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0079 JOAN ROAD - Health
79 JOAN ROAD CENTERVILLE A= 228 - 074 S M E A D WEEPING YOU ORGANI7_rn No. 12534 2-153LOR MK r�cvaFo colrtE�tr MVA MAM w USA 04FT OWANIM AT SUM.CM TOWN OF BARNSTABLE LOCATION �/,<f cr D0,%w4 (/C D SEWAGE# VILLAGE y:Ile ASSESSOR'S MAP&PARCEL I INSTALLER'S NAME&PHONE NO. ys ✓►� ..��a� f� �� SEPTIC TANK CAPACITY LEACHING FACILITY.(type) Z S60 C iwV-5�(size) 2!DCl-3 0-,"172 NO.OF BEDROOMS 7 OWNER Tr-,P.W at..4t,,/.f PERMIT DATE: ' COMPLIANCE DATE: S ZI Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 0 Topo Rou I ! L No.L/`' /J Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(t T/pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. e, Owner's Name,Address,and Tel.No. Qi k ,`� 11L Assessor's Map/Parcel -_220 D 9 (? +�i��/ LO f—c k �e y,? t� Installer's Name,Add l..Address,and Tel.No.PF2 e t/ �uf�� Designer's Name,Address,andTel.No. 1 ij / Type of Building: Dwelling No.of Bedrooms Y Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) V 3 ep gpd Design flow provided •'7 gpd Plan Date Number of sheets -2— Revision Date Title Size of Septic Tank Type of S.A.S. 2 —00 AIrm bw,7,S' Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to a the xsEem�in operation until a Certificate of Compliance has been issued by this Board of Health. Sig Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Zfl (Y5 Date Issued Fee ! �—�'C✓/ tTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for MIBfIOsaY *pstPln Construction Vertttit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System 0 Individual Components Location Address or Lot No. �;�': D Owner's Name,Address,and Tel.No. c t '' Tt` ' Assessor's Map/Parcel r �P.r1Tfl� tiy �-4 ,�^ 1 Installer's Name,Address,and.Tel.No. G0+,rJr 2c Designer's Name,Address,and Tel.No. �.J l '• f1 1.,t + U� a vt a c_1', � 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(min.required) gpd Design flow provided gpd Plan Date %" � s Z / Number of sheets . Revision Date Title ^ Size of Septic Tank 11� i A Type of S.A.S. Description of Soil 1Y Y Nature of Repairs or Alterations(Answer when applicable)' fyr �f C,lv1 w . . ..s _. t Date last inspected: ° Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health .e�"'��_ Signed Date Application Approved by � '"""��"' Date Application Disapproved by y i Date x for-the following reasons , "7 Permit No. Zp?/- Date Issued_ IJ, 7:7 0 Z / THE COMMONWEALTH OF MASISACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate Of Compliance THIS IS TO CERTIFY,' ,t�h}at the On-site Sewage Disposal system Constructed( ) Repaired( `) Upgraded( ) Abandoned( )by e�•+,,..f k_Z."` d% !`✓ /�yc at .,,? (;}, �4,� Q has been constructed in accordance / Z ZI- It{§ dated yl Z with the provi ions of Title 5/and thrrees�jor Disposal System Construction Permit No. `p Installer E � '�/ r Jj• + Designer Q)61PtE}2#&)6 G4)tJfe4t_I•S #bedrooms Approved design flow 330 .gpd The issuance of this permiVshall not be construed as a guarantee that the system w 11 fund as s e6 Date Inspector . No.; — t — I Y; i I Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposai *pstem Construction 3p ermit. Permission is hereby granted to Construct( ) epair Upgrade( ) Abandon( ) System located at f j o Ck— and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:ConJstrructio/�must be completed within three years of the date of this permit. �� Date (/,,?/� Approved by % Town Of Barnstable ��FYHE t Regulaton, Services * aaxvsrnat.a, Richard V. Scali,Interim Director � Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# Assessor's Map\Parcel ZZ7;_0-74 Designer: ; Mr- Installer: f1�L",e Address: 12 lAl. C rbSs f_d Address: S— MVA O 2G3 S On_ t�t� ��"-C was issued a permit to install a (date} (installer) septic system at?9 :Je,(-Nn Ln based on a design drawn by (address) Cngt'n2er'r'rtc L& Ik( dated )z� (designer) V 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in with the terms of the l\A approv tiers(if a licable) pE�Eft T. ji nstaller's Signature) CtvtL No.351os ssE`s (Designer's Signature)b Sn ) (Affix Designe ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS .FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. C2:,Septic,-Designer Certification Form Rev 8-14-13.doc Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfill.The engineer did not supervise construction of the system.The installer assumes responsibility for all materials,workmanship,backtiliing to specified grades with proper compaction and setting risers;covers as shown on the design plan. �sr Town of Barnstable KIE Inspectional Services Department BA MASS. � ' Public Health Division i679• '�Ear9" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8135 March 10, 2021 KEIL, RICHARD B TR 79 JOAN ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 79 Joan Road, Centerville, MA was inspected on 02/25/2021 by Troy Williams, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER O ER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\79 Joan Road Centerville.doc s SNE T°k, Town of Barnstable BARNSPABLE. ' �^ Inspectional Services Department AtfD MP'�� Public Health Division 200 Main Street, Hyannis MA 02601 Off ice: 508-862-4644 FAX: 508-790-6304 Thomas A. McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x'' marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house.due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of riveway due to H-10 components, etc) eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form �III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P -74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every ry page. Cityrrown 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:When filling out forms A. Inspector Information 6 I sr I isIK on the computer, use only the tab Troy Williams key to move your Name of Inspector cursor-do not Troy Williams Septic Inspections use the return Company Name key. 19 Hummel Drive „Q Company Address South Dennis MA 02660 City/Town - State Zip Code (508) 385 - 1300 S1682 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); l 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 February 25, 2021 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r c , Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P-74 `r Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every page. City/Town 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: , . ❑ I 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: 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. p 9 El ❑ N ❑ ND (Explain below): p t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 79 Joan Road, Centerville M -228 P,-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is p O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every ry 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 . r c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every 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 El ® 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 a� Commonwealth of Massachusetts Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 79 Joan Road, Centerville M -228 P-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is required for every P.O. Box 39 Yarmouth Port MA 02675 February 25, 2021 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 '/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 I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every page. City/Town 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 c Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P -74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every ry 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 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: N/A Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears 20=48,000 gals. g ' ( y usage g (gpd))' 19=51,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: vacant Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts x Title 5 Official Inspection Form ' I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 79 Joan Road, Centerville M -228 P-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every page. Cityrrown State .Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow (based on 310 CMR 15.203): N/A 9 Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: N/A Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A N/A Last date of occupancy/use: Date Other(describe below): N/A 3. Pumping Records: Source of information: Last pumped in 2020 per info from owner. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 181 Commonwealth of Massachusetts Title 5 Official Inspection Form Io Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25 2021 required for every ry page. City/Town 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: Cesspool is original to home from 1963. Overflow added on 7/31/79. Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ®40 PVC ® other(explain): Orangeburg Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. Orangeburg pipe was found broken and settled and in need of repacement. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P -74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every page. City/Town State Zip Code Date of Inspection I D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet I Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(expla;in) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No N/A Dimensions: N/A Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle N/A N/A Scum thickness Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? N/A Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form kPA Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P-74 �V Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is required for every P.O. Box 39 Yarmouth Port MA 02675 February 25, 2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A 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.): N/A 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day t5insp.doc-rev.7/2612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts i� Title 5 Official Inspection Form ' 1' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P -74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No N/A Date of last pumping: Date Comments (condition of alarm and float switches, etc.): N/A I i "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 N/A 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.): N/A t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ 4I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 79 Joan Road, Centerville M -228 P-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39 Yarmouth Port MA 02675 February 25 2021 required for everyry page. City/Town 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.): N/A * 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: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® 6 X 6 Leach Pit overflow cesspool number: with stone ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 79 Joan Road, Centerville M -228 P-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is required for every P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) i 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Pit was found dry on inspection with walls found stained above inlet line. This is evidence of leaching being full and in hydraulic failure when home was occupied. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration main cesspool Depth —top of liquid to inlet invert 5' Depth of solids layer 0" Depth of scum layer 2" Dimensions of cesspool 5'X5' ' Materials of construction cesspool block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ! Cesspool was dry on inspection due to vacancy with the walls found stained up to the inlet lines. This is evidence of cesspool being full and in hydraulic failure when home was occupied in the past. Orangeburg inlet line from home was settled and in need of repair. Crown of cesspool was unstable and has potential of cave in. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts IP Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Joan Road, Centerville Property Address M -228 P-74 Richard Keil c/o Attorney Tracy Shaughnessy Owner Owners Name information is — required for every P.O. Box 39, Yarmouth Port MA 02675 page. City/Town — February 25, 2021 State Zip Code bate of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 . : o c Commonwealth of Massachusetts Title 5 Official Inspection Form ' Fio Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is required for every P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 page. Cityfrown 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 �j O �5% I i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Joan Road, Centerville M -228 P-74 �u Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is p O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every ry 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: 12.0'+ 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: Groundwater estimated at over 12.0'. Bottom of leaching at 8.5'was found not to be located in the high groundwater elevation at the time of inspection. 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 79 Joan Road, Centerville M -228 P-74 Property Address Richard Keil c/o Attorney Tracy Shaughnessy Owner Owner's Name information is P.O. Box 39, Yarmouth Port MA 02675 February 25, 2021 required for every page. CitylTown 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 ® C. Inspection 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 SEWAGE PERMIT NO.J WATER TABLE LOCATION NO. STREET U l INSTALLERS NAME & ADDRESS Jn DATE PERMIT ISSUED DATE OF INSTALLATION -�,�/` G DRAWING/OF INSTALLATION ON BACK r �+b �� r , . f' ?9 FE31 5..:.00............ No.......�.. ...� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town...OF......BaZM. Stable..----.-•......................................... Apptiraation for Uhipaii al Work,5 C omitrurtion tirrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: ....loan.R ...,...CAnte=ill.e-t---Q2532........... ----------------------- --•-•-------------•----- Location-Address . dlese--or rNo. �alth�m, ��154 .....G:er.t de---Qrozln...----•---....••................................ 34-17..Mid x---- ... _ -. Owner Address a ............................ ol__Service 128 Biehops .Terraces Hyannis... 02601 Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........3................................Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons........?................. Showers ( ) — Cafeteria ( ) a Other 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. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by••---•---•-•-••--•••••••-•••-•-•--••.............•••---•--•--............ Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................--. Gt, Test Pit No. 2................minutes per inch Depth of Test Pit---................. Depth to ground water.---.................... 9 -••••-••-•-•---•------•--•-•••••-•........••--•-••-•••••............•-•................•-•--•-------........................................................ ODescription of Soil................Sa<ld--------------•----•--------._.........--------•-------------------------------------------------•-------•------------------•--•-••-------. :.. . -- -- ••••.--- ---- •• . •. V Nature of Repairs or Alterations—Answer when a plica le......installation of::a 1,000-_gAj1on $font;' packed pre-caet•••leach...---t o�rerfl...... ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT-1-E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued the bo r o earth. Signe :�-........... -- ...................--..................... ....... Date y Application Approved B -•••--- . ..... ... ..... . Date Application Disapproved for the following reasons:............................................................. --•........... ................•------------------------....------------------.............------....----------....--•---------------------------------------•----------------------------------•-•--- j Date Permit No..-•-------•-•.79m................................. Issued_...---•---•--.......?�131.79............... Date 00 F:c$............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---------_.--.._...-.--Tawas....OF.....3ar stc` ble---------------------------:.---...........--------- X -Appliratinn for Disposal Work Toustru.rtion Frruti# Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: ....Jaan_Rd...}...P,pantarvi-l..l e...--02632............ ...................................................................................................' Location-Address � or t No. ...CrgMin-----•--...•--••...............•---•-•-•••......-- 3A_-1----PjiddlPsex .�r...`9a:t.. ....02154 Owner Address a ............................A Csspool...Service 128• Bishop Terrace,.__Hyannis_, 02601 Installer Address Type of Building Size Lot............... .........Sq. feet Dwelling—No. of Bedrooms........3.................................Expansion Attic ( ) Garbage Grinder ( ) 4 Other—T e of Building 2 W yp g ............................ No. of persons_...._.................._... Showers ( ) — Cafeteria ( ) Other fixtures . w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal l P t Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. - 3 •No..................... Diameter.......... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes,per inch Depth of Test Pit_................. Depth to ground water........................ 914 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ i D Description of Soil................ x x U --•--••--•---•--•••----•••••---•----------••----••..:............................••--••--•-••••---•-•••-•..........-•---•------•---•-••-•-•--••••••.=-------•--••••--•--•...---•--••-•••--•••-------•-- w U Nature of Repairs or Alterations—Answer when applicable..._installation ©f a 1,D00-_.gallon .....stone...pa ked.._hre-cast__leach..L t....Coyerflaw:�`�...._.._ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'ZT I, 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 thrb/r o ealth. t ,Signs .. ...... .............. a.r- 4 47 Application ApprovFd By....... �r r . % .................. .7/13 7-9 Date Application Disapproved for the following reasons:............... •------------•-••-•-•----------------•------•-•------__.-----•---------...---•-•-•-•----•••-••. �. .................•----...........:................---------------•-•-------•----------•----•-------------•----••-•••-•...-•----------•-•-••------•••-----•----•-••-----•-......-----•-•-------••-•----- Date Permit No...............79. ................................. Issued..----••---•--......7f 1.3.179......-••••-.... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................{ ......OF.......Barnstable.............................................. Tntifiratr of f ompliFanrr THIS IS TO C RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired QC ) by...4..&-.B..Me'Sannul...S.emd e.,...12a...Bishops---Terrace-,...liyannia...Jda.....Q26o1........ Installer at.1-0an.--- i ...,...C�nte rill • Q.2 ... =... :.extrude...Qranln--------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 ot The State Sanitary Code as described in the tft application for Disposal Works Construction Permit No.____-79 _- .`'_..j'�... 'dated........7/13179..............•..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ED AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... `..d✓ er ------------------••-------•---- Inspector..... ----.._ .... .•..--------- ......_........ A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'a w T.o.4Vn............OF..... ar s.table....................................... No...7.9 A-0-;.. FEE..... Disposal Workii Taon'krudirrn Verutit Permission is hereby grantedA...&..B Ces-spool- Service, 12 Bishops Ter. , lyannis to Construct ( ) or Repair (X) an Individual Sewage Disposal System at No....Jnan...Rd......... x1 e Ii.l 1 .,...Q.2h .2. xertrede...Qronln -------- ------ ....---.... . Stre as shown on the application for Disposal Works Construction Pe No.__7_._. ted.._. 13/79 ..--•...--•-•-.... ' •- Boa d of Health DATE................................................................................ FORM 1255 HOBBS &.WARREN. INC.. PUBLISHERS r No7..... .1 .. Fwm.155. Io.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................. ...Town.. .....OF..........Barnstable---.......................................... Alip iratinn for Uiipusal Works Tonstrurtinn amit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: 1 3...Buck ogd..Dr*�.:.Hyannis.---•------•--•••-•----•- •=•---..._._..-•---------•- I�r� - .... Location-Address _-_ or Lot uenterville Richard Dre 88er 123 Buckwood Dr. , Owner Address a A--8c-_B--Cesspool-_•Service 128 Bish� s Terrace, yannis ------------------------ Installer Address Type of Building Size Lot----------------------------Sq. feet aDwelling—No. of Bedrooms____.__....................................Expansiou,_Attic ( ) Garbage Grinder ( ) a Other—T e yp of Building _______________ No. of persons_______ __________________ Showers ( ) — Cafeteria ( )p-' Other fixtures -------------------------------------------••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter_-----__________ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....-...............sq. ft. x 'Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area....:.............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit____________________ Depth to ground water_-___-_--_____-______-.- Gi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ R+ ----•---------------------------------------------------------------------------•----............_...-•--- ................................................ 0 Description of Soil.............Sand.•-----------------------------------•---------------------------------------------------------t-•----------------•--.._._.._•----••----•------. x W -------------------------- -------------------------------------------------- -------------------------------- ------ --- ---- UNature of Repairs or Alterations—Answer when applicable___Installation Ofa �_.bd�...gaY on stone packed. pre-cast leach pit. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T T L, 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 by the /7 boar-d 4V9 d - -•o--- � ....... ----------------8/21 9•--•--- Date Application Approved BY Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ..............................---................................................................................................................... -----------••------ j Date PermitNo.....7-,-_...------•-------------------•--------•-•. Issued.....................8F _/T9-................ Date FEs...$.rj: 4 L........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................Town.......OF............B..arnstabl.e-............................................ Applira#ion for Dh4pasal Workai Tuuuitrattatt ramit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: IZ3...Buak3uaod....Dr....---Hy.ann a----------------------- Location-Address or Lot No. .RI.cB,.ancl._DreS.BLer..................................................... 1�3... uckwood_-,Dr.._......Centerville ....... Owner Address H annis A...&...B..C.esa-paol...ServinE................................. 12 ..Bi s.ho�a-s... rx'� a X.............--------------- Installer Address d Type of Building Size Lot............................Sq. feet �. U Dwelling—No. of Bedrooms........4.................................Expansion Attic ( ) Garbage Grindet-(_. ) Other—Type of Building ---------------------------- No. of persons........5------------------ Showers ( ) — Cafeteria ( ) a' Other 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. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..--...--............--. Test Pit No. 2................minutes per inch Depth of Test Pit..---............... Depth to ground water----------.............. a .......................'----•....................•••---•--••--•....•-'••••••-'-••-•......-•--..-------•----------••••...................................... 0 Description of soil..............Sand--------------•----•---•---•-----------•------------•••----'•-----------------'-----•---------•--------------------------.-------------------- "� W ------- -------------------- .............................................................-..................................................................................................... U Nature of Repairs or Alterations—Answer when applicable.-..-;A-Ptallatlon--Of a..l.,.000.._gglon ............... stone...packed-1.... re--cast.leach.pit.-..•---------------------------'------------•--------"'------------------•-----"•-•-•-......------...--•-'- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T-TTLE, 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 by the board of health.. Sig d.. ..... '' .... .. . . . 8 { � '�-- �--'-- �--------------•---^- ate fJ / Application Approved BY :----------------------- 8 atIV Application Disapproved for the following reasons:............... ..............................---........................._.....................___.. `I',--------------------------•-••-----•--•-••-'•---••••--•-------•-•. i.......••••----•••--•----••---•......---------•--•-•-•-----•--------------------------•-------'•--•-'••----------- �t �J Permit No......7•9.---•-----------------------•--•----....,.... Issued--------------•----•-- 2 ...Date Date ....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............Town.................OF..................Barnstable: . ................................. Tntifirab of Toutphaurr T 1 1 TO CER IF T t the In'�v a Se 'a e Di sal S-stem c structed r R A a ess-poo� S�e'rv�ce, `� �Bis`WPs'sTe'rr ce, -` 'yannis(,by )M�. � ' ( X) ----------•--- 123 Buckwood Dr. , Hyannis -- RIA%I rd Dresser at.............................................................................................................................................................-_---------------------_---------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.---7 jt. ,_5"f fy............. dated----------812/7-9-------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. s/2/79 DATE..---......-•---------------•---------...:......----•-------....../..:... ... Inspector..:"'--• �._ .�/t ................... COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town..............OF 9_ .................................'---........... No. ........... FEE........................ "hip oat aark.5 (1.0aamArndivan >erbti A & B Cesspool Service, Hyannis Permission is hereby granted.A --•-•-----------------------•------- ----- ------ to Constru�} ( )) Qr Rep it ) a ndivid al S isposaL$ys cm at No_...:`- ._.BLICKW"Ie � . , yannfs 611g� -- Kicnard Dresser -•---------------- ----------------------------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permits- 0..79- ....-_ ated.............8� �?9..-........ ............................................ Board of Health / DATE----------------����Z9 FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS f -,16 / SEWAGE PERMIT NO. WATER TABLE LOCATION NO. STREET �� �� 'k, INSTALLERS NAME & ADDRESS i C3 ZtL-,,S 5 Al DATE PERMIT ISSUED / t DATE OF INSTALLATION DRAWING OF INSTALLATI N ON IkACK t � r C A r � f� 1 1�. ——64—— EXISTING CONTOUR 1 li { PROPOSED S.A.S. y !� 0 0`BriensCenterville 2-500 GAL CHAMBERS x 60.98 EXISTING SPOT GRADE ands me _ _1�_ insurariceAgency SURROUNDED W/4' STONE —W EXISTING WATER SVC. etery YJ+LCP 30469A H.14'.— OVERHEAD WIRES a EXISTING CESSPOOL TEST PIT s !I TO BE REMOVED-SEE NOTE 11 BENCHMARK EXISTING CESSPOOL ill$ ;j TO BE PUMPED, FILLED LEGEND 1. 79JoanRd. N WITH SAND & ABANDONED rjCerrterVille.MA 02632 18-03,0p„ 02.00. '�..a3. T �r 2 5 00 81.14 �;: o / LOCUS MAP ` PROPOSED SEPTIC TANK __�_ X55 / 1500 GALLON CAPACITY�CORNE BENCH oAoEK 111 TP-1Y �80.52` O 8 �6 MAY SUBSTITUTE CONCRETE TANK GENERAL NOTES: EL.=86.06 x / WITH INFILTRATOR IML530 TANK 79,77 \ N BM 81'98 d, tM� i r1�"(�J 1 BOARD ALL HOF HEALTTH TO TA D THE D SLAN SIGNBENGIINE APPROVED BY THE LOCAL 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 86,06 DECK X OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE Z 81.60 / LOCAL RULES AND REGULATIONS. 00 Ex. SEWER-t Ex. SEWER-2 C 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR (A fy INV.=79.0f ���79.t i , TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. CA iA .EXISTING X 83.03 N 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING C �'� HOUSE&79) / FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 00 GARAGE T.O.F.=84.0.t 46 o ENGINEER BEFORE CONSTRUCTION CONTINUES. f % O O 5. ALL ELEV FF EL.=84.9 ATIONS BASED ON AN ASSUMED DATUM. ������ O O 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF .. O THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF rn HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 81,61 x I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. WALK 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 82,5 �SPIK AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE ., + DIRECTED BY THE APPROVING AUTHORITIES. 83.89 X\ 85,58 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY LOT 29 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. A CL 'Q:�::: : 1 054f S.F. QF M 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND I OY REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 82.02 o PETER T. �, 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 3( ' McENTEE CIVIL INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 106.00' No. 35109 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 79,13 NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. \; S O5'S9 0 W X 83.07 GI$TF � 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN Qp 75,55 � 77,54 79,71 82.52 86,81 PARCEL ID: 228-074 P JOAN ROAD PROPOSED SEPTIC SYSTEM UPGRADE PLAN 79 JOAN ROAD, CENTERVILLE, MA Prepared for: Dean Stanley, 359 Cap'n Lijoh's Rd, Centerville, MA 02632 OWNER OF RECORD KEIL, RICHARD B TR Engineering by: SCALE DRAWN JOB. N0. ,, D RICHARD B KEIL 1999 TRUST Engineering Works, Inc. 1"=20' P.T.M. 148-21 70 JOAN ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (508) 477-5313 4/1/21 P.T.M. 1 of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 77.8 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX INSTALL RISER AND COVER PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & SET TO WITHIN 6" OF FINISH INSTALL RISER & COVER OVER ONE CHAMBER AND OUTLET AND SET TO 6" OF FINISH GRADE GRADE SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT T.O.F.=84.0t iEXISTING ' F.G. EL.=81.0f `F.G. EL.=81.2t -F.G. EL.=80.8t F.G. EL.=80.4t HOUSE(#79) EXISTING �( MAINTAIN 2% SLOPE OVER S.A.S. Lt = 24' bock of house LS _ 1 ® =1% (MIN.) L = 17' L = 5' 4"SCH40 PVC ®'SCH40(PVC) �4"SCH40(PVC) 2" LAYER OF 1/8" TO 1/2" 6" w DOUBLE WASHED STONE DECK �p"f a C-1-11 $ Ba (OR APPROVED FILTER FABRIC) B �'�i4., 2' EFF. aaaa aaaaINV.=78.50 48" LIQUID DEPTH �-3/4" TO 1-1/2" DOUBLE �` LEVEL INV.=78.25 4' 4 8' 4' WASHED STONE ?6,, �p GAS BAFFLE PROPOSED INV.=77.70 INV.=77.87 � EFFECTIVE WIDTH = 12.8' '7- Am AlmH-10 RATED INV.=77.50 T PROPOSED SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS 00 SURROUNDED WITH STONE AS SHOWN PROPOSED S.A.S. CONNECT TO EXISTING SEWER OUTLETS: H-10 RATED 2-500 GAL CHAMBERS f-----25' __ 1 SEWER-1 INV.=79.0t SEWER-2 INV.=79.3t TOP CONC. ELEV.=78.3t SURROUNDED W/4' STONE BREAKOUT ELEV.=78.00 NOTES: INV. ELEV.=77,50seemas®aa S.A.S. LAYOUT 663131363661301363 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aaaaaaaaaaa INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=75.50 4' 2 x 8.5' = 17.0' 4' 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' TRUE TO GRADE ON A MECHANICALLY COMPACTED PERVIOUS MATERIAL STABLE BASE OR OR SIX INCH AGGREGATE BASE, AS 5' (MIN.) ABOVE G.W. SPECIFIED IN 310 CMR 15.221(2). LEACHING SYSTEM SECTION ®®®® ®®® 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=69.2 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE r ®®®®®® ® ®®®® 33" AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. N > ® SEPTIC SYSTEM PROFILE Z ®�®®® ® ®®® N.T.S. 102" DESIGN CRITERIA SOIL LOG NUMBER OF BEDROOMS: 3 DATE: MARCH 24, 2021 (REF#TPT-21-67) 4" KNOCKOUT SOIL EVALUATOR: PETER McENTEE SE#1542 20" DIA. COVER SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) WITNESS: DAVID STANTON R.S. "HEALTH AGENT DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP— 1 DEPTH ELEV. TP-2 DEPTH 4" KNOCKOUT 4" KNOCKOUT 58" DAILY FLOW: 330 GPD 80.2 A 0" 80.4 A 0" 0 DESIGN FLOW: 330 GPD LOAMY SAND LOAMY SAND GARBAGE GRINDER: NO-not allowed with design 79.2 B 10YR 4/2 12" 79.6 B 10YR 4/2 8• 4" KNOCKOUT LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF LOAMY SAND LOAMY SAND .74 GPD/SF --�. 'te 10YR 5/6 10YR 5/6 PERC 500 GALLON CAPACITY, H-10 LOADING PROPOSED SEPTIC TANK: 1500 GALLON CAPACI '� 77.7 C 30 76.4 48" 30"/48" CHAMBERS MAY SUBSTITE INFILTRATOR IM1530 POLY TANK C PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIM ),�JI RATED USE 2-500 GALLON LEACHING CHAMBERS IN SERIES MED. SAND MED. SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 2.5Y 6/6 2.5Y 6/6 79 JOAN ROAD, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: Dean Stanley, 359 Cap'n Lijah's Rd, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. 69.2 132" 69.4 132' TOTAL AREA:.................... „ 471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 148-21 ................................. ������� PERC RATE <2 MIN/IN. B" HORIZON DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 4/1/21 P.T.M. 2 Of 2