t io2.ie Leona zd Date of Inspection: 7126103 SITE EXAM Slope Surface water Check cellar Shallow wells r Estimated depth to ground water rdr-feet • Please indicate (check)all methods used to determine the high ground water elevation: q e L Obtained from system design plans on record-If checked,date of design plan reviewed: 7126103 y e L Observed site(abutting property/observation hole within 150 feet of SAS) yes Checked with local Board of Health-explain: 4,3 Lu.i.Pt ea/id q. S Checked with local excavators, installers-(attach documentation) q Accessed USGS database-explain:h t t 2,//t o wn. a z n a t a&P e. m a. u b. You must describe how you established the high ground water elevation: aecl: qahlzety 9 Ni2Pe z (7ode e. 72116194 qzound wate2 e eevat.ion.a a&ove .6ea eeve e. eed: US S: Oe-3etvat.ion -w—eee data. une 7992 hed: US4S: 7echnica.P Pu.P.Pet.in 92-000- 1 /0.Pate #2 Annua.P Zan ez o g1zound_ watt-a e.Pevat.ionz. up ul rounu _- Pt/tat02b in -6ea ie'6. Zn hydzauQic Il ea-i,eu2e. 1 le Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the botto of the leaching pit and the adjusted �� feet. groundwater table is !7! 11 P +•nrn r-+.-n.r�.1T• .nrarn•nrn/.r'T,+'.nr�r„•�rw„rl�wr.,n1n,L Trl��r,wT TOWN OF BOARD OF HEALTH SUBSURFACE SEWAUF DISMSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •••TT•t�T••.':: -T,,1��.�TT.T,'.'1,1 T.ITI nRlR1I7R"TT:T•5't "I VTR't fTwI�TTT��t�7R� t�l �.. -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRES$68 Vezt Ninatea Road Centeay.i2.Pe, Na.3.6, ASSESSORS MAP, BLOCK AND PARCEL # 168-079 OWNER' s NAME l'laa oaie Leonaad PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber .Jr. COMPANY NAME J P Macomber & SoR Incr", COMPANY ADDRESS Box 66 Centerville Mass. 02632 Street Tovn or Clty State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage dieposa7 system at this address and that the information reported is true , accurate , and omplete as of the time of ,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : System PASSED , The inspection t+hich I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CMR 16 , 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection wllicll I have con tcted has found that the system fails to protect the public health and the environment in accordance with Title 6 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date f"�'2.� copy of this certification must be provided to the OWNER, the BUYER arne where applicable ) and the 130ARD OF HEAL'I'll. * If the inspection FAILED, the owner or"operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3,10 CMR 16 , 305 , partd , doc No. �`6 �/� Fee �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rppltratton for Mtgool *p5tem Conotruction Permit Application for a Permit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 40 We,5 o�1zr— - Owner's Name,Address and Tel.No. Assessor's Map/Parcel Ins ame Add el.No. Designer's Name,Address and Tel.No. 7 i� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow '2"3 h gallons per day. Calculated daily flowcj gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank c D—� , fQn r Type r G c L Description of Soil Co c-. 1;�'*-c� Nature of Repairs or terations(Answer when applicable) _Z79K-S%A� AX,6, /J-6!5,4 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 Certifi- cate of Compliance h Board eal Signed 1 Date Application Approved by Date ,/ . Application Disapproved for the following reasons Permit No. '13a Date Issued No. .Fv®�✓ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y b PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZippYicatton for Migpogal *pgtem Congtruction Vertu Application for a Pen-nit to Construct( )Repair( grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (rj�j (itlE'S%r 1��S mac/- Owner's; - Name,Address and Tel.N ro. .-G� ,�, Lidk Assessor's Map/Parcel4cel ' /_ Inst a& ame Address-and- 1. o. Designer's Name,Address and Tel.No. S Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 'Z:S n gallons per day. Calculated daily flow �S Kcj gallons. Plan Date Number of sheets Revision Date Title Size ofSepticiTank 5_;1CIs, .04" (a) 0,0 c-c. . Type�e 'S' Description of Soil -ram�1�.- Nature of Repairs or Alterations(Answer when applicable) tat 5l r�r "4, - Tnw t2 d r c A 64 le, C .J f_. j icy•L i/�Z-e r;; C 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 Certifi- cate of Compliance has-been_-issued-by_this Board o ealth_. Signed Date /d-/,2 Off) Application Approved by . Date Application Disapproved for the following reasons Permit No. 2,6Z /fit Date Issued I.�� �Z;W_1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comphance THIS IS TO CER-T1FW Ahat M.,. n-site Sewa� s o al System Constructed( )Repaired ( )Upgraded(y.T" Abandoned( )by .- _ cr '`E at to F3 t 1J�Sl ?fit&)i ST� OS?,"l � �-P has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permi 0"*� :lPated I'll -/Zr'.W.l3VL.© Installer Designer. ,-, n t"� The issuance of this pe h n 'construed as a guarantee that the syst�e,},�"w ll functioynr as designed -' Date Inspector I�F;I I (:&: . i� �&X_ ov I/ V ---- /—"�--y------------------------------ �—— No. � �"�/ Fee L ,,K�o1.) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Iigpogar *potent Congtructfon Verrnit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at to e'<I- AA and as described in the above Application for Disposal System Construction Permit.The applicant recognizes 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: Approved by 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated a la , concerning the property located at meets all of the following criteria: �• This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. (/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system �• There is no increase in flow and/or change in use proposed There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater,table elevation. [Adjust the groundwater table using the Frimptor method when applicable] v • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: ll A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation/ +the MAX. High G.W. Adjustment —I b = 43 DIFFERENCE BETWEEN A'and B -7c! 42 SIGNED : DATE: [Please Sketch proposed plan of system back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert /V f E > C TOWN OF BARNSTABLE ' a jOCATION (,2 (Lr. SEWAGE # — J VP.LAGE ife %<'C I///9Ze�ASSESSOR'S MAP & LOT/60' 1`19 l INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 0 00 LEACHING FACILITY: (tYDe) �� /�7OS (size) NO. OF BEDROOMS BUILDER OR OWNER . ?, 1NSp���, PERMITDATE: COMPLIANCE DATE: 00 Separation Distance Between the: p � 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 1 , F TOWN OF BARNSTABLE �1�, LOCATION !.y � /a,CP q,4 �n / W - SEWAGE # VILLAGE �a,,� %l'r ASSESSOR'S MAP & LOT I i n INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY / v o�� LEACHING FACILITY: (size) NO. OF BEDROOMS I BUILDER OR OWNER j PERMITDATE: COMPLIANCE DATE: 00 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 4.. Furnished.by c -No.....- THE COMMONWEALTH OF MASSACHUSETTS 1n � BOAR® OF HEALTH A�y, ec, sT'o I�'�LIV Appliration for Disposal Works Tonstrn.rtinn Vaunt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Le System at: A •--- --•-•-••-•-.....----•-•---•---••-•..._.....---••-••-••-......-•-••-•-•------•-•--------------•- Location-Address or Lot No. ........XG.,0`A,r /.�,,- e7.-! i L ............... . ..1 � L,(* ..................................... c. �w e• ---------•------------•-------••---.........AddvVss Installer Address a� UType of Building , Size Lot._.T i...7.........Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `1 Other—Type T e of Building p� yp g ............................ No. of persons............................ Showers ( ) Cafeteria ( ) Others&c res .......................................................................................................--------------------------- --•------•-••---•- W Design Flow............................................gallons per person per day. Total daily flow--........ !e�10___-__-___-__---------.gallons. WSeptic Tank—Liquid capacity/Q_-OO.gallons Length..............•. Width----------...... Diameter----------.----- Depth-------..-..---- x Disposal Trench—No. ............ ....... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No....ZVJ 1_0ftiameter.................... Depth below inlet___..............•.. Total leaching area--_-_----_____-__-sq. ft. Other Distribution box Dosing tank ( ) Percolation Test Results Performed bY...............•---•--•-•-------------•--•-•------------•------•---•-•.... Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.--_-_---------___----. (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_----_-_---________._.. a ------•--•-•---------•-------••------•--••----•---------•-••----•-•--•-•-----•-••-••--•---•-•-.-----•--•------•----•• •--•------------••--•------------- O Description of Soil----------------------- --------- AAe7- - -------------------------------------------------•. 1 aw,.. T°' -------- � -G �SrF x ----------------------------- /�t - 1"�i�s � ` U 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 Article XI of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been is t e o Ae .Signed 2� ....... --. --- -- ------- -------------------------------- ApplicationApproved BY------.. .,��-----,.----------------------------------------------------------------------- ....................Date -------------- ---•...................... .•--------- Date-------------- Application Disapproved for the following reasons:.................................................... - ---•-••-------------------------------------------------------------------------------------•-----------•--•--•--•-•---•-------•-•-••--•--•--•---------•---•--------•--....---------•••------------•--•- Date Permit No....�•y7------------------•-------------..---- Issued------4----& Date No.......e ;° a THE COMMONWEALTH OF MASSACHUSETTS v. BOARD OF HEALTH' Appliration for Bi,ipaoal Workii Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ':.- Location-Address or Lot No. ........_`_'_::__- '....--....41------ 4' 'a :..!"+ ✓1. � t T � �'�T a ! t' ' w, _.r _r. .... - ... t Owner c.. a ._.. - - W Add4Pss a •---•-------------•--•------------•------•.........-----------------••............................ -------------------••-••-•-•----------•----•••--------•-••--------..................--•q.......• Installer Address Q Type of Building Size Lot---=? _,._. _ A_..._.S feet Dwelling—No. of Bedrooms------.2..................................Expansion Attic ( ) Garbage Grinder ( ) `1 Other—T e of Buildin ___ a yp g ______________ ___ -------- Showers ( ) Cafeteria ( ) dOther fyxtures ......................................................---.....------------•-•------------------------------••--------•--.....-••-•--•----------.----• W Design Flow.._......... ........................gallons per person per day. Total daily flow__.......:./I.r+ ................ WSeptic Tank—Liquid capacity;✓6 /,_gallons Length................ Width---------------- Diameter-._---..----___ Depth_-.-____..__---. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. 3 Seepage Pit No.._,�_ _ ..y ameter.................... Depth below inlet.................... Total leaching area-___--__--_____-sq. ft. Z Other Distribution box O Dosing tank ( ) aPercolation Test Results Performed by-----•---•---•-------------••-••--------•--------•--••---------•---•----- Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-._-__--__---.______---- 44 Test Pit No. 2................minutes per inch Depth'of Test Pit-------------------- Depth to ground water__-_.-______________---. P ...................................-........................................................................................................................ 0 Description of Soil.................................................................................................................................;r U 1 r f J " 'a l l t� l l _..._.... . W ----------------------------------•••--•---------- f...... ............'.......... F U 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 Article XI of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued--by t board-of he Signed �� , =' ,� � .- a ---- ............D.-te.............. Application Approved By..._.._'7_._.z':�' ^�✓ D -----•-•--••-------------------•----------------- -------- --------------•------ -•------------ - ate Application Disapproved for the following reasons:............................................................................................D .-•-------•---•- ---------------------•-------------•--------------•------•-•---•-----------•-------••-•-•------•--•-----.--•-•......-----•-•---------•-------••-•-••-•---•---•------•--------•...---•-••---•------------ Date Permit No. 1_/- ..----•--------•---------••--•-------• Issued. = A-' "- -, ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................✓.. ..ac:J .....OF....... .. / .yry•, "...: ...........................• Trdifirate of Tautphau rr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------------------------------------------------------------------------------------------------------------------------....................................................................... y C Installer • -•---- ` s-k. . has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------t..r2_-7.................... dated-----_,f_-f`�_._. : -------------- ..._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ® AS A GU ANTEE THAT THE SYSTEM WILL FUN 10I SATISFACTORY. ell DATE Inspector ----- --•-• !6✓Lc: ... 6 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. '--•------ �t.���a��l �rk� Cnnn��rttr�i�n �frr�tit _. Permissionis hereby granted............................................................................................................................................. to Construct (v, ) or Repair ( ) an Individual Sewage Disposal System St et ^ as shown on the pplicatio for Disposal Works Construction rm' No.,>. _.. ..... --, �-�,,•,,--/- --------------- ----- --- . . ----- -•-.------ f �' DATE----.. rd of ea th FORM 125 , HOBBS & WARREN. INC.. PUBLISHERS ,r + CENTERVILLE. Nei PLAN REFERENCE - CONTOURS FALMOUT" R°AD � PLAN BOOK 327 PAGE 89 90 d E+ - - - - ROUTE 28 - p _. EXISTING - - 50 TER e ASSESSOR'S MAP: 168 MINIMAL GRADING PROPOSED <G WE5TMiN 5 h LOT: 79 34 ROAD LOCUS �t ' roe BENCH MARK �� 32 lk\ � PK NAIL IN DRIVE 'F'o ELEVATION - 38.50 I&A18 iN BARNSTABLE GIS DATUM �= � C'n \ � O 32 is � m 34 +000 � 24 ft x 12S f► x 2 ft �'�``� 36 LEACHING GALLERY p�� V`o LOCUS M A P NOT TO SCALE �' DFI+ Ww \ < \34 t ,� i ��EXISTING LEACFNlVG GALLERY L C G D W / \ EXISTING la r►' `\ \ GALLON SEPIC n SEPT TANK C' / Zcr � '` /I< PUMP CHAMBER \ \ T SOT PIT O � L(I J LL�0 32 UTILITY POLE w^T $ Ea L k m a I \ DRAIN TREE r -A&PSEP P.EFEP.S TO ONf1ETEP 0-0 30 OV P '655LEp ER DENNOOTES TYPE LOTS 2A AREA - 22C 28 Or. l \� ww 2I53 sf •- \ 24 00 ,36 34 / II i 24 �9 a ` si I PLAN e 1 V �tN OF MAs O 32 6( 26 � `F9 l' 'JO 28 SCALE: I in - 30 (t moo`' DAVID yGN o D. . IR FLOW PROFILE COUGH ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS 1093 No. 093 GISTE��O TOP OF FOUNDATION RAISE COVERS TO WITHIN I AR �S EL - 29.55 +— 6 in OF FINAL GRADE ONE INSPECTION RISER FOR Q V�vs LEACHING GALLERY 29.00 TO SGTIRON RADE COVER /p )X 3 2 %2* STONE' LAYER OF SEWAGE DISPOSAL SYSTEM PLAN �s DROP -TO SERVE EXISTING DWELLING FLOW LINE TEE 1 4 ROBERT & BRENDA ISAACS ` PRECAST 3i4'—I 114' 48 BAFFLE �, DRYWELL $TONE 68 WES TMINSTER ROAD CENTERVILLE. MA 2 +- BOTTOM OF 2.91 22.60 STONE 25.38 LEACHING SOIL ABSORPTION ECO-TECH ENVIRONMENTAL SYSTEM ewsTNG B A S E EXISTING 228 25.55 �; GALLERY 43 TRIANGLE CIRCLE SANDWICH MA 0256 EXISTING EXISTING 2. 25 1000 GALLON I8.66 6 in STONE BASE /8.3s (END VIEW) 23.25 5 f' 508 364-0894 1000 GALLON 44 ft i ETE-2079 AUG 16. 2005 f� 1/2 SEPTIC TANK 5 f' PUMP CHAMBER a' S.{' � ►2.5 -SEE DETAIL ON BACK b) 14. f' p THS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT ADJUSTED 17.96 BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGNEER SEASONAL HIGH ORIGINAL PLANS INTENDED FOR SUBMITTAL TO THE BOARD t GROUNDWATER OF HEALTH WLL BE SIGNED N BLUE AND STAMPED N RED. i DAT F TEST: JUNE SOIL TEST LOG SOIL EEVALUATOR: DAV D DI. COOUGHANOWR. RS � I NcA IONS WITNESS REQUIREMENT WAIVED NO VARIANCES SOUGHT DES G LCULAT NO GROUNDWATER ENCOUNTERED DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH ELEVATION - 31.41 PERC AT 80 in : 2 MIN/INCH IN C SOILS SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL F TH SOIL USDA SOIL SOIL COLOR SOIL OTHER CONDITION. IF NOT, INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) HES) HORIZON TEXTURE (MUNSELL) MOTTLNG DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 3141 0-4 O WOOD LOAM 10 YR 2/2 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 24 ft x .12.5 ft x 2 fi LEACHING GALLERY CAN LEACH 4-6 E LOAMY SAND 10 YR 3/1 NONE FRIABLE A b o i - ( 24 x 12.5 ) - 300 s f A s d w - ( 24 + 24 12.5 + 12.5 ) x 2 - 146 sf 6-12 A LOAMY SAND 10 YR 3/3 NONE FRIABLE A i o t - 446 s f 12-32 B LOAMY SAND 10 YR 4/6 NONE FRIABLE Vt 0.74 x 446 - 330.04 GPD 28.74 32-60 Cl COARSE SAND 10 YR 6/4 NONE LOOSE _ USE A 24 ft x 12.5 ft x 2 ft GALLERY. Vi - 330.04 GPD > 330 GPD REOVIRED 60=150 C2 MEDIUM SAND 10 YR 6/3 NONE LOOSE 18.91 GROUNDWATER ADJUSTMENT LEACHING GALLERY PUMP CHAMBER DETAIL 500 GALLON DRYwELL DIMENSIONS AIDD DETAIL INSTALL ONE INSPECTION GROUNDWATER LEVEL BASED ON RISER TO WITHIN SIX WATER LEVEL OBSERVED IN CONSTRUCTION DETAIL �E "-p INCHES OF FINAL GRADE NEARBY CRANBERRY BOG CHECK VALVE TO D-BOX ' AND INDICATE LOCATION DRYWELL UNIT STONE ON AS-BUILT PLAN OBSERVED GW 15.96 \ 8'-6-x 4'-10-x 2•-9' 24 ¢ 2 it EFF. DEPTH u' 24 in RESERVE INDEX WELL MIW-29 o ZONE D 24 O f t ALARM ON READING DATE JUNE. 2005 o w 5 in READING 6.9 PUMP ON ADJUSTMENT 2.0 "' 6 in ADJUSTED GW 17.96 PUMP OFF O 33 ul cz] p�� in ui IT N L12 in SUMP pOpp O p 0000 �popoDop�po �0�0 - 000pooa p0 op o FORCE MAIN PIPE TO BE 2 in SCHEDULE 80 PVC WITH op 0 �t� 8.5 8.5, 3.5' 1 CUBIC FOOT OF THRUST BLOCKING AT BENDS ' NOT TO i�2 in N O T E ys^ '', 24.0 f r SCALE PUMP CHAMBER TO BE MADE WATERTIGHT AND TO j^ rf CONFORM TO 310 CMR 15.221. 231. AND 254 1) GARBAGE `GRINDER ,NOT ALLOWED WITH THIS DESIGN CONTROL PANEL FOR PUMP OPERATION TO BE LOCATED 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. INSIDE DWELLING AND TO BE WIRED ON INDEPENDANT 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS CIRCUIT. HIGH WATER ALARM TO CONSIST OF AUDIBLE OF MASSACHUSETTS TITLE S SEPTIC CODE (310 CMR IS) AND VISIBLE SIGNAL. 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES USE I/2 HP M WHRE 5 PUMP OR EQUIVALENT. PUMP BEFORE EXCAVATING FOR SYSTEM. MUST BE ABLEE T TO O PASS I I/4 in SOLIDS. 5) EXISTING LEACHING GALLERY TO BE PUMPED, COLLAPSED. AND FILLED. 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DAWN SEWAGE DISPOSAL SYSTEM PLAN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK -TO SERVE EXISTING DWELLING 9) SYSTEM DESIGNED TOVER SEPTIC SYSTEM,WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES ROBERT & BRENDA ISAACS 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 68 WESTMINSTER ROAD CENTERVILLE. MA 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH ECO-TECH ENVIRONMENTAL SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED 43 TRIANGLE CIRCLE SANDWICH MA 02563 FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. ETE-2079 AUG 16. 2005 1 12/21