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HomeMy WebLinkAbout0145 OLD POST ROAD (CENT.) - Health 145 OLD POST RD. CENTERVILLE A = 209 062 Owrford, NO. 1521/3 O RA 10% i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is required for CENTERVILLE MA 02632 10/16/& every page. City town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information W forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A. BROWN cursor-do not use the return Name of Inspector key. D.A. BROWN BROWN 2 () Ob�� ) Company Name Q P.O. BOX 145 Company Address CENTERVILLE MA 02632 w Citylrown State Zip Code 508-420-4534 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/16/07 CO =' r nspe Signa a Date c r~ Toe system inspector shall submit a copy of this inspection report to the Appro ing Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title V Inspection Form.doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Dis pe g posal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is CENTERVILLE required for MA 02632 10/16/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E 1 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 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Title V Inspection Form.doc•0&06 Tithe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'r 145 OLD POST RD Property Address WALSH Owner Owner's Name information is required CENTERVILLE re wired for MA 02632 10/16/07 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumpingmore than 4 times a year due to y 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: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 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. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts up Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is required for CENTERVILLE MA 02632 10/16/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow ❑ ® 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. Title V Inspection Form.doc•08108 Tithe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r� 145 OLD POST RD Property Address WALSH Owner Owner's Name information is required for CENTERVILLE MA 02632 10/16/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is CENTERVILLE required for MA 02632 10/16/07 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 145 OLD POST RD Property Address WALSH Owner Owner's Name information is CENTERVILLE required for MA 02632 10/16/07 every page. City mown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 05-136/06-88 Sump pump? ❑ Yes ❑ No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title V Inspection Fonn.doc•08108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is CENTERVILLE required for MA 02632 10/16/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Reason for pumping: MAINTENANCE Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1/12/01 OFF AS BUILT CARD Were sewage odors detected when arriving at the site? ❑ Yes ® No Title v Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is required for CENTERVILLE MA 02632 10/16/07 lug every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No ----------------------------------------------------------------------------------------------------------------------------------------------- Dimensions: Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 511 Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is CENTERVILLE required for MA 02632 10/16/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS PUMPED AFTER INSPECTION BY SCOTT FRANK NO PREVIOUS PUMPING RECORDS WERE FOUND Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene y ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is CENTERVILLE required for MA 02632 10/16/07 every page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO LEAKAGE SOME SOLID CARRY OVER INTO OUTLET PIPE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Tide V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 145 OLD POST RD Property Address WALSH Owner Owner's Name information is required for CENTERVILLE MA 02632 10/16/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: NO OBSERVATION PORT FOUND Type: ❑ leaching pits number: ® leaching chambers number: 7 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): COULD NOT FIND ANY OBSERVATION PORT, COULD NOT DETERMINE LEVEL OF PONDING Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is CENTERVILLE required for MA 02632 10/16/07 every page. Ci mown State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title V Inspection Form.doc•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 145 OLD POST RD Property Address WALSH Owner Owner's Name information is required for CENTERVILLE MA 02632 10/16/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. let- V Boy 00TU Box r a Title V Inspection Fonn.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r< 145 OLD POST RD Property Address WALSH Owner Owner's Name information is CENTERVILLE required for MA 02632 10/16/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 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: Title V Inspection Form.doc•0&06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of IS Town of Barnstable OF IHE Tp� Regulatory Services BARNSTABLE ; Thomas F. Geiler,Director 1639. •�� Public Health .Division TED MP'�A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. Town of Barnstable P# qf3 CI Department of Health,Safety,and Environmental Services Public Health Division-" Date Z f l 3�150 cl 367 Main Street,Hyannis MA 02601 enrwareerra 1 6 9. �� Date Scheduled J)dC@ Z'� 2000 Time t I:r.0 Fee Pd._ 100 Soil Suitability Assessm'ent for Sewage Disposal Performed By: J 66 a o KL"►h,�1 - 1 u WitnesSed By: DO H M I DI�.I'Y�1 �� G'1. NEAL0�11IA I'1ON A� t �j Location Address 1 0 fOSf Owner's Name'vtj Cel�-1er�%�l�Q Address Z. 6MWAJV10"4 6a _ Assessor's Map/Parcel: Engineer's Name ` Nye 4 ZG�t� C NEW CONSTRUCTION REPAIR Telephone# 4;0 8• 4GI Land Use a Slopes N 3 ".S Surface Stones ljoy\c'- Distances from: Open Water Body N ft Possible Wet Area N A- ft Drinking Water Well ft Drainage Way ft Property Line _e'D �Xft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) t� TP I Y Parent material(geologic) ��11 V V+WV.4% Depth to Bedrock L 3t! Depth to Groundwater Standing Water in Hole: hl0 Weeping from Pit Face /✓Q Estimated Seasonal High Groundwater DETE1tlYtYNATYONU SEASQNA HT '�VA ;EYt'Y'ABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in.. Groundwater Adjustment ft. Index Well#_ .•.,. Reading Date: Index Well level• Adj.factor Adj.Groundwater Level PERCfJLATION,TEST nete Ttro� Observation Hole# I Time at 9" a Depth of Perc A0 Time at 6" Start Pre-soak Time©N Of I"oc . Time(9"-6") End Pre-soak �VeSk � Rate Min./inch Site Suitability"Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant p a3Sxa (J LG1 Tole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. u O—6 � Sa� . 1 O Y1R3 Z. I►/oN.,ae.. 1-7 5aAA - 6 C F P"" z-sv40/4 DEEP O�SR�ATI;QN HOLE LUG Hale Depth 6m Soil Horizon Soil Texture Soil Color Soil Other Surface(1n:)' (USDA) (Munsell) Mottling I(Structure,Stones,Boulderes. o 14 - �occw.y ®v wed u z. S/ DEEP Q3ERVATI:()NbLE THOU Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(tn.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.o DEEP OTiSERVATI;UN HOLE.......0 . . .: » Depth from Soil H orizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % I Flood insurance Rate Man: Above 500 year flood boundary No— Yes L''' Within 500 year boundary No V Yes Within 100 year flood boundary No Yes Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required traininn expertise and.experien4escribed in 310 CMR 15.017. Signature Date 1212, No. 7j177 I OC�o a - t ' Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0pplication for Migogal *pgtem Construction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S 00 T:w 9-A , Owner's Name,Address and Tel.No. C v�1te, VJI Lu l�l w AL g H Assessor's Map/Parcel _ I� d Id �SA RA , 2 Installer's Name,Address,and Tel.No. 1_I Designer's Name,Address and Tel.No. (7 / 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 S S 0 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 N's pr,I2 Q4,:�N Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by this Board of H Signed- ,��(�� Date ao i 0`/"00 Application Approved by j21� Date JkSJO Application Disapproved for the following reasons Permit No. 100 1 —0O LA Date Issued 11 S I O f ocxq THE COMMONWEALTH'OF,MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF,BARNSTABLEi MASSACHUSETTS 1 ZIPprication for MigoAal 4p#tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 CpS 'ou }w 9a Owner's Name,Address and Tel.No. CQ,vt-�e.vV i\V.. �J�.71t,-l.l W►•�1 V`.JY-ik�H Assessor's Map/Parcel `L4 S Q o t)SA � 2 2— Installer's Name,Address,and Tel.No. L�` ��} C Designer's Name,Address and Tel.No. UC-C 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 S 50 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 AS pre V->L VA\ Nature of Repairs or Alterations(Answer when applicable) . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- ',cate of Compliance has been issued by this Board of Health. Signed 7>�a�: %'`��1'�GG°li o Date 1~C1�/-0© Application Approved by _, �a �, / S ",6_o Date Q S Application Disapproved for the following reasons Permit No. -700 1 - 00(-v Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal Syste Co tructed( )Repaired by. V ( Upgraded( ) Abandoned( )f ��� - A / / �, (r Ae a at 1 � A n- as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9M1 -00k..v dated 1 S 0 Installer Designer s !f The issuance of this ermit hall not be construed as a guarantee that t el�syst(m will fun�jtion as de/s`igne"!� Date ® Inspector //11 pkl ------------------------------- ---------- No. 7 001 00( :, Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migosat *pstem Construction Permit Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( ) System located at 19S Ca)rl P en 4e,v 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: 1 l S l U 1 Approved by 1.(i t SC..•u-, TOWN O BARNSTABLE LOCATION P115DAD SEWAGE # �DD/— 006_ VILLAGE CS 47 20/1%' ASSESSOR'S MAP & LOT '010 —;,. INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY S00 LEACHING FACILITY: (type) Ct,/TC 330,s \ (size) NO. OF BEDROOMS6� BUILDER OR OWEl R i PERMITDATE: �' '-4 O! COMPLIANCE DATE: -qj4(*,,L- j 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 of Wetland and Leaching Facility(If any.wetlands exist wiftuii 300 feet of leaching facility) Feet �. ;Furnished by. { - - 61e „sZ° no4. T TOWN OFBARNSTABLE P a �1TION Z�15- Ole_ ­211� 9 SEWAGE # VIIJ AGE 'i- .V t f? ASSESSOR'S MAP & LOT NAME&PHONE NO. SEPTIC TANK CAPACITY p� LEACHING FACILITY: (type) C 0 l' e 1, (size)NO.OF BEDROOMS_. BUILDER OR OWNER r-0`� DATE: 10116 J Q°7 COMPLIANCE DATE: 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 wc"y IV A ii took. i,J 1jL 1 `1 G D3M TOWN O BARNSTABLE r o o� LOCATION /���s D/D �Q1T� SEWAGE # o�001 VF;LAGE t_E0T/P 11C ASSESSOR'S MAP & LOT -�O/PJra- INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY )goo CAI. LEACHING FACILITY: (type) 6,17PC 330'%' (size) IQ ` NO.OF BEDROOMS '� �V BUILDER OR qWNER PERMIT DATE: ` S44 Of COMPLIANCE DATE: 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 r Furnished by fi '� _ . .... -� . I 0��`"� �}0 �w� � �� � �8' �-----� /• '�. _ _ _�...r A 0 "/�� / r' " jg�h i�I� � G " '� y � 6 yS6 �` pv//cam its � �. tie a,sT��X aQ 6 I LOCATION SEWAGE PERMIT NO. VILLAGE Gen4enu(I 1p INSTALLER'S NAME i ADDRESS i IUILDER OR DER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �lJ��✓ ko (bv)(, P ._..........__ ............. ------------ 5.. .......... ......._..-- _--------- - ------ --- - ...._......_._ ............ w� ; I '' 1 - .._._ I I 00 tj Af j I I I . I i i I t 1 � F I 9 tr� 1 i I r I I I _ I I l I I I 0 I 1. �._...._. • I i q I ; I I I - rI , ' i , I I I I I j f : I i I I i i I Y F : I I ; 1 �i I. : i ; i I I I I I I i 1 i _ I I I I , I 0 I ! I I I I I I I I I 1 l i , I I i I _I 11 a ! a ' I- i — !. . _ ..-� is —._L. _ _. _ - '. Y _ ._'. _. __ — --- --- _ I ' I _ I I I I F I , I 1 A S !E ' 1 � , I I ` , i CROCKER o oti TOP OF FOUNDATION 110.8' 5 BEDROOMS AT 110 GPD/BEDROOM = 550 GPD CT .� / FINISHED BASEMENT FLOOR EXISTING a FINISHED GARAGE FLOOR N/A ADDITIONAL 50% FOR GARBAGE DISPOSAL --NA—_ SEWER INVERT AT FOUNDATION 106.5' FA MOUTH RD / SEWER INVERT INTO SEPTIC TANK 106.0' PERC RATE _ _2_ MIN. / INCH (CLASS 1 ) SEWER INVERT OUT OF SEPTIC TANK 105.75' LIAR 0.74 GPD/S.F. SEWER INVERT INTO DISTRIBUTION BOX 105.67 ' SEWER INVERT OUT OF DISTRIBUTION BOX 105.5' MIN. LEACHING AREA OF S.A.S. ° SYLVIA SEWER INVERT INTO LEACHING SYSTEM 104.0' LN �� P S� `�Z� �� �Q , c, 1 S� BOTTOM OF LEACHING TRENCH 102.0 550 GPD/ 0.74 GPD/S.F. = 743 S.F. MIN. RDULLE LOCUS v°� e� z WATER TABLE f96.4' LO �' / PROPOSED SYSTEM 606 GPD W/ LEACHING AREA OF 820 SF ( / LONG POND / 0 -0 ° GENERAL NOTES I'i�d, 0 F- t S� T , w.... ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE �� �, ��G �� ` +� P ,� "" ' _'' WITH TITLE V OF THE STATE SANITARY CODE DATED MARCH 31, LOCUS MAP , �j J 1995 & ANY LOCAL RULES APPLICABLE. oti N.T.S. ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING BY MAP 209 PARCEL 62 '`" ZONING DISTRICT RC �� �J �.. � R� QO � E�N� � HE DESIGNING ENGINEER WHEN CION/ O� Q�OQ�G� ^ NOTIFY E ENGINEEERI& CB ARD OF H ALTH � TCFOR ILLING, MIN. BUILDING SETBACKS , � Q Q, INSPECTION. FRONT=20' SIDE=10' REAR=10' �� /r O�S� / �� q� �'O ALL SANITARY DISPOSAL SYSTEM PIPING TO BE SCHEDULE 40 � 6 � '`� S" � C A\� T`9� PVC. FS p EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING / 05+ �-�-�� O Q `L F, S�.O �\ �. �,..... :.._, THE LEACHING FIELD FOR A DISTANCE OF 5', PER 310 'CAR 15.255. DATUM ASSUMED o� / 12' LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND `� SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE y= FINISHED GRADE UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. w \/\/\/\/\/\/\/\/\/\/\/\ \/\/ COMPACTED FILL L ��. `\� 36"MAX.— //\//\//\//\//\//\//\//\//\//\//\// �/\//\// r �C9 J�' s• 12 MIN. 2 ;:: PEASTONE O : J / �6�j 6.5 a a 314O,� T 1 1/2 . ° 1 l✓. 4 Q O DOUBLE 6� d 24 a d o° WASHED STONE 4.. / ,;F, , y►x�$p P J SECTION NO SCALE r _ LEACH CHAMBER DETAIL ALL PIPES TO BE SCHEDULE 40 PVCjo ' H;N3 1 k OJ a 2 J7`4 /c`"s 1 � 35 I CERTIFY THAT THE PROPOSED FOUNDATION COMPLIES WITH THE TOWN OF BARNSTABLE SIDCLINE �� �,��• s ,� : AND SETBACK REQUIREMENTS AND IS NOT LOCITED WITHIN THE FLOODCPNIN. c�—a¢-�� �� ;vv•! `� IZ DATE: ( ^, R.L.S. lI THIS PLAN IS T BAS D ON AN INSTRUMENT SURVEY AND THE OFFSETS SH OT BE USED TO DETEFMINE LOT LINES. w, 145 old Post Road Centerville, Massachusetts \ PREPARED FOR William B. Walsh TITLE Septic Design BAXTER, NYE & HOLMISREN, INC. FINISHED GRADE = 65.0 TYPICAL SYSTEM PROFILE P-9898 DATE 12/13/00 NOT TO SCALE ENGINEER: BOARD OF HEALTH: BARTER, NYE & HOLMGREN, INC. TOP OF JOHN D. KUCHINSKI DOIINA MORANDI Registered Professional FOUND. = EXIST FINISHED GRADE OIVER TANK = 108 t FINISNED GRADE OVER D. BOX = 108t PIT 2 Engineers and Land Surveyors TEST PIT 1 TES FINISHED GRADE OVER LEACHING FACILITY = 107.5t G.S.E. = 107.7' Ci.S.E.'' = 107. 1 812 Main Street, Osterville, MA 02655 8"MIN. 3" mi . r - - Phone 0 42 1 1 Fax - 508 428-3750 58 893 4" SCH. 40 PVC ;. .. • . FIRST LEV ) ) FILL 4" SCED. 40 PVC FI 2' (TO BE EL 9" (min) Cover (TYPICAL) 0 A LOAMY SAND 0 6- (min.) > OL2 6 min SUM F 36" (max) Cover 6" 10 YR 3/2 9�, :.• : PVC�or '.. , 10` CI � ES P ,,. GAS BAFFLE 4' SCH. 40 PVC FINISHED CONSTRUCT ACRCEN Pea tonel/8 to1/2" LEACHING CHAMBERS B SAND A LOAMY cAND 20 0 20 40 BASEMENT MANHOLE OVER FLOOR = EXIST ..: TO TANK"TO AT LEAST '. .; ,. . ,.:•. :., 10 YR 6 1 CONCRET 6" CRUSHED ;'... Slope = 0.005 min _ .... . .. . . 27" 21' WITHIN 6 FINISH G 6/ 0 YR 1/2 REINFORCEDSTONE SCALE IN FEET FOOTING • • O • O • O O • • C) • ., 4 PVC SCALE: 1 "=20' DATE: 1/4/2001 .. . :..: •. O O> O O • O O O O O t} O O O O O O O O O O C� MEDIUM SAND LOAMY SAND „ 2.5 YR 6/6 10 YR 5/6 REV. DATE: REMARKS 136 24 BOTTOM ELEV. _ ** DISTRIBUTION BOX 5' MIN C MEDIUM 1500 GALLON SEPTIC TANK SANS TO BE INSTALLED ON A LEVEL STABLE BASE TO BE INSTALLED ON A LEVEL STABLE BASE j " 2.5 YR!5/4 DRAWING NUMBER rNo Groundwater Observes At Elev. ** 132 I � SEPTIC TANK TO BE INSPECTED & CLEANED ANNUALLY 3 OUTLETS REQUIRED CULTEC D RECHARGER 330 NO WATER ENCOUNTERED PERC @ 40 H: 2000 2000- 109 SURVEY worksht 200109se .dw -- _ RATE= < 2 MIN/IN -- JOB # 2000- 109