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0920 BUMPS RIVER ROAD - Health
PF 920 Bumps River Road Centerville A= 168 —042 r S M E A D No. H163OR UPC 10259 smead.com • Made to USA No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pplitation for Misposal fps m Construction permit Application for a Permit to Construct( ) Repair_v�Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. VC) 44 ,,0 ,e'4_ 's Name,Address,and Tel.No Assessor's Map/Parcel A7 A0 oq:; 42%k) Ins er's Name,Address and o. Desi er's Na dres ,and Tel.No. Type of Building: ,5 32 J 1 Dwelling No.of Bedrooms Lot Size e. sq.ft. Garbage Grinder( ) Other Type of Building rr No.of Persons rs( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �� gpd Design flow provided gpd Plan Date Number of sheets IR�e�'s:ion Date Title Size of Septic Tank Z160D Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4 J42 o Date last inspected: ---------- Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 'gow&-- Date Issued l Fee i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN.OF`BARNSTA�BI.E�, MASSACHUSETTS Yes � pYtc tip for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair U grade(1,< Abandon( ) ❑Complete System ❑Individual Components as Location Address or Lot No. G)�� /�► 3.t '� Own/er's Name,Address,and Tel.No Assessor's Map/Parcel fil!A0 �� a� Ml*-•/� �� C e���i5 Installer's Name,Address and T6VNo. Designer's Name„ ddress,and Tel.No. Type of Building: y o(� - j�� ^ ,2,7 J 1 Dwelling No.of Bedrooms Lot Size -) sq.ft. . Garbage Grinder( ) Other T e of Buildin 1 t yp g ��l?! /7 No.of Persons -Showers( ) Cafeteria( ) Other Fixtures [J Design Flow(min.required) _�_ �� gpd Design flow provided _ �j �l 0� gpdr Plan Date -3 - ��, �,�,' Number of sheets ::A Revasion Date / Title Size of Septic Tank / �y. —�'C.� w Type of S.A.S. Description of Soil A I Nature of Repairs or Alterations(Answer/when applicable) l-- QC j(1 t,/ D-`- ( B -- 71470 Date last inspected: i, - Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in s j !accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ~-- " w ;K Signed• ;,; Date V4 Application Approved by t, A'D Date Application Disapproved by '� i '� —Date----- j for the following reasons r�� / r~ ' ' Permit No, c-y�l�" '" d�0 (U Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(A/) Abandoned( )by at M PS 4 �is been constructed in accordance with the provisions of Title 5 and for Disposal System Construction Permit No. !?S -Ci4 dated j - Installer OX, orl DY) +� � �� �V Designer f�)(,/er to :f>--_33© I ! #bedrooms L� Approved design flow ., ,...,,. gpd The issuance of this permit shall[L� of be construed as a guarantee that the system will function as de igneid, Date l / � Inspectors ► i ----------- - - - ---------------- --------------------------------------------- No. , I Fee Al THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *psterri Construction permit Permission is hereby granted to Construct CConstruct( ) Repair( ) Upgrade( ) Abandon( ) System located at z�4 /y)�l, f I V i It e. i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date /! �� Approved by -� rom: 04/17/2018 15:32 #418 P.001/001 Town of Barnstable Regulatory Services Richard V. Scali, Interim Director • BARNSfA13LL v� MAM �0� Public Health Division 19. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 'y Sewage Permit# 20I'6-- Ote �PAssessor's MapTarcel I GLOT Designer: Meyer Sys ���- Installer: PGV0 6 y d ca kri n 0 ��l Address: {0 Address: 7-/1 CD V{, �A SA14ew�v44 NA, 42_S3� On q _ Un 0 _was issued a pen-nit to install a ate) (installer) septic system at M Q S F VY`{(' V , based on a design drawn by (address) 9(X_(CPA Mdated �2 p d signer X .s I cent that�e se�tt�em 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. Strip out (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 system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (ii-required) was inspected and the soils were found satisfactory. I certify that the system referenced above was construct a with the terms of the approval letters(if applicable) DAM E ( ns is tgnature) 1140 i J y-l�. lg esigner's Signature) (Affix Designer amp Here) PLEASE RETURN TO BARNSTAB PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:1SepticlDesigner Certification Form Rev 8-14-13.doc TOWN OF BARNSTABLE LOCATION L, D `V jNSEWAGE#.Z 6 ,VILLAGE C2.x.'Ie,( ( I��. ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. of SEPTIC TANK CAPACITY CT t U LEACHING FACILITY.(type) S-oo (size)S 0 NO.OF BEDROOMS. OWNER Vyy PERMIT-DATE: COMPLIANCE DATE: L Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet y 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 leachin facility Feet FURNISHED BY a,�-s� r � ��� � - _ _, �� j ',. k � ��� _ � k �' � �1. GS ,'� .l � � . . �` �3 � l . . ���. 4 3 � �� 6S� BARNSTABLE SEWAG .:# , vtLLAGiw SSATt'S'MAZ' iNSTi�LE'Lt'S NA.1171L�P1HOI�tE ILIA Sfilv1'tC T',q I CAPAc �U l p1UI1.IC��R OP.C9WKE.IR. CC�N31bC•.IP►NC»� DI�TL 4 SapAratcoec�rstwu� 8stv�eeiak�e �: - ': Maxit�numActjust6d:GraurndwAcet'Cabletot laGBattomai�X�e chin in6ilit�r ae� PilvuBu W'�pf4r Su�i�ly�telf a�id i.ais,hing i?flcatity:£�mY arc tls ex(st within 200 feet of Wilt 'us fACWI}Y) koat. �c1Lr c��1iV tQand and Loaefltln FWllty(Y , V,- ndS ex is Re t � �rltlaut'QU fc et p leacliing rya Door poor � � 8 C � o -71 u A-a - ate, a�� - 13k2 A3 C -3 - y' A-y- &3 5 i Town of BArnstable NJ Z�o S� Department of Regulatory Services L ' Public Health Division Date �r Ass$ 200 Main Street,Hyannis MA 02601 Date Scheduled f G 2-7 !Time 14 Fee Pd. 0 a I, oily Suitability Assessment.for Se) age Disposal Performed By: I!Y ✓� C/► Witnessed By'. • i LOCATION& GFNRRAL'INFORMATION Location Address•. 4 t b jg U M Ps kyV&-/U; Owner's Name �/� i 230 G�pAj1-, Rro t✓� r C I Address eg,f Pir'V t t), Assessor's Map/Patcel: (0 /b Engineer's Name McYe(-# NEW CONSIRU( ,PON / REPAIR Telephone#t7m 0S S66- 3311 p I . Land Use VS t O 41/ Slopes( ) ' `•20; Surface Stones, Distances from: Open Water Body.> fit Possible Wee Areab!1dC1 LR Dgking Water Welt��ft Drainage Way A, Property line }I�'i ft Other ft SKETCH:($trees name,dimensiods'of lot.exact locations of test holes&pert tests,locate wetlands in proximity to holes) 7� GAr' Aw I i i I . i 1 ' • � l Parent material(geologic) to CI ✓Il/V t Depth to Bedrock /V/14 Depth to Groundwater: Standing Water in Hole::- N i Weeping from Pit Face Estimated Seasonal fifth Groundwater. -- D tTION FOR SEASONAL HIGH WATER TADLE Method Used: ' Depth Clbpervcd s andingjin obs.hole In. Depth I. to gall tnOttlRst In. Depth toiweep➢ng from side of obs.hole - I in: On+,u ri+'ntLAdjuattnenh' -" Index Well#_ Readiug Date indat Well levd Ara.fijj r-,,,._ - Adj.Groundwater Level,,,,., I PERCOLATION TEST1, Date '>iltw Observation - l I TSmo 4t 0" Hole# 4$t'_ • Depth of Pere Time at G" ......,_..�_ Start Pre-soak Time.@ , Time(9"-6') End Pre-soak -r--- Rate lAmAnch Site Suitability Asse0sment Site Passed Site Failed; Additional Testing Needed(YIN) Original .Public 1Ie'alth Division i M1 Observationole Data To Be Completed oti Back— ***If percola#on test is to be conducted within 100' of wetland,:you must first notify the Barnstable C44servation Division at least one (1)wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc % vel o 464-c,Q 2- S 6l DEEP,OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) .(USDA) (Munsell) Mottling (Structure,Stones,Boulders. consistency.%GMvell /�=2e. Leafs ,-j 3l cb DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil, Other Surface(' (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc n G vel 4- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C sisten Flood Insurance Rate May: Above 500 year flood boundary N01 Yes Within 500 year boundary No Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us terial exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe vious material? .. Certification I certify that on D (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the required t aim e p rtise ato I perience described' CUR 15.017. Signature Date 1 D Q:\SEPTICIPERCFORM.DOC Town of Barnstalble .Barn stable Regulatory Services Department "" ``ac j BAPNSTAHM Public Health Division m F01AA 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0145 February 27, 2018 —SECOND NOTICE CATERINO, COSMO J PO BOX 585 CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 920 Bumps River Road, Centerville, MA was inspected on 02/06/2018 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE B ARD OF HEALTH Thomas McKean, R.S., CIO` Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\920 Bumps River Road Centerville SECOND NOTICE.doc Town of Barnstable Barnstable Regulatory Services Department j eicaC-y,. b 9 ,m Public Health Division �fDNN1°�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0114 February 22, 2018 CATERINO, COSMO J 230 CEDRIC ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 920 Bumps River Road, Centerville, MA was inspected on 02/06/2018 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ` PER ORDER OF THE BOARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\920 Bumps River Road Centerville.doc r _ r i Town of Barnstable i AgNCT1Af F_ � Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA-02601 Office: 508-9624644 Richard ScA Dircctor FAX 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO REPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) _ An`Y"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground . ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLINE CRITERIA Static liquid level in the distribution box above outlet invert due to an overloaded or Y clogged SAS or cesspool ❑Any portion of the'SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis.'(ibis system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool• ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level,<12"below inlet (per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTICIDEADLINES TO REPAIR FAILED S MS.doc ljoB -oya - i- Commonwealth of Massachusetts Title 5 Official Inspection Form 1-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 920 Bumps River Rd � Property Address ,.i Carol Caterino Owner Owner's Name information is Centerville MA 02632 2-6-18 required for every page. City/Town State Zip Code Date of Inspection u Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 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 ❑ Needs Further Evaluatio he Local Approving Authority 2-6-18 Inspector's Signature Date The system inspector shall submit a copy'of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form x' I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a% L jl!e✓ 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) I , Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System.Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the'box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND :below (Explain ) t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments p 3! 920 Bumps River Rd .- Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced -❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts lal Title 5 Official Inspection Form �4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1{!a 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning 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 Non 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 AS or cesspool or clogged S ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments aFi 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18- page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a-surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts �al � Title 5 Official Inspection Form G� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a% _�_s ✓' 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form W Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2018 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts lal Title 5 Official Inspection Form �+ � I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Bumps River Rd l J' Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form pSubsurface Sewage Disposal System Form -Not for Voluntary Assessments � �.J!✓ 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name f information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16" feet Material of construction: x ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): 8" � Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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 z t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 < Commonwealth of Massachusetts a= Title 5 Official Inspection Form I r�r �H Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t at/ 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . , • Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts al Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � jF! 920 Bumps River Rd Property Address Carol Catefino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town • State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box had water at normal level with stain lines above outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts ; laa Title 5 Official Inspection Form ,,., (; �, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Infiltrators ❑ 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.): Infiltrator leach field was full at inspection with water above above inlet pipe. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts =aa Title 5 Official Inspection Form f &II Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts , t Title 5 Official Inspection Form .1f;4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately j I f � ` _. JIG iill Aw3 � C —3 r f. r �JU ry t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts } , Title 5 Official Inspection Form : I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is required for every Centerville MA 02632 2-6-18 page. City/Town 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: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: I - documentation)® Checked with local excavators, Installers (attach docu ) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 ti Commonwealth of Massachusetts Title 5 Official Inspection Form II., Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 jF� 920 Bumps River Rd Property Address Carol Caterino Owner Owner's Name information is Centerville MA 02632 2-6-18 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 in what you discussed with them. Hazardous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists Working Phone Number �— Actual Amounts -( le. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) !-----Storage Information -location of storage, how long is storage for? If nor e, note that. =Disposal Information -where and who? If none, note that. Applicant Signature -understand what is listed and noted Staff Initial -any questions, know who to ask Veh' le Washing/Rinsing? -give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 3' 11V . Fill in lease: please: APPLICANT'S YOUR NAME/S: PQ LA, Fa �r r t A I BUSINESS YOUR HOME ADDRESS: q d-d V e 7�1-41 7' 5,� ervl 16 #' j•pt � TELEPHONE # Home Telephone Number . S Off /f5 NAME OF:CORPORATION NAME OF NEW BUSINESS ` TYPE OF BUSINESS c IS THIS A'HOME OCCUPATIONS u YES NOJ. ADDRESS,OF BUSINESS R77 MAP%PARCEL NUMBER r [Assessing]. When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual ha n 'nforme oft er it re ,irement t pertain to this type of business. Authorized Sign COMMENTS: M 0 • 1`%!?RDCiI)�;An.ATf=GI�i c nrr.,,. g�-'-.:., . 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: r� II ,' I a TOWN OF BARNSTABLE Date: 7// . 5. / TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: �,� k',o 44V n,fl J ''Cf0 ;') BUSINESS LOCATION: pr J V�Y E INVENTORY MAILING ADDRESS: 'Ao r 5 , , ' /- TOTAL AMOUNT: TELEPHONE NUMBER: - CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUM ER: �7 - �' - ?iC MSDS ON SITE? TYPE OF BUSINESS: Le vi dd-1C Gk_4 INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive - ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints varnishes stains, a ns, dyes Other chlorinated hydrocarbons, Y y , Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers V (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applica is Signature Staff's Initials Town of Barnsta We pft— �IRE rrjl Departmcxxt of Regulatory Services PublicHealthDivisionDa<te H.ARNBTAHI.E, a t 6y 7• ti� 200 Pvlain Street,Hyanuis MA 02601 n 1 tole T"e�Pd. Date Scheduled_ Y ' Soil Suitability Assessnie art for Sewage Disposal Pcrfonned By: ^.I WA, A" 0-a_Ad_A, tl W'llnessed By.: � ✓"^�'n"'�� Location Address �jp�0 iyj �� ve— � Owner's Name � � �V1 l[CPiy`�il� t P Address Assessor's Map/Parcel: /6�j Engineer's Name l� NEW CONSTRUCTION REPAIR Telephone fl �0 , Land Use. aat2t m&uri_,ci Slopes(%) 10 -"LO 10 Surface Stones AC Distance's from: Open'Water Body 'P -;VO ft Possible Wet Area 5 _,X1i7 ft Drinking Water Well eft Drainage Way_ _ ft Property Line !to— _ft Other ft SKETCH, (Street came,dimensions of lot,exact locations of test holes 8c perc tests,IOeate LveLlands'i d n proRinuly to holes) 7V i r _........�..--_ �,lR+ y •�' - ..- _ �- _ .. � Mom; C1. \ ✓ 3 t •-^row, C) Ix r. CYJ V. 111 Co M Parent material logic)g )_ a�-�"� Dcptlr Lg Eeclroclx Depth to Groundwatcr: Standing Water in Hole: Weeping PI'onl Pit fatice Estimated Seasonal High Groundwater ]D]E7CERAUNA7I'ION FOR SEASONAL HIGH WATICUR TABLE IYlcthod Used: ?4 A Depth Observed standing in obs.hole: In, Depth 10 sQll Mulll..n: III, Depth to weeping;from side of obs.hole: ILi, Grouudwatar Adjustment,u.— fl. Index Well!# Reading Date: Index Well IeYnl ^ „ , Ad�j,ftlCtbr Adj.Orr�tnldWatdr bevel e - ]PE RCOLATION 7l'ES � Vh(Q TIinm Observation Hole It Time.tit 9" �t Depth of Pere Tlrrip al 6" _ Start Pre-soak Time @ _ Time(9"-6") End Pre-soak N V Rate Min./Inch L u.J Site Suitability Assessment: Site Passed_ Silg,Failed: Additional Testing Needed(Y/ft) Original: Public Health Division Observation Hole Data To Be Coinpleted on Back----------- ***If percolation test is to be conducted vvitliiii I00' of vva;t and, you must first uaotafy fiic. Barnstable Conse>l'Viltioll I)iVlSioll kit least oiie (1) week prior to begii nh..1g. Q:\SEPTIC\PI:RCPORM.DOC ID)1CIE][� OBSERVATION HOLE, LOB Depth from Soil horizon Hole #' r Surface(in.) Sail Texture Soil Color — i (USDA). Soil Other (Mansell) Mottling (Structure,Stones;Boulders, Con istenc % ravel ]i�REP OBSERVATION ION HOLE.LOG Depth from Soil Horizon Hole# I— SurFace(in.) Sail Texture Soil Color �— (USDA) Soil (Mansell) Mott Other ling (Structure,Stones, Boulders. Consis e c %Cravel Depth from Soil Horizon �' Surface(in.) Soil Texture Sall Color. (USDA) Soil (Mansell) Other Mottling (Structure,Stones,Boulders. (10sistrngy,%Onvel) ------------ �__ _ i Depth from Soil.Horizon Hole#_ Surface(in.) Soil Texttre Soil Color Soil(USDA) (Munsell Other Mottling (Structure,Stones; Boulders, Consi�encv,qb t?�ay.� t • Fliood ItInsm"a6ncL Rate M P. Above 500 year flood boundary No Yes Ivithin 500 year boundary No Yes - Within 100year flood boundary No "Yes —'e>�t➢� o�'P+T�ata�rt•n➢➢y.____oon¢r'�'➢n�]��irva�ous iVQaterls� Does at least four feet of naturally occurring perviou` terlal exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring perviou material? I certify that (date)I have passed the soil evaluator examination approved by the Department off Environmental PIVCCtlDfl and that the above a,naly.;is was performed by me consistent with the rec)tlir ain(ing, expertise and experience descriUed in10 CM12 15.017. Si Date (i'nature Z�. P r� - g � "— � j Q;\S,HPTIC\PERCRORM.DOC I LEGEND CEN.T�RVILLE PROPOSED CONTOUR ® PROPOSED SPOT GRADE -- ----5-00 --__-30 EXISTING CONTOUR + 96.52 EXISTING SPOT GRADE LOT 21 - -32 T .,. W= EXISTING WATER SERVICE - ' 30 ---- -- --- AREA = 2052_4-s-f-4-'� -- -- -- _ O TEST PIT 32- - ti LAND--EeL T PLAN 31 043— A a LOCUS SCALE: 1"=20' --- -------=------ 34 _ OO ASSR MAP1 68 PCL 42 _ ------- - — ---- --- ------------ ———————— 34 �O�Z PS Rw�R RO 36— � — - gvM __ _____ —_ _----- — VENT �---- — ---_ -36 40 _ } — --- = ; LOCUS MAP Ys Q C�Q� - p '------- >o _ O 42 VENT PIPF� - fir\t N -`- 38 LOCUS INFORMATION PLAN REF: LCP31043-A 44--___ _ \\ TITLE REF: DW334 40, PARCEL ID: MAP 168 PAR. 042 46 ___ \\ FLOOD ZONE: "X" COMMUNITY PANEL: 25001CO564J DATED:07/16/14 10 ft SEPTIC SYSTEM o ��\ REPAIR PLAN BENCH MARK N -- LOCATED AT: * ` -42 920 BUMPS RIVER ROAD PAINT SPOT ON SONO TUBE SUPPORT 48, o CEN TER VI LLE, MA 46.61 \ BARNSTABLE GIS DATU PREPARED FOR \ � E \ co e XI STING DWELLING CATERINO ;•. 44 i I I e TOP OF FNDN MARCH 1, 2018 REV. MARCH 16, 2018 I I I EL =I 48.53+I I I I -A� OF I / o� ----- O. 1 0 "' I I O PAVED Q :-j \\ i SgNITAR\a� 1 �� 1 \ I _ DRIVEWAY UTILITY MEYER & SONS, INC. POLE 48 �- '� _ \ I 46 1 125.00' P.O. BOX . 981 EAST SANDWICH, MA. 02537 / i `\ PH: (508)360-3311 ----- __� _ EDGE OF PAVEMENT \_--------'�/® DRAIN \----.—/ \__ FAX: .(774)413-9468 ----- B U v p s meyerandsonstitle50gm ail.com ER R OAD SHEET 1 OF 2 J 1894 ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE. (38.0) = 48.53 F.G.EL: 42.5 F.G.EL: 41.50 F.G. EL: 38.50 VENT A MAINTAIN 2% MIN SLOPE OVER LEACHING AZ\ T, c / '" F.G.EL: 40.4 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" 'F� f- N... STORE ,OR FILTER FABRIC DOUBLE WASHED STONE 4" SCH 40 PVC 1o"I 14 6 ® S= 1% (MIN. ®®®®®®®®E3E A' TEE'S ARE TO BE INV.35.20 ®®®®®®®®®®® 4" SCH 40 PVC 2 E F. DEPTH ®®®®®®®®®®® INV.39.15 INV J . .35.0 4' 2 X 8.5' 4' IxlsnNc ounEr BA FFLE LE PROPOSED DB-3 •. .. DISTRIBUTION BOX EFFECTIVE LENGTH = 25' INV. 39.40 1 (1-120) INV. ELEV.= 33.0 EXISTING 1,500 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON �P��� OF ' ss9c BREAKOUT OUTLET TEE AS MANUFACTURED BY ti NOTES: TUF-TITE, ZABEL, OR EQUAL DbRRENR . r TOP CONC. ELEV.= 34.0 ELEV.= 34.0 1) CONTRACTOR SHALL VERIFY ALL EXISTING c PIPE INVERTS PRIOR TO CONSTRUCTION N 1 0 INV. ELEV.=- 33.0 2) D-BOX SHALL BE SET LEVEL AND TRUE TO p ®®® GRADE ON A MECHANICALLY COMPACTED SIX ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN pa ®®®®®®® S4NITAR� r BOTTOM EL.= 31 .0 ®®®®®®® , 310 CMR 15.221(2) 3.75 5 FT. 3.75 3) REPLACE EXISTING 1,500 GALLON SEPTIC TANK WITH 1500 GALLON SEPTIC TANK IF FAILED, ��� 1 EFFECTIVE WIDTH = 12.5' DAMAGED OR UNDERSIZED. SEPARATION 5.20 FT. 4) INSTALL INLET & OUTLET TEES W/ SEPTIC SYSTEM PROFILE SOIL ABSORPTION SYSTEM SECTION GAS BAFFLE AS REQUIRED BOTTOM. OF TESTHOLE EL: 25.80 _ ) 5) PLACE SANITARY TEE IN D-BOX (500 GALLON H-20 LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#: 15605 BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOOM 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: FEBRUARY 27, 2018 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) LOCAL RULES AND REGULATIONS, ExCEPT AS REQUESTED BELOW: DESIGN PERCOLATION RATE: <2.MIN/IN 310 CMR 15.405 (1) (8): WITNESS: DON DESMARAIS, BARNSTABLE HEALTH DEPT.1) A 1.0 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D. = TO BE 4.0 FT (MAX) BELOW GRADE VS REWD 3 FT. (H20/VENT PROVIDED) Elev. TP-1 Depth Elev. GARBAGE GRINDER: NO (not designed for garbage grinder) � TP-2 Depth 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 36.80 0" 38.10 uw- SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,500 GAL. SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE FILL FILL LEACHING AREA REQUIRED: 330 0.74 = 445.94 S.F. DESIGN ENGINEER. 35.30 18" 36.60 18" ( )/ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING A LOAMY SAND A LOAMY SAND FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN IOYR 3/2 10YR 3/2 USE TWO (2) 500 GALLON H-20 PRECAST LEACH CHAMBERS W/ 4' ENGINEER BEFORE CONSTRUCTION CONTINUES. 34.48 28" 35.78 28" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B LOAMY SAND B LOAMY SAND STONE ON ENDS & 3.75' STONE ON. SIDES: 25' L x 12.5' W x 2'D 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10YR 5/8 10YR 5/8 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL. BOARD OF 32.80 C 48" 34.10 C 48" BOTTOM AREA: 25 x 12.5= 312.5 SF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. PERC TEST SLOE AREA (25 + 12.5) X 2 X 2 = 150 SF 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED o EL 37-77 MEDIUM MEDIUM TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. SAND 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 2.SY 6/4 2.5Y 6/4 DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 25.80 1 132" 27.10 132" PROPOSED SEPTIC SYSTEM UPGRADE P LA N 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PERC RATE <2 MIN/IN. ("Cl" HORIZON) 920 BUMPS RIVER ROAD, CENTERVILLE, MA AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY NO GROUNDWATER OBSERVED 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. Prepared for: Caterino 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. Design and Site Plan by: SCALE DRAWN DATE 15. ALL PIPING TO BE 4" SCH 40 0 1/8`/FT (UNLESS SPECIFIED) INC. 16. REMOVE ALL UNSUITABLE SOILS IF PRESENT). 5 FT AROUND LEACHING TO Darren Meyer, R.S., CSE MEYER&SONS, N.T.S. t hereby certify that t am currently approved by MADEP pursuant to 310 CMR 15.017 DMM 03/01/18 ( ) to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX 981 REV GATE EL 34.10 OR TOP OF "C" LAYER AND REPLACE WITH CLEAN MEDIUM requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. EASTSANDWICH,MA02537 CHECKED SHEET NO. SAND PER TITLE 5. 506-3622922 03/16/18 DMM 2 Of 2 r LEGEND CENTERVILLE PROPOSED CONTOUR (� 9® PROPOSED SPOT GRADE -— ---------- 12z_ 30 �� ——98 —— EXISTING CONTOUR + 96.52 EXISTING SPOT GRADE L- o IT 21 - _32 ROUT 8 W— EXISTING WATER SERVICE 30 -,---------------- AREA = 20524,&f�'� TEST PIT Q. O SCALE: 1"=20' 32 ------- -------------LANQ C617RT PLAN 31 043— A LOCUS ASSR MAP1 68 PCL 42 �� 34 -_-___--- N ® ----- - - - ------ ---------------- 34 36- _ � V gVMp ------------------ VENT _ - -- ___ Q'_�� ------ -36 40 - --- --- _ ' - 1 , LOCUS MAP 42 ___--__ VENT PIPba� N 38 LOCUS INFORMATION ------ -- PLAN REF: LCP31043-A 44-__--__ TITLE REF: D940334 40 PARCEL ID: MAP 168 PAR. 042 46 ---- FLOOD ZONE: "X" COMMUNITY PANEL: 25001CO564J DATED:07/16/14 N SEPTIC SYSTEM REPAIR PLAN 10 ft BENCH MARK N `� C' - LOCATED AT: PAINT s OT ON �� -42 920 BUMPS RIVER ROAD SONG TUBE SUPPORT 48 `46.61 CEN TER VI LLE, MA BARNSTABLE GIS DATU EXI S TI ° PREPARED FOR ��� DWELLING CATERINO I � 44 - i I TOP OF FNDN MARCH 1, 2018 REV. MARCH 16, 2018 j EL = 48.53+ _ OF ,Vgs�9 DAM\ \ o _ I 6/ O PAVED 3 z STE I � } I -' \\\ I SgNITAR\A� I -\ DRIVEWAY ji---- - -�` Po�ETY -----_► --'_''' \� \` MEYER & SONS, INC. 48 i 46� 125.00' - ` ----i-- ___ P.O. BOX 981 _-- ---- ; % EAST SANDWICH, MA. 02537 EDGE OF PAVEMENT --- --� \� PH: (508)360-3311 UMPS DRAIN - ------- FAX: (774)413-9468 B RIVER meyerandsonstitle50gm ail.com ROAD SHEET 1 OF 2 J#1894 ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE. (38.0) = 48.53 �F.G.EL: 42.5 F.G.EL• 41.50 F.G. EL;- 38.50 VENT " MAINTAIN 2% MIN SLOPE OVER LEACHING AREA e 2" OF 3/8" DOUBLE WASHED F.G.EL: 40.46 1' 3/4" - 1-1/2' + STONE OR FILTER FABRIC DOUBLE WASHED STONE A 6" " 4" SCH 40 PVC 10"I MtE3ME3N. 0 ®®®®14 ® S= 1% MIN. ®a®®®®®®®®TEES ARE TO BE INV.35'.2O ) ®®®®®®®®®®4 SCH 40 PVC 2 EFF. DEPTH ®la®®®®®®®® �•��•��•��• INV.39.15 I NV.35.0 4' GAS J 2 X 8.5' 4' . EXISTING DB-3NG OUTLET BAFFLE DISTRIBUTION BOX EFFECTIVE LENGTH = 25' • .. . INV. 39.40 (H20) ' INV. ELEV.= 33.0 EXISTING 1,500 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ��� OF 'ass OUTLET TEE AS MANUFACTURED BY �`�� 9�y BREAKOUT NOTES: TUF-TITE ZABEL, OR EQUAL o D REN ELEV.= 34.0 , 1) CONTRACTOR SHALL VERIFY ALL EXISTING � Y.R TOP CONC. ELEV.= 34.0 PIPE INVERTS PRIOR TO CONSTRUCTION N 1 0 INV. ELEV.= 33.0 �®®� ®® 2) D--BOX SHALL BE SET LEVEL AND TRUE TO ®®®®®® . GRADE ON A MECHANICALLY COMPACTED SIX V 9fG�$Tt��" ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED INNITAR�a� I BOTTOM EL.- 31 .0 , ®®®®®®® 310 CMR 15.221(2) 3.75 5 FT. 3.75' ` 3) REPLACE EXISTING 1,500 GALLON SEPTIC TANK � b I _ WITH 1500 GALLON SEPTIC TANK IF FAILED, EFFECTIVE WIDTH - 12.5' DAMAGED OR UNDERSIZED. SEPARATION 5.20 FT. 4) INSTALL INLET & OUTLET TEES W/ SEPTIC SYSTEM PROFILE GAS BAFFLE AS REQUIRED BOTTOM OF TESTHOLE EL: 25.80 SOIL ABSORPTION SYSTEM (SECTION) 5) PLACE SANITARY TEE IN D-BOX (500 GALLON H-20 LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL' LOGS P#: 15605 BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOOM 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: FEBRUAR`( 27, 2018 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: DESIGN PERCOLATION RATE: <2 MIN/IN - 310 CMR 15.405 (1) (8): WITNESS: DON DESMARAIS, BARNSTABLE HEALTH DEPT. 1) A 1.0 Fr. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING DAILY FLOW: 110 G.P.D.' X 3 BR = DESIGN FLOW: 330 G.P.D. TO BE 4.0 Fr (MAX) BELOW GRADE VS REWD 3 Fr. (H20/VENr PROVIDED) Elev. TP-1 Depth Elev. TP-2 Depth GARBAGE GRINDER: NO (not designed for garbage grinder) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 36.80 0" 38.10 p'r- SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,500 GAL. SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE FILL FILL LEACHING AREA REQUIRED: 330 0.74 = 445.94 S.F. DESIGN ENGINEER. 35.30 18" 36.60 18" ( )/ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN LOB S�D A LOAD SAND ENGINEER BEFORE CONSTRUCTION CONTINUES. USE TWO (2) 500 GALLON H-20 PRECAST LEACH CHAMBERS W/ 4 34.48 28" 35.78 28" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B LOAMY SAND B LOAMY SAND STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10YR 5/8 10YR 5/8 THE CONTRACTOR R OWNER TO NOTIFY THE LOCAL BOARD OF C 48" C "HEALTH FOR PROPER 32•80 R INSPECTIONS DURING CONSTRUCTION. 34.10 4$ BOTTOM AREA: 25 x 12.5= 312.5 SF SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED PERC TEST TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. O EL 32.77 MEDIUM MEDIUM TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 2 51 6�4 2 SAND D DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 25.80 1 1 132" 27.10 132" PROPOSED SEPTIC SYSTEM UPGRADE PLAN 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PERC RATE <2 MIN/IN. (*Cl- HORRON) 92O BUMPS RIVER ROAD CENTERVILLE, MA AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY NO GROUNDWATER OBSERVED ' 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. Prepared for: Caterino 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. Design and Site Plan by: SCALE DRAWN DATE 15. ALL PIPING TO BE 4' SCH 40 O 1/87FT (UNLESS SPECIFIED) MEYER&SONS,INC. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 BOX 981 N.T.S. DM M 03/01/18 PO 16. REMOVE ALL UNSUITABLE SOILS (IF PRESENT), 5 FT AROUND LEACHING TO to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX NOW/CH,MA02537 REV DATE CHECKED SHEET N0. EL 34.10 OR TOP OF 'C' LAYER AND REPLACE WITH CLEAN MEDIUM requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. SAND PER TITLE 5. 508-362-2922 03/16/18 DMM 2 of 2