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HomeMy WebLinkAbout0131 CRANBERRY LANE - Health 131 Cranberry Lane Barnstable P A = 234 -066004 H .. Y i. • � r• o �, a .. � aA E a .. .. r �.,� ��a ..,;� V ...rt +� :M-!Jr+s $ ,--c >• a>ri Y 1': TOWN OF BAIRNSTABLE .LOCATION �3 CrM��,rr IMt` SEWAGE # r�VILLAGE N5�4 ASSESSOR'S MAP & 1.0173-34'©W506- INSTALLER'S NAME'&PHONE NO. SEPTIC TANK CAPACITY urN LEACHLNG FACE ITY:.(type) K 6 (size) NO.OF BEDROOMS 3 BUILDER OR OWNERS C f PERMITDATE: 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 leachi g facility)_ Feet . Furnished by �2S,et. mr, FI 1 Y3 ly 3 ;LO y k Y 3y y°► . A TOWN OF BARNSTABLE 1,e,LQCATION t 3 J C ✓1 SEWAGE# raQJ 7 _ /(D VILLAGE ASSESSOR'S MAP&PARCEL M : INSTALLER'S NAME&PHONE NO. 0113 Ar&T 0rCanS'd 3 Zt 0&0C SEPTIC TANK CAPACITY /ado Ex rsT Nci-- SOU(aa(o?37 LEACHING FACILITY. (type)A So 0 C*AK661-S (size) 13 5( As P< A�FE� NO.OF BEDROOMS '5 T;f 4-L 1V&Q OWNER N a . PERMIT DATE: I ay-1 i I COMPLIANCE DATE: Separation Distance Between the: N; 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 t � A-i_ r A,2. a9t la-to r A-3- sg.b t A ag' t � � l r No. Fee —00— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ell ����6� plitation for M18t108al *pstem Cunstruttiun Permit Application for a Perm t to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ��� Ct��,� �' "v 'l l 9^'( Owner's Name,Address,and Tel.No. Assessor's�ap/Parcel g,,f✓l.$4q tj� 9 y�' b( Installer's Name,Address,and Tel.No. $' '3 611 �B/a Designer's Name,Address,and Tel.Nosew 3(01. 13 M Type of Building: ,/ Dwelling No.of Bedrooms Lot SizeQl '7�.YO.4 sq.ft. Garbage Grinder( Other Type of Build i � F'"' � �� o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date VVV- I/a 7 Number of sheets .47 Revision Date Title 1W�Q /I� Size of Septic Tank `jf Type f .A.S. Description of Soil "a ^�R7 Nature of Repairs or Alterations(Answer when applicable) e� f� �'► �rv` 'Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in * accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o£H lth. i ed d Date 4 ( - Application Approved by Date Application Disapproved y Date for the following reasons t Permit No. Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION --TOWN OF BARNSTABLE, MASSACHUSETTS Yes .4pliLation for Disposal 6pstrm Construction ertnit Application for a Perm to.Construct( ) Repair(V/Upgrade( ) Abandon ❑Complete- .stem ❑Individual Components ( ) P Y P Location Address or Lot No. 131 G yl~ yr Owner's Name,Address;and`Tel.No. 4,_4 AssessoLrrastap/Pa ceT `00 Q'f v i! it r3 s19kg 01 °J 775, Installer's Name,Address,and Tel.No. 5 cA ,bc�, Ga � Designer's Name,Address,and Tel.NoS 3(�/ f 1-1i�5 e3r0�'l-trS Cc�t�r�bt l� � / �f�S �C� ���-� ><�n. �1 Type of Building: J v Dwelling No.of Bedrooms 3 Lot Size 424 sq.ft. Garbage Grinder Other Type of Building�1-`'� *Vlj .A- "&o.of Persons I Showers( ) Cafeteria( ) • / Other Fixtures 1 � Design Flow(min.required) 33a_ gpd Design flow provided 3Y3 gpd Plan Date p 7 Number of sheets � Revision Date r Title -T 0 Size of Septic Tank �7 Lo c)— TypeaA.S. Description of Soil a I } ¢Nature of Repairs or Alterations(Answer when applicable) dJ `�' G�' /0�► Lv .r i j { Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the-provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of e lth. � `p'J igned � !/fir-, Date �`(f � �,�.,t / o e Application Approved by �/ �� - f Date Application Disapproved b �- P Date for the-following reasons Permit No. z Date Issued y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Ertificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded(. ) .--- Abandoned( )by r 11 t 16 Oro iJ401s C 0,7.S) , - at r 3I C tq '1 L f ^i was eeonst�ra en acc �'e .� with the provisions of Title 5 an the for Disposal System Construction Permit No. � I t d Installer � 1 1 I s(bco]urs C-o✓►o Designer �' 5&ItJ�P tg #bedrooms 3 Approved designeflo. ��,,, 33 6 gpd The issuance of this permi shall no be construed as a guarantee that the syste ill fa ncti n deslgne . Date , Inspector ---- -------------------------------------------------------------------------------- No. f Fee [/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pst ConstCULtlon i3ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at +3 a,�N ) 6(ti) op q ; Q/. i I; and as'described in the above,Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio ust be lom feted within three years of the date of this permit. Date Approved by l .. i Town of Barnstable Regulatory Services Richard V. Scali,Interim Director Ff` + BARNSTABLE MAS• Public Health'Division 039. ► °i Thomas McKean,Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 s Fait: 508-790-6304 Installer& Designer Certification Form Date: - 2- l Sewage Permit# ©` 16 Assessor's Map\Parce'l Designer: 5 gk Installer: Address: �'Z Z-`� . Address: a -� r w ' uwA F On " �o' 1-7 ���-�5- d2oS•-C a�t$T was issued a permit to install a (date) (installer) septic system at 3 � � L-A&-based on;a design drawn by (address) ��l4tIZ ated (designer) � n--�- �:-�-^_ _; . ;•. . I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the � Y pp g distribution box and/or septic tank. Strip out,(if required) was inspected and the soils were found satisfactory. r I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. . ,. I certify that the system referenced above was constructed in c liance with the terms ` of the IAA approval letters (if applicable) Lgw of gas DAVID S9cyGN .. - 4 P D. i . • o (I taller's Si nature) " �Ir AuuL�� !��_ �RT`( JR.1211 A • - 9�Q,S T EPA® _ agN1TAR%p� (Designer's Slgnature) (Affix Desig i'' amp Here) Y PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc " i@, Legend Town Boundary - Railroad Tracks Buildings ; _ Painted Lines Parking Lots O Paved r !7G Unpaved Driveways 0 Paved (: Unpaved s 'QalbO Roads . : ` 13 Paved Road Unpaved Road - Bridge LLe 13 Paved Median' Streams s a> Marsh r 13 Water Bodies 4 g Q-�i maa R yl wowpa t 2340660 #1290 �• Map printed on: 9/17/2017 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi 10 21 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862-4624 reflect current conditions,and may contain such as building locations. pprOX.Scale: 1inch= l0 feet cartographic errors or omissions. gist?a town.barnstable.ma.us Town of Barnstable P# ' Department of Regulatory Services B aw,ar�nr�a Public Health Division • Date 'b j 2 f �d39 200 Main Stract,Hyannis MA 02601 .. /� P�5 Date Scheduled -Tfine Fee Pd.— �� �`✓ a Spil Suitability Assessment for Sewu e'Disposal Performed-By:_ rJf Witnessed Hy: R�. 1 - LOCATION&.GENERAL INFO N Location Address Owner's Name �1�1 �►.1 E—t'� �C M Ld 9tt �.rz.�+v tnt` ac � ticvt 411lbllP1o�ta4 �yc�?94s ' Address, Assessor's Map/Parcel; Z?J4 r0 c�'O Engineer's Name�O t ?s� q,J,u� . uzss.� NEW CONSTRUCTION REPAIR 13Telephone ~ o 00 QrS {Cos # Land Use b-1F-- f�-Z e . Slopes(96) a H�Rt9 ! Surface Stones Iva-- Y 6 Dietancoa firm: Open WatcrB ody� i'osaib(c wet Area ft Drinking Water Well Dralhage Way �"`' �` ft 'Property Llne Other 3 6 ft SIKETCHe(Street name,dimensions of lot,exact locations of test holes&pore testa,locato wetlands in proximity to holes) ,Y # Parent material(geologic) ce�atr !1 Depth to Eedrook Depth to Oroundwater, Standing Water In Hole: �; Weeping fratrl Pit Roo Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONAL'IIIGH WATER TABLE ' Method Used: Depth Observed standing In obi.hole: �/'u In, Depth Mail mottlec- Doilth t weeping from side of�o�b�'�hole: °"� b1, taroundwater djustment Index Well�t Reading Dato:. - Index Well lmvol Adj,•factor .Acj,Oroundwator-Level,,..? �z PERCOLATION TEST Dale. a Time Observation Hole# / Tinto at 9" (/Depth of Pare �`� , Time at 6" Start Pro-soak Time @ ' " 'lima(9"46") End Prce soak /2- Rate Mln./Inoh Site Sultabillty Assessment: Sltd Passcd Sitp Failed: Additional Testing Needed(YIN) - ND Original: Publio Health Division Observation Hole Data To Be Completed on Back— ✓ ' •***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conseirvation Division at least one W week prior to beginning. Q:\SHPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole#_emu z Depth from Solt Horizon Sall Texture Shcl Color Soil• Other Surface On.) (USDA) (Munsell) Mottling (Stnueture,Stonei,Boulders. - /� y �slekoncy.9tr't3revell /v X ¢3 DEEP OBSERVATION ROLE LOG Hole# Depth from. Soil Horizon Soil Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling . (Structure,Stones,Boulders. ,i. �b �»al /4j'e •��3 ✓ 7.Sr2 r/ a o g Y2 cl DEEP OBSERVATION HOLE LOG Hale# Depth from Sail korizon Sall Texture Sail Color Sall Other Surface(In.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sall Texture Sall Color 81311 Other Surface(In.) (USDA) (Munsell) Mottling (Structure,SRopes;Boulders, Consistency, i Flood Insurance Rate Map: Above 500 year Mood boundary- No— Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No.�_ Yes Depth of Naturaft Qccurrine Pervious Mit erlsl Does at least four feet of naturally occurring pervlou mtitorial oxlst in all areas observed thrpughout the area proposed for the soil absorptibn system? s If not,what Is the depth of naturally occurring per lour material? Certl.--�°II t. I certify that on �/d.`` 5- (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . ' the required trainin ortise n erte a descrlbed in 4 10 CMR 15.017. !/- 2 Signature Datts , Q;MPTIOPERCPORKDOC '. ' A. TOWN OF BARNSTABLE' BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date l�' I ® �� Time: In Out Owner DRO 1 D JAMoNA Tenant Address 6 CSao Ct/— Address Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities- • 4. Water Supply �s 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service _ 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing OR 18. Driveway Width is 19. Number of Tenants Observed PART 11 37. Placarding of Condemned Dwelling; s Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed max) Number of Persons Allowed (max) Person(s) Interviewed �(%�14(�f Inspector If Public Building such as Store or Hotel/Motel,specify here I COMMONWEALTH OF MASSACHUSETT'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS lug DEPARTMENT OF ENVIRONMENTAL PROTECTION VED F E B 0 9 2005 TOWN Ut +RNSTABLE TITLE 5 HEAL-r H DEPT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 131 Cranberry Lane r Gente"ilk. MA 02632 Owner's Name: Joe Crine .. Owner's Address: 14 Farm Road y Rey Bebnont, MA 02478 Date of Inspection: January 14, 2005 .: q o(olo p04 Name of Inspector: (Please Print) James M. Ford 'AM Company Name: James M. Ford T - Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported - below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: January 30, 2005 The system inspector shall su it 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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 131 Cranberry Lane Centerville, MA Owner: Joe Crine Date of Inspection: January 14, 2005 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: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 J v Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 131 Cranberry Lane Centerville, MA Owner: Joe Crine Date of Inspection: January 14, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 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 r "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: . 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 131 Cranberry Lane Centerville, MA Owner: Joe Crine Date of Inspection: January 14, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z 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 well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water.supply well., ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 • Page 5 of 11 OFFICIAL INSPECTION FORM'-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 131 Cranberry Lane Centerville, AM Owner: Joe Crine Date of Inspection: January 14. 2005 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: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 131 Cranberry Lane Centerville, AM Owner: Joe Crine Date of Inspection: January 14. 2005 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 0 Does residence have-a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2003-116.000 Pals::2004- 73:000 gals. Sump Pump(yes or no): No Last date of occupancy: Weekend use COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 1998-per owner Was system pumped as part of the inspection(yes or no): 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) ' Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and.source of information: Approximately 1993-per owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Cranberry Lane Centerville, MA Owner: Joe Crine Date of Inspection: January 14, 2005. BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) ' If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 izal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" 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: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 a Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Cranberry Lane Centerville, MA Owner: Joe Crine Date of Inspection: January 14, 2005 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarn level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even. 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 D-box was level. The Iiauid level was normal. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 131 Cranberry Lane Centerville, MA Owner: Joe Crine Date of Inspection: January 14, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 gal.) leaching chambers,number: 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.): The leach nit was dry. The scum line was approximately 1,up from the bottom. There did not appear to be any signs of allure The bottom to grade was 10.5'. The cover was 10"below grade. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 f Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 131 Cranberry Lane Centerville, MA Owner: Joe Crine Date of Inspection: January 14, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. JA �c T 10 r a 3 :01- I ly6 S , 3 �o yk Y 3y q 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Cranberry Lane Centerville, MA Owner: Joe Crine Date of Inspection: January 14, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the mans were showing approximately 25'+1-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 3 V TROY WILLIAMS - �EfiEIVE� L - LI In» 1 0 19g . 9 SEPTIC INSPECTIONS �` W Certified by MA Department of Environmental Protection TMo ,` (508) 385-1300 19 Hummel Drive 6 . South Dennis, MA 02660 E COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION �Op� ONE H'INTER STREET, BOSTON, MA 02108 617.292-5500 WILLIAM F.WELD TRUDY CORE Govcmor Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr 0 PART A CERTIFICATION Property Address: ( C " v% Le w rr 7 L , . C 44n.k,,v1 f I¢Address of Owner. Date of Inspection: r(�y�y 8 (If different) A y: Rn b.i! "7 0a-u L►`'`- Name of Inspector: Troy Wi.l l i ams SP«i41 47 .„a- 1 am a DEP approved system inspector pursuant to Section 1S.340 of Title S (310 CMR 15.000)Company Name: Troy .Wi111dms Septic Insaections Mailing Address: -19 Hummel Drive - "South Dennis , MA 02660 Tui.ti9c.fGsP�r�� Ma.Telephone Number: —4 508) 385-1300 CERTIFICATION STATEMENT o.Z C?r 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: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's SignatuFe: J_-1-- !/"'L��C.c.Gt�,.� Date: 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, 8, C, Or D: - A] SYSTEM PASSES: 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: eB] SYSTEM,CONDITIONALLY PASSES:. A///j 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. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If'not determined',explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of ' Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank e - as approved by the Board of Health: - (—i—d 04/25/97) _ Para 1 or 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 131 Cranberry Lane,Centerville,MATIFICATION (continued) s Property Address: Attorney Robert J. Donahue MA Owner: November 4, 1998 Date of Inspection: BI SYSTEM CONDITIONALLY PASSES (continued) /1/'/19 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). Describe observations: 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 pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland"or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, *APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has aseptic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 131 Cranberry Lane, Centerville,MA Owner: Attorney Robert I Donahue Date of Inspection: November 4, 1998 DI SYSTEM FAILS: You must indicate er,,.er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. .The basis for this determination is identified below. The Board of Health should be contacted to determine what will'be necessary to correct the failure. Yes No Backup of sewage 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 clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged'SAS or cesspool. _ liquid depth in cesspool is less than 6" below invert or available volume is less than 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 l of a public well. f 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: Al 1q You must indicate either "Yes" or "No" as to each of the following: " The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 serisitive area (Interim Wellhead Protection Area - IWPA) or mapped Zone II of a " public water supply well The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and.6.00. Please consult the local regional office of the Department for further information. { '; (rwiud 04/25/97) ~ ... I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 131 Cranberry Lane, Centerville,MA Property Address: Attorney Robert J. Donahue Owner: November 4, 1998 Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ 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 pan of this inspection. —/ A�/j As built plans have been obtained and examined. Note if they are not available with N/A. Y _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material-of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. A Existing information. Ex. Plan at B.O.H. Y 3L _ Determined in the field (if any of the failure criteria related to Part C is at is unacceptable) (15.302(3)(b)j sue, approximation of distance is H a= Ir iv d 04/75./971 - ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 131 Cranberry Lane,Centerville,MA Property Address:Owner. Attorney Robert J. Donahue i Date of Inspection: November 4, 1998 RESIDENTIAL: FLOW CONDITIONS Design flow: 11 e.p-d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: Garbage grinder (yes or no): Aid Laundry connected to system (yes or no):-yeS Seasonal use (yes or no):IV 0 „ Water meter readings, if available (last two (2) year usage (gpd): 9 7�5 8 = 6 ��e o� // s- q6 /y _ /U Sump Pump (yes or no):_&/-6 Last date of occupancy: 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: TD o. )t t.c ti•il- System pumped as part of inspection: (yes or no) n(o ��T' If yes, volume pumped: gallons 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) I/A Technology etc. Copy of up to date contract? r Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 0 r Sewage odors detected when arriving at the site: (yes or no) /V (revised •04/25/971 s. - f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Cranberry Lane, Centerville,MA Owner: Attorney Robert J. Donahue Date of Inspection: November 4, 1998 BUILDING SEWER: IVA (Locate on site plan) Depth below grade: Material of construction: _cast iron._ 40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade: 'Zo�' Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions:_ cS x y �x Sludge depth: G 111 Distance from top of sludge to bottom of outlet tee or baffle:_o _�2 Scum thickness: 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: y" How dimensions were determined: e—ry 6—• omments: } (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inve , structural integrity, evidence of leakage, etc.) -Al(— / 'd' GREASE TRAP: A11,19 (locate on site plan) Depth below grade: 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: I Date of last pumping t.t . . 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.) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 131 Cranberry Lane, Centerville,MA Property Address: Attorney Robert J.Donahue Owner: November 4, 1998 Date of Inspection: TIGHT OR HOLDING TANK:(Tank must be pumped prior to, or 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/day Alarm level: Alarm in working order_Yes; No Date of previous pumping: Comments: (condition of.inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: ; (locate on site plan) Depth of liquid level above outlet invert: c.v Comments: a (note Alevel and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) A- L,-j a—. �-. W o ✓ `l c r ty PUMP CHAMBER: A (A r (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Cranberry Lane,Centerville,MA Owner: . Attorney Robert J. Donahue Date of Inspection: November 4, 1998 SOIL ABSORPTION SYSTEM (SAS): (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: 6 �6 leaching pits, number. Uti t- � L L w"� (,� f•�, ,�- GJ. .� � 'S-to�.e leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: " Alternative system: TM Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Wor tr l t.✓A.It� LJ V c�r s� ✓rt u 1 . C 4— . '/'�/✓c. w o✓{L. �•.5 L A✓.J u.,.j d,e S S�-L� 11O f c 1,1 al/r G "c -at'- u•• '1'� CESSPOOLS: bL/1q a 4- ??�, o sy-C &_ (locate on site plan) 5 U YS�c:.•. vr. s dy+�• . . �I 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: s : 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 "i,`I (locate on site plan) Materials of construction: Depth of solids: Dimensions. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (r*vie-d 04/25/97) ' Page I of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Cranberry Lane, Centerville,MA Owner: Attorney Robert J. Donahue Date of Inspection: November 4, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: , include ties to at least two permanent references landmarks or benchmarks ' locate all wells within 100' (Locate where public water supply comes into house) CIO ot 'L �Ln u, . w S. it SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 131 Cranberry Lane, Centerville,MA Property Address:Owner: Attorney Robert J. Donahue Date of Inspection: November 4, 1998 Depth to Groundwater Feet _ adjusted high groundwater level Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) Grov+.� ✓c. f tr J1 / -tDy c$ f""S c. . 'A o .114 36 6 P S u t t.J C_ K o r J 4 4-c✓ '} ►^-� r.. . v� .!w. O �s t e, f�-o � � � - ,/-ulcer c.. 1.• '� 9 / .S J. .� � c.�, d � .s h o �- �u c. :A�c�.( f Ir—is.d 04/35/97) r TOWN OF BARNSTABLE LOCATION f 3 G���, �i�"✓H Lam. SEWAGE # s,®: VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:.(type) 1;7' 'L (size) -2 NO.OF BEDROOMS BUILDER OR OWNER p PERMrrDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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.--r7 ti`s A�`i� t` T _ 1 • fro� �•'- �� YF 41 )Li . a , I�q TOWN OF BARNSTABLE L`L.�CATION L y �"&I a cwto�/ SEWAG # VILLAGE J �SSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. c outt .�3 0 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) Ll; t NO. OF BEDROOMS -3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER < DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: `/ a v —f VARIANCE GRANTED: Yes No u i T 4 ' 1 I J t LOCUS DATA _ � - • : i BENCHMARK N CORNER OF .FRONT d LOT- IOT STEP. ELEV=63.04 i CURRENT OWNER DAVID M. DRANETZ Fp�- °F s RAMONA DRANETZ €DwARD g . A PLAN REFERENCE 426-8 . , STONE Aq _ ti No.289 0 EXISTING �92FA DEED REFERENCE , 19651-45 < o� LEACHING ,PIT Locus' F �� i �N TO BE REMOVED RO 132 L J ZONING DISTRICT .-,RF-1 / 'GP _ �U ' o,°' iJ �d�: EXISTING TREE TO Jo��� •LOCUS MAP FLOOD ZONE REMOVED :. NOT TO SCALE: X ASSESSORS MAP 234 o, 17-0127 0 PARCEL 066-004' - � o� `\\ ��. HYDRANT OVERLAY .DISTRICT ZONE .II co LOT AREA . 24,404f S.F. EXISTING GARAGE DRIVEWAY - — ro^� SITE &' " SEWAGE . DE MC W. W w---_�' / G #131 \ N a 4. R E P-A I-R D.T. 2 PLAN P . EXISTING p C� �Q F 3 BEDROOM k DWELLING C o .H. I 20 64 CRA NBERR y LANE 15.4. E - 1 . DECK \ IN3- _ 9 BARNSTABLE MASS � 2 6.1 DATE: NOVEMBER' ,10,- 2018 ° t 1� � p� PROPOSED 4 4 1 LEACHING ' y AREA 13'x2 5' OWNER/APPLICANT: LOT I `^ . r R -' DAVID & RAMONA DRANETZ PROPOSED `z w 911 CR OOKED KED 'STICK ' �5 . EXISTING 1,000 .. COLLEGE STATION GALLON SEPTIC TX 77845 ` • TANK TO REMAIN ` �{ O , O SH EET 1 OF 2 1 r � - PREPARED BY: �• � . r EAS SURVEY, INC. 5 . . P. O. BOX 1729 _ 0 30 45 60 LOT 3 ; SANDWICH , MA 02563 PH. (508) 888-3619 GRAPHIC SCALE: CELL (508) 527-3600 1 INCH = 30 FEET EAS.SURVEY@YAHOO.COM y t � , �j SYSTEM DESIGN RAISE COVERS .TO WITHIN 6" OF FINISH GRADE ` " CENTER CHAMBER RISER '. . DESIGN FLOW TCF = 63.29 FINISH GRADE 11RAISE TO WITHIN 6" 3_ BEDROOMS.AT 110 GPB D 3-N- GPD ELEV. 62.2 FINISH GRADE OF FINISH GRADE FINISH GRADE - /. ELEV. 62.1 ELEV. 62.1 + ELEV. 62.0 REQUIRED SEPTIC TANK , /a1- /mil /_�//ate / � 1' MIN•-3' MAX. COVER TOP ELEV 59.1 330 x 2 = -- AL. EXISTING 4" PVC 14'®S=0.04 6�•-OS= 0.04 --- G 000 AL. 4" PVC SCH 40 12'®S= 0.02 O O O' o o O O O FILTER 'FABRIC EX. SEPTIC TANK.PROVIDED - __, ___G �• SCH 40 INV.- 2 MIN-3 AX O O O O o + • I = XISTING o o I » SIZE OF LEACHING FACILITY REQUIRED t. 59.32 10"TEE 14 TEE INV•= O0000, O0000 ;� 3/4 TO 1 1/2 �. 59.12 O O 0 0 O o o p O p O p DOUBLE.WASHED INSTALL 6" O O O! O . O . O DESIGN PERC RATE'___<_2_ --MIN./INCH GAS BAFFLE 3 OUTLET 4'-1" LIQUID LEVEL H-10 DB3 r TWO 5'-0"x8'-6"x3'-O" CHAMBERS LONG TERM APPL. RATE_0•74_GPD/S.F. INV.=58.51 - i x w EAC I SYSTEMPROVIDED: " SAS.. (13.0' 25 0') SIZ E L H S STE r, - - INV.=58.10 � - .o w c , ` ZE OF`LEACHING , INV.=58.34 DATUM: 6.1 330 - 0.74 SF/GPD 446 S.F. MIN. REQ. VERTICAL DATUM: EXISTING 1,000 GALLON 51.1 SING H-20 CONCRETE LEACHING CHAMBERS J MSL* / BARNSTABLE GIS SEPTIC TANK TO REMAIN U BENCH MARK USED: , WITH 4', OF STONE ALL AROUND CORNER OF FRONT STEP _ BOTTOM (13.0' x 25.0') = 325 fS.F. ELEVATION 63.04 CONSTRUCTION NOTES: SIDE WALL (13.0'+25.0') 2x2 . =-152 S•F 17-0127 "• - = 00000 0 :o 00000' 7 S.F. w , 4 _ 7 _ 1..CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND 00000 O O O ` 99,^ / ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING O 0 0 0 o p O0 00 477 S:F.x 0.74 G/SF. = 353 GPD { SIT{E CX. SEWAGE ..WORK ON THE SITE. : o O 0 0 O 353 GPD PROV,> 330 GPD REQ. = 23 GPD RES. O O O 2. NO DETERMINATION HAS BEEN MADE-AS TO COMPLIANCE ' o a T WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 4 0 5.0' . ' 4 0 NO (GARBAGE DISPOSAL / GRINDER ALLOWED) REPAIR PLAN ,• , • � • ' � e,-�-�- ' '---I IS TO OBTAIN SUCH DETERMINATION FROM-APPROPRIATE AUTHORITY. #15520 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND' PLACING • ' MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND 13.0 - D•T.H. #1 D.T.H. #2 p /�/ p K. LANE /�/c S.A.S. AREA IS PROHIBITED I f DATE: 11-2-2017 DATE: 11-2-2017 CRA/V igE \R / . L A/V C - GROUND ELEV. 62.8 : , ,GROUND ELEV. 62,6 � SIDE`VIEW GENERAL NOTES: I• CERTIFY THAT I AM CURRENTLY APPROVED'BY THE NO GROUNDWATER, N0 GROUNDWATER p pNI 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. DEPARTMENT OF ENVIRONMENTAL PROTECTION TO CONDUCT. f D A R N S TA B L E, MASS TITLE V AND THE TOWN OF :BARNSTABLE RULES AND REGULATIONS; SOIL EVALUATIONS AND THAT THE.RESULTS OF MY SOIL y A - '° k FOR SUBSURFACE DISPOSAL OF SEWERAGE. LOAMY SAND LOAMY SAND "EVALUATION ARE ACCURATE AND IN. ACCORDANCE WITH 310 2.'AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE 1OYR 4 3 10YR 4/3- 1 /1 H 0 .CMR 15. 0 OUG „ „ „ DATE: NOVEMBER 10, .2018 ACCESSIBLE WITHIN 3 OF FINISH GRADE, WITH ANY REMAINING 12 B ' -ACCESS PORTS BROUGHT TO-WITHIN 12" OF FINISH 'GRADE. _ _ _ _ __ __ _ LOAMY SAND LOAMY SAND 'n ` ` 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE.. . '� EDWARD ,A. STONE, CE IFIED~SOIL EVALUATOR y' 7.5YR 5/6 CAPABLE OF WITHSTANDING H-10,LOADING:UNLESS I _ * , 24' 28"- OWNER APPLICANT: 7.5YR 5/6 OTHERWISE-SPECIFIED., ' 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION C-1 ' aC-1 D A VI D 8C .R A M O N A D R A N E TZ OF ALL UTILITIES PRIOR TO ANY EXCAVATION. OF INDICATES DEEP SILT LOAM SILT LOAM + `�_9 CROOKED STICK 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE _ M,„ j" DTH`#1 TEST HOLE . 10YR 6/4 1OYR 6/4 OR WITHIN 6" OF GRADE SHALL BE MORTARED IN. PLACE. �� D „ � 52 44 , COLLEGE STATION 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER o EL.` 58.5 EL. 58.9 FOOT OVER THE S.A.S. AND DISTRIBUTION 'BOX. �, �' H Y, R. N INDICATES o: 1 11 E P-1 '' 66" PERC TEST • TX 77845 , • 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF - ``• SCHEDULE 40 PVC AND SHALL EXTEND A-MINIMUM OF 6 ABOV 'P�ySTE = C-2 66" C-2 SHEET 2 OF 2 THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND :� NO MOTTLING COARSE SAND COARSE SAND ` LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. NirnR�PN NO WEEPING 2.Y 7/6 2.Y 7/6 8. THE INLET PIPE INVERT ELEVATION SHALL .BE NO LESS THAN 10% GRAVEL 10% GRAVEL PREPARED BY: 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT 6� l NO G.WATER NO G.WATER, " ELEVATION OF THE OUTLET PIPE. 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVEROF-9 INCHES 4 �,�1 138" INDICATES ADJ. GROUNDWATER EL. = 51:8 t32 EL. = 51.T 138- E A S SURVEY INC. 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF -4" PVC NO OBS. GROUNDWATER B.O.H: , P. O. BOX 1729 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND DON EVALUDESMATOR RAIS SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE j SOIL EVALUATOR FEET OUT F THE I NO OBSERVED GROUNDWATER ED. STONE . FIRST TWO EE 0 0 DISTRIBUTION BOX WHICH SHALL i SANDWICH , M A 02563 BE LEVEL .� DEPTH TO BOTTOM OF HOLE- 11.5' BACKHOE OPERATOR. PH, (508) 888-3619 12• CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION KEVIN - ELLIS BROTHERS TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW , VARIANCES REQUESTED r SOIL TYPE: CELL (508) 527-3600 AND APPROVAL: PERC RATE: ! 2 MIN. PER INCH EAS.SURVEY©YAHOO.COM 13.• MAGNETIC TAPE ON ALL COMPONENTS. NONE LOADING RATE: 0_74 GAL/SF/MIN p ,