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0015 YACHT CLUB ROAD - Health
15 Yacht Club Road Centerville V A = 210 021 -- �- -- � - - - ter- - ---� ---- --- -- _- — - - --- - - - - — �OYft UPC 12534 • S No.2-1533LOR HASTINaS,MN 9 sav-) i Town of Barnstable Health Inspector �OpTHE tp� Office Hours y�P ti� Regulatory Services 8:30-9:30 Thomas F.Geiler,Director 1:00—2:00 &AIMST9ABr Public Health Division MASS. iG39. ♦0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: 6a 15 vo-"t'4 3-Address: Map� ® Parcel Name: Phone#:-7 l o— 0 .2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? Yv�o If yes, how many? 2c. How many bedrooms total are proposed at this roe (including the amnesty' unit ? property rtY � g amnesty' ) 2d. Please include a copy of the floor plans for the entire property- showiligithe exerting , rooms in the home plus the proposed amnesty apartment n or addition.Wlease label each room clearly on the plans. C t. � � 3. Is the dwelling connected to public sewer? or N,« 0= If the dwelling is connected to public sewer,skip questions#4 t ough#9 below. 4. Location of dwelling is INSIDE or SUTSI)D /�raZoneofCo tion to public supply wells? 5. Is'the dwelling connected to an ONSITE WELL or to P LIC WA ER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at.this property. Special Conditions: Signed: Q;/health/wpfiles/amnestyapp SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print lWitem 4 if Restricted Delivery is desired. ) . +V a` ■ Print your name and address on the reverse _ C so that we can return the card to you. C. Si ature ❑A.. •■ Attach this card to the back of the mailpiece, g or on the front if space permits. X - D. Is delive address iffe an AenN 1. Article Addressed to: If YES,enter delivery address below: ❑ No mil,e 6- TD Ced4L— 0. 3. S�erviType ;Certified Mail ❑ Express Mail t U ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. �p( 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number - 70o o I -3 0 000 Y (Transfer from service label) / J�J PS Form 3811, March 2061 Domestic Return Receipt 102595-01-M-1424 E'Ir-►c/— UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS li Permit No.G-10 i j • Sender: Please print your name, address, and ZIP+4 in this box • 1 Down Cape Engineering,.kit 93® Llain St. -- Suite C Yarmouth Port, MA 02675 I � t ffidl j i -7^ 1.i�flitlltli�f![rtlFlf f !!1�l�iltl�IfJf���fitlf !.t !Ifl - `,`� I� I ee s THE COMMONWEALTH OF MASSACHUSETTS Entered in compu Y s; . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASS A HUSETTS Zipprication for Migool bpetem Construction Permit 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. Ass! or's Mapes ape �1 �S 9 C jh (�/ /�v•� Installer's Name,Address,and Tel.No. CJ- Designer's Name,Address and Tel.No. 'gyp Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 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 L rrJ Nature of Repairs or Alterations(Answer when applicable) DESIGNING ENGINEER MUST VNSTALLATION AND CERTIFY IN 1 :7^ ,JTti",- r Date last inspected: THE SYSTEM WAS INSTALLED IN STF:i;T Agreement: ACCORDANCEE TO PLAN. The undersigned agrees to ensure t onstruction and maintenance of the afore described on-site sewage disposal system in accordance with the pro ions of Title f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be sued y f Health. �h' Signed � � Date f 1✓ Application Approved V Date Application Disapproved for the following reasons Permit No Date Issued CE . "�( ,y yaiar,k. 1s " e ' ' t THE COMMONWEALTH OF M%�SSACHUSETTS Entered in computer: r �;x Yr �,, PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLE., MASS CHU'SETTS - Z(ppricatton for Miopogal *pMem Con.!5truction 3permif Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual'Components Location Address or Lot No. \ wner's Name, Adddress, nd Tel.No 7 7, 4 9 Assessor's Map/P e,I �_ a ('/�� �N c�G1 r-� 7� � e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. w ' �_�)IS fc7Cc,l7`icJ ��'nS✓' C� Jam,,__ ��i� ���-`�-prr''`'r�l�""� 3 AM` OpG �J ''Type of Building; ' t Dwelling No.of Bedrooms Lot Size f` sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures -� DesignFlow gallons per day. Calculated daily flow g p y y _ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ' Description of Soil S L Nature of RepairsrAlterations(Answer when applicable) ✓ 'f SE'�J✓�� C `-1 �s Date last inspected-.- Agreement: The undersigned agrees to ensure onstruction and maintenance of the afore described on-site sewage disposal system in accordance with the prov• ions of Title K ofof the Environmental Code and not to place the system in operation until.a Certifi- cate of Compliance has be�n s`u_ed y�r1i Bo f Health. Signed �J_ ►�.i+ Date "o Application Approved b, \ Date t/I Application Disapproved for the following reasons e �r °* Permit No. 2 L 2 3 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 at 1410/'a h��U� �44/7 Ii e-al 11'P i'n 5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.'16 .?- 77 L-/ dated -3 Installer }-1 I i 1 1&-c-L , f 6A Designer ��;✓� ��,�i° 1. �,,� �s �'C' , i +' The issuance of this per it shall not be construed as a guarantee that the system wwill function as designed. Date Inspector ^� — � No. �_�� 2 2 3� Fee 4,;0 ' THE COMMONWEALTH OF MASSACHUSETTS-"NUN, a L 1r, PUBLIC HEALTH DIVISION — BARNSTABLE., MASSACHUSETy� �� TB�„ ME SYST`1/I r,cco WAS INS LEDf'•7 ll 17+T.":_:'TMtgaar *pgtem Conotrurtton Wr Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at I C. U Gi cl,J- 0/lr( /3 R c efd�. r,0,7 sr s/, /1�4 117 `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: p/ A.1 Approved by ��—�.'``' TOWN OF BARNSTABLE LOCATION 15 YACHT CLUB ROAD, CENTERVILLE SEWAGE # 2002-234 VILLAGE CENTERVILLE ASSESSOR'S MAP &LOT2- 0 INSTALLER'S NAM$&PHONE NO._ELLIS B ROTHERS OONST. CO.. I SEPTIC TANK CAPACITY I o o LEACHING FACILMY: (type) (0 500 C 5 a (size). NO.OF BEDROOMS BUILDER OR OWNER RICHARD FIRTQK PERMIT DATE: 6/3/0 2 COMPLIANCE DATE:_?����d X Sep ation Distance Between the: '' um Adjusted Groundwater Table and Bottom of Leaching Facility Feet "vate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by g A_ J7 ' -2- a3 i TOWN OF BARNSTABLE � LOCA`'&ION 15 YACHT CLUB ROAD, CENTERVILLE SEWAGE # 2002-234 VILLAGE' CENTERVILLE ASSESSOR'S MAP &L01210/21 INSTALLER'SNAME&PHONE NO. ELLIS B ROTHERS OONST. CO. . SEPTIC TANK CAPACITY i e LEACHING FACILITY: (type) ' 0 1> -� 5 (size) NO.OF BEDROOMS G BUILDER OR OWNER RICHARD Ff RI .K PERMIT DATE: 6/3/02 COMPLIANCE DATE: 7L.5-14 9- Sep ation Distance Between the: , aI*um Adjusted Groundwater Table and Bottom of Leaching Facility Feet 'vate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Y• Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by .d a3` V-7 i 4. Itte Town of Barnstable `k Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. May 30, 2002 Mr. Arne H. Ojala, P.E., PLS Down Cape Engineering, Inc. 939 Main Street, Route 6A Yarmouthport, MA 02675 RE: 15 Yacht Club Road, Centerville, A = 210-21 Dear Mr. Ojala, You are granted a conditional variance on behalf of your client, Richard Elrick, to construct an onsite sewage disposal system at 15 Yacht Club Road, Centerville. The variance granted is as follows: 310 CMR 15.405, State Environmental Code, Title 5 (Maximum Feasible Compliance): la To reduce the separation distance between the soil absorption system and the property line to four (4) feet in lieu of the required ten (10) feet separation distance. This variance is granted with the following conditions: (1) No more than six (6) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The septic system shall be installed in strict accordance with the engineered plan dated March 15, 2002, signed by the designing engineer on March 20, 2002. , (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted Oj ala6 e w plan dated March 15, 2002, signed by the designing engineer March 20, 2002. This variance is granted because the physical constraints at the site severely restrict the location of the soil absorption system due to the small size of the property. It is the opinion of this Board that the proposed new soil absorption system is designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sincerely yours, Susan G. R , R.S. Chairperson Ojala6 �OF THE T DATE: • FEE: ' • BARNSrABLF- MASS. 9qj i6g9• ,0� REC. BY Town of Barnstable SCHED. DATE: Board of Healt.h. RECEIVED 367 Main Street, Hyannis MA 0 601 APR 1 9 2002 Office: 508-862-4644 Susan G. k,RS. FAX: 508-790-6304 Sumner ufman,M.S.P.H. TOWN OF BARNST�� Murphy,urphy,M.D. HEALTH DEP VARIAINCE REQUEST FORIM LOCATION Property Address: Assessor's Map and Parcel Number: 010 21 Size of Lot:_ .19 1 rj Wetlands Within 300 Ft. Yes Business Name: No_ G� Subdivision Name: APPLICANT'S NAME: �1p Phone Did the owner of the-Rroperry authorize you to represent him or her? Yes *4 _ No PROPERTY OWNER'S NAME CONTACT PERSON Name: �tGN-o.2b EL-R-14-k--- Name: �—;;A-ez�y_ 0--7scj.Ak. Address: _15 yam+' GL-44 3 2� C4=&j Address: her.r Ok3�/ �S� �t4a✓ cif` �i Phone: Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) I S.40 5 l a. t>..�-n o NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System Checklist(to be completed by office staff-person receiving variance request application) _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans sui.-mirted(e.g.house plans or rest,ur tit hitcher,plans) Signed letter stating that the property owner authorized you to represent him/her for this request 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 variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals(same owner/leasee only],outside dining variance renewals(same ownerileasee only],and variances to repair failed sewage disposal systems (only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meering 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. Q:/WP/VARIREQ tel.(508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 down cope engineering civil engineers& land surveyors structural design Arne H.Ojala P.E., P.L.S. Daniel A.Ojala,P.L.S. land court March 25, 2002 Timothy H.Covell,P.L.S. surveys Barnstable Board of Health site planning 367 Main Street Hyannis, MA 02601 sewage system Re: 15 Yacht Club Road, Centerville designs Dear Board Members: inspections The enclosed represents a"Maximum Feasible Compliance"filing for a septic upgrade from an existing older Title 5 septic system which failed a DEP certified permits inspection, conducted for an impending real estate transfer. No addition of habitable space is proposed. The following variance is requested: 15.405 (la): Reduction in SAS setback to the (southerly) property line (10' to 4'). Due to the existing number of bedrooms and the size of the lot, the variance is necessary in order to maintain the requisite distance to the foundation. We are also able to avoid having any portion of the system in the driveway. We feel that by granting the lot line variance, the same degree of environmental protection can be attained without the need for strict adherence to Title 5 regulations. Thank you for your consideration. Very truly ours, Arne H. Ojala, PE, PLS Down Cape Engineering, Inc. cc: Richard Elrick ABUTTERS LIST FOR ELRICK MAP 210/21 MAP 210/20 PETER & DIANE EAMES 3 YACHT. CLUB ROAD CENTERVILLE, MA 02632 MAP 210/22 ROBERT & LOUISE EGAN 15 INDIAN TRAIL CENTERVILLE, MA 02632 MAP 210/23 RUTH RODERICK, JOHN RODERICK, BRIAN RODERICK 27 YACHT CLUB ROAD CENTERVILLE, MA 02632 MAP 210/49 ALISA PAKSTYS 54 HAWKTREE DRIVE WESTWOOD, MA 02090 MAP 190/170 PAUL & MICHELE GERETY 40 CEDAR ROAD (OFF FOREST STREET) MEDFORD, MA 02155 =f tel.(508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass02675 down cope engineering civil engineers& land surveyors structural design Arne H.Ojala P.E., P.L.S. Daniel A.Ojala, P.L.S. land court Timothy H.Covell, P.L.S. surveys April 16, 2002 Richard Elrick site planning 15 Yacht Club Road Centerville, MA 02632 sewage system designs Dear Mr. Elrick: A public hearing has been scheduled for the Barnstable Board of inspections Health to take action on a request for a variance from a Barnstable Board of Health regulation for the proposed septic system at your home. The variances requested are as follows: permits Title 5, Maximum Feasible Compliance, 15.405 (la) : reduction in setback to property line for leaching facility, 10' to 41 . Said hearing will be held in the School Administration Building Basement Conference Room, off South Street, Hyannis, May 28, 2002, at 7:00 pm. Please check with the Health Department to confirm date and time. Sincerely, Sarah B. Ojala Down Cape Engineering, Inc. cc: Abutters file Barnstable Board of Health RICHARD D.ELRICK A i IORNEY Al LAW 15 YACHT CLUB ROAD CFNTFR VIT.I.F..MA 02632-2465 TELEPHONE(50R)T7511984 FAX(509)771-5409 Email xWck@aabLcom April 9, 2062 Down Cape Engineering 039 Main Street Yarmouth Port,A-La 02675 To Wbom It May Concern: Please except this letter as my authorization for you act for me before the Barnstable Board of Health regarding my septic upgrade, Sincerely, iz� Richard D.Elrick I i s 30r • :34AC : C �.23ACMgl 7O tti �� 10 ® RED WING TRAIL N 1 ` rg zza 404C 0 33 4 = o iltr wow �v '� .184C .19 C 4f + f POND s ` 4C ® �o4C s 3t © © n ,3 314C 4 ti I 1 C .32� c 0 I, ry )• 93 a019 •f 41 8 h0 4 Y '7 -� Y • I0e h�0 of ` •2�4C 90 a� .3sac ®39 �® 214C o 40M,Ov7 194C v 44 4•22 ® •1 1� 4. 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Signature ■ Attach this card to the back of the mailpiece, X ❑Agent or on the front if space permits. ❑Addressee 1. Article Addressed to: D. Is delivery a dress different from item 1? ❑Yes If YES,enter delivery address below: ❑ No 3. Serviga-Type I Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. O�v( 0 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ?000 /C?0 o0o /� (Transfer fromservicelabe ! 14 t f! 111111 ' ,44 ,ltfill". l+ PS/Focm 811, March 2001 Domestic Return Receipt 102595.01-M-1424 f UNITED STATES POSTAL SEE rf �� +rst-.Class Mail =P.ostage,&—FefRaid IJ.E Y off" Permif No.G=10 �.:. . • Sender: Please pri e, add ress-aW'd Zi-PgT47In h s'oX- Down CaN Engineeffig, W. 939 Main St. -- Suite C Yur rnouth Port, MA 02675 . 7 i I • 3p j ( y g i - y j g p i flf!ifimd!If SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. to f Delivery item 4 if Restricted Delivery is desired. ��rl J 2 ■ Print your name and address on the reverse so that we can return the card to you. C. Signature ■ Attach this card to the back of the mailpiece, ❑Agent or on the front if space permits. �' "'¢ ❑Addressee D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No ci 3. Service Type El'106rtified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number '>��O 1,,W 000 a (Transfer from service label' r( (t,t J j = 11 PS FPrm.38 1, March 2001 Domestic Return Receipt 102595-01-M-1424 L_�l ��,Cl4 ii 1 Y i�i �i+ s t iS UNITED STATES POSTAL SERVICE! First-Class Mail f0 Postage&Fees Paid LISPS y ,; Permit No.G-10 • Sender: Please print your name, address, andllr+ iri�f�s box• — �' Down Cape Engineering, Inc. 939 Main St. — Suite C YarffWh PW,.MA 02675 li r- _ itI{{?I.tale{fl3l{ii{iI{I{ {{CIS'{{II{{{ii {I!{;{fil:!{?IIIIi?!. 1 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) 7B7at of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. C. Sign re N Attach this card to the back of the mailpiece, X ❑Agent ! or on the front if space permits. ❑Addressee D. s delivery address diffe from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery a dress below: ❑ No i� zn06 u 3. �SServic��e Type - 6i ertified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑yes 2. Article Number ' 7�00 J�30 000(J 19RA sx�/ (Transfer from service label) / PS For 38V, March'2001111 11 11 I Domestic Return Receipt 1 11 11 11 ' ➢ 1 102595-01-M-1424 III �L �r7�C � ti } , t�ii it tilit� UNITED STATES POSTAL SERVICE First-Cla$s Mail I Postage&Fees Paid c USPS Permit No.G-10 . 1 • Sender: Please print yourname, address,and ZIP+4 in this box • f Down Cape Engineering, Inc. AA n St. -- Suite C II I ygrnla th Port, AAA 02675 � a� i ..... •` 'Ifi(l!!!i11.Il11!l11111111I:l1:7111l111}11diJl!j llit!li1jl1!-j I A 1 d DATE: 1 2/31 /01 _-- PROPERTY ADDRESS5 -Yacht Club Road --------------- Centerville,Mass. ---_--------------------- 02632 ------------------------- On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -1500 gallon septic tank. 2 . 1 -Distribution box. 3 . 2-1000 gallon precast leaching pits, . Based on my Inspection, I certify the following conditions: 4 . This is a title five septic system. ( 78 Code ) 5 . The septic system is' in hydraulic failure. --6 . A new leaching area needs to be installed. 7 . The septic tank is fine. 8 . Two pit covers were broken. 9 .' They have been replaced. SIGNATURE:- Name:_ IW_ �PON_ Company: Jose.2h_P . Macomber_& Son , Inc . Address: Box 66 Centerville , Ma . 02632-0066 Phone: 508_775_3338______- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 • c� �--\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL. PROTECTION r TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 Yacht Club Road CentervillefrlaGG _ Owner's Name: Ri chard P1 ri ck Owner's Address: camp Date of Inspection: 12/31 /01 Name of Inspector: (please print) J.P. Macomber Jr. Company Name:Joseph P. Macomber & Son Inc Mailing Address: P_0= Box 66 r nt-prxi17le Ma 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I cenify 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: Passes Conditionally Passes Beds Further Evaluation by the Local Approving Authority ✓ F ils Inspector's Signature: Date: The system inspector shall s mit a copy of t nspec his ition report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ""This report only describes conditions at the time of Inspection and under the conditions of use at that time. This inspectiondoes not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Nee 2 of 1 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Yacht Club Road en ervi e, ass. Owner:Richar E ric Date of Inspection: 12 31 0 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes. I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 17304 exist. Any failure criteria not evaluated are indicated below. Comments: The two leaching pits are in hydraulic failure. A new leaching ., - area needs to be instalied. B. System Conditionally Passes: Nd 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. .116 The septic tank is metal and over 20 years old* or the septic tan};(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: 4/46 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: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Yacht Club Road Centerville,Mass. Owner: Richard Elrick Date of Inspection: 12/31 /01 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: ,la The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or rributary 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. 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 I QP feet bu 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: J 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:1 5 Yacht Club Road entervi e,Mass. Owner:Richard Elrick Date of Inspection: 1 2/31 /01 D. System Failure Criteria applicable to all systems: You must indicate "yes" or"no" to each of the following for all inspections: Yes No ackup 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 4 _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ; Il ,41N,4` _ squid depth irLcesspacl-ts less than 6"below inverti or available volume is less than h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped y portion of the SAS, cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary ro a surface water supply. y portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (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 d' the system is within 400 feet of a surface drinking water supply - t th system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive a _ — _ Y g area(Interim Wellhead Protection Area IWPA) or a mapped Zone 11 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 eves" 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 i 5.304 The system owner should contact the appropriate regional office of the Department. 4 „Page 5 of I I , OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 Yacht Club Road en ervi e,Mass Owner: Richar E rick Date of Inspection: 1 2 31 01 Check if the following have been done. You must indicate"yes”or"no"as to each of the following: Yes Now �/ 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 faciliry or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out ? Were all system components,**wluding 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: Yno . / Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Pafe 6 of 1 I ; OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Yacht Club Road Centerville,Mass. Owner: Richard Elrick Date of Inspection: 12/31 /01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): b DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): 91527r Number of current residents: Z_ Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or no):;U� [if yes separate inspection required] Laundry system inspected(yes or no): �y Seasonal use: (yes or no):44"5 !' Water meter readings, if available(last 2 years usage Sump pump(yes or no): .11�� �" `— Last date of occupancy: , COMM ERCIAL/WDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): dW Grease trap present(yes or no): V0 Industrial waste holding tank present(yes or no):N,$ Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use:X9 OTHER(describe): zj/f GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): ' If yes, volume pumped: 0 gallons-- How was quantity pumped determined? A Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box, soil absorption system Single cesspool ,VP Overflow cesspool 4Z Privy Z9 Shared system(yes or no)(if yes, attach previous inspection records, if any) 14J Innovative/Altemative 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): fiJ Approxim to oe of com on nts date in tailed (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):, 6 • Page 7 of I I k ' OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:l 5 Yacht Club Road Centerville,Mass . Owner Richard Elrick Date of Inspection: 1 2 31 /01 BUILDING SEWER (locate on site plan) Depth below glade: Materials of construction: cast L, �'40 PVC 4Vother(explain): tip Distance from private water supply well or suction line: XP l'' Comments (on condition ofjoinu, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage. The system is vented tzolcate rough the house vents:: SEPTIC TANK: on site plan) Ai Depth below grade: 1� Material of construction: ccncrete.dd metalA_fiberglass,!f Polyethylene ,lJ4)oiher(explain) VI;F If tank is metal list age: !40 Is age confirmed by a Certificate of Compliance (yes or no): (anach a copy of cenificate) f c ^ T Dimensions:��_ V�O ��QJll� Sludge depths iJ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance hom top of scum to top of outlet tee or baffle: 7 Distance from bonom of scum to 'bonom of outlet tee,,or baffle: A61 How were dimensions determined: �1 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inven, evidence of leakage, etc.): Pump the septic tank every 2-3 years.Inlet & outlet tees are in place.The tank is structurally sound and shows no evidence of leakage.Liquid level at the outlet' invert is 51 GREASE TRAWke(locate on site plan) Depth below grade: Material of consmuctionyA concrete-WOmetalW4fiberglass e,6olyethyleney�other (explain): Dimensions: Scum thickness: Distance from top of scum. to top of outlet tee or baffle: Distance from bonom of scum. to bonom of outlet tee or baffle: Date of last pumping: Comments (on pumping recomme:dations, inlet and outlet tee or baffle condition, structural integrity, liquid IeveLs as related to outlet inven, evidence of leakage, etc.): Grr- GP t-ra}) is noel—resent. 7 Page 8 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:1 5 Yacht Club Road en ervi e, ass. Owner: Richard Elrick Date of Inspection: 12 31 TIGHT or HOLDING TANK4&E.(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: QA Material of construction: 04 concreteA ld_metal fiberglass& Polyethylene_other(explain): A114 Dimensions: Capacity: gallons Design Flow: _ 4JX gallons/day Alarm present(yes G{�or no): Alarm level: -�ILII_ Alarm in working order(yes or no): Date of last pumping: 'ItIll Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not 2resent DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: A0 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.): Distribution box has two laterals.There is evidence of solids _carry over.No evidence of leakage into or our or the box. PUMP CHAMBER,Ck(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.): Pump chamber is not present 8 Page 9 of 1 1 • OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 5 Yacht C1__ Read CenterVille�c. Owner: Richard F�_1_xi rk Date of inspection: 19./ 1 r n 1 SOIL ABSORPTION SYSTEM (SAS): zoocate on site plan, excavation not required) 2— stone; Both leaching pits are in hydraulic failure. A new leaching area ne4 If SAS not located explain why: to be installed. Loc Type rd�X10 leaching pits,number: ji AZj!� leaching chambers, number: D leaching galleries,number: A4 leaching trenches,number, length: O leaching fields, number,dimensions: D overflow cesspool, number: V - innovative/alternative system Type/name of technology:/%—y rl'/ 7d f!; Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to boney fire sand Both leaching nits are ; n hydraulic failure A neG> 1 oac:hing area net�s to be ; ns -=l l ed CESSPOOLS 4L)a(cesspool must be pumped as part of inspect ion)(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.): Cesspools are -not- PRIYYA�4/ (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.): Privy is n 9 Page 10 or I I � R OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Yacht Club Road en ervi e, ass . Owner: Richard E rie Date or Inspectioo: 1 2 31 01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch or the sewage disposal system including tics to at least two permanent rererenee landmarks or benchma.rks. Locate all wells within 100 rect. Locate where public water supply enters the building. o S W4►aR1.tNf C 8 3 O 4 D A I- l�% 2- 23 'z- Iq I 3_ �9 , 3- 1 y- 34, Lt. 21' G 5- 2-2' 10 Page 31 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:1 5 Yacht Club Road Centerville,Mass. Owner: Richard Elrick Date of Inspection: 1 2/31 /01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�_feet Z ' dicate (check)all methods used to determine the high ground water elevation: tained from s si lans on record - If checked,date of design plan reviewed: I Please site abutting prope bservation hole within 150 feet of SAS) ecke with local Board of Health-explain: TA1� 0 Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used: Gahrety & Miller made.1 12 16/94 Ground water_eleyati nn above sea level . USGS; Observation Well Data_ .Tune 19Q2 USGS; Annual Ranoae of Grnund Water Elevat;i January 1992 92-000-1 Plate#2 Leaching Pit ,eet Groundwater: t=ee( Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom 1 Of the leaching pit and the adjusted groundwater table is feet. 11 �.rrn l'+r.—n'1'If'1•T�♦rnrilR'nl.nrrTn+tnrnrR7.-rsTrl�rf*Rmn rern�t*r�'�rrYf 1fT .rn-7TT-fir--...•,,— TOWN OF Barnstable BOARD OF !HEALTH 311113URFACF SFWACF DISPOSAL ,SYSTEM INSPECTION FORM - PART D •- CERTIFICATION t•'1^T••••..!—�.I I.^�7•T.1R I'NI'n.'Hr1 TT]fTTI T1'7'11'r!.'t rltRR'71RT^-�T'IR'wr Af�R111�'A'1R7 InI1 n -TYPE OR PRINT CLEARLY- PI?OPERTY INSPECTED STREET ADDRESS15 Yacht Club Road ASSESSORS MAP , BLOCK AND PARCEL # 1� OWNER' s NAME Richard Elxick PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME Joseph P. Macomber & Svn Inc COMPANY ADDRESS P.O. Box 66 Centerville Ma 02632 Street Town or City Stat• ZIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1 578 R CCRTIFICATION STATEMENT I certify that I have personally inspected the sewage diaposa7 system at this address and that the information reported is true , accurate , and omplete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one ; System PASSED The inspection which I' have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe environment as defined in 310 CMR 15 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of d this form , I' System FAILED* r \ The inspection wllicli I have con acted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspecti orm , • Inspector Signature Date copy of this a ,ification must be provided to the OWNER, the BUYER one Where applicable and the BOARD OF HEALTH, * If the inspection FAILED, the owner or•"•operator shall upgrade he ayste within one year or. the date of the inspection , unless allowed or t requiredm otherwise as .provided in 3.10 CMR 16 . 305 , partd . doc g 75 fee-f' ►� �,m UP 5 Q�v�oa do C ho�e�S ¢Ckcn ' t =r?.� � �r� • /on.r- /YKQ ,'o -kouse L � v ',70 .0 r f 35 �t y ,_,3� ��r t o 0'k2 d-Q -e C-40 r--i- z I-kAO 70 G(os�l of 1��_i•��-?.sty � ,�{�;i:t - �, i Q �. J _ _ — Y s a ana 10 q,5 NP •�, back �— i; p 4Q Cni !� fl�r� �Q� a�-�• - ,fig? CD u THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......... ................................OF....................---------..........-------- ..................................... Appliratinn for Disposal Works Tonstrnrtiun amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ---•----_•- -•,----.dark�104I.&e)----------------------------------------------------------------•--••--•......---------- ._-------•Location-Address _ --_••-.-•••or- Lot No. IM; *....*................................................................................................ Address Installer Address d Type of Building Size Lot...........................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) A4Other fixtures ---------------------------------------•----•--------------------------------------•-----_ W Design Flow............................................gallons per person per day. Total daily flow.......................................:,...gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__._____.-_._._. Depth................ x Disposal Trench—No.......:............. Width.................... Total Length.................... Total leaching area...........`_.......sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) a 'Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------ --------- x �uof Description of Soil .�. �t ... . . WF� e i x / 17 fi ao a U Nature o R p rs or Alterations—Answer when applicable... ______/!J___.__.___._._..._._........._.___.._.._..__........_. ------------ - -.l �r ---------------•------------------------...........----•--------------------------••-•-------•----------....•--- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'L U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued(bb board of heal h. Signed--- . -� ----------------- ..r � Date Application Approved By....... . .......--•---..._ . --- --•...::.................... �-�g 45?s.... Date Application Disapproved for following reasons---------------------•-•--------•-----•-•----------••--•--------------------------------------------------_---•- .........-•---•--•--••----•-••-•----•------------------------------------------------------•---•-•-••----......---....._.....----....------------------------------------------------------•--------•--- q 6 Date Cv[ Permit No------------ ........................................ Issued---•---- D�� ----------- THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f.. fr ,t,... ,- O F.................................................................................... �rrfgfiratr of Toutphaurr T4, S I$ TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) --.•........................m-............................................. ------......--•-----------------•--.........-•-----•-------....----•-....------.....• ---..... I ... r Installer has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated----------._________---_____.___-----_-_-------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE z SYSTEM WILL.FUNC 10 SATISFACTORY. DATE---................. _....,�. ................. Inspector.............. •-- . --•-- .................................................. THE COMMONWEALTH OF MASSACH S TTS BOARD OF HEALTH %VoS1d',Vjyrk.s Toptrt uan Mprrmit . Permission is hereby granted :� p................................ � ` to Construct I or Rgpair (I" .an jndividual Sewage Disposal System r r P F _ . _ , r Street --- as shown on the application for Disposal Works Construction Permit __-� �'. ____ Dated___.`..._ '... -;-•, 6�s ...................... '. •.. --•-- .............................. Board of^Health DATE...... ----------••-------•--•------...--•--=-•--•--•-•----... FORM 1255 A. M. SULKIN, INC., BOSTON IS -M No........................ Fps..........IS.....0�? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ..................OF......................................................................................... APPRiation for 11hipugal, Works Tomitrurtion "amit V Application is hereby made for.a Permit to.Construct or Rep an Individual Sewage,Disposal. -r- System at: 4, ..................... ....................................................... ......................................................................................... Location-Address or Lot No. ................................................................................ .................................................................................................. Owner Address 4, .............,............................... ........... .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................R3Zpansion Attic Garbage Grinder a Other—Type of Building .................7---------- No. of persons............................ Showers Cafeteria Other fixtures .......................................................................................................................................................; Design Flow..............................................gallons per person per day. Total daily flow....................................... ....gallons. 9 Septic Tank—Liquid capacity...........gallons Length................ Width___...........__ Diameter..._.._..__..__. Depth:---- -------- Disposal Trench—No..................... Width....._.............. Total Length___................. Total leaching area....................sq. ft. > ............. ... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Seepage Pit No:, Z Other Distribution box Dosing tank Percolation Test Results Performed by-------------------=- ..................................................... Date......................................... Test Pit No. I................minutes per inch Depth of Test Pit................._._ Depth to ground water......................... 4� Test Pit No. 2................minutes per inch Depth of Test Pit____..........____.. Depth to ground water........................ r- ---------�6L---------------- .............. 0 f; .......................................................................................................... Descripti0aiof Soil.......L442A2(....... .........f ,-�')�,,, , I.,•....................• I........................................................................................................ ------4F ---A014a.,_ ............................................................... U Nature�f Rep .?....,,airs or Alterations—Answer when applicable- .......... --------------- ............................................................. _h�yjb.................................... ............................. ........................................................................................................................... Agreement: The undersigned-, agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the,provisions of TITLE 56f-the State Sanitary Code-The un''dersigned'furtlier-agrees not to place the system in operation until a Cerfificat of Compliance has been issued by the board of health. ------------------- -------------------------------------------- A eN V Application Approved By.................................... ---- ....................................................... --- . .... D to Application Disapproved foi the following reasons:.......... ......................... .......................................................................:..... .................................... . ........................... ............................ .................................... C),r Date fT Permit No...................................................... IssuedL.. .. ........................................ D LOC Alt ION SEWAGE PERMIT NO. VIL LAC E IN��ST c LLER'S NAME i FAO RESS J . C42r SUILOER OR OWNER E L c fq . GATE PERMIT 15SUED �L--Z6 - DAT E COMPLIANCE ISSUED r � � 15 ' L*,' CAelION SEWAGE PERMIT NO, V I L' A E I N S T A LLER'S NAME i ADDRESS I. ER OR WNE w DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 6"A To G� X , ,� 30 I No...... __ .... Fims.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH . _.. - .....OF. . ' --------------- ............................... Appliratinn -fur Bhip vial Workg Cnnntrurtinn Vrxntit Application is hereby made for a Permit to Construct ( ) or Repair r(� ) an Individual Sewage Disposal System at: ------.....----- ------------------------------------------------------ ------------------------------------------------------------------------------------------------- -ocation•Address -_-•--------------------------------------or Lot No. --- ------- ---------- - - --- -------------------------------------- ....--------------------------_.._....._..._--- ner --------------------------------------------Address-- Installer Address d Type of Building Size Lot____________________________Sq. feet U Dwelling—No. of Bedrooms----- ____________ _______________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ___________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------------------------------------------------------------------------------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity-_________gallons Length................ Width_-_____--_--. Diameter____---_-_-__ Depth---.------------ x Disposal Trench—No_____________________ Width-------------------- Total Length...................- Total leaching area-------------.------sq. ft. Seepage Pit No..................... Diameter......_............. Depth below inlet.................... Total leaching area_-_-__-__-________sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by------------- ------------------------------------------------------------ Date----------------------------------- .... a a Test Pit No. I................mtnutes per inch Depth of Test Pit-------------------- Depth to ground water.______--______-__-_---- (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Ix ------------------------------------------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W UNature of Repairs or Alterations—Answer when applicable.- .................................... �_9 fib/Z/�L4�,cJ--------------------------------------------------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be • sued b the boa dVofhth. Signed-W , t -�1 6�j� Date Application Approved By Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ate Permit No.-------y fir------------------------------- Issued.------- ---- -- �-' . ... ..���..._te-------------------------------I - - — -- ate - 'THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH oF. �' k ,r...... e - ..................... ..... < <3 iaurr w '$ire#r of �>am It Cnrrtt � THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed x, ) orp,RePaired ( ) Installer at...........�/, G�'t�' t' �' -'- -/t- - a2.t- °..... -•--- ,�,,,�, -............... . -= -=----- has bee installed in accordance with the-pi of Article XI of�The State Sanitary Code as described in the r application for Disposal Works"Construction Permit No :: _,_---_--_-- dated..... "- ---- ---------- ---- THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT-THE SYSTEM WI L FUNCT19N SATISFACTORY. DATE-- --- --------------------------------- ._ Inspector >- w da THE COMMONWEAL T OF MASSACHUSETTS i v t BOARD OF HEALTH r _ F .� _A- � 'FEE.......................- -- ;Tinvjafitt1 g 11 TV� tr�tryi ,t rr ft Permission is hereby. granted------------ - -!----------`---•--••-•-.C.S r G.':--------•-------------------- ------------------------------------ - to Construct ( ) or Repair ( J an Individual Sewage Dispos 1 Syst atNo._.••__ �y -�.____._.• .w-__ -sue _. .................................................................. ______________ �.r�r2 as shown on the application for Disposal Works Construct"i0n`'' erm rt No..................... Dated-------------_-- ----------------_-____- q�.{ y� ----------------------------------------------------------- Board.of-Health DATE-------------------------------------- n ---- ....................... FORM 1255 HOBBS & WARRED C f�IPUBLIER$ x�-: No..----41-•9.. ..... FRic.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH :-o F .. �%tea'L. ................................................... .��..:. Appliration_for Di vocal Works Tomitrnrtion Prrmit •e).E Sh,��r.�.� Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: . � ocation_Address or Lot No. ....--- "' ner Address a Installer Address dType of Building Size Lot___________ ________________Sq. feet U Dwelling—No. of Bedrooms------ _____________________________Expansion Attic:( ) Garbage Grinder ( ) aOther—Type of Building _-__._..................... No. of persons..___________-_____'-______ Showers ( ) — Cafeteria ( ) Otherfixtures ...................................................... Design Flow___________________________________________:gallons per person per day. Total daily flow------------- ------------------------------gallons. W "`�. W _..,,Septic Tank—Liquid capacity-------�.,gallons Length----------------_Width................'lDiameter__.,�....------- Depth---------------- Disposal Trench—No_____________________ Width,_ __;;__ Total L(:�fgth-------------------- Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter._.____..._.._.__': Depth below•`inlet.................... Total leaching area-------._ ........sq.'ft. z Other Distribution box ( ) " ,.-Posing.tank.( ) aPercolation Test Results Performed by._.. - _, ---------------------------------------------------------- Date---------------------------------------- Test Pit No. i____ _________minute per inch Depth of Pest Pit.................... Depth to ground water.._____..____.____.__... ,, e fi Test Pit No. 2...........:....minutes:per inch. Depthjo{ Test Pit.___�-�___________ Depth to ground water__._._________.______.. �+ r --- -----______---------- `- ; ODescription of Soil---------------=-----------------=------------------{•--------:------------------------------------------ ------------------------------------------------------ U W ----------•----------------------- -------------------------------------------------------------•--------------------------------------------------------------------------- ........................... U Nature of Repairs or Alterations—Answer when applicable " "" u�: ----:__..---'------------------------ - - ---- /opt �A `• .l G�if`coc. - ..................:::::_:_:::::--------------- Agreement.: The undersigned agrees to install the'ado.-edescribed Individual Sewage Disposal System, in accordance with the provisions of Article NI of the State Sanitary 'Code— The undersigned further agrees not to place the system in operation until a'Certif cLte of Compliance has b sued b the bo of th. g Sined "! ...•,r r° 4 t ?vtr '� is"� ' r..{: ! Date Approved BY-•-f{�"' ��` "`np' " ,' -' -------- - ----- - --------------- Application (/ , ' Date Application Disapproved for the following reasons: =--------------------------- --•••••-•-•-----------------•--==--.-.-..------•-----•------..-----------•-------•---•••---••-----•--•-• ----- --------------------------- ------ ------------ ate it _ s sued.._____ TOP FNDN EL, 42.8' PROVIDE SYSTEM f D R 0 E . L E TEST HOLE LOGS ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT TO VALE) - ACCESS COVER (WATERTIGHT) TO ENGINEER: ARNE H. OJALA, PE MINIMUM .75' OF COVER OVER PRECAST WITHIN 6` OF FIN. GRADE DAMD STANTON 2% SLOPE REQUIRED OVER SYSTEM 42 0' _ 42 5' WITNESS: o t27. EL. 41.1' RUN PIPE LEVEL 2' DOUBLE WASHED PEASTONE DATE: 3/12/02 I a FOR FIRST 2' I Q LITTLE EXIST, QQ_ \� 3' MAX. PERC. RATE _ _ < 2 MIN/INCH z MARSH RD. o 711 A N G LLO SEPTIC TANK (H- 10 ) GAS 39,92' CLASS I SOILS P# 101U RE-USE BAFFLE o«� 39,27' - _ LOCUS--- ° 39,44 C7 C� E� � CJ [� C] C:1 6" SUMP o 39.09' m C7 m E1 m E7 m CI C 1 r3' AT SIDES ELEV. g 6' CRUSHED STONE DR MECHANICAL C7 [� o C7 C] E� C] s 3.5' AT ENDS 0� 42.3' w GREAT MARSH ROAD 1% 4 COMPACTION: (15.221 123) o�0 2' M ED E� L� E� 0 C7 a 37.09' A DEPTH ❑F FLOW = ( 1 "/. SLOPE) ( 1 % SLOPE) TEE SIZES: ° 3/4° TO 1 1/2" DOUBLE WASHED STONE L3 �e �o INLET DEPTH = 10 CONFIRM TEE SIZES AND REPLACE AS NEC. 10YR /2 5 OUTLET DEPTH = 14 ADD GAS BAFFLE IF NEC. B LOCATION MAP NTS L5 FOUNDATION— EXIST SEPTIC TANK 16' _ D' BOX 20' LEACHING FACILITY 18" 2.5Y 5/4 40.8, ASSESSORS MAP 210 PARCEL 21 5,79' c PERC MED/COS VARIANCE REQUESTED UNDER 15.405 (MAX. FEASIBLE COMPLIANCE) 31.3' 2.5Y 6/4 la: REDUCTION IN SETBACK, SAS TO LOT LINE (10' TO 4') _f>i'.�)A AND CE RMFY F 7 I _- 'STEM WAS INSTeJ_Lr0 TO VAN- 39.9 j + 4 133' " 31.3' NO WATER ENCOUNTERED \ NOTES: G� fJ 4 0.1 `SEPTIC DESIGN: (GAFBAGE DISPOSER IS NOTA LOWED ) I. DATUM IS APPROXIMATED FROM QUAD ,T / �k 40. � STONE / DESIGN FLOW: -6_ BE DRODMS ( 110 GPD) = 660 GPD 2, MUNICIPAL WATER IS EXISTING p 40.7 PARKING `� p. \ I GPD DE S IG, FLOW �'. 1?, Lh: "1, Liu-I . o � 40.5 � �"� � _1SE A 660 � _ � ,,, ,.� �, ,E �-,- . �•- B^ 1 ;� r __PTIC TA qK: 660 � Q.0 GI'D ) = 1320 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASH❑ H- 10. V, Q Sz e \� 4VIM ..'SE A 150 5. PIPE JOINTS TO BE MADE WATERTIGHT. + 42. DECKS ��, o GALLON S P1`IC TANK (EXIS" ) * 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. \ +, EACHING: EXIST. 1500 GAL. SEPTIC 4�- 42 \ �L=31.42 1 -- ENVIRONMENTAL CODE TITLE V. 422 R='20.00' + o 2= + 1G.8 L2 (_74�_ 204 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE TANK (CONFIRM SIZE) SIDES: USED FOR LOT LINE STAKING. 4 0.0 RE-USE IF / EXIST. DWELL. \ POTTOM: 58 x 10.8:> (.7.4) - 464_ 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. SUITABLE TF = 42.8 / OTAL: 902 S.F, 668 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT -F 39.9 SE 6 500 GAL. LEACHING CHAMBERS (ACME OR INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED + 42.4 a 1.1 LOI_ 6 ( ) FROM BOARD OF HEALTH. / DECK 9,915E SQ. FT. EQUAL) WITH 3' STONE AT SIDES AND 3.5' A-i ENDS O - 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PITS ,O 426 TH �\`/ 42042.8 / "'ONFIPM SIZE OF SEPTIC TANK (AS-BUILT CARD INDICATES 1500 11. WATER TEST D'BOX FOR LEVELNESS 42.3 G�,L. ;,-.NK) L-P 2 o y 40.0 ���(�� 4�� + 42.E Q�Q .�. /� 1. �" D TITL E .5 SITE PLAID 41.9419 p 100.0 PROPOSED SPOT ELEVATION OF 100xi1 EXISTING SPOT ELEVATION 15 YACHT CLUB ROAD 43. 1. S a / IN THE TOWN OF: 42.0 BENCH MARK - TOP OF ,�00 40.5 10Q PROPOSED CONTOUR CONCRETE BOUND o 4 . STONE , �,2.6 PARKING ( CENTERVILLE ) BARNSTABLE EL. = 42.7, / �' -- 100 EXISTING CONTOUR PREPARED FOR: / RICHARD ELRICK EXIST. SHED (RE-LOCATE) 40.9 , 20 0� 20 CFO 6.0 + 41•1 BOARD OF HEALTH i�PPROVED DATE MA SCALE: 1" = 20' DATE: MARCH 15, 2002 REMOVE ANY UNSUITABLE SOIL WITHIN 5' OF LER,H FACILITY AND REPLACE WITH CLEAN MED. SAND. off 508-362-4541 fax 508 362-"80 �1N Of� 010Wn cape engineer' t.Q• qJ.� �� q�1' ing, lnC•. ARNE J��G� �� ARNE H. H. g CIVIL ENGINEERS OJALANo.26 y . m : . LAND SURVEYORSL Y� 2-oto �ISTEREh479 c �Ro 030 939 main st, yarmouth, rna 02675 ARNE H. 0JALA, P.L.S. DATE