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HomeMy WebLinkAbout0222 PINE STREET (HY - Health (2) 222 PIKE STREET Centerville A = 229 - 124 5 M EAD KEEPING YOU ORGANIZED No. 12534 2-153L©R SUSTAINABLEFORM AlIN RECYGU:D � IVE CONTM10% Grofwd Fiber Soomhnp pOST.CONWMM wwwAnpro2 aLm 001290 MADE W USA QV INMANW AT SME.AD.GGIN1 Commonwealth of Massachusetts o (p, Title 5 Official Inspection Form Q Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams . Owner Owner's Name ' information is required for every Centerville MA 02632 8-24-20 " page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in"any way. Please see completeness checklist at the end of the form. A. Inspector Information Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address East Falmouth MA 02536 City/Town . State Zip Code 508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8-24-20 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 Commonwealth of Massachusetts µ� Title 5 Official Inspection Form i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-,24-20 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; ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 2) System Conditionally Passes: ❑ One or more system components as described in the "Co nditionalPass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y El ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts it Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 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. r ❑ Observation of sewage backup or breakout 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 El ❑ 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 El ❑ 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 Commonwealth of Massachusetts r� Title 5 Official Inspection Form ill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , . W4'.;� 222 Pine St J- Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health ('and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 4 of 18 Commonwealth of Massachusetts �w Title 5 Official Inspection Form :C�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form ,i�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 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 I ❑ ® 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? ® ❑ Wasthe 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 AN:. Commonwealth of Massachusetts r� Title 5 Official Inspection Form �.1' c�f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments # .7 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2020Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts 3/ Title 5 Official Inspection Form �1 w. ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes'® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 i Commonwealth of Massachusetts fY Title 5 Official Inspection Form i 1;4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 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: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 12"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.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts 0 Title 5 Official Inspection Form I�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: roll feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �Y Title 5 Official Inspection Form !' i.l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form ! I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 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: Alarm in working order: ❑ Yes ❑ No Date of,last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. 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 w' i�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >ry �. 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 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.): * 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: 3-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments z, 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition with water level and stain line at 6"off bottom of chamber. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form h. I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Ell Title 5 Official Inspection Form <;'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town State Zip Code Date of Inspection D. System Information (coat.) 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 A-- 1 , 5 Y/ .r." 3 F/ s t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts k Title 5 Official Inspection Form ,i Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is Centerville MA 02632 8-24-20 required for every j 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'+ 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: Original design plans show groundwater at greater than 12'. 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 j-r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 222 Pine St Property Address Nancy Williams Owner Owner's Name information is required for every Centerville MA 02632 8-24-20 page. City/Town 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 r� V ��'"" � TOWN OF BAMSTABLE L \ UY_A'l'ION aL_ �-3`i r n. s SEWAGE # n i- G 3✓ Vh.LAGE � �="` '� ASSESSOR'S MAP & LOT J'STALLER'S NAME Sr PHONE 1NO. ��,� i•�s a 7�.��:57 7 SEcPT][C TANK CAPACITY LEACHING FACILITY: (type) Z- L (size) 10 NO. OF BEDROOMS 3 BUILDER OR OWNER iT. 14•10'70 ` PERMIT DATE: 9--?-/'° / COMPLIANCE DATE: s_G I Separation Distance Between the: Maximum Adjusted Groundwa r Table to the Bottom of Lear Feet Private Water Supply Well d Leaching Facility (If am on site or within 200 f t of leaching facility) Feet Edge of Wetland and aching Facility(If any wetl: within 300 feet of leaching facility) Feet Furnished by d q )£le! b� ,r �r rA Health Complaints 05-Apr-02 Time: 12:00:00 PM Date: 4/1/02 Complaint Number: 3180 Referred To: LEE MCCONNELL, Taken By: FLORENCE SMITH Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: Number: 222 Street: Pine Street Village: CENTERVILLE Assessors Map-Parcel: 229/124 Actions Taken/Results: LM investigated complaint 4/5/2002. Spoke with Doug Williams the hired contractor and owner of the home about complaint. He stated he was using the proper procedures to remove the asbestos shingles. He stated all the _. employees are wearing PPE including respirators, and all the shingles are being properly disposed of. Doug stated he would send us a manifest from the landfill who will be taking the asbestos shingles. Investigation Date: 4/5/02 Investigation Time: 10:00:00 AM 1 TOWN OF BARNSTABLE BUILDING PER T'APPLICATION Map �' Par el 0q, TO YIN OF DART-ISTASL>» Permit# Health Division S^ T)c-., ei-t ill- Date Issued - t Conservation Division j Jun, ® �'--- Fee a Tax Collector. DIMS- .� USlON Treasurer T Planning Deft. u"f Psi C � �� 'Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address-A". h e— S-r a c7 '1 ' Village , rCe�--s2,V t -.c. Owner _N 4"Ja , 14. (,-2��- �- ✓�-r*-i C -t-_J)wJ[85Uddress Nat /Ss �9yc 2s Nt 1L Al . Telephone 2? Permit Request _ c��-re - i?�r•1 a��c_„- 4-A 2 '',4V7 f-5 Fb 6A_&4615 __f� Aye" Square feet: 1 st floor: existing JOb . ^,@7� proposed l rb 2nd floor: existing 3 SD proposed G,�� Totalnew 1940 3�Estimated Project C Zoning District b 1 Flood Plain Ao Groundwater Overlay Construction.Type juooL Ra rh P Lot Size Grandfathered: 0 Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family I Two Family El Multi-Family(#units) Age of Existing Structure 18 LI q Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full . 4 Crawl ❑Walkout ❑Other Basement F' ' IJ o Basement Unfinished Area(sq.ft) 0IN) - Number of Baths: Full:existing 1 new -3 Half:existing ZQ new Number of Bedrooms: existing 3 new X Total Room Count(not including baths):existing new First Floor Room Count y Heat Type and Fuel: fJ Gas AOil ❑ Electric ❑Other Central Air: /11 Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Nc Detached garage:existing ❑new size Pool:❑existing ❑new size tJf Barn:❑existing C)(new size -LZZ. Attached garage:❑existing ¢knew size G2A Shed:❑existing ❑new size ND Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑)Yes *No If yes,site plan review# Current Use �Ce s 1 Aew,c e Proposed Use 3,054 c e•to e_ 0 (.A.) n e, Ya,. BUILDER INFORMATION Name Nu w c._C, Telephone Number Sc `'11 5— 15 O 6 Address I-S 5 ' t�2,�_ � /�r�lC License# 01 A. • A<Lc_ Ow 1JS 2 Home Improvement Contractor# Worker's Compensation#ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO DATE SIGNATURE — -• - 222 Pine Street :_.:._. _..: .:.......:,,: ..,� .:::..i.•.,is Centerville,Ma. 0...2..6.3.,2....,..._. ...... .... _..... .................._..........._........-._...__...._.._......._. _ ... ....... ..._.__.... . ........._. •::: �.l. June 2... .g,.g.9 ........._..............._-... ......................_...... __._._.._........................ - -..... ' ...:....................---........................................ over time - . . : 283 ,. . Unknowtj . .. #2 r 1k Fuel oil :• •• ,•, :;•,:�;� otified proper agencies 6%2 2/8 9.,.. : 15 4.5... "' iXX i': ,{,...: :.6 22/89''.E. 1445 ,...;�...5..;, ,....:.. ie Called .to observe the removal of a 275 _ allon #•2 Fuel ._; : .. oilunderground tank.On re.................._.,........,.........................._.....,._.._...,.......................•......_.............,.............. to be significant amount of product about top of tank,extending -................... down the sides Also,soil appears to be saturated around where .. ....... ............. _ tank was sitting i.n ground.L.C.R. Tank services , (420-3365)•._.is...._.•...__.._...... removal company,and technician was in process of taking soil readings and samples.Seam on lower side of tank appears to be leaking.Majority of_ product appears to e b from overfilling tank. _.................................._.........._.................................._.....:_................_. _.................... ................... - ................................_............ ................._..........................._.............._.._............................................................................_....................,._......................... ...................- ............................_-..,.__......._....._._. ...._..... .._......_.._...._......._......_.._.... .._.._._....._.._...... __......_ . _,._._..._.._. _...,... • :a":=��. = Lt. Wilcox .. : .....: ....._._...June 22 1989 :.... YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: zY d Fill in please: . YOUR NAME/S Ft, APPLICANTS S YOUR HOME ADDRESS: ;r� ¢wt� r� r BUSINES r,t, rrt s r s erns .s K TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME'OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YE N� ADDRESS OF BUSINESS �� ,0 — MAP/PARCEL NUMBER �� �� `� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St..- (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: _�Z7 ._JN /J VT- rawgo -tom ,a, �r�vrr s 2. BOARD OF HEALTH This individual has been inf J'r f the)�ermit r quirements that pertain to this type of business. Authorized/Signature COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been inf i d p4he licensing requirements that pertain to this type of business. Au horized Signature* COMMENTS: r go ME -!m -lip Los 3t W Aut—fr:�4f3 I .7g- 5 GE: ASSESSOR'S MAP &LOT'<'P� INSTALLER'S NAME&PHONE NO. �7A/? 9,5'�19-7-74 AP It=EPnC tANK C A k (size) -LEACHINQ-FACIL=: (type) NO. OF BEDROOMS BUILDER OR.OWNER*. TERMrF DATECOMPLIANCE.DATE:� 'S�eparatioh,Distance Between:the: �4Axiihuhi-Adjusted Groundwa Ilet6the.Bottom- dLeachin Facility y. Feet . Well Private:Water-Sul Leaching Facility. (If any wells exist Feet O:onsieorwi�Nh2W t of le'ac hg facihty)-' E ' f Wetland'and aching Facility(If any wetlands exist d F6ei'i" of Wiffifi :Jw:fledr.� dachinkfaciLity) :F"she d b, 1i a I I I I r� 777 I, I . o Y LOCATION hi f " hi a hir�eac - W TOWN OF BARNSTABLE LOCATION 4L 2 ►s- S SEWAGE #.,n G 3 ASSESSOR'S MAP & LOT a 11 STALLER'S NAME&PHONE 1NO- c+,i w i a 7 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 'G L (size) NO. OF BEDROOMS BUILDER OR OWNER .y a j ,Z.S-Cs f PERMITDATE: �"��" COMPLIANCE DATE:v .. Separation Distance Between the: Maximum Adjusted Groundwa Table to the Bottom of Leaching Facility Feet Private Water Supply Well d Leaching Facility (If any wells exist on site or within 200 f t of leaching facility) Feet Edge of Wetland and aching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I a� �'' I. � �t i s�� i 0 ,ab a, a'�� � � No. � �'" .� Fee 5 0 /V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zlppltration for Oiopooal Op$tem Conotruction Permit Application for a Permit to Construct( . )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 222 Pine St. , Centerville Wm. Bachman Assessor'sMap/Parcel 1874 Vesthaven, Port St. Lucy, FL �a9 r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Daniel Johnson P O box 1089., Centerville 804 Main St. , Osterville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of BuildingRe s i d ent i a 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Subsurface Sewage Disposal System ' Size of Septic Tank /.50x:�5Cs- Type of S.A.S. 3 'S (s Description of Soil: gravely sand-sand 13S i x I X Nature of Repairs or Alterations(Answer when applicable) replace cesspools with a 1 , 5 0 0 g a l. septic tank and 3 leachoina chambers (35L x8W x2H) 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 Bo d o ealth. ,, _, A Signed � ^- ✓ Date Application Approved by C-• Date q Application Disapproved for the following reasons Permit No. Date Issued '� U - _ r••�- - � T: F r..r, tr..,-•t tY wJ• .•r .e 1 t'5' ( fir � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mioozaf *,pgtem Conotruction Permit Application for a Permit to Construct( )Repair('k )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components i Location Address or Lot No. Owner's Name,Address and Tel.No. 222 Pine St. , Centerville Wm. Bachman fr Assessor'sMap/Parcel 1874 Vesthaven Potr"t St. Luc FL Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Daniel Johnson P O box 1089, Centerville 804 Main St. , Ost'erville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. �' Garbage Grinder( ) Other Type of BuildingResidential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 0 gallons per day. Calculated daily flow gallons. , Plan Date Number of sheets Revision Date Title Subsurdace Sewage Disposal System !. Size of Septic Tank Type of S.A.S. ravel sand-sand �S X it / X ,2 1 Description of Soil gravely Nature of Repairs or Alterations(Answer when applicable) replace cesspools with a 1 ,500gal. septic tank and 3 leachoing chambers (351, X8W X2H) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system l d, 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 Bo d o 'ealth. /7_ f Signed •`.�1•'v Date 9 Application Approved by o cl V Date 4 —1 C Application Disapproved for the following reasons Permit No. Date Issued 1 if THE COMMONWEALTH OF MASSACHUSETTS Bachman BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 222 pIne St. ,Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.QUC)I- U%0 dated 5 l a l U Installer Wm. .E. Robinson Sr. Designer Dan Johnson The issuance of this e r t sh 11 not be construed as a guarantee that the syste will functi°�n as desig�jed. o Dates �C�1 Inspector �`t 4 .G Cis 1�Q. No. \ Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH'DIVISION - BARNSTABLE,, MASSACHUSE17S Bachman Mi!gpooal *pgtem Cow5truction Permit Permission is hereby gran d Wsnect9t )Ree it(Xent )Upgrade pille )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: Approved by 5MI01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM `J , hereby certify that the engineered plan signed by me dated 9�i��o , concerning the property located at Le-^-re(LV.1Lc C meets all of the _. following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface FIevation (using GIS information) r° B) G.W. Elevation +adjustment for high G.W. DIFFERENCE BETWEEN-A and B 3 X SIGNED : \ DATE: NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. -. q:health Folder.percexmp aN - YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you. must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis, Take the completed form to the Town Clerk's Office,.1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get'the Business Certificate that is required by law. i7 4J)� 14�h+ vx '` gay I DATE: ZV l Fill ple se: APPLICANT'S YOUR NAME/S: x r BUSINESS ervlb�rl�`�J�k �" 5 YOUR HOME ADDRESS: 2 ZZ, f��l fi t r �� s`7`?f--/�� G" �37 U G2vIV 2 d(ot TELEPHONE # Home Telephone Number _ --9 '7 — c:t;G;781A NAME'OF CORPORATION NA,ME. ESS0F NEW BUSIN : Js o i'►C :. .u4 Gi .. y TYPE OF BUSINESS I$THIS A HOME OCCUPATIOIV� 'YES ; �IIO r AODRESS OF;{B.CJSINES5 :' v S c'�4� kUl = MAP .PARCEL.NUIViBER. ) When starting a hew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable.. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & (Main,Street) to.make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFI This individual ha een ' form any permit requirements that pertain to this type of business. MUST COMPLY.WITH HOME OCCUPATION Authorized Signat COM . NTS: RULES AND REGULATIONS.' FAILURE TO Qrn� ; LT 2:BOARD OF HEALTH ST COMPLY WITH AkL This individual has ben i f ed,�f the permit requirements that pertain to this type of business. ��U�� NAATE.RIALS RECLATI(�,i Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: c � TOWN OF BARNSTABLE Date:2,/-7-0/&jS— TOXIC AND HAZARDOUS MATERIALS REGISTR TION FORM NAME OF BUSINESS: BUSINESS LOCATION: INVENTORY MAILING ADDRESS: �xek,� TOTAL AMOUNT: TELEPHONE NUMBER:. -6-cf> CONTACT PERSON: , L-C- EMERGENCY CONTACT TELEPHONE NUMBER:` - '1`2`=/ICJ MSDS ON SITE? TYPE OF BUSINESS: rw e, INFORMATION / RECOMMENDATIONS: Fire District: if-4-0 Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product- Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash � � 4M WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initial FOR PMflNED OF �` 11 ,MTU4�Ni C3 PHON YOElFt CALL AREA�COOlf NUMBER EXTENSION P GALL; MESSA n WIiLCIkIL AGAIN `. (J� * WANTS TO SI NED "` 111V@l 48003 3y bf a'��I � j z i E •• (Domestic CERTIFIED MAIL RECEIPT I No h E isurance Coverage • r im i� 07F F I C I A Lr..^ rU Postage $ .r �/ Certified Fee o• ®.�� G 7 � i° Er u, SEP 1 °P°sb"a�l'r Retum Receipt Fee � ��>(Endorsemenrt Requred) Here I`O Restricted Del"Fee p (Endorsement Required) O Total Postage&Fees $ ` L4 p D- Sent To Street,Apt.No.; or PO Box No. o city,state, 3 a- Certified Mail Provides: ■A mailing receipt n A unique identifier for your mailpiece ■A signature upon delivery ■A record of delivery kept by the Postal Service for two years Important Reminders: ■Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. ■Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. ■For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT,Save this receipt and present it when making an inquiry. PS Form 3800,January 2001 (Reverse) 102595-M-01-2425 SENDEA: ■ Compfite items 1,2,and 3.Also complete A. Signature cti item 4.4f Restricted Delivery is desired. Agent ■ Print your name and address on the reverse r-- = Addressee so that we can return the card to you. p B. Receivef,1 y(k'SNamejoato of Delivery ■ Attach this card to the back of the mail iece,or on the front if space permits. r i `� , D. Is delivery address di j• 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No 3. ervi Type VCQ449'+v 1, , ertified Mail ®Ex s Mail ❑ Registered lllReturn Receipt for Merchandise I ®2n.--3 ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7001 1940 0004 9042 1693 (transfer from service labeo, PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICEr�- F�tq .m. a_, ,Fjrst,Class,M^`I �-- ,f���' h Postage& -2!sELP.aid y� USPS "" a v Permit No.G-10 •Sender: Please prinVyour,na62address, and ZIP+4 in this box • I 'TOWN CIF BAs�LNSTABL VIIrL�l�. ��.��'v d•.�/.� ". �a5S1�3SOlZ'S CRAP,�L(JT } MOP'Ss . 1R OR D cpN1 mtB 1DA' Et �pa�ati� BeEwae�4h0 _ - D�imum�l�d3�e�tlCit�tt�w�a.'Ts61�tn P+rkv��l'�' ��13►'l��l["�t�ffi Mgt I�enY + . . y A ' o � 3 CAN o S�P Tl G � 5 J E�'1 _ 1500 GALLON SEPTIC TANK v P Y r ° 3 SG'A LE l" L©� r. TEST PIT DATA MODEL: SHOREY ST•1500•H-10 FINISHED GRADE Performed By: Daniel B. Johnson, R.S. , C.S.E. -= 24"DIA _ 24"DIA S'7MIN) 24"DIA , 1 Date: August 27, 2001 0 a- 1 TP-1 (LI`L. 97.1) I 6" S" ' 4"SCN 40 0" - 16" A, 1 OYR4/3 Fine sandy loam 4"SCH 40 1>7 FLOW LINE 14•' 7ABEL FILTER 16" - 30" Bw, 10YR5/8 Loamy sand 4"SCH 40 TEE SEPTIC TANK TO MEET 30" - 72" C1, 10YR4/6 Gravely coarsesand 4'LIQUID LEVEL REQUIREMENTS OF ' GAS BAFFLE 310 CMR 15.226 FOR 72" -14 4" C2, 2.5Y8/3 Medium sand 4"SCH 40 WATER TIGHTNESS, j No Observed ESHWT TEE ETC o�I�EvIA�'I� No Observed Groundwater ALL WALL SLEEVES/GASKETS SHALL BE CAST IN PLACE OR C' g' (MIN.) O c MECHANICALLY PERCOLATION TEST DATA j INSERTED AT FACTORY. c�' a O COMPACTED 6R�g6E I CRUSHED STONE 9T t s Date: August 27, 2001 ! STABLE LEVEL BASE <.3/q•�pIA i SEPTIC TANK DIMENSIONS. 10' 6"L X 5' B"W X 5'B"H Soil Class : Class 1 (0. 74 G/SF) G Y/ / Perc RAtn: < 2 MPI (TP- 1 ) ! DISTRIBUTION BOX y ZEAcdIN� C1Fk�r3CRs ` � H -10 e q'ScNI 3S Qw 4�'k (�f�Ect� 00 SS oIo 9 L o Depth of Pert 'fast : 3©,• �• 48" I REMOVABLE COVER 4"SCH 40 OUTLET LATERALS DISTRIBUTION BOX TO MEET SHALL BE SET LEVEL FOR A BCRExfVL1E Olr` tLSV`1►TItyNB REQUIREMENTS OF 310 CMR MINIMUM OF THE FIRST TWO 15.232(WATER TIGHTNESS, FEET AND CONNECTED TO 4 rp$T v46, I CONSTRUCTION,ETC) 7' 0 EACH DISTRIBUTION LINE GCssvoot,S Inv. Out FoondAt ion Ur)known WITH SOLID SCH 40 FVC PIPE Inv. e 4"SCH 407 6" In Snp>'a c Tank 9t,. 2;a NO.OF OUTLETS-2 Inv. Out Soptic Taunt. �`�. 00 � � 1 � y,SP^ce'y bFE%11,ot E>~tSriN� ,� I. C c 6"(MIN) o � MECHANICALLY CRUSHED Inv. In Distribution Sox 94 `1, � a o 0 a . � „ �,,,� CESrI I Noy ' STONE (<�314 DIA.) _ Inv. Oat. Di nt»ri but Son Box 94 . 50 trav/oo.3t E�P9�'I �+IST��b Inv, In Leaching CtlambeL' 94 , 40 STAPLE LEVEL BASE E30ttt0m Of Stone of T,eachint) Chamber 91 . 90 � / 974 for q"Str1ER Bottom of TP-1 (No Obs. GW/ESHWT) 85. 1 f +� `97.�`0� E �`' �` 9 of I 8EN otlr�r�ak EL,'- too�o o T6P of bR-Ich - - 51,8/ serrrc Existing Contour - .. - 98 _ LEAC311NGDRYWELLS�500GA1.LONS l ("W) TANK 98 s to o p 'END"CROSS SECTION Proposed Contour ;- '- 98 ----- MOPEL; $MOREYPRECAST CONCRETE �►'t FINAL GRADE TO BF. STABILIZED 97f7 Test Pit FINISHED GRADE(SLOPE .07) Finished Floor Elevation FFE H•10 go,00' 1�3.4b Basement Floor Elevation BFE LEACHING DRY WELLS:3 9G"LX4'10"WX71"H a � r� WASHi PEA SOTON�E ..�..,._ 5' c� 5' Water Line W �"�' OVERALL LEACHING AREA 3/4"•1 i/Z'DOUBLE 35'L X R W X Z H © ` 71' ` WASHED STONE I �+ I � « "�+r oROc 0 EET TCCHEAMBERS ou rEK 8'6 ' REQUIREMTNETS OF �z GN fNS Ito `` 310 04R 15.252 "LM° r alto MAID FARMS " 28 ° 1 ` ILVII[RRY Nrtl RD b r .� , R R Y h�o ♦- — - s LOW CarrS v ���rsorJ o"ct o o .� '"�/N or NOTES , M / i L ONG•' . . 'POND i Jr _ as .1 1 1 . All construction methods shall conform to tie Title V (310 CMR 15) and the Barnstable Board of Health Regulations. 41 ro i> • tw I.. �'� "�► `' ° '� o'� M """ " 2 . There are no known private or° `N :,....- �° ±� P public proposedlls tleachhin inO area. or SEMC. l S �'` +� •� '� o r W feet/400 feet, respectively, of the g e A► 0t� ° /tAER* ,A Ap i J RS 54OWRl ,,Nr "+ k V,A `rR s r`f9 ( 3. Existing cesspools to be' b , LA } 2 ' .� 0AN °� �, g P pumped and backfilled prior to c o ,fig „Rc installing the new septic tank. ,A O„A AV �Ifr f a y- , tin y .+ 4r`R F a� AA/Irf i 4 . No changes are to be made in the field without the approval of the Board of Health and the design engineer. BfF,too. Ioo 5 . Proposed leaching field is not designed for use with garbage disposal. i 6. Contractor to notify Dig Safe 72 hours prior to ��qWr. ��srtnrlr �>R-R� construction. (800) 344-7233. 98 t-sPAa^' 7 . Property line information taken from Plan � of Land in �--- Centerville - Barnstable, prepared by Joslin Whitney, dated February 1976 (PLan Hook 310, Page 81 ) . evST1NG orrnlG C2jr� CALCULATIONS f � F y3 Bedrooms (Existing) 110 GPD/Bedroom X 3 Bedrooms - ;330 GPD s o V921Ff ( Percolation sc 4o cola�tion Rate - < 2 MPT (TP-1 ) s_.ol M/ Soil Class: class I (0. 74 G/,SE') 9q 4,�5 q,SB 0 PROPOSED LEACHING AREA: DtSt,+�tQ t�0^1 Y. i I Leaching chambers : 3 at 35' L x 8' W x 2' H Side Area: 172 SF X 0. 7.4 G/SF - 127 . 3 GPD Bottom Aroa:1 280 SF X 0. 74 G/SF - 2,07 .2SPD K 9l t i Total Leaching Capacity: 334 . 5 GPD 'r. �K 3 r,ER�N�ntG c�Ma�S 5EPTt G 7. r r 90 3s L ri g rr � 1 N CEfF�%� � Z'kR�EL Ti1LTEIt 7v B E' iu s r�ctE� j i Pvc P1,4r, fig' 8 < Bg u i 0 t 0 i SUBSURFACE SEWAGE DISPOSAL SYSTEM s g o n,� 222 Pine Street, Centerville No ofiS fv0 rA ' Ni '^ SCALE: APPROVED BY DRAWN BY 0 0 g S 6.(# 7' J10 'S' ,t = a° # 1U77 DATE: 9/12/01 Daniel 8 Johnson D.a. aohnsoa w � G� Prepared William aacbmAn (561) 337-1364 � w ,, 0410 0+10 Ot 4 O OfSp / Z ,: �3,�- ?, .•' Lucy, n 34952 Ix � ♦ •�; �. 1674 aL Vesthaven Ct, Port St. .;- � o-�3a 0tbo pt>o pr8o Ofyo /too t1a �+f'.�b Y F e Prepared DCN2STIC ELPTIC DLSIM, i>RC. (500) 420-1904 DRAWING NUMBER , u r by: 804 ?fain Street, mite >s, Ostszville, 1D1 02655