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Home My WebLink About0173 WILLOW RUN DRIVE - Health i 'i 73 WiiioW Run Drive Centerville P 210 065 2' UPC 12543 No. 531_OH, HASTINGS, MN k c Commonwealth of Massachusetts 6210rd&S �o ,!A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 173 Willow Run Property Address v M� Murphy to , en Owner Owner's Name information is Centerville Ma 8/8/,19 required for every 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. Important:out forms A. Inspector Information filling out forms on the computer, j use only the tab Chad hathaway key to move your Name of Inspector cursor-do not HPS use the return Company Name key. P.O.Box 151 Company Address Forestdale Ma 02644 Cityrrown State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8/8/19 Inspector's ature Date The system inspector shall tays t a cop of this inspection report to the Approving Authority(Board of Health or DEP)within 30of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the ir and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems Information on care and do's and don't's can be found at town health dept or mass.gov 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/2 day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. 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 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No 'Last date of occupancy: current t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 r Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: owner pumps every 2 years Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �n =. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information:, Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 6' at tankfeet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): none t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 5.5'feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene , ❑ other(explain) 1500+500 gla RC If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 3„ Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 0 Distance from bottom of scum to bottom of outlet tee or baffle 0 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.): tees in place. no scum present t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form qi�W,P Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 173 Willow Run Property Address Murphy Owner Owner's Name information is Centerville Ma 8/8/19 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information '(cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form 4�o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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.): Solid no roots t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 10. 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 and alarm tested has weeping hole * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4 flow defusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): no. Dry at time of inspection 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form 1' a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �� 173 Willow Run u Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 I 22 3 od0 ❑.3 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 7 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 ❑ 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: system located inside large mounded wall top of mound 7.5' above pond level. bottom of SAS is 2' below grade leaving estimated 5' seperation from lake level to bottom of SAS Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville Ma 8/8/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked mm inspection® C. Ins p Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 R/D-Olo6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t,. GSM 173 Willow Run r Property Address Murphy Owner Owner's Nam 07 information is Centerville/ Barnstable Ma 7/2/2016 ml required for every page. City/Town State Zip Code Date of Inspection 41� 4D 07 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:When filling A. General Information onn the the out forms ��computer, q� use only the tab 1. Inspector: key to move your cursor-do not Chad Hathaway use the return Name of Inspector key. H.P.S. � Company Name P.O.Box 151 Company Address Forestdale Ma 02644 City/Town State Zip Code 774-274-2581 12866 Telephone Number License Number B. Certification I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7/2/2016 Inspector's r ature Date The system inspector shall bmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 ays 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. Citylrown 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: tank in good cond. no visable cracks or leaks pump chamber in working order. Dbox had root growth inside. roots were removed from Dbox and pipe going to leaching system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ti Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/Barnstable Ma 7/2/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/Barnstable Ma 7/2/2016 page. CityTrown 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 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/Barnstable Ma 7/2/2016 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- 1 0,000g pd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. Citylrown 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 y p c udmg the SAS, located on site? ❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 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? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)j: Detail: Sump pump? ❑ 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., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (coat.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner pumps every other year 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) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other.(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 6'at tank feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 5.5' feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 x 500 p.c Sludge depth: 2 t5ins-3/13 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 s. 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/Barnstable Ma 7/2/2016 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 23" 1 Scum thickness Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pump every 2-3 years as maint. to protect leaching Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. Cityrrown 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.): Dbox in good chape. had root growth that was cleared Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: flow defusers dry at time of inspection no staining to indicate past failure t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 flow defusers ❑ leaching galleries number: El leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 9 Pc. o D 0 � a3 i t � - fC, l 3 3y �4h 3 - It, � �4 / 19 "C t5ins•3/13 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 GSM 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 7'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: 1990S Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: system is in al large mounded area with a wall. top of mound is 7.5' above pond level. bottom of system is 2' below top of mound. leaving a estimated 5' of seperation Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 173 Willow Run Property Address Murphy Owner Owner's Name information is required for every Centerville/ Barnstable Ma 7/2/2016 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 a F �_. No. Fee 7HE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Z(pprication for M gpool *pgtem Comaruction 3permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. k Assessor's Map/Parcel e!/r - 514 — 14 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. •J� � .�.t�i.s ley �rz1�v�'.r✓ ' �® Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other TI pe of Building 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 Tank Type of S.A.S. Description of Soil Nature of epairs Alterations(Answer when a licable) Date last inspected: Agreement: The undersigned agrees to ens a construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions Tit 5 of the En iron al Code and not to place the system in operation until a Certifi- cate of Compliance has been is u this d Signed Date &4Y Application Approved by Date Application Disapproved for the following reason Permit No. Atr Date Issued No. _ Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS-1 � Zipphratton for Mi!6pogal *pgtem. Construction Vermit A Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. elk/73 Owner's Name,Address and Tel.No.,yGivn� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tef.-No.'" Gia xJ S IlGr//�.0 Al ' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. ' Garbage Grinder(. ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 3 Design Flow gallons per day. Calculated daily flow f l gallons: . Plan Date Number of sheets Revision Date Title f Size of Septic Tank Type of S.A.S. r : � I V y. -Description of Soil Nature of lRepairs o Alterations(Answer when a licable) ,00W Date last inspected: Agreement: The undersigned agrees to ens a construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions XTitjle 5 of the En ironme al Code and not to place the system in operation until a Certifi- y 1 cate of Compliance has,been is u b this and e s Signed �� Date f y APP1icaUon Approved b _ 1�tf ! :;. x� f r• x'rw r .�i�vt +ram Application Disapproved.for the following reasons �- r i' Permit No. �� Date Issued 1 / - -————————— .—-————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNStABLE, MASSACHUSETTS y Certificate of Compliance THIS IS TO C TIFY that the On-site Sewage Disposal System Constructed( ) Repaired Upgraded( ) r Abandoned( )by Vr, l n; , at 1 3 1/v; L o, f r rn Po has been constru ted in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No.Ddt)<<_ft b-7 dated 7 I.nsta-llerMt Designer r ` 'The.issuance f t 's permit shall not be construed as a guarantee that the s wff11 function - signed. Date pl�S( b Inspector l I fC —�—l ---- -------------------------- No. /h '� Fee v 7THE r COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE., MASSACHUSETTS Migozal *potem Congtrurtton permit Permission is hereby g ann e o Construct( )Repair( )U•gra e- Abandon f� i System located at ` � f . 1 ��. �/(/�=. l C:t/V ! 4,.P ' 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. 4 ` ' Provided:Construc 'on e e co 'leted within three years of the date of this per', it,. Date:_ `�/ / Approved by \ I� -� i I � � i_. z10 LOT a TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_ /�f� Lvl��d w -;�/? Owner's Name:_ A414," R Avtleh) ` RECEIVED 2. Owner's Address: Date of Inspection:_ ��! SEP z 8 2004 Name of Inspector: (pleasSErint ��j//,� �� TOWN OF BARNSTABLE Company Name: �.�,`f• �,+Jl/V! �� HEALTH DEPT. Mailing Address: �r e��s 4L-"1' q y z:- Telephone Number:,5-d6— 7 3cZ — 2VZ0 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: asses zP Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature Date: D 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 ,�/,�L'�1/�%'L TI�c ,,�fF/� G�9// ,�-f��i� �.� S��G ��✓�- .�1a.� �o�e,off ��f� Gv�s rl�,v .cam �•�i�rr�. ,� ,G'��l�i� 'Grs9s ��,nl fr' �r� Tf��u �/�- 71,��i o� �ir�� ****This report only describes conditions at the time of inspection and under the conditions of use a ? �71' r that time.This inspection does not address how the system will perform in the future under the same -15 ��sL� or different conditions of use. �lJ� 11/5C-�- //?fd,4-IV- M aw aw /,7 a ,Vz L i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_ ///-1 �IIAU Owner:_ y�• Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: zI 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 exists.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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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: the system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced Obstruction is removed ND explain: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART A CERTIIFICATION(continued) Property Address:_ �� /�I.� %ez"n Owner:_ b6e,/9 Date of Inspection:_ o//0ld' C. Further Evaluation is required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1) (b)that the system is not functioning in a manner which will protect public health,safety and the environment: _Cesspool or privy is within 50 feet of a surface water _Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. d .F _The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more _ from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: I - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_ /zr z 4ow 2 Un Owner:_ /5l A&XIVIV Date of Inspection:_ M®le�J D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ckup of sewage into facility or system component due to overloaded or clogged SAS or cesspo —4.�Ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool - �squid depth in cesspool is less than 6"below invert or available volume is less than'/Z day flow equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ Je'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. jZ 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 The system is within 200 feet of a tributary to a surface drinking water supply The system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B 7 ,CHECKLIST Property Address: Owner: Date of Inspection:_ �/®A 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 _ ZWere any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? tZ Has large volume 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 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,ethe 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: 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 CNIR 15.302(3)(b)J OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_ l7.7 &-V 1110Gv 2v'9 Owner: Date of Inspection:_ T FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): A�49. Number of current residents: _3 Does residence have a garbage grinder(yes or no):/r ? Is laundry on a separate sewage system(yes or no) [if yes separate inspection required] Laundry system inspected(yes or no): — Seasonal use(yes or no):—4!�l Water meter readings,if available(last 2 years usage(gpd)): "3.� ® I ��36css 2�1f 4/01P Sump pump(yes or no):4/,v o2002 - Ilk �t 3A3 Last date of occupancy .I � COMMERCIAL/INDUSTRIA Type of establishment: Design flow(based on 310 CMR 15.203): Up Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records / Source of information: M&Z ��49"I� Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM 1� /Septic tank,distribution box,soil absorption system / V50All- -Single cesspool �'��,2 � y� d�� _Overflow cesspool s _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate a e o all components,date' stalled(i o ) d source of information- - C1r ,� Were sewage odors detected when arriving at the site(yes or no :_ OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_ / �� /�� ;tv--.7 Owner:_ Date of Inspection:_ M/G )a/ BUILDING SEWER(locate on site plan) ) Depth below grade: it �t4e1/c-11e1, ;; 6 �� SZ;j0TfC- 56/7,� Materials of construction:_cast iron�Z40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condi ion of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) / y� Depth below grade:�j/ 6-' �101•✓ &7X&— 5� S/ /✓'C I644j (glV dR- Material of construction:tzconcrete_metal_fiberglass_polyethylene_other(explain) If tank is metal list age:_ is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: y/000 a,41 Sludge depth: ' O-2d Distance from top of sludge to bottom of outlet tee or baffle; Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet teg or baff'o�- = How were dimensions determined: i/� D Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid. levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete— — metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) erty Prop Address:_ /79 �l1I w �Z /1? Owner: Date of Inspection: 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:/ !—rUYG— Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage' to or out of box,etc.): /1� .pia �sJ PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEMINFORMATION(continued) Property Address:_ �� e/w!/w 12U"'? Owner:_ e�AtjML' Date of Inspection:_ J S SOIL ABSORPTION SYSTEM(SAS):Izoocite on site plan,excavation not required) If SAS not located explain why: Type Leaching pits,number:_ Leaching chambers,number: Leaching galleries,number: aAA5S 04,5 Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of veg!t,ption,etc.): / �2 B 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 or no): 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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_ 173 Z,& ac� �R v,' Owner:_ ^/ h 1 Date of Inspection:_ �l/0/� l SITE EXAM Slope Ye13 Surface water /VO Check cellar 1V6 Shallow wells ,MO -Bstimmed depth to ground water 7 feet S l/S&;ef (71 Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: c57s� Observed site(abutting property/observation hole within 150 feet of SAS) 1sC to Lo 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: M42 a4 �2—'tee -16c4 J .� 3 J/ r OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_/�✓ GU� I d Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. U�f V �j �9 el J n V V ® � 7 r 7 - c TOWN OF BARNSTABLE F1HEr0 OFFICE OF BOARD OF HEALTH seaasrssLa MAM e, 367 MAIN STREET ppA :639. `{b�' HYANNIS, MASS. 02601 �0 MAY r December 16, 1988 Ms. Ann R. Murphy 137 Willow Run Drive Centerville, Ma 02632 Dear Ms. Murphy: You are granted multiple variances from Title V, the State Environmental Code and Town of Barnstable Health Regulations, to upgrade an onsite sewage disposal system at 137 Willow Run Drive, Centerville. The variances granted are as follows: Regulation 15.03 (7): The separation distance from the leaching facility to wetlands will be 42 feet, in lieu of the required 50 feet (Title V) and 100 feet (Town of Barnstable). Regulation 15.06 (17): The invert of the septic tank will be less than one foot above groundwater. Regulation 15.13: The use of an impervious barrier to prevent break-out, in lieu of additional fill is authorized. The above variances are granted with the following conditions: (1) You must submit a revised onsite sewage disposal plan designed by a professional engineer or registered sanitarian. The plan must show the proposed leaching facility at least four (4) feet above the maximum height of the groundwater. (2) The dwelling cannot have more than three (3) bedrooms, one den, and one Study ruin. The den and study rooms cannot be utilized as sleeping areas. Enclosed porches, finished cellars, mudrooms, sleeping Iofts, and similar type rooms are considered bedrooms according to DEQE. (3) Garbage grinders are not authorized. (4) The onsite sewage disposal system must be installed in strict accordance to the final approved plan. (5) The septic tank shall be properly sealed against leakage. (6) The designing engineer must be onsite to supervise construction of the system and certify in writing to the Board of Health that his design has been strictly adhered .to prior to the issuance of a Certificate of Compliance. Ms. Ann.R. Murphy Re: 137 Willow Run Drive, Centerville December 16, 1988 (7) The septic system must be pumped every two (2) years by a licensed septage hauler. . This variance is granted because the existing system is located in close proximity to groundwater and is in all probability contributing to contamination of wetlands. Very truly yours, Grover _. __, Farrish; M.D. C;airman Board of Health Town of Barnstable GF/bs I BAXTER & NYE, INC. Professional Land Surveyors and Civil Engineers 812 Main Street/ Osterville,Massachusetts 02655 /Tel. (508) 428-9131 WILLIAM C.NYE,PIS.-President RICHARD A.BAXTER,PLS-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering May 19 , 1989 Town of Barnstable Board of Health P.O. Box 53.4 Hyannis, MA 02601 Re: Repair of Septic System 137 Willow Run Drive Permit No. 89-73 Dear Board: As per the Disposal Works Permit, I have conducted several inspections during the repair of the existing system. The system has been installed as per the approved plan. I trust that this meets your present needs. very truly yours, n Peter Sullivan, P.E. Baxter & Nye,Inc. PS/fmj cc: Henry Murphy, Esq. U IJL ` .li S � Y r� rt 1 41 MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS BA►XTER & NYE, INC. {I Professional Land Surveyors and Civil Engineers 812 Main Street • Osterville, Massachusetts 02655 • Tel. (508) 428-9131 WILLIAM C.NYE, P.L.S. -President PETER SULLIVAN, P.E. -Vice President-Engineering RICHARD A. BAXTER, P.L.S.-Vice President - January 10 , 1990 Town of Barnstable Conservation Commission Town Hall Main Street Hyannis , MA 02601 RE: SE3-1915 Murphy, Willow Run Drive Dear Commission : Please consider this request to issue a Certifcate of Compliance for the Murphy 's property at willow Run Drive . All work has been completed as per the approved plan . Specifically, the septic system was installed to the elevations directed by the Commission . I trust that this `Meets your present needs . Very truly yours , Peter Sullivan , P . E. Baxter & Nye, , Inc . PS/fmi vt% OF G <s KTER 6 SULLIVAN N No..29733 L EtiL�� MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS TOWN OF BARNSTABLE �fIRETp OFFICE OF t BOARD OF HEALTH i aaHx9TaELL POLO 387 MAIN STREET o, �Op i639• HYANNIS, MASS. 02601 December 16, 1988 Ms. AnneR. Murphy 137 Willow Run Drive Centerville, Ma 02632 Dear Ms. Murphy: You are granted multiple variances from Title V, the State Environmental Code and Town of Barnstable Health Regulations, to upgrade an onsite sewage disposal system at 137 Willow Run Drive, Centerville. The variances granted ' are as follows: Regulation 15.03 (7): The separation distance from the leaching facility to wetlands will be 42 feet, in lieu of the required 50 feet (Title V) and 100 feet (Town .of Barnstable). Regulation 15.06 (17): The invert of the septic tank will be less than one foot above groundwater. Regulation 15.13: The use of an Impervious barrier, to prevent break-out, in lieu of additional fill is authorized. The above variances are granted with the following conditions: (1) You must submit a revised onsite sewage disposal plan designed by a professional engineer or registered sanitarian. The plan must show the proposed leaching facility at least four (4) feet above the maximum height of the groundwater. (2) The dwelling cannot have More than three (3) bedrooms, one den, and one eCudy iuum. The den and study rooms cannot be utilized as sleeping areas. Enclosed porches, finished cellars, mudrooms, sleeping lofts, and similar type rooms are considered bedrooms according to DEQE. (3) Garbage grinders are not authorized. (4) The onsite sewage disposal system must be installed in strict accordance to the final approved plan. (5) The septic tank shall be properly sealed against leakage. (6) The designing engineer must be onsite to supervise construction of the system and certify in writing to the Board of Health that his design has been strictly adhered to prior to the issuance of a Certificate of Compliance. ., Re: 137 Willow Run Drive, Centerville December 16, 1988 (7) The septic system must be pumped every two (2) years by a licensed septage hauler. . This variance is granted because the existing system is located In close proximity to groundwater and is In all probability contributing to contamination of wetlands. Very truly yours, GroVer� __ Farri�h; M.D., ai chaff Board of Health rn�a�� Town of Barnstable GF/bs .I of 0 VT (9) REFRAME ROOF SECTION RE—FRAME ROOF SECTION (�>If Flo V) hs NO T 1 -T_ - «' ------ �TT TT ( T00) I EllfTN .:7 rc > LL!L T FT z esa FRONT ELEVATION tu_ ®_ SCALE: 1/4" V-O" t9B lu to 1 r SHEET M1� JCF3: 07IS PRAWN EM KW DATE: EV:20/07 0 Us) �= IL ,_11 IicuJ A 1L ADDITON ABOVE ADDITION ABOVE EXISTING FIR5T 5TORY1 EXISTING FIR5T STORY LT lnJf c<�� ((IL M� ! eiai' lc�j 01 FTF EllI! 1 I'w , I I I ( �� Ii i � u�I�l ;I \� an----- --- I Ih� i (ILI- FIT [+--ji FFH klF- 11 Ll [I L� qu -- — 4FLL, Z z 0- i p I. ADDITION I � fi au Q 3 REAR ELEVATION SCALE: 114" s V—O" 3 i ' SHEET r JOB: 0715 1 GRAWIV BY: KW . - - 11 DATE: 11/20/07 I ti O �l\� ; ADDITION RE-FRAME ROOF SECTION REFRAME ROOF SEC710N ZxO's Ib'O.C. - 2x10's Ib'O.C. I �fJi� q'o 2x10's 16°O.C, ADDITION /•,\ �� l� i'rt 17 2x0's Ib°O.G. r.�• lLY _ - --- C0 ao ji7U. - '� w -- z ADDITION ADDITION � lu LEFT ELEVATION R1G44T �ELEVA714N � tu SCALE: 1/41 - 1'-O" SCALE: 114' a V-O' 4 i f SHEET .I AB .CB: 0715 DRAWN BT: KW DATE: I I/�O/07 _ b 4 0 �VI ) 4'-4' 7'-8° Oil �.—.� (Q) PCG 2966 v 29 31.OW65 3/4° j 0 11CI I.a� I� 1 � ., fL l�FNM 2 o (u i�� 29 3/4� Ur a 1;4 N I LARRYS TJEN GREAT ROOM a l�� _t l 3 1/2x 3 I/_N 6/ TS 3 1/2x 3 1/2x 5/I i.S) - 1 a ,�,,�, ,1?•'1". ,. .. u.,.t, - - ---0-------- ,t (2) AWN 3S2 IOxFO 51 L 13f'T ABOVE FLU514 r P �EDRCOM #1 36 3/4°sQ9 3/4• U s I ( o0 0 2 FIRE 411 S7 - L 3g co I 6y '`1 2 1 o O O 01j ,k 'L A"rear O C O 4 ® I �' 2 �� I (3)(9 1/4• LVL AP 1 R . Exigrm4 STL 9M ABOVE o PTD 2953 _________ I I 1 13'-O' n 29 3/4■xS3 3/4° GARAGE KITCHEN el 2-4 PI"D 2959 GARAG I AT;4 #t 29 3/4°269 3/4• a s tti2corCo o ava —- all® I uw 1' 399 DINING III FOYE eo11� ( _ V ( III e lli J j Z3 a ICI �I�I 6eJ ax, ; 3.2 PAN-MY { I FORCH IL x Iv I O b I SHEET FIRST FLOOR PLAN A,4- , SCALE: 1/4' 1'-O" 'cB: 0715 DRAWN BY: KW 11 DATE: II/20/07 ' I I 1 0 Nf 23'-0• [� . 1 6'-5• - 6,_5a tl1_ba 11'-6' B'-O• B'-O' .1 vo r i! (06 L) L NEW RAFTERS � !+HOVE s 1-- - L- � 23 O•. -- 1 — _ SITTING ABOVENEW ERs u D -7 BALCONY _ z . (3) II 7/B' VL U-)SW ROOF BM U- �V (2) AWN 352R >r, CIO 3 I/Tx 3 1/=Y a/ j (3)11 7/B• LVL FLUSH ROOF 01'1 �.l OrCJ o CI Ts �� 38 3/4°x29 3/41 Llll w� yw m BEDROOM .#2 O[ 6� '....... EXISTING RAFTERS— ABOVE V IB'-2• z r 6'-II• _— ' �S w N of �",�I roll (0) - STUDY \ WS LL t — o Q WALK-INN —a '-'�� w B'_4. 1L I � o ... m ..., m s 'a m MASTER i 1 Ri 29 3/4°gSd 3/4• a2g 1I�J 2� aBATH .. , III I ". I 5'-B• ; :._... ,rr - - N a.,..:. .. i /1111 MOTIF 2A MASTER A (,l ENT. —r--- NBC-IN DESK3 I '` ,a��lr''; �i Z. BUILT-IN - — - j _--m �!4414, I4 j 1 �LAUNDRY Q II II II L ATTIC o STORAGE Z -- 3 SEAT = 4' KNEE'WALL 3; x :zxr vrr:vy•-„3 1/�a 311/2x 5/16 IL TS DORMER 6'-O• 10,�� 7'-01 12,_ • 12a_2� 15,_6. 63'-4• SWEET A5 SECOND FLOOR PLAN J05; 0716 ; SCALE: 1/40 P-0• DRAWN H7= KW ' DATE: II/20/07 ! I 1 - I i O 24'-0° g", KQ) ---- Q-- - - -- -- - 7777777777 -�l ILxrc vFxr Z _CWZM WALL ' I i'IATGbI 101XIO CONTINUS ACOT➢NG I _ OU EXISTING F1R5T FS-0CR v I�� 0�� i� NER1P1' IN 7iL— r:3i (7 1 NEW ti 8 W SPACE o VAPOR HARRIER L( ® CRAHL SPACE Pu TO Pu TO l 1 1 ... - 9TL Bt7 � _ � 3TL?3a Q .. ilil ACt3s (flo IU�j 1 flu) ExlsnNr. 2xldm i I6"O.S. G EXISTING EXISTINGpp EXISTING acl0'� y (2)4 tn° WOO® WO'm g # vi°C.G. - ® 9 ii°0.6. �. ALIGN UNDER POST DAtiN vt m Q E R0'!6vE EXISTING FIRMEPLACE TERRT REPLACE GEN =n EXISTING lu GARAGE FIX S� Q Z wasnNG lu !� CRAWL St''-A.Ca= QC�cAWL SPACE 9 1/2° DIA. STEEL COLUMN 801x30°xw GCNCRETE PAD �L ' � n r (2) 9 t/2° LVL's -j ALIGN UNDER ?CST OC IN n I o I I POW-W I I TOW V BELCH MCLISE TGSW SWEET FfJ'IJN ATION PLAN Ate/ 5CALE; 1/4" 1'-O" 0715 p DRAWN BY: KW ° DATE: 11/20/07 Y' �N gig 7. f DA e 71 � i � 0 - ' LOWER THAN EXISTING EXISTING PLATE HEIGHT III IN 74 3-0 A IA El15TING _ p _ iry � O \i M.4TCN EXISTING E ,4 t Hi I_r 'Ir HOFjo _ C o D M URPY 4 RESIDENCE E am 11E 1_ U P LDllH\ n ' ,O 'IC,M/=-1-F-2S: f 5EGTI®N5 c 7 } ASSESSORS REF.: I Map 210. Parcels 65 d: 66 f \ _ � A Y .j -02) OC / •�� i fir: `Beach Area �1.°c — \ OVERLAY DISTRICT: _ s - e qu-AP Aquifer Protection District ` I ! Cone Apriin _ — _ — — — — — — — �� ' \As Shown W l'Revised Groundwater titled Overlay Districts- - Apra, 1993 •� eF�" E- Stgre /�\ �OBrick 1!dk. �' , ..L Yam•'; R -c.'!`.i►+, sE-3-+065)6j LOCATION MAP: \ \......perScale 1 = 2000 . _ -._ J � FLOOD ZONE. - " f �0' \ ) Zone 8 dr C (see plan cp / �. _- �'' I Community Panel No ZONE.- .. / e 1250001 0005 C e mDeck Deck :�_ ` f y I August 19,.1985 Area (mRD-1 Fronts en(min) SF 20' \ \ Landward edge of proposed meadow elevation 37 yyd8, min) 125' coo °`z cii PROP Mow 2 times a year to height of 6 inches. Setbacks o .� c_ OSED ADDI77ON � I Front 30' o°i f +yR EX. DECK c ' / ` Side 10' c �" `'+: 173 PROPOSEDK ABOVE 3 Rear 10' �D w�e/y/ing FLOOR GABLESD �+ = r'»sr f7 PROP : DIRECTIONS: Q. (/ d E7-J6.82• PORED o I I I I From Hyannis - Take Route 28 towards Centerville; Take a right onto Old Stage Road and then bear right onto Shootfiying Hill Road; Take first right onto Great PROPOSED 1 ): / I I Marsh Road and then second left onto 5 PER l , l ' I Willow Run Drive; House is at the end, Walk / N/r f173..... Rogv S. g Ann L Brown \ / /� Sk.12597 PS256 j OFM.4S Stone Drive Q(\J •,-- _ ) I/ o` PETER G� SULLIVAN -i O� ,� w'''�� l _ Boat : i / _ 1 / CIVIL N \0 I F ---------------- - House : Eon off I G _ / No.29733 Rr� 0 �9 utaity ��.of _ .: 05 .li Pole _ --- O eck BenCl7lnOrlC:Top of Angle lron(fnd) Revised Plan Submittal Sheet E1.=36.76' (NGVD 29) / SE3r1683 Applicant's Name: Anne R.Murphy Project Location: 173 Willow Run Dave,Centerville This project was before a Public Hearing on 11/13/07. i Norms "er,ue°FM r WA=er ""E Site Fran L,nw mos"as lnbmbttt sham me Ulm�,Im CapeSury proposed Addition ,- o.oi d can MaJOW n- 810mm c M Anne R. MLgphy r aeon hgnp�v tiaNw.v°eeo...a 173 Mow Run Drill oS +a0A � ye at.w w meat At o hrn m m am Vdb Cmterlelb¢ uA 02632 RwDo o«L3012 nor ciao m-.sw im"ms r T babnw�,V.07,,,, .�..�... 173 Willow Run Drive i bam (Centerville) Mass. g S)ilr ihww u—d i NY.10 710.°end nwo. p .� FiAd e1R/IQr krdRevision:November 14,2007 Add mitigation meadow ° P Ps C.'W AID" VA TV SePh A2007 3rftF-- I Ruled a 0c„a 11