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Home My WebLink About0012 CARLETON LANE - Health l 1.2 Carleton ]Lane Centerville, A= 190-231 E a i No 22C-1�153 OR WTMW I t 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 -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:..- _ 0/5 Fill in please: APPLICANT'S. YOUR NAME/S: iq i✓ir P ( BUSINESS YOU HOME AD ESS: ✓ LN v� 2 6 • a TELEPHONE # Home Telephone Number ' A 1 £ k 3 NAME.OF CORPORATION:... I NAME OF NEW BUSINESS jFi r ke. , Se Us TYPE OF BUSINESS` u i IS THIS A HOME OCCUPATIONS YES O /� L6 3 ' ( ADDRESS.OF BUSINESS MAP/PARCEL NUMBER:' (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 COM 1 SION R'S OFFICE This individu I h'a vnfor f er requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS, FAILURE TO ** f.0,1MFtY. MAY RESULT IN FINES. "Au on Sin re , .. MMEN S: ff7 2. BOARD OF H LTH This individu!t�ized informed of th rmit r irements that pertain to this type of business. MUST'COMPVY WITH ALL uh Signature HItZARDOUS MATERIALS.REGUL�IION.S' ' COMMENTS: 3. CONSUMER AFFAIR (LICENSING AUTH This indivi I has b in r e of b i n in a uirements that pertain to this type of business. Authorized ure* COMMENTS: i k`1\' Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS NAME OF BUSINESS: V-/Jfits pd l 'v BUSINESS LOCATION: L r INVENTORY MAILING ADDRESS: ?O 13 �J!S Pf - TOTAL AMOUNT: TELEPHONE NUMBER: -- CONTACT PERSON: uZaiijik, Oza ric r EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 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, dyes Other chlorinated hydrocarbons, 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 (including bleach) Spot removers &cleaning fluids (dry cleaners) 100,L) V av �C Other cleaning solvents Bug and tar removers Windshield wash - 17 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS A plicant's Signature Staff's Initials C Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 12 Carlton Lane Property Address Ilnea Moore Owner Owner's Name information is required for every Centerville MA 02632 09/01'/1'2 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered'in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms t �'L or the computer, use only the tab 1. Inspector: key to move your cursor-do not MichaelKellett use the return Name of Inspector key.. Aardvark Environmental Inspections Company Name PO Box 896 Company Address East Dennis MA 02641 Cityrrown State Zip Code 508-385-7608 S13742 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: z s ® Passes ❑ Conditionally Passes ❑ Fails i -„ - ❑ Needs Further Evaluation by the Local Approving Authority i.-5 / 09/05/12 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 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. w �f� /'z t5ins•11/10 Tide 5 official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carlton Lane Property Address Ilnea Moore Owner Owner's Name information is required for every Centerville MA 02632 09/01/12 page. Citylrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the faiure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not:evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ one or more system components as described'.in the'Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y,N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11/10 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 12 Carlton Lane Property Address Ilnea Moore Owner Owner's Name information is required for every Centerville MA 02632 09/01/12 page. Cityrrown 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)thatthe system is not functioning in a mannerwhich 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•i if ip TrUe 5.,"ifiCrl lnWc bon Fmw Subsulace Sewage Vaposal%Vam•Page 3 of 17 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w '( 12 Carlton Lane Property Address Ilnea Moore Owner Owner's Name information is required for every Centerville MA 02632 09/01/12 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 mannerthat protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within. 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carlton Lane Property Address Ilnea Moore Owner Owner's Name information is required for every Centerville MA 02632 09101/12. page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year 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 coliforim bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria e)dst as described in 310 CMR 15.303,therefbre 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`fifes"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 faded 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments '( 12 Carlton Lane Property Address Ilnea Moore Owner Owners Name information is required for every Centerville MA 02632 09/01/12. page. Cityfrown State Zip Code Date of inspection C. Checklist Check if the following have been done.You must indicate`fifes°or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced.to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling.inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information.For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5Official inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carlton Lane Property Address llnea Moore Gunner Owner's Name information is Centerville MA 02632 09/01/12 required for every page. Cityfrown 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?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings,if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No 04/12 Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15203): 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carlton Lane Property Address Ilnea Moore Owner Owner's Name information is Centerville MA 02632 09/01/12. required for every page. Cityrrown 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: 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/Altemative 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 UA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carlton Lane Property Address llnea Moore Owner Owner's Name information is required for every Centerville MA 02632 09/01/12 page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 08/01/05 per BOH Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 2.8 feet Material of construction: ❑ cast iron 0 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 2.0 p g 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: 1,000 gal Sludge depth: 3" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurtace Sewage Disposal System Form-Not for Voluntary Assessments '< 12 Carlton Lane Property Address lineal Moore Owner Owner's Name information is required for every Centerville MA 02632 09/01/12, page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete Or 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•11/10 Tftle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 12 Carlton Lane Property Address Ilnea Moore Owner Owner's Flame information is required for every Centerville MA 02632 09/01/12 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•Iv,0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments w 12 Carlton Lane Property Address Ilnea Moore Owner Owner's Name information is Centerville MA 02632 09/01/12 required for every page. Citylrown State Zip Code Date of inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The box was level and tight with tees in place and liquid at 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.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments yt 12 Carlton Lane Property Address Ilnea Moore Owner Owner's Name information is Centerville MA 02632 09/0 /1'2. required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number: ❑ leaching trenches number,length:. ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): This system has 5 infiltrators in a 37'x11'field of stone.There was no sign of ponding or failure in the stones. 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•11/10 Title 5 Official inspection Foam:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carlton Lane Property Address linea Moore Owner Owners Flame information is required for every Centerville MA 02632 09/01/12 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonweaiffi of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary moments 12 Carlton Lane Property Address Nnea Moore Owner Owner's Name "riOnnattOrIs r required for every Centerville MA 02632 09)01112 page. Citylrown State Zip Code Date of tnspeWon 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 of 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 �6 ear q01 a� csnm-,v,o TM s omct kispecftn F=L sa6w+dam sewage DmpoW syb,„•Page is of V Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 12 Carlton Lane Property Address Iinea Moore Owner Owner's Name information is required for every Centerville MA 02632 09/01/12 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: 12.0 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: 07/27/05 Date ❑ Observed site(abutting:property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators,installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Design plans Show no water at 12 feet. Before filing this Inspection Report,please see Report Completeness Checklist.on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official lnspecfion Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Canton Lane Property Address Ilnea Moore Owner Owner's Name information is Centerville MA 02632 09/01/12 required for every page. CitYlTovun 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i TOWN OF BARNSTABLE % LOCATIOi /o;� SEWAGE # ty VILLAGE ��, !/� `�� ASSESSOR'S MAP & LOT o INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /DOJO f LEACHING FACILITY: (type) (size) NO. OF BEDROOMS �.I, BUILDER OR OWNER �� /y eel r. ! PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility . Feet Private Water Supply Well and Leaching Facility (If any"wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Lea ing Facility (If any wetlands exist within 300 feet W le ility) Feet \V I& — Furnished' tf r t�. ,c r No. `-' Fee v 0 THE COMMONWEALTH OF MASSACHUSETTS, Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for � gpogof *pgtem Congtruction Permit Application for a Permit to Construct( )Repair X Upgrade( )Abandon( ) ❑Complete System individual Components Location Address or Lot No. CP-(u_6 m J Loa nlE Owner's Name,Address and Tel.No. Assessor's Map/Parcel S A-M E Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. p�ci fS C l-1AY 60,J0, `5QCS, C048 - 53\0 6 Type of Building: Dwelling No.of Bedrooms 44513 Lot Size 15ILV95sq.ft. Garbage Grinder � Other Type of Building No. of Persons o� Showers(.Cafeteria Other Fixtures 1_.At��To�Y i�i°�cxc o►16cy Design Flow 3 2>0 gallons per day. Calculated daily flow s l- b0 gallons. Plan Date `'M I O Number of sheets Revision Date Title \7 C. r. Size of Septic Tank 3 CC-0 C cz Type of S.A.S. S Jnl F� L'T�2 to-"tZ�2 `i�-�C�l r; Car � d\C'�l1O� x X t Description of Soil Nature of Repairs or Alterations(Answer when applicable) PQ Qc2c A—p G � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ued b his Bo e lth. Si ned Dat Application Approved b Date Application Disapproved for the following reasons Permit No. ®�'S Z� Date Issued g S � y� 4 No. C�-� S Fee �a THE COMMONWEALTH OF MASSACH sCTT Entered in computer: �.�.. Yes PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS Application for -Migpogaf *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(X Upgrade( )Abandon( ) K®Complete 'Aidividual Components r , Location Address or Lot No. (oZ CP QG.E'TOrI L.A nJE Owner's Name Address and Tel.No. CQ�.,Sultle.a MA 8CRS5►15 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -S,k.iPY C►u, SvCs. G48 - 55 o S39 r '.Type of Building: �b Dwelling No. of Bedrooms—� — Lot Size ``�_ M 8s sq.ft. Garbage Grinder(API- Other Type of Building /"o—)e- No.of Persons a Showers(r Cafeteria( of Other Fixtures LAUATU2-Y . /�i Tcr(Z") `jIVAk , LWnJ6 Qy Design Flow 3� gallons per day. Calculated daily flow 3�1 �� gallons uPlan Date O5umber of sheets Revision Date Title NAb Do-sa-A S 'M v 1.r: Size of Septic Tank >< l ST 1 000 Ca Q< Type of S.A.S. Z3 0//\I Ft LT,;e tA-TUQ \Q ENC4l .. i0 a x 3q..as' x r ' Description of Sod; ,tt7 P\K� %Nature of Repairs or Alterations(Answer when applicable) a Date last inspected: Agreement: _ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a CertifP cate of Compliance has been is ed b, this Board of ealth. ` . Si ned Date Application Approved b Date 5 Application Disapproved for the following reasons Permit No. C900 5 0 Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE34T FY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( �) Abandoned( )by at IZ C.Lt E=Q ri L k e- _ N( 11-'C*7.-- has been construrt5 in accordance with the pro tsi�'ns of Titlyy-�.,�a��ndyth�e Disposal System Construction Permit No. CP S � 70 dated Installer M4ILI 1 1 v vi Designer The issuance of this permit, l of be construed as a guarantee that the � stem" c on as desigrie . Date �� Inspector ^. ?. . . . No. S J 70--------------------------Fee /UU THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5po5ar *pgtem Construction Permit Permission is hereby granted to Cf gtstruct( ))�Repai ( )Upgra e()d)Abandon ) System located at 1 2- im rl e-'>'V� an Ub r, V(� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constr�cttioit must be completed within three years of the da e of this p i. Date:_._ ��lUj I` 5 Approved by <.�. TOWN 04 BARNSTABLE LOCATION r�d SEWAGE 4t� VILLAGE Cy SESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �✓`U'`� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: ; A COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist _ on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 3 at 'ra�� Town of Barnstable �1ME Tp� o Regulatory Services ., Thomas F. Geiler, Director BARNMASS. Health Division . 1639� �0 p'ED 39 Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 8/03/05 Designer: Shav Environmental Services, Inc. Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth, MA On 8/03/05 Robert Septic Service was issued a permit to install a (date) (installer) septic system at 12 Carleton Lane, Centerville, MA based on a design drawn by (address) Shav Environmental Services, Inc. dated July 28, 2005 (designer) XX I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. N OF MASS�c9 (Insta is Signa moo= CAREMEN ys��A SHAY No. 1181 0 �""'GIs-T Designer's Signature) (Affix 42 p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM �A PH hereby certify that the engineered plan signed by me dated a OS concerning the property located at meets all of the following criteria: • This failed system is connected to a residential dwelling only. There.are.no.commercial or business uses associated with the:dwelling. • The soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests at the site without a health agent present. • There is no.increase in flow and/or change in use proposed • There are no variances requested or needed. • The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ��,cc B) G.W. Elevation S+adjustment for high G.W. • _ �� O DIFFERENCE BETWEEN A and B SIGNED : DATE: lq4 as 1®S— NOTICE Based upon the above information; a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. gASepdc\percexemp.doc Boca Raton, FL March 17—05 From: DeAssis Ciro M, Ruth V, Jairo C. To: Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas Mckean, Director 200 Main Street, Hyannis, MA 02601 Thanks for your, letter about the house located at 12 Carleton Ln, Centerville, that was inspected on march 9, 2005 by Donald Desmarais, RS health inspector for the Town of Barnstable. In response to it, I'd like to say four things: 1. After April 1st our house will be empty. We will not have tenants living there. 2. In attention of your letter all trash was removed from the back yard. It was done last March 161n The septic system will be improved and treated according to professional advice. 4. Since we are not going to rent our property anymore there will not be a need for an additional electric meter. We appreciate your letter and attention. We are ready to do everything to solve these problems. Your advice and help will be welcome. Sincerely, Ciro, Aj�is Ruth1M sis Jairo Chaves Assis r DATE: 11 /1 7/01 PROPERTY ADDRESS:12 Carleton Lane ----------------------- --Centerville,Mass_--_--- 02632------------------------ On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank. 2. 1 -Distribution box. 3 . 1 -1000 gallon precast leaching it. 6 'X10 ' Based on my inspection, I certify the following conditions: 4. This is a title five septic system. ( 78 Code ) 5. The septic system is in proper working order at the present time. 6. Waste water in the leaching pit is 66" below the invert pipe. 7. House has been vacant for 2-3 months.Has had very little activity SIGNATURE:' Name:—J . P . . Macomber Jr --__--- Company: Joseph_P. Macomber_& Son , Inc . -- ---- -- - RECEIVE Address: Box 66 -------------------- Centerville , Ma . 02632-0066 DEC 0 7 2001 -------------------- TOWN OF BARNSTABLE Phone: 508-775-3338 HEALTH DEPT. r THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 12 Carleton Lane Centerville,Mass. Owner's Name: Evelyn Pi . .i Owner's Address: Larne Date of Inspection: 11 17 01 Name of Inspector: (please print) J.P. Macomber Jr. Company Name:Joseph P. Macomber & Son Inc Mailing Address: P.O_ Box 66 r An+ ervillc, Ma 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: '0 Date: The system inspector sha ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ""This report only describes conditions at the time of Inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 12 Carleton Lane Centerville,Mass, Owner:Evelyn M. Pizzi Date of Inspection: 11 /17/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A System Passes: have not found an i�exist. �nyy hich indicates that any of the failure criteria described in 310 CMR 15.303 or m 15.304ailure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B. System Conditionally Passes: AD One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined" please explain. t)d The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: XV Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3ofII OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 12 Carleton Lane Centerville,Mass. Owner: Evelyn M. Pizzi Date of inspection: 1 1 /1 7/01 C. Further Evaluation Is Required by the Board of Health: VO Conditions exist which require fiuther 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: A1a Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: Vb 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. ,00 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. 4.0 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 1(}0 feet but 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 Carleton Lane Centerville,Mass. Owner: Evelyn M. Pizzi Date of Inspection: 11 /1 7/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ ackup 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 y.�lDGL7 _ squid depth in G666P8e1 is less than 6"below invert or available volume is less than h day flow t/qRequired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number /of times pumped Q. _ ✓ y 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. 1 Vl/�Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no/ _ the system is within 400 feet of a surface drinking water supply Al the system is within 200 feet of a tributary to a surface drinking water supply "' the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well T If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:1 2 Carleton Lane Centervil 1 P a G_ Owner: Evelyn M. .Pizzi Date of Inspection: 11 /17/01 Check if the following have been done. You must indicate`yes"or"no"as to each of the following: Yes No Pumping information information was provided by the owner, occupant, or Board of Health t//Were any of the system components pumped out in the previous two weeks? _/Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,.Kcluding the SAS, located on site? Y— Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. !/ — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:1 2 Carleton Lane C`PntPrvillP�Macc Owner: EyP 1 vn M P i 7 z i Date of Inspec— tt—on: 1 1 1 7 f 01 FLOW,CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):AA?� Is laundry on a separate sewage system_(yes or no): [if yes separate inspection required) Laundry system inspected(yes Seasonal use: (yes or no): W&O Water meter readings, if avalable(last 2 years usage(gpd)): �� pS.. Sump pump(yes or no): •�'rJ 1-40Cd l P/ �p �yff 6lJoi O 0 y• /�� Last date of occupancy: / A417 f'/ �` �,y10 5„ �,� .��76 t7 j 11V, COMMERCIAL/INDUSTRIAL Type of establishment: I-f-a Design flow(based on 310 CMR 15.203): d Basis of design flow(se ats/persons/sgft,etc.): Grease trap present(yes or no):A9 Industrial waste holding tank present(yes or no): AJ Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: 4111 OTHER(describe): lv/� GENERAL INFORMATION Pumping Records Source of information: Ama21 Was system pumped as part of the inspection(yes or no): If yes, volume pumped: _gallons--How was quantity pumped determined? A_1,¢ Reason for pumping: TY OF SYSTEM Septic tank,distribution box,soil absorption system Wd Single cesspool �� Overflow cesspool Me 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) ND Tight tank Attach a copy of the DEP approval /1/_Other(describe): WO Apploximat ag�ll components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):"�/d 6 Page 7 of 1 I ; OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 12 Carleton Lane Centetville,Mass. Owner: Evelyn M. Pizzi Date of Inspection:1 1 /1 7/01 BUILDING SEWER(locate on site plan) Depth below grade: W Materials of construction:N 6cast iron V 00 PVCA-D_other explain): Distance from private water supply well or suction line: l Comments(on condition ofjoints, venting, evidence of leakage, etc.): .Tnini-c a part; .. t.Ne evidence—efleaka System is vented through the house vents. SEPTIC TANK: zocate on site plan) MOO P-1 o Depth below grade: Material of construction: concrete 40metalfiberglass &polyethylene 10V6other(explain) 40 If tank is metal list age: is age confirmed by a Certificate of Compliance (yes or no)rfjft(attach a copy of certificate) �d I Dimensions: d � �/ � Sludge depth: Distance from to o lud a to bottom of outlet tee or baffle. P g Scum thickness: Distance from to of scum to to of outlet tee or baffle: P P ��-- Distance from bottom of scum to bottom of outlet tee gr baffle:Y&Z.---U How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of.leakage,etc.): PumPth0 s®4)ti; tank eve Inlet & nt,t-1 Pt i eees are in pi ace.The tank ; G Gtr„r-t,,,-a1�S —und and shown no evidence ll of leakage. GREASE TRAH�spl4locate on site plan) Depth below grade:A0 Material of construction��concrete4Ametawh?fiberglass&polyethylene4-0other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:—A�9 _ Distance from bottom of scum to bottom of outlet tee or baffle:4_ Date of last pumping:�/I Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present- 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 12 Carleton Lane Curl Pryi1IA.Mass. Owner: Evelyn M. Pizzi Date of Inspection: 11 /17/01 TIGHT or HOLDING TANK,d21/t-(tank must be pumped at time of inspection)(locate on site plan) Depth below grade:_Vl� Material of construction:AY concrete w metal. fiberglass&k Aolyethyleneg?el_other(explain): Dimensions: WX Capacity: allons Design Flow: gallons/day Alarm present(yes or no): Alarm level:Li�t Alarm in working order(yes or no): ti/0 Date of last pumping:Z)14 Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present. DISTRIBUTION BOX:Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: /L6 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.): No evidence of solids carry over.No evi ence of ea agte into or out of the box. PUMP CHAMBE )e (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump chamber is not—pr-esent-. 8 r Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:1 2 Carleton Lane Centerville,Mass. Owner: Evelyn Pizz.i Date of Inspection: 11 17 01 A SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) _ , nnn ,,,1 1 g F--eea-s- �eael�. g. p � 6 ' X1 0 ' If SAS not located explain why: Located; Sao pago--� Typ leaching pits,number: 1leaching leaching chambers,number: C) galleries,number: �6leaching trenches,number, length: C) leaching fields,number,dimensions: 0 NO overflow cesspool, number: }� ....--�� innovative/altemative system Type/name of technology:71'& , Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): T.oamV canri to roarca fi nt- sand Nn ci gns of hV8raij i r fa i 1 art- or nnnrli ncl Rni I.-, art- r1r),_4agptat i an i c nnrma 1 CESSPOOLS (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 0 Depth—top of liquid to inlet invert: AJ Depth of solids layer: AA Depth of scum laver: Dimensions of cesspool: AW Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY(locate on site plan) a Materials of construction: _ 144 Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Pri y= is not nraSpnt 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 12 Carleton Lane Centerville,Mass. Owner, _Evelyn M, Pizzi Date of Inspection: 1 1 /1 7/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i z G� 10 i i Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 12 Carleton Lane Centerville,Mass. Owner: Evelyn M. Pizzi Date of Inspection: 11 /17/01 SITE EXAM Slope Surface water Check cellar Shallow wells t Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used; Gahrety & Miller Model;Groundwater above sea level USGS; 92-000-1 Plate#2 USGS; Observation well data Tup of Ground Leaching Pit _ GroundwaterIq Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. 11 4k l: � •r...nn,.-R,�r.,,_l��ml•nTs+1ls•',rn renrT.m M1TTrtnrl+sR�t1.n TfR„tJ 1*s�+•reR a1T T*P.Tr-�f.,�- TOWN OF Barnstable BOARD OF HEALTH r 0 SUIISURFACE SEHACF DISPOSAL ,SYSTEM INSPECTION FORM - PART D •- CERTIFICATION ,,.,r.....e._....,,...,..,..,.�..�.., .. n 1 -TYPE OR PRINT CLEARLY- PI?OPERTY INSPECTED STREET ADDRES$ 12 Carleton Lane Centerville,Mass. ' ASSESSORS MAP , BLOCK AND PARCEL # �7Uf OWNERRIs NAME Evelyn M. Pizzi PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME Joseph P. Macomber & Svrn Inc COMPANY ADDRESS P.O. Box 66 Centerville Ma 02632 Street Town or City COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 790 1578scat• LIP ) _ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true , accurate, and omplete as of the time ofinspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Chlfec11 one ; y System PASSED The inspection trhich I have conducted has not found any information which indicates that the system fails to adequately protect public health or, Lhe. environment as defined in 310 CMR 15 . 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 tcted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date O ne copy of this ce ification must be provided to the OWNER, the BUYER Where applicable ) and the 130ARD OF HEAL1'il, * If the inspection FAILED, the owner or""h 'Perator shall upgrade he aYste within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3.10 CMR 16 . 306 , partd .doc No..--......;[sly... PC'16 Fl��...JId.................. THE COMMONWEALTH OF MASSACHUSETTS 3 BOARD F HE TH ....._0F....... . ....... .. .... ... . .................. ......................... Appliration -fur Bitiputitt1 Workii Towitrnrtion Vrrnfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at v -------------------------------------- --- ------�-9-�----- o�--::._...... _...__.._._• �- -- --fit .------ --- ' o n-Address - or Lot ---�--•---------------•--•--•----•--• Address .......•-...............•• -•--•-•....................•..... ----••--•.......-•----..................... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms._._--___._ Expansio ;Attic ( ) Garbage Grinder (, U ---••_------- - Other—Type of Building ---------------------------- No. of persons....... ----------------- Showers ( ) — Cafeteria ( ) a' Other fixtur Q W Design Flow----Sba_ _ __ !:` gallons per p da erson per y. Total daily flow....._.....- --:."`__ -------_-gallons. WSeptic Tank-[Liquid capacity4PTI..gallons Length---------------- Width........-------- Diameter_--_-. -.-.__-_ Depth..-------------- x Disposal Trench—No--------------------- Width.................... Total Length.................... Total leaching area--------------------sq. f t. Seepage Pit No____ ______________ Diameter14 45JO. Depth below inlet_.n.___._ ._.__ Total I aching area-------.----------sq. ft. Z Other Distribution box ( ) Dosing tank aPercolation Test Results Performed bY.......................................................................... Date------------------------------------.... Test Pit No. 1----------------minutes per inch Depth of Test Pit-.-_-___-_____-•--. Depth to ground water........___.---.--.-.._. (1 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--..-._..__--_-__---._.. ---------- - ----- o D- — h Description of Soil-- - - ..: x 9i z u -------......----•----------------------------------------------------- ----- /__. Gu - - W ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- VNature 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 Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu b boar�d�of a ned - - / /7+7G------------------- Date Application Approved BY ------ 7 . Date Application Disapproved for the following reasons: -------------------------•----------•------•----_---•-------•--•---•---•-•-------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date 1------ -_ ��-- --- -- ---------------- ----------------'a------------------ J No......................... FEE.... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD �jF HE T .......OF...............Lp..1/...... ......................I. .................------ Applirtttiun -fur Bi,ipuiitti Workfi Cnunitrurtiun Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....l.. .....................................................-G 'o n-Address t % .............. + � Owner Address .............. ...... -�...........•_.................--_- Installer Address Type of Building Size Lot____________________________Sq. feet Dwelling—No. of Bedrooms---------- .•__________________________Expansio�`Attic ( ) Garbage Grinder Other—Type of Btilding ____________________________ No. of persons..._...`�.._...._...._._. Showers ( ) — Cafeteria ( ) Q' Other fixture t__-_f_/ __________ ___ W ' �.J l _.. F!�!gallons per person per day. Total daily flow__..__.___. _6-__:� g� -----_-------------------- Design Flow �� = = = ------------_-- Mons. 1:4 Septic Tank-1 Liquid capacity/�aA_gallons Length................ Width................ Diameter-----.---------- Depth.....___-__---. xDisposal Trench—No_ --------------------- Width-------------------- Total Length.................... Total leaching area...............-----sq. ft. Seepage Pit No-------_____________ Diameter__Ld�7T !J Depth below/,inlet___ _ ___________ Total aclii .- e1•t�..______.______sq. ft. z Other Distribution box ( ) Dosing tank ( ) 0 w � � - 'x G y aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. L_______________minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------------....... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.__..._-.._--_______ Depth to ground water____.._______..____..--. O Descri tion of So --•- � / L — (� f) cc� ` x p - - U -------------Cl= z l' ? W x ------ ---------------------- ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------ 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 Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu b board of h l). i ned- --------- --- -- - -------�G� - ----------------------------------------------- —------------------------- �} D e Application Approved By------------- - ------ ---- ---v.. / (�!/CiJ •_ .. .- 7G . Date Application Disapproved for the following reasons:.......-----------------------------------•_-.----.-_----.------------_-.......................................... -------------------------•---------------•------------------•-•--------•------------•----------------•--------•--•---------------------------------•--------------•-------------------••----------.----- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G Z '?............O F.......... - ��'.-.z r J � - ................................... Trrtifiratr of TlImpiitturr �/ y THIS Is TO C IF That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Yi ------ -•----- ------ - >' � Ins.Il at..__ ....; :.•• ��` f/1� � ----•- -------- - ---------------------- - has been installed in accordance with the provisions of ArticlI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___'______________�'_S__�_____._. dated.....�9....-_�-.�__ __7 C THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � \ DATE .. Inspector--�` ---- -- THE COMMONWEALTH OF MASSACHUL TS 07� BOARD S— OF, HEALTH, ..... f ..: � .............J ......... OF........ ..... No......................... ----•-•---......... � u k� nun�trnrtiun �rrntit Permission i reby granted ft � ..----•---... � -------------------------•--•----•--------------- to Construct ( r e. air /�' 1n nclwldual wage Dispos �Syst``'`m "-- •-�-- J : - - "�: -� at No. ---.'-�-----•l --- Street _/ > 7G as shown on the application for Disposal Works Construction Permi __________________ Da d__.._.._._...___. /_.._................. -� Board -- Health DATE------------------------------------�.._..------------....-- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .i _ LOCUTION SEWIJ,C,E- PERMIT 1J0. VILLAGE c' � /1' -� ` Of IWST&LLER*S W&ME ADDRESS T P .S - G .4 bU1LDER 5 Q &V AF- 4t, &.DDRI=SS ,T //- Q A s s /F' ?- ? sv /4, - - � ii R /1-1 c a — DQTE PERMIT ISSUED' DATE COMPLI &MCE Is U 0 : -7z�l- ` r Q- �b h e 0 v � SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ; , ❑Agent ■ Print your name and address on the reverse ddresse so that we can return the card to you. B. Recei y(Printed Name) C. Date of Delive ■ Attach this card to the back of the mailpiece,or on the front if space permits. e1�A �1 /� D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No G 1'6 DP-i)t:52�5 3. Service Type � ified Mail ❑ Express Mail / ❑ Registered /Return Receipt for Merchandis p�(Q ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) 7,003i 1680 0004 5,458 12049 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M•l! UNITED STATES POSTAL SERVICE r1� First-Class Mail , G� G> Postag(!.&Fees Paid �, L1SPS '{Permit No. G-10. • Sender: Please prin yy L inamg; address;and ZIP+4 io'tMis--box-•--•- Public Health Dhrisloo Town of Bamstable 200 Main St. usetts 02601 Hyannis,Massac h III I)till 11111t,111111 till 1111111,,Ill IIIt till l oFt T Town of Barnstable Regulatory Services BAMSrnaLE. g Y v MAss. �' Thomas F. Geiler,Director �p 163iq. ♦0 'Enr��a Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 14, 2005 DeAssis Ciro M.,Ruth V., Jairo C. 12 Carleton Ln. Centerville, MA 02632 NOTICE OF VIOLATIONS OF BARNSTABLE CODE CHAPTER 360 ARTICLE VII 4360-16, ARTICLE 1 4353.1. VIOLATION OF 105 CMR 410.354 STATE SANITARY CODE The property owned by you located at 12 Carleton Lane, Centerville, was inspected on March 9, 2005 by Donald Desmarais, RS Health Inspector for the Town of Barnstable, because of a complaint. The following violations were observed. 4360-16; Town of Barnstable Code: The septic system is in hydraulic failure. Raw sewage was observed at ground level and some liquid wastes were observed seeping down the side yard. Sewage odors were detected. Puddles from sewage overflow, were observed on top of the ground. 4353-1; Town of Barnstable Code: Multiple trash bags were observed on the ground adjacent to fence. 105 CMR 410.354 State Sanitary Code: There are no separate electricity meters provided for two separate dwelling units. Tenants claim that they are required to pay for the electricity. You are ordered to correct the above listed violations within the time frames listed below: 1) You are directed to hire a licensed septage hauler to pump the overflowing septic system within twenty-four(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary(daily if need be)to keep it from overflowing onto the ground. 3) You are further directed to contact and hire a professional engineer to design a septic system which meets local and state regulation requirements within fourteen (14) days of receipt of this letter in order to repair this system or connect to town sewer. 4) The newly installed septic system shall be completed on or before May 15, 2005. 5) Trash must be disposed of within twenty-four(24) hours of receipt of this letter. 6) If the tenants are required to pay for electricity, a separate electrical meter must be installed for those tenants. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance may result in the issuance of a $100.00 non-criminal ticket citation. Each day's failure to comply with an order of the Board of Health shall constitute as a separate violation. ;PER ORDER THE BOARD OF HEALTH mas . McKean Director of Public Health cc: Daniel Prado, Tenant 0�9 haf' oFtME Town of Barnstable Regulatory Services v i639• Thomas F. Gefler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 14, 2005 DeAssis Ciro M.,Ruth V., Jairo C. 12 Carleton Ln. Centerville,MA 02632 NOTICE OF VIOLATIONS OF BARNSTABLE CODE CHAPTER 360 ARTICLE VII 4360-16, ARTICLE I §353.1. VIOLATION OF 105 CMR 410.354 STATE SANITARY CODE The property.owned by you located at 12 Carleton Lane, Centerville, was inspected on March 9, 2005 by Donald Desmarais, RS Health Inspector for the Town of Barnstable, because of a complaint. The following violations were observed. 4360-16; Town of Barnstable Code: The septic system is in hydraulic failure. Raw sewage was observed at ground level and some liquid wastes were observed seeping down the side yard. Sewage odors were detected. Puddles from sewage overflow, were observed on top of the ground. 4353-1; Town of Barnstable Code: Multiple trash bags were observed on the ground adjacent to fence. 105 CAM 410.354 State Sanitary Code: There are no separate electricity meters provided for two separate dwelling units. Tenants claim that they are required to pay for the electricity. You are ordered to correct the above listed violations within the time frames listed below: 1) You are directed to hire a licensed septage hauler to pump the overflowing septic system within twenty-four(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary(daily if need be)to keep it from overflowing onto the ground. . 3) You are further directed to contact and hire a professional engineer to design a septic system which meets local and state regulation requirements within fourteen (14) days of receipt of this letter in order to repair this system or connect to town sewer. 4) The newly installed septic system shall be completed on or before May 15,2005. 5) Trash must be disposed of within twenty-four(24) hours of receipt of this letter. 6 If the tenants are required to a for electricity, a separate electrical meter must be q pay tY� p � installed for those tenants. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance may result in the issuance of a $100.00 non-criminal ticket citation. Each day's failure to comply with an order of the Board of Health shall constitute as a separate violation. ;PER ORDER THE BOARD OF HEALTH mas . McKean Director of Public Health cc: Daniel Prado,Tenant Boca Raton, FL March 17—05 From: Ciro M. Assis,Ruth V, Jai.ro C. To: Town of Bamstable Regulatory Services Thomas F. Geiler.,Director Public Health.Division Thomas Mckean, Director. 200 Main Street, Hyannis,MA 02601 I've just received your March 23 letter, and understand that I have to hire an engineer to design a new septic system. I've already asked my tenants to move. My intentions are to build a new septic system,fix up the house and the hard then put the house up for sale. In order to do that In.eed more time, so I'm asking;you to reconsider this matter and.give me a little extra time to hire the engineer,because I don't live in Massachusetts any more. You can rea.cb me at: cell(954) 257-9019 br(954) 257-9024, please do not send any letters to Carleton lane,because I don't live there anymore, my new address is 211,31 Rusticwood Ave., Boca.Raton,FL 33248. Thank you.f-or, your time and understanding. Sincerely, Ciro M Assis Ruth Assis J'airo Chaves Assis 2 I -ME Tp� a Town of Barnstable �O Regulatory Services * anxxsrABLE, v Mnss. $ Thomas F. Geiler,Director �p 1639. 10 rEn r„p+" Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 DeAssis Ciro M., Ruth V., Jairo C. March 23, 2005 12 Carleton Ln. Centerville, MA 02632 Owners of 12 Carleton Lane; I received your letter stating what your intentions are. In referencing#3, you do not state that you will hire a professional engineer to design a septic system (according to #3 of the order letter that you signed for). Treating the septic is not an option. You are to carry out the directions of the Order Letter. I enclosed my business card in the original order letter and will enclose one in this letter also, so if you have any questions feel free to call me. You have until March 30 to hire a professional engineer or you will be subject to fines of$100 per day, every day that you do not comply. Sincerely, Donald Desmarais RS Health Inspector Town of Barnstable t I / 801L L0.0 2 PE —— _ i I_LLw MA_•NE 4M l T SIGrr\.NO edium Ll DIST. ° I ° 1 y' " ` 1 ° ° °I o N ^ San 4 C. I. I I Box II I° ° °° ° I °24'MIN i� SM,N 1 I000 I I° Do °°p° 1000— GAL. V� GAL. a D PRECAST, OR SEPTIC 6.io Da ° °.°;i BLOCK I 1 TANK °°, ° SEEPAGE PIT° • o r - -- - 20' MINIMUM FOUNDATION G 2 , . �o l '/e° WASHED STONE CY-Kf—I i - . `` EOz. ELEVATION SKETCH 1. ---------- 10 —_— -- —{ 'PERc., RATE l�s><r�,Q., TEST BYf,(a•bcrnry PE SCALE.: 1' = 4' - TOWN INSPECTOR Pain � dr%a wA i E'z BAC KHOF OPERATOR J1 A��tr+�oSS21^t TEST MADE ON 9 ti n /7 v62-2S--S 1 E 0 g9 4 ,fib r o. 4� 1o�b N�q 2 g�. Bs,o,� c� c�3 IL Z�• T Fvl-pfZ6 �o 7 - p,�T �� E Pnc rNK Barg e� q �4 y/'\ !� / Q' r 140 o I pa Apo >< 96°3L n3: ~Q7.y6 oShoo! V o k 98°S 6 97,S6 97,o b CA 2 l F To IV K L,A yC gM 40' Wlb& PAvEQ,Pnuctf. is I n 100,00 3 .LOT"/O { T�Qrt LJtlr�tty 11+ou/h lab L1 h�e� ��yy �`i�c• �y,,�,,,, APPRO'vED BY BOARD OF HEALTH D A T E v��oLtA OF b14`F�9 ,` �AI�H OF Rf40 o`' 4'GioI yG\ eD DUNG +WINU `IOUNG N)* _ -- ti k1'o. 12134 s FF S T E- S� NAL SUR\A�W ELEVATION SCHEDULE PROPOSED SITE PLAN • A INV AT FOUNDATION 9.16 SEWAGE SYSTEM DESIGN IV INTO SEPTIC TANK = _�c�• G� ^� IN �- �/yp� oV JLT %f SEPTIC TArrr<, _ 10 QAI2Ns-rAeLc- t MA4' s' '\T0 D STRIBUTION BOX = APO SCALE : I yC AP2r L !9 Ito ' N . !)U? )� CISTR:BUT;Or; BOX = g7 3 c -sz� IC-9 CAPE COD SURVE ( CONSL' 'ANTS iN T�? SEEPAGE PIT = �. ROUTE 132 F " 7')rV OF PIT = 9I•S'O HYANN.S, MASS. Q A UIVISUN SCSTUN SURVEY '.C-SULTANTS, !NC T r, F rT0IV, Of- :_TONE _AYER *NOTE: ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. VENT PPE (O Lace 24 inches tall) SECTION A -A •11Ar��rw17 4O ALL OUTLET PIPES FROM TIE 10' min. from Schedule PVC •/Charcoal Odor f7tsr UIS7RBUt10N E,O)t SHALL BE '' $ ! Existing Foundation [house to septic tank o-eox nMi.t PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET LEVEL FOR AT LEAST 2 FT. -1r COIs RETE nowt Saplic ton* cores mud be TOP OF FOUNDATION = ELEV. 100.00 (Assumed) rN1+ti 6 in. ar finished 9 within 6 in or IWrniehed grade ,__. : Erode over septic TarNc - 99.5o Grads over 0-am- 99.50 over SAS- ".50 3" of 1/8' - 1/2' Washed Peast \ KNOOCOUJTSSr 3/4' to 1 1/2 Washed shed Stone • s•'' t r-yf/RN w rto t. OUTLET � 12' ft-ET _ r„env�+MEN , S - 0-02 3 HOLE H-10 (GAPPED)♦' PVC CAPPED INSPECRON PORT TO BE T. Box 3' Mmkrre^ Cow. Tap OF System- Elev. -96.50 INSTALLED AND TO BE VATHIN 6.OF GRADE - 6" 7 . Ss0.01 or Greater - 4' P j xf3 CsMsMe la I t 1 1 o cay� �htn I EXIST. PIPE ^ Ji :H AL. p 60 S` 0�"Per root 10"EMeetive Depth 1S 5' 4" - SCH. 40 T` 1` 1.75' FRW EXIST. F[MMTBIN a, TANK 8 r- PLAN SECTION CROSS-SECTION'o...rr °' s units a 625' = 30'CDrxETE rTAl �s�" a0.83' (10 inches) 3 3' �f SYSTEM PROFILE 6 In.of 3/4"-1 ,/Y � 1 i u7i °�' �31.25' 3 HOLE H-10 DISTRIBUTION BOX Not to Scale S oompacbd done 5 c NOT TO SCALE B easrt,�r +WdGr.wer• tuMrEt �J s , r cr 37.25' > 4' 4' 6 Effective Length ° - _ 0 3 ' ® SOIL ABSORPTION SYSTEM (SAS) GENERAL NOTES 8 in.of 3/4'-1 1/2' D 11• o compacted done < Effective Wici#' INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE 9 m 1. Contractor is responsible for Digsafe notification, Verification of Utilities_ o (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. w The septic tank anq distribution box shall be set NOTE: OVERALL HEIGHT OF INFILTRATOR IS 1B' /EFFECTIVE HEIGHT IS 10" 2. level on 6 of 3/4 -1 1/2' stone. ♦Obs. Groundwater - Test Hole 1 Elev.= 88.00 (Adj. Per CAPE COD COMMISSION = ELEV. 88.60) 3. Bockfill should be clean sand or gravel with no V PROJECT ADJ. Groundwater = ELEV. 88.60 stones over 3" in size. 4. This system is subject to inspection during installation PE R C 0 LAT I 0 N TEST by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance DM oJ�Date of Percolation Test: JULY 27, 2005 with Title V of the Massachusetts state code, the approved plan �. �' and Local Regulations. Test Performed By. CARMEN E. SHAY, R.S., C.S.E. nj �� 6. If, during installation the contractor encounters an Results Witnessed By. WAIVER (per Barnstable B.O.H.) 9 Y EXCAVATOR: Shay Env. Svcs. ,� soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI ® 36' ,' from those shown on the soil log or in our design installation must halt & immediate notification be Test Hole Test Hole ,� made to Carmen E. Shay - Environmental Services, Inc. No. 1 No. 2 �� 7. No vehicle or heavy machinery shall drive over the DEPTH SOILS ELEV. DEPTH SOILS ELEV. septic system unless noted as H-20 septic components. 0 99.50 0 99.50 /� 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Sand Loom Sand Loam 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Y Y / N/F Alden MlJckonen °�� LOT #8 10. All solid piping, tees & fittings shall be 4" diameter 10 YR 3/2 10 YR 3/2 i / /' Schedule 40 NSF PVC pipes with water tight joints. 0"-9. Ae 00 0"-9" A, 98.00 ,' Z .7' 11. Municipal Water is Connected to ALL OF The Residence and Abutting Sandy Sandy Loam Loam / $g / /� ,� Properties Within 150 Feet. 10 YR 5/6 10 YR 5/6 i'/ ��/ ` THE PROPERTY LINES ARE SURVEY APPROXIMATE AND ED BY 9"- W. Be 97.00 9"- 24' Be 97.50 / /' �i �� /� COMPILED PLAN Medium Medium ,' / WILLIAM BRYANT, RLS OF HYANNIS, MA Sand Sand i� ,' D-Box -s 9 ENTITLED "FOUNDATIONLOCATION PLAN OF LOT9 CARLETON LANE, 2.5 Y 7/4 2-5 Y 7/4 PROJECT BENCH MARK �/ ,/ /� ,'� {' 1rs CENTERVIL.LE, MA", DATED DATED MAY, 1976 36'- 144 G 24'- 144 C, TOP OF FOUNDATION i� �� '� �� • AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN ELEV. = 100.00 (Assumed) : IT SHOULD BE USED FOR NO PURPOSE OTHER THAN EXIST. 1000 GAL. e THE SEPTIC SYSTEM INSTALLATION. cD SEPTIC TANKLS7. 5' _ -- _ TEST HOLE 2 = T • ;:, EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE 0 / c96, \ �GJ• /� / ` 'x' • }•t'_ NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATF ` Patio >tia •';- FROM THE EXISTING LEACH PIT TO BE DISPOSFD OF AS PER BOARD OF HEALTH SPECIFICATIONS. Perc #1 EfXIST. . Or THERE ARE NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY Ueptn to Perc: 36" to J4" �0 � j - Perc Rate= 2 MPI -� 0� 4" PVC 29' \ � ASSESSORS MAP 190 PARCEL 231 SDW252/ZONE C - INDEX = 46.2 for 7/05 ADJUSTMENT = 0.6 FEET �� Vent `\\ --L�G E N D- --- --- - - ----- OBSERVED H2O Elev. = 138" or 11.5' below Grade EXISTING � -- t (� 2 BEDROOM -------- "1 O 1 HOLE TEST xnfr.�F � �� 0 -'� DENOTES PROPOSED ` X ELEV.= 99.50 ,10 - 104X 1 SPOT GRADE 2-tir DIAM. ACCESS MANHOLES \Failed #f2' C- E *P �\ Leach Pit o'1;. �\pR `\ DENOTES EXISTING X 104.46 SPOT GRADE °10 , PL PROPERTY LINE INLET >/^ • � � � � \y/=/-/- y --- ouTIET r- PROPOSED CONTOUR v r THE ACCESS COVERS FOR THE SEPTIC TANK, Ch 00 /i TW -- - - - - -9 7 EXISTING CONTOUR DISTRI6LJT10N Box AND LEACH94C COMPONENT MJ�] LOT #9 •_ _:rr.;._. s-TL SET DEEPER THAN 5 INCHES BELOW FINISHED •_ y�' ' " GRADE SHALL BE RAISED TO WITHIN 6' or STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE O f5,485 Squa►ie Feet +/- O II PA) DEEP TEST HOLE & PLAN VIEW INSTALL TLIF-nTE GAS BAFFLES OR EouALs / /r F PERCOLATION TEST LOCATION .3--24' REMOVAKE covv�s / w ^ �J \G�� _/ 6 FOOT STOCKADE FENCE 00 : 3' mh clearance t I tr earT �pt� --------- - - --------- - INLET m<n.T Y mN, irdet to outlet --� Liquid OUTLET I. �� 3 PLOT P LAN 5 r I$ t.• I ,s -r p�, Liquid °- depth_ OF PROPOSED SEPTIC SYSTEM UPGRADE .s PREPARED FOR El -10" r CIRO DEASSIS CROSS SECTION END-SECTION AT TYPICAL 1000 GALLON SEPTIC TANK # 12 CAR LETO N LANE NOT TO SCALE CENTERVILLE , MA Design Calculations 'OF s q PREPARED BY: Number of Bedrooms: Equivalent to-?2.tl.Gal./Day (330 Gal./Doy Min. per Title V) A No CARAMY E. rS11A Y r. 111' Lr' Garbage Grinder: } Leaching Capacity Proposed: 330 Gol./Day Minimum (Min. Per Title V) U Z. --- --------------- Septic Tank : - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. S ENVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. a 273.8 gallons ISTE P.O. BOX 627 Sidewall Area: 0.74 god./sq. ft. x 78 sq. ft. = 58 gallons 0 20 40 50 s EAST FALMOUTH, MA 02536 Providing: s 331.80 gallons _ gN17ARWA TEL/FAX : 508-539-7966 Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE: 1 "=20' DRAWN BY: CES DATE: JULY 28, 2005 TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE SCALE: 1"=20' PROJECT SD776 FILENAME: SD776PP.DWG SHEET 1 OF 1 ON THE ENDS. NO STONE UNDER. Y