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Home My WebLink About0114 WILD GOOSE WAY - Health 114 WILD GOOSE WAY, CENTERVILLE A = �1ACYt!&p��Z UPC 12534 No.2153LOR �9�sroo � HASTINGS. UN i Commonwealth of Massachusetts Q. Title 5 Official Inspection Formin Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 114 Wild Goose Way Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick T. Sullivan cursor-do not Name of Inspector use the return key. Ready Rooter, Inc. Company Name P.O. Box 371. Company Address Sandwich MA 02563 n City/Town State Zip Code 508-888-6055 SI 12843 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenanc"f on site sewage disposal systems. I am a DEP approved system inspector pursuant to-Section i5�340 Title 5 (310 CMR 15.000).The system: .- =) o ® Passes ❑ Conditionally Passes ❑ Falls ❑ Needs Further Evaluation by the Local Approving Authority March 13,2012 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or , has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 2 V t5ins-11/10 Title 5 Official Inspection Form: Vgesposal System•Page 1 of 1 e Commonwealth of Massachusetts AM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 every page. Cityrrown 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: 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", "/nn determine (Y, N, ND) for the following statements. If"not determined," please expla The septic tank is metal a yea old* or the septic tank(whether metal or not) is structurally unsound, exhinti infiltration or exfiltration or tank failure is imminent. System will pass inspection if the n is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pction if it is structurally sound, not leaking and if a Certificate of Compliance indicating tha is less than 20 years old is available. ❑ Y ❑ N (Explain below): r ' t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 every page. City[Town 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 roken, settled or uneven distribution box. System will pass inspection if(with approval of Bo of Health): ❑ broken pipes) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is remove El El El ND (Explain below): ❑ distribution box is I veled 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/Requiy the Board of Health: ❑ Conditions exist whicher evaluation by the Board of Health in order to determine if the system is failing toc health, safety or the environment. 1. System will passd 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 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1 2012 every page. Cityrrown 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 a orption system (SAS) and the SAS is within '100 feet of a surface water supply or t utary to a surface water supply. ❑ The system has a septic tank and S S and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank an SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has aseptic tank and SA and the SAS is less than 100 feet but 50 feet or more from a private water supply we Method used to determine distance• **This system passes if the well ter analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates abse and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provide hat 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 4 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goetz Co owner: Beth Christensen Owner Owner's Name information u edfor irls required Centerville MA 02632 March 1, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 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" r°no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is withi 400 feet of a surface drinking water supply ❑ ❑ the system is w' hin 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system i located in a nitrogen sensitive area (Interim Wellhead Protection Area—IW )or a mapped Zone II of a public water supply well If you have answered "yes"to ny question in Section E the system is considered a significant threat, or answered "yes" in Section above the large system has failed. The owner or operator of any large system considered a signifi nt threat under Section E or failed under Section D shall upgrade the system in accordance wit 310 CMR 15.304. The system owner should contact the appropriate regional office of the De artment. t5ins•11/10 Me 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 5 of 5 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 336 GPD t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 6 Commonwealth of Massachusetts .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goetz Co owner: Beth Christensen Owner Owner's Name information is required for . Centerville MA 02632 March 1, 2012 every page: City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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)): 2010=257 GPD • Detail: 2011= 197 GPD Sump pump? El Yes ® No Last date of occupancy: Current 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., c.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank presen . ❑ Yes ❑ No Non-sanitary waste discharged to he Title 5 system? ❑ Yes ❑ No Water meter readings, if avail le: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y� 114 Wild Goose Way Property Address Phillip Goelz Co owner. Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): y. General Information Pumping.Records: Source of information: No previous record found Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Site tube on truck Reason for pumping: Maintenance Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11110 Title 5Official Insp ection Form:Subsurface Sewage Disposal System-Page 8 of 8 r Commonwealth of Massachusetts Titre 5 Official Inspection Form Subsurface Sewage Disposal System"Form -Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known) and source of information: System installed 11/04/1999. Certificate of Comppiance on file at Board of Health. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): �rpn Depth below grade: 218feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction tine: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): i Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 11'X 5'X 4.5' 1500 gallons Sludge depth: 6" t5ins•11110 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 9 of 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goelz Co owner. Beth Christensen Owner Owner's Name information is Centerville MA 02632 March 1, 2012 required for State Zip Code Date of Inspection every page. Cityfrown D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 30" 811 Scum thickness . 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 4" Tape measure and dip tube. 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.): Inlet and outlet PVC tees in place. Liquid level at outlet invert. Tank was pumped and cleaned after inspection Riser bring covers within 6"of grade 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 scu to top of outlet tee or baffle Distance from bottom o scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 t, i Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 every page. Cityfrown 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 • y ❑ 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 Trtle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M •''� 114 Wild Goose Way Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name---- ------- ------- — ----- ---- information is Centerville MA 02632 March 1, 2012 eve _required for _ page. City/Town _ every p g 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 evid_� evidence of leakage into or out of box, etc.): One inlet, one outlet. Very light solids carryover. Liquid level at outlet invert. No sign of high water staining over outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump amber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 12 Commonwealth of Massachusetts w _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u sye'� 114 Wild Goose Way ._.------------------ ---- -------- ---------------_--------- ---- Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3- H2O units w/ 2.5'of stone. ❑ leaching galleries number: [❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS located and inspected with camera. Liquid level 2" below invert at time of inspection. No sign of past hydraulic failure. All unit located under driveway. 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 i Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s� 114 Wild Goose ----- Property Address Phillip Goelz Co owner: Beth Christensen _ Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 -------... ---._.....__- ------------ ------------------- every page. Cityfrown 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 hydraulic failure, level of ponding, condition of vegetation, etc.): 1, t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14 i Commonwealth of Massachusetts Title 5 Offidial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goelz Co owner. Beth Christensen Owner Owner's Name requiredfo is Centerville MA 02632 March 1,2012 required for every page. Cityrrown state Zip Cade Date of Inspection D. System Information (cone.) 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 33 "6 l ,' �`•� �.r�.�� a� Flo�S-Z.. 1 � 01 t5ins•11/1 D Title 5 Official In spection Form:Subsarface Sewage Disposal System•Page 15 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Wild Goose Way Property Address Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 .__..__-...__._._...._. every page. City/Town State Zip Code Date of Inspection D. System information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 1 feett e 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 1990 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: Test hole to 180" (elv= 8) below grade found no ground water(1990). Slope away from property drops below base of SAS. Accessed local ground water contours and topo mapping. —---._..------------- ---------- —-- - -.—..---------------- 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 16 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Wild Goose Way ' --- ------------------- Property Address ----�------------------------ Phillip Goelz Co owner: Beth Christensen Owner Owner's Name information is required for Centerville MA 02632 March 1, 2012 every 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 BARNSTABLE LOCATION I r�� C,cJ',1� �(,c�l,,;o SEWAGE# k'VILLAGE ASSESSOR'S MAP&PARCEL (6 7_ (59/-7 INSTALLER'S NAME&PHONE NO. QOP4 Z7 �,�s6 77(-4304 SEPTIC TANK CAPACITY LEACHING FACILITY.(type) W�D e) < ( .&1v%�s-GX3 (size) 3 - 5-0c> NO.OF BEDROOMS OWNER��.,r`, PERMIT DATE: COMPLIANCE DATE: cao 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)) T t 0 Feet FURNISHED BY� r �� , 3 o ®I ZONE: RO-I wN Area(min.)87,720 SF Frontage(min)20' Width(min)125' Setbacks y Front JO' Side 10' r ' Rear to, - I��I! 11IN, �^.4 FLOOD ZONE: •�"` Zane,AE El. 13)&x $M Cammun'ty Pone/No. - r y25001 C O56J J July 16,2074 - Y�7 :• LOCATION MAP: N� I ASSESSORS REF.: ,lames E. &6arbaro L.Murphy Mop 167 Parcels 047 N !~ JD494 OVERLAY DISTRICT.- -;a S85'08'12"Wgu;er-I AP-A f Protection District /- DIRECTIONS: / / f /./ / / , From Hyannis Fallow Route 28 West towards Centerville, joke o tin of the lights t onto l l / / h 4''ryry ti o// / f / / 'Ir 1/ , I Phinneys Lane; Continue straight at stop sign, c /� // / h A ro / , / I and then take a left onto Bumps River Rood, Take o left onto Wild Goose Way, Site is on cz y the left, #114. // (O' M CB/DH ;n ' , , f0 /r` Lot 9 / , // /'/ / /4 / FND 50 )od / I -'G+oje\ CBi�H / li 114 / a �• - / / , pd',Pi;7 — 1 t2 sty w/f /( a O sou Moran . l� I welllag / p i PP. F+��l_ I`r / P= / S�• u - - — �'. / /♦ZR O.P Y � i r 4-.,+��+ ~— / all, ` fa+ Erfb� OEM EAS /245.89/' BUFFER CALCULATIONS: •.,�1 , 1 / , ,/ / , / / / 0-50'Surfer: Proposed Deck=661 SF Janet Joslin Voute-Allen -7 I 1 ` 1' Mitigation Re4vire0=661 SF x J=2,646 SF NI'F / r / �/ //' ,' MI;gotioa Provided-Z665 SF PLANTING SCHEDULE: ®24-Sweat PePPerbush-5 Cal/4'O.C. 5-Swamp Rosa-5 col/4'O.C. J-Mountain Laurel-5 col/6'O.C. q }2-American Holly-4-5' REVISION: Incur orate Can Cam Plantin Recommendations 06 07 iB "W TITLE: Site Plan PREPARED BY: PREPARED FOR: NOTES: I) The property line informotion shown was Proposed Improvements Engineering& Philip Meany compiled from ovoiloble record information. m At inl� 2) The topographic information was obtained ~ 114 Wild Goose Way SuilivanConsulting,Inc. from on n the ground survey performed an y (508)4M3344•P.O.Box 659.7 Parker fbad,OsterAlle,MA 02655 04/MAYA. �► Barnstable (CentelVille) Mass. sed@su11i" ngin.c: •www.a1livarw4n.com 3) The datum used is NAVO '88. '1 Oroif:: CT' Field: WHK/C7R 20 0 10 20 40 80 �d DATE May 17,2018 SCALE: 1n'20r Review: JOD Camp.: CTR Project: 32010 Project: \ N Fee UCH rus THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes 0[ppricatiou for �Digogar 6petem Cori.5truction hermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address ocLot No. f f q Gvo►j o &tos g v/,y Owner's Name,Address and Tel.No. Tf}IW4 /111 U,<ril y Assessor'sMap/Parcel Crtk,Aj�� (l S� /! ��Ib (saoSr, -a-,Ay- Assessor's Installer's�N�rne,A dress,and Tel.No. 2-�a " Designer's Name,Address and Tel.No. n 0 G LM A�LTAJ> ky. Type of Building: Dwelling No.of Bedrooms Lot SizesiKta—sq.ft. Garbage Grinder(1JQ Other Type of Building ice - No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tanks� � Type of S.A.S. �fl Description of Soil LLk:ACS Nature of Repairs or Alterations(Answer when applicable) 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 operatio until a Certifi- cate of Compliance has been' d of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No.. '� �.; Fee THE.COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASS%ACHUSETTS Z(pprication for �Biopool *pgtem Con.5tructialY Permit C,r, Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or.Lot No. Lc.Jr D 10 6bc)S fr- Owner's Name,Address and Tel.No. 7�1r rs 119 U r IGgy Assessor's Map/Parcel �� icJlrC� �C�ISr w�g� Installer'®e, ddress,and Tel.No. Z Tea Designer's Name,Address and Tel.No. O(� wows T. 6-1 , /&-J,< so-'A/ Type of Building: Dwelling No.of BedroomL Lot Siz3z3 ? sq.ft. Garbage Grinder Al(� .Other Type of Building Lk No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow :3 n gallons. Plan Date Number of sheets Revision Date Title r Size of Septic Tank c ( t`"" Type of S.A.S. �O , Description of Soil _ (w"Lwk V.. (VN%M. t Nature of Repairs'orAlterations-(Answer when applicable) 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 operatio until a Certifi- _ Cate of Compliance has been ' s d of Health. r Signed Date C P Application Approved b Date Application Disapproved for the following reasons r Permit No. Date Issued ' - . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed )Repaired( )Upgraded( ) Abandoned )by Sf&U -1 - ,, at f v has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated_ Installer Designer The issuanc of i p •t . 11 not be construed as a guarantee that the0��!TVVIV op ass d ed. p Date Inspector � k , l xk -------------------------------- No. Fee�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS l Mi5po5ar *pgtem Construction Permit Permission is hereby granted to Constru )Repair( Upgrade( Abandon( ) System located at i 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 A TOWN OF BARNSTABLE Qy LOCATION SEWAGE # t I VILLAGE. ��lJi C ASSESSOR'S MAP& LOTJ.�7'6LV 7 INSTALLER'S NAME&PHONE NO.� T C=Si ill 'r�'�.l Z71 q�Ql SEPTIC TANK CAPACITY O 0 C. i 1 LEACHING FACELITY: (type) C 3)Size) 30i X )C2 .. NO.OF BEDROOMS BUILDER OR OWNER c N� PERMIT DATE: �`25 "91 COMPLIANCE DATE: Separation Distance Between the: ( a Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility `P 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 k 1 Feet Furnished by 1 SHE �n'i1 ,zf a7 SZh-'s :LZ --fi--d 1QZ MUD ` TOWN OF BARNSTABLE LOCATION (q 1� UD C=5EI WAy SE RGE# ' VuL,LAGE ASSESSOR'S MAP&LOT of—b47 INSTALLER'S NAME&PHONE NO.�� Cam,I a-( 77 SEPTIC TANK CAPAC= ISO 1 LEACHING FACII.PfY: (type) C 3 size) --zt � i X � cz NO.OF BEDROOMS S BUILDER OR OWNER MES, MOZT01 I PERMPTDATE: �� — l I COMPLIANCE DATE:_ '1"�9 Separation Distance Between the: f 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 lEdge of Wetland and Leaching Facility(If any wetlands exist o . within 300 feet of leaching facility 1 Feet Furnished by ft-( -33.S, �T o —5s -7-1 1 1;00, 6AL t4 — La s OOL -V -milk 1 i 'GOD 2Q ALL Cs,-,gmp ��. S�t�c�TO7\ i, TOWN OF BARNSTABLE �F TH E raw OFFICE OF Dsaa9TG.DL s BOARD OF HEALTH y MADa. °o 039. \em 367 MAIN STREET �c MaY►. HYANNIS, MASS.02601 July 21, 1998 James E. Murphy 1170 Route 132 Hyannis, MA 02601 RE: Lot 9 Wild Goose Way, Centerville A=167-47 Dear Mr. Murphy: You are granted variances on behalf of your client, Elizabeth Talerman, to construct an onsite sewage disposal system at Lot 9 Wild Goose Way, Centerville, Massachusetts. The variances granted are as follows: 310 CMR 15.405: To reduce the separation distance between the soil absorption system and the coastal bank to thirteen (13) feet in lieu of the required 100 feet separation distance. 310 CMR 15.405: To reduce the separation distance between the future reserve area and the coastal bank to ten(10) feet in lieu of the required 100 feet separation distance. These variances are granted with the following conditions: (1) The engineered septic system plan shall be revised to show the locations of the percolation tests performed and the location of the proposed water line. (2) The engineered septic system plan shall be revised to list both variances requested (as indicated above). (3) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board that the system was installed in strict accordance with the revised plans. These variances are granted because the applicant previously obtained the necessary permits to construct a septic system on this property. Unfortunately the most recent murphyl disposal works construction permit expired on March 28, 1998, three (3) days before the effective date of the newly revised State Environmental Code, Title V regulations. The septic system plans were recently revised to meet the maximum feasible compliance provisions of the State Environmental Code. It is the opinion of this Board that denial of the variances requested would cause manifest injustice in light of circumstances described here. Sincerely yours, Susan G. Rask, R.S. Chairman Board of Health Town of Barnstable SGR/bcs cc: t. Geiler murphyl �t Town of Barnstable Department of Health, Safety, and Environmental Services MST"B ' Public Health Division i639 �� 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health June 16, 1998 Arne H. Ojala Down Cape Engineering 939 main Street Yarmouthport, MA 02675 RE: Lots 9 & 10 Wild Goose Way Centerville, Ma Dear Mr. Ojala: I am in receipt of your letter dated June 12, 1998 and the attached plans. As you stated on the plans, variances are needed. Please complete the attached variance request forms, (one for each lot) and notify the abutters by certified mail ten (10) days prior to the hearing. Due to the latness of your letter and revised plans, and due to the abuttor notification requirement the hearing will not be scheduled on June 23. It will have to be scheduled on the next avaiolable date July 14, 1998 after 7:00 P.M. Sincerely yours, to!m�as McKean Director of Public Health Town of Barnstable TM/bcs `Ap. Wild ttti[ DATE: • 1 AABis, � � 1 ► f � own of Barnstable REC. eY ,6, PE EIVEO Board of Health JU N 2 3 1998 x�7 Main Street,Hyannis MA 02601 �Offi �. TV ce 508-790.62$5Susan O.Rusk,R.S. FAX. 508-790-61O4% Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE RED 1ST O M LOCATION Property Address: Lam" Pe-a-r-c L- 1 tXJ ,ao 5 t- L-j t—r Assessor's Map and Parcel Number: _ l�1 ��-�] Size of Lot: 'i Z-, -;i t-Z S r— Wetlands Within 300 Ft. Yes x Subdivision Name: No Business Name: APPLICANT � �`�-' '�`t� I CONTACT PERSON l Name: 1:t.\Zvr6ET1-t Name: -- ,�E-�> � • '`��+�� Address: 'I S (5 0—O t-a 0et L1 tje- lei Address: 1\-I- �� t 3 2 Phone: _ G Phone: l'ZI- FAX: FAX: VARIANCE FROM RE ,ULATION(List Reg) REASON FOR VARIANCE.(May attach irmore span needed) 15•4-0_ 5 ( I!� ) ( -1-11tr2 TRa�cSrC�.�.a 2yL,65 S.0051 _ t}-t r- Dec (to*be completed by office staff-person receiving variance request application) four (4)copies of plan submitted(including septic system plans and!or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) ariance request application fee collected(w fee for lifeguard modlfOhonnenenL,grntftnpV�nlncem+ �l7tevneo.nerAeateeonlrjabldt dining virisoce rcncwsls(fame owe,erAenee onlyl,rand vviD110 to repair fired M&ge dismal systems lonly if no expansion to the building proporedl) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED_ Susan G. Rask,R.S.,Chairman NOT APPROVED _ Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL_ Ralph A.Murphy,M.D. I let.(508)362-4541 939 main street rt 6a yarmouth port fax(508)362 9880 mass 02675 down cape engineering structural design civil engineers& land surveyors Ame H.Ojala P.E.,P.L.S. Timothy H.Covell,P.L.S. land court June 20, 1998 David C.Thulin,P.E. surveys Barnstable Board of Health site planning 367 Main Street Hyannis,MA 02601 sewage system Dear Board Members: designs The enclosed represents a filing for approval by the Board of Health for Lot 9, Wild inspections Goose Way, Centerville. Previously,the lot had been issued a Disposal Works Permit under old Title 5; the pen-nit has since expired and the Board has requested that a Title permits 5 `95 design be incorporated. The enclosed represents this. In accordance with Transition Rules Regulation 15.005 3(c), the system has been designed to the maximum extent feasible under 310 CMR 15.000 pursuant to 15.404 and 15.405. Under 15.405 1(g), a variance is being sought from the required setback to a Town-defined Coastal Bank . The system can maintain the minimum 50' setback to the State DEP definition of a Coastal Bank and therefore no variance is required. Due to site constraints, including topographic limitations and wetland location,this is the only area of the lot that a Title 5 `95 design can be reasonably incorporated. The Coastal Bank is heavily vegetated and stable; a work limit line of staked haybales and silt fence will be used to confine the work space and protect against any possible erosion. The vegetated wetland is greater than 100' from the system. We feel that by granting this variance under 15.005 and the system having been designed as required to the maximum extent feasible, the intent of 31.0 CMR 15.000 is upheld and that a level of environmental protection is at least equivalent to that provided under 310 CMR 15.000 is achieved without strict application of the required setback distance to the Coastal Bank. Thank you for your consideration. Very truly yours Arne H. Ojala,PE, PLS Down Cape Engineering, Inc. cc: E. Talerman Gil s� / Gctj tel.(508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 down cape engineering civil engineers& land surveyors structural design Ame H.Ojala P.E.,P.L.S. Timothy H.Covell,P.L.S. land court June 12, 1998. David C.Thulin,P.E. surveys Barnstable Board of Health site planning 367 Main Street Hyannis,MA 02601 sewage system Re: Lots 9 and 10,Wild Goose Way, Centerville designs Elizabeth Talerman and James Murphy inspections Dear Board Members: permits Enclosed.are revised plans for the above-referenced sites, in response to a Board of Health request during a previous hearing. The Disposal Works Permit has expired under old.Title 5. The plans have been revised to current Title 5 standards under "Transition Rules- 15.005",with maximum feasible compliance. A reduction in the required setback to both a DEP Coastal Bank and Town-defined Coastal Bank is necessary due to site constrictions. These plans are currently scheduled to be heard at the Conservation Commission meeting of June 16. We look forward to your hearing on June 23. Very truly yours, 1st �Amell Ojala,PE,PLS �f Down Cape Engineering,Inc. ` Via. cc: James Murphy _ JUN 12 1 Elizabeth Talerman 998 Abutters to Map 167, Parcel 47 44 Annmarie Murphy, 975 Bumps River Rd., Centerville 46 Elizabeth Ellen Murphy, 975 Bumps River Rd., Centerville 43 J. Douglas and Virginia Murphy, 111 Wild Goose Way, Centerville 48 James E. Murphy, 1170 Route 132, Hyannis, MA 02601 45 Janet J. Voute-Allen, 18 Ch. De La Grand Gorge, Geneva Switzerland Joe; ,3. 4 19 March 1998 FROM: Elizabeth M. Talerman TO: Town of Barnstable Board of Health RE: Disposal Works Permit 95-707 ---------------------------------------------------------------------------------------------------- To Whom it May Concern: I am requesting an extension on the above referenced Disposal Works Construction Permit for LOT-_9, 104 Wild Goose Way, Centerville (Assessor's Map 167, Parcel 047). I have an notice of intent pending with the conservation commission, and we are on the docket for April 22, 1998 for a second hearing. Obviously, I will pass the deadline for installation of the sewage system, since we are awaiting approval from conservation. We expect to receive this approval in the next several months. Sincerely, Elizabeth M. Talerman 1 2 3 ,4cy ROD VEU . MAR 2 0 1998 'OWNHEALTHDEPT.ABLE i i F$s..1.. THE H BOAALTHC F MASSACHUSETTS RD OII�- HEALTH 7— /.•v.l...... ............0 Avv iratiott for Diiivviial ltorkt,s Towitrurtion Fratit -` Application is hereby made for a Permit to Construct (t--)-'or Repair ( ) an Individual Sewage Disposal System at/• ......... ............ ...4............ - Locat n•-Address �ryc?15 . ........................................ ( .!.\1... (. or No. /• Ad ress G'�rJLqv3'2f / f , ............................................................................................... _ Installer Address - Type of Building Size Lot.32.. 312 Sq. feet .y Dwelling—No. of Bedrooms........... �........ .....Ex Expansion Attic P ( ) Garbage Grinder ........--••----- . persons.........................•-• Showers — Other—Type of Building ....-----•• No of erson � ( ) Cafeteria Other fixtures ....--.•-•••.............•--..........-••---••••............................_......................... Design Flow........,/Q .....gallons per person per day. Total dailyflow �?.................... Ions. r , Septic Tank—Liquid capacity./.470,0.gallons Lengths.':.rv../. Width,.44 �Diameter...-�......-- De th / // Disposal Trench—No. ................... Width O................ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../.......... Diameter..... . ........... Depth below inlet........6......... Total leaching area..94-.7...sq. ft. Other Distribution box (!-)— Dosing tank ( ) /'n ;. Percolation Test Results Performed by...C.'t.YP.VA;.,Q..L.v'oe". - ypJ Date..... ....�!!�..-./c.Q......... Test Pit No. l'G.2.....minutes per inch Depth o Test Pit... ..... Depth to ground water..IAV).e...L�JC. Test Pit No. 2. .2.....minutesper inch Depth of Test Pit....?T4?.��... Depth to ground water../7Q./.7C_0., 00 Description of Soil....;5.R.Yt.cy.!......... --#•---..�..eQA.....-...�4?..._...Ca.Q�...��...SGz.!ts��.....�C!.f�.�.sz,�.l. ....�o�i...�'.. ' 1...Z..o.•'...c.�lz�as�.... ...... `L ......... .............. ........................••----.......--•--......•---•.......... ..................................... 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.I:U; 5 of the State Sanitary Code— "The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beemissued by tile boardof health. Signed.0 iE :k. ��'�?� ...:2 ............... .. � .4i!isC� l 'r Application Approved B Date y 1 __ ?? ........................................ Date Application Disapproved for the following reasons: ........................................................................................... ... Permit No....,E. r•- ---... OZ �� D=�............« it ..................... Issued...�� -..........« Date .. THE COMMONWEALTH OF MASSACHUSETTS OARD�F jH�EALT� ^ ........../................. .Y....OF..... J./.. ..L..... .. ..`J. 1 ` ....,.....�. .......................... Tertif irate of Tomplitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....... /.........................................•---......................................................... _........................ ..«.......... at.. ..0 :'0 1....... .....� �.2. In I ... ..... ....... . . ........ ....� . �.. .... f has been installed in accordance with the provisions of T _ >of Tie/ ate Sanitary Co e as e- Eb to the application for Disposal Works Construction Permit No..... ��. -_--.__-_ dated..... j ..�... ............. THE ISSUANCE OF THIS CERTIFICATE SHALL E CQj UED AS A,yHAT T"T_THE. SYSTEM WILL FUNCTION SATISFACTORY. �✓ ll z DATE.................................................•--....................... . Inspector..................... ............................................................... THE COMMONWEALTH OF MASSACHUSETTS ! ' POAR OF HEALT (�.l<l/Y.II......OF.....`� ^ ............................... „`.' . .�... ..L Novaottl Vlarb Totuitrurtioit Funtit Permissioni hereby granted....................................................................................................................................... «.. to Constr ct Repai ( ) Individual Sewage Dis stem at No...... ........ .. .� --. ......-[li/ ...-... J/..... ..`t/• ...... .. .... ...•-......... as shown on the application for Disposal Works.Construction Permit No-/, ..,l� Dated....... ...�/�Q--_- ............................. ..BoardHealth I o r ® 46 v-- e LA-s o'T To _ � i• � ti� /� �` % Ili � NCO OE \W. 1. .� . I �y (� q•� � �� S— PPr- O, �TT rlo 1 7 _ o I lop N Ok/ 41 o \ o .'( // W I \ — '- I u o- ,,� 43 (, 6 ._ r �v. �F rt v9. Z -s 50 "'0'; r:LEn.I GLF.I,AI cone "a 5a�o rime PCOI I FEM4 G�Gnp�,{ppS 51 D .5A�9 L.�turiluveu WaTER IS LVAII�fStE. I I _ to �,o �.Plce YITG�(• I/+'/PR u�lt,e.s oTue2wlse, �lorEv. 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