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HomeMy WebLinkAbout0019 CATS PAW WAY - Health i 9 Cats Paw Way Centerville P A = 192 118 � 0))©!,g or_ N0. 152 1/3 ORA 100/4!A ,1 _ e No. Fee VU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1/1 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for 0sposai 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade(JrAbandon( ) ❑Complete System ndividual Components Location Address or Lot No. C�C o cz_m ll Owner's Name,4ddress,and Tel.No. Assessor's Map/Parcel `Z\- a Installer's Name,Address,and Tel.No. Ste$-27<fe-<O$ ' Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 gpd Design flow provided gpd Plan Date e,(� ( 7 Number of sheets Revision Date Title Size of Septic Tank k ©00 z✓kL�Type of S.A.S. ti` a© Description of Soil Nature of Repairs or Alterations(Answer when applicable) - b 'a h( �a� 5a® �t E.LI ,,., l.. cz.e�l ,. , u,.s,�4 ��r� ,✓' yr Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. . Si Date 77 Application Approved by Date 7 Application Disapproved by Date for the following reasons Permit No. Date Issued Y7 / r No. 2o(7- Fee UCJ- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplicatlon for Disposa1.6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade(✓Abandon( ) ❑Complete System EXndividual Components Location Address or Lot No. `�G d S �.p� cl fit,_ Owner's Name,Address,and Tel.No.SJ'Z-a4/6 S7?C •P� ` fr_ , I_Q v 4 Assessor's Map/Parcel , Z\Q H �71 C -' c G' 3 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. t Type of Building: Dwelling No.of Bedrooms Lot Size t sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons b Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 gpd Design flow provided 7� gpd Plan Dates r : Number of sheets Revision Date Title f Size of Septic Tank ��k� Type of S.A.S. 1 A -a b C a C k-, Description of Soil G �aa. Nature of Repairs or Alterations(Answer when applicable) ���Q �...��� �c�1 -Q Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date 7 Application Approved by WAA _LPY 12,rDate Application Disapproved by Date for the following reasons Permit No. r-/! 7- I a I Date Issued t 7 --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System C nstruction Permit No.2r}s-7 j dated ;? // 7 Installer .,-Q�, �c ��r �1,�,,�, c� Designer #bedrooms ^� Approved design flow �j gpd The issuance of this permit shall no be construed as a guarantee that the system will funct,o e igned. Date Inspector No. 2° 1 7- /) !1 Fee �U✓ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstrm Construction 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( V4,`� Abandon( ) System located at 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 /ompleted within three years of the date of this permit. Date / /3 ' 7 Approved by V i Town of Barnstable Regulatory Services Richard V.Scali,Interim Director • Beans ARIA • HAMPublic Health Division ► " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 5 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form p Date: `�' 3 1 Sewage Permit#Lic)q- ti a \ Assessor's Map\Parcel 2' D Designer: -M^te 4 SW S `V G Installer: � 1. Address: T G i�N Ti Address: Vo 02��7V�) On "/ Z— gt� Tasissued a permit to install a (date) (installer) septic system at C� P� W1 �A4io based on a design!drawn by (address) dated (design � / XI rt aify that septi system rlre,(nced 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 1m of the septic system) but in accordance with State&Local Regulations. Plan revision or j certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was construct a with the erms of the RA approval letters(if applicable) M. (Installer's Signature) (Designer's Signature) (Affix Designer Here) PLEASE RETURN TO BARNS LE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, Q:\Septic\Designer Certification Form Rev 8-14-13.doc L %"Z BETTERMENT AGREEMENT 3> PURSUANT TO M.G.L. c. 111, s. 127B '/2 w m This Agreement is between the County of Barnstable(the "County"), by its County .J Commissioners and Treasurer, and Pavel Naydenov and Nana T. Stankova-Naydenova (the "Owner") this 25th day of March 2017. WHEREAS, the Owner owns residential property, including improvements thereon, known as and numbered as 19 Cats Paw Way, Centerville, Massachusetts, 02632, (Assessor's Map 192, Parcel 118) and described in a deed dated January 7, 2008 and recorded with the Barnstable Registry of Deeds in Book 22594, Page 262 (the "Property"); and WHEREAS, the Owner has petitioned the County to make findings pursuant to M.G.L. c. 111: and WHEREAS, the Barnstable Board of Health has made findings, pursuant to M.G.L. c. 111, that the on-site subsurface sewage disposal system serving the Property exhibits one or more of the failure criteria set forth in Title 5 of the State Environmental Code, 310 CMR 15.00 (the "Failed System"), such findings being made by the Board of Health prior to, or during the course of proceedings conducted pursuant to M.G.L. c. 111, s. 127B; and WHEREAS, the Board of Health has adopted an Order requiring the Owner to repair, replace or upgrade the Failed System to comply with the requirements of said Title 5; and WHEREAS, the Owner has, pursuant to M.G.L. c. 111, s. 127B '/z, applied to the County for assistance to repair, replace and/or upgrade the Failed System; and WHEREAS,the Department of Environmental Protection("DEP") has approved the County's proposed program of offering betterments pursuant to M.G.L. c. 111, s. 127B '/2 to homeowners to repair, replace and/or upgrade the Failed System for financing under the Local Septic Management Program, and the County has received a State Revolving Fund ("SRF") loan from the Water Pollution Abatement Trust(the "Trust")to finance said betterment program; and WHEREAS, the County intends to provide financial assistance to the Owner in the form . of a Betterment Agreement made pursuant to said M.G.L. c. 111, s. 127B '/2 and funded from the SRF loan received by the County under the Local Septic Management Program; and . WHEREAS, the Owner intends by this Betterment Agreement to cause the repair, replacement and/or upgrade of the Failed System in compliance with Title 5 and to complete other work directly or indirectly related thereto (the "Project" as described in Paragraph 4 hereto); and 1 WHEREAS, the Owner intends to have work performed by one or more persons under contract to complete the work(the"Contractor(s)"); and WHEREAS,the public purpose of the Project is to protect the public health, safety, welfare and the environment by the repair, replacement and/or upgrade of the Failed System; and WHEREAS,the County, by its County Commissioners, has agreed to provide financial assistance in the form of a Betterment Agreement in an amount up to $10,550.00,unless a higher amount is approved by the County,but in no event more than is necessary to pay all eligible Project costs; and WHEREAS,the County, by its Treasurer, has determined and agreed that interest on the amounts advanced by the County shall be computed annually at the rate of five percent (5%) per annum; and WHEREAS, the Owner intends this Agreement to be a Betterment Agreement made pursuant to M.G.L. c. 111, s. 127B '/2. NOW THEREFORE, for and in consideration of financial assistance from the County in an amount necessary to pay all eligible Project costs,up to $10,550.00, unless a higher amount is approved by the County, with interest on the amounts advanced by the County to be computed annually at the rate of five percent (5%)per annum,the Owner hereby agrees to the terms of this Agreement, as set forth below. 1. REPAYMENT and TERM: THE AGREEMENT The County has agreed to provide financial assistance in an amount up to $10,550.00, unless a higher amount is approved by the County, to be advanced from time to time by the County to the Owner pursuant to the terms of this Agreement. The Owner promises to repay to the County,with interest as set forth herein, all sums provided to the Owner by the County. Interest on the amounts advanced by the County to the Owner shall be computed .annually at a rate of five percent(5%) per annum on the outstanding principal balance provided that payments by the Owner to the County are made on a timely basis. If scheduled payments are late, interest at the rate of fourteen percent(14%)per annum will accrue on the outstanding principal balance until the payments become current. Furthermore, should payments not be made, the County, in addition to the preceeding, has statutory authority to take title to the Property and, subsequently, to undertake proceedings to foreclose the Owner's right to redeem the Property from tax title. The amounts to be repaid shall be repaid monthly to the County of Barnstable. A fee of$50.00 will be applied for any check returned because of insufficent funds. 2 I - All outstanding amounts due to the County by the Owner, if not prior paid, shall be due and payable on February 1, 2036. Prepayment: If the Owner pays off the entire loan balance within twelve (12)months of receipt by the County of the Owner's first payment,the County shall charge the Owner, and the Owner agrees to pay the County, a fee of$400.00. If the Owner sells or transfers the Property, whether voluntarily or involuntarily,the unpaid balance of principal and interest shall become due and payable to the County, unless the County has agreed in writing to permit the buyer or transferee of the Property to assume the obligation to pay the unpaid balance. With respect to the indebtedness incurred pursuant to this Agreement,the undersigned hereby expressly waive(s) any claims under any Declaration of Homestead under chapter 188, M.G.L., or otherwise, for protection of the real estate covered by this Agreement. This Agreement represents the entire and integrated agreement between the parties hereto and supersedes prior negotiations, representations, or agreements, either written or oral. The Agreement may only be amended or modified by a written modification. 2. TERMS FOR INSTALLMENT PAYMENTS OF FINANCIAL ASSISTANCE TO OWNER The County shall make advances of funds to Owner and Contractor, pursuant to the terms of this Agreement, from time to time to pay for the Project. Such advances shall be made solely for the purposes of this Agreement. The obligation of the County to advance all or any part of the proceeds of the Loan for repair or replacement of the on-site disposal system for the dwelling on the Property is subject to the following: A) Inspection of the failed on-site disposal system by a representative of the Board of Health or by a DEP Certified System Inspector, as deemed necessary by the Board of Health; B) Submission by the Owner or Contractor on behalf of the Owner of plans approved by the Board of Health for the Project. In the event Owner seeks payment to pay for field work and preparation of plans for the Project,.the Owner (i) shall solicit bids (at least three (3), unless the County waives the requirement for multiple bids) for the necessary field work and plan preparation from registered professional engineers or registered sanitarians, (ii) shall submit documentation of these bids to the County and (iii) specify the Owner's choice of an engineer or sanitarian. The Owner must provide an explanation if the proposed engineer or sanitarian is other than the low bidder. The County may approve an installment 3 payment not to exceed the amount of the selected bid. An installment payment for field work and plan preparation shall be made by check payable to the engineer or sanitarian, and shall be payable upon submission of plans approved by the Board of Health for the Project; C) Submission to the County by the Owner, of the bids (at least three (3), unless the County waives the requirement for multiple bids) for the Project in accordance with the plans from the licensed (including but not limited to, a Disposal System Installer's Permit), insured, septic system contractors, which bids shall contain detailed breakdowns of the cost of the work by tasks; D) Confirmation that the contractor for the construction of the Project(the "Contractor') selected by the Owner has a valid Disposal System Installer's Permit in effect for the time period covering the System upgrade financed under this Betterment Agreement. Approval by the County of a Contractor for the Project selected by the Owner from these bidders. The Owner must provide a detailed explanation if the proposed Contractor is other than the low bidder; E) Approval by the County of a Project Budget based on the bid submitted by the Contractor; F) Execution of a construction contract between the Owner and the Contractor pursuant to plans and specifications which.have been previously approved by the Board of Health; G) Issuance of Disposal Works Construction Permit with respect to the Project. 3. CONDITIONS FOR PAYMENT Installment payments of the fiscal assistance are to be made by the County under the following conditions: A) An installment payment for field work and preparation of plans shall be made to the Owner and engineer in accordance with Subsection(B) of Section 2. B) A reasonable time before the date on which any other installment payment is requested to be made, the Contractor shall.give notice to the Owner and the County specifying the total installment payment requested. Such notice shall consist of a detailed request describing the value of the completed items of work. The amount of the request shall equal the amount of the requested installment. The request shall also be accompanied by a sworn certificate of the Contractor that all subcontractors and employees have been paid for prior work on the Project. The County will approve or disapprove the requested installment payment or notify the Contractor and Owner that further supporting documentation is required. Upon approval of a requested installment payment, the County shall issue a check payable to the contractor. 4 C) The County may require, as a condition of any installment payment,that the Owner submit satisfactory evidence that there are sufficient remaining funds to pay for completion of the Project in accordance with the approved plans. D) Prior to making an installment payment, the Board of Health may cause the Project to be inspected to verify that the work items described in the request have been actually completed. In any case, the Contractor shall provide verification that the work referred to in the installment request has been completed in accordance with the approved plans. E Prior to paying the final installment, the Contractor shall provide verification that all work has been completed in accordance with the approved plans, and the Board of Health shall have issued a Certificate of Compliance for the Project. 4. SCOPE OF WORK FOR THE PROJECT The County shall determine the scope of the Work necessary to bring the Failed System into compliance with Title 5, and eligible Project Costs. Eligible Project Costs may include, but are not limited to, costs incurred for: (A) performing soil and percolation tests and other necessary site analyses; (B) specification of the Failed System components to be repaired, replaced and/or upgraded; (C) design of the System or components thereof to be repaired, replaced and/or upgraded; (D) obtaining all applicable federal, state and local permits and approvals required to complete the Work; (E) seeking bids and awarding contracts for assessment, design, consulting and constructing work and materials in accordance with applicable laws, regulations and requirements; (F) minimizing any disruption of utility service, and reasonably restoring the Property to as near its original condition as practicable; (G) administrative and legal costs, and recording and filing fees; and (H) engaging such other services and procuring such other materials as, within the reasonable discretion of the County, shall be necessary to complete the Work in a good and workmanlike manner. All such Work done by Contractors shall be performed pursuant to written contracts and agreements. 5 5. COUNTY'S RIGHT TO INSPECT The Owner agrees to allow DEP,the County, the Board of Health, Health Agent and other officials, employees and agents to enter onto the Property, as is reasonably necessary, and upon reasonable notice, to test, examine and inspect the Project to verify completion of the Work. 6. COVENANT NOT TO SUE The Owne r covenants and agrees not to sue the Count for an claims of damage to g Y Y g or loss of property of the Owner or others, or for breach of warranty regarding the performance or condition of the project, or for injury, illness or death arising out of the performance of any contractors or agents.engaged to perform the Work. This Covenant Not To Sue provision shall have no application to causes of action which may have arisen prior to the execution of this Agreement, or to causes of action that are unrelated to this Agreement, or to causes of action against any person or entity other than the County. 7. OWNER'S REPRESENTATIVES AND WARRANTIES TO THE COUNTY The Owner represents and warrants to the County that: A) Financial Information: Financial information furnished to the County by the Owner is accurate and complete and accurately presents the financial position of. the Owner. B) Title: The Owner has good record title to the Property subject only to encumbrances of record. C Permits and Compliance With Law: The Owner has obtained or will obtain all necessary governmental permits for the Project. The On- Site Disposal System for the dwelling on the Property, after completion of the Project, will comply with all applicable building, zoning and sanitation ordinances, regulations and laws, including the Title 5 regulations. D) Insurance: The Owner and Contractor have procured or will procure insurance in such forms and in such amounts as shall be satisfactory to the County. Each of the foregoing representations and warranties in this section shall remain in force until the financial assistance is repaid in full. The Owner shall indemnify and hold harmless the County from and against loss, expense .or liability(including costs of defending any claim), directly or indirectly from the falsity, inaccuracy, or breach of any of the above representations and warranties. 6 8. OWNER'S OBLIGATIONS During the term of this Betterment Agreement, the Owner agrees that the Owner shall comply with all of the terms and conditions of this Agreement and any related agreement and that the Owner shall: A) Completion of Project: Cause the Project to be completed in a timely manner in accordance with the approved plans and with the Project Budget and in compliance with all applicable laws, regulations, codes and ordinances and notify the County when the Project is complete. B) Records and Cooperation with the County: Keep complete records relating to the Project, which records shall be available for inspection and copying by the County, and cooperate fully with any audit of the Project if so requested by the County. C) Performance of Other Obligations: Perform all the Owner's obligations and agreements under any present or future mortgage or other Covenant or Agreement which encumbers the Property. D) Use of Financial Assistance: Use of the proceeds of the financial assistance solely for costs included in the Project Budget and ensure that the proceeds of the Loan are not used for any other purpose. The financial assistance is provided for the public purpose of protecting the public health, safety, welfare and the environment. 9. EVENTS OF DEFAULT The Owner shall be in default under this Betterment Agreement upon the occurrence of any one or more of the following events: A) Sale Transfer or Assignment Without Approval: The Owner assigns or transfers any money advanced or to be advanced hereunder to any person or entity not approved by the County, or the Property is sold, conveyed, or otherwise transferred without the written approval of the County. B) False Representations or Warranties: Any representation or warranty made herein shall prove to be false or inaccurate in any material respect. C) Breach of an Obligation: The Owner defaults in the performance of any of the Owner's obligations contained herein. 7 10. COUNTY'S RIGHTS ON DEFAULT Upon the Owner's default, the County shall have no further obligation to make any further installment payments; all amounts advanced by the County to the Owner shall become immediately due and payable; and the County may exercise all other available remedies. For good cause, the County may waive penalty interests and costs notwithstanding an event of default. 11. NOTICE OF BETTERMENT AGREEMENT Upon execution of this Agreement by the Owner, a Notice of this Agreement shall be recorded as a betterment and shall be subject to the provisions of M.G.L. c. 80 relative to apportionment, division, reassessment and collection of assessment, abatement and collections of assessments, and to interest provided, however,that the lien,which shall arise pursuant to M.G.L. c. 111, s. 127B 1/2 shall take effect by operation of law on the day immediately following the due date of such assessment or apportioned part of such assessment and such assessment may bear interest at a rate determined by the County Treasurer by agreement with the Owner. The Betterment Lien, if any, shall be deemed to secure all amounts advanced hereunder, together with interest thereon, and shall include costs of collection and reasonable attorney's fees. 12. IMPROVEMENTS TO THE PROPERTY Any alterations or improvements to the Property resulting from the Work shall become the property of the Owner, and the County shall bear no responsibility for the condition of the improvement or its maintenance. 13. CANCELLATION OF THE AGREEMENT BY THE OWNER The Owner may, by written notice to the County, cancel the Owner's further obligations for repayment under this Agreement at any time prior to the end of ten (10) calendar days following notice to the County in writing of the Owner's proposed successful construction bid,based on the Owner's evaluation of the proposed scope and cost estimate of the System upgrade derived from the field of work, project design and the.successful construction bid. However, in the event of . such cancellation, the Owner shall remain liable for repayment of all sums advanced by the County to the Owner pursuant to this Agreement. All sums advanced by the County to the Owner shall be repaid with interest and within the term set forth in Section 1 hereof. Upon application of the Owner, the Board of Health may revoke the Order for Improvements, provided however, that the owner shall remain liable to comply with the provisions of Title 5. " 8 14. PERSONAL OBLIGATION OF THE OWNER In addition to those remedies available to the County regarding the assessment and collection of betterments, the Owner shall be personally liable for the repayment of the amounts advanced, plus interest thereon. After written request of the Owner, in connection with the purchase or transfer of the Owner's entire interest in the Property, the County shall permit the assumption of the personal liability hereunder by said purchaser or transferee and shall release the personal liability of the Owner. The assumption and release of liability hereunder shall be in writing and shall be executed by the Owner, the Purchaser or Transferee and the County. 15. FUNDING FOR THIS AGREEMENT The obligations of the County are expressly contingent upon funding. In the event that funding for the County's obligation is unavailable, upon notice to the Owner, the Agreement may be cancelled by the County and all obligations of the County shall be null and void. 16. NOTICE Any notice required to be given under this Agreement shall be made in writing and shall be delivered by either hand delivery or by prepaid, first class mail. If notice is made to Barnstable County, it shall Barnstable County shall be t ty Department of Health& Environment, Community Septic Management Loan Program, Attention Administrator, P.O. Box 427, Barnstable, MA 02630. Notice shall be deemed given on the day it is hand delivered or three (3) days after the date of first class mail. 17. ENFORCEMENT OF LAWS Nothing in this Agreement shall be deemed to stop or effect a waiver, or otherwise act as a bar or defense, to any legal proceeding by the County relating to the system or the property. . 18. SEVERABILITY In the event that one or more provisions of this Agreement is deemed unenforceable by a court of competent jurisdiction,the Agreement, except as deemed unenforceable, shall remain in full force and effect. 19. GOVERNING LAW This Agreement shall be governed by Massachusetts law. 9 IN WITNESS WHEREOF, the undersigned parties have signed this Agreement as an instrument under seal this 301'�- day of 2017. OWNERS: V r COMMONWEALTH OF MASSACHUSETTS Barnstable County: ss On this36 ay of .M4a-Cl,( 2017, before me,the undersigned notary public,personally appeared PAVEL E. NAYDENOV and NANA T.•STANKOVA-NAYDENOVA (names of document signers), proved to me through satisfactory evidence of identification, which were Vim- b2.iJ-4�. L C.L-0s� , to be the persons whose names are signed on the preceding document in my presence. JOANNE M.STELMA * Notary Public N �,Public (official signature and seal of notary) Commonwealth of Massachusetts My Commission Expos December 24,2023 My Commission expires: 10 TOWN OF BARNSTABLE LOCATION `� Cm`s �,p� �,2�,p� SEWAGE# QQ® ] — ViLAGE C t-)'14WP, ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ��,. e,�nle�rs a .�rts".e.(size) �S� C ,.S�•C NO.OF BEDROOMS c� OWNER � PERMIT DATE: y ( 7 �('� COMPLIANCE DATE: s Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S 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�-C�OC�G✓� C����S"' k�L �� p� �.JaGy� CY RVGaJ.S� ` a A'Ll 23= 63 ' CD a�`� „ DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sol Texture Sdil Color Soil. Other Surface On.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. tslitency.Varaval) tJ Ci C-L' T ►N �' DEEP OBSERVATION HOLL LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsol/nll) 1Mottling (Structure,Stones,Boulders. Q i 1^ U d'= 13V A-Q.. Sct J 2: 64 DEEP OBSERVATION HOLE LOG Holy# A Depth fiorri Soil Horizon Soil Texture Soil Color Soil 'Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. DEEP OBSERVATION HOLE LOG Hole# NIA Depth ttnm Soil Horizon Soil Texture Soil 61or Soil Other Surface(In.) (U4DA) (Munsell) Mottling (Structure,Slopes;Boulders, Flood Insurance Rate Map: Above 500 year Mood boundary No— Yes Within 500 year boundary No �� Yes ' Within 100 year flood boundary No.,,� YEs , Death of Na rally Occurring PerviouslMaferlal Does at least four feet of naturally occurring pervious mtiterlal exist in all areas observed thrpughout the area proposed for the soil absorption system? [•(e' �._..,. If not,what Is the depth of naturally occurring pkvlous material?,.___._...�..._. Cer'tli5cat on I cortify that on (date)I havepassed the soil evaluator examination.approved by the Department nv mental Protection and that the above analysts wss performed by me consistent with . the required train xperd alqdox rience described in�10 CMR 15.0 7. Signature i Datb V Q;%AP7I0PR11CPORM.DOC To wn of Barnstable P# De artinent of� p Regulatory 5ervlces Public Health Division Date 200 Main Street,Hyannis MA 02601 j • �} N //'JJ / CA Date Scheduled `T/3, / Time / Fee Pd, �4ioil Suitability Assessment for Se e isposal ' 9 Performed•B : 10 Witnessed By: LOCATION&.GENERAL INFORMATION . Location Address Owner's Namo P,o fitt. %A • Addioss G CAS � W` C�� \ Assessor's Map/Parcel. ' `� Q� / O Bnglni acesName eJ.a.Ewa V1� C.✓�! �.G�l ,l�',soiuSv�w NEW CONSTRUCTION REPAIR Tele 4hone# O CO-3 3/ Land Use• j Ta Slopes(9G)_ �7' Sur&co Stones Distances tiom: Open Water Body [�� ft Possible Wot,Ann _ () ft Drinking Water Well 1_,Y ft Dralhago Way y li[;) ft Property Une :L�ft Other i ft SKETCHC(Street name,dimensions of lot,exact locations of test holes&pain teats,locato wetlands?n Wxlmlty, to halos) • i. RJE ��� p1 e- q/L%l 7 Parent material(geologic) t�✓I �'1—C,5t-N Depth to Bedrock N r Depth to Groundwater. Standing Water in Hole: Waoping i1 om Pit Fnae N Estimated Seasonal High Groundwater ' i D RMINATION FOR SEASONAL'HIGH WATER TAME Method Used: Depth Observed standing in obs.hole: in. Depth to Sall mottles, Dooth to weeping from aide of obs.hole: In, Groundwater Adjuathtent it. index Well► Ronding Dato: index Well Imvel Adj hotor.,,,,_, Adj.On undwater.l ebal,.,,_, PERCOLATION TEST bate Time�! Observation '' �3 Hole# Tlme at 9" ,�0 1 Depth of PareQ• �D Time at 6" Start Pro-soak Time 1 Time(911•611) End Pro-soak 11101 4301 Rate Min./Inoh Site Suitability Assessment: Site Peascd x Slip Palled: Additional Testing Neat ad(Y/N) Original: Public Health Division Observation Hula Data To Be Completed onB ack • i ***If percolation test is to be conducted within 100' of wetland,you must flrj it notify the Barnstable Conse}wation Division at least one(i)week prior to beginning. /Q:�SBPTI0PERCPORM.DOC 1d a �S y� Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 19 Cats Paw Way Property Address Christopher.J. Ward Owner Owner's Name t YKI Q l ' information is required for Centerville Ma. 0263 8/13/2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name f� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S 14454 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 Ev luation by the Local Approving Authority v i _ 8/13/207 Inspector's lidrratuK 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 a — report to the appropriate regional office of the DEP. The original should be sent to the system owner F ct ! 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 j- 1�;at that time.This inspection does not address how the system will perform in the future under ;3the same or different conditions of use. 1 " t5inspl•08%06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. City/Town 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', ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The'septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval.of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed t5inspl•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: I ❑ 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: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water, ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5inspl•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Cats Paw Way Property Address Christopher J.Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 . every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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: F 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 Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water.elevation. ❑ ® Any portion of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface water supply. t5inspl•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'' 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead 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. t5inspl•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS;located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5inspl-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No 1 Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2006:63,000 g ( y g (gpd)): 2006:63,000 Sump pump? ❑ Yes ® No Last date of occupancy: 8/13/2007Date 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: Last date of occupancy/use: Date Other(describe): t5inspl-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Capewide Enterprises,LLC Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: . _ 1000 gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ ' Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 20+years Were sewage odors detected when arriving at the site? ❑ Yes ® No t5inspl•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents.. Septic Tank (locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificate ❑ Yes ❑ No 9 Y P ( PY ) -------------------------------------------------------------------- ------------------------------------------------------ Dimensions: 8'6"x4'1 0"x57' Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle na Scum thickness 0 Distance from top of scum to top of outlet tee or baffle na M Distance from bottom of scum to bottom of outlet tee or baffle na How were dimensions determined? tank pumped empty t5inspl•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every 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.): Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound.Pump septic tank every 2-3 years. 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 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): t5inspl•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert no 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.): Box is level and has one outlet.lateral.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(Locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5inspl•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is Centerville Ma. 02632 8/13/2007 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ® leaching pits. number: 1-1000 gallon ❑ leaching chambers. number: ❑ leaching galleries number: 6 ❑ 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.): Sandy dry soil.No evidence of hydraulic failure.Water to invert was 19" in leaching pit at time of inspection.No visible stain line above water level. t5inspl-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): I i t5inspl•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 (D� O t5inspl•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Cats Paw Way Property Address Christopher J. Ward Owner Owner's Name information is required for Centerville Ma. 02632 8/13/2007 every 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 ground water: Bottom of leaching 40' 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: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used:Gaherty& Miller model 12/16/1994 ground water elevations. Used:USGS Observation Well Data June 1992. Used:Technical Bulletin 92-000-01 Plate#2 annual ranges of ground water elevations. t5inspl-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable OF 1HE Tp� Regulatory Services anxivsrnsLe Thomas F. Geiler,Director AT�p Nlpr A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIVED Property Address: 19 Cats Paw Way Centerville,MA J U N 2 5 2003 Owner's Name: Barbara Murphy,Executrix for Reagan Owner's Address:3 Springdale Terrace TOWN OF BARNSTABLE Canton,MA 02021 HEALTH DEPT, Date of Inspection 06/19/03 Name of Inspector:Janet E. DuPont Company Name: Wind River Environmental MAP Mailing Address: 120 Great Western Road PARCEL ` 1 South Dennis,MA 02660 Telephone Number: 508-760-4827 LOT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: _06/19/03 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. Notes and Comments: System seems to be functioning as designed. It should be noted that in the course of the inspection I discovered a broken pipe from the tank to the d-box. Pipe is schedule 20 PVC and I recommend replacement of pipe from tank to d-box and from d-box to leaching with schedule 40 PVC. Effluent appeared to be reaching d-box as all components were at normal levels. ****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. DECEIVED JUN 2 3 2003 TOWN OF BARNSTABLE HEALTH DEPT. OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 19 Cats Paw Way Owner:Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 Cats Paw Way Owner: Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "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: I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 Cats Paw Way Owner: Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than V2 day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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 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 an question in Section E the system is considered a significant threat or answered Y Y any Y g "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. OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 19 Cats Paw Way Owner: Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection ? NA Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up ? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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 ? _X_ _ 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 _X_ Existing information.For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 19 Cats Paw Way Owner: Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_NA_ Number of bedrooms(actual):_2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_220 gpd_ Number of current residents:_0 Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage system (yes or no):No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):_ Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no):No Last date of occupancy:Approx. 1 year ago_ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,ete.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Never pumped according to owner's representative Source of information: Was system pumped as part of the inspection (yes or no): Pumping ordered by rep. post inspection_ If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping:_Maintenance TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool _Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information:_Approx. 23Years olf per owner's rep. r Were sewage odors detected when arriving at the site(yes or no):No OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 Cats Paw Way Owner:Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 BUILDING SEWER(locate on site plan) Depth below grade:_34inches from top pf foundation_ Materials of construction:_cast iron _40 PVC_other(explain): Schedule 20 PVC Distance from private water supply well or suction line: 20+' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_E+F_(locate on site plan) Depth below grade:_6"_ Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1000 gallons Sludge depth_5" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_4" 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: How were dimensions determined:_Probe 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 appears to be sound with no indications of leaking. Due to accumulations and length of time with no pumping,it was recommended to owner to have system pumped for maintenance and tank was pumped on following day. Overall conditions were good. GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 Cats Paw Way Owner: Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_G_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_Liquid at outlet invert_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):D-box is in excellent condition,no evidence of carryover or leaking. PUMP CHAMBER: (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.): f OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 Cats Paw Way Owner: Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number:_1 standard 6 X 6 pit_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.):Pit was not opened for inspection due to location in heavily wooded area. Inside of pit was inspected with a sewer camera and found to be dry. No indications in d-box of previous backup. 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 or no): 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.): i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 Cats raw way Owner:Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 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, 1 F 30 q �, FO O E C) - 11 .29 1 p- H 33 r OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 Cats Paw Way Owner: Barbara Murphy,Executrix for Estate of Reagan Date of Inspection 06/19/03 SITE EXAM Slope Level Surface water None Check cellar Dry Shallow wells None Estimated depth to adjusted ground water is _10.1_feet from bottom of SAS 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) _X_Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: You must describe how you established the high ground water elevation: Site elevation is approximately 63' A.S.L. per maps and Map and Parcel books in file at Barnstable BOH. Top pf pit is 30 inches below grade. Bottom of leach pit approx. 102"below grade.(8.5') Site is monitored by USGS well SDW 252 Zone C Data on file Barnstable BOH dated June 1992 shows groundwater in area at approximately 35' A.S.L. Adjustment figure for maximum potential high groundwater for June 1992 is 9.25' 63—(8.5 +9.3 +35)= 10.1' Ar Vo. W Fee 03- -V� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Mir gar bpztem Conztructiou. Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and T 1.No. Assessor's Map/Parcel ���^r (?e47 0'91L Installer's Name,Address,and Tel.No.�f ?2t qjd^31 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Natu a of Repairs or Alterations(Ans er when applicable) I eel, Date last inspected: Agreement: The undersigned agrees to ensure a cons ction and maint a of the afore described on-site sewage disposal system in accordance with the provisions of Tid 5 f th tnvi n d and no the system in operation until a Certifi- cate of Compliance has been issu by t Bo do ea / Signed Datef� Application Approved by Date Application Disapproved for the following reasons Permit No. ZGe g, Date Issued telZ 0 —————————— ..._,— _��--�------------- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y Y f Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Tipprication for Mimansmi 6potem Construction Permit Application for a Permit to Construct( ')Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. /q n��S°'14-A Owner's Name,Address and T I No. Assessor's Map/Parcel �U���/ (!e47�rvi/ 192-I1k Installer's Name,Address,and Tel.NoeP// �'�//-9J`�-31 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description,'0f Soil f .S/ / ' I Nature of Repairs or Alterations(Answer when applicable) Date last inspected: `? Agreement: The undersigned'agrees to ensure t e constr ction and maint a of the afore described on-site sewage disposal system in accordance with the provisions of Tid 5 of th Env' on d and no a the system in operation until`a Certifi- cate of Compliance has been issZ by t Bo o ea Signed DataA Application Approved by Date y 3 Application Disapproved for the following reasons Permit No. 2 G G q, Date Issued let2 � THE COMMONWEALTH OF MASSACHUSETTS Ce + BARNSTABLE, MASSACHUSETTS - 1 a, (Certificate of Compliance t THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(' )Repaired(✓ )Upgraded( ) Abandoned( )b Y at I I ,S ✓, has been constructed 'n acc (dance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2C0 —Z FS dated 2 Lj Q 3 Installer Designer The issuance oft s e it shall not be construed as a guarantee that the syste n r e Date 3 Inspector - ----------------------------- No. - 3 S Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS cm(7 �i.5pozal bpztem �tCon,5truction Permit Q`� Permission is hereby gra led to Cons ct( I pair(�pgrade( )Abandon( ) System located at �� Ca ,� !/ 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:Corns ction m st be completed within three years of the date of this pe t. Date:_ l0 2b ? Approved by TOWN OF BARNSTABLE LOCATION 'SrSEWAGE # & VILLAGE ASSESSOR'S MAP & L T INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �A" LEACHING FACILITY: (type) l� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: l--2ti - S� COMPLIANCE DATE:— jo 3" Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet caching facility) - Furnished byJA F/ IV M � �t it +\ 37' _�jQ qaA TOWN OF BARNSTABLE t i LOCATION ZT S SEWAGE # � VILLAGE T ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS C_/0"— BUILDER OR OWNER C® i PERMITDATE: 1;�� ' �' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of-Leaching facility)f� Feet j Furnished by /'U//' /✓C•�YL/��) 1 � l M i TOWN OF BARNSTABLE LOCATION SEWAGE # D VILLAGE 2 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ' SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �l� (size) NO.OF BEDROOMS C_IINV-4��—��1� 77f�l BUILDER OR OWNER PERMTTDATE: l-26 ` 6 5 COMPLIANCE DATE: th Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of-Leaching facility) Feet Furnished by ,U�1//� /✓UYl��/!� CIS ;2-7' .I No......................... / F��d. ..................... / ( THE COMMONWEALTH OF MASSACHUSETTS I BOARD F HEA TH � LP=+ ...OF... .... ...................... .... .................. .F Appliratiun -fur M_qpuiittl Workii Tomitrurtiun Vrruift Application is hereby`made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Syst at ,!:;� �,, 4.X!,4 '---------------------------------------------------------------------�----� ••------------------------------------------••---••------•--------------------------------------- ., Locatio �= dress .�i� or Lot No. � .... �--s --------------------------- ---------------------- ..... er _.-- Address - W J-�� 1 d �--•-� � '�-C -----•-••-•-------------- ---•-••---••-•----•- �`-zav ................... Installer Address d feet Type of Building Size Lot_,.�___�_.�_�' S__ q. U Dwelling—No. of Bedrooms--------- .............................Expansion Attic (. ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) a'' Other fixtures ....e-yt-d-_ ________ __ __ _ W Design Flow.....__..5_=_-0-------------------------gallons per person per day. Total daily flow-----------j_`_ ..................----gallons. WSeptic Tank—Liquid capacitw''":" llons Length---------------- Width................ Diameter__----_---_--- Depth._.-._-_...... x Disposal Trench—No..................... W'd h-__---__--__-----__- T 1 Length.......:...... __._ T. tal leaching area-------.------------sq. ft. Seepage Pit No..___�-�'�`-- D' ___.__._ D l'e1 = _..._...__ Trotal leaching area.....___._.---__sq. it. x G; �Dosin tank ® XX — Z Other Distribution bo ( ) g. ( ) 77 Percolation Test Results Performed by........................................................................... Date--------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...-_-.-.-_--.-----.---. LL Test Pit No. 2......----------minutes per inch Depth of Test Pit-------------------- Depth to ground water---_------------------- ---------------- ----------------------------- r . .....- Descnption of Soil " �_` _ .��/ _ _ � ...— ----�•- - x // n f 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 XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. v . ne - -- --_- - s~ /�f ' ------------------------- , (1 Date Application Approved By--.---•-- ......... Y=_ -- -� --2- Date Application Disapproved for the following reasons------------------------------------------.---..-.-------..---.-.-.-.--------------------------------------------- .......................•----•---------......... ---------------------------•----•------------------------•------•----------------•-----•--•----•--•------•---•------------------------•-------•---.----- Date PermitNo......................................................... Issued---------------------- ................................. Date Tit No......................... Fa$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARDffV. l.Y ,3 „; ... - ------------------- tit ir L�r�Z Yt� rllrfi>QYtPrflltit SystAppticatiori`is hereby`made for a Pe rnri�to Construct ( ) or Repair } afuridtrta' age Disposal ,... -- ��.t- -� -------•------ r r_ cat-- 4i s or Lot N��.,,• .-yam•-•---_.. .... --•------- ------ ----- Address--------••---------------- a ress --''r-- W (/id .'U!t/-!_•nrt.....-- ....------•-------.•----••------------------- -----------------------....................................... ----------_--- Installer Address Type of Building Size Lot----------------------------Sq. feet I Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building f ---- No. of persons____________________________ Showers �— Cafeteria ( ) ` Q Other fi,,tues --------- ----------------------------------------------------------•---•----- ------------------------...... --------------------•------•------- Design Flow___-__---_-_�__ __-- aons per per-son per day. Total daily flow................................. ..._gallons. W .,. - ----------- �r�-�-� P P P Y• Y ------- g� WSeptic Tatik—Liquid capacity_.__-___ _gallons Length X-Vidth XVidth..__.... �D*�rmeter__..__.------- Depth---------------- W Disposal trench—No._ ._. .._____...___ To+ - fig?h - _`.`Tdtai leaching area--------------------sq. ft. Seepage Pit No.....................�Dieter._..........___.... Depth belowj nlet �jx area.___-___--.-.--_sq. it. aDr_ : _ opal le // Z Other Distribution box ( ) } Dosing tank ( ) PL'�" d" Percolation Test Results Performed bY.......................................................................... Date--_---------------------------------.... Test Pit No. 1................mmutes per inch Depth of Test Pit-------------_------ Depth to ground water...._______--.--.--._. G14 Test Pit No,.2-I•t-------------minutes per inch D th of Test Pit____________________ Depth to ground water--------..-_--__---._. -- --------- ....... ....................... D Description of Soil---------------- ---- ----------- .................................. - -------- -------------- -- x �' -/X-- ----- ;------------------------------ VNature of Repairs or Alterations—Answer when applicable._:-___......................................................................................... Agreement: F The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agreys not to place the systkm inf operation until a,Certificate of Compliance has be slue tl boa f,healtli? `- �/ 7177 ed.... . ....... ' Application Approved B ____--- �7 PP PP Y----- Date Application Disapproved for Tie following reasons:'.----- •-----------•--;--- --------------------------•---.--_-----------•--._... ---------------- ..............•--•-••-•...----...•-•---•.••--•--..--•---•--•-------------.--•-••--------••----••-•---•--- Date V6rmitNo......................................................... Issued...................... ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF,�' EALT�j�' ..........................................OF..............................:................. .................................... y Qwr#if iiratr of aY�rP THIS IS T1D—C� ERTIIF, Tha� the,, lil-vi 1 Sewage Disposal System coritru t • ( ) oy�epaired ( ) byf ---- <, _ .. ---------------- - --------------- .A: �a =��.� �- at � .:.. %-•-- -----------------------------------•- .................-••--------------- _ has been installed in accordance with the provisions of Articl A ate Sanitary Co1 ri the application for Disposal Works Construction Permit No---- --------------------_____:____ _a'-'dated------.___-____._...y........�__......_......... THE ISSUANCE OF THIS CERTIF;..CATE,,S9Akl. NOT BE,C-dhSTRUE® AS A GUARANTEE THAT THE SYSTEM 1Pd11. FUNCTION SATISFACTORY. C. L DATE ------------7--------------------- .......................... Inspector......... A ------------ --------------------- THE COMMONWEALTH OF MASSACHUSETTS' ,BOARD OF, .Ft�EALT,H /� ,— ---- low No......................... FEE........................ Permission is hereby nted ! ... '......._ .............. �f to Construct i- aril,( ) an Individual SspoI��SssrP� ( ) or at No.- fJ - '�� G % Str as shown on the application for Disposal WorksNConstruction•Per t o.__.____ _.._ /7y------------------------- l -••---•--- t✓' f o H6---'� l 7� �• � Board ealth � DATE........ ,--------------------------------------•--•-•------ - FORM 1255 HOBBS �& WARREN. INC.. PUBLISHERS i =iS a 1 L 07 c.o L O T• 5 J (� G .3 S , ' I0 $cam TrA NK 1_E Ac N Y I I t~UU li D { \t)) a.. LOCATIOlt-; CENTERvtt, Lt= 1 V T 11=Y T H A T T 14 t= r:'c>Lj Q QL\T'IO Q 5 t-lc w►J �-IEIZ�c�.i �or1il�L�f"S W I TA TI-►C -jl DE L0-JC K �j G T T V L, L P\ G S-' p>v� SETS/��K VGQUllZCNic"TS DO--- TNc ��"�' G -Tow►.,i ot= P.5 A e W'ST/��L Imo. , - DA-rC-. 4.15"-n z 3 PG. 12 7 t3AXTe►Z :W fj E: <<�c. tzcGlSr So "wc;, SuZv �r�szs "I WIS PL/>I...I I-z; W07 154eev V+-4 4w OS'T ZV� L.LG l ASi� `, Is.lSt`�v.t.�c=�.1`; Sv2�lC-�! 1'I{L c:►=t=Sc�S S+�c l:a I APc-,I-IGh.1JT' CW,)5 \Aj t v l LEGEND •CENTERVILLE PROPOSED CONTOUR 9® PROPOSED SPOT GRADE z EXISTING CONTOUR OHO o=o i + 96.52 EXISTING SPOT GRADE S> o ` / Nr S9 W— EXISTING WATER SERVICE 9�' o-' TEST PIT �9 z LOT 71 �'I`Z' ? - 10 o' O SCALE: 1"=20' LOCUS = O FLAG O 58 `: \� o I o 1 D FLAGQ o v Q�TP-I i► ,' 1 58.2 58.0 LOCUS MAP , LOCUS INFORMATION PLAN REF: 318/80 TITLE REF: 22594/262 PARCEL ID: MAP 192 PAR. 118 EXIST. 1,000G ' �� ZONING: "RC" LOT 72 / SEPTIC TANK 0��,� _ _ - LOT 70A FLOOD� oOMMUNITY PANEL: 25001CO561J DATED:07/16/14 _ = AREA=15,103t S.F. 1 h SEPTIC SYSTEM == �' REPAIR PLAN LOCATED AT: __ 19 CATS PAW WAY BM. - T F- 9 =- `� `x, y;% CENTERVILLE, MA. TOP OF CB/DH _- ELEV=56.00 == 0 5 .3 \ � PREPARED FOR - - Wi L % �'� PAVEL E. NAYDENOV/ - \ READY ROOTER EXC. G -_-_- �,�\\ �j' AA\\P APRIL 24, 2017 OF �As`S9 DAlQR.N M. s LOT 69A G UPOLE \� �,� c � 114�0, %' � °y `.� •� G .p�� f J ; AN1 TAR0P� MEYER & SONS, INC. Qj P.O. BOX 981 'GRAPHIC SCALE EAST SANDWICH, MA. 02537 R-20� so o �0 20 80 PH: (508)360-3311 FAX: (774)413-9468 ( IN FEET_ ) meyerand son stitle50gmail.com I inch = 20 ft. SHEET 1 OF 2 J 1912 { i ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE i (Existing) FINISHED GRADE (58.50) 59.30 F.G.EL: 58.0 F.G.EL: 57.8 F.G. EL: 58.30 VENT MAINTAIN 2% MIN SLOPE OVER LEACHING AREA .D 2" OF 3/8" DOUBLE WASHED F.G.EL: 3/4" - 1-1/2" 57.04 �'' STONE OR FILTER FABRIC DOUBLE WASHED STONE A 6' w T 4" SCH 40 PVC msmm 4 10"1 6 MIN.) ®®®®®®®®®®® TEE'S ARE TO BE 14 INV.54.75 S= 1% ( , ®®®®®®®®®®E3 4" SCH 40 PVC 2 EFF. DEPTH ®®E3®®®®®®®® :.Q.:.:A' INV.55.75 INV.54.55 4' 2 X 8.5' 4' GAS 1 - PROPOSED DB 3 EXISTING OUTLET BAFFLE ' INV. 56.0 " �"���" �" � • �� ' DISTRIBUTION BOX EFFECTIVE LENGTH = 25 . (H20) INV. ELEV.= 54.25 EXISTING 1 ,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON P��`� OF MAss9 BREAKOUT OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL, OR EQUAL YE RAM'` G TOP CONC. ELEV.= 55.25 -771 ELEV.= 45.75 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING • �1�1 INV. ELEV.= 4. 5 �® F \ `Z � 5 2 ® ®08 ®® . PIPE INVERTS PRIOR TO CONSTRUCTION E00®®®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO 'PECISTt�" ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX QNIT00 BOTTOM EL. 52.25 ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN 3.75' 5 FT. 3.75' 310 CMR 15.221(2) �' EFFECTIVE WIDTH = 12.5' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 5.05 FT. WITH GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGEDED,, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM (,SECTION 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 47.20 _ ) GAS BAFFLE AS REQUIRED (500 GALLON (H20) LEACH CHAMBER) GENERAL NOTES: SOIL LOGS P#05315 DESIGN CRITERIA I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOOM DESIGN BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: APRIL 3, 2017 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) " OF THE STATE ENVIRONMENTAL CODE, TITLE v, AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 - 310 CMR 15.405 (1) (B): DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. . 1) A 0.25 Fr. VARMCE FROM 310CMR15.221(7) TO ALLOW LEACHING WITNESS: DON DESMARAIS, BARNSTABLE HEALTH TO BE3.23 Fi (MAX) BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED) GARBAGE GRINDER: NO (not designed for garbage grinder) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Elev. SEPTIC TANK: TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE TP- 1 Depth aev. TP-2 Depth 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK DESIGN ENGINEER. 58.20 0" A 58.60 A 0" (330) = 445.94 S.F. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED: FROM THOSE SHOWN HEREON SHALL. BE REPORTED TO THE DESIGN 10YR 4/2 10YR 4/2 •74 ENGINEER BEFORE CONSTRUCTION CONTINUES. 57.53 B 8" 57.93 8" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. LOAMY SAND B USE TWO (2) 500 GALLON H-20 PRECAST LEACH CHAMBERS W/ 4' c 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10YR 6/6 LOAMY 6/6 SAND STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 56.20 C 1 24" 56.44 C 1 26' BOTTOM AREA: 25 x 12.5= 312.5 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. PERC ® LOAMY-FINE FlNE LOAMY-FINE SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED EL 54.20 10SA 6/4 SAND TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 10YR 6/4 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 53.87 52" 54.44 50" 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 C2 CONSTRUCTION. FINE C2 FINE 10. EXISTING LEACHPIT TO BE PUMPED, CRUSHED AND REMOVED PER TITLE .5. 2,5Y 6/6 2.5Y/6 PROPOSED SEPTIC SYSTEM UPGRADE P LA N REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. 47.20 132" 47.60 132" 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 19 CATS PAW WAY, CENTERVI.LLE, MA <2MIIN/INCH IN 'Cl' SOILS 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY NO GROUNDWATER OBSERVED Prepared for: Noydenov/ eady Rooter Exc. 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. Engineering and Survey by: SCALE DRAWN 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING, I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. N.T.S. DMM 15. ALL PIPING TO BE 4' SCH 40 ® 1/8'/FT (UNLESS SPECIFIED) to conduct soil evaluations and that the above analysis has been performed by me consistent with the POBOX981 requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. EAST SANDWICH,MA02537 DATE CHECKED SHEET NO. 50e-3622W 04/24/17 DMM 2 of 2