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0328 AMES WAY - Health
328 Ames Way A = 170-057-015 Centerville i i �I /// S M EA DO Na 240WIt UPC In" .maaoom • Y.a.ln usn �e� II i i �I .� r t Town of Barnstable Barnstable ti Regulatory Services Department A • + snuvsr�►sLe v suss. 039.A, Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0001 2273 2565 January 19, 2016 Morton J Shuman 328 Ames Way Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 328 Ames Way, Centerville,MA was inspected on 11/30/2013,by Chad Hathaway, a certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to.the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair/replace the septic system within one(1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH cKean,R.S., CHO Agent of the Board of Health Q:;/Letters Septic Inspection Failures or Future Evl/328 Ames Way Cent Jan 2016 ' Parcel Detail Page 1 of 3 77 0.7 ,M I B+Sii\.iTht,l.„E {, hItASS,y j 9s.t k tt�P-,r '.$ i....✓ _ a `�4 ,P&J6+ f \ x •�£o j�nia i _� rrti'ti''i't�itJ� "` � ,��*mt,,� �!��ll, Logged In As: Parcel Detail Thursday,February 25 2016 Parcel Lookup Parcel Info I DeveloperLot LOT 42 Parcel ID -170-057-015 Location `328 AMES WAY Pri Frontage;100 I Sec Road l Sec Frontage Village;CENTERVILLE � Fire District Town sewer exists at this address NO .» ,..�..� Road Index 40027 ���......�..op....,.,.,._.._.�....,..�„_...,�>-I Interactive i Map 1= �t • Owner Info owner;SHUMAN, MORTON J& MARCIA J ( Co-owner Streetl r582 PLEASANT ST -I Street2 city FRAMINGHAM _ State MA zip E�01701 Country I� Land Info Acres 0.34� Tf ) use pSingle Fam MDL-01 � Zoning RC Nghbd I0105 P ed� Topography Level Road�I I Utilities;Public Water,Gas,Septic ' Location Construction Info Building 1-of 1 Year I1979 Roof Gable/Hip Ext Clapboard Built Struct Wall LivingRoof t" AC I Are11348 � Cover'Asph/F GIs/Cmp - Type,Central sWDKA Int Bed 12 Bedrooms Style iRaTh wan Drywall _ Rooms` Model.i Residential ( Int Hardwood �� Batn'2 Full-0 Half � � Floor Rooms [�f6AW, ° '�Heat t - Total f % � � �GradeAVrg T e,If10t Water Rooms'yPsmries 1 Story Heat Gas Found-iPoured Conch �Fq Fuel ation Gross'3452 Area s Issue Date_ Purpose Permit# Amount Y Insp Date Comments http://issgl2/intranet/propdata/ParcelDetai1.aspx?ID=11294 2/25/2016 Postal CERTIFIED MAII.,�PECEIPT •. Only ru For delivery information,visit our website at www.usps.com". r%- Certified Mail Fee ru $ ru Extra Services&Fees(cheek box add fee as appropriate) s[- ❑Return Receipt(hatdeoPY) $ J cis. O rq ❑Return Receipt(electronic) $ b* C3 ❑Certified Mall Restricted Delivery $ HJ-- Pe 0 ❑Adult Signature Required $ _Adult Signature Restricted Delivery$O Postageru � Total Postage and Fees � $ a Morton J. Shurman 328 Ames Way �1 Centerville, MA 02632 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label), for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted"`� retgrp receipt for no additional fee,present this delivery. USPS67,postmaiked Certified Mail receipt to the ■A record of delivery(including the recipients retail associate. signature)that is retained by the Postal Service'" Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mal®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified. ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage`automatically included with accepted as legal proof of mailing,it should beg a certain Priority Mail items. USPS postmark.If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office7'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion' of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.c electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. PS Form 3800,Apdi 2015(Reverse)PSN 7530-02-000-9047 � i r Town of Barnstable ' saRtvsr�st.E, � ass a i639. Regulatory Services Department p 1�m rED MA't� Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scab,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6,-2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the o is the failure criteria and associated repair deadline 60 DAY DEADLM-CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year.not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE 1 YEAR DEADLINE CRITERIA Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or.cesspool ❑Any portion of the SAS, cesspool, or privy, below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water-quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA. ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) ❑.Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER Repair deadline: Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc . Parcel Detail Page 1 of 3 E L ft..tEdAu TART Logged In As: Parcel Detail Wednesday,January 13 2016 Parcel Lookup Parcel Info Parcel ID 170-057-015 I DeveloLo� LOT 42 _ �.. Location�328 AMES WAY Pri Frontage 100 I Sec Road i ®� I Sec Frontage Village CENTERVILLE I Fire District iC-O-MM Town sewer exists at this address.ND -" I Road Index 0027 Interactive Map -w Owner Info Owner tSHUMAN, MORTON J&MARCIA J i Co-Owner . Streetl ,5 2 PLEASANT ST I Street2 City'FRAMINGHAM � ( State MA Zip f01701 Country Land Info Acres •0.34— I Use'Single Fam MDL-01 ( Zoning RC _.� I Nghbd 1010,1 Topography jLevel I Road Paved utilities Vublic Water,Gas,Septic I Location w � Construction Info Building 1 of 1 Year. 1979 "" �I Roofb�e/Hip I Ext'F6lapboard Built. Struct Wall Living Roof( AC 1 Area 0348 �� cover•Asph/F GIs/Cmp Type Central , Bed Style Ranch ( In {Drywall Rooms 2 Bedrooms I _- 14 74 21 go. Wall f._. Int° - Bath » Model ,Residential I Floor LHardwOod Rooms 2 FUII-0 Half I �`� _ 6AR 26, 2 2 QA5BMT ' Grade Average I Heat HoYWater I Total 5 Rooms Type Rooms `' P i4114 ' r fib �4D' ---—•--- stories fi Story I Fuel .Gas- Fou anon.Poured Conc. I Gross 3452 Area Permit History _ http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=11294 1/13/2016 No. "�LS✓1 (� �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN,OF BARNSTABLE, MASSACHUSETTS Yes 4ptiCatlon for Misposar 6pstrm Constru>rtion Permit Application for a Permit to Construct( ) Repair(Y4lllupgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.3 L1__Otyner's Name,Address,and Tel.No,�/ 1 pas�✓! -'c, Assessor's Map/Parcel /70 0/oc le C► - 7 e,r— ©/ 1;xla r r SDI V AI✓+71;L IV Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. LLr y J o r,i e v►n lbr e, 5re0!.2 f/e?. Type of Building: Dwelling No.of Bedrooms Lot Size %S. 0 D (a sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -LLB gpd Design flow provided 3 y gpd Plan Date ?f ' 7—% G Number of sheets Revision Date Title Size of Septic Tank L,,i) r c !' ®v O Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign(d_-N, Date Application Approved by ,r Date Application Disapproved by Date for the following reasons Permit No. pv (9 `�® Date Issued U t_l Fee41 THE COMMONWEALTH OF_MASSACHUSETTS Entered•incomputer: Yes PUBLIC HEALTH DIVISION - TOWN -414R' NSTABLE, MASSACHUSETTS 4pliration for Disposal *pstem ConstrUrtion permit Application for a Permit to Construct( ) Repair(l4l"Upgrade( )' Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 3 Z ���J �,��y aVer's Name,Address,and Tel.No.11 1l1— Assessor's Map/Parcel /70 b f—/ Lo r o r U N /$-///-IV Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. v d If ti rn/fil re �hes<<i sre,4--_ Ao t/4, L , Type of Building: Dwelling No.of Bedrooms Lot Size 0 D 0 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -2 gpd Design flow provided 3 9 gpd Plan Date 3 — 7—/ G Number ofsheets Revision Date Title Size of Septic Tank F ,j I, .' / d b o i 4 Type of S.A.S. Description of Soil t t Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign d �� Date Application Approved by Date �} Application Disapproved by Date for the following reasons F Permit No. L9 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(r/) Upgraded( ) Abandoned( )by at �3.g �r� has been constructed in accordance 1 // with the provisions of Title 5 and the for Disposal System Construction Permit NO—C/6 ' �f dated q/L/ Installer &I d jo/- C7 Designer S rw P o y/l #bedrooms Approved design flow gpd The issuance of this�el�it shall not b'construed as a guarantee that the system wil functi Jas designed. Date `//�/%/ 6 �� ' Inspector r ---------------------------------------------------------- No. Fee �o - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction 3pPrmit Permission is hereby granted to Construct( ) Repair(V/ Upgrade( ) Abandon( ) System located at w/fli 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:Construction must be completed within three years of the date of this permit. Date 1 Approved by f i Town of Barnstable Regulatory Services „ Thomas F. Geiler, Director BARNMBLE9 H+SS• Public Health Division ��TEO 39. aim Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: L 1 6 Sewage Permit# 1 of E - v Assessor's Map\Parcel Lo 6 3-7` d i.)— Designer: S C oj'Y!c ���~�-- /L T Installer: �YGc Address: �l '�U �' �,� +�fz Address: —Y Y f� ������✓` r On l� rvr ZZi%� was issued a permit to install a date) (installer) septic system at 3-4 4-M,9-" f� based on a design drawn by I^ (address) oJI�IJ dated (designer) 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 distribution box and/or septic tank. 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. OF GOTr (Installer's griature) 8 iA v �+ NO-1224 g� gip. L ` PED� P (Desi Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BAIZNSTABLE 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:Health/Septic/Designer Certification Form 3-26-04.doc TOWN OF BARNSTABLE LOCATION ex w ! SEWAGE# 2 0/6 ' VILLAGE L�e�'f`trcro/ e ASSESSOR'S MAP&PARCEL �U' (� �7'�f S INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l9 d j LEACHING FACILITY:(type) Z-f mo yet- o f re o le (size) 1,6 o O o NO.OF BEDROOMS �Z OWNER A l o,^`- 5 V' A"!_r✓ PERMIT DATE: ��y/�6 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) �' I Jr, eet FURNISHED BY o4r rl.�fa /�ilr /�. Vro l k , ecr ° 3 Y 3 e qo ® e A 10 32 t ftfvvef W rc s r� �0 M, Postal CERTIFIED o . M •. • For delivery information,visit our webpite at www.usps.com'O. m ,1`- r� Certified Mail Fee ni ni Extra Services&Fees icheckbar,add fee as appropdate ❑Return Recelpt(hardoopy) $rq E3 ❑Return Recelpt(electronic) $ ( C—vppstma a 0 ❑Certified Mail Restricted DeMery $ ❑Adult Signature Required $ �. ❑Adult Signature Restricted Delivery$ O Postage rULn $ Total Postage and Fees � 13 $ Morton J. Shaman Nc 582 Pleasant Street Framingham, MA 01701 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. 1 associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipients retail associate. signature)that is retained by the Postal Selvtce" Restricted delivery service,which provides for a specified period. delivery-do the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavallable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,It should bear a. certain Priority Mail items. USPS postmark If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion_ of delivery(Including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece., electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return .. Receipt attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. Ps Form 38OOv Apol 2015(Reverse)PSN 7530-02-000.9047 - SENDER:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. A. Si nature ■ Print your name and address on the reverse [3 Agent so that we can return the card to you. 0 Addressee ■ Attach this card to the back,of the mailpiece, B. Received by(Printed Name) C. Da coif elivery or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item'I? L7 . s M o rt o n J. Shaman If YES;enter delivery address below: 0 Na 582PLeasant Street Franq#gham, MA 01701 3. Service Type ❑Priority Mail Express® II I IIIIII IIII III I I I I I IIIII IIIII II I(I II IIII(III ❑Adult Signature ❑Registered Mail ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted ❑Certified Mail® Delivery 9590 9403 0923 5223 2894 46 ❑Certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise 2.-Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation*"' - —;--- - =*.-p ❑Insured Mail ❑Signature Confirmation "15 15 2 0 01 2273 17 3 ❑Insured Mail Restricted Delivery Restricted Delivery (over$500) PS Form 3811,July 2015.PSN 7530-02-000-9053 Domestic Return Receipt ; USPS R " K ' # >� u,. ��-;:•>� First-Class Mail w1 n Postage&Fees Paid Ue mS No.G-10 ' 9590 9403 0923 5223 289446 Urted States •Sender:Please print your name,address;and ZIP+q®in this box• Postal Service Town of Barnstable I Public Health Division 200 Main Street Hyannis, MA 02601 I S '�I C ER TIFIED MA IL tNE ro f' U.S.POSTAGE>>PITNEY BOWES POF„ wti Town of Barnstable F' � Public Health Division RARNSTARI,F.�'' 200 Main Street f .� . _ 5 A +639• e ZIP 02601 $ 006.73 rEO MP�P Hyannis,MA 02601 ' 0000336455 JAN. 21. 2016. I ' I 7015 1520 0001 2273 2565 vo > Morton J. Shuman ks 328 Ames WaY_,<,_,��_ --- fi Centerville, ,a 1 V-E . e15 .. D E I. R,E•.TU'R.WfT'Oe SE,N,.DE'-R`` ATTE MPT:CC, _. 6�fyYT K%9�t 6�f R� UNABLE TO FORWARD 1� SC: 026014.002€30 *03.22-0.4:806-2.1-41 �I �� .:4" 1, _, _.:�}� - ____.� ___ -- --..._. _ � -r`_� _- � ��— - - --•-----T- SENDER:,COMPLETE THIS SECTION • • ON DELIVERY I ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent I ■ Print your name and address on the reverse X ❑Addressee I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, e,� I or on the front if space permits.. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No jMorton J. Shurman ! j 328 Ames Way I Temerville, MA 02632 3. Service Type ❑Certified Mail ❑.'Express Mail ` ❑Registered ❑Return Receipt for Merchandise I. ❑Insured Mall ❑C.O.D. I I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article.Number f - (Transfer from service►abed J. 7 015 1520 0001 2273 2 5 6 5 C ! ` PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540? �I r i i i L i ` e Town of Barnstable Barnstable Regulatory• Services Department A&AMedoM 1 sn KA"M&Le I I , 1 ��' Public Health Division a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7015 1520 0001 2273 2565 January 19, 2016 Morton J Shuman 328 Ames Way Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 328 Ames Way, Centerville,MA was inspected on r 11/30/2013, by Chad Hathaway, a certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair/replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH i cKean, R.S.; CHO ' Agent of the Board of Health 'I Q:;/Letters Septic Inspection Failures or Future Evl/328 Ames Way Cent Jan 2016 Town of Barnstable Barnstable ,r A*A Regulatory Services Department j MART ' 161 Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1520 0001 2273 3173 February 29, 2016, Morton J. Shuman 582 Pleasant Street Framingham, MA 01701 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The.septic system located at 328 Ames Way, Centerville, MA was inspected on 11/30/2015/15, by Chad Hathaway, a certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair/replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH i 1 c ean, R.S., CHO Agent of the Board of Health Q:/SEPTIC/Septic inspection Failures or Future Eval/328 Ames Way Cent Feb 2016 Town of Barnstable P# l 92_� Department of Regulatory Services $ ruu��we a Public Health Division Date , Mass ,f'Tl 200 Main Street,Hyannis MA 02601 t.I, rft)MX/h P� Date Scheduled Time Fee Pd.— r_n f'4d Soil Suitability Assessment for Sewage • isposal Performed By:_70 Witnessed By: V z: " �- W 5 �-k� LOCATION&.GENERAL INFORMATION Location Address Owner's Name jl'JUiYIQrJI Assessor's Map]/Parcel:.. Address <2Engloser s Name ttj " NEW CONSTRUC rION REPAIR J1 Telephone# 81 Q G4 � Land Use _Re� ,c +�o,� Slopes(96) Surface Stones Distance's-from: Open Water Body >Sm ft Possible Wet Area ft Drinking Water Well��ft Draihage Way i ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity, to holes) DEAR OF NOW WPAV o Parent material(geologic) f A7llM9L11►- Depth to Bedrock 148 Depth to Groundwater. Standing Water in Hole: n�.... Weeping from Pit Fn'ca I ME Estimated Seasonal High Groundwater 713a�}MrnQC'1Q DETERMINATION FOR SEASONAL•HIGI1 WATER TABLE Method Used: r Depth Observed standing in obs.hole; 713a� In, Depth to still mottles: 3aI In. Depth to weeping from side of obs,hole: 7 1`3�-'� ln, Groundwater Adjustment �ft. Index Well# Reading Datc: Index Well levol Adj.factor, Adj.Groundwater Level,,s PERCOLATION TEST Date Thne...�., Observation Hole# Tlmo at 9" Depth of Perc Time at 6" Start Pre-soak Time® 1D _ A. Time(V-6") _ End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Palled: Additional Testing Needed(Y/N) Original: Public 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 Conservation Division at least one (1)week prior to beginning. Q:ISEPTIC%PBRCFORM.DOC • � VS DEEROBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. tsistency.Varavell -$ d r;a0.M 54 �d dt �y�a c Medl s�Nd asy lOoSe 5a C ,N SAN�I. idY R ldosc 1,' Tr 13a. c a tao -e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. iOraye IOR h� l - C • e •5 � �oS�P •• _$ (12 M I CIS A-9) Ir 3f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,SSortes;Boulders, Flood Insurance Rate Man: Above'500 year flood boundary No— Yes Within 500 year boundary No= Yes Within 100 year flood boundary No.� Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring p rvious material? Certification I certify that on �eEa�n�'PCCQ (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 tr ning,expertise experience described in 10 CIvM 15.017. Signature Date Q:W gPT1CWBRC PORM.DOC Commonwealth of Massachusetts �� o_o� _�� . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information -3 3g on the computer, / use only the tab 1. Inspector: key to move your cursor-do not Chad Hathaway use the return Name of Inspector key. H.P.S. r� Company Name P.O.Box 151 Company Address Forestdale Ma 02644 Cityrrown State Zip Code 774-274-2581 12866 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 11/30/15 1 nspector'sCSignature Date The system inspect shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal SystAfi• a�of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. CitylTown 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: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G M 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown 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 in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•3/13 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 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown 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- 1 0,000g pd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 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): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 328 Ames Way �M Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1000 gal tank has black staining over pipes to indicate tank has been overfull. camera inspected to leach pit. Leach pit has been overfull Number of current residents: 0 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: unknownDate 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 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: none 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•3/13 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 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1979 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 14"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 24'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 8" 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: 1000 Sludge depth: 10" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown 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 . 21" 811 Scum thickness 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 8" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pump every 2-3 years as maint. to protect leaching 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Citylrown 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.): N/A 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: leach pit over full staining to ceiling of pit(camera inspected) t5ins•3/13 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 �M 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 k . , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G'M 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown 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.): vegetation is taller over leach pit area 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•3113 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 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. City(rown State Zip Code Date of Inspection 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 3 iOL 00 �i g t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 page. Cityrrown 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: 15' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: usgs topo maps You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 328 Ames Way Property Address Shuman Owner Owner's Name information is required for every Barnstable Centerville Ma 11/30/15 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 LOCATION SWAGE PERMIT NO. LZIA y VILLAGE INSTA LLER'S NAME Qi jADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1/81-2 r i 2�, — . � , � _ _ S a ', _EG Q� , ,. a-- �:3 !9 / // No..------. =�t�►- Fes$...&4 . .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HE I-I �.. ....................oF........ 0.................------.. lrpfira#iun for Uiu�ruuai Works C�unulrnrtiun tirrmit I Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at ................-._... -- --•-••-- ............. ... .. _.. .. .-- ------. --. --..- / Location-A. ress o......... Owner ,t Addrits ........,.. Installer Address U Type of ing Ex ansion Attic Size Lot.-Garbage �nderSq. feet Dwelling—No. of Bedrooms...........______ No. of ersons.___.._....__...._...(._:.>Showers Cafeteria ( )a, Other—Type of Building ........................... p ( ) ( ) Q' Other fixtures ---------------------------•--•- d -------------------- W Design Flow.......... ..................gallons per person per day. Total daily flow.._..:::.._ :----.-•------•--•-•--gallons. WSeptic Tank—Liquid capacit/g allons Length................ Width---------------- Diameter___- -__- Depth................ x Disposal Trench—No._____•-------------- Width ------- Total Length..................... Total leaching area....................sq. ft. Seepage Pit No._--._J..---------- Diameter...... __.._--- Depth below inlet...'..G.......... Total,:leaching area......./_.sq. ft. z Other Distribution box ( ) Dosing t ) a Percolation Test Result Performed by.. !/ � Date........�9�'/----------- Test Pit No. l.:C -_•-minutes per inch Depth of Test,?it.................... Depth to groundwater........................ Test Pit No. 2................minutes per inch Depth of Test Pit......A Depth to ground water-----_.................. P4 -----------•-•--•••--•••-••--•......••-••-•-•-•-•-•••• ...................•-• --• --------•-- ---- •----f / _ •• •-•--•. A0 Description of.Soil--_... -• -• � --- U /--••-•--•-•-•--•--•-••-••.•• -------- -- --------------------- --•-- •• --•---. ---•--......-••--------•------ --- �2-- 7 ............................................................ U Nature of Repairs or Alterations—Answer when aW icable.;-:....::..:........................:.......::................................................ --------------------------------•--•------------------------------------------------•--.............----•--------------------------------------- •--•---------•----•--..._•-•--- Agreement: " The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code— The u rsi d further agrees not to place the system in r operation until a Certificate of Compliance-has ben : sued t a d f health. q /� Sig Date ' ApplicationApproved By................................................................................................. ........................................ Date Application Disapproved for the following reasons:................................................................................................................ •-•-•-----•-•---•----•--••----•--•------•----•-•-•-----•-•-....-•-----•--•-•---••-•...-------•••••--•-•-.------•••--•--•---•--•-•-••-•...:..•--••-------------------------------•-••......••---•-------- Date PermitNo......................................................... Issued....................................................... Date PU No.__......` .. ...'�....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEH oF.................. ... Appliration for Disposal Works Tontrnrtion ramit Application is hereby made for a Permit to Construct (4�f`�or'Repair ( } an Individual Sewage Disposal System at: ................_.._ ............... �--�- '--- ---- --. ------•------ Locatio dress f .. N {" 4 ................ . ... Own.. .. ........................................... t. Add 5 W [ ! ..... .. ........ ........... ..........................••• .............................••...#..-•-..._.........•-•-----•--.........................•....... Installer Address d Type of 'ding Size Lot---- /_ -_----Sq. feet U Dwelling—No. of Bedrooms..........��-:...........-.-.--------- .Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures . W Design Flow......... .__:^....................gallons per person per day. Total daily flow......... ....................gallons. W Septic Tank—Liquid capaci;/hvvgallons Length................ Width---------------- Diameter------------------ Depth................ x Disposal Trench—No.....................Widt ------------•-•-- Total Length___................Total leaching area.._...........__._•.sq. ft. Seepage Pit No_____i_____________ Diameter..... ----------- Depth below inlet..-..G........... Total leaching area..P.- ...sq. ft. Z Other Distribution box ( ) Dosing a Percolation Test Re79-- Performed by----.A- - -------•----•-- Date. . !Ap ........ ,-a Test Pit No. 1 ___minutes per inch Depth of Test Pit.................... Depth to ground water---------------------__. Gi, Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix ---------------- . -• -----•---•------•-•-••....... •. ---•-•.-----••-- O Description of Soil..... ,_ __L.-_'/ I / "� =-. ... oew U ----------------------- •-------- •-----• `.. ...................... W ---------------------------------- t/ ""J...------s- , - _- ---- ------------------------------------------------------------- U 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 TIT 5 of the State Sanitary Code— The u ersi ned further agrees not to place the system in operation until a Certificate of Compliance has en sued y t �roa �of health. �/, Q / ' Sig �� � ..... ..............................::....... ....--._................_ �••--••�.... { } Date ApplicationApproved By--••-•--•••----•---•--••---..---•---------------•--•---.....:..........--•------•----•-- Date Application Disapproved for the following reasons:-•-•---••---•----•...........•-•-•-----•---------•-----•----••-----------•-••-•---•------•--•----------------- ...........................................................-............................................................................................................................................. Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR F HET ......:.... .......OF....'. .u�°" " `] ?" ............................... (9rrtifirate of Toutpliatta THIS IS TO CERT Tat the I idu - o age Disposal System constructed r Repaired ( ) by....................... .................. '----------- ------------------- Installer has been installed in accordance with the provisions of, application 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nb& 5 dated----- `.�. `!' ................... Ik THE ISSUANCE OF THIS CERTIFICATE SHALT: NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL. FUf4CTION SATISFACTORY. 9 DATE........ .8 7 ........................•-•------•--•-----•---- Inspecto .-------.`.'.._�`.�_.r!l..-----�.. ................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT ...............OF..- ..... *t'- .. ter" N ............ FE ..................... io rk n ion hermit . s Permission is h eby granted...__._..,/&�................... _�"": ._+�_�........................ to Constru �.0�,07y r Repair ( an Individual Sewage D sacl" ystem� { f.� atNO.' et--S--. e7� .._.....4� .:..�f.k!!!!"��[. ..............................................." " S" i........................................................... Street p as shown on the application for Disposal Works Construction P r- it No.- _�_-.t. Dated..~L -. f................. .............................. - DATE- ,1 Board of Heat f -----•-•-•-• ........... ............................................... {n� FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ASSESSORS DATA: MAP 170 PARCEL 57-015 - SEgNS c/ R _........._.__. .__._.._ ........._..._o REFERENCE DEED: 3022-132 .................. _.._ �.. V REFERENCE PLAN: 324-72 LOCUS 0 J� ZONING DISTRICT: RC lOT OVERLAY DISTRICTS: N76/pp,p0' 1V iygY ZONE II, WP*-SALTWATER ESTUARY o /5'33 a ' �` w Bit DG�S PATry / +45.4 p�' FEMA FLOOD ZONE: "X" 1 'p`�' �O,y MAP 25001 C05G I J LOT 4 2 �/ +40.9 MAP DATE: JULY I G, 2014 / ( 1 5,000 ± S.F. /� _ t� Q v 1 � SEPTIC SHOWN PER AS-BUILT CARD / ,��`^f // o LOCUS MAP upe"Sim t- / t / +41.1 / ia.ga "r TP +41 2 m' i `�• BM: BASEMENT DOOR SILL PLOT PLAN OF LAND +41.2 EXISTING SPOT GRADE / / / ' `�cQ ELEV. 36.56 ° °' I DATUM: NAVD88 PREPARED FOR ——42——— EXISTING CONTOUR / DECK O n +36.14 V4 / W REPORTED WATER UNE / ( +36.4 #3 28 AM ES WAY ' r , Cr; EXISTING CATCH BASBN +3/� t=Xis4{t,�G ! G01 0 I GARAGE r . / -� t„� CENTERVILLE, MA55ACHU5M5 TP TEST PIT CV r, O�ELLING ® r \ DATE: FEBRUARY 1 1 , 20 I G tk �' " = EXISTING UTILITY POLE m SCALE: I 30'/ i \\i '' 0 !� U)// f1 42-�`` 42 i 30 60 39.5 m Feet CID� IS76o 5CALE: 1" = 30' PLAN REVISIONS: q> , , 5' �� ; /pp � of �q _-` �Vq� `a'-�' ►►��`�t�its ,i�1���� i STEPHEN �N DOYLE ► G-A" tJO. -r559 _ � 5TEPHEN DOYLE AND A550CIATE5 Sk o� �: 42 CANTERBURY LANE ;R�+E� ` EAST FALMOUTH, MA55ACHU5ETT5 0253ro TELEPHONE: 505 540-2534 3-"tf to 5J D5 U RVEY@ AOL.COM SEPTIC SYSTEM PROFILE (NOT TO SCALE) INSTALL RISERS Basement door sIII -SEPTIC TANK INLET AND OUTLET COVERS ARE REQUIRED TO BE MIN FINISHED GRADE OVER S.A.S.=37.5(approx.) OF20"IN DIAMETER WITH THE MIDDLE COVER MIN8". INSTALL MAINTAINAMINEL.OF37.5FOR15FEETAROUNDTHEPERIMETEROFTHETOPOFTHES.A.S.TO SOIL ABSORPTION SYSTEM EL.=36.56(walk out) RISERS TO BE 6"OF FINAL GRADE AS/IF NEEDED. PREVENT BREAKOUT. BACKFILL S.A.S.WITH CLEAN MATERIAL AND ESTABLISH VEGETATIVE COVER. -INSPECTION PORTS WITHIN 3"OF FINAL GRADE MAX COVER OVER SAS IS 3'. COMPONENT LAYOUT D-BOX INSTALL RISERS TO BE WITHIN 9"OF FINAL GRADE 12 83' Grade el over tank 36.4 10 _ Slope %min , FILTER FABRIC OVER STONE OR Level het 2'out d-box WASHED PEA STONE O O Q Op p C=C� 24"EFFECTIVE LEACHING O EACH CHAMBER Ex.Inv.el. �� TEE O C� =C� 0 DEPTH 8.5'LONG X 35.14 TEE cas , Ex.Inv.EI.34.89 `�` l O O O O s _ ' 4.83'WIDE 4'EFFLUENT BAFFL� nV e.34.58 i Bottom of S.A.S 25 DEPTH ' NEW SOIL ABSORPTION SYSTEM el.= 2 0 Inv.el.34.75 ,� 3 •5 2-50o H-2o GALLON LEACHING CHAMBERS O NEW DISTRIBUTION BOX(db-; Inv.el.=34.50 i 4'OF%"TO 1 X"DOUBLE WASHED CRUSHED STONE ALL H 20 WITH 3 OUTLETS AROUND CHAMBERS TO A DEPTH OF 2' EXISTING loon GALLON H-10 SEPTIC TANK SET ON A LEVEL COMPACTED BASE 4'stone all Inspect tank/tees or baffles to ensure proper function OF%,"CRUSHED STONE MIN 5'NATIVE SUITABLE SOIL and suitability for reuse. around BELOW S.A.S.(C-LAYER) PIPING SPECIFICATIONS ALL PIPING TO BE 4"SCHEDULE 40 PVC OR GREATER WITH A MIN SLOPE 1%or 1/8"in/ft. ALL PIPE CONNECTIONS MUST BE GLUED AND WATERTIGHT. PIPES MUST BE PROPERLY BEDDED. GW SEPARATION: 6.5'FROM BOTTOM OF TEST HOLE 26.00 TO BOTTOM S.A.S.32.50 GENERAL NOTES: - SHOREV DI919 1. All changes to this plan need prior approval from the local board of DESIGN CRITERIA SOIL EVALUATION CPRECAST ONCRETE SHOREY LEACIMWC;D.lt," PRODUCTS health and the septic designer. SEo'�?(9l PAECAST SOO GAL CONCRETE 2. All work and materials shall conform to the requirements of the MA Number of bedrooms(actual): 2 DATE: 01/11/16 STD ko6 PRODUCTS State Environmental Code,Title 5, and any applicable local rules and - per Town Assessors records PERFORMED BY: Scott McGann regulations. Number of bedroom (design): 3* WITNESSED BY: David Stanton 3. The sewage disposal system shall not be backfilled prior to the . Soil class:1 TP 1 EL.=37.00 inspection and approval by the local board of health and the septic Percolation rate(MPI): <2 Depth Hor texture color el � 0-10- A Loamy sand 1oyr3/1 36.25 Q °-- � designer. Daily flow(req'd):33o*GPD 10-24 B Loamy sand 1oyr5/8 35.00 ®0 4. Any conditions encountered during the installation from those Daily flow(provided): 349GPDao- shown in this plan shall be reported to the septic designer prior to Garbage grinder: NOT ALLOWED 24-52 - C1 Med Sand 2.5y7/4 32.50 °�0 continuing construction. 5z-84 C2 Fine sand 2.5 6/3 30-17 84-13z r ,.,d 5. Water supply supplied by town water service. No wells were found CALCULATIONS: C3 Med sand 2.5y7/4 26.0o of to be within too'of the proposed S.A.S. OAT 6. This Ian is to be used for this septic stem install only. BOTTOM AREA TP 2 EL.=37.00 M� P P y y' 25'X 12.83'=320.75 ft2 Depth" Hor texture color el PI ate: 6 McGANN V i 7. It is the installer's responsibility to verify the location of all SIDEWALL AREA o 10 A Loam sand 10 r3h 36.25 328 Ames Way ►do."22a � , underground utilities prior to construction. 2 ' 2 X2+12.8 ' 2 X2= 10-24 B Loamy sand 1oyr5/8 35.00 Assessor's MAP 17o/BLOCK/057/LOT 015 USE CODE 1olo 8. Septic designer is not responsible for any undocumented septic 5 3 O ' system components not shown on this plan. 151'32ft2 24-52 C1 Med Sand 2.5 7/4 ' 32.50 9. No Garbage Grinder Allowed! TOTAL AREA=472.07FT2 54-84 C2 Fine sand 2.5 6/3 30.00 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 10. This property is located in a State Zone II 84-132 C3 Med sand 2.5y7/4 26.00. No increase in bedroom LTAR FOR<2MP1 CLASS I SOIL IS.74 328 Ames Way, Centerville, MA 02632 number is proposed or allowed with this plan. Due to title 5 Depth of perc 63" regulations,this system is designed at the 33o GPD minimum. Start:10:2. 11. No drinkingwater wells according to Town Water Department who 42oSQFT X.74 =349 GPD 3 Prepared for. Prepared by: g P End presoak 10:38-all water drained in<15 Arthur Joia (A.Joia Construction) Scott McGann, R.S: verified abutters are on town water. 349 GPD>33o GPD minutes so.the perc rate is<2 mpi in C layers 12. This septic design is based off a plan developed by Stephen Doyle 49 Somerset Rd. _ 41 Durfee Drive and Associates named"Plot Plan prepared for 328 Ames Way, Groundwater(GW)not observed @a 132"- Mashpee, MA 02649 East Falmouth, MA 02536 Centerville,MA",dated 2-12-16 *Minimum size per Title 5 elevation 26.00 5o8 264 3733 LOT 4 6 PALkL_ ML1f�t�HY 15000 5 LPL V, LOAM LEACH . ;.., .. - s ��+ TES:I R[5ER.vt Df5-r &0X S�F�aQiL. t ofo EjCtM //'� TANK Q ;'' `Y `° F't U + l9kb i0' >t3. - �: .t •y ;'�, M1 ''E h•. * d / •.i, / IS 1 / 7 Mi ?s i j } FOCI Lid / lfx3' '+ C'Zm • / ��/'(�r/ (] �{: .• , - � /.'� " ��fJ�(y,rj/'��ry4w)/1��� �{�.]�'�+�y��/�Y{•,jy[ Aa 1.4�t�.i - /. r! 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