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HomeMy WebLinkAbout0695 BAY LANE - Health 695 BAY LANE, CENTERVILLE A= — ----- ----------------- — --- 4 UPC 12534 No.2 3LQR 'tt�cae .HA8TINO9.YN, No. (� � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in co puler: PUBLIC HEALTH DIVISION - TOWN 6F BARNSTABLE, MASSACHUSETTS Yes Application for MIsp08aY 6pstetn CDristrULtlDtt Permit �Iea/131 Application for a Permit to Construct( ) Repair( ) Upgrade 06 Abandon( ) [:]Complete System 41ndividual Components Location Address or Lot No. &q j L-34y U4 4c: Cc.,.c tc-- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel t 9 S 7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. CAP6_al �& 6_-T-61 f jtiLLI_ 1bF147? -€S71 T(, 6Hfr'.e`^'! SO9 Z-73 63 '7­7 Type of Building: Dwelling No.of Bedrooms Lot Size 3 2, + sq.ft. Garbage Grinder( ) Other Type of Building S L��le— Ccrw:,�y No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1x.s i+i!) WOO c,dy/ Type of S.A.S. A26 3c- G 3v is,3 Z �rencC� Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ex,i_� i # f)q� T-D D - 0 0'Y- TO Two T-,/,--�l 12 -Tb rk74 Date last inspected: O 1 .y 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 b this Board of Health. ie Date Z ZOO z Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued _ ��r— --�.------ --— --J g _ YY ,. No. t _ V � Fee THE COMMONWEALTWOF MASSACHUSETTS Entered in co puter: PUB HEALTH DIVISION -fAN OF BARNSTABLE MASSACHUSETTS VYes - -� RptlYlLatlon for M18tlD8aY *pstPtn Construction 30Prtnit Application for a Permit to Construct( ) Repair( ) Upgrade O� Abandon( ) ❑Complete System $4 Individual Components Location Address or Lot No. 67r(5- ,y L,4,7� �� ,f�• l l Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1 �8 -7 /(p✓✓7 /*1 c 17.?rr+ri,�✓R Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. C14PtEw;C& CnIrrje, cl 57�,? c177 71 SC CHJ ,� .1� �U� 2 -73 63 -7'7 Type of Building: Dwelling No.of Bedrooms Lot Size 3 2L — sq.ft. Garbage Grinder( ) Other Type of Building S,y,,�� Goyr ,ty _ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 6 x.y��;..•' t©�c7 ,�l Type of S.A.S. AaZ -;,_ 44 / (3G /t.,�� ��� Z Tee,�c� Description of Soil Nature of Repairs or Alterations(Answer when applicable) y l-t T;7 -69 4- 7 ;Q, T_ Mt A) o TJ-t. 7nCr7 I 9,1-L 7 L p Date last inspected: p J Z— 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 b this Board of Health. ' ig ed 6 Date Z Z v L Application Approved by _ �� Date v - Application Disapproved by Date for the following reasons A en �.- Permit-No. Date Issued 1 ------------------ --------------------------- --------- - - -- ---- --------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS CErtificatr of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(X) Abandoned( )by- ✓-yetr cc, J_ e-1%4/ n V, * S 1..L Q at to'?j L o,,' (�,,,, i. ; /r has been const ct d'n ac rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. ~ ed Installer e ,A,e„t`, 14 ��y ��,�t S L.lc Designer TL C. 6 n, iA-4. ,,�.c #bedrooms Approved design flow god The issuance of this permit sh 11 not a construed as a guarantee that the system ill fun 'Lass' ed. Date ���� � Inspector ---------- - - -- - - - -- -- --- -- -- - - -- - ---- - - - - -- No. / '��V Fee " / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstrm Construction Vermit Permission is hereby granted to Construct( ) Repair( ) Upgrade(N Abandon( ) System located at pL t�(� 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 Lst b completed within three years of the date of this permit. r Date Approved by /� 011/08/2012 00:32 5082730367 #1620 P. 001/001 Town of Barnstable Regulatory Services Thomas F. Geiler,Director HARNSTABLE. : Public Health Division MAti6. Thomas McKean,Director lEo Mtd° 200 Main Street, Hyannis,MA 02601 Office; 508-862.4644 Fax; 508-790-6304 Date: (V 6"(2- Sewage Permit# 2r °Assessor's Map/Parcel i B e/� I Installer&Designer Certification Form Designer: SC Engtoeecf!t , T n Installer: Ca(?ewik 64"Pcls e.5, G4 G Address: Z&5y Cs6n � -r w t h Address: l 3 Co---r•, rc AL S i EasA k)oreh AI'1(1 ' Fl f� c z53$ �V3�1-`a ✓l't On 2-1'1- C�,,�,�;r ► �,p®rg was issued a permit to install a (date) (installer) septic system at 615, $01y Lorne- based on a design drawn by (address) End;.n e e i AS , 70C. _ dated ockober 3 i, 20 t 2 (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. Stripout (if required) was inspected and the soils were found satisfactory. 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 systern) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if re q ' 'nspected and the soils were found satisfactory. %"OFb(Ap •1CHN l.. �`� JR. (Ins II is Signat ) No ai3�� esigner's Signatur (Affix esi e s Omp Here) PLEASE RETURN O 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 y':ull'i;�IiiimslJ.;ignurrccrliliiauun Ibnn.duc TOWN OF BARNSTABLE LOCATION SEWAGE# 2 0 VILLAGE Ce yi llle ASSESSOR'S MAP&PARCEL 10 -7/ INSTALLER'S NAME&PHONE NO. C_c,pgNbcr_ t.Y1 r $ LGC 7T 77 SEPTIC TANK CAPACITY /000 LEACHING FACILITY:/ e R(AAC 36 F{G. H-aQ] (size 'T ^W"J a»c Trench NO.OF BEDROOMS r.'erica Ue",105 OWNER Itf, 4- h�_/i'zA1oe_fh ✓1e N,,w► sr eL PERMIT DATE: l Z COMPLIANCE DATE: %/ `7 oZ Separation Distance Between the y® CvaiL,r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -Xt /a6 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 LAC. 3 C 0 A-i-i3,5 -4-3`l 0-g-76' do� TO OF BARNSTABLE L XATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT -00171 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Fee Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet-of leaching facility) Fee Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fe t leac 'ng facii ' ) Fee Furnished f // I. G ` �n / Q l� LO J 9 0 i i Y-3--33 6 ' LCCAT-ION S SEWAGE PERMIT NO. VILLAGE ^ -' _-- I NSTA LLER'S NAME i A00IIESS BUILDER OR OWNER DATE PERMIT ISSUED J DATE COMPLIANCE ISSUED��� OJ 6 t , /fir` LO TIO��C`f _ _ SE Q ..ER T A10. VIL 71"STAL E 5 DM E ADDRE S � - --- � � 6WLC)ER9��� —t�J-/�ME— AD-DRESS=_- -_-- OlaTE-P-ERM1T ISSUED-_ __���T`�__— D.AT_E—COMP-L Lb,1,4CE_ISSUE-.---.����� w ; t . a Town of Barnstable P#--/ � rY 4 Departinent of Regulato Services „MUMBLA :' Public Health Division Date A 5//J, >,u►S rFD a�� 200 Main Street,Hyannis MA 02601 Date Scheduled /C5 '!5)1- Time / C Fee Pd. Soil.Suitability oilSuitability Assessmentfor Sewage Disposal Performed-By:- HG Ap- Y2w C 17 cs e- - Witnessed By: Y" LOCATION& GENERAL INFORMATION Location Address O ct j I3 A,( ILA—, Owner's Name M c G e-vt T{/pie`LZ Address tc q e— Assessor's Map/Parcel: t o l 1 / Engineer's Name (1,�'t J-k _4- Tc G)51yi"eerM5 NEW CONSTRUCTION REPAIR ✓/ Telephone# 5 0 F t{ Z Z $ ?7 ---Z 27 3-d 3'7 Land Use: 5eP1 S(Q- �Gimi(y Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area - ft Drinking Water Well - ft Drainage Way ft Property Line 7 Q ft Other � ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) SE✓� a��e�roc� P(� Parent material(geologic) OlweS41 Depth to Bedrock Depth to Groundwater. Standing Water in Hole: _ Weeping from Pit Face Estimated Seasonal High Groundwater (2��loss DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: 0 4-00- 66s erq-A an Depth Observed standing in obs.hole: 712(, In, Depth to soil mottles: Depth to weeping from side of obs.hole: In. Groundwater Adjustment Fr. Index Well# Reading Date: Index-Weil level __., Adj.factor— Adj:Groundwater Level,.Z- PERCOLATION TEST bate ±-Y-12-Time PI A-tt Observation Hole# Time at 9" Depth of Perc ,2ri 36 tr T Time at 6" Start Pre-soak Time® I I'I 11 eM Time(9"-6") End Pre-soak I I I b prq Rate Mini/Inch L Z I Site Suitability Assessment: Site Passed �e S Site Failed: Additional Testing Needed(Y/N) 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:t.SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# 1+2- Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. to ,v.%Gravel) 6 �tZ Fj( l2- 12(o G DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consiatency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenoy, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes . Within 500 year boundary No_ Yes..; Within 100 year flood boundary No..r _ Yes Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Ye S _ If not,what is the depth of naturally occurring pervious matorlal? Certification 'I certify that on ��" q 1 (date)I have passed the soil evaluatorsexamination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 10 CMR 15.017. <Signature Datb /6-31-12 • /i��%!� ,� , QN EPTIMERCFORKDOC AsBuilt Page 1 of 1 TOO -OF BARNSTABLE LOCATION A i C SEWAGE N I VILLAGE ASSESSOR'S MAP&LOTL#10071 INSTALLER'S NAME&PHONE N0, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: i Separation Distance Between the: I Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Fee" Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet-of leaching facility) Fee Edge of Wedand and Leaching Facility(If any wetlands exist within 30(}fe5t IcacWng face Fee Furnished hw�, - 21 xc 1 tp! � l http://issgl2/intran6t/propdata/prebuilt.aspx?mappar=188071&seq=1 11/2/2012 r Town of Barnstable Barnstable Regulatory Services Department EsicaC G nARNSTABLE,( I! m MASS. m Public Health Division �A 1639. , 2007 lED MAt> 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 6871 October 16, 2012 Joseph Angelakis 695 Bay Lane Centerville, MA 02632 The septic system located at 695 Bay Lane, Centerville, MA was last inspected on 10/4/2012 by James D. Sears, a certified septic inspector for the State of Massachusetts. The Health Division has determined that the system "Fails". • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days 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 c can, R.S. CH Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\695 Bay Lane Cent.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis Owner Owners Name Informations required for every Centerville MA 02632 10-4-12 page. C[tyfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please sere completeness checklist at the end of the form: Important:When A. General information filling out forms ( \`�����iH�OF 1fgs on the computer, ` �.�3yt�,. !S-q use only the tab �` ���[[[ 0 1. Inspector: , o; , key to move your : �; cursor-do not James use the return D. Sears =g: �AhhE AR� =o. -4 �€ --�i key. Name of Inspector * • * Capewide Enterprises,LLC '•° o na Company Name x\````` 153 Commercial St. Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification Fr o ,' s -f 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 16.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ +Fails ; Fy y Y nt u« ❑ Needs Further Evaluation by the Local Approving Authority 10-8-12 4 4 ; nspedor's Signature Date ;, -•^ � The system inspector shall submit a copy of this inspection report to the Approving Adthority`(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. 0 iltulu [sins•11/10 s s cial Inspeellon Forth:Subaurtece Sewage Disposal system•Page 1 of 17 Oct 08 12 02:13p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angeiakis Owner Owner's Name information is required for every Centerville MA 02632 10-4-12 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I 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. 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. k 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•11110 Title 5 Official Irv"dien Form:Subsurface Sewage Disposal System Page 2 of 17 Oct 08.12 02:13p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis Owner Ownees Name information is required for every Centerville MA 02632 10-4-12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cant.) 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 ❑ NO (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): Elbroken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): . Q 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(7)(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-11/10 Title 5 ORdel Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Oct 08 12 02:13p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 695 Bay Ln Property Address Joe Angelakis Owner Owner's Name information is required tor,every Centerville MA 02632 10-4-12 page. Citylrown 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 OEP 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 faiiure 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 wagers 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 is less than 6" below invert or available volume is less than 1h da flow 4£i9'r-h/j,v C 15ins-11110 Tide.5 OfRdel Inspection Form:Subsurface Sewage Disposal System-Page 4 of±7 Oct 08 12 02:14p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis Owner Owner's Name information is Centerville MA 02fi32 10-4-12 required for every page. City[Town state Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. © ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S 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 facillty'with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 16.303, 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 fleet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Oepaftrnent. , {sins•11/10 T1rle 5 Ofridal Inspection Form Sub=fece Se%vMe Disposal System-Page 5 of 17 Oct 08 12 02:14p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis Owner Owners Name information is required for every Centerville MA .02632 10-4-12 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ 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) 1310 CMR 15.302(5)j D. System Information Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): DESIGN flow based on 310;CMR 15.203(far example: 110 gpd'x#of bedrooms): 550 15ins•11110 Tide 6 Mdal Inspeetian Fort:Suneurfa Sewage Dloponai Sy¢lam•Papa 6 of-1 7 Oct 08 12 02:14p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form o Not for Voluntary Assessments 695 Bay Ln ---- Property Address Joe Angelakis Owner Owner's Name information is required for every Centerville MA 02632 10-4-12 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal precast tank D Box and Pit 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection requiredl ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No 2010-35,000Gal Water meter readings, if available(last 2 years usage(gpd)): 2011-314,00OGal Detail: Sump pump? ❑ Yes ® No Na Last date of occupancy: Date Cornmerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 15.203): Gauons per day(gpd) Basis of design flow(seatsfpersons/sci t., 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 ireadings. if available: TR:e 5 Oftal tnspedion Foam:UbsuAace Sewage Disposal Syetem•Pap 7 of 17 Oct 08 12 02:15p p.8 Commonwealth of Massachusetts Title 5 Official -Inspection .Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis Owner Owner's Name information is Centerville NIA 02632 10-4-12 required for every page. Cityrrown State Zip Code Date of Inspedion D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General information Pumping Records: Source of information: Na 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): 15ins•11I10 Tipe 5 ofridal Irspeafon Foam:Su owl.'a a.Sewage Disposal System•Page 0 or 17 Oct 08 12 02:15p p.9 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Say Ln Property Address Joe Angelakis - Owner Owner's Name information is Centerville MA 02632 10-4-12 required for every page. Cdyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known) and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 20" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: et Comments(on condition of joints, venting,evidence of leakage, etc.): Pipeing is 4" PVC .SCH 40 Septic Tank(locate on site plan): Depth below grade: et 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: 100013al Precast Sludge depth: 111 tsins-11110 Miles Official Inspection Form:Subsurface.Sewage Oisposel System-Page get 17 Oct 08 12 02:15p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angeelakis Owner Owneds Name information is Centerville MA 02632 10-4-12 required for every _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29" 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 12' Distance from bottom of scum to bottom of outlet tee or baffle 18' How were dimensions determined? A -Tape Sluudgdg e 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.): Tank at working,tank and covers at 14"below grade wloutlet baffle No sogn of leakage or over loading Grease Trap(locate on site plan): Depth below grade: met 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 Dins-11110 Title 5 Offidal Medion Form:.Stbsutface Sewage Disposal System•Page 10 0!17 Oct 08 12 02:16p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form r. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis Owner Owner's Name information Is Centerville MA 02632 10-4-12 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 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-11/1 D Title 5 Official lr spe6on'form;Sutaurface Sewage Disposal System-Page 11 of 17 Oct 08 12 02:16p p.12 Commonwealth of Massachusetts rn Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis - Owner Owner's Name information is Centerville MA 02632 10-4-12 required for every page. City/Town Stale ZipCode Date of Inspection D. System Information (cons) 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.): D Box is 16"x16"-16"below grade w/one out box is clean and solid no sign of over loading or solid carry over 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_): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I5e1s•11110 Tlle 5 Ofidal Mspecoon Fortrt:S�aurLaoe 3ewape Disposal System•Peee 12 d 17 Oct 08 12 02:16p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis Owner Owner's Name information is MA 02632 10�-12 required for every Centerville page. Cilyrrown state Zip Code Date of Inspection D. System Information (cons.) 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.): Leaching is one 6'x6' precast pit, Pit and cover at 1'below grade, Pit is dry,clean, no sign of overloading, solid carry over or high stain line, Wall's like new 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 t51ns•11/20 TMe 6 ORKIM Inap-0—Form:Sube ,F—8-2.DWPp Mt System•Page 12 of 17 Oct 08 12 02:17p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis Owner Owner's Name informatrequired for a Centerville MA 02632 10-4-12 required For every page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•1 U10 T'<lo 6 OftmW Invpoc*—Foam.SA—rise.S-U.Dkc—fi System•P.M*1A of 17 i Oct 08 12 02:17p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln. w ?roperty Address Joe Angelakis Owner Owner's Name information is Centerville MA 02632 10-4-12 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 9' �L_S fie.Ti m � �;�,' d3-1 3/ f 'i a ; i __ , - C . �� , :3 - /-�lvl✓'� s jJt�jr i ISins•71N0 Tlue S or odso Mspec&"Fong Subzufaee Sewage O*Mel bystem•Pag®15 0l 17 Oct 08 12 02:17p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis Owner Owner's Name information is required for every Centerville MA 02632 10-4-12 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: 16 + - teat 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 propertylobservation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: J You must describe how you established the high ground water elevation: Past Report 2000 Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ms•11fto Me 5 tffictal hspechan Form:Subeadaoe Sewage Digxnat Syslem•Page 16 of 17 Oct 08 12 02:18p p.17 v Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis Owner Owner's Name information is MA 02632 10-4-12 required for every Centerville page. Cityfrown State Zlp 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•11110 Title 5 OMdal hespedon Fomr.Subsurface Sewage Disposal System•Pogo 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis' Owner Owner's Name information is required for every Centerville MA 02632, 10-4-12 page. Citylrown State Zlp 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. hnng out f rms A. Genera! Information ,��1►�+""""'���ai filling out forms on the computer. use only the tab 1 Inspector; 2:' key to move your JA M ES G cursor-do not James D. Sears -o m' use the return , SEARS =67 ke Name of Inspector Y• Capewide Enterprises,LLC Company Name ��in5i�N S9 153 Commercial St. 111111101 Company Address r� Mashpee MA 02649 Cityrrown State Zip Code 5D8-477-8877 S 1623 Telephone Number License Number B. Certification f s S 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 ® ;Fails a= 1 ❑ Needs Further Evaluation by the Local Approving Authority _- f CO 10-8-12 ,Plnspectors Signature Date 1 y The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,.if applicable, and the approving authority. ****This-report only describes conditions at the time of inspection and under the conditions of use at that time.This Inspection does not address how the system will perform in the future under the same or different conditions of use. Title SOfTdal Ina n txm:Subsurface Sewage Disposal System-Page i or 17 IOct08 12 02:35p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln. Property Address Joe-Angelakis Owner Owner's Name Information is Centerville required for every MA 02632 10-4-12 page. CitylTown State Zip Code . Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I 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 16.303 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): Tttle 5 OrSdal Inspection Fem Subsurface Sewage Disposal System-Page 2 e 17 IOct08 12 02:35p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Say Ln. Property Address Joe Angelakis Owner owners Name requiradfo is Centerville MA 02632 10-4-12 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 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 isms-11H� Tdle 5 of►cial Inspection Farm Subsurface Sewage Disposal System.Page 3 of 17 Oct 08 12 02:22p p.2 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 Bay Ln, Property Address Joe Angelakis Owner owners Name information is required for every Centerville MA 02632 104-12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fait 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 milk less than 6" below invert or available volume is less than %day flow .0&4 clsrirvG //W 5 A3£FA- t5ins•1111 D Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Oct 08 12 02:23p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis Owner Owner's Name ind for every on is required Centerville MA 02632 10-4-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) . Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue 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 1 DO 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 coliforrn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 3 ppm, provided that no other failure criteria are triggered_A copy of the analysis and chairs of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 20009pd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system'owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems_ To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protecuon Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes' to any question in Section E the system is considered a significant threat, or answered"yes" in Section'D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 GMR 15.304, The system owner should contact the appropriate regional office of the Department. 15ins•1 f/fo Title 5 OfStal Inspection Forth:Subsurface sawsp Disposal system•Page S of 17 i Oct 08 12 02:23p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis Owner Owner's Name information a Centerville MA 02632 10-4-12 ' required for every page. Cityrrown state Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate'yes* or"no"as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant; or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as NIA) ® ❑ 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)1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: NA Number of bedrooms(design): Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 [Sins-11/10 Title 5 01fidai Inspection Form:SubsWace F5mage Disposal System-Page 6 or 17 Oct 08 12 02:23p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis_ Owner owner's Name Information dfo Is r every required for Centerville MA 02632 10-4-12 page. CityfTown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal precast tank and Pit i 0 Number of current residents: Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2010-35,00OGal g ( y g (gPd)) 2011-314,000Gal Detail. Sump pump? ❑ Yes ® No Last date of occupancy: Na Date CommerciaUlndustrial 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 El No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available_ t5ins•11l10 Me 5 Otfh M trlspemon Form:Subsurface Sewage Disposal System.Page 7 of V Oct 08 12 02:23p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln Property Address Joe Angelakis Owner Owner's Name reqon is ui redd for every Centerville MA 02632 10A-12 requr page. City/Town state Tap Code Date of tnspeclion D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): { I General Information Pumping Records: Source of information: Na 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 D 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): 15ins-11/10 Ttlle 5 Official Inswc9on Form:Subsurface Sewage Disposal Sytam•Page 8 of 17 I Oct 08 12 02:24p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Folftn-Not for Voluntary Assessments 695 Bay Ln. Property Addfess Joe Angelakis Owner Owner's Name information is required for every Centerville MA 02632 10-4-12 page. Cityrrown state Zip Code Date of Inspection D. System Information (cons.) Approximate age of all components, date installed(if known) and source of information: NA Were sewage odors detected'when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): i8 Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ® other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing tank to pit orange burge Septic Tank(locate on site plan): Depth below grade: 10 feet Material of construction: 2 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: 1000Gal Precast Sludge depth: 311 tsns•11110 Tdle 5 Of6dal hspedion Form:Subsvfacs Sewage Disposal System•Page 9 of 17 I Oct 08 12 02:24p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Say Ln Property Address Joe Angelakis Owner Ownees Name Informrequir dfbtion is Centerville MA 02632 10-4-12 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cant.) Distance from top of sludge to bottom of outlet tee or baffle 2T 1 Scum thickness Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape 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.): Tank at working level,tank and covers at 10"below grade w/outlet baffle signs of tank being over full in the past i 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-11110 TWO 6 Official bapoclionForm:Subsurface Sewage Diopead Syotore-Pogo 10 of 17 Oct 08 12 02:24p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis Owner Owner's Name informationis requiredequired for every Centerville MA 02632 10-4-12 page. City/Town State Zip Code Date of Inspection D. System Information.(cunt.) 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 lsins-11/tC Title 5 Official dlspectlon Form.,Subwrtace Sewage Disposal System•Page 11 of 17 Oct 08 12 02:25p p.10 Commonwealth of.Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis Owner Owner's Name information is required for every Centerville MA 02632 10-4-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Sox(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): 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.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 - Title 5 ORiciel InBpection Form Subsurface Sevege Disposef System•Peas 12 of 17- Oct 08 12 02:25p p.11 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -,Wiwi 695 Bay Ln. Property Address Joe Angelakis Owner Owner's Name information is required for every Centerville MA 02632 104-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 Typelname of technology: Comments (note condition of'soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Leaching is one 6'x6'precast pit Pit at 23"below grade w/cover at grade, 6"water. wall's show sign's of being full in the past. Need to replace leaching 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 ISiins-11110 Title 5 Official iispection Form:Subsurface Sewage Disposal System-Pege 13 of 17 Oct 08 12 02:25p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis Owner owner's Name information is required for every Centerville MA 02632 10-4-12 � page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of soils,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids . Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): tsins-11110 Title 5 Official ktspection Forth:Subsurface Sewage Disposal System-Page 14 of 17 ,Oct 08 12 02:26p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis Owner Owner's Name information is required for every Centenrille MA 02632 10-4-12 page. Cityrrown State Zip Code Date of tnspection 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 5 L/5TSM A J= A -3 - -57 3 -a = -3s" 13--3 � r c: a C-a_ 39 , • A 0 03 Lq. Fl?bvT t5ine•1 Ill 0 Tine 5 Oftel M spedian Fortn:.5ubsufaat Sewage Disposal System•Page 15 0(17 Oct 08 12 02:26p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis _ Owner Owner's Name information is Centerville MA 02632 10-4-12 required for every 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: 1 + feee t 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 propertylobservation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Past Report 2000 Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Farm:Subsurface Sam-age Disposal System-Page 16 of 17 Oct 08 12 02:36p p.4 Y N, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Bay Ln. Property Address Joe Angelakis Owner Owner's Name information is required for every Centerville MA 02632 10-4-12 page. City/rown 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 !Sins•11110 rGre 5 Olfided Inspectim Form:Subsurface Sewage Disposal System•Page 17 of 17 I RECEIVED , CCIP Tauu o 8 zooJ TOWN OF BARNSTABLE Cape Cod & Islands Property Management HEALTH DEPT. "a full service conWany" P.O. Bog 1144 Phone: 508-428-0503 Osterville,MA 02655 Fax: 508-428-1949 08/01/06 Robert A. Burgmann, P.E. Town Engineer Town of Barnstable Department of Public Works 230 South Street Hyannis, MA 02601 As you know, May and June received record rainfalls. My property has always been dry. I have 2 years of direct knowledge and 20 years of knowledge from prior owners and friends. We installed a new Septic System March and April. There were trucks and backhoes driving on the property, also evidenced by Ed Pesce, my engineer. The 6.45 inches of rain we had in May did not accumulate on my property, but the rain on June 7d'that dumped some 4.5 inches made a pond overnight. I thought it would go away quickly but it did not. I was jogging"�i the rain w/o 6/24 and noticed the storm drain on Bay Lane(372' from South Main)was clogged and the whole end of Bay Lane was draining onto my property. (See attached pictures) 372' one way and 378' the other way multiplied by 23' width of street gives you an awful lot of water. I called Susan at the Highway Division of the Town to report this and have them clean it out. They said it would be taken care of. On 07/10 I called again and was told by Ann that it had not been done and she would get it done. They did come that day to clean it out. There is no burro around this storm drain and water still comes onto my property. This is why I was pumping into the storm drain, and I only did it on 3 occasions, only when it was dry and the drains were not in use. Due to the recent lack of rain and the storm drain unclogged (called in 7/31 to Highway Division to install burm around storm drain)my land is almost dry again. Thank you for your understanding. Sincerely Kerry McNamara June 7th Storm Totals Rainfall totals from around the region 777 ..-.g:T9........ ...:.�.._.....__ ------._. __:_ ._..__w: . _....::. . ' ......... 3 k 4"97 s 5.t t ...... ' .�.__ —'� .... ..._ _ r 3.64 ,- v �-0 IA .�b it ., ALL- i �, k- fe 4•� ._ rai�'-�i[ -t w, k �� �.. The unusual late season noreaster t at hit the Cape la n June 6th and into the 7th, provided a widespread 3 to 6 inch rainfall across the 15 town region. Spotter reports into the National Weather Service and data collected by Cape Cod Weather.Net shows the higher totals focused on the Upper Cape. Even so, widespread basement and street flooding was reported across the entire region. . The heavy rainfall was the result of a slow moving upper level low pressure system and associated surface low that tapped into deep tropical moisture and wrapped it westward towards coastal New England, bringing several hours of very heavy rainfall. - As shown on www.coecodweather.net May 2006 Summary A look back at May 2006 `.- -R-WR 80 r5 1 70 65 60 NIGN 55 1 a cow 50 - - _ _X/� Ors 4 35 - 30 t 2 3 ! .5 6 i 8 9 4 11 12 13 14. f5 iG 17 18 19.-20 2t-22 2] Z1 B ZG 27 28 29 38 31. May 2006 started off quite similar to May of 2005,with chilly readings and lots of wet weather. On the first and third of the month, highs remained in the upper 40s at our Harwich climate station. Our warmest reading of the month was 770F on the 28th and our coolest May temperature was a chilly 40OF on the 8th. The mean temperature for the month was 55.3°F. We picked up 5.94" of rain as well. Other mean temperatures and precipitation totals: (unofficial data from NWS) Chatham: Temp: 55.9°F Rain- 7.1 5" of rain yannis: \TAW 55.2°F Rain: 6.45" of rain Falmouth: n, - Temp: 57.0°F Rain: 3.68" of rain Provincetown: Temp: 55.1 OF Rain:9.33"of rain June 2006 Summary A look back at June 2006 q2mn 70. s5 �/�oN► sa �o 4o 1 Z E { s 8 7 R f t0 11 12 18 if i9 1i fl it 13 2D 31 ?3 2E ti 8 27 8 29 0 Above are the observed high and low temperatures for June 2006 at the CapeCodWeather.Net weather station in Harwich, MA. Looking back, the area saw a wide range in temperatures in June, with a chilly high of 570F on the 4th, the 6th and the 7th and a warm 860F on the 17th. There were 20 days with a high temperature of 70OF or warmer, and the coolest reading was 51.3°F on the 8th. 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Town of Barnstable Barnstable °fIHE T Regulatory Services Department "�""'�'sa�`" 1 913A MASS.LE Q Public Health Division Q Dm MASS. 0 � 8 �A 039. rf0 MPt p1 200 Main Street, Hyannis MA 0.2601 200� Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 6871 October 16, 2012 Joseph Angelakis 695 Bay Lane Centerville, MA 02632 The septic system located at 695 Bay Lane, Centerville, MA was last inspected on 10/4/2012 by James D. Sears, a certified septic inspector for the State of Massachusetts. The Health Division has determined that the system "Fails". • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days 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 c ean, R.S. CH Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\695 Bay Lane Cent.doc PROPERTY ADDRESS:--.0 —U&Y,.Lane _______-- ` Centerville ------------------------ Mass 02632 ------------------------ on the above date, I Inspected the septic system at the above A-ddtess� This system conslsts of the following, 4 1 . 2-1000 gallon septic tanks: . ' 2. 1 -Distribution box.Front .sY stemf (JNA3-1000 gallon precast leaching pits. UG 2 Based on my In3pectlon, I certify the following oondltlonv yawal �000 4 . This is a title five septic system. ( 78 Code ) •. ,� 5. This is a split system. 6 . System in front;Leaching pit is dry. 7 . System in back;Waste water was within 17" of the = � invert pipe of the leaching pit. s 8. Pumped leaching pit at time of inspection. 9.:' The septic system is -in "r SIGNATURE--, proper working order at the; present t m r ' N a m e ;_�.�.: -. J S S Ia 1z.a.L. ______ 1 J { d J h P Macomberb Son , Inc . c o m p a n y•--o-a-..2---.-------- — Address __Bo__x_66____ Centerville L Nay-02632-0066 Phone;___ S08_775_ THIS CERTIFICATION OOPS NOT CONSTITUTE A OVARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC- Tinks•C9aspools•l.vichflflds Pump0d G Insttllod Town sewor Conneotlons P,0• Box 67y5•J338o�77, MA 02632.0066 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600 TRUDYCOXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Commissioner Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTUICAT10N Property Addrw: 695 Bay Lane Name of ownw Melinda Hoffman Centerville Ma Address of otwrw: N�� , (pt6a"rQ,�Joseph P. Macomber Jr. I am a DEP approved syetwn vupKtor pursuant to sect on 16.340 of Tk3e 6 (310 CUR 16.000) c,� Nww: Jose h P. Macomber & Son Inc. ox en t ervi e M 6 3 2-0 0 6 6 T"optsona Nurnb+r' — — CER CAMN 3TATEUENT i certity that I have personally Inspected the sewage disposal system at this address and that the Information repo ad 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 maurtenance of on-site sewage disposal systems. The system: r /Poses Conditionally Passes _ Needs Funhrr Evaluation By the Local Approving Authority _ Fails d's s4%atu Data: in spect fe: The System Inspect shall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)w)dJn 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 fhsll submit the report to the appropriate regional otfice of the Department oAGtvironmentaf Protection. The original should'be sent to Vw system owner and coples sent to the buyer. If applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 I'sQeIofII printed on 0.ecycbd Paper SU&SURFACL SEWA04 DISPOSAL SYSTEM IX3►£CTION IFOW PART A ��,•. CERTUiCAMN (oondnye4l IogwyAddraaa: 695 Bay Lane Centerville Ma 02632 °rr"`. Melinda Hoffman Deos of hapoctlon. 8/3/0 0 N3r*CTlON SU&AMAAY: ch r-k A. B, C, w D: A. SYSTEL►A33F3: )L) I have not found any Information which lndieatss that any of the Wure condtdom described In 310 CMR 14.303 exist. Any tabu, crhorts not evalustod are IndJcated below, C0111.t.FNT3: S. SY37TU CONDfT OkAUY PASSES: ` _,VQ,_ One or more system sompononu sa dosorlbod In the 'CortdJ4"►was'section Mod to be replacod or ropairod. The eyum, upc completion of the replacement w ropalr, as approved by the Soard of Health, will pre. tn41eoto y�e/s,,1 no, or not dotorminod(Y, N. w NO). Dosertbo b"a of dstwmination In alf trutanoes. If 'not dotermInod', explain why not. The eoptie tank Is metal, urJess the owner w opwotw has provided the system Irupeertor wkh a copy of a Cerdlteate of CompUanco (artochod)(ndlcatinp that the tank web Inat"od wlWn twenty(:0)years priw to the dau of vw tnspocvon: the soptic tank• whether or not metal,Is crooked, evvewrally unwound, show@ substanda)lnWedon or oxvVedon. o+ u (allure Is Imminent. The system wW pass Irupoodon If the oxJednp sepde tank Is replaced whh a oomplytno aspdc taro a approved by the Dowd of Health. $swags backup or breakout or Nph sutio wetar Isvol obsorvod In the dJstrlbutlon box Is due to broken or obrwcud pips or due to a broken, sotdod or uneven distribution box. The system wW pass InapootJon If(with approve.) of the Doaro of HaaJth)• broken plpo(s) we replaced obewcdon Is romovod dlsvlbudon box Is levelled or replaced N� The s yn s m r o Quk e d paunplrl gTr-ort,tdwt lota-tim•@ v ye ar tiu•w broken a obetry oted pipe(s). the*Y*t=m .e�ryeas-- In4poc0on II Iwlth approval of the Doard of Health): broken plpo(s) are replaced obstruction la removed revis-ed 9/2/98 Page 2orIt SUBSURFACE SEWAGE DISPORT ASYSTEM INSPECTION FORM CERTIFICATION (ccrrd—od) NW-Ty Ad&—: 695 Bay Lane Centerville Ma 02632 OwTM': Melinda Hoffman D.ts of��.8/3/0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: j/D Conchions exist which require further evalustion by the Board of Health in order to determine If th@ flyatem I► fapinp to protect the public health, safety and the envi(onment. 11 SYSTDI WILL PASS UNLESS BOARD OF HEALTH OETVJAINES W ACCORDANCE WITH Si0 R a 303 ITB OlB THAT t-THE SYSTD IS NOT FUNCTIONING IN MANNER WH1CKYALL.PROTFCT THE PUBLJC kiFJLLT}IAND iJ1FETY /) Cesspool or privy Is within 60 feet of surface water Cesspool or privy is within 60 loot of a bordering vegetated wetland or a salt marsh. 2) SYSTEM V/lll FAIL UNLESS AND THE EWVIRO`"k NT: THE BOARD OF HEALTH"D PUBLIC WATER SUPPLIER,IF A)M D�i�THAT THE SYSTEM 1 FUNCTIONING IN A MANNERTHATPROTECTS THE PUBLIC HEAL AND SA M a au The system has a ►Optic tank and soil absorption system (SASI and the SAS is within 100 teat of o W rf«wpD1Y wsti ace water piY ° trlbvtary.to.a surface water supply' The system has a ►optic tank and soil abeorptlon system and the SAS Is wltNn a Zone I of e The system has a septic tank end-soil absorption system and the SAS Is within s less n feet Of private water wpptY wall. nd nds lndicstss tt%at The system has s �Opwoll`aunless and a wsoil sllbwetstianaly►Is o•collt•m bacitsria and vdad�100 torpanic compou biA 60 loot nds�o � e privets water supply well Is free from pollution from that facility and the prof smmoniaon not vaUd)Nvate nJvo9M Is rv"+i to °r O►• than 6 ppm. Method used to determine distance 7i OTHER Pitt)of 11 revised 9/2/96 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIACATION (con*-0d) prO9e,M Addy—:695 Bay Lane Centerville Ma 02632 owner: Melinda Hoffman Dote of if 1 W-16 "8/3/0 0 D. SYST A FAILS: You must Indicate either 'Yes' or 'No' to each of the following: to correct tee tabu ns exist as �� I have d etermined that one or more of the following ailure co be cc ntacted to deterimin lwhatt WiU be necessary • bra for s determination Is Identified below. The Board of He alth shouldYes No oornpo"nt•doe�to em ove o�� Backup o+eew+g+I(Mo f.clNty-or•.Tet+rn ed SAS or Discharge or ponding of stfluent to the surt+ce of the ground or surface•wabsre due to an overloaded or dog9 cesspool. ed SAS or cesspool. Sufic liquid level In t IsttJbu oonnb'�^y Outl4t I v R due to an overloaded or clogged r¢ �4y' flow. Liquid depth Insss+P�hls less than 6' below invert or ■vall+ble volume Is less than 112 day / In more than 4 times In the lest year mO due to clogged or obstructed pipe($). Required pumping �. 111«< Number of times pumped groundwater elevation. , cesspool or privy Is below the hlgh 9 Any portion of the SOiI Absorption System I or tributary to a surface water wp;Wy / Any portion of a cesspool or privy Is within 100 feet of + surface water supD y Any portion of a cesspool or privy is•withln a Zone I of a public wall. rivets water suDPIY well. — Any pbrtlon of a cesspool or privy Is within 60 feet of + D realer than 60 feet from a private water wpplY well with r% anal sls. If the well has been analyzed to be acceptable. attach copy of well water +rhalYsis to Any Donlon of a cesspool or privy Is less-than 100 feet but g acceptable wets( quality Y unds, ammonia niucgen•and nitrate nitrogen. -colllo(m bacisria, volatile organlo•compo E. LARGE SYSTEM FAILS: You must Indicate following rcrltsrla Apply oo laorge systems In each of the additionto the criteria above:The nlficant tveat to System serves • facility with a design flow of 10.000 9Pd or greater(Large System) and the system le a sJg The Y Thelth and safety and the environment because one or more of the following conditions exist; stsm Is within 400 feet of a surface drinking water supply Yes N�/ . . �-- .. 1/ the sy W-ou►►iy.... { / the syetem•Is-wlt� 200 {++tof�-M�►tary-1e�wriw�� 'w+ n+(rive area(interim Wellhead Protection Area, IWPA) or • mapt� Zone llof he system Is located In a nitrogen of et t -- water supply an well) such system shall upgrade the system In accordance with 710 CMR 16.304121• Please con+ult � l re The owner or operator of Y oMce of the Dspartmsnt for further Inforpadon. psgslorII revised 9/2/98 SUBSURFACE SEWAGE DISP03AL SYSTOA INSPECTION FORM' PART B CHECKLIST P-9—y Ad&—: 695 Bay Lane Centerville Ma 02632 0Wroef: Melinda Hoffman Onto of 4tapocdon: 8/3/0 0 Check If the following hays been done: You must Indicate either 'Yes' or 'No' as to each of the following: Yet No / •-i•�/ Pumping Information was provided by the owner, occupant, or Board of Health. None of the system<orrgoaanu kaya:baan posrtpad+flosaatJaaat 3wo•waaka svadtke z'ystam haabMowoel:aog wood 1tt rates during that period. large volumes of water have not been Introducsd Into the system recently or as part of wl Inspection. As built plans have been obtained and exemined. Note If they are not available with N/A. _ The facility or dwelling was Inspected for signs of*swage backup. The system does not receive non•sanitary or Industrial waste now. _ The *He was Inspected for signs of breakout. _ All system components, 4luding the Soil Absorption Systsm)hays been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was Inspected for condition of OaM or tees, material of construction, dlmenslons, depth of UQuld, depth of sludge, depth of scum, The size and location of the Soil Absorption System orrthe site has been determined based on:- Existing,Information. For example. Plan at B.O.H. f/ _ Determined In the field (If any of the failure criteria related to Part C is at Issue, approximation of distance Is unacceptab+, 116.302(3)(b)l _ The facility ownu Iand.��;.+•,Jf dltlaraW tract aucaarl.►�ar�,pznWrt&ejwLth Inform„tomon rha pzn •,m ;g•_x.Q Qf SubSurlsce Disposal Systems. revised 9/2/98 Page Sof11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMA PART C SYSTEM WFORMAT10N Address: 02632 Proq•artY 695 Bay Lane Centerville Ma D1MT1 : Melinda Hoffman Date cd lf,s�: 8/3/0 0 Flow coNDmoNs RESIDENTIAL: DosJ9n flow:• A g•p•d•�edro m. Number of bedrooms d sig 1 Number of bedroom+(actual):.(Q Total DESIGN flow Number of currant tssldsnts:,� Garbage grinder(Ye+ or no):_a Laundry(separate sY+tsm) ea or no _; It Ya+• ++Pata2a1naPactJon.reQuirad _ IOf/ 0 Laundry system Inspected es r no) , �(pb Co f�)�0�� l} P.�_^ 0T Seasonal use (Yes or nol: �/ �(/ Weser moist readings,It available (last two year's usage 19pd): �1 Sump Pump (yes or no): � Op = lJ Last date of occupancy: ComiAERC1A VW DUSTRIAL: Type of establishment: Design flow: d I Based on 16.2031 Basis of design flow Ores@ trap present: (yes or no) industrial West@ Molding Tank present: (Yes or no)IY2 Non-sanitary waste discharged to the Title 6 system: (Yes or no)dff Weter meter readings.If available: Lest date of occupancy: AA OTHER:(Describe) A/t � lsst date of occupancy: GENERAL INFORMATION PUµPWG ORDS d ourca 1lnfor tion: �no) , Sys%• pumped as part o Inspection: (yes If yes, volume pumped: gallons Reason for pumping: TY OF SYSTEM Septic tankIdlstribution box/soil absorption systemS- J Single cesspool Overflow cesspool Privy Shared system(Yes etc. or no) 111 poles up to datech ious operation ation records.If any) nd maintenance contract IfA Technology etc. Attach copy 27 Tight Tank Copy of DEP Approval Other ���' APPROXIMATE AGE of all components, date Inotalled44f known)-end souroo 044w(orrywtl n: Sewage odors detected when-striving at the ;Its: (Yes or no)10 PsQe 6 of 11 revised 9/2/98 SUBSURFACE SEWAGE DISPOSACSYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (can*w-ed) PrW-yAd&—: 695 Bay Lane Centerville Ma 02632 Dom: Melinda Hoffman Data of Inspoctlon:8/3/0 0 BUILDING SEINER: (locate on site plan) �.Depth below grade:�t1 Material of construction: _cast Iron 7�4O PVC other(explain) Distance tromhrivet• water supply well or suction line /C;I- Diameter�_ , Comments: (condition of Joints, vondng, evidence of laaka1111e,-rtc.l Jo' S (locals on she plan) Depth below grade Material of construction:zoncreteN&metalA&FlbsrglassA61_polyethyleno4Aother(explalnl if tank Is Instal. Ilst age ,Ig is.ape.confamed by Certlflcate of Compliance (Yes/No) Dimensions: �C r tY' SWdge deptl / Tiy9�'e Distance from top L sludge to bottom of outlet tee or traMe' � Scum tNckness: At!4f-t— Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet t e or baffle:.4 l Mow dimensions were determined: Comments: (recommendadon for pumping,u�Ptlo of Inlet and outlet tees or•batfles,-depth of liquid level In reledQpnq eut teesatn+ctt+rel integrity. evidence of leakage, etc.) YY the se tic tank l 1 L 1 ui cent and outlet tees s is i on tanks are struc Urally sound And ence o ea GREASE TRAP: ,locate on Ills plan) Depth below grade:AP9 Material of construction&concretrlVgmetall 1�QFlberglasePolyethylene�Qother(ezplaln) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee ti btoo o Distance hom bottom of scum to bottom of outlet tee or baffle: oats of last pumping: Comments: (recommendation for pumping, condition of.lniet and outlet tees or baffles, depth of Uquid level In relation to outlet Invert, atrtwtural Integrtty. evidence of leakage, etc.) Grease tra is r,ir 7 or l l revised 9/2/98 SU83URFAC9 VEWAOE OLSP03AL SYSTEVA WSP£CTION FOFUA ►AAT C J" SY3TuA WFORmAnON(corttf wodi Prop*M Ada►..+: 695 Bay Lane Centerville Ma 02632 Ow^•: Melinda Hoffman O.a of vupec4on`8/3/0 0 TIOMT OR HOLDING TANK: OIT&nk mart be pumped prior to, or at time of, Inap•ction) locate on rite plan) Oepth below grader Material of conrtrvgt on;&con4:r•to&hmet&L&Flb•rpl&&$&A►olyethylonc42othor(cxplalln) Olmenr,lons: r Capaclty: 14 gallon+ 0@sign Ilow: gollonslday Alarm plerenl Alarm I@rel: Alarm In working order:Yee4g NOM Oat@ of p(evlovs pvmpingi W_ Commenu: 1cOndldoA of Wet tee, condition of &farm and float $witch•$, sic.) Or rP nnt- a rccont- WTRIBUTION SOX: llocata on Nt@ plan) 0@pth of liquid level above ovdet Inven: A/0. Comments: RR ��tt n e II level and dlsirlbution Is equal, evidmw of adld@ carryover, widen&$ of leakage WistrtibViori Where is only - s one a er in o or o pVldp C14AIABS:2'�VI? Ilocet• on site plan) ►vmps In working order:(Y@s or NO)� Alarms In working order Ire$ of Nol Comments: Mole condition of pump chamber, condition of pump$ and appurtenances,•to.) pUMTr1S n0 DrpSPnt ht@ t of 11 revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART C SYSTEM INFORMATION(cQn*u-mod) PropenyAddre": 695 Bay Lane Centerville Ma 02632 Owrw: Melinda Hoffman Dante of 1nsp.cd—:8/3/0 0 SOIL AzsORYTION SYSTEM(SAS) ldv (locate on site plan, If possible: excavation not required,location may be approximated by non-Inwslve methoda) If not located, explain: Type: leaching pits, number:,, leaching chambers, number: Issching galleries, number: leaching trenches, number, length: leaching fields, number, dlmenlons: overflow cesspool, number: Alternative system: ,Ole Name of Technology: e Comments: g mote condition of soil, signs of hydraulic failure, level of pondijy, d S D soil.ns o dl or�of tCrauliC c f ai.lure Loamy mP 1a 1 rmal in 5oi s r ve Ct.at.iora is CESSPOOLS: e (locate on site plan) Number and configuration: Dspth•top of liquid to Inlet Invert: Depth of solids lays(. Depth of scum lays(: Dimensions of cesspool: , Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of Inspection) 0o s are no r Comments: Inots condition of soil, signs of hydraulic failure, level of pending,condition of'vegetadon' etc. DOO s are no PPJVY: � (locate on site plan) Dimenslons: IVA Materials of construction: Depth of sollds:i�iE Comments: Inote condition of soil, signs of hydraulic failure, level of ponding, condition of vegatation, etc. Privy is no Peas 9 or l i revised 9/2/98 SUSSURIACP S[WAOL DISPOSAL WYWTiAI kN$P9 TiOM FORJd PART C *YVTTM LNFORLMTIOM(oondm*ed) �. prW.MAddl—: 695 Bay Lane Centerville Ma 02632 Ow""' Melinda Hoffman Dew of tn.p.o '8/3/0 0 SKVCH OF SEWAGE DISPOSAL SYSTEM: Include des to et least two permanent reference landrrwks or benchmarks locate all wells wlWn 100'(Locate where publJo wales supply comes Into hwao) r i i _D t V'1 1 L` 19 1 \ 1 \1 _ yg, revised 9/2/98 Page to of I I SUa3URFACE SEWAGE DISIt M SYSTEM INS►ECTTON FORM ' PART C SYSTEM WFORMArION IcornlnuwCl I„o..Addea": 695 Bay Lane Centerville Ma 02632 own«: Melinda Hoffman 0—of 4+►p+a —:8/3/00 MRCS R►pon name Soil Type_ Typical depth to groundwater U50S Dole w►btlt►vldt►d Ob►►n►tlon W►IU chocked Modmt� C��p Oroundw►m depth: Slt►Ilow SITE EXAM Slope surface wall( Check COW Shallow Wall$ r Etum►t►d Depth to Oroundw►t►r //&Feat n►►r►Indlc►t► all the methods used to d►t+rmin►Mlph Groundwater Elevation: _Obt►lned from D►►Ipn Plans on record Observed Slit IAbutdnp p(op►ny observation hole,b►earnorit sump•tc.l 0►t►rrrin►d from local conditions Checked with local So►rd of health Checked FEMA Maps 'h►ck►d pumpinp records '01�ch►ck►d local►'COY" "In►t►Il►n Ur►d U503 Dole 0►ruio► how yov►►t►DtI►MO the High Oroundw►ur Elevation.Ih+yn be completed) USED: Water Contours Map. Gahrety & Miller Model 12/16/94 ' Ai►IloEll revised 9/2/98 I I•OWN OF BARNSTABLE WARD OF IIEALTII SUIISUIIFACF, SFMAOF DISPOSAL SYSTF,M INSPECTION FORM -' PART D— CEIITIFI CAT ION -TY►C OA PANT C1,6AtLY- PII0PEE1?TY INSPECTED STREET ADDRESS 695 Bay Lane Centerville Ma. 02632 ASSESSORS HAP, DLOCK AND PARCEL I OWNER' s NAME Melinda Hoffman PART D - CERTIFICArSOH NAME OF INSPECTOR Joseph P. Macomber Jr, COMPANY NAME Joseph P. Macomber S"Son, Inc. COMPANY ADDRESS Box 66 Centerville MA. 02632-0066 $trfgt Tovn or City flat• t1"P COMPANY TELEPHONE ( 508 ) 775 _ 3338 FAX ( ) - cen,rIFICATION STATEMENT I certify that .I have personally inspected the sewage disposa`1 system nt Drlecoinmendat* lons his nddress and that the information reported is true, accurate, and omplete as of the time of.-inspection . The inspection Has performed and any regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one; _��Sys teoi PASSED ' The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public keAlLh or the environment as defined in 310 CHR 16. 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form, System FAILED* \ The inspection which I have con trcted has found that the system falls to protect the E)ublic health and the environment in accordance with Title 5 , 310 CHR 15 , 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form, � Y - Inspector 8ignatur r - Data ecopy of tills certification must be provided to the OWNER, the BUYERDFn where applicable) and the BOARD OV HEAL1'1l. • If the inspection FAILED, th`s owner or operator shall upgrade the system within one year or the dnte of the inspection, unless allowed or required otherwise as provided 1n 3.10 CHR 16 , 306 . partd.doc I No��.w ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........)O WJ?_.........O F........B ApplirFatiun for Uiipuual Work,5 Tunitrurtiun rautit Application is hereby made for a Permit to Construct ( ) or Repair (L-� an Individual Sewage Disposal , System at ..........• _15 ---•----- ......... Locayfo ddr s No. ------•••.......• , - Q �rr, -------------- O ner ss -----.......a,_a.. � v� ........................................... Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................... .. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length_............... Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-__-_-_--___-__...__ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------- -- -- -------^j ........................---•---•-----------•----•-•------•--------•------------- ODescription of Soil-----------------------r �{.l i_-- �� =I -------------------------------------------------------------------•------------- x �l .•-•--•-•----------------•-------------------•--------•-----••---••---•--•--•......-•----•----------=-•--•----- f V Nature of Repairs or Alterations—Answer when appli77)OOV bl --___ (� ..� /.__ _.... .......................... ............ -9al...•-7� ------------------------------------ Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agree of to place the system in operation until a Certificate of Compliance has been ' sued by the boa=d ealth. ate ApplicationApproved By..... ---••-• --•• --•-•- ............................................................... ...... •--••-- .?. . Date Application Disapproved r the ollowing reasons:................................................................................................................ Date PermitNo......................................................... Issued....................................................... Date No...................-,e.—. Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------- .... _ -- ........OF.............................I.....I............. .... -.... Applaration for Disposal Works Tonstratr#ion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -----------------------------------------------------------------------•---•---------------------- ...--•--•---•----------••------•-------------•-------------------•-••----------------------...-•-- Location-Address or Lot No. ......................_.......................................................................... .................................................................................................. Owner Address W Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P-4 Other fixtures ---------------------------------------- ------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity___._______gallons Length---------------- Width---------------- Diameter---------------- Depth_-__.__-____._-. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------- ------------------•--•-••-•-••-••------•---••---------•----•--•--- Date........................................ Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water---------------......... GL, Test Pit No. 2................minutes per inch Depth of Test Pit_--____.________-_- Depth to ground water--.--._--__-____-__-_._. P' --------•-----------------------•----•-------- .............................................................................................................. 0 Description of Soil....................................................................................................................................................................x U W ------ •-•---------------•--- 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 TITI E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. J ned. .= ...... ... ............ Ithollowing Date -.Application Approved B == ------%= . ` ..:.-DatApplication Disapproved reasons:---------------------------------------------------------------------------------------------------------------- ..•••••--••-•-•--•-•••••-•--•-•-••---•-------•-•--•-•-•----•••-••--•------•--•--------•....••--•----•-----------•--------•------•-•----•••-------•••••-•----------------•-------------•---•---•------- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................I..................OF................................................I............I...................... Trr#ifiratr of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.........................................................................................................----------------•---------------------------------•---------•--------------.-------------- Installer at_.......................---•----------•-••------------•---•----•-----•------------•--------•---------------------------•------------------- . ---- -••------ - has been installed in accordance with the provisions of TITL:-; 5 a#: 1 State Sanitary ;CO . ass . scribed in the application for Disposal Works Construction Permit No. ___-_'_..__� -'._ ......... date d_`:-.-. ` ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................... 1 Y/C!�------------------ Inspector....---- =V1-��'--'-.............................. ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................'OF.........................................................._....................... NO'............... '� FEE........................ Disposal Works Tons rudioat Vrrmit Permissionis hereby granted_------------ ----•---•-------•-----...-............................................................................................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.............................................------------------•--- -------------•-----------------------------------------------------------------------------------------------.•--- Street /I as shown on the application for Disposal `Yorks Construction Permit f-_..-.-ted.......................................... ---•------•• • ...••-• .. Boafd of Health ---------------- DATE................................................................................ II FORK 1255 HOBBS & WARREN. INC.. PUBLISHERS ._..-�� , T.O.F. EL.= 48.4'± INISH GRADE OVER D-BOX= 48.0'± GENERAL NOTE S PROVIDE EXTENSION RISER 4„SCHEDULE 40 PVC FINISHED GRADE OVER BIODIFFUSERS = 4$,Q' - 4$,3' WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER @ MIN. SLOPE 1% INSPECTION PORT WITH ACCESS SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE 1 METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 48•3'± F.G. OVER TANK EL. = 4$,0'± 5"DIA. OUTLET(S) BOX TO WITHIN 3"OF F.G. CODE AND ANY APPLICABLE LOCAL RULES. _. (ONE PER TRENCH) _ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE i DESIGN ENGINEER. PROPOSED 4" 9"MIN. EXISTING 4' - 36"MAX. 9"MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL ,. SEWER PIPE PVC SEWER PIPE 36"MAX. TOP OF SAS/B.O. = 45.63' SYSTEM UNLESS OTHERWISE NOTED. f _ -= 6 3" DROP MAX „ �+ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN " L = 50_ - I 2" DROP MIN 3 9 MIN.SLOPE @ 1% JOINTS (TYP.) ELEVATION =45.63' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4"PVC IN FROM CLEAN SAND 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF � LL� 1 14" * ,Q'± SEPTIC TANK 4" PVC OUT TO 1.33' nJTYP 6„.TYP THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. OHING FACILITY 0.90, (TYP.) 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. CONTRACTOR CONTRACTOR SHALL � , SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 45.50IXC45.33 45.20' �-44.30' (LAID FLAT) 2.875'(34.5")--I- 5.75'� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE CRUSHED STONE 5 0� (NP•) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS ER MECHANICALLY NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE (TYP.) 5'MIN. 11.50' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 30.0'(TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. ELEVATION OF 49.00' ---!^- -- _ -- TO BE INSTALLED ON A LEVEL STABLE ESTABLISHED ON TOP OF A NAIL SET IN TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV= < 36.90' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE" DISTRIBUTION BOX DETAIL 12 - ARC 36HC (#3616 B D) BIODIFFUSERS TO THE DESIGN ENGINEER.TO ANY WORK & NOTIFY ENGINEER IF DIFFFRFNT NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING rY _ TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM #695 '' Q .. • 0 PERC NO. 13781 APPROPRIATE AUTHORITY. EXISTING « , eech l INSPECTOR: Donald Desmarais, RS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS • LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE 5-BEDROOM • • •"* ° - -- - EVALUATOR: Michael Pimentel, EIT, CSE THEY SHALL WITHSTAND H-20 LOADING. HC-1 DWELLING ( • ; • ••' C.S.E.APPROVAL DATE: Oct. 1999 TOF =48.4'± • 0 , .• DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND FINES. r o; • • October 31, 2012 ' • •�; TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE DECK /'' ` * 0 = • . / MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ), 5181 an rry •�* • ' • • ELEV TOP = 47.40' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ELEV WATER= < 36.90' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 2) 43 • PERC RATE _ < 2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN HC-2 / Q SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 00 +' • i ` • DEPTH OF PERC = 12"-30" 16. PROPOSED PROJECT IS LOCATED WITHIN: LOCI '� TEXTURAL CLASS: 1 ASSESSOR'S MAP 188 PARCEL 71 a • UOWNER OF RECORD: KERRY M. & ELIZABETH McNAMARA U (4 .u.. ��ti • • `q • v 11 ADDRESS: 695 BAY LANE MAP 188 0 3) • • : �� • 0" 47.40' CENTERVILLE MA 02632 PARCEL 119 - ., � � � Fill 12„ 46.40' Perc = FEMA FLOOD ZONE C 30" 44.90' COMMUNITY PANEL# 250001 0016 D 47x1' � EXISTING LEACHING PIT TO BE PUMPED AND SWING-TIES SCALE: 1° =20' �,/ � �... '--" . • 17. DEED REFERENCE: LAND COURT CERTIFICATE#163651 / MAP 188 FILLED WITH CLEAN, COARSE SAND & ABANDONED ' - 18. PLAN REFERENCES: 1.)L.C. PLAN 15087-K DESCRIPTION HCA HC-2 ' ,�, ,+ 2.)L.C. PLAN 15087-L PARCEL 72 • • BIODIFFUSER CORNER(1) 34.2' 35.6' 4"` . Coarse Sand C 2.5Y 6/6 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. ,c�X EXISTING 1,000 GALLON SEPTIC TANK TO BIODIFFUSER CORNER(2) 28.0/ 24.3 i - - ;. . (loose) 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY FNCFk�� BE UTILIZED AS PART OF THIS DESIGN -- , ./ -- • �.- FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY ` BIODIFFUSER CORNER(3) 56.9' 41.9' � au � • FOR USES OF THIS FLAN OTHER THAN ITS INTENDED PURPOSE. O 47x5' _ O LP \ z 89"292p" , i ' O 48x3' 2'324� w LOCUS PLAN 47x8' #695 SCALE: 1"= 1000' � EXISTING 126" 36.90' 5-BEDROOM w k GAS w \ No Mottling, Standing or Weeping Observed DWELLING - i PROPOSED TOF = 48.4'± �AS�� DESIGN DATA TEST PIT DATA LEGEND y DISTRIBUTION BOX / PERC NO. 13781 � DECK /`'�. INSPECTOR: Donald Desmarais, RS 48x5' e MAP 188 NUMBER OF BEDROOMS(DESIGN) 3 MAP 188 PARCEL 70 DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, EIT, CSE 50x0' EXISTING SPOT GRADE � ti ��.� CAS - - C.S.E. APPROVAL DATE: Oct. 1999 - 50 - EXISTING CONTOUR PARCEL 74 "�Q0' 24.3' \ TOTAL DESIGN FLOW 330 GAUDAY DATE: October 31, 2012 '�--., \ ` � C DESIGN FLOW X 200 % = 660 GAUDAY 50 PROPOSED CONTOUR l 48x3' \ A.C. TEST PIT#: 2 00 o USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP = 47.40' _-- ❑�H�W EXISTING OVERHEAD UTILITIES o s \ - a 4L ELEV WATER- < 36.90' GAS EXISTING GAS LINE 0 s INSTALL 12 - ARC 36HC (#3616BD) BIODIFFUSERS PERC RATE = moo / 47x5 U.P. #44S ��HiW4, \ W W- EXISTING WATER LINE PROP. TOTAL 12 ARC 36HC BIODIFFUSERS \ TP 2 (6 BIODIFFUSERS EACH TRENCH) CO Cy DEPTH OF PERC = j 4~, � �p�H�� s SYSTEM CAPACITY TEST PIT LOCATION 48x7' TP 1 J \ TEXTURAL CLASS: 1 %PROPOSED INSPECTION PORT WITH '�� a I 4 x, CO 47x9' LP b. ti�so Cq w _` Oi - (TOTAL L.F.OF BIODIFFUSERS)(7.79 SF/LF)(0.74 GPD/SQ.FT.)= GPD F070 EXISTING 1,000 GALLON SEPTIC TANK ACCESS BOX TO GRADE (TYP OF 2) EXISTING 1,000 GALLON SEPTIC TANK TO 4- ��,,`�'''�; \ �� '� (60.0')(7.79 SF/LF)(0.74 GAUSQ.FT.)= 345.9 GAL. LEACHING/DAY O, / 0" 47.40' REMAIN IN PLACE AND ACTIVE FOR USE \6'�p Cyf Fill PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE Benchmark I _ A8 EXISTING DISTRIBTION BOX TO REMAIN PROPOSED DISTRIBUTION BOX Nail Set in Tree ��\ 4 x8' IN PLACE AND ACTIVE FOR USE / TOTALS: 12" 46.40' O Elev. =49.00' Approx. M.S.L. EXISTING LEACHING PIT TO REMAIN TOTAL NUMBER OF BIODIFFUSERS: 12 Q PROPOSED ARC 36HC(#3616BD) BIODIFFUSER NS), IN PLACE AND ACTIVE FOR USE i \ TOTAL NUMBER OF COUPLINGS: 0 TOTAL LEACHING AREA: 467.4 SQ.FT. / TOTAL LEACHING CAPACITY: 345.9 GAL./DAY I REV. DATE BY APP'D. DESCRIPTION Coarse Sand PROPOSED SEPTIC SYSTEM UPGRADE P MAP 188 Q C 2.5Y 6/6 PREPARED FOR: MAP 188 PARCEL 71 �O� NOTE: (loose) PARCEL 69 32,926 S.F. ± �3`'�^ EFFECTIVE LEACHING AREA OF 7.79 SF/LF OBTAINED FROM THE CAPEWIDE ENTERPRISES DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR LOCATED AT SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3, 2003(LAST AN 4!JJ MODIFIED MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. 695 BAY LANE NOTES: �P `o� CENTERVILLE, MA 02632 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF , `°° 126" 36.90' SCALE: 1 INCH = 20 FT. DATE: OCTOBER 31, 2012 EACH SEPTIC SYSTEM COMPONENT. ,► ? 0 10 20 40 80 FEET No Mottling, Standing or Weeping Observed 6 OF JgAS a s ' PREPARED BY: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF RESERVED FOR BOARD OF HEALTH USE JOHN L. THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST ciiu CCHIL IVILL JR JC ENGINEERING, INC. PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL NO 18 2854 CRANBERRY HIGHWAY BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. ��F T EAST WAREHAM, MA 02538 � / ` f r J ! 508.273.0377 3.) PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. ���� PLAN SCALE: 1"=20' Drawn By: MCP Designed By:MCP_TChecked By: JLC JOB No.2337