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HomeMy WebLinkAbout0650 OLD STRAWBERRY HILL ROAD - Health 650 OLD STRAWBERRY HILL, HYANNIS A= 273 205 p I I I TOWN OF BARNSTABLE LOCATION 19 F�d 01d �]*(-awLgM4 4111 P CI SEWAGE# VILLAGE C'efTLP—► id b. ASSESSOR'S MAP& LOT ` J3 a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY J C co I O nS LEACHING FACILITY: (type) I+ (size) Q k 6 x 1p NO.OF BEDROOMS 3 OWNER dBOLE C - O_ -�- PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 7 1 2— '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 aka -a�s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Mp 650 Old Strawberry Hill Road Property Address U7 Barbara Hebert Owner Owner's Name information is till,_ /� n e)I required for every C vV MA 02632 04/04/2018 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. Important:When A. General Information /02 filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Mike DeCosta, Jr. use the return Name of Inspector key. Wind River Environmental Company Name 46 Lizotte Drive Company Address Marlborough MA 01752 City/Town State Zip Code (508)400-8083 'SI 13230- Telephone Number License Number B. Certification I certify that[;have Personally Inspected the sewage disposal system at this address and that the information reported belQw is•#rue accurate.and cornplete as of the time of the insPectign.The::inspection. was performed<based on my<fraining.and experience in the proper function and maintenance of on site Sewage dis osal s. toms 1 am a;DEP a roved:s stem in g. P.. ys... PA y Spector pursuant.to Sect Ion. '!5:346 of Title 5(310 CMR°15.OpQ):The system.: [ 'Passes [] Condtionail}i Passes Fails Needs further Evaivatian.by the Local Approving Authority. / y 01 '1 ,Signatu _ate The _._.. D �_.._.�. The system inspector shaft submit.a copy of this inspection report to the Approving°,Authoi`ity(Board of Health..or.DEP)within 30 days of completing this inspection Ifthe systemhas a design flow of 10'.Q00 gpd orgreater,the inspector and-the system owner Shall submit.the_report:to the appropriate regional off ce of the DIP:The original should be sent to the system;owner and copies sent to the buyer, if applicable, and'the approriing authority. '****This report only describes conditions:at the'time of inspection:and under the condiEions";af use at that time This irtspeietton does"ndt address how the"system will perform m the future un2#ar the same'Or(different conch#ions of use.. - x5ins.tltic•7ev:8l16 TA18 5:OfWal tr4060h From-.Subsuftm Sewage tJisposai System-'Pap 1.of}] 4o (d A Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Both covers are 1' below grade. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the,replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further,evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning inn-a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 0 ® 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 Y2 day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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 j 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 11 of a public water supply well If you have answered "yes to any question in Section E the system is considered a significant threat, or answered "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. Lt5,ns.d.c•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. City/Town 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5ins.doc•rev.6/16 Title 5 ff i 0 is al Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Wind River Environmental - Last pumped 11/15/2017. See attached record. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1998 per plans Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"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.): All joints sealed, no leaks, the vent is on the roof. Septic Tank(locate on site plan): 1 . 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: 8'x5'x4' Sludge depth: 6" t5ins.doc-rev:6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4N , 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is Centerville MA 02632 04/04/2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 2" I Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? The dimensions were determined by sludge judge, rod, and ruler. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both covers are 1' below grade.The tees are in good condition.There is no filter installed on the outlet. The liquid level is normal with light solids and sludge. The tank appears to be structurally sound and not leaking. Recommend installing a riser on the outlet cover and a filter on the outlet. Also recommend pumping the tank annually. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet.and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑. No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The distribution box is 24" below grade and 16"x 12". The box has one outlet. The liquid level is normal with minimal carryover into the box.The box is showing signs of deterioration. The box is watertight and not leaking. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is Centerville MA 02632 04/04/2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 @ 28'x 1 V x 2' ❑ 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.): Dry, sandy, compact soil. No ponding. Showing no signs of hydraulic failure. Vegetation is normal. 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 l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is Centerville MA 02632 04/04/2018 required for every page. Cityrrown State Zip Code Date of)nspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply-enters the building. Check one of-the boxes below: ® hand-sketch in the area:.below ❑ drawing attached separately Ira a7�c O t t y ! 0 ktc> 'Zia l - k_rlb"Z 3 2-t B7Z btt1 23 ' Cr-rc� - l t5ins.Coc•rev..6;1& Titles o#w,al lnspectipn Farb`Subsuftcg S¢w8pe Uisposal$¢aem•page 15 0!17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 6+ 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: 10/14/1998 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: Obtained from copy of design records. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 650 Old Strawberry Hill Road Property Address Barbara Hebert Owner Owner's Name information is required for every Centerville MA 02632 04/04/2018 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Work Order# 0217062107 Cust# 1812304 Customer Since: 2 015 Tax: 6 . 2 5 0 0 0 Job Comments Tech Comments 11/15/2017 SVC 1000g, cover located in back yard 5 ft from right corner of deck, lite digging, no alt# , home, cc on file (dg) [Neighborhood Septic Services - Imported Work Order] SERVICED 1000 GALLON RESIDENTIAL SEPTICDISCOUNT System Owner System Location Barbara Hebert Primary Home 650 Old Strawberry Hill Road 650 Old Strawberry Hill Road Centerville, MA 02632 Centerville, MA 02632 (508) 237-2099. Hebert Barbara (508) 237-2099 Service Date: WED 11/15/2017 09:0o AM Frequency: Call to Confirm: Service Type: Standard Previous Service: Approx. Gals: 0 CCLS: Location Details: Depth Below Grade: Custom Clean Fs Cust Home: NO Filter Township: lnspeitt onlTS. lk County Barnstable BUtld 07p ON DE�SCTgiptlOt l r Zy � r 1C xt P t Pumping 1000 a 1 00'- $ $0M;4875 $ 280 49 Environmental Compliance Residential 1 00 $ l 55000 $ 19 50 Digging per 6 inches. 'First 6'InchesgFr�ee 'A A 0 00 $ 44 d.,00�$ 0�0 00 Q 4 �''$� ' A Cm = - ;_ -:n�b...M.� w..�.adJ3�kvxuc !ilA:...x^, t ePSECv//ee_ �'�"� �z 3 t 00 ; 8 y r WK subcoWt ,$ z99.99 We suggest these 3 keys steps to keep your system healthy: Tax $ 0.00 • Regular servicing • Use CCLS bacteria additive Totat $ 299.99 . Use a filter Disposal Site: WSG Disposal Volume: Payment Detail: Waste Code : Pumpseptic 1000.0000 Master xxxxxxxxxx6232 06/2020 Sales Rep : CSR : Dawn Grenier Due on Receipt Truck :1920 Technician : Craig Bryant On Site : 09:56 AM P 0 Number Tech Notes : Normal water level. Moderate top solids. Moderate bottom sludge. Outlet baffles are intact. Main line Clear. No filter is present on the tank. Recommended Boost additive, CCLS' additive,Installing a filter,Installing a riser. Cover(s) secured. Recommend installing 6 inch riser on outlet with poly 122 filter and boost combo. X Customer Signature RRIF ENVIRONMENTAL Remit payment to 46 Lizotte Dr Suite 1000,Marlborough,MA 01752 i � �.3. � �: ,t .j .� r. �� � �� $xY: , r � � f . �� r. f z t � Y. .4 �. :� �� �, �: r� a s s s- :'i;. _,� _ :�,: _ � ..o. i r �! >, g'.a' p. �- s. �- �; ;s ":�.. .r .:;... �' � �,, / ,.3: K�: ��� � I � � y y .,: i y i ,. _., ,Y 3 5 �Fa, �. ;�... ���% �,� N� ,� r - F f �,; , '.� �? �„ `�i�i � l � r � �� �`�� sa ',� � �. �., . r ,, .1 1 ^� ,. •= �, q/ 5 r„ i�a t � �, a TOWN OF BARNSTABLE h LOCATION Ll 5 U b�� LQ,�'kZ" k.t I( !ZZ SEWAGE.# �VILLAGE ASSESSOR'S MAP &LOT13—2, INSTALLER'S NAME&PHONE NO. D 6,VX\, SEPTIC TANK CAPACITY /W Y-0 LEACHING FACILITY: (type) �U (size) I�, ;-7& g NO.OF BEDROOMS BUILDER OR OWNER A PERMITDATE: �K- -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 t � C,i � � � 8 s ..) r M' i ��� \�h � `� _ � ! )� .. ,: , . x r, � L 4 f r '�S'�- � �S .. ./�a./�Jr�. "" ���{ i ' 'rF'gfa� A � � :r No. Fee$50 .00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z[ppYication for Zigozal *potent Construction 3permit Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 650 Old Strawberry Owner's Name,Address and Tel.No. 77 5—5712 Hill Rd. Hyannis Barbara Hebert Assessor'sMap/pazcel 650 Old Strawberry Hill Rd, Hyannis Installer's Namp,Address,and Tel.No. Designer's Name,Address and Tel.No. W E Robinson Septic Sry PO Box 1089 Centerville MA 0263 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature o f orAltera o (Answer hens licable) Title 5 leaching system consisting o U' ox, an ` `Shree son�'�acke maximizers . 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 Environments ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this d Health. Signed Date Application Approved by Date Application Disapproved for the following reason Cy Permit No. Date Issued ry'n..v ra.."' ♦f.-. ..+ram .,-. .,. n .., ..«1. -� . e �. t ,f a- • .r Ta. .. • _ ....-� ♦ I. n •`... .,/♦ •',� `-No. Fee$50.00 , c !, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppri{cation for Migpogal *pgtem Congtruction Vermit Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 650 Old. Strawberry Owner's Name,Address and Tel.No. 7 7 5—5 712 Assessor's Map/Parcel Hill Rd Hyannis Barbara Hebert -- 650 Old. Strawberry Hill Rd., Hyannis Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W E Robinson Septic Sry PO Box 1089 Centerville MA 0263 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(n� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of StA.S. Description of Soil sand. Nature of a a' orAltera 'o Answer w en a lica le Title 5 leaching system consisting of -' ox, an ` riree sthon��ac � . maximizers 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 Tide'5 of the Environmental ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this&ard o Health. G� q Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued r THE C IrIMONWEACTH OF MASSACHUSETTS Hebert �✓ ` � 6�4R ABLE, Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(xx)Upgraded( ) Abandoned( )by at 650 Old Strawberry Hill Rd Hyannis has been/cons ted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. W" ated Installer W E Robinson Septic Service Designer. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ----------------------------- No. $50.00 Fee f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Hebert MiOogar *pgtem Congtruction Vermit Permission is hereby granted to Construct( )Repair(x)5 Upgrade( )Abandon( ) System located at 650 Old. Strawberry hill Road Hyannis MA Installer W E Robinson Septic Ser vice and as described in the above Application for Disposal System Construction Permit. The applicant recogniz "s his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction m st bey completed within three years of the date of this ermit. t Date: /C/ Approved by NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 650 Old Strawberry Hill Road. Hyannis, meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will nD I be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) C SIGNED: DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). d. C� �_' �. ` ~� b _F-. �� d TOWN OF BARNSTABLE LOCATION `�D b SEWAGE # VII.LAGE_ ASSESSOR'S MAP& LOT .. - � . INSTALLER'S NAME&PHONE NO. 17 6ln SEPTIC TANK CAPACITY LEACHENG FACILITY: (type) ( U k`e (size) NO.OF BEDROOMS BUILDER OR OWNER �- PERMTTDATE:_ �U °�--S 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 GAL�, se � VD a T Commonwealth of Massachusetts Executive Office of Environmental Affoirs Department of Environmental Protection VAlllem F.Weld Governor Trudy Coxo . ' fecnl►ly cOG David B. Struhs commlr f loner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION,�` Property Address: 650 Old Strawberry Hill Rd. Address of Owner: Date of Inspection: July 23, 1996 �I�' (If different) Name oWnspector, Robert Saben Company Name, Address and Telephone Number: Barnstable County Systems Inspectors 25 Mid—Tech Drive West Yarmouth, MA 02673 CERTIFICATION STAT17M17NT (508) 778-0101 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes _ Conditionally Passes _ .Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Dale: July 24, 1996 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, G. C, or D: A) SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 1 r.303. Any failure criteria not evaluated are indicated below. 111 SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon cornptctinn of the rel,lacrnu•nt passes.inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not clpiermined", (­YlNlain why not) _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or ex fill ration, or tank bilurr is imminent. The system will pass inspection if the existing septic lank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) Onn V,IIntnr Street • Poston,},lassnchusetts 021011 • FAX(617) 55fr10,19 • Telephone (617) 292.5500 �. rnnrrd nn r. L.I r, t r Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 650 Old Strawberry Hill Road Owner: Todd Hebert Date of Inspection:July 23, 1996 BJ SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will piss inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require funkier evaluation by the Board of Health in order to determine if the system is fai ing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IV A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 10 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND TH ENVIRONMENT- the cvctem has a septic tank anti soil absorption system and is within 103 feri to:, surl`Lce walet upp:, at surface wale.r supply. _ The sy�tcm ha• a septic tank and soil absorption system and is within a 'Zone I of a public --ter supply -:cIL _ The system h.i< a septic Cant: and soil absorption system and is within SO feet of a private water supply %.evil. _ The sy>jen, a septic tan:, and soil absorption system and is less than 100 feet but So feet or more fro n a private wi:cr supply well, unless a well water analysis for eoliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than S ppm• D) SYSTEM FAILS: I have determined thal the system violates one or more of the following failure criteria as defined in 310 CMR 15.103. The basis for this determination ii identified below. The noard of)-Health Should be contacted to cleternune what will Iw ne•et:,vy to cornet the failure. Backup of selvage into facility or system component due to an 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 r logged SAS or cesspool. Z (revised 'B/1S/95) i SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPKTION FORM PART A CERTIFICATION (continued) Property Address: 650 Old Strawberry Hill Road Owner: Todd Hebert Date of Inspection: July 23, 1996 D) SYSTEM FAILS (continued): 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 112 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 Soil Absorption System, cesspool or,privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within So 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 !upply%veil with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of wel: water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The (ollowing criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to publi: health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet o(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 %Vellhead Protection Area (1\A11PA) or n ma pp•d 7.one II of i public wily supply wV11) The owner or operator of any such system shall bring the system and facility into full compliance with the ,rroundwater t eatment prof-.rim requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 650 Old Strawberry Hill Road , Owner: Todd Hebert Date of Inspection: July 23, 1996 Check if the following have been done: X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _As built plans have been obtainer( and examined. Note if they are not nvailable with N/A. X The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow X The site was inspected for signs of breakout. X All system components, excluding the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected (or condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive. methods. X The facility owne, (and ncrupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 650 Old Strawberry Hill Road Owner: Todd Hebert Date of Inspection: July 23, 1996 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 s•allons Number of bedrooms: 3 Number of current residents: 4 Garbage grinder (yes or no): No Laundry connected to system (yes or no):Yes Seasonal use (yes or no):No Water meter readings, if available: Last date of occupancy: Current COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: Gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: No pumping records — by property owner System pumped as part of�inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM X Septic tank/distribution boylsoil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 1984; Design Plans Sewage odors detected when arriving at the site: (yes or no) No (revised a/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORT i PART C. SYSTEM INFORMATION (continued) Property Address: 650 Old Strawberry Hill Road Owner: Todd Hebert Date of Inspection: July 23, 1996 SEPTIC TANK:X (locate on site plan) Depth below grade: 16" Material of construction: Xconcrete _meta(_FRP_other(explain) Dimensions: 5x4x8 — 1,000 gallon Sludge depth: 2' „ Distance from top of sludge to bottom of outlet tee or baffle: 2 10 Scum thickness: 6„ Distance from top of scum to top of outlet tee or baffle: 1 Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Inlet and outlet tee in good condition Liquid level 3/4" above _bottom of outlet. Strucutral integrity appears Qood. Recommend system be pumped - requires regular maintenance GREASE TRAP:_, (locate on site plan) Depth bclo%v grade: Material of construction: _concrete _metal _FRP-other(explain) Dimensions: Scum thickness: Distance from top of Scum to tnp of outlet tee or baffle: Distance from hotto- M «it^i t^hottnm of owlet We or battle: Comments: (recommendation for pumping• condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of Ic•akagt% 00 (revised 8/1S/9S) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 650 Old .Strawberry Hill Road Owner: Todd Hebert Date of Inspection:July 23, 1996 TIGHT OR HOLDING TANK:_ ' (locate on site plan) Depth below grade: Material of construction: _concrete _metal_FFP—other(explain) Dimensions: Capacity gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION SOX- N/A (locate on site plan) Depth of liquid level above outlet invert: Comments: Com if ts: and C1iStribu;ibl: i eau..!. C',idcnco of Solids Carr;over, ev;dence of leakage Into or out of bo.!. etc.) (notePUMP CHAMBER:____ (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamher, condition of pumps and appurtenances, etc.) f' 7 (revised 8/1S/95) t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 650 Old Strawberry Hill Road Owner: Todd Hebert Date of Inspection: July 23, 1996 SOIL ABSORPTION SYSTEM (SAS):X , (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: 9x5x6 Leaching pit leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: _ leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vcgetation,etc.) No signs of hydraulic failure, normal vegetation. No ponding. CESSPOOLS: (locate on site plan) Number and configuration- Depth-lop of liquid to inlet invert: .Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groun(Iwate,. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Dimensions: Materials of cnn,tniction: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised $/15/95) B SUBSURFACE SnVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 650 Old.. Strawberry Hill Road Owner. Todd Hebert Date of Inspection: July 23, 1996 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells.within 100' 1 3y yo ' / Rig of Drr,T11 TO GrzOUND%VATrr( Depth to ,groundwater. > 12 feet method of determination or approximation: VS G S M A P P1 a 9 (revised 9/is/9s) 9 BARNSTABLE COUNTY SYSTEMS INSPECTORS 25 MID-TECH DRIVE WEST YARMOUTH, MA 02673 <. '9 June 26, 1996 dy�� , ¢ . Town of Barnstable Barnstable Health Department South Street Hyannis, MA 02601 Dear Health Department: Enclosed please find a Subsurface Sewage Disposal System Inspections for property located at 650 Old Strawberry Hill Road, Centerville. If you have any questions, please do not hesitate to call me at (508) 778-0101. Sincerely, 1 Robert W. Saben, Jr. Certified Systems Inspector __ I LOCATION SEWAGE PERMIT NO. ' GSO a40. S�oQ�4w��ie2V N�%� QvA/� VILLAGE INSTA LLER'S NAME i ADDRESS" Q UILDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 7_ 3U � �s' r r+- r r � W w s t n r No.5S74-995 THE COMMONWEALTH OF MASSACHUSETTS kc,p BOAR® OF HEALTH /0-wN..................OF...... .tV. - ............................... Appliration for Diapoiial Works Tonstrurtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -----. ......(- ...:. - Location-Address or Lot No------------------------------------ 1 Owner Address ...................... -( 1 ................................................ Installer Add ess QType of Building Size Lot...l _�VIP....Sq. feet Dwelling—No. of Bedrooms-------------------'-----•-•--......___....Expansion Attic ( ) Garage Grinder p,, Other—Type of Building ..4.QB_�.......... No. of persons...................... Showers (I ) — Cafeteria ( ) G4 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---yt:E........ ........ 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........................ Pa' ----------------------------------------- •------------------------------------------- --------------- ---------------------------------... --------------------- 0 Description of Soil............ ...........---------------•---------------•--•---...-•---•------•-------------------------------------•---•----------------------------------------------- x W ------------------------------------•------•-•-••-------------------------------------....--------------•--------------------._...--------------------•---------•----•---------------------.....--..•••- UNature of Repairs or Alterations—Answer when applicable..:............................................................................................ -------------------------------------------------------------------------------------------------•-----•---•••------------•----------•--------------------•........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL% 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. t� / V'K� Signed......01111. .-.1 ......A......... .............. ....1.1-G� J- ,�) Application Approved By----- ------ �%:_ !►.---------------------------------------- ... A- -. ------ Date Application Disapproved for the following reasons---------------------------•=--•--------------------•-••---•-----------------------------------•-------•-••..... ----------•------------------------------••-•----------------...-•--•-----...------..........-•----------------•--------•---•---....----•••--•-----•-••--------•-•------------••--------------------.--- Date PermitNo...... ----C- ----- ---( . -_ Issued-....................................................... Date 44 THE COMMONWEALTH OF MASSACHUSETTS 705� � BOARD OF HEALTH . N..:.....:.........OF..... ................................ ApplirFation for Disposal Works Tonstrurtinn frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. �---------------------------------------------- c "/s'�N.—Ai...rw------- 1 j ...... Owner Address a ......... a It.. 0 C '- ................................................. �lalsT��,.2_.�....J-- ................................... PQ Installer Address V Type of Building Size Lot4� _.0 ".._..Sq. fee .-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder A/ '_l Other—Type a ype of Building _,LR�O4c�.._._._.... No. of persons____: ___________________ Showers (j ) Cafeteria ( ) Other fixtures -----------------------------------•--•-•-•---••. . d --------------•----•---•--------------------------••••......---•--•.... W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W 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__ C5.........EAG:W .*.... Date.......Y:- y......... W - Test Pit No. I................minutesper„inch Depth of Test Pit.................... Depth to ground water......................... fr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R'+ --••••••••-..................................................................................................•-----....----••-•-•---•..._..._.....---•-.----- ODescription of Soil............. .........................................-.......................................................................................................... U. .:---•.........................•----=------------.....----------------------------••--------•-•------•------------------------------•------------------•-•--------. .................................... 0 Nature of Repairs or Alterations—Answer when applicable:....:.......................................................................................... .......--•--------------------------------------------•-•------------------------- ............................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 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. 11 // q _ r Signed.....1 � .....f:!.t_.... .-----•----- --�---�-��-...�:�--•-- Dat Application Approved By---M :_ s. ..................................•----------- --------- - ` Date Application Disapproved for the following reasons----------------•----•---•---•----•----------------------------•-----------------------..._.........--•-•----•--. ---••--•--••---••••......•-•--•••...--•--•........•-•-•--••-•••--•-•---•--•••---...-•-----••••••-•------•--••-•-•---------•••---•-•------•••--•-••--•---••----••--••-----•----......................... Date PermitNo.- y .................. Issued....................................................... Date THE COMMONWEi LTH OF MASSACHUSETTS. BOARD OF HEALTH ..........................................OF..........................I.......................................................... Trr$ifirFate of TOutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...........J __t.... _#cy�- ........................................ ---- --- •--------------- ------.......----••----------.......------....------ C v Installer has been installed in accordance with the provisio TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit 'No......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A WARANTEE THAT THE SYSTEM WILL FqNCTION SATISFACTORY. DATE.. --2,0 ----------------------- Inspector. fi THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FEE........................ sposat Work vtonstrurtion Vrrnti# Permission is hereliy granted.....__..+ ............. ................................................ ••••........ at No.......... ___ t._�..�__ `'�--�( ,����-'fi Individual Sew ge D>s osal System to Construct --8 e air an Inds Street as shown on the application for Disposal Works Construction Permit No.:_�__.."�. Dated..... .. . ........................... (_A -DATE---......•-----.--------------- Board of Health FORM 1255 A. M, SULKIN, INC., BOS TON - 1D 'c t,.bT 15p4-4:sr acj ��Q 4 07 Q 104.0 Ot-D ST�.vc8trz4�y �� � oar REGISTERED CIV E j�1 OF Mq�gcy WALTER G E. SMITH,JR. 1520o �q GlSTER��0� �(SPasA�L 'PLAQ GiP-A-14AAA : Lt T7-L E'-rb tJ f Nn� F—N6, P,.A6.50 jw,c , R�`4Ni -IIA QA A 10 C DIs94:50 14 8" YZ GFr.�. CA Aa. G Pi7- ScP��� T4 n k 94 SS 4 4a G GAD 4A a a 3F� g8.O A �A �s► 3 a , v / �A • .i �.¢,—� �Z Kln,hcd Stone BoT• FiT ELF-y LA O�D�Rou►Jp u 970 g � zrrr�-rnr o U E S 16,N D�T•q PE R-C.O L!A'T I O N < � (� 3�" TEST PER F'oRM E� A U C7 3 QGDRooMS K I l0 C�pD = /000 C PD LEAr-"iqC-, �,EQ CoAQSE No GrAREWgCnE DISPOSAL USE looms �AL•SePTccT/.�.J 92. Q roy7 of CAPAGITy (,2" PR-0VlDF- D . t-cKG• HO -E • Cl ep-�I cL. S l D E 5 {Z x X Z = E(, S C-) P D q 1,7 �� I OT/4,L CAFAC ITy 6z,78 C PP Co c l� oTE— D 15 Po sA L Sy ST Dc.s IC-7 N E D 1 n( ACLORDP.NGE w I TfL4 PROVISIONS 0.F - - `-�-:► i D GODC. • B4,o. No CeouJ ,jD AM Cc,vC-T0LJ1,3 - 1 -42 Lo T I ©LD 5T pAW ILAe R 05't--ABLE OIL 5rcz ArA (�;I • o N 0 C q m 3 V W 2 0 v � r C NEW 8" GONG. (h M. Q t u; FOUNDATION `r I w WALL TYPICAL - W ON 20"XIO" GONT. � STRIP FOOTIN6 N 2X4 KEYWAY. m W • 0 A 2 GONGRETE SLAB A201 N 4" GONGRETE SLAB ON 6 MIL POLY VAPOR BARRIER, REINFORCED WITH 6X6 W2.G X W2.a W.W.F. (SHEETS) ON GONGRETE BRICKS. SLAB ON 12" GOMPAGTED'%" WASHED STONE BASE, GOMPAGT IN (2) 6" LIFTS. I ALTERNATIVE FOR W.W.F: PROVIDE FIBER6LA55 RE I NFORGED GONGRETE ADD I T I ON m SAW GUT EXI5TIN6 FOUNDATION DOWN TO SLAB AT EXI5TIN6 EX I ST I NCB BASEMENT WINDOW LOGATION. TIE NEW FOUNDATION INTO w EXI5TIN6 - .#4 REBAR @ 12" O.G. 3 MIN. INTO WALL W/ o -EPDXY @ ALL LOGATIONS ' SHOWN. Fp� �1 Q F (V N 9 0 5'-0" 00406 A101 -,--IN51DE FACE OF EX15T.5 8-011 ' 0 N VELUX SKYLIGHT- 2 4'-0" 4'-011 OVE 150 CENTERED ON WINDOWS IN EACH a DIRECTION A5 SHOWN. �1 DA5HED LINE u' SEE ELEVATION5. INDIGATE5 FAGE OF CL EXI5TIN6 5I0IN6 EX15TINC FAGE OF EXI5TIN6 BULKHEAD TO 5TUD WALL / REMAIN OUT51 DE FACE OF m TUB DECK- 7-4' X 3-b". 'y W MAXIMUM HEIGHT = 2'-O" EX15T. FOUNDATION. — _INFILL XL aa A ll I C3 = FACE OF' TILE I I EXI5TIN615TUD I A201 I WALL. I I I I I I I I I I I I I I I II I EX I�t I NG BEI�i�ooM Z IN I a 1 5H0 R`r is TOWEL IW�RMER I _ BUILT INTO 5HELVE GABINE�T.1 - 5' _ -4' II II z -------� 1 Q STRIP YELL TO CLOSET=� �� m a CARPET 31 5TUD5. INEW 6YP. 2 I BD. AN> 'PLA5TER. -- L----------J L----------n----� ------� L------ P05T wr INFILL I III ALIGN NEW WALL I a EXI5TIN6 i WITH EXI5TIN6. 1 GL05ET TO ----a_a--------------- REMAIN. I `------------ I-7------------�-u; EXI5TIN6 WALL5 = TO BE 1 O EX I T I NCBHOUSE REMOVED.. lu - I aR DWOOD _n I II II II H F E WINDOW5EAT - - --- o 05 20/O6 -----LL ——— 1'-41 51-011 1_4 L - - - - - - - - - - - - - -71_81ll LINE OFI5' S1DE ` 2 1�'YARD 5ET13AGK. \ Lu 00406 r PROVIDE ICE AND WATER SHIELD z o OVER ROOF TO WALL INTERSECTION u e AND ALONG SIDE HALL OF HOUSE. 3 ' m 3 ASPHALT ROOF 5HINC6LE5 4 ROOF I N6 FELT a a 5/8" FIR PLYWOOD ROOF C 5HEATHIN6 TYP. 'y Q ROOF RAFTERS SEE Q a FRAMING PLANS y W ALUM DRIP EDGE, AND 3' OF ICE AND WATER SHIELD ALONG PERIMETER OF ROOF E06E. 2 R, 4 h 2nd. FINISHED FLOOR ADDITION TOP PLATE IIXS FASCIA BD. 2" SOFFIT VENT Q Q . CL TYP. EXT. HALL GON5T. 1/2" BLUEBOARD TYP. - 2x4 STUDS @ 16' O.G. 1/2" FIR PLYWOOD, TYVEK, o 51DIN6, - SEE ELEVATIONS. u- MISTER BATHROOM Ist. FINISHED FLOOR AL16N ADDITION oFo Ist. SUB FLOOR Ist. SUB FLOOR R-21 BATT INSULATION —APPROX. 6RADE BISEMENT III=111=111=1 i 1=1 I '� ADDITION =1I1=1I1=1II—III III—III—III—I 1=1 BASEMENT 11 1=1 1=1 i 1=1 0 ril-Ili-IT i-I� 2X6 KD SILL ON A 2X6 J/ I—II I-1I1=1I I EXI5TIN6 I I El I I—I I I- PT. PLATE ON GLOSED =1I =1I1= CELL-SILL SEAL II IIiII II I I I=1 11= 1/2" x 12" ANCHOR —III—III g El I I—I I 1=1 o BOLTS © 6-0" O.G. III=TII-I 11= � ALI67N =1 I-III=1 05 20/06 Ill illl,'' BASEMENT SLAB 5 C T ION . A 00406